A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression.

BACKGROUND: Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire. OBJECTIVE: The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches. PARTICIPANTS AND SETTING: Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes. METHODS: We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes. RESULTS: Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes. CONCLUSIONS: Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.

The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement.

OBJECTIVE: Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs. METHODS: We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions. RESULTS: Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event. DISCUSSION: We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.

Universal Design for Measurement: Centering the Experiences of Individuals With Disabilities Within Health Measurement Research.

People with disabilities comprise roughly 25% of the U.S. adult population yet remain underrepresented in mainstream public health and evaluation research. The lack of measures of common constructs that are validated in but not specific to this population may impede their inclusion. This article describes the use of Universal Design for Measurement (UDM), a novel method for developing self-report measurement instruments validated among broad populations to minimize the need for scale adaptation. We applied UDM to the development and content validation of a new body image scale. We assessed content validity by surveying subject matter experts (SMEs) and conducted a Delphi panel study to assess consensus about scale items among community women with (n = 18) and without (n = 15) disabilities. Most scale items were found acceptable by SMEs and community women. The Delphi panel study was useful toward evaluating consensus about scale items among women with and without disabilities. Findings support the use of UDM in developing inclusive and psychometrically sound measurement scales to ultimately facilitate the full inclusion of people with disabilities within health research.

Original Research: Family Presence During Resuscitation: Medical-Surgical Nurses' Perceptions, Self-Confidence, and Use of Invitations.

BACKGROUND: Family presence during resuscitation (FPDR) upholds family-centered care principles and can result in better family member outcomes; yet it isn't routinely implemented by nurses. Prior studies have examined predictors of support for FPDR among nurses caring for high acuity patients, but limited research involves medical-surgical nurses. This is problematic because resuscitation occurs in all inpatient settings. PURPOSE: This study sought to examine the personal, professional, and workplace factors associated with medical-surgical nurses' perceptions, self-confidence, and use of invitations regarding FPDR. It also aimed to explore potential barriers to FPDR and nurses' educational preferences, in order to inform the design of interventions that might improve FPDR implementation in this practice setting. METHODS: A cross-sectional survey design was used to examine which factors are predictors of medical-surgical nurses' FPDR perceptions, self-confidence, and use of invitations. Data on nurses' perceptions of barriers and educational preferences were collected via survey as well. RESULTS: The sample of 51 medical-surgical nurses reported overall neutral perceptions of FPDR. Yet 63% had never invited family members to experience resuscitation. The most significant predictor of more favorable perceptions, higher self-confidence, and greater use of invitations was having prior experience with FPDR. Analysis of perceived barriers indicates that these can be addressed through providing nurses with supportive FPDR policies and education. But only 14% of participants reported that their facility or unit had a written FPDR policy and just 16% had ever received any FPDR education. CONCLUSIONS: FPDR is not commonly practiced on medical-surgical units. Providing medical-surgical nurses with experience, policies, and education is recommended to improve FPDR implementation rates in this practice setting.

Development and initial validation of the Perceived Scarcity Scale.

Though socio-economic status (SES) partially explains the experience of stress and health outcomes, most research to date has relied on a small number of traditional indicators that fail to capture the full domain of socioeconomic factors. The recent reconceptualization of perceived scarcity is proposed as a subjective indicator of SES when attempting to predict both stress and health outcomes. Although a conceptualization of perceived scarcity has been advanced, a psychometrically sound scale is needed to assess the utility and scientific import of this concept. No such scale exists. Therefore, the current paper describes the development, psychometric properties, and initial validation of the Perceived Scarcity Scale (PScS). Four studies using traditional scale development processes were employed to develop (Studies 1 and 2) and provide an initial validation (Studies 3 and 4) for the PScS. Results support the existing model of perceived scarcity and indicate that the measure is valid. Moreover, the scale predicted concurrent perceived stress, as well as longitudinal ratings of perceived stress, global health, quality of life, and symptoms of depression and anxiety. The development of the new scale provides clinicians and researchers with a brief, validated measure that can assess the level of perceived scarcity individuals currently experience.

