Parental Academic Socialization and Youth Adjustments: A Comparison of Korean Youth in South Korea, China, and the United States.

Although parental academic socialization may be a product of culture, ethnic/racial minority status may play a significant role, above and beyond the impact of culture, in shaping parental academic socialization and its implications for youth adjustments. This study examined Korean youth living in South Korea (N = 524, Mage = 14.98, SD = 1.45, 50.1% female), China (N = 267, Mage = 15.24, SD = 1.66, 58.9% female), and the U.S. (N = 408, Mage = 14.76, SD = 1.91, 47.3% female) who share the same heritage culture but have different social positions (majority or minority). Korean youth as an ethnic/racial minority in the U.S. or China reported higher parental academic socialization than those in South Korea, supporting a significant role of social positions in how parents practice academic socialization. This study also found that the distinct practices of academic socialization function differently in youth adjustment. Parental commitment to education, parental involvement, and autonomy support were positively associated with youth's school engagement, but achievement-oriented psychological control was associated with more depressive symptoms and antisocial behaviors. These associations did not differ across the three samples. Some nuanced differences also emerged. Parental commitment to education was associated with higher grades in Korean Chinese (but not Korean American) youth, and achievement-oriented psychological control was associated with lower school engagement among Korean Chinese (but not South Korean) youth and higher grades among South Korean (but not Korean American) youth. These findings highlight the role of academic socialization as an adaptive strategy for ethnic/racial minorities to succeed in host societies and the generally universal role of parental academic socialization in youth adjustments.

Correlates of Stigma Toward Mental Health Service Use Among Filipino Americans and Korean Americans.

Asian Americans are less likely than Whites to seek mental care and when they do, there is a substantial delay in help-seeking. Stigma associated with mental health service use is one of the major barriers to help-seeking among Asian Americans. However, few studies have examined multi-layered contextual predictors of stigma to examine joint as well as unique contributions of each predictor. Using a cross-sectional study of 376 Filipino and 412 Korean American parents from the Midwestern U.S., we investigated how individual, familial, ethnic cultural, and macro level factors were associated with stigma among immigrant parents. The findings from hierarchical regressions suggest that familial and ethnic cultural factors are prominent predictors of stigma among Korean Americans, whereas macro level factors are particularly pertinent to Filipino Americans. This study highlights the significance of subgroup specific interventions to be effective in addressing unmet mental care needs in distinct subgroups of Asian Americans.

Explaining the Asian American Youth Paradox: Universal Factors versus Asian American Family Process Among Filipino and Korean American Youth.

This study used longitudinal survey data of Filipino American and Korean American youth to examine ways in which universal factors (e.g., peer antisocial behaviors and parent-child conflict) and Asian American (AA) family process variables (e.g., gendered norms) independently and collectively predict grade point average (GPA), externalizing, and internalizing problems. We aimed to explain the "Asian American youth paradox" in which low externalizing problems and high GPA coexist with high internalizing problems. We found that universal factors were extensively predictive of youth problems and remained robust when AA family process was accounted for. AA family process also independently explained youth development and, in part, the AA youth paradox. For example, gendered norms increased mental distress. Academic controls did the opposite of what it is intended, that is, had a negative impact on GPA as well as other developmental domains. Family obligation, assessed by family-centered activities and helping out, was beneficial to both externalizing and internalizing youth outcomes. Parental implicit affection, one of the distinct traits of AA parenting, was beneficial, particularly for GPA. This study provided important empirical evidence that can guide cross-cultural parenting and meaningfully inform intervention programs for AA youth.

