Lifetime HIV testing among three samples of adults with histories of incarceration in Southern California.

ABSTRACTJustice-impacted persons may inconsistently access HIV testing. This cross-sectional secondary analysis investigates lifetime HIV testing prevalence among adults with prior histories of incarceration in Southern California, United States, participating in health-focused programming (n = 3 studies). Self-reported demographic and lifetime HIV testing data were collected between 2017-2023; descriptive analyses were conducted. Across the three samples, at least 74% of participants were male; Latino and African American individuals accounted for nearly two-thirds of participants. Lifetime HIV testing ranged from 72.8% to 84.2%. Males were significantly more likely than females to report never being tested in two samples and accounted for >95% of those never tested. No statistically significant differences in testing were observed by race/ethnicity. Single young adults (ages 18-26) were less likely than their partnered peers to report testing. HIV testing is critical for ensuring that individuals access prevention and treatment. HIV testing among justice-impacted adults in this study was higher than in the general population, potentially due to opt-out testing in correctional settings. Nevertheless, these findings underscore the importance of implementing targeted interventions to reduce structural (e.g., health insurance, access to self-testing kits) and social barriers (e.g., HIV stigma) to increase HIV testing among justice-impacted males and single young adults.

Access to Healthcare Among Young Adult Probationers Participating in a Pilot Health-Focused Reentry Program.

Justice-involved adults experience disparities in healthcare access. This pilot study examines healthcare access among young adult probationers (n = 66) receiving 6-months of Service Navigation and Health Coaching support implemented between 2017 and 2021. Data are from baseline, 6-month follow-up and satisfaction surveys. Between baseline and follow-up, the proportion of insured young adult participants (66%-88%; p < .001) and those using healthcare services (36%-71%; p < .001) increased significantly; report of unmet physical healthcare needs decreased significantly (44%-26%; p = .003). Satisfaction data revealed increased self-efficacy, motivation, focus, and improved organizational, goal setting, and communication skills. The program improved healthcare access by increasing health insurance and recent use of healthcare services. Longitudinal studies are needed to assess maintenance of these outcomes and potential impacts on disparities in health status and access to care indicators. Integrating navigation and coaching supports to advance the well-being of justice-involved young adults is a promising mechanism to facilitate healthcare access.

A randomized clinical trial testing a health literacy intervention to reduce disparities in access to care among Justice-Impacted Adults (JIA).

BACKGROUND: Low health literacy is costly and observed among justice-impacted adults (JIA), a group that often faces numerous barriers in accessing healthcare and a disproportionate burden of illness. Health literacy interventions for JIA are critically needed to improve healthcare access and related outcomes. METHODS: This manuscript describes the protocol for a longitudinal mixed-methods randomized clinical trial that assesses the effectiveness of a coach-guided health literacy intervention on JIA's healthcare access. The intervention was previously piloted with justice impacted adults. We will recruit 300 JIA ages 18 + in San Diego, California. Participants will be randomized 1:1 to the Treatment Group (i.e., coach-guided intervention providing 12 sessions of individualized health coaching and service navigation over 6 months) or the Control Group (i.e., self-study of the health coaching program, and brief service navigation support). We will quantitatively assess JIA's healthcare access defined as: use of healthcare, health insurance status, and regular source of care at 6-months as the primary outcomes. Participants will also be surveyed at 12-months. Statistical analyses will incorporate the intent-to-treat (ITT) principle and we will estimate mixed-effects logistic regression for the primary outcomes. We will also conduct qualitative interviews at 6 and 12-months with 40 purposively sampled participants, stratified by study arm, who reported healthcare access barriers at baseline. Interviews will explore participants' satisfaction with the intervention, healthcare attitudes, self-efficacy for and barriers to healthcare access over time, perceived contribution of the intervention to health and well-being, and diffusion of intervention-related information within participants' social networks. We will conduct deductive thematic analyses of qualitative data. DISCUSSION: Low health literacy among JIA is a foundational challenge requiring tailored intervention strategies. Findings from this trial may inform policies and the structure of service delivery models to build health literacy among JIA in institutional and community settings throughout the United States and elsewhere. TRIAL REGISTRATION: This study is registered with the United States' ClinicalTrials.gov registry under protocol # 161,903.