"It's very valuable to me that I appear capable": A qualitative study exploring relationships between body functionality and appearance among women with visible physical disabilities.

A current hypothesis is that women who learn to focus on their body's functionality versus appearance may experience improved body image outcomes. This research is underdeveloped in considering the perspectives of women with visible physical disabilities (WPD), who have differences in body functionality and appearance that influence their body image. Our study aimed to understand how WPD conceptualize body image and body functionality and to clarify relationships between these constructs. We conducted semi-structured interviews with 15 women representing a range of ages (21-53 years) and disabilities. We used a constructivist grounded theory approach, applying the constant comparative method and engaging in reflexivity throughout the research process. We interpreted themes and subthemes based on their emergence across and explanatory value within cases to develop a conceptual model of the findings. Four major themes emerged: meanings and definitions, body image stability, factors that influence body image, and the interaction of appearance and body functionality. A new concept, "functional-aesthetic body image," emerged describing women's perceptions about the appearance of their body when engaged in functions or activities. Results may stimulate advancements in body image theory and measurement, and guide further exploration of the complex appearance-functionality relationship and its links with holistic health outcomes.

Factors associated with nurses' perceptions, self-confidence, and invitations of family presence during resuscitation in the intensive care unit: A cross-sectional survey.

BACKGROUND: Family presence during resuscitation is not widely implemented in clinical practice. Prior research about nurse factors that may influence their decision to invite family members to remain in the room during resuscitation is contradictory and inconclusive. OBJECTIVES: To describe intensive care unit nurses' perceptions, self-confidence, and invitations of family presence during resuscitation, and to evaluate differences according to nurse factors. DESIGN: A cross-sectional survey design was used for descriptive and correlational analyses. SETTING: Data collection occurred online. PARTICIPANTS: A convenience sample of 395 nurses working in intensive care units across the United States was obtained. METHODS: Participants completed a survey to collect personal, professional, and workplace information. The Family Presence Risk-Benefit Scale and Family Presence Self-confidence Scale were administered, and frequency of inviting family members to be in the room during resuscitation was collected by self-report. Following descriptive analysis of univariate distributions, a series of hierarchical OLS regression analyses was used to identify which personal, professional, or workplace factors yielded the largest unique impact on nurse perceptions, self-confidence, and invitations of family presence during resuscitation. RESULTS: Despite high frequency of performing resuscitative care, one-third of participants had never invited family members to be in the room during resuscitation during their careers, and another 33% had invited family members to be present just 1-5 times. Having had clinical experience with family presence during resuscitation was the strongest predictor of positive perceptions, higher self-confidence, and increased invitations. In addition, having received education on family presence during resuscitation and a written facility policy were found to be key professional and workplace predictors of perceptions and invitations. CONCLUSIONS: Nurses who work in a facility with a policy on family presence during resuscitation, are educated on it, and have experienced it in the clinical setting are more likely to have positive perceptions and higher self-confidence, and to invite family members to be in the room during resuscitation with increased frequency. Nurses in leadership roles should create policies for their units and provide education to nurses and other healthcare providers. Due to the apparent importance of clinical experience with family presence during resuscitation, it is recommended to initially provide this experience using simulation and role modeling.

Psychometric Validation of a Brief Self-report Measure of Diet Quality: The DASH-Q.

OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for primary and secondary prevention of cardiovascular chronic diseases. This study describes the development, internal consistency, and validation (predictive and convergent) of a population-based, self-report measure (the DASH Quality [DASH-Q]) to assess adherence to the DASH diet among adults. DESIGN: Cross-sectional online surveys to evaluate the psychometric properties of the DASH-Q. PARTICIPANTS: US adults consisting of a national sample (n = 407) and a Southern university sample (n = 405). MAIN OUTCOME MEASURES: Diet quality scores. ANALYSIS: Item and scale psychometric properties were examined using corrected item total correlations and principal component analysis. The authors validated the DASH-Q by examining associations with an existing self-report nutrition scale and other nutrition-related behaviors. RESULTS: The DASH-Q yielded acceptable internal consistency (α = .77-.83) in both samples. The DASH-Q scores correlated moderately to strongly with all nutrition-related criteria (P < .01), suggesting evidence of predictive and convergent validity. Less than 15% of either sample reported high diet quality. CONCLUSIONS AND IMPLICATIONS: The DASH-Q had sufficient psychometric robustness for use as a population-based measure. The DASH-Q is recommended as an easily used measure of DASH adherence for populations that need to modify their diet to manage chronic illness.

Accuracy of the Yamax CW-701 Pedometer for measuring steps in controlled and free-living conditions.

OBJECTIVE: The Yamax Digi-Walker CW-701 (Yamax CW-701) is a low-cost pedometer that includes a 7-day memory, a 2-week cumulative memory, and automatically resets to zero at midnight. To date, the accuracy of the Yamax CW-701 has not been determined. The purpose of this study was to assess the accuracy of steps recorded by the Yamax CW-701 pedometer compared with actual steps and two other devices. METHODS: The study was conducted in a campus-based lab and in free-living settings with 22 students, faculty, and staff at a mid-sized university in the Southeastern US. While wearing a Yamax CW-701, Yamax Digi-Walker SW-200, and an ActiGraph GTX3 accelerometer, participants engaged in activities at variable speeds and conditions. To assess accuracy of each device, steps recorded were compared with actual step counts. Statistical tests included paired sample t-tests, percent accuracy, intraclass correlation coefficient, and Bland-Altman plots. RESULTS: The Yamax CW-701 demonstrated reliability and concurrent validity during walking at a fast pace and walking on a track, and in free-living conditions. Decreased accuracy was noted walking at a slow pace. CONCLUSIONS: These findings are consistent with prior research. With most pedometers and accelerometers, adequate force and intensity must be present for a step to register. The Yamax CW-701 is accurate in recording steps taken while walking at a fast pace and in free-living settings.

Diagnostic Differences and Demographic Predictors of Respondents Adjudicated Civilly Incompetent Versus Competent.

The purpose of this study was to determine if diagnostic and demographic variables predict civil competency adjudications, a topic that has received scant research attention. Respondents (i.e., individuals alleged to be incompetent) were evaluated by a licensed psychologist to assist the court in civil competency and possible guardianship determination. Prior research using some of the same participants demonstrated select differences on activities of daily living between these groups (Quickel & Demakis, ), but the current set of analyses was not conducted. The current study included 107 competency evaluations in Mecklenburg County North Carolina and, at conclusion of the case, the public record of the adjudication was obtained. Based on prior legal theorizing in related criminal areas--focused on discrimination of individuals with mental illness--we predicted that cases involving respondents with psychiatric diagnoses would be likely to be overrepresented in those referred for evaluation as well as those subsequently adjudicated incompetent. A series of analyses indicated no statistical differences between competency groups (psychiatric/substance abuse, neurological, both psychiatric and neurological, and intellectually disabled). In a series of exploratory logistic regression analyses, we found that respondents who were single versus in a relationship and those not living at home versus living at home were significantly more likely to be adjudicated incompetent, even after controlling for difference in activities of daily living. There were no differences in incompetency adjudication by age, education, gender, race, or relationship status. Results are discussed in terms of implications for individuals with mental illness in incompetency hearings, as well as specific issues for psychologists evaluating a broad range of respondents.

Development and validation of a measure of food choice values.

