Natural mentoring among college students of color: Considerations for their ethnic-racial identity and psychological well-being.

This study examined: (a) the roles of ethnic-racial similarity between mentors and mentees and mentors' support for ethnic-racial identity (ERI) in mentees' ERI private regard, (b) the roles of ethnic-racial similarity and ERI support in mentees' psychological well-being, and (c) the indirect effects of ethnic-racial similarity and ERI support on psychological well-being via private regard. Participants were 231 college students of color who completed a survey and reported having a natural mentor. Path analyses were conducted to test the hypothesized model. More support for ERI was significantly associated with higher private regard and higher self-esteem. Higher ethnic-racial similarity was significantly related to higher psychological distress and higher self-esteem. An indirect effect was found between ERI support and ethnic-racial similarity and psychological well-being via private regard. The findings fill a gap in the literature on ethnic-racial processes in mentoring critical to the development of college students of color.

The Reciprocal Effects of Language Proficiency and Depression among Low-Income Latinx Youth.

Extant research associates language with essential social and emotional processes. Although the risk for depression among Latinx youth in the United States is well documented, the link between their language proficiency and depressive symptoms remains poorly understood. Further, research employing standardized language assessments with Latinx early adolescents is scarce and reciprocal associations between language proficiency and depressive symptoms have not been examined. This longitudinal study addressed these gaps by investigating the relation between language proficiency and depression in a sample of 218 dual language Latinx students of predominantly low-income backgrounds (Mage = 12.1, SD = 1.1; 49.1% female) recruited from seven public schools in a large city in the Midwest of the United States. Language proficiency in English and Spanish was assessed using the Woodcock-Muñoz Language Survey-Revised and depressive symptoms were assessed using the Children's Depression Inventory. Paired samples t-tests showed lower than expected growth in English vocabulary and higher than expected growth in the ability to reason using lexical knowledge in Spanish over a one-year period. Cross-lagged panel analyses (χ2 (99) = 211.19, p < .001, CFI = .93, TLI = .92, RMSEA = .07 (90% CI [.06, .09])) indicated that growth in English language proficiency is predictive of decreased depressive symptoms. Likewise, increases in depressive symptoms are predictive of decreased English language proficiency. Results have important implications for the design of appropriate psychological interventions and sensible educational policies for students of linguistic minority backgrounds.

Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery.

BACKGROUND: Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone. METHODS: A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty. RESULTS: The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone. CONCLUSIONS: Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.

Examining current physical activity interventions in Black school-age children and parents: A systematic review.

Obesity is prevalent in Black children and adults; increasing physical activity (PA) can aid in reducing childhood obesity in both age groups. The purpose of this systematic review is to examine current research on PA interventions in school-age Black children. Adhering to PRISMA guidelines, a systematic search was conducted in six databases for PA interventions in Black children. A total of 13 articles met inclusion criteria (n = 7 randomized controlled trial, n = 5 quasi-experimental, n = 1 cross-sectional). The majority of the articles were on a combination of diet and PA programs (n = 9). Four articles targeted PA and parental role modeling of PA as the outcome showing positive intervention effects. Nine additional studies included PA as an outcome variable along with at least one additional obesity-related predictor. PA interventions for Black school-age children typically use a parent-child dyadic approach (n = 13), are guided by theory (n = 11) and are high quality. However, continued investigation is warranted to draw definitive conclusions and determine how to best involve parents within the PA interventions. Theory-driven higher quality trials that clearly describe the structured PA component and outcomes among Black parent-child dyads are needed.

The Perceived Payoff of Education: Do Generational Status and Racial Discrimination Matter?

The purpose of this study was to examine the associations among racial discrimination, generational status, and perceptions of the economic value of education among Latina/o youth. Participants were 400 urban, low-income, Latina/o students from a large Midwestern U.S. city who completed surveys in both 9th and 10th grades. Results revealed that more perceived racial discrimination was associated with more perceived economic limitations of education. When analyzed by generational status, more racial discrimination in 9th grade was significantly related to lower perceived economic value of education in 10th grade for third-generation and later participants, but not for first- or second-generation participants. The results provide evidence for the diverse experiences of racial discrimination and perceived economic value of education across generational groups.

The Costs and Benefits of Active Coping for Adolescents Residing in Urban Poverty.

