Intelligibility in Context Scale: Sensitivity and specificity in the Jamaican context.

The present study investigated the sensitivity and specificity of the English Intelligibility in Context Scale (ICS) and the ICS-Jamaican Creole (ICS-JC) translation with bilingual preschool-aged Jamaican children. Participants in this study were 262 English-Jamaican Creole simultaneous bilingual children (aged 3;3 to 6;3, M = 4;11, SD = 7.8). The ICS and ICS-JC were administered to parents in auditory form, rather than written form. Although recent evidence has demonstrated the validity and reliability of the ICS as an assessment tool in various languages, further data are needed to determine diagnostic accuracy of the ICS and ICS-JC in Jamaican children. The sensitivity and specificity of both tools were high in this cohort of children, indicating that in the Jamaican context, these versions of the ICS could be used as screening tools to identify children who require further assessment of speech sound disorders. A cut-off score of 4.12 was used for both tools to achieve high sensitivity (0.84) and specificity (0.70) values for the ICS, as well as high sensitivity (0.84) and specificity (0.71) for the ICS-JC. The results of this study also demonstrate that administration of the auditory ICS is a valid way of collecting parent reports about children's speech intelligibility, which has implications for use of the ICS in languages with no written form or with parents who have a low level of literacy in the languages they use. This investigation is relevant not only to this underserved population but broadens knowledge of research-based tools for working with bilingual children.

Measuring Trauma Exposure: Count Versus Variety of Potentially Traumatic Events in a Binational Sample.

Traumatic event checklists typically ask respondents to indicate whether they have experienced particular types of potentially traumatic events (PTEs) and then sum these endorsements to gauge cumulative trauma exposure. However, the sum of these endorsements indicates the variety of PTEs respondents have experienced rather than the count of exposure events. The main objective of the present study was to explore the association between PTE count and variety to examine assumptions regarding the use of traumatic event checklists to measure cumulative trauma exposure. The limited empirical research suggests that count and variety are strongly associated; however, there may be variation in magnitude concerning whether participants' environments confer an increased or decreased risk of exposure. We present Life Event Checklist data from a large sample of Mexican and U.S. participants (n = 1,820), which allowed us to compare reports of count and variety. Count and variety were strongly correlated, Kendall's tau-b = .74, such that count accounted for 54.6% of the variance in variety. A negative binomial regression analysis revealed that this association was moderated by county and municipio homicide rate, used as a proxy for violent crime, but not by natural disaster history. Variety was more strongly associated with scores on the Posttraumatic Stress Checklist for DSM-5, Kendall's tau-b = .26, than was PTE count, Kendall's tau-b = .22, Fisher's z = -8.04, p < .001. Although there are challenges in estimating PTE counts, the present findings suggest that PTE variety is not a good proxy for cumulative trauma exposure.

Benefit of Early Initiation of Influenza Antiviral Treatment to Pregnant Women Hospitalized With Laboratory-Confirmed Influenza.

BACKGROUND: We describe the impact of early initiation of influenza antiviral treatment among pregnant women hospitalized with laboratory-confirmed influenza during the 2010-2014 influenza seasons. METHODS: Severe influenza was defined as illness with ≥1 of the following: intensive care unit admission, need for mechanical ventilation, respiratory failure, pulmonary embolism, sepsis, or death. Within severity stratum, we used parametric survival analysis to compare length of stay by timing of antiviral treatment, adjusting for underlying conditions, influenza vaccination, and pregnancy trimester. RESULTS: Among 865 pregnant women, the median age was 27 years (interquartile range [IQR], 23-31 years). Most (68%) were healthy, and 85% received antiviral treatment. Sixty-three women (7%) had severe influenza, and 4 died. Severity was associated with preterm delivery and fetal loss. Women with severe influenza were less likely to be vaccinated than those without severe influenza (14% vs 26%; P = .03). Among women treated with antivirals ≤2 days versus those treated >2 days from illness onset, the median length of stay was 2.2 days (interquartile range [IQR], 0.9-5.8 days; n = 8) versus 7.8 days (IQR, 3.0-20.6 days; n = 7), respectively, for severe influenza (P = .03) and 2.4 days (IQR, 2.3-2.5 days; n = 153) versus 3.1 days (IQR, 2.8-3.5 days; n = 62), respectively, for nonsevere influenza (P < .01). CONCLUSIONS: Early initiation of influenza antiviral treatment to pregnant women hospitalized with influenza may reduce the length of stay, especially among those with severe influenza. Influenza during pregnancy is associated with maternal and infant morbidity, and annual influenza vaccination is warranted.

