Clinician and Staff Perspectives on Implementing Adverse Childhood Experience (ACE) Screening in Los Angeles County Pediatric Clinics.

PURPOSE: To understand clinician and clinical staff perspectives on the implementation of routine Adverse Childhood Experience (ACE) screening in pediatric primary care. METHODS: We conducted a qualitative evaluation in 5 clinics in Los Angeles County, California, using 2 rounds of focus group discussions: during an early phase of the initiative, and 7 months later. In the first round, we conducted 14 focus group discussions with 67 participants. In the second round, we conducted 12 focus group discussions with 58 participants. Participants comprised clinic staff involved in ACE screening, including frontline staff that administer the screening, medical clinicians that use screening to counsel patients and make referrals, and psychosocial support staff who may receive referrals. RESULTS: Themes were grouped into 3 categories: (1) screening acceptability and perceived utility, (2) implementation and quality improvement, and (3) effects of screening on patients and clinicians. Regarding screening acceptability and perceived utility, clinicians generally considered ACE screening to be acceptable and useful. In terms of implementation and quality improvement, significant barriers included: insufficient time for screening and response, insufficient training, and lack of clarity about referral networks and resources that could be offered to patients. Lastly, regarding effects of screening, clinicians expressed that ACE screening helped elicit important patient information and build trust with patients. Further, no adverse events were reported from screening. CONCLUSIONS: Clinic staff felt ACE screening was feasible, acceptable, and beneficial within pediatric care settings to improve trauma-informed care and that ACE screening could be strengthened by addressing time constraints and limited referral resources.

Reframing Achievement Setbacks: A Motivation Intervention to Improve 8-Year Graduation Rates for Students in Science, Technology, Engineering, and Mathematics (STEM) Fields.

Despite increased emphasis on educating students in science, technology, engineering, and mathematics (STEM) disciplines, nearly half of U.S. college students who enroll in these programs fail to graduate with STEM degrees. Using archival data from the Motivation and Academic Achievement Database, we tested whether a motivation intervention to reframe causal attributions for academic setbacks improved graduation rates for college students in STEM disciplines (N = 496). Results showed that the intervention increased the odds of 8-year graduation for students who were at risk of college dropout. Findings highlight the potential of theory-informed psychological interventions to increase persistence to graduation for at-risk students in STEM fields.

Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection.

BACKGROUND: Urogenital Chlamydia trachomatis infection remains prevalent and causes substantial reproductive morbidity. Recent studies have raised concern about the efficacy of azithromycin for the treatment of chlamydia infection. METHODS: We conducted a randomized trial comparing oral azithromycin with doxycycline for the treatment of urogenital chlamydia infection among adolescents in youth correctional facilities, to evaluate the noninferiority of azithromycin (1 g in one dose) to doxycycline (100 mg twice daily for 7 days). The treatment was directly observed. The primary end point was treatment failure at 28 days after treatment initiation, with treatment failure determined on the basis of nucleic acid amplification testing, sexual history, and outer membrane protein A (OmpA) genotyping of C. trachomatis strains. RESULTS: Among the 567 participants enrolled, 284 were randomly assigned to receive azithromycin, and 283 were randomly assigned to receive doxycycline. A total of 155 participants in each treatment group (65% male) made up the per-protocol population. There were no treatment failures in the doxycycline group. In the azithromycin group, treatment failure occurred in 5 participants (3.2%; 95% confidence interval, 0.4 to 7.4%). The observed difference in failure rates between the treatment groups was 3.2 percentage points, with an upper boundary of the 90% confidence interval of 5.9 percentage points, which exceeded the prespecified absolute 5-percentage-point cutoff for establishing the noninferiority of azithromycin. CONCLUSIONS: In the context of a closed population receiving directly observed treatment for urogenital chlamydia infection, the efficacy of azithromycin was 97%, and the efficacy of doxycycline was 100%. The noninferiority of azithromycin was not established in this setting. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00980148.).

Incarcerated Youths' Perspectives on Protective Factors and Risk Factors for Juvenile Offending: A Qualitative Analysis.

OBJECTIVES: We sought to understand incarcerated youths' perspectives on the role of protective factors and risk factors for juvenile offending. METHODS: We performed an in-depth qualitative analysis of interviews (conducted October-December 2013) with 20 incarcerated youths detained in the largest juvenile hall in Los Angeles. RESULTS: The adolescent participants described their homes, schools, and neighborhoods as chaotic and unsafe. They expressed a need for love and attention, discipline and control, and role models and perspective. Youths perceived that when home or school failed to meet these needs, they spent more time on the streets, leading to incarceration. They contrasted the path through school with the path to jail, reporting that the path to jail felt easier. All of them expressed the insight that they had made bad decisions and that the more difficult path was not only better but also still potentially achievable. CONCLUSIONS: Breaking cycles of juvenile incarceration will require that the public health community partner with legislators, educators, community leaders, and youths to determine how to make success, rather than incarceration, the easier path for disadvantaged adolescents.