The present study addresses the lack of specificity and diversity highlighted in recent stress literature reviews by examining active coping in relationships between exposure to violence and internalizing and externalizing symptoms in a sample of urban youth from predominantly low-income, African American and Latino backgrounds. Two hundred and forty-one youth (mean age at Time 1 = 13 years; 66 % female; 41 % African American, 28 % Latino, 14 % European American, 6 % Asian American, 7 % mixed/biracial, 1 % American Indian/native American, .5 % Hawaiian/Pacific Islander, 2 % other) and their parents participated in this three-wave study. Hierarchical regression analyses tested for moderation, and a cross lag panel path analysis tested for mediation. The results provide greater support for active coping as a variable that changes the relationship between exposure to community violence and externalizing symptoms, or moderation, rather than one that explains or mediates it. Further, specificity did not emerge for type of psychological outcome but did emerge for gender, such that active coping exacerbated the association between exposure to community violence and both internalizing and externalizing symptoms for girls, but not boys. These findings highlight the importance of contextual and demographic factors in influencing stress and coping processes during adolescence.

Predicting Depressive Symptoms and Weight from Adolescence to Adulthood: Stressors and the Role of Protective Factors.

Depressive symptoms and weight gain follow similar developmental trajectories from adolescence to adulthood and stressors are a risk factor for both. However, less is known about whether they share protective factors that reduce the risk for depressive symptoms and weight gain. The goal of the current study was to examine the role of stress and four protective factors (social support, self-esteem, physical activity, and sedentary behavior) as predictors of depressive symptoms and body mass index over time. Participating in the current study were 6504 (51.6 % female; 60.7 % European American, 22.5 % African American, 11.4 % Hispanic, 3.3 % Asian American, and 2 % other ethnicities) adolescents from the National Study of Adolescent and Adult Health. Participants were followed for three waves from adolescence to young adulthood (Wave I age range = 12-18; Wave III age range = 18-26). Data were analyzed using multi-level modeling and results showed that stressors significantly predicted trajectories of depressive symptoms and body mass index over time. Social support buffered the effects of stressors on BMI over time. Self-esteem influenced trajectories of both BMI and depressive symptoms. Differential effects were found for physical activity with physical activity predicting declines in depressive symptoms and sedentary behavior predicting declines in BMI over time. The current study suggests that stress is a common risk factor for depressive symptoms and weight gain, but that there is specificity in how the protective factors influence each type of outcome.

Mediating effects of parent-child relationships and body image in the prediction of internalizing symptoms in urban youth.

Youth are faced with many stressful interpersonal, contextual, and identify development related challenges that contribute to the increased risk of negative outcomes during adolescence. The current study examined two important factors related to youth's development and well-being: parent-child attachment and negative body image. Specifically, the current study examined body image as one mechanism responsible for the effect that mother and father attachment has on internalizing symptoms in a sample of low-income, ethnic minority youth. Additionally, differences across gender and ethnic/racial groups were examined. Participants included 140 (71 % female) ages 10-16 at baseline recruited from urban public schools in Chicago with high percentages of low-income students. The current sample was ethnically diverse (41 % African American, 30 % Latino, 16 % European American, 6 % Biracial, 6 % Asian, and 1 % other). Participants completed measures of their relationships with their mothers and fathers, negative body image, and internalizing symptoms across two periods of time separated by approximately 1 year. Results showed that body image mediated the relation between both mother and father attachment and internalizing symptoms. These results were further moderated by race/ethnicity, but not by sex. For African American participants, mother attachment was related to internalizing symptoms through negative body image while for Latinos, paternal attachment was related to internalizing symptoms through negative body image. Although maternal attachment had direct effects on internalizing symptoms for Latinos, negative body image did not mediate this relationship. These results support an integrative model in which interpersonal risk lays the foundation for the development of cognitive risk, which in turn leads to internalizing symptoms for urban youth.

Relationships Among the Endorsement of Superwoman Schema and Health Outcomes.

OBJECTIVE: To examine associations among endorsement of elements of the superwoman schema (the obligation to manifest strength and the obligation to help others) and health outcomes and to test if stress mediates the association between the obligation to manifest strength and depression in adult Black women. DESIGN: Cross-sectional design. SETTING: Community space in the Chicago metropolitan area. PARTICIPANTS: Ninety-one adult Black women. METHODS: Participants completed questionnaires to assess endorsement of superwoman schema roles, physical activity, healthy eating, weight satisfaction, depression, and stress. Height and weight were collected by research assistants. We used descriptive statistics, bivariate correlations, multiple regression models, and linear mediation analysis to analyze data. RESULTS: Higher levels of obligation to suppress emotions were associated with lower physical activity, r(88) = -0.25, p < .05. Obligation to manifest strength was associated with higher levels of stress, r(79) = 0.53, p < .01, and symptoms of depression, r(71) = 0.36, p < .01. Stress mediated the relationship between the obligation to manifest strength and depression with a significant indirect effect, b = 0.37, SE = 0.10, 95% confidence interval [0.20, 0.60]. CONCLUSION: Our findings offer insight into the psychological and social processes that affect Black women and may aid in the development of culturally responsive prevention and intervention programs at individual and community levels to reduce chronic diseases.

Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Pilot Randomized Controlled Trial.

BACKGROUND: Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention. OBJECTIVE: This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF. METHODS: Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments). RESULTS: A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100% responded very or somewhat true to the statement "If I have access to the [platform] moving forward, I will use it." Some (n=9, 47%) intervention participants indicated they required support to use the digital platform. A total of 19 (100%) intervention participants and 25 (89%) control participants had ≥5 CHW interactions during the 30-day study period. All intervention (n=19, 100%) and control (n=26, 93%) participants who completed trial activities indicated their CHW interactions were "very satisfying." In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12% vs n=8, 26%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits. CONCLUSIONS: This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/55687.

Feasibility, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Protocol for a Randomized Controlled Trial.

BACKGROUND: Interventions focused on remote monitoring and social needs care have shown promise in improving clinical outcomes for patients with heart failure (HF). However, patient willingness to use technology as well as concerns about access in underresourced settings have limited digital platform implementation and adoption. There is little research in HF populations examining the effect of a combined digital and social needs care intervention that could enhance patient engagement in digital platform use while closing gaps in care related to social determinants of health. Here, we describe the protocol for a clinical trial of a digitally enabled community health worker intervention designed for patients with HF. OBJECTIVE: This study aims to describe the protocol for a randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of an intervention that combines remote monitoring with a digital platform and community health worker (CHW) social needs care for patients with HF who are transitioning from hospital to home. Given the elevated morbidity and mortality, identifying comprehensive and patient-centered interventions at the time of hospital care transitions that can improve clinical outcomes, impact cost, and augment the quality of care for this cohort is a priority. METHODS: This trial randomized adult inpatient participants (n=50) with a diagnosis of HF receiving care at a single academic health care institution to the 30-day intervention (digital platform+CHW pairing+usual care) or the 30-day control (CHW pairing+usual care) arms. All study participants completed baseline questionnaires and 30-day exit interviews and questionnaires. The primary outcomes will be acceptability, feasibility, and preliminary effectiveness. RESULTS: This clinical trial opened for enrollment in September 2022 and was completed in June 2023. Initial results are expected to be published in the spring of 2024, and analysis is currently underway. Feasibility outcome measures will include the use rates of the biometric sensor (average hours per day), the digital blood pressure monitor (average times per day), the weight scale (average times per day), and the completion of the symptoms questionnaire (average times per day). The acceptability outcome will be measured by the patients' response to the truthfulness of the statement that they would be willing to use the digital platform in the future (response options: very true, somewhat true, or not true). Preliminary effectiveness will be measured by tracking 30-day clinical outcomes (hospital readmissions, emergency room visits, and missed primary care and cardiology appointments). CONCLUSIONS: The results of this investigation are expected to contribute to our understanding of the use of digital interventions and the implementation of supportive home-based social needs care to enhance engagement and the potential effectiveness of clinically focused digital platforms. These results may inform the construction of a future multi-institutional trial designed to test the true effectiveness of this intervention in HF. TRIAL REGISTRATION: ClinicalTrials.gov NCT05130008; https://clinicaltrials.gov/study/NCT05130008. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55687.

An Adaptive Healthcare Organization Can Effectively Respond to Medical Crises.

Healthcare systems are challenged by unexpected medical crises. Established frameworks and approaches to guide healthcare institutions during these crises are limited in their effectiveness. We propose an Adaptive Healthcare Organization (AHO) system as a framework focused on the dynamic nature of healthcare delivery. Based on seven key capabilities, the AHO framework can guide single and multi-institutional healthcare organizations to adapt in real time to an unexpected medical crisis and improve their efficiency and effectiveness.

Integration of patient experience factors improves readmission prediction.

