La Linterna: Clinical model for trauma-exposed, migrant children.

OBJECTIVE: Exposure to childhood adversity is increasingly recognized as an important topic in pediatric medicine and a powerful driver of adult disease burden. While significant evidence exists that early intervention is critical for children exposed to adversities, few models have been established for addressing the complex medical, psychological, and social needs of these patients in a holistic manner. METHOD: La Linterna is an interdisciplinary clinical initiative providing trauma-informed primary care, mental health treatment, immigration legal counsel, and comprehensive case management to children (and their families) exposed to adversities throughout the migration process. Started in 2019, the clinic serves immigrant families throughout the city of Los Angeles. Described as the process of implementing an interdisciplinary, trauma-informed practice to meet the medical, mental health, social care needs of this uniquely vulnerable patient population. RESULTS: Strong evidence exists in the medical literature arguing for the implementation of a holistic, trauma-informed model of patient care. We describe "principles" and "lessons learned" during implementation, as well as detail an approach to improving services to immigrant families who have experienced adversities via an interactive, patient-centered process. CONCLUSIONS: Trauma-informed care is critical for meeting the needs of vulnerable children and their families. La Linterna represents an innovative and effective way to enhance care for one of the most vulnerable United States populations, immigrant and refugee families. Implementation of all or some of the program's components is possible throughout the United States and would mark an improvement over current practice. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents.

The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.

International student trauma during COVID-19: Relationships among mental health, visa status, and institutional support.

Objective: This study explored the predictive relationship among international student trauma responses, visa status anxiety, and perceived institutional support. Researchers also sought to understand the relationship between help seeking behaviors and trauma exposure responses. Participants: International students (n = 172) from U.S. colleges and universities enrolled since March 2020. Methods: Data were collected via an electronic survey administered during the fall 2020 academic term. Results: The model was found to be significant, explaining 67% of the variance of student trauma responses. Anxiety surrounding students' ability to stay in the U.S. was found to be the greatest contributor to the model. Additionally, particular clusters of trauma symptomatology were significantly correlated with help seeking from specific individuals within student networks. Finally, students reported moderate levels of mental health help seeking behaviors, with friends and family being the most likely sources sought out for help. Conclusions: Despite focus on students' health and wellness concerns related to the COVID-19 pandemic, visa policy uncertainty was a primary driver of self-reported trauma symptomatology at the onset of the pandemic.

Moving towards multipolarity: shifts in the core-periphery structure of international student mobility and world rankings (2000-2019).

Over the past 20 years, international student mobility has experienced a three-fold increase, as planned and emerging education hubs have attracted increasing numbers of students. The appeal of alternative destinations is strengthened by their cultural, linguistic, and geographic proximity, as well as a growing number of internationally ranked universities. This article quantifies shifts in international student mobility and world university rankings over a consequential 20-year period (1999/2000-2018/2019) at the beginning of the twenty-first century. It examines shifts in the number of county-to-country connections (density), relative country importance in the network (centrality), and network structure (multipolarity). The results indicate the overall network density steadily increased year-to-year, with a three-fold increase in the number of country-to-country connections, as influence was more widely and evenly distributed among a larger number of core countries within the network. As the number of universities in planned and emerging destinations listed in the rankings doubled, the network structure indicated a movement toward multipolarity, where a more diverse set of countries exerted greater relative influence in the overall network. The results suggest that while core-periphery dynamics in international student mobility persist, they also have begun to shift, as a larger and more diverse subset of planned and emerging educational hubs in Asia, South America, Africa, and the Middle East exert increasing influence in the overall network.

Socio-Spatial Segregation of Unhealthy Food Environments across Public Schools in Santiago, Chile.

