Do Ethnic Identity, Familial, and Community Contexts Impact the Association Between Adverse Life Events and Psychopathology Among Latinx Adolescents?

OBJECTIVE: Few studies have explored the interplay of how individual identity, parental, familial, and contextual factors impact associations between Latinx adolescent adversities and psychopathology. This study aimed to examine whether these factors mediate the relationship between adversities and psychopathology in Latinx youth. METHOD: Latinx youth (n = 2,411) data from the Adolescent Brain Cognitive Development (ABCD) Study were used to examine path models with adverse childhood experiences (ACEs) as the predictor and either youth- or caregiver-rated internalizing/externalizing scores over 4 timepoints as the outcome (ages 9-13 years). Models examined 3 potential mediators: (1) ethnic identity, (2) familial context (comprising parental monitoring, family conflict, and caregiver acceptance), and (3) community cohesion. Models were conducted separately for internalizing and externalizing symptoms. RESULTS: Greater adversity was associated with greater youth- and caregiver-rated internalizing/externalizing psychopathology over time. Greater adversity was associated with lower family functioning and lower ethnic identity, and greater family functioning was associated with lower psychopathology. Family functioning mediated associations between adversity and psychopathology over time (youth-reported internalizing: 95% CI = 0.012-0.019; youth-reported externalizing: 95% CI = 0.020-0.028). In contrast, there was not strong evidence for ethnic identity and community cohesion mediating associations between adversities and psychopathology over time. CONCLUSION: Unlike previous studies, ethnic identity did not influence the relationship between ACEs and psychopathology over time. Additional research is needed to identify whether possible tensions rise as Latinx youth acculturate into US culture and achieve optimal levels of ethnic identity formation. Providers need to assess specific Latinx parental and familial contexts that may interfere with youth identity formation.

Adolescent Mental Health and Family Economic Hardships: The Roles of Adverse Childhood Experiences and Family Conflict.

Rising and economically disproportionate rates of adverse mental health outcomes among children and youth warrant research investigating the complex pathways stemming from socioeconomic status. While adverse childhood experiences (ACEs) have been considered a possible mechanism linking socioeconomic status (SES) and child and youth psychopathology in previous studies, less is understood about how family environments might condition these pathways. Using data from a longitudinal, multiple-wave study, the present study addresses this gap by examining the direct relationships between family economic status and youth internalizing and externalizing symptoms, if ACEs mediate these relationships, and if conflictual family environments moderate these direct and indirect relationships. The data were obtained from 5510 youth participants [mean age at baseline = 9.52 (SD = 0.50), 47.7% female, 2.1% Asian, 10.3% Black, 17.6% Hispanic, 9.8% Multiracial/Multiethnic, 60.2% White] and their caretakers from the baseline, 1-year, and 2-year follow up waves. Conditional process analysis assessed the direct, indirect, and moderated relationships in separate, equivalent models based on youth- versus caregiver-raters of ACEs and youth psychopathology to capture potential differences based on the rater. The results of both the youth- and caregiver-rated models indicated that lower family economic status directly predicted higher levels of externalizing symptoms, and ACEs indirectly accounted for higher levels of internalizing and externalizing symptoms. Additionally, family conflict moderated some, but not all, of these relationships. The study's findings highlight that lower family economic status and ACEs, directly and indirectly, contribute to early adolescent psychopathology, and conflictual family environments can further intensify these relationships. Implementing empirically supported policies and interventions that target ACEs and family environments may disrupt deleterious pathways between SES and youth psychopathology.

Supportive Neighborhoods, Family Resilience and Flourishing in Childhood and Adolescence.

Flourishing is linked with health and well-being in childhood and adulthood. This study applied a promotive factors model to examine how neighborhood assets might benefit child and adolescent flourishing by promoting family resilience. Using data from the combined 2018 and 2019 National Survey of Children's Health, structural equation models tested direct and indirect relationships between neighborhood physical environment, neighborhood social cohesion, family resilience, and flourishing among 18,396 children and 24,817 adolescents. After controlling for multiple covariates that may influence flourishing, the models supported that higher levels of neighborhood social cohesion were directly associated with higher levels of flourishing adolescents, and indirectly by positive associations with family resilience for both children and adolescents. No indirect effects between neighborhood physical environments and flourishing were supported by the data for either children or adolescents. However, neighborhood physical environments were positively associated with adolescent flourishing. Understanding social environmental factors that strengthen and enhance child and adolescent flourishing are critical toward designing prevention, intervention, and policy efforts that can build on the existing strengths of families and their communities.

