Prospective associations of health literacy with clinical outcomes in adults with CKD: findings from the CRIC study.

BACKGROUND: Limited health literacy is associated with significant morbidity and mortality in the general population but the relation of health literacy with long-term clinical outcomes among adults with chronic kidney disease (CKD) is less clear. METHODS: Prospective data from the Chronic Renal Insufficiency Cohort (CRIC) Study (n = 3715) were used. Health literacy was assessed with the Short Test of Functional Health Literacy in Adults (dichotomized as limited/adequate). Cox proportional hazards models were used to separately examine the relations of health literacy with CKD progression, cardiovascular event (any of the following: myocardial infarction, congestive heart failure, stroke or peripheral artery disease), and all-cause, cardiovascular and non-cardiovascular mortality. Poisson regression was used to assess the health literacy-hospitalization association. Models were sequentially adjusted: Model 1 adjusted for potential confounders (sociodemographic factors), while Model 2 additionally adjusted for potential mediators (clinical and lifestyle factors) of the associations of interest. RESULTS: In confounder-adjusted models, participants with limited (vs adequate) health literacy [555 (15%)] had an increased risk of CKD progression [hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.06-1.71], cardiovascular event (HR 1.67; 95% CI 1.39-2.00), hospitalization (rate ratio 1.33; 95% CI 1.26-1.40), and all-cause (HR 1.54; 95% CI 1.27-1.86), cardiovascular (HR 2.39; 95% CI 1.69-3.38) and non-cardiovascular (HR 1.27; 95% CI 1.01-1.60) mortality. Additional adjustments for potential mediators (Model 2) showed similar results except that the relations of health literacy with CKD progression and non-cardiovascular mortality were no longer statistically significant. CONCLUSIONS: In the CRIC Study, adults with limited (vs adequate) health literacy had a higher risk for CKD progression, cardiovascular event, hospitalization and mortality-regardless of adjustment for potential confounders.

Promoting Health Literacy and Cultural Humility: CBOs and Wraparound Services.

The COVID-19 pandemic placed demands on community-based organizations (CBOs) to address human needs to promote the health and well-being of diverse communities experiencing high rates of disparities. To enhance the capacity of CBOs in engaging with their communities, we developed webinars on health literacy and cultural humility. The concept that drove the training was wraparound services, with the objective to increase CBOs' skills and knowledge for addressing the needs of the whole person.

Dimensions of Parenting and Children's Bullying Victimization: A Look at the Racial/Ethnic and Grade Level Differences.

The associations between the various dimensions of parenting and adolescent bullying have been widely studied, but it is unclear whether these associations vary by race/ethnicity and grade. The current study utilized the Health Behavior in School-Aged Children data in the United States for the investigation. The findings show that supportive parenting and permissive parenting were negatively associated with bullying victimization. However, controlling parenting and neglectful parenting were positively associated with bullying victimization. The results further revealed that the dimensions of parenting were similarly associated with bullying victimization across racial/ethnic groups. Parenting was also similarly associated with bullying victimization for both middle and high school students, except for supportive parenting, where middle school students with more parental support reported less bullying victimization. The implications of the findings are discussed.

The social ecology of adolescent-initiated parent abuse: a review of the literature.

This article provides an ecological framework for understanding adolescent-initiated parent abuse. We review research on adolescent-initiated parent abuse, identifying sociodemographic characteristics of perpetrators and victims (e.g., gender, age, race/ethnicity, and socioeconomic status [SES]). Bronfenbrenner's [1] ecological systems theory is applied, which examines the risk and protective factors for adolescent-initiated parent abuse within micro- (maltreatment, domestic violence, parenting behavior and disciplinary strategies), meso- (peer influence), exo- (media influence), macro- (gender role socialization), and chronosystem (change in family structure) levels. Findings from our review suggest that older and White children are significantly more likely to abuse their parents. Females are selective in the target of their aggression, while males target family members in general. Mothers are significantly more likely to be abused than fathers. However, researchers also report variations in the association between SES and parent abuse. Domestic violence and child maltreatment are risk factors, while findings on parenting behavior and disciplinary strategies are mixed. Peer influence, exposure to media violence, gender role socialization, and change in family structure can potentially increase the risk of parent abuse. Practice and research implications are also discussed. An ecological systems framework allows for an examination of how various contexts interact and influence parent abuse behavior, and can provide needed directions for further research.

Tools to Measure Health Literacy among US African Americans and Hispanics/Latinos with Type 2 Diabetes: A Scoping Review of the Literature.