Update: influenza activity - United States, September 28- December 6, 2014.

CDC collects, compiles, and analyzes data on influenza activity year-round in the United States (http://www.cdc.gov/flu/weekly/fluactivitysurv.htm). The influenza season generally begins in the fall and continues through the winter and spring months; however, the timing and severity of circulating influenza viruses can vary by geographic location and season. Influenza activity in the United States increased starting mid-October through December. This report summarizes U.S. influenza activity during September 28-December 6, 2014.

Influenza activity - United States, 2013-14 season and composition of the 2014-15 influenza vaccines.

During the 2013-14 influenza season in the United States, influenza activity increased through November and December before peaking in late December. Influenza A (H1N1)pdm09 (pH1N1) viruses predominated overall, but influenza B viruses and, to a lesser extent, influenza A (H3N2) viruses also were reported in the United States. This influenza season was the first since the 2009 pH1N1 pandemic in which pH1N1 viruses predominated and was characterized overall by lower levels of outpatient illness and mortality than influenza A (H3N2)-predominant seasons, but higher rates of hospitalization among adults aged 50-64 years compared with recent years. This report summarizes influenza activity in the United States for the 2013-14 influenza season (September 29, 2013-May 17, 2014†) and reports recommendations for the components of the 2014-15 Northern Hemisphere influenza vaccines.

Update: influenza activity - United States, September 29, 2013-February 8, 2014.

Influenza activity in the United States began to increase in mid-November and remained elevated through February 8, 2014. During that time, influenza A (H1N1)pdm09 (pH1N1) viruses predominated overall, while few B and A (H3N2) viruses were detected. This report summarizes U.S. influenza activity* during September 29, 2013-February 8, 2014, and updates the previous summary.

Synthesis and reactivity of new aminophenolate complexes of nickel.

New well-defined, paramagnetic nickel complexes have been prepared and characterized by X-ray crystallography. The complexes were found to be active for the cross-coupling of alkyl electrophiles (especially ethyl 2-bromobutyrate) with alkyl Grignard reagents. The ligand architecture in these new complexes could potentially be rendered chiral, opening up future possibilities for performing asymmetric cross-coupling reactions.

A Systematic Review of Response Styles Among Latinx Populations.

Culture influences responses to psychological measurements in ways unrelated to target constructs, thus biasing test scores and potentially contributing to under- and over-diagnosis of mental health problems in populations for which measures have not yet been normed. We conducted a systematic review of publications addressing response style among Latinx population groups in North and South America. In a final corpus of 24 studies, Latinx/Latin American populations were generally found to exhibit higher levels of extreme response style (n = 17), acquiescent response style (n = 10), and socially desirable responding (n = 5). The few publications (n = 3) that investigated midpoint responding reported no differences. Seven publications (29%) attempted to adjust scores to mitigate response style bias, using both scale design and statistical techniques. Findings suggest that researchers and clinicians should directly assess culturally patterned response style as a construct, rather than inferring style indirectly using other measures. For clinicians, knowledge of response style represents another facet of case conceptualization.

Cross-Cultural Measurement Invariance of the Harvard Trauma Questionnaire Across Nine Adolescent Samples.

Trauma researchers often make claims about the severity of posttraumatic stress disorder (PTSD) across populations, and yet cross-cultural measurement invariance (MI) is rarely assessed. Nine youth samples with Harvard Trauma Questionnaire (HTQ) responses were grouped based on sampling strategy used into two sets: representative (Denmark, the Faroe Islands, Iceland, and Lithuania, n = 1,457), and convenience (Greenland, India, Kenya, Malaysia, and Uganda, n = 2,036). Confirmatory factor analysis (CFA) was used to gauge whether configural, metric, scalar, and residual invariance of different models held between national samples within the two sets. Configural invariance held for most PTSD models in convenience samples, not in representative samples. Metric invariance was less common, and scalar and residual in general did not hold. Cultural similarity between samples seemed to be associated with invariance. Findings suggest that although PTSD symptoms may cluster similarly across culturally distal groups, comparisons of the severity of symptoms using the HTQ across adolescent samples are not likely valid.

