Illness uncertainty and quality of life in patients with advanced cancer and their family caregivers: An actor-partner interdependence model analysis.

OBJECTIVE: The relationship between illness uncertainty and quality of life (QOL) has been examined for either the patient or caregiver, but not among the patient-caregiver dyads. This study examined relationships between illness uncertainty and QOL among patients with advanced cancer and family caregivers. METHODS: We conducted a secondary analysis of data from a randomized clinical trial that examined the effects of a dyadic-based intervention on psychological outcomes for patients with advanced cancer and family caregivers (N = 484 dyads). Illness uncertainty and QOL were measured using the shorten version of the Mishel Uncertainty in Illness Scale for Adult and the Functional Assessment of Cancer Therapy, respectively. The actor-partner interdependence model was used to examine whether an individual's uncertainty (either a patient's or caregiver's) was associated with their own QOL (i.e., an actor effect) and/or their partner's QOL (i.e., a partner effect). RESULTS: Significant actor effects included a negative association between patients' uncertainty and their own QOL (b = -0.422; p < 0.001) and a negative association between caregivers' uncertainty and their own QOL (b = -0.408; p < 0.001). In terms of partner effects, patients' uncertainty was negatively associated with caregivers' QOL (b = -0.095; p < 0.01). No partner effect was found for caregivers, suggesting that caregivers' uncertainty was not related to patients' QOL. CONCLUSIONS: Study findings support targeted interventions offered to both patients and their family caregivers to manage their illness uncertainty and improve their QOL.

Climate Change, Fragility, and Child Mortality; Understanding the Role of Water Access and Diarrheal Disease Amongst Children Under Five During the MDG Era.

The present study examined the influence of improvements to Water, Sanitation, and Hygiene (WASH) infrastructure on rates of under-five mortality specifically from diarrheal disease amongst children in fragile states. The World Bank's Millennium Development Goals and Sustainable Development Goals both include a specific target of reduction in preventable disease amongst children, as well as goal to improve WASH. Although gains have been made, children under the age of five remain particularly vulnerable to diarrheal mortality in states identified as fragile. Increasingly, climate change is placing undue pressure on states labeled fragile due to their inability to properly prepare for, or respond to, natural disasters that further compromise WASH development and water safety. The impact of climate change upon child health outcomes is neither direct nor linear and necessitates a linkage framework that can account for complex pathways between environmental pressures and public health outcomes. The World Health Organization's Drive Force-Pressure-State-Exposure-Effect-Action conceptual framework was used to draw the connections between seemingly disparate, and highly nuanced, environmental, and social measures. Using a multilevel hierarchical model, this analysis used a publicly available UNICEF data set that reported rates of mortality specifically from diarrheal disease amongst children age five and younger. All 171 formally recognized countries were included, which showed a decline in diarrheal disease over time when investments in WASH infrastructure are compared. As states experience increased pressure because of climate change, this area of intervention is key for immediate health and safety of children under-five, as well as assisting fragile states long-term as the move toward stability.

Correlates of illness uncertainty in cancer survivors and family caregivers: a systematic review and meta-analysis.

PURPOSE: Illness uncertainty is widely recognized as a psychosocial stressor for cancer survivors and their family caregivers. This systematic review and meta-analysis aimed to identify the sociodemographic, physical, and psychosocial correlates that are associated with illness uncertainty in adult cancer survivors and their family caregivers. METHODS: Six scholarly databases were searched. Data synthesis was based on Mishel's Uncertainty in Illness Theory. Person's r was used as the effect size metric in the meta-analysis. Risk of bias was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Of 1116 articles, 21 articles met the inclusion criteria. Of 21 reviewed studies, 18 focused on cancer survivors, one focused on family caregivers, and 2 included survivors and family caregivers. Findings identified distinct correlates for illness uncertainty in cancer survivors, including sociodemographic factors (e.g., age, gender, race), stimuli frame (e.g., symptom, family history of cancer), structure providers (e.g., education), coping, and adaptation. Notable effect sizes were observed in the correlations between illness uncertainty and social support, quality of life, depression, and anxiety. Caregivers' illness uncertainty was associated with their race, general health, perception of influence, social support, quality of life, and survivors' prostate-specific antigen levels. Insufficient data precluded examining effect size of correlates of illness uncertainty among family caregivers. CONCLUSION: This is the first systematic review and meta-analysis to summarize the literature on illness uncertainty among adult cancer survivors and family caregivers. Findings contribute to the growing literature on managing illness uncertainty among cancer survivors and family caregivers.

