Explaining the frequency of alcohol consumption in a conflict zone: Jews and Palestinians in Israel.

Experiencing stress and exposure to terrorism may have an adverse effect on health risk behaviors. Few studies have examined alcohol use among adults living in Israel under chronic, stressful terrorism-related conditions. In this study, we examined the relationships of demographics, past stressful events, and terrorism exposure to the frequency of alcohol use and the mediating roles of depressive and post-traumatic stress disorder (PTSD) symptoms. We used three waves of data from a 2007-2008 nationally representative sample of Jewish and Palestinian adults in Israel. We assessed past stressful events, in addition to direct and indirect exposures to terrorism. Results indicated that past stressful events and exposure to terrorism were not directly associated with alcohol use, but were indirectly associated and mediated by depressive and PTSD symptomology. Mental health symptoms were differentially associated with alcohol use. More frequent drinking was mediated by higher levels of depression, including for women and Palestinians; however, PTSD symptom severity was related to less frequent drinking. Mental health may play a prominent role in the frequency of alcohol use among adults exposed to terrorism in Israel. Alcohol use, as a coping mechanism, may differ by demographic characteristics (gender and ethnicity) and psychological symptomology for adults living in a conflict zone in Israel.

Mindfulness training improves attentional task performance in incarcerated youth: a group randomized controlled intervention trial.

We investigated the impact of cognitive behavioral therapy and mindfulness training (CBT/MT) on attentional task performance in incarcerated adolescents. Attention is a cognitive system necessary for managing cognitive demands and regulating emotions. Yet persistent and intensive demands, such as those experienced during high-stress intervals like incarceration and the events leading to incarceration, may deplete attention resulting in cognitive failures, emotional disturbances, and impulsive behavior. We hypothesized that CBT/MT may mitigate these deleterious effects of high stress and protect against degradation in attention over the high-stress interval of incarceration. Using a quasi-experimental, group randomized controlled trial design, we randomly assigned dormitories of incarcerated youth, ages 16-18, to a CBT/MT intervention (youth n = 147) or an active control intervention (youth n = 117). Both arms received approximately 750 min of intervention in a small-group setting over a 3-5 week period. Youth in the CBT/MT arm also logged the amount of out-of-session time spent practicing MT exercises. The Attention Network Test was used to index attentional task performance at baseline and 4 months post-baseline. Overall, task performance degraded over time in all participants. The magnitude of performance degradation was significantly less in the CBT/MT vs. control arm. Further, within the CBT/MT arm, performance degraded over time in those with no outside-of-class practice time, but remained stable over time in those who practiced mindfulness exercises outside of the session meetings. Thus, these findings suggest that sufficient CBT/MT practice may protect against functional attentional impairments associated with high-stress intervals.

"I live by shooting hill"-a qualitative exploration of conflict and violence among urban youth in New Haven, Connecticut.

To elucidate urban youths' perceptions of conflict and violence we conducted a qualitative study among minority urban youths in New Haven, Connecticut. We utilized the ecological framework to explore the multilevel nature of the findings, and triangulated results with a parallel quantitative study. We found risk factors for violence at multiple levels including lack of interpersonal anger management skills (individual level); parents not physically present in the household (relationship level); residence in crime and gang-ridden neighborhoods (community level); and socioeconomic inequalities between neighborhoods, as reflected by participants' perception of the inadequacy of neighborhood resources to provide safety (societal level). Neighborhood resources were perceived as sparse, and police were not regarded as a protective factor (sometimes rather as racially discriminatory). Participants' statements pertaining to feelings of isolation, racism, and violence without strong parental, neighborhood, and school support may impede prosocial attitudes and behaviors throughout adolescence and young adulthood.

Evaluating the impact of conflict resolution on urban children's violence-related attitudes and behaviors in New Haven, Connecticut, through a community-academic partnership.

Numerous schools are implementing youth violence prevention interventions aimed at enhancing conflict resolution skills without evaluating their effectiveness. Consequently, we formed a community-academic partnership between a New Haven community-based organization and Yale's School of Public Health and Prevention Research Center to examine the impact of an ongoing conflict resolution curriculum in New Haven elementary schools, which had yet to be evaluated. Throughout the 2007-08 school year, 191 children in three schools participated in a universal conflict resolution intervention. We used a quasi-experimental design to examine the impact of the intervention on participants' likelihood of violence, conflict self-efficacy, hopelessness and hostility. Univariate and multivariable analyses were utilized to evaluate the intervention. The evaluation indicates that the intervention had little positive impact on participants' violence-related attitudes and behavior. The intervention reduced hostility scores significantly in School 1 (P<0.01; Cohen's d=0.39) and hopelessness scores in School 3 (P=0.05, Cohen's d=0.52); however, the intervention decreased the conflict self-efficacy score in School 2 (P=0.04; Cohen's d=0.23) and was unable to significantly change many outcome measures. The intervention's inability to significantly change many outcome measures might be remedied by increasing the duration of the intervention, adding additional facets to the intervention and targeting high-risk children.