Food choice values (FCVs) are factors that individuals consider when deciding which foods to purchase and/or consume. Given the potentially important implications for health, it is critical for researchers to have access to a validated measure of FCV. Though there is an existing measure of FCV, this measure was developed 20 years ago and recent research suggests additional FCVs exist that are not included in this measure. A series of four studies was conducted to develop a new expanded measure of FCV. An eight-factor model of FCV was supported and confirmed. In aggregate, results from the four studies indicate that the measure is content valid, and has internally consistent scales that also demonstrated acceptable temporal stability and convergent validity. In addition, the eight scales of the measures were independent of social desirability, met criteria for measurement invariance across income groups, and predicted dietary intake. The development of this new measure of FCV may be useful for researchers examining FCVs (FCVs) in the future, as well as for use in intervention and prevention efforts targeting dietary choices.

Sleep characteristics, body mass index, and risk for hypertension in young adolescents.

Inadequate sleep has been identified as a risk factor for a variety of health consequences. For example, short sleep durations and daytime sleepiness, an indicator of insufficient sleep and/or poor sleep quality, have been identified as risk factors for hypertension in the adult population. However, less evidence exists regarding whether these relationships hold within child and early adolescent samples and what factors mediate the relationship between sleep and risk for hypertension. Using data from the Study of Early Child Care and Youth Development, the present study examined body mass index (BMI) as a possible mediator for the effects of school-night sleep duration, weekend night sleep duration, and daytime sleepiness on risk for hypertension in a sample of sixth graders. The results demonstrated gender-specific patterns. Among boys, all three sleep characteristics predicted BMI and yielded significant indirect effects on risk for hypertension. Oppositely, only daytime sleepiness predicted BMI among girls and yielded a significant indirect effect on risk for hypertension. The findings provide clarification for the influence of sleep on the risk for hypertension during early adolescence and suggest a potential need for gender-specific designs in future research and application endeavors.

Measuring meaning and peace with the FACIT-spiritual well-being scale: distinction without a difference?

The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp; Peterman, Fitchett, Brady, Hernandez, & Cella, 2002) has become a widely used measure of spirituality; however, there remain questions about its specific factor structure and the validity of scores from its separate scales. Specifically, it remains unclear whether the Meaning and Peace scales denote distinct factors. The present study addresses previous limitations by examining the extent to which the Meaning and Peace scales relate differentially to a variety of physical and mental health variables across 4 sets of data from adults with a number of chronic health conditions. Although a model with separate but correlated factors fit the data better, discriminant validity analyses indicated limited differences in the pattern of associations each scale showed with a wide array of commonly used health and quality-of-life measures. In total, the results suggest that people may distinguish between the concepts of Meaning and Peace, but the observed relations with health outcomes are primarily due to variance shared between the 2 factors. Additional research is needed to better understand the separate and joint role of Meaning and Peace in the quality of life of people with chronic illness.

Using latent growth curve modeling to examine changes in mental health outcomes for children enrolled in a system of care.

MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. This study employed latent growth curve (LGC) modeling to examine (a) the degree to which youth improved on indicators of adjustment over the course of the first year of enrollment in MeckCARES, and (b) the services or demographic variables associated with individual differences in the rate of change over time. Participant caregivers (N = 121) reported on 3 major indicators of youth adjustment at baseline, 6-month follow-up, and 12-month follow-up. Primary analyses indicated that there was a modest yet significant improvement in all 3 outcome measures over the first year of enrollment in MeckCARES. Additional analyses revealed that caregiver reports of receiving case management at any point in the first year were associated with improvement in behavioral and emotional strengths as well as a reduction in psychological and behavioral symptoms. No significant differences in rate of change were observed based on caregiver-reported receipt of individual or family therapy nor any demographic variables. These findings suggest that MeckCARES may be particularly effective when youth are receiving case management services. Additional implications for practice are discussed.

Educational outcomes in a system of care for children with emotional disturbance.

