Challenges and Successes in Health Communication Messaging With Asian Americans.

Asians are the fastest growing racial and ethnic group in the United States, and in Michigan, Asians represent 3.4% of the state's population. Asians have long been aggregated as a homogeneous group and stereotyped as a "model minority." Asians, however, are very diverse, and each subgroup has different values, histories, beliefs, and dialects. The diversity among populations and variations in chronic disease risks demonstrate the importance of disaggregating Asian American ethnicities with respect to health promotion, which must be culturally and linguistically tailored to make the biggest impact. This article describes our challenges and successes in health communication messaging with Asian Americans during the 4 years of our Racial and Ethnic Approaches to Community Health (REACH) Cooperative Agreement.

Assessing and improving students' collaborative skills using a mental health simulation: A pilot study.

People with severe mental illnesses have complex needs that require coordinated care. However, students in different health professions are usually educated in silos without an emphasis on collaborative skills. Students would benefit from exposure to other disciplines that would increase appreciation of collaboration. This pilot study sought to understand how a mental health simulation (SIM) would influence a student's perception of collaboration. The mental health SIM involved nursing, social work, occupational therapy and public health students who worked with standardized patients. Students were given the Interprofessional Socialization and Valuing Scale-21 (ISVS-21) that measures attitudes, values, and feelings about interprofessional collaboration. A baseline of 113 students in the four health professions were administered the pretest and a subset of nine who participated in the SIM completed the posttest. This study suggests that SIM may be a promising way of improving attitudes toward collaborative care, though it is important for the SIM to reflect real life treatment conditions.

Research on discrimination and health: an exploratory study of unresolved conceptual and measurement issues.

OBJECTIVES: Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination. METHODS: We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods. RESULTS: More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts. CONCLUSIONS: Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.

Perceived discrimination and psychological well-being in the U.S.A. and South Africa.

OBJECTIVE: To explore levels of perceived racial and non-racial discrimination and their associations with self-esteem and mastery in the U.S.A. and South Africa. DESIGN: We used ordinary least square regressions to test the cross-sectional associations between discrimination and psychological resources using two national probability samples of adults: the National Survey of American Life and the South African Stress and Health Study. RESULTS: Levels of perceived racial discrimination were higher in the U.S.A. than in South Africa. In the U.S.A., both African-Americans and Caribbean blacks have comparable or higher levels of self-esteem and mastery than whites. In contrast, South African whites have higher levels of both self-esteem and mastery than Africans, Coloureds, and Indians. Perceived discrimination, especially chronic everyday discrimination, is inversely related to self-esteem and mastery in both societies. In South Africa, stress and socioeconomic status (SES) but not discrimination are important determinants of racial differences in self-esteem and mastery. CONCLUSIONS: In two racialized societies, perceived discrimination acts independent of demographic factors, general stressors, social desirability bias, racial identity, and SES, to negatively affect the psychological resources of self-esteem and mastery.

The City Doesn't Sleep: Community Perceptions of Sleep Deficits and Disparities.

While sleep research has focused primarily on aspects of the immediate physical environment and behavioral factors, a growing body of evidence suggests that broader social determinants may play an important role in sleep insufficiency. Yet public health education efforts for sleep largely address "sleep hygiene", with an emphasis on information for getting a good night's rest. The Flint Sleep Project employed community-based-participatory research methods to try to understand more about the sleep experiences of residents of an urban community reporting sleep insufficiency. The academic and community partner developed recruitment materials with community residents. The focus group protocol also utilized community input. Seven focus groups, with a total of 70 participants, were conducted. When asked about their view of causes for poor sleep, participants identified a range of stressors reflective of social determinants. Economic, safety, and future insecurity were the dominant themes emerging across all seven discussions. Participants also expressed feeling a lack of control over important aspects of their lives. Interventions to improve sleep are more likely to be effective if they include the perspectives of the community. A community-based approach offers opportunities for community empowerment and engagement that can improve efforts at sleep health promotion.

Resilience to loss and chronic grief: a prospective study from preloss to 18-months postloss.

The vast majority of bereavement research is conducted after a loss has occurred. Thus, knowledge of the divergent trajectories of grieving or their antecedent predictors is lacking. This study gathered prospective data on 205 individuals several years prior to the death of their spouse and at 6- and 18-months postloss. Five core bereavement patterns were identified: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. Common grief was relatively infrequent, and the resilient pattern most frequent. The authors tested key hypotheses in the literature pertaining to chronic grief and resilience by identifying the preloss predictors of each pattern. Chronic grief was associated with preloss dependency and resilience with preloss acceptance of death and belief in a just world.

Beyond the "self" in self-efficacy: Spouse confidence predicts patient survival following heart failure.

Ratings of patient efficacy to manage illness, made by 191 congestive heart failure patients and their spouses, were examined as predictors of patients' survival over the next 4 years. When considered alone, both the patient's self-efficacy and the spouse's confidence ratings predicted survival, but only spouse confidence remained significant when both partners" efficacy ratings were included in the same Cox regression model. The overlapping prognostic significance of spouse confidence and a global, multicomponent measure of marital quality positioned the former as a proxy for the latter, reflecting a fundamentally social protective factor in patient survival. Successful adaptation to heart failure appears to involve more than the patient's personal agency, and psychosocial data from spouses can improve prediction of patient outcomes.