Supporting Culturally Responsive Assessment Practices With Preschoolers: Guidance From Methods in the Jamaican Context.

PURPOSE: There is a shortage of available methods to accurately inform the developmental status of children whose cultural and linguistic backgrounds vary from the mainstream. The purpose of this review article was to describe different approaches used to support the accurate characterization of speech, language, and functional communication in children speaking Jamaican Creole and English, an understudied paradigm in the speech pathology research. METHOD: Approaches used across four previously published studies in the Jamaican Creole Language Project are described. Participants included 3- to 6-year-old Jamaican children (n = 98-262) and adults (n = 15-33). Studies I and II described validation efforts about children's functional communication using the Intelligibility in Context Scale (ICS; speech) and the Focus on the Outcomes of Communication Under Six (FOCUS; speech and language). Study III described efforts to accurately characterize difference and disorder in children's expressive grammar using adapted scoring, along with adult models to contextualize child responses. Last, Study IV applied acoustic duration (e.g., whole word) and an adapted scoring protocol to inform variation in speech sound productions in the Jamaican context where a post-Creole continuum exists. RESULTS: Studies I and II offered promising psychometric evidence about the utility of the ICS and the FOCUS. Study III revealed strong sensitivity and specificity in classifying difference and disorder using adult models. Last, in Study IV, linguistically informed acoustic analyses and an adapted protocol captured variation in speech productions better than a standard approach. CONCLUSIONS: Applying culturally responsive methods can enhance the accurate characterization of speech, language, and functional communication in Jamaican children. The innovative methods used offer a model approach that could be applied to other linguistic contexts where a mismatch exists between speech-language pathologists and their clientele. PRESENTATION VIDEO: https://doi.org/10.23641/asha.23929461.

Characterizing Speech Sound Productions in Bilingual Speakers of Jamaican Creole and English: Application of Durational Acoustic Methods.

PURPOSE: This study examined the speech acoustic characteristics of Jamaican Creole (JC) and English in bilingual preschoolers and adults using acoustic duration measures. The aims were to determine if, for JC and English, (a) child and adult acoustic duration characteristics differ, (b) differences occur in preschoolers' duration patterns based on the language spoken, and (c) relationships exist between the preschoolers' personal contextual factors (i.e., age, sex, and percentage of language [%language] exposure and use) and acoustic duration. METHOD: Data for this cross-sectional study were collected in Kingston, Jamaica, and New York City, New York, United States, during 2013-2019. Participants included typically developing simultaneous bilingual preschoolers (n = 120, ages 3;4-5;11 [years;months]) and adults (n = 15, ages 19;0-54;4) from the same linguistic community. Audio recordings of single-word productions of JC and English were collected through elicited picture-based tasks and used for acoustic analysis. Durational features (voice onset time [VOT], vowel duration, whole-word duration, and the proportion of vowel to whole-word duration) were measured using Praat, a speech analysis software program. RESULTS: JC-English-speaking children demonstrated developing speech motor control through differences in durational patterns compared with adults, including VOT for voiced plosives. Children's VOT, vowel duration, and whole-word duration were produced similarly across JC and English. The contextual factor %language use was predictive of vowel and whole-word duration in English. CONCLUSIONS: The findings from this study contribute to a foundation of understanding typical bilingual speech characteristics and motor development as well as schema in JC-English speakers. In particular, minimal acoustic duration differences were observed across the post-Creole continuum, a feature that may be attributed to the JC-English bilingual environment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21760469.

Linguistically Informed Acoustic and Perceptual Analysis of Bilingual Children's Speech Productions: An Exploratory Study in the Jamaican Context.