Many readmission prediction models have marginal accuracy and are based on clinical and demographic data that exclude patient response data. The objective of this study was to evaluate the accuracy of a 30-day hospital readmission prediction model that incorporates patient response data capturing the patient experience. This was a prospective cohort study of 30-day hospital readmissions. A logistic regression model to predict readmission risk was created using patient responses obtained during interviewer-administered questionnaires as well as demographic and clinical data. Participants (N = 846) were admitted to 2 inpatient adult medicine units at Massachusetts General Hospital from 2012 to 2016. The primary outcome was the accuracy (measured by receiver operating characteristic) of a 30-day readmission risk prediction model. Secondary analyses included a readmission-focused factor analysis of individual versus collective patient experience questions. Of 1754 eligible participants, 846 (48%) were enrolled and 201 (23.8%) had a 30-day readmission. Demographic factors had an accuracy of 0.56 (confidence interval [CI], 0.50-0.62), clinical disease factors had an accuracy of 0.59 (CI, 0.54-0.65), and the patient experience factors had an accuracy of 0.60 (CI, 0.56-0.64). Taken together, their combined accuracy of receiver operating characteristic = 0.78 (CI, 0.74-0.82) was significantly more accurate than these factors were individually. The individual accuracy of patient experience, demographic, and clinical data was relatively poor and consistent with other risk prediction models. The combination of the 3 types of data significantly improved the ability to predict 30-day readmissions. This study suggests that more accurate 30-day readmission risk prediction models can be generated by including information about the patient experience.

Feasibility and Acceptability of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Single-Arm Pilot Study.

BACKGROUND: Heart failure (HF) is one of the leading causes of hospital admissions. Clinical (eg, complex comorbidities and low ejection fraction) and social needs factors (eg, access to transportation, food security, and housing security) have both contributed to hospitalizations, emphasizing the importance of increased clinical and social needs support at home. Digital platforms designed for remote monitoring of HF can improve clinical outcomes, but their effectiveness has been limited by patient barriers such as lack of familiarity with technology and unmet social care needs. To address these barriers, this study explored combining a digital platform with community health worker (CHW) social needs care for patients with HF. OBJECTIVE: We aim to determine the feasibility and acceptability of an intervention combining digital platform use and CHW social needs care for patients with HF. METHODS: Adults (aged ≥18 years) with HF receiving care at a single health care institution and with a history of hospital admission in the previous 12 months were enrolled in a single-arm pilot study from July to November 2021 (N=14). The 30-day intervention used a digital platform within a mobile app that included symptom questionnaire and educational videos connected to a biometric sensor (tracking heart rate, oxygenation, and steps taken), a digital weight scale, and a digital blood pressure monitor. All patients were paired with a CHW who had access to the digital platform data. A CHW provided routine phone calls to patients throughout the study period to discuss their biometric data and to address barriers to any social needs. Feasibility outcomes were patient use of the platform and engagement with the CHW. The acceptability outcome was patient willingness to use the intervention again. RESULTS: Participants (N=14) were 67.7 (SD 11.7) years old; 8 (57.1%) were women, and 7 (50%) were insured by Medicare. Participants wore the sensor for 82.2% (n=24.66) of study days with an average of 13.5 (SD 2.1) hours per day. Participants used the digital blood pressure monitor and digital weight scale for an average of 1.2 (SD 0.17) times per day and 1.1 (SD 0.12) times per day, respectively. All participants completed the symptom questionnaire on at least 71% (n=21.3) of study days; 11 (78.6%) participants had ≥3 CHW interactions, and 11 (78.6%) indicated that if given the opportunity, they would use the platform again in the future. Exit interviews found that despite some platform "glitches," participants generally found the remote monitoring platform to be "helpful" and "motivating." CONCLUSIONS: A novel intervention combining a digital platform with CHW social needs care for patients with HF was feasible and acceptable. The majority of participants were engaged throughout the study and indicated their willingness to use the intervention again. A future clinical trial is needed to determine the effectiveness of this intervention.

Sports Participation, Frequency, and Competence Differentially Impact Youth Depressive, Anxious, and Somatic Symptoms: Gender, Neighborhood, and Sports Type Effects.

Mental health problems are prevalent in adolescence, but sports participation may offer mental health benefits through this developmental period and beyond. Characteristics of sports participation including perceived frequency and competence may differentially predict adolescent depressive, anxious, and somatic symptoms over time and results may further vary according to gender, neighborhood context, and type of sport engagement. Data were collected at two time-points six months apart from an ethnically diverse sample of adolescents (N = 183, female = 51%). Youth sports participation and symptoms were measured using the Youth Self-Report (YSR; Achenbach & Rescorla, 2001). Path analyses were used to test for main and moderating effects of sports on symptoms. Results showed that categorical sports participation did not prospectively predict any type of internalizing symptoms, but perceived frequency and competence did. Competence predicted lower levels of symptoms while frequency predicted higher levels of symptoms. These results were further moderated by gender, neighborhood, and sport type such that frequency and competence predicted symptoms for girls and for youth in more resourced neighborhoods and who participated in team sports. These findings highlight the impact that sports participation can have on adolescent mental health in an ethnically diverse sample of urban youth.