Este estudio utilizó datos de una encuesta longitudinal de jóvenes filipinoamericanos y coreanoamericanos para analizar las maneras en las que los factores universales (p. ej.:las conductas antisociales entre pares y el conflicto entre padres e hijos) y las variables de los procesos familiares asiáticoamericanos (p. ej.: las normas de género) predicen independientemente y colectivamente el promedio de calificaciones y los problemas interiorizados y exteriorizados. Nos propusimos explicar la "paradoja de los jóvenes asiáticoamericanos" en la cual un bajo grado de problemas exteriorizados y un alto promedio de calificaciones coexisten con un alto grado de problemas interiorizados. Descubrimos que los factores universales fueron en gran parte predictivos de los problemas de los jóvenes y se mantuvieron firmes cuando se tuvo en cuenta el proceso familiar asiáticoamericano. El proceso familiar asiáticoamericano también explicó independientemente el desarrollo de los jóvenes y, en parte, la paradoja de los jóvenes asiáticoamericanos. Por ejemplo, las normas de género aumentaron el distrés mental. Los controles académicos hicieron lo opuesto a lo deseado, por ejemplo, tuvieron un efecto negativo en el promedio de calificaciones así como en otras áreas del desarrollo. La obligación familiar, evaluada por actividades centradas en la familia y por la colaboración, fue beneficiosa tanto para los resultados exteriorizados como interiorizados de los jóvenes. El afecto implícito de los padres, uno de los rasgos distintivos de la crianza de los asiáticoamericanos, fue beneficioso, particularmente para el promedio de calificaciones. Este estudio ofreció importante conocimiento empírico que puede guiar la crianza intercultural y respaldar de manera significativa programas de intervención para jóvenes asiáticoamericanos.

Extent and Impact of Opioid Prescribing for Acute Occupational Low Back Pain in the Emergency Department.

BACKGROUND: Initial management of acute occupational low back pain (AOLBP) commonly occurs in the emergency department (ED), where opioid prescribing can vary from the clinical guidelines that recommend limited use. OBJECTIVE: The objective of this study was to explore how opioids are prescribed in the ED and the impact on work disability and other outcomes in AOLBP. METHODS: A retrospective cohort study was conducted. All acute compensable lost-time LBP cases seen initially in the ED with a date of injury from January 1, 2009 to December 31, 2011 were identified within a nationally representative Workers' Compensation dataset. Multivariate models estimated the effect of early opioids (received within 2 days of ED visit) on disability duration, long-term opioid use, total medical costs, and subsequent surgeries. RESULTS: Of the cohort (N = 2887), 12% received early opioids; controlling for severity, this was significantly associated with long-term opioid use (adjusted risk ratio = 1.29; 95% confidence interval 1.05-1.58) and increased total medical costs for those in the highest opioid dosage quartile, but not associated with disability duration or subsequent low back surgery. CONCLUSIONS: Early opioid prescribing in the ED for uncomplicated AOLBP increased long-term opioid use and medical costs, and should be discouraged, as opioid use for low back pain has been associated with a variety of adverse outcomes. However, ED providers may be becoming more compliant with current LBP treatment guidelines.

The importance, measurement and practical implications of worker's expectations for return to work.

PURPOSE: Workers' own expectations for return to work consistently predict work status. To advance the understanding of the relationship between RTW expectations and outcomes, we reviewed existing measures to determine those which we felt were the most likely to capture the construct. METHOD: A comprehensive search of the work-disability rehabilitation literature was undertaken. The review of the measures was conducted in three steps: first, a review of terminology; second, an examination of whether a time reference was included; third, an evaluation of ease of comprehension, and applicability across contexts. RESULTS: A total of 42 different measures were identified. One of the most striking findings was the inconsistency in terminology. Measures were also limited by not including a time reference. Problems were also identified with regards to ease of understanding, utility of response options, and applicability in a wide variety of research and applied settings. CONCLUSIONS: Most previously used measures contain elements that potentially limit utility. However, it would seem that further development can overcome these, resulting in a tool that provides risk prediction information, and an opportunity to start a conversation to help identify problems that might negatively impact a worker's movement through the RTW process and the outcomes achieved. Implications for Rehabilitation Return to work is an integral part of workplace injury management. The capture of RTW expectations affords a way to identify the potential for less than optimal RTW processes and outcomes. A mismatch between an injured worker's expectations and what other stakeholders might expect suggests that efforts could be made to determine what is causing the injured worker's concerns. Once underling issues are identified, work can be put into resolving these so that the worker's return to the workplace is not impeded.