PURPOSE: The aim of this study was to characterize speech acoustics in bilingual preschoolers who speak Jamaican Creole (JC) and English. We compared a standard approach with a culturally responsive approach for characterizing speech sound productions. Preschoolers' speech productions were compared to adult models from the same linguistic community as a means for providing confirmatory evidence of typical speech patterns specific to JC-English speakers. METHOD: Two protocols were applied to the data collected using the Diagnostic Evaluation of Articulation and Phonology (DEAP) Articulation subtest: (a) the standardized DEAP protocol and (b) a culturally and linguistically adapted protocol reflective of the Jamaican post-Creole (English to Creole) continuum. The protocols were used to analyze responses from JC-English-speaking preschoolers (n = 119) and adults (n = 15). Responses were analyzed using acoustic (voice onset time, whole-word duration, and vowel duration) and perceptual (percentage of consonant correct-revised and response frequencies) measures. RESULTS: The culturally responsive protocol captured variation in the frequency and acoustic differences produced in the post-Creole continuum, with higher amounts of "other" responses compared to "standard" target responses for both children and adults. Adults' whole-word durations were shorter and showed more consistent prevoicing during initial plosives compared to the children. CONCLUSIONS: Applying culturally responsive methods, including knowledge of the variation produced in the post-Creole continuum and with adult models from the same linguistic community, improved the ecological validity of speech characterizations for JC-English preschoolers. Acoustic properties of speech should be investigated further as a means of describing bilingual development and distinguishing between difference and disorder. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20249382.

Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial.

BACKGROUND: Research has underscored the need to develop socioculturally tailored interventions to improve adherence behaviors in minority patients with hypertension (HTN) and type 2 diabetes (T2D). Novel mobile health (mHealth) approaches are potential methods for delivering tailored interventions to minority patients with increased cardiovascular risk. OBJECTIVE: This study aims to develop and evaluate the acceptability and preliminary efficacy of a tailored mHealth adherence intervention versus attention control (AC) on medication adherence, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemoglobin A1c (HbA1c) at 3 months in 42 Black patients with uncontrolled HTN and/or T2D who were initially nonadherent to their medications. METHODS: This was a two-phase pilot study consisting of a formative phase and a clinical efficacy phase. The formative phase consisted of qualitative interviews with 10 members of the target patient population (7/10, 70% female; mean age 65.8 years, SD 5.6) to tailor the intervention based on the Information-Motivation-Behavioral skills model of adherence. The clinical efficacy phase consisted of a 3-month pilot randomized controlled trial to evaluate the tailored mHealth intervention versus an AC. The tablet-delivered intervention included a tailoring survey, an individualized adherence profile, and a personalized list of interactive adherence-promoting modules, whereas AC included the tailoring survey and health education videos delivered on the tablet. Acceptability was assessed through semistructured exit interviews. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale, whereas blood pressure and HbA1c were assessed using automated devices. RESULTS: In phase 1, thematic analysis of the semistructured interviews revealed the following 5 major barriers to adherence: disruptions in daily routine, forgetfulness, concerns about adverse effects, preference for natural remedies, and burdens of medication taking. Patients recommended the inclusion of modules that address improving patient-provider communication, peer vignettes, and stress reduction strategies to facilitate adherence. A total of 42 Black patients (23/42, 55% male; mean age 57.6 years, SD 11.1) participated in the clinical efficacy pilot trial. At 3 months, both groups showed significant improvements in adherence (mean 1.35, SD 1.60; P<.001) and SBP (-4.76 mm Hg; P=.04) with no between-group differences (P=.50 and P=.10). The decreases in DBP and HbA1c over time were nonsignificant (-1.97 mm Hg; P=.20; and -0.2%; P=.45, respectively). Patients reported high acceptability of the intervention for improving their adherence. CONCLUSIONS: This pilot study demonstrated preliminary evidence on the acceptability of a tailored mHealth adherence intervention among a sample of Black patients with uncontrolled HTN and T2D who were initially nonadherent to their medications. Future research should explore whether repeated opportunities to use the mHealth intervention would result in improvements in behavioral and clinical outcomes over time. Modifications to the intervention as a result of the pilot study should guide future efforts. TRIAL REGISTRATION: ClinicalTrials.gov NCT01643473; http://clinicaltrials.gov/ct2/show/ NCT01643473.

Current Methods of Evaluating the Language Abilities of Multilingual Preschoolers: A Scoping Review Using the International Classification of Functioning, Disability and Health-Children and Youth Version.