Prenatal health care beyond the obstetrics service: utilization and predictors of unscheduled care.

OBJECTIVE: The objective of the study was to describe the patient characteristics of prenatal care utilization within and outside of routine obstetric care, and the clinical and psychosocial factors that predict care utilization. STUDY DESIGN: Four hundred twenty pregnant women enrolled in a randomized controlled trial receiving prenatal care in a university-affiliated clinic. All hospital encounters were obtained by review of computerized databases. The Kotelchuck index (KI) was computed, and the characteristics of inadequate, adequate, or excessive prenatal care were described. Demographic and psychosocial predictors of unscheduled visits were evaluated. RESULTS: A total of 50.5% of women were adequate users by KI, with 19% being inadequate. An average of 5 additional unscheduled encounters occurred (standard deviation 4.2; range, 0-26). Almost 75% of participants made an unscheduled obstetric visit, with 38% making 2 or more unscheduled visits. Overweight/obese, younger women, high symptom distress, and excessive and inadequate prenatal users were more likely to utilize the labor floor before delivery. CONCLUSION: Unscheduled care is common during pregnancy.

Using clinical classification trees to identify individuals at risk of STDs during pregnancy.

CONTEXT: Few studies have used classification tree analysis to produce empirically driven decision tools that identify subgroups of women at risk of STDs during pregnancy. Such tools can guide care, treatment and prevention efforts in clinical settings. METHODS: A sample of 647 women aged 14-25 attending two urban obstetrics and gynecology clinics in 2001-2004 were surveyed in their second and third trimesters. Baseline predictors at the individual, dyad, and family and community levels were used to develop a classification tree that differentiated subgroups of women by STD incidence at 35 weeks' gestation. Logistic regression analyses were conducted to assess whether the classification tree groups or commonly used risk factors better predicted STD incidence. RESULTS: Nineteen percent of women had an incident STD during pregnancy. Classification tree analysis identified three subgroups with a high STD incidence (33-61%), one with a moderate incidence (16%) and three with a low incidence (6-11%). Women in subgroups with high STD incidence included those not living with the partner with whom they conceived and those who had a moderate or a high level of depression, a history of STDs and a low level of social support. A logistic regression model using groups defined by the classification tree analysis had better predictive ability than one using common demographic and sexual risk predictors. CONCLUSION: This classification tree identified risk factors not captured by traditional risk screenings, and could be used to guide STD treatment, care and prevention within the prenatal care setting.

Group prenatal care and perinatal outcomes: a randomized controlled trial.

OBJECTIVE: To determine whether group prenatal care improves pregnancy outcomes, psychosocial function, and patient satisfaction and to examine potential cost differences. METHODS: A multisite randomized controlled trial was conducted at two university-affiliated hospital prenatal clinics. Pregnant women aged 14-25 years (n=1,047) were randomly assigned to either standard or group care. Women with medical conditions requiring individualized care were excluded from randomization. Group participants received care in a group setting with women having the same expected delivery month. Timing and content of visits followed obstetric guidelines from week 18 through delivery. Each 2-hour prenatal care session included physical assessment, education and skills building, and support through facilitated group discussion. Structured interviews were conducted at study entry, during the third trimester, and postpartum. RESULTS: Mean age of participants was 20.4 years; 80% were African American. Using intent-to-treat analyses, women assigned to group care were significantly less likely to have preterm births compared with those in standard care: 9.8% compared with 13.8%, with no differences in age, parity, education, or income between study conditions. This is equivalent to a risk reduction of 33% (odds ratio 0.67, 95% confidence interval 0.44-0.99, P=.045), or 40 per 1,000 births. Effects were strengthened for African-American women: 10.0% compared with 15.8% (odds ratio 0.59, 95% confidence interval 0.38-0.92, P=.02). Women in group sessions were less likely to have suboptimal prenatal care (P<.01), had significantly better prenatal knowledge (P<.001), felt more ready for labor and delivery (P<.001), and had greater satisfaction with care (P<.001). Breastfeeding initiation was higher in group care: 66.5% compared with 54.6%, P<.001. There were no differences in birth weight nor in costs associated with prenatal care or delivery. CONCLUSION: Group prenatal care resulted in equal or improved perinatal outcomes at no added cost. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00271960 LEVEL OF EVIDENCE: I.

CenteringPregnancy group prenatal care: Promoting relationship-centered care.

CenteringPregnancy is an innovative model of group prenatal care that has been implemented at more than 100 prenatal care sites since 1995. CenteringPregnancy provides group prenatal care that is relationship centered, nurturing and transforming relationships among women, their families, and health care professionals. Complete prenatal care is provided in a group setting. Prenatal assessment, education, and support occur in a facilitative environment. The model offers effective and efficient care that is sustainable and can enhance the health of women, their families, health care providers, and communities.