Couples coping with congestive heart failure: role and gender differences in psychological distress.

Psychological distress and marital quality were assessed with male (n = 128) and female (n = 49) congestive-heart-failure (CHF) patients and their spouses. Hopkins Symptom Check List--25 scores were in the distressed range for 57% of patients and 40% of spouses. This role difference was greater for men than for women, and a gender difference (more distress in women than men) was greater for spouses than for patients. The patient's distress, but not the spouse's, reflected the severity of the patient's illness, and distress for both partners correlated negatively with ratings of marital quality. Female-patient couples reported better relationship quality than male-patient couples, however, and a mediation analysis indicated that the gender difference in spouse distress could be explained by marital quality. Results highlight the contextual nature of CHF distress and suggest that role differences in distress vary by gender.

Do special occasions trigger psychological distress among older bereaved spouses? An empirical assessment of clinical wisdom.

OBJECTIVES: Mental health professionals have suggested that widowed persons experience heightened psychological distress on dates that had special meaning for them and their late spouse, such as a wedding anniversary or the late spouse's birthday. This study examined the effects of such occasions on grief, anxiety, and depressive symptoms in a community sample of older widowed persons. METHODS: OLS regression models were estimated using data from the Changing Lives of Older Couples (CLOC) study, a large prospective probability study of late-life widowhood. Participants were interviewed prior to and both 6 and 18 months after spousal loss; married matched controls were interviewed at comparable times. RESULTS: Widowed persons reported heightened psychological distress when interviewed during the month of their late spouse's birthday, a post-holiday period (January), and in June, a month associated with wedding anniversaries and graduations in the United States. The distressing effects of special occasions on psychological symptoms were evidenced only within the first 6 months postloss, and were not apparent at the 18-month follow-up. DISCUSSION: Our results support the clinical observation that persons in the early stages of spousal bereavement are at increased risk of psychological distress at times with special significance to the couple. We highlight methodological and clinical implications.

The impact of the Truth and Reconciliation Commission on psychological distress and forgiveness in South Africa.

BACKGROUND: Legislation to establish a Truth and Reconciliation Commission (TRC) was passed soon after election of South Africa's first democratic government. Discourse around the TRC focused on the importance of bearing witness to the past, and on the healing powers of forgiveness. However, there was also a concern that individuals with TRC relevant experience would simply be re-traumatized by participation in the process. To date, there has been little empirical data for either hypothesis. METHODS: A nationally representative survey of the South African population (n = 4,351) was undertaken 6-8 years after the TRC process began. Information about subjects' exposure to and participation in the TRC was collected, and views about the testimony of survivors and perpetrators were assessed. To determine the predictors of distress, anger, and forgiveness, linear regressions were undertaken with inclusion of demographic variables, exposure to TRC variables, and attitudes to the TRC. RESULTS: Distress was significantly associated with specific demographic factors (female gender, less education), with having a TRC-related experience to share, and with negative perceptions of the TRC (a negative view of survivors' testimony). Anger had similar associations but was also predicted by lower age. Forgiveness was associated with age and education, with being Coloured, and with having a positive view of perpetrator's testimony, while it was inversely associated with having a TRC experience to share. Distress and anger correlated inversely with forgiveness. Perceptions of the TRC were moderately positive irrespective of many demographic variables (race, education, age). CONCLUSION: In this cross-sectional study, causal relationships are difficult to ascertain. Nevertheless, relationships between increased distress/anger, having a TRC relevant experience to share, and negative perceptions of the TRC, support a view that bearing testimony is not necessarily helpful to survivors. However, in the population as a whole, moderately positive attitudes towards the TRC across sociodemographic variables support a view that the TRC helped provide knowledge and acknowledgment of the past.

Early antecedents of adult work stress: social-emotional competence and anger in adolescence.

We hypothesized that youth with elevated coronary heart disease (CHD) risk who exhibit diminished social-emotional competence and frequent anger in adolescence experience increased occupational stress after becoming adults. Perceived job control and support from coworkers in 57 young Black and White men and women were regressed on measures of social problem-solving skill (SPS) and anger arousal (AR) obtained 5 years earlier when participants were in high school. In models controlling for grade point average (GPA), SPS and GPA independently predicted coworker support in adulthood; anger in high school predicted diminished job control. These findings suggest that occupational stress may have identifiable social-emotional antecedents early in life.

The South Africa Stress and Health Study: rationale and design.

The South Africa Stress and Health Study (SASH) is a large psychiatric epidemiological survey that is currently underway in South Africa. It is a part of the World Health Organization's World Mental Health (WMH) 2000 initiative and seeks to complete interviews with a nationally representative sample of 5000 adults. The WMH initiative is obtaining population-based data on the prevalence and severity of specific psychiatric disorders, demographic and psychosocial correlates of these diagnoses, and the levels and adequacy of mental health service utilization. SASH is using the fully structured pencil and paper version of the WHO Composite International Diagnostic Interview (CIDI) to assess lifetime and 12-month rates of mental disorders using both the DSM-IV and the ICD-10 diagnostic systems. In addition, the SASH seeks to collect information on the prevalence of exposure to physical and psychological torture in South Africa and to assess the association between such traumas and specific psychiatric disorders. It will also assess a broad range of risk factors and resources that may modify the association between exposure to human rights violations and mental health.