Psychosocial interventions for siblings of children with cancer: A mixed methods systematic review.

OBJECTIVE: This review systematically (1) describes the characteristics of psychosocial interventions for siblings of children with cancer (SCC); (2) assesses the effect of the psychosocial interventions on SCCs' outcomes, and (3) describes SCCs' experiences and perceptions of these interventions. METHODS: Seven databases were systematically searched for relevant literature. We included both quantitative and qualitative studies of psychological interventions designed to improve the adjustment of SCCs. RESULTS: Our database searches yielded 19 publications. We found a range of psychosocial interventions being used among SCCs, with group interventions being the most common. The primary outcomes focused on the SCCs' depression, anxiety, and quality of life. Quantitative studies provided insufficient evidence to draw definitive conclusions about the interventions' effects, whereas the qualitative studies indicated that SCCs can derive benefits from these interventions, including an enhanced sense of belonging and bonding, improved family relationships, increased self-awareness and confidence, increased cancer knowledge, and decreased somatic symptoms. CONCLUSIONS: Although a growing number of psychosocial interventions have been developed to improve the adjustment of SCCs, research evidence of the effects of these interventions on SCCs' adjustment remains limited. Future research needs to rigorously evaluate the effects of these interventions.

"They were just waiting for me to mess up": A critical discourse analysis of immigrant Latinx teens' perceptions of power dynamics.

This paper explores Latinx adolescents' perceptions of power dynamics with authority around them. We seek to inform how community-based professionals engage with and seek to understand members of this population. We conducted a critical discourse analysis of data collected during a community action photovoice project with 13 Latinx adolescents living in a metropolitan region of the southeastern United States. Participants felt they were under greater surveillance scrutiny by authority figures in social and academic spaces than their non-Latino peers. They discussed ways their movements were at times constrained because others presumed they were deviant, and how that affected their identity development. Judgments and assumptions held by both powerful adults and oppressed groups alike serve to reinscribe social stratification that places Latinx adolescents at a power disadvantage relative to their white peers. These experiences and understandings of power relations shape the circuitous racial dispossession of youth.

Findings from a Feasibility Study of an Adapted Cognitive Behavioral Therapy Group Intervention to Reduce Depression among LGBTQ (Lesbian, Gay, Bisexual, Transgender, or Queer) Young People.

Depression disproportionately affects LGBTQ (lesbian, gay, bisexual, transgender, or queer) adolescents and young adults. Cognitive behavioral therapy (CBT) is an evidence-based treatment approach; however, there has been limited work to adapt and evaluate CBT with LGBTQ young people. This study examined the feasibility of an intervention called Being Out With Strength (BOWS), which is an 8-session, small-group, CBT-based intervention to reduce depression among LGBTQ young people. We used a descriptive cross-sectional mixed-methods feasibility study design to evaluate the feasibility of BOWS. Survey data were collected from 79 LGBTQ young adults, and interview data were collected from nine mental health professionals. Almost half of the young adults had clinically significant depressive symptoms. All providers indicated depression as a problem facing this population and a need for BOWS. Two-thirds of young people were interested in participating in BOWS. Providers believed that BOWS would be acceptable for LGBTQ-identified individuals, those in late adolescence or early/young adulthood, and those with mild or moderate depression. Youth and providers also made implementation recommendations concerning settings to implement BOWS, times of day for BOWS sessions, number of sessions, group size, and facilitator composition. There is a demand for BOWS, and it is likely acceptable for the target population. Study findings can be used in the future to successfully implement BOWS and evaluate preliminary efficacy.