Acculturation, Communication Competence, and Family Functioning in Mexican-American Mother-Daughter Dyads.

Little is known of how intergenerational acculturation discrepancy relates to communication skills differences that may influence relationship quality among parents and adult children. Mexican-American mother-daughter dyads (n = 59) were studied using the Actor Partner Interdependence Model to examine dyadic associations of acculturation and communication competence with family functioning and mediation analysis to determine the indirect effect of acculturation discrepancy on family functioning through communication competence differences. Communication competence of mothers exerted significant actor and partner effects on daughter-perceived cohesion and closeness. Higher acculturation discrepancy predicted greater communication competence difference which in turn was associated with lower cohesion and closeness. There was a significant indirect effect of acculturation discrepancy on daughter-perceived cohesion through communication competence difference. Communication competence of mothers impacts their own as well as their daughters' perceptions of dyad cohesion and closeness. Intergenerational discrepant acculturation contributes to discordant communication skills that impair family functioning, which has implications for psychological well-being.

Overview of a Pilot Health-focused Reentry Program for Racial/Ethnic Minority Probationers ages 18 to 26 in Southern California.

There is a significant gap in reentry programming that is tailored to the needs of young adults ages 18 to 26 who are in a unique developmental life stage that involves ongoing maturity in their neurobiology, cognitive development, and social and financial transitions to adulthood and independence. This article describes the structure and approach of a 6-month health-focused reentry program designed for racial/ethnic minority young adult (YA) probationers in Southern California. The UCSD RELINK program includes service navigation and an optional psychoeducation health coaching program to build health literacy, problem-solving, and executive functioning skills relevant across multiple life domains. We describe participant characteristics and service needs at intake. Between 2017 and 2019, 122 YA probationers ages 18 to 26 responded to interviewer-administered baseline surveys. Participants needed basic services including housing, nutrition assistance, employment, and educational/vocational training. Depression and anxiety symptoms, Adverse Childhood Events, trauma, and unmet physical and mental health care needs were pervasive. Given the dearth of research on reentry programming for YA, this article documents the approaches taken in this multi-pronged health-focused reentry program to ensure that the program was tailored to YA reentrants' comprehensive needs. These data serve to concretely illustrate the range of needs and how YA reentrants view their own health and social needs in the context of multiple competing demands; such data may be useful for program planners and policymakers seeking to advance service delivery for YA minority reentrants.

Religious Coping and Glycemic Control in Couples with Type 2 Diabetes.

This study examines the role of religious coping in couples' diabetes management processes. Eighty-seven couples where one spouse had type 2 diabetes were surveyed. The relationships between religious coping (positive and negative), shared glycemic control activities (e.g., planning a healthy diet), and glycemic control were examined using repeated measures ANOVA and SEM. Findings show spousal engagement in shared activities is significantly associated with glycemic control. Furthermore, the use of negative religious coping by the diabetic spouse, and positive religious coping by the nondiabetic spouse, related to lower levels and higher levels of shared glycemic control activities, respectively. Religious coping and shared glycemic control activities appear integral to couples managing type 2 diabetes and, may serve as useful points of intervention.

Partner expressed emotion and diabetes management among spouses living with Type 2 diabetes.

INTRODUCTION: Expressed emotion has been consistently shown to be a significant predictor of relapse and poor disease management across numerous physical and mental health conditions, however very little research has been conducted on its relationship to the management practices of individuals living with Type 2 diabetes. This study examines the relationship between expressed emotion (EE) and diabetes management among couples where 1 spouse has Type 2 diabetes. METHODS: The authors surveyed 106 couples where 1 partner was diagnosed with Type 2 diabetes. Partners without diabetes completed questionnaires about their level of criticism, emotional involvement, and warmth toward their partners. Partners with diabetes completed questionnaires on diabetes control, diabetes management practices and attitude toward their diabetes. RESULTS: The authors found that, individuals living with diabetes who had partners with high EE reported significantly poorer diabetes management in all areas (diet, physical activity, and attitude toward diabetes). Diabetes management was found to mediate the relationship between EE and diabetes control. Results suggest that partners with high EE may have a significant influence on diabetes management practices in their partner. DISCUSSION: These findings highlight the important role couple interactions may play in diabetes management. Findings also emphasize the potential benefit of conceptualizing diabetes management from a systems/relational perspective. In addition, greater consideration should be given to using family-based approaches for diabetes management and treatment among coupled individuals living with Type 2 diabetes. (PsycINFO Database Record