Personal goals as predictors of intended classroom goals: comparing elementary and secondary school pre-service teachers.

BACKGROUND AND AIMS: The literature documents fewer classroom mastery goal structures in secondary school compared to elementary. However, little is known about how personal achievement goals may influence classroom goal structures. This is especially true at the level of pre-service teachers. Our objective was to investigate if pre-service teachers' personal goals predicted their intended classroom goal structures. SAMPLE: Participants were 125 elementary and 175 secondary school pre-service teachers from two Western Canadian universities. METHOD: Structural equation modelling was used to examine if the structural relationships and latent means of personal and intended classroom goal structures differed for elementary and secondary school pre-service teachers. RESULTS: The results revealed that personal goals predicted the goal structures that pre-service teachers intended to establish; however, the relationships and means differed between elementary and secondary school pre-service teachers. Specifically, personal mastery-approach goals positively predicted classroom mastery goals much more strongly at the elementary than the secondary level. Furthermore, elementary pre-service teachers had significantly higher latent mean scores on personal mastery-approach goals than their secondary counterparts. CONCLUSIONS: It seems possible that the currently documented differences between classroom goal structures noted for elementary compared to secondary school may be based on the personal goals endorsed as pre-service teachers. The results are further discussed in terms of alignment with research on practising teachers' personal and classroom goals and implications for teacher education.

A three-dimensional taxonomy of achievement emotions.

We present a three-dimensional taxonomy of achievement emotions that considers valence, arousal, and object focus as core features of these emotions. By distinguishing between positive and negative emotions (valence), activating and deactivating emotions (arousal), and activity emotions, prospective outcome emotions, and retrospective outcome emotions (object focus), the taxonomy has a 2 × 2 × 3 structure representing 12 groups of achievement emotions. In four studies across different countries (N = 330, 235, 323, and 269 participants in Canada, the United States, Germany, and the U.K., respectively), we investigated the empirical robustness of the taxonomy in educational (Studies 1-3) and work settings (Study 4). An expanded version of the Achievement Emotions Questionnaire was used to assess 12 key emotions representing the taxonomy. Consistently across the four studies, findings from multilevel facet analysis and structural equation modeling documented the importance of the three dimensions for explaining achievement emotions. In addition, based on hypotheses about relations with external variables, the findings show clear links of the emotions with important antecedents and outcomes. The Big Five personality traits, appraisals of control and value, and context perceptions were predictors of the emotions. The 12 emotions, in turn, were related to participants' use of strategies, cognitive performance, and self-reported health problems. Taken together, the findings provide robust evidence for the unique positions of different achievement emotions in the proposed taxonomy, as well as unique patterns of relations with external variables. Directions for future research and implications for policy and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patient and Caregiver Perspectives on Implementation of ACE Screening in Pediatric Care Settings: A Qualitative Evaluation.

INTRODUCTION: This qualitative research study explored the perspectives of adolescents, 12 to 19-years-old, and caregivers of children under 12-years-old on the acceptibility of adverse childhood experiences (ACEs) screenings in five pediatric clinics. METHOD: A constructivist grounded theory approach was utilized. One-on-one semistructured phone interviews were conducted with 44 adolescents and 95 caregivers of children less than 12 years old. Interviews were analyzed using thematic analysis. RESULTS: Most participants reported feeling comfortable discussing ACEs with their providers. Some reported that screening helped build trust. Others expressed privacy concerns and did not receive information about the reason for screening. Adolescent patients shared conflicting feelings-of both comfort and discomfort. Caregivers attending to multiple children, foster parents, and monolingual Spanish speakers disclosed unique challenges to ACEs screening. We found no evidence of lasting adverse effects. DISCUSSION: Participants generally found ACEs screenings acceptable. Some adolescents identified benefits from the experience. However, clinics planning to adopt routine ACEs screening should ensure clear messaging on why screening is occurring, anticipate and address privacy concerns, and adopt workflows to discuss screening results.

Attributional retraining: Promoting psychological wellbeing in older adults with compromised health.

Older adults make up the largest portion of the population of physically inactive individuals. Health challenges, and psychological barriers (e.g., maladaptive causal attributions), contribute to reduced activity engagement and low perceived control. This pilot study tested an attributional retraining (AR) intervention designed to increase control-related outcomes in a physical activity context for older adults with compromised health. Using a randomized treatment design, we examined treatment effects on a sample of older adults attending a day hospital (N = 37, M age = 80). We employed ANCOVAs, controlling for age, sex, and morbidity, to assess differences in post-treatment outcomes between AR and No-AR conditions. AR recipients (vs. No-AR) reported lower post-treatment helplessness and more perceived control over their health. Our study offers evidence for AR to increase control-related outcomes and lays the groundwork for further research into supporting older adult populations with compromised health.