"What I wish my doctor knew about my life": Using photovoice with immigrant Latino adolescents to explore barriers to healthcare.

BACKGROUND: Latinos in the USA have reported more frequent discriminatory treatment in healthcare settings when compared to their White counterparts. In particular, foreign-born Latinos report discrimination more than Latinos born in the USA. Such patient-reported racial/ethnic discrimination appears to contribute to specific health consequences, including treatment seeking delays, interruptions in care, and medical mistrust. Immigrant Latino adolescents in the USA experience a variety of health disparities, yet little is known about their views of the healthcare experience, their perceptions of discriminatory treatment, or ways in which they would like their relationships with healthcare providers to be different. METHODS: This work, based in a larger interdisciplinary social work-led initiative, used photovoice with two groups of immigrant Latino adolescents to explore the topic "what I wish the doctor knew about my life." The findings were used to engage healthcare stakeholders as part of a pilot intervention aimed at decreasing provider bias toward immigrant Latino youth. RESULTS/DISCUSSION: Findings illuminated ways that the immigrant experience affects the lives and health of Latino adolescents in North Carolina. To improve their health, it is critical to understand, from their perspectives, the ways their lives can be complicated by experiences of migration, stereotypes, and cross-cultural communication challenges and how their interactions with authority figures in one sector, such as education, influence interactions in health care. Understanding the healthcare barriers faced by immigrant Latino youth is critical to any effort to improve the system of care for immigrant Latino populations.

Exploring the relationship between welfare participation in childhood and depression in adulthood in the United States.

OBJECTIVE: Depression is a serious mental health disorder, and untangling its causal agents is a major public health priority in the United States. This study examines the relationship between participating in welfare programs during childhood and experiencing depression during young adulthood. METHOD: This study used wave I and IV data from the Add Health (N = 15,701). Multiple imputation is used to deal with missing data. Propensity score matching is used to reduce the selection bias, and then multiple regressions were used to examine the welfare participation and depression relationships. RESULTS: Overall, young adults from welfare-recipient families reported significantly higher depression scores, rather than the clinical diagnosis of depression. Subgroup analyses showed only the poor group had significantly higher depression scores, whereas only the near-poor group had a significantly diagnosed depression outcome. Additionally, significantly higher depression scores were found for female youth from welfare-recipient families. However, no significant differences were found between the gender groups regarding diagnosed depression. DISCUSSION: Using welfare participation as an economic marker, the subgroup analyses help to identify target populations for future intervention. Implications of this study will be of interest to policy makers and have value for informing policy decisions.

The Role of School Context in Implementing a Statewide Anti-Bullying Policy and Protecting Students.

Bullying is a significant problem in U.S. schools. Policies have been developed to reduce bullying, yet policy implementation by educators is an essential yet difficult and complex process. Few studies have investigated factors that act as barriers to or facilitators of bullying policy implementation and teacher protection of students. This study examined the influence of school context on educators' capacity to implement a statewide bullying law and protect students from bullying following the enactment of the policy. Data were collected from 505 educators in 324 schools. School administrators tended to rate fidelity of policy implementation and teacher protection of students higher than teachers, education support professionals, and student service professionals. Policy implementation fidelity scores were higher in high schools than elementary schools. School size and the prevalence of student suspensions were inversely related to implementation fidelity. Higher levels of teacher protection were reported in elementary schools.

Fidelity of Implementation of a State Antibullying Policy With a Focus on Protected Social Classes.