Assuaging COVID-19 Peritraumatic Distress Among Mental Health Clinicians: The Potential of Self-Care.

Undoubtedly, the 2019 novel coronavirus, also known as COVID-19, has put mental health clinicians under stress. Despite the promise of self-care in assuaging stress, very few, if any, studies have investigated the impact of self-care on stress among mental health professionals. This exploratory study examined COVID-19 related distress, self-care, and the predictive relationship between the two. Primary data were collected from a sample of mental health social work clinicians in one southeastern state (N = 1568). Results indicate that participants were experiencing mild peritraumatic distress associated with COVID-19. Participants who were married, identified as heterosexual or straight, financially stable, and in good physical/mental health were experiencing less distress than other mental health clinicians in the sample. Analyses revealed that higher self-care practices predict significantly less distress. Overall, data suggest that self-care can be integral to assuaging distress among mental health clinicians. This study offers insight into how to support mental health practitioners during COVID-19.

Social support reduces the risk of unintended pregnancy in a low-income population.

Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health. PURPOSE: To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. METHOD: A cross-sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309). RESULTS: Sixty-two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78-0.97, p = .011, OR = 0.86, 95% CI = 0.77-0.95, p = .005). A positive drug screen was associated with an almost three-fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49-5.58, p = .002). CONCLUSION: Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs.

Reported Barriers to Hepatitis C Treatment among Pregnant and Early-Parenting Mothers Undergoing Substance Use Disorder Treatment in One U.S. State.

Nationwide, the prevalence of the hepatitis C virus (HCV) has risen in recent years. At least 90% of infected persons must be treated to achieve global elimination targets. The current study aimed to explore barriers to, and facilitators of, direct-acting antiviral (DAA) HCV treatment uptake amongst pregnant and early-parenting women undergoing comprehensive substance use treatment. Twenty participants with documented HCV antibody positivity were recruited from two substance use treatment centers in central Kentucky. Semi-structured interviews were conducted to explore knowledge about HCV, previous experiences, and intentions to seek care. Themes were extracted using an inductive analytical approach. Most participants were aware of the dangers posed by HCV infection. However, there was a high degree of misinformation about transmission mechanisms and treatment eligibility requirements. Low priority for HCV treatment also surfaced as a barrier to treatment uptake. Participants reported being unable to seek care due to time and resource limitations in the presence of a highly demanding treatment process. Findings from the current study suggest that more work is needed to eliminate residual barriers that limit access to HCV treatment among pregnant and early-parenting women in treatment for substance use disorder.

Validating the eHealth Literacy Scale in Rural Adolescents.

PURPOSE: Given that the recent eHealth literacy literature supports the properties of the 3-factor eHealth literacy scale (eHEALS) model in samples with millennials, adults, and older adults, the appropriate next step is to establish whether the model can be reproduced in a rural adolescent sample. The purpose of this study was to evaluate the recent 3-factor model by Paige and associates with a sample of seventh-grade students. METHODS: This cross-sectional study included a subsample of students (n = 146) from 3 school districts in Appalachian Kentucky. We used confirmatory factor analysis (CFA) procedures and small sample model fit guidelines to evaluate our model, and the 1-sample bootstrap algorithm with bias-corrected and accelerated 95% confidence intervals to estimate associations among eHEALS and health and technology variables. FINDINGS: A total of 137 students, or 61% of enrolled seventh-grade students, completed the study. CFA results showed eHEALS 3-factor loadings-information awareness, information seeking, and information engagement-were high (≥0.63) and statistically significant. We observed evidence of a good model fit (root mean square error of approximation [RMSEA] = 0.07, standardized root mean square residual [SRMR] = 0.03, comparative fit index [CFI] = 0.99) and results are comparable with Paige and associates' model fit (RMSEA = 0.06, SRMR = 0.08, CFI = 0.98). Correlations showed that students with more access to technology were associated with higher information seeking (r = 0.31) and higher information engagement (r = 0.23). eHealth literacy scores did not differ by level of rurality or gender. CONCLUSIONS: The 3-factor eHEALS is a reliable and valid instrument in assessing eHealth literacy in a group of rural seventh graders from Appalachian Kentucky.