The cascade of medical services and associated longitudinal costs due to nonadherent magnetic resonance imaging for low back pain.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To compare type, timing, and longitudinal medical costs incurred after adherent versus nonadherent magnetic resonance imaging (MRI) for work-related low back pain. SUMMARY OF BACKGROUND DATA: Guidelines advise against MRI for acute uncomplicated low back pain, but is an option for persistent radicular pain after a trial of conservative care. Yet, MRI has become frequent and often nonadherent. Few studies have documented the nature and impact of medical services (including type and timing) initiated by nonadherent MRI. METHODS: A longitudinal, workers' compensation administrative data source was accessed to select low back pain claims filed between January 1, 2006 and December 31, 2006. Cases were grouped by MRI timing (early, timely, no MRI) and subgrouped by severity ("less severe," "more severe") (final cohort = 3022). Health care utilization for each subgroup was evaluated at 3, 6, 9, and 12 months post-MRI. Multivariate logistic regression models examined risk of receiving subsequent diagnostic studies and/or treatments, adjusting for pain indicators and demographic covariates. RESULTS: The adjusted relative risks for MRI group cases to receive electromyography, nerve conduction testing, advanced imaging, injections, and surgery within 6 months post-MRI risks in the range from 6.5 (95% CI: 2.20-19.09) to 54.9 (95% CI: 22.12-136.21) times the rate for the referent group (no MRI less severe). The timely and early MRI less severe subgroups had similar adjusted relative risks to receive most services. The early MRI more severe subgroup cases had generally higher adjusted relative risks than timely MRI more severe subgroup cases. Medical costs for both early MRI subgroups were highest and increased the most over time. CONCLUSION: The impact of nonadherent MRI includes a wide variety of expensive and potentially unnecessary services, and occurs relatively soon post-MRI. Study results provide evidence to promote provider and patient conversations to help patients choose care that is based on evidence, free from harm, less costly, and truly necessary. LEVEL OF EVIDENCE: N/A.

Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine the effect of early (receipt ≤30 d postonset) magnetic resonance imaging (MRI) on disability and medical cost outcomes in patients with acute, disabling, work-related low back pain (LBP) with and without radiculopathy. SUMMARY OF BACKGROUND DATA: Evidence-based guidelines suggest that, except for "red flags," MRI is indicated to evaluate patients with persistent radicular pain, after 1 month of conservative management, who are candidates for surgery or epidural steroid injections. Prior research has suggested an independent iatrogenic effect of nonindicated early MRI, but it had limited clinical information and/or patient populations. METHODS: A nationally representative sample of workers with acute, disabling, occupational LBP was randomly selected, oversampling those with radiculopathy diagnoses (N = 1000). Clinical information from medical reports was used to exclude cases for which early MRI might have been indicated, or MRI occurred more than 30 days postonset (final cohort = 555). Clinical information was also used to categorize cases into "nonspecific LBP" and "radiculopathy" groups and further divided into "early-MRI" and "no-MRI" subgroups. The Cox proportional hazards model examined the association of early MRI with duration of the first episode of disability. Multivariate linear regression models examined the association with medical costs. All models adjusted for demographic and medical severity measures. RESULTS: In our sample, 37% of the nonspecific LBP and 79.9% of the radiculopathy cases received early MRI. The early-MRI groups had similar outcomes regardless of radiculopathy status: much lower rates of going off disability and, on average, $12,948 to $13,816 higher medical costs than the no-MRI groups. Even in a subgroup with relatively minimal disability impact (≤30 d of total lost time post-MRI), medical costs were, on average, $7643 to $8584 higher in the early-MRI groups. CONCLUSION: Early MRI without indication has a strong iatrogenic effect in acute LBP, regardless of radiculopathy status. Providers and patients should be made aware that when early MRI is not indicated, it provides no benefits, and worse outcomes are likely. LEVEL OF EVIDENCE: 3.