Purpose The purpose of this scoping review was to identify current measures used to evaluate the language abilities of multilingual preschoolers within the framework of the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY; World Health Organization, 2007 ). Method This review adhered to established models for conducting a comprehensive, iterative scoping review outlined by Arksey and O'Malley (2005) and Levac, Colquhoun, and O'Brien (2010) and included the following phases: (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results. The ICF-CY was used to frame the identified measures ( World Health Organization, 2007 ). Results Three hundred twenty-five peer-reviewed publications were identified and included in this review. The majority of publications used measures that evaluated the activity component of multilingual preschoolers' language (70%), with few evaluating participation (9%). Most identified measures (73%) assessed children's semantic language skills. We also observed that 88% of studies explicitly measured children's language input to interpret assessment results. Conclusions A variety of measures are currently used that address the activity component of the ICF-CY with a particular emphasis on semantics. There is, however, a dearth of measures examining language abilities for participation. The authors strongly recommend an increased focus on the development, use, and evaluation of measures that explicitly assess multilingual preschoolers' language participation, particularly in school-based settings. Supplemental Material https://doi.org/10.23641/asha.8637206.

Youth Risk Behavior Surveillance - United States, 2017.

PROBLEM: Health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults in the United States. In addition, significant health disparities exist among demographic subgroups of youth defined by sex, race/ethnicity, and grade in school and between sexual minority and nonsexual minority youth. Population-based data on the most important health-related behaviors at the national, state, and local levels can be used to help monitor the effectiveness of public health interventions designed to protect and promote the health of youth at the national, state, and local levels. REPORTING PERIOD COVERED: September 2016-December 2017. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of other health-related behaviors, obesity, and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. Starting with the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts were added to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their questionnaires. This report summarizes results from the 2017 national YRBS for 121 health-related behaviors and for obesity, overweight, and asthma by demographic subgroups defined by sex, race/ethnicity, and grade in school and by sexual minority status; updates the numbers of sexual minority students nationwide; and describes overall trends in health-related behaviors during 1991-2017. This reports also summarizes results from 39 state and 21 large urban school district surveys with weighted data for the 2017 YRBSS cycle by sex and sexual minority status (where available). RESULTS: Results from the 2017 national YRBS indicated that many high school students are engaged in health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 39.2% of high school students nationwide (among the 62.8% who drove a car or other vehicle during the 30 days before the survey) had texted or e-mailed while driving, 29.8% reported current alcohol use, and 19.8% reported current marijuana use. In addition, 14.0% of students had taken prescription pain medicine without a doctor's prescription or differently than how a doctor told them to use it one or more times during their life. During the 12 months before the survey, 19.0% had been bullied on school property and 7.4% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 39.5% of students had ever had sexual intercourse and 9.7% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 53.8% reported that either they or their partner had used a condom during their last sexual intercourse. Results from the 2017 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. Nationwide, 8.8% of high school students had smoked cigarettes and 13.2% had used an electronic vapor product on at least 1 day during the 30 days before the survey. Forty-three percent played video or computer games or used a computer for 3 or more hours per day on an average school day for something that was not school work and 15.4% had not been physically active for a total of at least 60 minutes on at least 1 day during the 7 days before the survey. Further, 14.8% had obesity and 15.6% were overweight. The prevalence of most health-related behaviors varies by sex, race/ethnicity, and, particularly, sexual identity and sex of sexual contacts. Specifically, the prevalence of many health-risk behaviors is significantly higher among sexual minority students compared with nonsexual minority students. Nonetheless, analysis of long-term temporal trends indicates that the overall prevalence of most health-risk behaviors has moved in the desired direction. INTERPRETATION: Most high school students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that some subgroups of students defined by sex, race/ethnicity, grade in school, and especially sexual minority status have a higher prevalence of many health-risk behaviors that might place them at risk for unnecessary or premature mortality, morbidity, and social problems (e.g., academic failure, poverty, and crime). PUBLIC HEALTH ACTION: YRBSS data are used widely to compare the prevalence of health-related behaviors among subpopulations of students; assess trends in health-related behaviors over time; monitor progress toward achieving 21 national health objectives; provide comparable state and large urban school district data; and take public health actions to decrease health-risk behaviors and improve health outcomes among youth. Using this and other reports based on scientifically sound data is important for raising awareness about the prevalence of health-related behaviors among students in grades 9-12, especially sexual minority students, among decision makers, the public, and a wide variety of agencies and organizations that work with youth. These agencies and organizations, including schools and youth-friendly health care providers, can help facilitate access to critically important education, health care, and high-impact, evidence-based interventions.