Santiago, Chile is a very segregated city, with higher childhood obesity rates observed in vulnerable areas. We compared the counts and proximity of unhealthy food outlets (UFOs) around a 400 m buffer of 443 public schools (municipal and subsidized) located in socioeconomically diverse neighborhoods in 14 municipalities of Santiago. This was a cross-sectional study in which the socioeconomic status (SES) of the population living inside the buffer was classified as middle-high, middle, and low. We used the Kruskal-Wallis test for comparisons of density and proximity between type of school, SES, and population density. We used a negative binomial model (unadjusted and adjusted by population density) to determine the expected change in counts of UFOs by SES, which was compared to the reference (middle-high). Low SES neighborhoods had significantly more counts of UFOs, and these were located much closer to schools. Low and middle SES neighborhoods had an 88% and 48% higher relative risk of having UFOs compared to middle-high SES areas; (IRR = 1.88; 95% CI 1.59-2.23) and (IRR = 1.48; 95% CI 1.20-1.82), respectively. A socio-spatial segregation of UFOs associated with childhood obesity across public schools was observed in Santiago.

We Don't Have a Lot of Healthy Options: Food Environment Perceptions of First-Year, Minority College Students Attending a Food Desert Campus.

First-year college students are at particular risk of dietary maladaptation during their transition to adulthood. A college environment that facilitates consistent access to nutritious food is critical to ensuring dietary adequacy among students. The objective of the study was to examine perceptions of the campus food environment and its influence on the eating choices of first-year students attending a minority-serving university located in a food desert. Focus group interviews with twenty-one first-year students were conducted from November 2016 to January 2017. Students participated in 1 of 5 focus groups. Most interviewees identified as being of Hispanic/Latino or Asian/Pacific Islander origin. A grounded theory approach was applied for inductive identification of relevant concepts and deductive interpretation of patterns and relationships among themes. Themes related to the perceived food environment included adequacy (i.e., variety and quality), acceptability (i.e., familiarity and preferences), affordability, and accessibility (i.e., convenience and accommodation). Subjective norms and processes of decisional balance and agency were themes characterizing interpersonal and personal factors affecting students' eating choices. The perceived environment appeared to closely interact with subjective norms to inform internal processes of decision-making and agency around the eating choices of first-year students attending a minority-serving university campus located in a food desert.

Glucoregulatory and Cardiometabolic Profiles of Almond vs. Cracker Snacking for 8 Weeks in Young Adults: A Randomized Controlled Trial.

The transition to nutritional independence makes new college students vulnerable to alterations in eating patterns, which can increase the risk of cardiometabolic disorders. The aim of the study was to examine the potential benefits of almond vs. cracker snacking in improving glucoregulatory and cardiometabolic profiles in new college students. A randomized controlled, parallel-arm, 8-week intervention of 73 college students (BMI: 18⁻41 kg/m²) with no cardiometabolic disorders was conducted. Participants were randomized into either an almond snack group (56.7 g/day; 364 kcal; n = 38) or Graham cracker control group (77.5 g/day; 338 kcal/d; n = 35). Chronic, static changes were assessed from fasting serum/plasma samples at baseline, and after 4 and 8 weeks. Acute, dynamic effects were assessed during a 2-h oral glucose tolerance test (OGTT) at 8 weeks. Almond snacking resulted in a smaller decline in HDL cholesterol over 8 weeks (13.5% vs. 24.5%, p < 0.05), 13% lower 2-h glucose area under the curve (AUC), 34% lower insulin resistance index (IRI) and 82% higher Matsuda index (p < 0.05) during the OGTT, despite similar body mass gains over 8 weeks compared with the cracker group. In general, both almond and cracker snacking reduced fasting glucose, and LDL cholesterol. CONCLUSIONS: Incorporating a morning snack in the dietary regimen of predominantly breakfast-skipping, first-year college students had some beneficial effects on glucoregulatory and cardiometabolic health. Almond consumption has the potential to benefit postprandial glucoregulation in this cohort. These responses may be influenced by cardiometabolic risk factor status.

A trauma-informed approach supports health and development in children and youth with spina bifida.