Risk and Resilience Factors for Psychobehavioral Symptom Trajectories Among Child Welfare-Involved Youth.

The primary aim of the study was to investigate the development of psychobehavioral symptoms (internalizing, externalizing, and posttraumatic stress [PTS]) of child welfare-involved adolescents over a 3-year period and to identify predictors of the trajectories. Using three waves of data from the National Survey of Child and Adolescent Well-Being (NSCAW-II), latent growth curve modeling was conducted on a sample of 350 adolescents who were between 11 and 13 years of age at baseline. Findings indicated that adolescents' internalizing symptoms decreased over time, whereas externalizing symptoms remained stable over time. PTS symptoms decreased over time in girls, but not boys. Physical abuse predicted higher levels of externalizing behaviors and sexual abuse predicted a slower decrease in PTS symptoms. Greater child prosocial skills and higher quality of caregiver-child relationship were associated with lower initial levels of externalizing symptoms. In addition, a higher quality caregiver-child relationship and greater satisfaction with peer relationships were associated with lower initial levels of internalizing and PTS symptoms. Findings suggest that intervention strategies should consider gender, maltreatment type, and interpersonal and social skills to effectively prevent the development of psychobehavioral symptoms among child welfare-involved youth.

Racial Differences in the Relationship between Neighborhood Disorder, Adverse Childhood Experiences, and Child Behavioral Health.

The neighborhood and family context in which children grow profoundly influences their development. Informed by ecological systems theory and social disorganization theory, we hypothesized that adverse childhood experiences (ACEs) mediate the relationship between neighborhood disorder and child externalizing and internalizing behaviors, and that these pathways vary by race/ethnicity. We conducted secondary data analysis using Fragile Families and Child Well-being study data. To test hypothesized pathways, we performed a mediation path analysis on a sample of 3001 mothers of children (ages 3 and 5) living in 20 U.S. cities. A moderated mediation path analysis was used to test racial/ethnic differences in hypothesized pathways. We found that living in disordered neighborhoods increased children's likelihood of exhibiting externalizing and internalizing behaviors through childhood ACEs. Compared to Black and Hispanic children, White children's ACEs were more susceptible to negative neighborhood environment effects, suggesting that White children's behavioral health may be more indirectly affected by neighborhood disorder. The finding that ACEs mediated the pathway from neighborhood disorder to child behavior problems provides opportunity for child psychiatrists and pediatricians to interrupt negative pathways by providing interventions for children and families. Our findings on racial/ethnic differences highlight the need for culturally sensitive programming to address children's behavior problems.

Preventive Benefits of U.S. Childcare Subsidies in Supervisory Child Neglect.

Using data from age 3 of the Fragile Families and Child Wellbeing Study, the current study explores the complex relationships between U.S. child care subsidies and neglect. Specifically, the study examines two research questions: (1) Are U.S. child care subsidies associated with self-reported neglect among low-income mothers? (2) What individual types of self-reported neglect are significantly reduced by receipt of child care subsidy? Using negative binomial regression examining the relationships among mothers who were income-eligible for child care subsidy, we found that child care subsidy was associated with lower levels of supervisory neglect, indicating an important role of subsidy in the lives of low-income families.

Associations of first trimester co-use of tobacco and Cannabis with prenatal immune response and psychosocial well-being.

PURPOSE: This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only. METHODS: A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1ß, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women. RESULTS: Participant average age was 29.1 years, approximately half had a high school education or less, and half were unemployed. Compared to tobacco only users, co-users were more likely to be non-White, younger and more economically disadvantaged. In the adjusted linear regression models, TNF-α levels were significantly lower among co-users relative to tobacco only users, after adjusting for age, race/ethnicity, body mass index and tobacco use group (tobacco cigarettes, electronic nicotine delivery devices [ENDS] or both). TNF-α was the only immune marker found to be significant in this analysis. Measured stress levels (M = 5.9, SD = 3.3; potential range 0-16) and depression scores (M = 7.8, SD = 5.8; potential range 0-30) were low across all participants and did not differ as a function of co-use. CONCLUSION: Preliminary results suggest women co-using during the first trimester exhibit decreased pro-inflammatory immune responsivity on one out of eight markers. Further research is needed to determine the impact of this immune modulation on fetal health outcomes and the unique contribution of cannabis.

