Innovating resilience promotion: Integrating cultural practices, social ecologies and development-sensitive conceptual strategies for advancing child well-being.

This chapter's goal is to interrogate the intersectional significance of race and socioeconomic status for children of varied statuses of human vulnerability. It provides a context-connected, culture acknowledging, systems model and identity formation perspective. This strategy is ideal for delineating behavioral consistencies (and interpreting inconsistencies). When operationalized with programming opportunities, it accommodates the nation's diversity and aids the interpretation of findings. This chapter is divided into several sections: First, it interrogates critical insights afforded by a "resiliency-vulnerability" approach; second, it draws attention to the roles of culture, culturally competent practices, and justice-informed contexts for children's perception-based "meaning making" as each-increasingly with age-navigates multiple social ecologies. Third, it shifts to and emphasizes the intersectionally relevant factors of race (e.g., identifiability and skin color stereotyping) and socioeconomic status (i.e., both low resourced and privileging situations); and following a synthesis of the previous sections-as Section 4-it then frames the cumulative and integrated conceptual strategy (phenomenological variant of ecological systems theory: PVEST). In Section 5, the chapter presents theory-focused exemplars to illustrate the theory's efficacy, which are followed by results of two recent preliminary application projects. Salient is that the two projects presenting preliminary findings add to and afford important child development insights salient as strategies for neutralizing intersectionality effects and maximizing resiliency outcomes. To sum, synthesizing several decades of scholarship, theorizing, contemporary research and programming application efforts, the handbook chapter concludes with suggested strategies for creating more informed policies and practices relevant to all children's overall resiliency, healthy development and well-being.

Association between unemployment rates and prescription drug utilization in the United States, 2007-2010.

BACKGROUND: While extensive evidence suggests that the economic recession has had far reaching effects on many economic sectors, little is known regarding its impact on prescription drug utilization. The purpose of this study is to describe the association between state-level unemployment rates and retail sales of seven therapeutic classes (statins, antidepressants, antipsychotics, angiotensin-converting enzyme [ACE] inhibitors, opiates, phosphodiesterase [PDE] inhibitors and oral contraceptives) in the United States. METHODS: Using a retrospective mixed ecological design, we examined retail prescription sales using IMS Health Xponent™ from September 2007 through July 2010, and we used the Bureau of Labor Statistics to derive population-based rates and mixed-effects modeling with state-level controls to examine the association between unemployment and utilization. Our main outcome measure was state-level utilization per 100,000 people for each class. RESULTS: Monthly unemployment levels and rates of use of each class varied substantially across the states. There were no statistically significant associations between use of ACE inhibitors or SSRIs/SNRIs and average unemployment in analyses across states, while for opioids and PDE inhibitors there were small statistically significant direct associations, and for the remaining classes inverse associations. Analyses using each state as its own control collectively exhibited statistically significant positive associations between increases in unemployment and prescription drug utilization for five of seven areas examined. This relationship was greatest for statins (on average, a 4% increase in utilization per 1% increased unemployment) and PDE inhibitors (3% increase in utilization per 1% increased unemployment), and lower for oral contraceptives and atypical antipsychotics. CONCLUSION: We found no evidence of an association between increasing unemployment and decreasing prescription utilization, suggesting that any effects of the recent economic recession have been mitigated by other market forces.

Association between the commercial characteristics of psychotropic drugs and their off-label use.

BACKGROUND: Off-label prescribing, or the use of a medicine for non-Food and Drug Administration (FDA)-approved indications, is especially common for psychotropic therapies and often lacks scientific support. We quantified the association between 4 commercial characteristics of prescription medicines-product age, therapeutic class age, drug volume, and promotional expenditures-and off-label use of antidepressants, antipsychotics, and mood stabilizers from 1998 through 2009. METHODS: We linked data from the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based physicians, with data from FDA@gov and the drug compendium DrugDex, to derive information regarding off-label use. Our primary outcome was the rate (per 1000 uses) with which a drug was prescribed for non-FDA-approved indications during a given calendar year. We used mixed-effects regression models with random intercepts for each drug, adding measures of commercial characteristics as fixed effects within this model. RESULTS: From 1998 through 2009, the average proportion of all uses that occurred off-label was 23.3% for antidepressants, 60.7% for antipsychotics, and 54.2% for mood stabilizers. There was a positive association between the annual rate of off-label use and drug volume [incidence rate ratio (IRR), 1.41; 95% confidence intervals (CI), 1.32-1.50], although the strength of this association was not uniform across the therapeutic classes examined. There was also a small but statistically significant association between product age (IRR, 0.96; 95% CI, 0.94-0.98) and class age (IRR, 1.03; 95% CI, 1.01-1.06) and the rate of off-label use, also varying across therapeutic class. There was a statistically significant inverse association between promotional expenditures and off-label use (IRR, 0.94; 95% CI, 0.93-0.96) when controlling for our other commercial characteristics. These associations were similar when examining scientifically unsupported rather than all off-label use. CONCLUSIONS: Our findings suggest that drug prescription volume, rather than product age or therapeutic class age, should be scrutinized further to identify settings where the public health impact of unsupported off-label prescribing may be particularly important.