Children with developmental disabilities may be at greater risk for experiencing maltreatment and traumatic events, threats to their physical and psychological safety and well-being. Young children and youth with spina bifida benefit from being considered in light of this risk, and may be especially vulnerable given the complexity of their neurodevelopmental condition. A trauma-informed approach brings together evidence from the neurosciences, epidemiology and psychology to promote improved developmental, behavioral, physical and mental health status. Incorporating a trauma-informed approach strengthens a longitudinal, interdisciplinary and developmentally-oriented care model for children and youth with spina bifida. A case example further illustrates how using a trauma-informed approach and evidence-based interventions can foster the development and well-being of youth with spina bifida who have been impacted by a traumatic event.

Longitudinal trajectory of vitamin D status from birth to early childhood in the development of food sensitization.

BACKGROUND: Increasing evidence supports the immunomodulatory effect of vitamin D on allergic diseases. The combined role of prenatal and postnatal vitamin D status in the development of food sensitization (FS) and food allergy remains understudied. METHODS: Plasma 25-hydroxyvitamin D (25(OH)D) levels of 460 children in the Boston Birth Cohort (BBC) were measured at birth and early childhood, and the subjects were genotyped for rs2243250 (C-590T) in the IL4 gene. We defined FS as specific IgE levels of ≥0.35 kUA/l to any of eight common food allergens; we defined persistently low vitamin D status as cord blood 25(OH)D <11 ng/ml and postnatal 25(OH)D <30 ng/ml. RESULTS: We observed a moderate correlation between cord blood 25(OH)D at birth and venous blood 25(OH)D measured at 2-3 y (r = 0.63), but a weak correlation at <1 y (r = 0.28). There was no association between low vitamin D status and FS at any single time point alone. However, in combination, persistence of low vitamin D status at birth and in early childhood increased the risk of FS (odds ratio (OR) = 2.03, 95% confidence interval (CI): 1.02-4.04), particularly among children carrying the C allele of rs2243250 (OR = 3.23, 95% CI: 1.37-7.60). CONCLUSION: Prenatal and early postnatal vitamin D levels, along with individual genetic susceptibility, should be considered in assessing the role of vitamin D in the development of FS and food allergy.

Development of educational materials to improve rates of early eye care for Hispanic children.

The purpose of this study was to develop targeted materials to encourage Hispanic parents to seek eye care for their children. Hispanic children present with high rates of eye problems such as astigmatism, strabismus, and amblyopia. Related vision impairment can be prevented with timely detection and treatment. After failing a vision screening, a child must obtain professional eye care to take care of the suspected problem. We involved Hispanic community members and health care experts in Alabama to develop educational materials to encourage Hispanic parents to seek eye care for their children. There were six stages in the development of the educational materials: (a) focus groups with Hispanic parents, (b) development of preliminary materials (c) panel with Hispanic health experts (d) panel with members of the target population (e) final production of materials (f) pilot testing of materials. The parents and health experts suggested the information should be provided in the form of radio announcements, brochures, and newspaper advertisements. They also noted the content should stress the importance of seeking vision care for children even when there were no visible problems. Materials developed through this project included messages designed to overcome specific barriers identified by Hispanic parents and to educate them on the importance of comprehensive eye care for all children, regardless of the presence of visible symptoms.

Religion, relationships and reproduction: correlates of desire for a child among mothers living with HIV.

Despite challenges facing HIV-positive women in the U.S., some maintain strong desires and intentions for motherhood. We explore correlates of desire for another child-particularly current parenting experiences (number of children, parenting efficacy, parenting satisfaction, parenting practices, parental distress, and child-related quality of life), age, spirituality/religiosity, stress, coping, hopelessness, partner's desire for a child, social support, and stigma-among a sample of HIV-positive mothers (n = 96) in Alabama. Partner's desire for a child, participation in private religious practices, avoidant coping, and parity were significantly associated with desire for a child in multivariate models. Such findings indicate a need for reproductive counseling and education that is sensitive to the role of religious norms and values in fertility decision-making and suggest opportunities for partnership with faith-based organizations. Further studies examining the impact of relationship dynamics on childbearing desires among U.S. women living with HIV/AIDS are also needed.

Using downloadable songs from Apple iTunes as a novel incentive for college students participating in a Web-based follow-up survey.