Bullying threatens the mental and educational well-being of students. All states have enacted antibullying laws. This study surveyed 634 educators about the implementation of the North Carolina School Violence Prevention Act, which enumerated social classes protected from bullying: race, national origin, gender, socioeconomic status, sexual orientation, gender identity, appearance, and disability. Results showed that local antibullying policies most often included race as a protected class and least often included sexual orientation and gender identity. More educators had been trained on bullying based on race than any other social class. Students were more often informed that bullying based on race was prohibited and were least often informed about prohibitions regarding sexual orientation and gender identity. Reporting, investigating, and remediating bullying was highest for racial bullying, followed by disability bullying, and was lowest for bullying based on sexual orientation and gender identity.

Making a difference in medical trainees' attitudes toward Latino patients: A pilot study of an intervention to modify implicit and explicit attitudes.

Negative attitudes and discrimination against Latinos exist in the dominant U.S. culture and in healthcare systems, contributing to ongoing health disparities. This article provides findings of a pilot test of Yo Veo Salud (I See Health), an intervention designed to positively modify attitudes toward Latinos among medical trainees. The research question was: Compared to the comparison group, did the intervention group show lower levels of implicit bias against Latinos versus Whites, and higher levels of ethnocultural empathy, healthcare empathy, and patient-centeredness? We used a sequential cohort, post-test design to evaluate Yo Veo Salud with a sample of 69 medical trainees. The intervention setting was an academic medical institution in a Southeastern U.S. state with a fast-growing Latino population. The intervention was delivered, and data were collected online, between July and December of 2014. Participants in the intervention group showed greater ethnocultural empathy, healthcare empathy, and patient-centeredness, compared to the comparison group. The implicit measure assessed four attitudinal dimensions (pleasantness, responsibility, compliance, and safety). Comparisons between our intervention and comparison groups did not find any average differences in implicit anti-Latino bias between the groups. However, in a subset analysis of White participants, White participants in the intervention group demonstrated a significantly decreased level of implicit bias in terms of pleasantness. A dose response was also founded indicating that participants involved in more parts of the intervention showed more change on all measures. Our findings, while modest in size, provide proof of concept for Yo Veo Salud as a means for increasing ethno-cultural and physician empathy, and patient-centeredness among medical residents and decreasing implicit provider bias toward Latinos.

Familial Influences on Dating Violence Victimization Among Latino Youth.

Despite theoretical and empirical evidence suggesting that the family environment plays a central role in Latino youth development, relatively little is known about how family processes influence dating violence victimization among Latino adolescents. To address this gap in the literature, we used data from 210 Latino parents and their 13- to 15-year-old adolescents to examine associations between several different family processes, including both parenting practices (parent monitoring, parent-adolescent communication) and aspects of the family relational climate (family cohesion, family conflict, acculturation conflict) and psychological, physical, and sexual dating violence victimization. Consistent with expectations, lower levels of family cohesion and higher levels of family and acculturation conflict were associated with risk for dating violence victimization, although associations varied depending on victimization type. In contrast, neither parental monitoring nor parent-adolescent communication was significantly associated with any type of dating violence victimization. In addition, we found that parent, but not teen, Anglo-American acculturation was associated with higher dating violence victimization risk. Findings suggest that family-based dating abuse prevention programs for Latino youth should seek to increase family cohesion and decrease family conflict, including acculturation-based conflict.

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review.

BACKGROUND: In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. OBJECTIVES: We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals' implicit attitudes about racial/ethnic groups and health care outcomes. SEARCH METHODS: To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. SELECTION CRITERIA: We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. DATA COLLECTION AND ANALYSIS: We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. MAIN RESULTS: Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicit bias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient-provider interactions and health outcomes than treatment processes. CONCLUSIONS: Most health care providers appear to have implicit bias in terms of positive attitudes toward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicit bias may contribute to health disparities for people of color.

Bullied youth: the impact of bullying through lesbian, gay, and bisexual name calling.