Paternal depression during pregnancy and postpartum: An international Delphi study.

BACKGROUND: Fathers are at risk for depression during a mother's gestation and postpartum. Assessment, detection, and treatment are hampered by the lack of consensus on this issue. The purpose of this study was to reach expert consensus through the Delphi method on the defining factors of depression in peripartum fathers. METHODS: Purposive sampling resulted in the surveying of 14 international expert panelists. The study used a modified Delphi approach in which experts participated in two rounds of open-ended and scale questionnaires, followed by two rounds of opportunities to adjust their responses and/or comment on evolving data until consensus was achieved. RESULTS: Experts responded to 10 questions on terminology, diagnostics, symptomology, risk/protective factors, biological factors, assessment tools/protocol, cost implications, and key stakeholders. Of these 10 questions presented for discussion, the analysis resulted in 197 coded themes. Consensus was met for 119 of the 197 coded responses (60.41%). LIMITATIONS: Diversity of opinion within this Delphi Study was excluded for the sake of consensus. Regression to the mean may have occurred after continuous surveying and when evolving results were shared with panelists. Critics of Delphi methodologies have pointed to the issue of small expert samples typically used and the subjectivity of "expert." CONCLUSION: Consensus identified diagnostic criteria and symptomology that differentiates the paternal experience of peripartum depression. Experts indicated the importance of a father's social context, biological risk factors, limitations of current assessment tools, key stakeholders, and potential financial costs. Stakeholders on this issue would benefit from translating consensus into assessment and treatment.

Training for teamwork: A case study.

As the field of collaborative care, or integrated behavioral health, continues to develop, lessons are learned from attempts to establish such programs (Sieber et al., 2012; Unützer, 2014). Part of the success of collaborative care programs is the function of an interdisciplinary team. In this article, faculty from University of San Diego (USD) and University of California, San Diego (UCSD) share changes needed to curriculum and career development to support leadership and teamwork skills essential to program development, implementation, and sustainability for integrated behavioral health. This article uses Unützer's (2014) 4 factors of creating a successful collaborative care program (i.e., shared vision, leadership, staffing, and financial sustainability) to discuss implications for effective collaboration between 2 universities and the training of primary care providers in teamwork and leadership skills for overcoming barriers and pitfalls to expand collaborative care beyond their initial training.

Establishing the Collaborative Care Research Network (CCRN): a description of initial participating sites.

Collaborative care has increased dramatically in the past decade, yet the variability in collaborative strategies and the diversity of settings in which collaboration is being implemented make it difficult to assess quality and outcomes. Therefore, three aims were addressed in the current study: (a) describe and characterize the sites in the Collaborative Care Research Network (CCRN), (b) identify factors associated with practices' self-identified collaborative care model (e.g., coordinated, integrated, care management), and (c) identify limitations of available survey data elements so as to propose additional elements for future surveys. Initial (CCRN) sites completed surveys regarding several organizational factors (e.g., setting type, size of patient population, number of behavioral health providers). Results from 39 sites showed significant heterogeneity in self-identified type of collaborative care model practiced (e.g., integrated care, coordinated care), type of practice setting (e.g., academic, federally qualified health center, military), size of clinic, and ratio of behavioral health providers to medical providers. This diversity in network site characteristics can provide a rich platform to address a number of questions regarding the current practice of collaborative care. Recommendations are made to improve future surveys to better understand elements of the patient-centered medical home and the role it may play in outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).