PURPOSE: Compare the impact of offering two versus four downloadable songs on response rates to a Web-based survey. DESIGN: One month after participation in a sexual health workshop, students (N  =  138) were invited by e-mail to complete a Web-based posttest. The initial incentive of two downloadable songs was increased to four songs midway through data collection. SETTING: University of Alabama at Birmingham. SUBJECTS: Undergraduate participants in a peer education workshop. MEASURES: Response rates were monitored to assess the impact of varying incentive levels on study attrition. ANALYSIS: Frequencies and Pearson's χ(2) statistics were used to compare response rates between individuals offered two songs and individuals offered four. Response rates were also examined to assess the impact of doubling the incentive among individuals who were nonrespondents when offered only two songs. RESULTS: Of respondents offered two songs (n  =  61), 18% completed the survey. When the incentive was increased to four songs, 26% of those who had not responded to the invitation for two songs (n  =  50) completed the survey. Of respondents only offered four songs (n  =  77), 57% completed the survey. CONCLUSION: Increasing incentives from two to four songs significantly improved response rates (p < .001). Determining an acceptable level of incentives for Web-based research has the potential to impact high attrition rates. Downloadable songs could become a mainstream incentive in Web-based research with young adults.

Microfinance against malaria: impact of Freedom from Hunger's malaria education when delivered by rural banks in Ghana.

A community randomized pre-test/post-test design was used to compare the knowledge and behaviors of microfinance clients receiving malaria education (n=213) to those receiving diarrhea education (n=223) and to non-client controls (n=268). Comparisons assessed differences at follow-up as well as within-group changes over time. At follow-up, malaria clients had significantly better malaria knowledge than comparison groups: 48.4% of malaria clients were able to identify groups most vulnerable to malaria compared with 39.2% of diarrhea clients (P=0.044) and 37.7% of non-clients (P=0.024). Malaria clients were more likely than diarrhea clients (P=0.024) (P<0.001) and non-clients (P=0.028) (P=0.004) to report that insecticide-treated nets (ITNs) provide the best protection against malaria, and to agree that pregnant women should use ITNs, respectively. Between baseline and follow-up, malaria clients were most likely to: improve in knowledge of malaria complications during pregnancy; to own at least one bed net; and to report at least one child or woman of reproductive age sleeping under a bed net. Malaria clients also experienced the greatest increases in ITN ownership/use (9% vs. 2.9% and 6.7% among diarrhea clients and non-clients). Results indicate that, although significant barriers to malaria control remain, a malaria education program provided by microfinance institutions can effectively contribute to community and national malaria initiatives.

Attitudes and sociocultural factors influencing vaginal douching behavior among English-speaking Latinas.

OBJECTIVES: To describe the practice/correlates of douching among a national sample of English-speaking Latinas. METHODS: Three hundred twenty-five (325) computer-assisted telephone interviews were completed. Analyses compare ever douchers to never douchers and identify correlates of douching. RESULTS: Of respondents, 50% had ever douched; 15% douched at least monthly. Douching practices among respondents were similar to those of other groups. Age at sexual debut was the strongest correlate of ever douching. Regular douching significantly increased as the perceived benefits of douching and the number of sources recommending douching increased. CONCLUSIONS: Interventions to prevent douching and to support cessation should be tailored to characteristics and perceptions of Latinas. Targeting secondary audiences may prove valuable.

Classroom approach for managing dietary restraint, negative eating styles, and body image concerns among college women.

OBJECTIVE: In this exploratory study, the authors evaluated the impact of an elective college course on dieting levels, eating styles, and body image among college women. PARTICIPANTS: Participants were a convenience sample of 29 self-selected female students at a western university who were mostly white, normal-weight seniors with significant dieting experience. METHODS: The authors used valid and reliable instruments to collect data both before and after testing. An instructor conducted the program in an undergraduate course that met twice weekly for 15 weeks. Theory-based lessons focused on resisting media pressure, modifying dietary restraint, eating in response to hunger (intrinsic eating), and achieving healthy body image. Dependent variables included intrinsic eating, dieting involvement, emotional eating, body image, and self-esteem. RESULTS: A comparison of pretest and posttest scores identified significant improvements for most measures. CONCLUSIONS: A theory-driven elective course implemented within a college setting may improve women's eating styles and body image.