Bullying is a common experience for many school-aged youth, but the majority of bullying research and intervention does not address the content of bullying behavior, particularly teasing. Understanding the various forms of bullying as well as the language used in bullying is important given that bullying can have persistent consequences, particularly for victims who are bullied through biased-based bullying, such as being called gay, lesbian, or queer. This study examines bullying experiences in a racially and ethnically diverse sample of 3,379 rural elementary-, middle-, and high-school youth. We use latent class analysis to establish clusters of bullying behaviors, including forms of biased-based bullying. The resulting classes are examined to ascertain if and how bullying by biased-based labeling is clustered with other forms of bullying behavior. This analysis identifies 3 classes of youth: youth who experience no bullying victimization, youth who experience social and emotional bullying, and youth who experience all forms of social and physical bullying, including being bullied by being called gay, lesbian, or queer. Youth in Classes 2 and 3 labeled their experiences as bullying. Results indicate that youth bullied by being called gay, lesbian, or queer are at a high risk of experiencing all forms of bullying behavior, highlighting the importance of increased support for this vulnerable group.

Adapting an empirically supported intervention for a new population and setting: findings and lessons learned from Proyecto Puentes.

With an increasing emphasis on evidence-based practice, the need for social work researchers and practitioners to adapt empirically supported interventions for new populations and cultures is essential. However, social work suffers from a lack of guidance and detailed examples of intervention adaptations that may not proceed "by the book" and actually falter but recover. Many of these situations result from lack of attention to setting and context even when researchers believe they have full stakeholder buy-in. This article presents process evaluation findings from an intervention adaptation called Proyecto Puentes that allowed for self-correction and successful intervention development.

Unmet health and mental health need among adolescents: the roles of sexual minority status and child-parent connectedness.

Using a representative national sample from the National Longitudinal Study of Adolescent Health (Add Health) survey (N = 18,924), this article explores sexual minority status (SMS) and child-parent connectedness in relation to the unmet needs for health or mental health care among adolescents. Through the use of logistic regression models, data were analyzed to determine whether SMS and child-parent connectedness predict unmet health and mental health need. In addition, models tested whether child-parent connectedness, sex or gender, and race or ethnicity interact with SMS to predict unmet need. Results show that both SMS and child-parent connectedness predict unmet health and mental health need. Being a sexual minority youth (SMY) significantly increases the odds of having an unmet need for health or mental health care; female SMY have the highest odds of an unmet mental health need. Child-parent connectedness is a predictor of unmet need regardless of SMS. Youth with lower levels of child-parent connectedness have significantly higher odds of an unmet health or mental health need. Findings call for service providers to address the unmet needs of SMY both in terms of outreach to youth and parents and to communicate the importance of the parental role in helping teens access care.

Comparing health and mental health needs, service use, and barriers to services among sexual minority youths and their peers.

Using a representative national sample (N = 20,745), this article explores health and mental health needs, service use, and barriers to services among sexual minority youths (SMYs) and heterosexual peers. SMYs were defined by ever having a same-sex romantic attraction or having a recent same-sex romantic relationship or sexual partner. SMYs accounted for 7.5 percent of the sample. Data were analyzed to ascertain prevalence of risks and explore group differences. Compared with peers, SMY self-reports indicated higher prevalence rates on all indicators of health and mental health need. SMYs reported more sexual activity, more sexually transmitted disease diagnoses, a higher perceived risk for HIV/AIDS, and more forgone medical care than peers.Also compared with peers, SMYs reported higher levels of anxiety depression, suicidality, and physical and sexual victimization and higher rates of unmet mental health need. SMYs also reported greater concerns about confidentiality and were less likely to use school-based services.The majority of SMYs reported same-sex attraction only. Social work and other helping professionals should incorporate same-sex attraction questions into assessment protocols to target services for this population. School- and office-based providers must consider whether their services are welcoming and offer sufficient assurances of confidentiality to facilitate access by SMYs.