In North Carolina, only 69% of high school students graduate in 4 years; however, recent data suggest that only 42% of students with mental and emotional disabilities graduate. MeckCARES, a system of care (SOC) in Mecklenburg County, North Carolina, is designed to serve youth with severe emotional disturbances and their families. The SOC philosophy is a prominent family-focused approach intended to provide comprehensive, coordinated networks of services, tailored to the needs of the child and family, while emphasizing the strengthening of natural community supports. In addition to other mental health objectives, a particular goal of MeckCARES is to address specific school-based needs of system-identified youth to improve educational outcomes and reduce the risk of dropping out. This study sought to assess empirically the impact that enrollment in MeckCARES has on graduation precursors; namely, grades, suspensions, and absences. This study found that, on average, enrollment in MeckCARES is not associated with positive changes in educational variables. Implications of these findings are discussed, as are future directions. For example, additional research is needed with more sensitive measurement and data collection procedures (i.e., access to graduation rates and Medicaid information) to adequately assess the impact of enrollment in MeckCARES on educational outcomes.

The effects of caregiver social connections on caregiver, child, and family well-being.

This study examines the degree to which caregiver social connectedness influences the effects of strain associated with caring for a child with severe emotional disturbance (SED) on caregiver well-being. We propose a model describing the relationships among the variables of interest and investigate elements of this model. Caregiver strain and social connections were significantly associated with caregiver well-being. Although, no significant interaction effects of caregiver strain and social connections were detected, study findings suggest that caregiver well-being can affect child progress and adjustment. Implications for child- and family-serving systems are considered.

What shelters can do about euthanasia-related stress: an examination of recommendations from those on the front line.

Shelter employees with euthanasia responsibilities are an at-risk population for a variety of psychological and emotional ailments. This study surveyed 305 employees from 62 shelters throughout the United States to gather first-hand perspectives on what should be done to assist shelter workers in dealing with euthanasia-related stress. Researchers conducted a qualitative analysis of 359 improvement suggestions to identify broad common themes and sorted the suggestions into 26 thematic categories. The most common participant suggestion concerned management supportive-ness (13.17% of participants). Some other issues raised involved providing counseling, job rotation, assistance or more help, breaks and time off, support groups and meetings, better communication, skills-based training, stress and coping seminars, and employee appreciation and morale-boosting initiatives.

An examination of psychometric bias due to retesting on cognitive ability tests in selection settings.

Using a latent variable approach, the authors examined whether retesting on a cognitive ability measure resulted in measurement and predictive bias. A sample of 941 candidates completed a cognitive ability test in a high-stakes context. Results of both the within-group between-occasions comparison and the between-groups within-occasion comparison indicated that no measurement bias existed during the initial testing but that retesting induced both measurement and predictive bias. Specifically, the results suggest that the factor underlying the retest scores was less saturated with g and more associated with memory than the latent factor underlying initial test scores and that these changes eliminated the test's criterion-related validity. This study's implications for retesting theory, practice, and research are discussed.

Impact of euthanasia rates, euthanasia practices, and human resource practices on employee turnover in animal shelters.

OBJECTIVE: To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. DESIGN: Cross-sectional original study. SAMPLE POPULATION: 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. PROCEDURES: By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. RESULTS: Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. CONCLUSIONS AND CLINICAL RELEVANCE: Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations.

Forced-choice assessments of personality for selection: evaluating issues of normative assessment and faking resistance.

Recent research suggests multidimensional forced-choice (MFC) response formats may provide resistance to purposeful response distortion on personality assessments. It remains unclear, however, whether these formats provide normative trait information required for selection contexts. The current research evaluated score correspondences between an MFC format measure and 2 Likert-type measures in honest and instructed-faking conditions. In honest response conditions, scores from the MFC measure appeared valid indicators of normative trait standing. Under faking conditions, the MFC measure showed less score inflation than the Likert measure at the group level of analysis. In the individual-level analyses, however, the MFC measure was as affected by faking as was the Likert measure. Results suggest the MFC format is not a viable method to control faking.