A systematic review of the psychosocial impact of emotional numbing in US combat veterans.

CONTEXT: Previous studies have linked posttraumatic emotional numbing symptoms in US combat veterans with an adverse impact in multiple important life domains. OBJECTIVES: We updated and evaluated the evidence examining the psychosocial impact of combat-related emotional numbing, including ethnoracial and gender differences. METHOD: We reviewed 1,209 articles published betwen January 2012 and 2018 and selected 24 studies for inclusion. We assessed the overall study quality as fair using a national quality assessment tool. RESULTS: Studies found emotional numbing to wield adverse effects in the areas of symptom nonimprovement, mental health difficulties, increased service utilization, poor relationship functioning, reduced quality of life, substance use disorders, suicidality, and aggression/violence. We also found evidence of ethnoracial and gender differences in veterans' posttraumatic stress disorder-related emotional numbing symptoms. CONCLUSION: Clinicians should incorporate findings on emotional numbing into assessment, treatment planning, and monitoring, to improve treatment retention and psychosocial outcomes. Implications for ethnoracial and gender differences require further exploration.

The effects of recurrent physical abuse on the co-development of behavior problems and posttraumatic stress symptoms among child welfare-involved youth.

The primary aim of the current study was to examine the longitudinal effects of ongoing physical abuse on the co-development of externalizing behavior problems and posttraumatic stress (PTS) symptoms among child welfare-involved adolescents. Using three waves of data from the National Survey of Child and Adolescent Well-Being, we performed unconditional and conditional parallel process latent growth curve modeling in a structural equation modeling framework. The study sample included 491 adolescents who were between 11 and 13 years of age at baseline. Higher levels of initial PTS symptoms were associated with higher levels of externalizing behavior problems, but the rate of change in PTS symptoms were not significantly associated with the rate of change in externalizing behavior problems over time. Although physical abuse was concurrently associated with both externalizing behavior problems and PTS symptoms at all assessment points, there were no lagged effects. Additionally, we found that physical abuse indirectly affects subsequent development of externalizing behavior problems and PTS symptoms through ongoing physical abuse. Findings highlight the comorbidity of externalizing behaviors and PTS symptoms among early adolescents in the child welfare system, underlining the importance of screening for and addressing these problems simultaneously. Findings also point to the need for continued assessment of and protection from ongoing physical abuse during adolescence.

Exploring the self-compassion of health-care social workers: How do they fare?

Indubitably, the challenges facing health-care social workers are becoming increasingly complex. Whilst these problematic professional circumstances compound the need for self-compassion among health-care social workers, few studies, if any, have explicitly examined self-compassion among this practitioner group. This cross-sectional study explored self-compassion among a sample of practitioners (N = 138) in one southeastern state. Results indicate that health-care social workers in this sample engage in self-compassion only moderately. Further, occupational and demographic/life characteristics (e.g., age, years practicing social work, average hours worked per week, health status, and relationship status, among others) are able to predict self-compassion scores. After a terse review of relevant literature, this paper will explicate findings from this study, discuss relevant points derived from said findings, and identify salient implication for health-care social work praxis.

If mothers had their say: research-informed intervention design for empowering mothers to establish smoke-free homes.

The Empowering Mothers to Establish Smoke-free Homes (EMESH) project developed in response to an interdisciplinary health team seeking effective interventions for reducing/eliminating the environmental tobacco smoke exposure of infants with compromised respiratory status. Two study phases that informed the EMESH intervention design are described. Phase I involved semi-structured interviews with 20 caretakers of infants diagnosed with Bronchopulmonary Dysplasia (BPD). In Phase II, 75 randomly selected medical records of infants with BPD were reviewed to explore the family demographics and staff behavior regarding environmental tobacco smoke (ETS) interventions. Interview results suggest that families are open to partnering with social workers and interdisciplinary team members in addressing infants' ETS exposure, families' unique circumstances indicate a need for tailored interventions, and the use of self-efficacy and decisional balance tools are feasible options. Results from the medical records review indicate that many families are economically vulnerable and reside in regions where smoking is common. There is a paucity of staff documentation regarding ETS conversations and interventions, indicating that these conversations may not take place. Together these results suggest a two-pronged approach in the next phases of EMESH: staff training in hosting and documenting ETS conversations and a tailored, parent-driven set of intervention options.