Teens in trouble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia.

OBJECTIVE: To describe the prevalence of cigarette smoking and to identify risky behaviors associated with smoking among adolescents attending high schools in a district of La Paz, Bolivia. METHODS: The Youth Risk Behavior Survey was administered to a sample of 394 males and 182 females, from 13-18 years of age, at six, randomly-selected schools in District II of La Paz. Frequencies, chi-square tests, and logistic regression were employed to identify factors associated with cigarette use during the 30 days prior to the survey. RESULTS: Approximately 40% of the sample (39.4% of males and 33.7% of females) had smoked cigarettes in the 30 days prior to interview. For both males and females, consumption of alcohol was the single greatest risk factor associated with cigarette use. The males and females who reported consuming at least one alcoholic beverage on three or more occasions in the previous 30 days were 22.3 and 58.5 times (95% CIs: 6.7, 74.1 and 6.8, 502.6, respectively) more likely to smoke tobacco than those who reported no alcohol consumption. Additional risk factors included having participated in a physical fight, having carried a weapon, having had sexual intercourse, and having used illicit drugs during the previous 30 days. CONCLUSIONS: Because teenagers who smoke are also likely to engage in a variety of other risky behaviors, parents, school administrators, and health educators may wish to use smoking to identify at-risk individuals. Among Bolivian teenagers, interventions should focus on preventing cigarette use and associated risk behaviors.

Teens in trouble: cigarette use and risky behaviors among private, high school students in La Paz, Bolivia

OBJECTIVE: To describe the prevalence of cigarette smoking and to identify risky behaviors associated with smoking among adolescents attending high schools in a district of La Paz, Bolivia. METHODS: The Youth Risk Behavior Survey was administered to a sample of 394 males and 182 females, from 13-18 years of age, at six, randomly-selected schools in District II of La Paz. Frequencies, chi-square tests, and logistic regression were employed to identify factors associated with cigarette use during the 30 days prior to the survey. RESULTS: Approximately 40 percent of the sample (39.4 percent of males and 33.7 percent of females) had smoked cigarettes in the 30 days prior to interview. For both males and females, consumption of alcohol was the single greatest risk factor associated with cigarette use. The males and females who reported consuming at least one alcoholic beverage on three or more occasions in the previous 30 days were 22.3 and 58.5 times (95 percent CIs: 6.7, 74.1 and 6.8, 502.6, respectively) more likely to smoke tobacco than those who reported no alcohol consumption. Additional risk factors included having participated in a physical fight, having carried a weapon, having had sexual intercourse, and having used illicit drugs during the previous 30 days. CONCLUSIONS: Because teenagers who smoke are also likely to engage in a variety of other risky behaviors, parents, school administrators, and health educators may wish to use smoking to identify at-risk individuals. Among Bolivian teenagers, interventions should focus on preventing cigarette use and associated risk behaviors.

OBJETIVO: Describir la prevalencia del consumo de cigarrillos e identificar las conductas de riesgo asociadas con el hábito de fumar en adolescentes de enseñanza media superior de un distrito de La Paz, Bolivia. MÉTODOS: Se aplicó la Encuesta sobre Conductas de Riesgo en los Jóvenes a una muestra de 394 varones y 182 mujeres de 13-18 años de edad de seis escuelas del Distrito II de La Paz seleccionadas al azar. Se identificaron los factores asociados con el consumo de cigarrillos durante los 30 días previos a la encuesta, mediante el análisis de frecuencias, la prueba de la ji al cuadrado y la regresión logística. RESULTADOS: Aproximadamente 40 por ciento de la muestra (39,4 por ciento de los varones y 33,7 por ciento de las mujeres) había fumado cigarrillos en los 30 días previos a la encuesta. Tanto para ellos como para ellas, el consumo de alcohol fue el mayor factor de riesgo asociado con el consumo de cigarrillos. Los varones y las mujeres que informaron haber consumido al menos una bebida alcohólica en tres ocasiones o más durante los 30 días previos presentaron 22,3 y 58,5 veces (IC95 por ciento: 6,7 a 74,1 y 6,8 a 502,6, respectivamente) mayor probabilidad de fumar que los que informaron no haber consumido alcohol. Otros factores de riesgo adicionales fueron haber participado en una pelea física, haber portado un arma, haber tenido relaciones sexuales y haber tomado alguna droga ilícita durante los 30 días anteriores. CONCLUSIONES: Debido a que los adolescentes que fuman tienden también a incurrir en otras conductas de riesgo, los padres, los responsables escolares y los educadores sanitarios podrían utilizar el hábito de fumar para identificar a los adolescentes en riesgo. Las intervenciones dirigidas a adolescentes bolivianos deben enfocarse en la prevención del consumo de cigarrillos y de las conductas de riesgo asociadas.