OBJECTIVE: To provide an overview of the health literacy tools that have been validated in samples of African Americans and Hispanics/Latinos with type 2 diabetes, growing segments of the US population. METHODS: Following PRISMA guidelines, three electronic databases were searched. The following inclusion criteria were used: peer-reviewed research; examined validity of a health literacy tool; and included US African American and/or Hispanic/Latino adults with type 2 diabetes. RESULTS: Sixteen studies were selected; none exclusively included African Americans while 3 exclusively included Hispanics/Latinos in the sample. Seventeen health literacy tools were identified. Among African Americans, 2 health literacy screeners, 2 diabetes knowledge, and 3 numeracy tools have been validated. Among Hispanics/Latinos, 1 health literacy screener, 1 diabetes knowledge, and 1 numeracy tool have been validated. However, cross-cultural adaptation principles were rarely considered in the development and validation of these tools. CONCLUSION: In those with type 2 diabetes, future studies should investigate the validity of health literacy screeners among English-speaking Hispanics/Latinos and general health literacy tools among African Americans and Hispanics/Latinos. Evidence on the validity of diabetes knowledge and numeracy tools was mixed across studies. PRACTICE IMPLICATIONS: Findings can inform the selection of culturally-appropriate health literacy tools in clinical and research settings.

The use of strategies from the social sciences to inform pipeline development programs for under-represented minority faculty and students in the health sciences.

Representation of under-represented minority (URM) faculty in the health sciences disciplines is persistently low relative to both national and student population demographics. Although some progress has been made through nationally funded pipeline development programs, demographic disparities in the various health sciences disciplines remain. As such the development of innovative interventions to help URM faculty and students overcome barriers to advancement remains a national priority. To date, the majority of pipeline development programs have focused on academic readiness, mentorship, and professional development. However, insights from the social sciences literature related to "extra-academic" (e.g., racism) barriers to URM persistence in higher education suggest the limitations of efforts exclusively focused on cognitively mediated endpoints. The purpose of this article is to synthesize findings from the social sciences literature that can inform the enhancement of URM pipeline development programs. Specifically, we highlight research related to the social, emotional, and contextual correlates of URM success in higher education including reducing social isolation, increasing engagement with research, bolstering persistence, enhancing mentoring models, and creating institutional change. Supporting URM's success in the health sciences has implications for the development of a workforce with the capacity to understand and intervene on the drivers of health inequalities.

Autism Spectrum Disorder Updates - Relevant Information for Early Interventionists to Consider.

Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social communication skills as well as repetitive, restricted or stereotyped behaviors (1). Early interventionists are often found at the forefront of assessment, evaluation, and early intervention services for children with ASD. The role of an early intervention specialist may include assessing developmental history, providing group and individual counseling, working in partnership with families on home, school, and community environments, mobilizing school and community resources, and assisting in the development of positive early intervention strategies (2, 3). The commonality among these roles resides in the importance of providing up-to-date, relevant information to families and children. The purpose of this review is to provide pertinent up-to-date knowledge for early interventionists to help inform practice in working with individuals with ASD, including common behavioral models of intervention.

Individual and Contextual Factors Associated with Immigrant Youth Feeling Unsafe in School: A Social-Ecological Analysis.

Despite the increasing proportion of immigrant youth in U.S. school districts, no studies have investigated their perceptions of their school. This study examines factors associated with perceptions of school safety among immigrant youth within individual, family, peer, and school contexts. Data were drawn from Wave II of the Children of Immigrants Longitudinal Study (n = 4288) and hierarchical logistic regression analyses were conducted. African-Americans, females, and youth with limited English proficiency were more likely to perceive their school as unsafe. Youth who reported that family cohesion was important and those who had close friends perceived their school as safe. Also, those who experienced illegal activities in school reported feeling unsafe. Assessment and intervention in schools needs to consider individual and contextual factors associated with perceptions of school safety. Additional research is needed to examine individual and contextual factors related to immigrant youths' perceptions of school.

School-based social work interventions: a cross-national systematic review.

Across the globe, social workers serve schools in a variety of capacities, providing services such as skills training; individual, group, and family counseling; crisis intervention; home visits; parent support and education; and advocacy for students, families, and school systems. To date, no synthesis of the literature exists examining tier 1 and tier 2 cross-national school-based social work interventions. Therefore, the purpose of this systematic review was twofold: (1) to identify tier 1 and tier 2 school-based interventions that involve social workers and (2) to examine the extent to which the interventions are efficacious with school-based youths. A computerized search with inclusion and exclusion criteria was conducted using several databases. Eighteen studies were included for the final sample in this review. Effect sizes were calculated for all outcomes to determine magnitude of treatment effect. Results indicated that most of the studies were conducted in the United States (n = 14) and half (n = 9) of the included interventions were tier 1. Many positive effect sizes were found. Interventions aimed to treat a variety of outcomes such as sexual health, aggression, self-esteem, school attendance, identity, and depression. More research is needed to determine the effectiveness of school-based social work worldwide.

Assessing the adaptive behavior of youths: multicultural responsivity.

Nearly 25 years ago, Allen-Meares and Lane appraised the status of adaptive behavior assessments in use at the time, citing their usefulness and relevance to the overall assessment of school children. This article revisits those instruments and examines select current instruments to gauge whether they include the multicultural sensitivity required to fairly assess the growing diverse populations of school children. Many of the popular adaptive behavior assessment instruments have not been normed with a wide array of racial groups or with cultural considerations in mind. This leads to suggestions of how social workers in particular may ensure that referred students are assessed fairly.