Youth at risk: identifying correlates of violence in Bolivia.

BACKGROUND: Although violence is one of the leading causes of mortality worldwide, in Latin America the prevalence of violence and factors associated with violent behavior among youth are largely unknown. OBJECTIVE: We describe the prevalence of carrying a weapon among Bolivian adolescent males and identify risk factors associated with weapon carrying. METHODS: The Youth Risk Behavior Survey was administered to a sample of teenagers 13-18 years of age (394 males and 182 females) from randomly selected schools in La Paz, Bolivia. The study is limited to males because of the small sample size for females. Frequencies and chi-square tests were calculated and logistic regression was used to identify factors associated with carrying a weapon in the past 30 days. RESULTS: Among the sample population, one-quarter of adolescent boys reported carrying a weapon in the previous 30 days. Ever having used cigarettes was the risk factor most strongly associated with weapon carrying. Additional risk factors included having participated in a physical fight, having used cocaine, and sniffing glue or other inhalants. CONCLUSION: Our results showed a link between weapon carrying and other risk behaviors, including smoking, drug use and fighting. Understanding the factors associated with carrying weapons among youth is an essential step in determining which risk behaviors should be included in comprehensive programs focused on youth violence prevention.

Who sleeps under bednets in Ghana? A doer/non-doer analysis of malaria prevention behaviours.

BACKGROUND: Malaria prevention programmes should be based in part on knowledge of why some individuals use bednets while others do not. This paper identifies factors and characteristics of women that affect bednet use among their children less than five years of age in Ghana. METHODS: Data come from the baseline component of an evaluation of Freedom from Hunger's malaria curriculum. A quasi-experimental design was used to select clients (n = 516) of Credit with Education (an integrated package of microfinance and health education) and non-clients (n = 535). Chi-squares, Fisher's Exact tests and logistic regression were used to compare the characteristics of mothers whose children use bednets (doers) with those whose children do not (non-doers) and to identify factors associated with bednet use among children less than five years of age. RESULTS: The following factors were most closely associated with bednet use: region of residence; greater food security; and caregivers' beliefs about symptoms, causation and groups most vulnerable to malaria. Most respondents knew mosquitoes caused malaria; however, 20.6% of doers and 12.3% of non-doers (p = .0228) thought overworking oneself caused malaria. Ninety percent of doers and 77.0% of non-doers felt that sleeping under a net was protective against malaria (p = .0040). In addition, 16.5% of doers and 7.5% of non-doers (p = .0025) identified adult males as most vulnerable to malaria. CONCLUSION: Greater knowledge about malaria does not always translate into improved bednet use. Though culturally-based ideas about malaria may vary between communities, integrating them into traditional health education messages may enhance the effectiveness of public health efforts.

Public health perspectives on the family: an ecological approach to promoting health in the family and community.

The family, as a setting of practice, is increasingly recognized as critical to health promotion. A better understanding of the nature and process through which families take an active part in their own health can serve as the basis for designing and linking health interventions with public health programs. The integrating function of the family, viewed through an ecological context, makes it an effective entry point and central focus in health promotion.