Adjustment and acceptance beliefs in achievement settings: Implications for student wellbeing.

Research suggests that when dealing with personal setbacks, secondary control (SC) adjustment and acceptance beliefs can foster psychological wellbeing. However, little research has examined these beliefs, in combination, and how they impact students in their academic development. We conducted secondary analysis using an eight-month longitudinal study design over a two-semester introductory course on a sample of university students (n = 237; 64% female; M age = 19 years old). Multiple regression analyses assessed whether the students' Semester 1 adjustment and acceptance SC beliefs influenced Semester 2 learning-related emotions, perceived stress, and perceived course success, and whether Adjustment x Acceptance interactions emerged involving these outcomes. Adjustment beliefs promoted learning-related positive emotions (hope, pride), perceived course success, and reduced perceived stress; acceptance predicted higher shame and perceived stress. Students' adjustment predicted lower helplessness for students with high acceptance beliefs. These findings are discussed in light of the role that SC beliefs might play in curbing psychological distress reported by students on postsecondary campuses.

African American adolescent males' views on doctors and the health care system.

OBJECTIVE: African American adolescent males have disproportionately high rates of morbidity and mortality and low levels of primary care use. To optimize health care for this group, there is a need to understand their views on doctors and health care, reasons for foregone care, and preferences regarding provision of health care. METHODS: This was a pilot survey of African American adolescent males attending community groups in Chicago. RESULTS: A majority of respondents agreed with declarative statements about doctors being considerate, truthful, and respectful (63%, 80%, and 80%, respectively). A majority also indicated that the health care system informs them of ways to stay healthy (65%), but fewer agreed that it meets the needs of adolescents and minorities (44% and 33%, respectively). Race/gender concordance with physicians did not seem to be a high priority. Significant reasons for foregone care included conflict with school hours, parents not having time, and lack of transportation. Despite access issues, only a minority of participants wanted health care services co-located with other aspects of their daily lives (school, community centers, church, and barbershops). CONCLUSION: African American adolescent males may view doctors and the health care system positively. Eliminating barriers to care and ensuring positive interactions may create opportunities to improve health issues afflicting these at-risk adolescents.

The Detrimental Consequences of Overestimating Future Health in Late Life.

OBJECTIVES: Although forecasting a positive future can be adaptive, it may not be when expectations are unmet. Our study examined whether such inaccurate expectations about future health status (overestimation) were maladaptive for older adults who commonly experience late life declines in physical functioning. METHOD: We analyzed data from the nationally representative German Aging Survey (DEAS; 1996-2011; n = 2,539; age range 60-85 years) using multilevel growth models that assessed the influence of inaccurate health expectations on older adults' physical functioning over a 9-year period. RESULTS: Overestimating future health status predicted reduced day-to-day physical functioning when age, gender, and self-rated health were controlled. A Time × Overestimation interaction indicated that the negative effects of overestimation on physical functioning became more pronounced over the 9-year period. DISCUSSION: Results suggest that repeatedly unmet health expectations may undermine motivational resources and accelerate late life declines in physical functioning.

A healthy dose of realism: The role of optimistic and pessimistic expectations when facing a downward spiral in health.

RATIONALE AND OBJECTIVES: Whether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health. METHOD: This 18-year-long study of community-dwelling older Canadians (n = 132, 72-98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality. RESULTS: Support was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic). CONCLUSION: These findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.

Attributions for physical activity in very old adults: predicting everyday physical activity and mortality risk.

OBJECTIVES: Although physical activity is recognised as a health-promoting behaviour for older adults, notable barriers exist that may reduce physical activity in this age group. Limited research has explored causal beliefs (attributions) as a barrier to physical activity. Our study assessed associations between older adults' attributions about physical activity and objective health outcomes. METHODS: We examined the role of attributions as a predictor of everyday physical activity (EPA) and subsequent mortality risk over a 10-year period (2006-2016) in a sample of older adults (Mage = 87, N = 261). RESULTS: OLS and Cox proportional hazard regression analyses revealed older adults who endorsed more internal and uncontrollable attributions for limited activity (physical incapacity) when feeling unwell had lower subsequent EPA (ß = -0.18), and higher 10-year mortality risk (HR = 1.46). Other attributions with different dimensional properties (e.g. internal and controllable) were not associated with EPA or mortality. DISCUSSION: Findings suggest that causal beliefs older adults have about their physical activity can influence their future behaviour and longevity. Psychological treatments designed to discourage maladaptive attributional thinking for older populations who face barriers to physical activity may be an important avenue for future research.

Exploring the commonalities between adaptive resources and self-enhancement in older adults' comparative judgments of physical activity.

Objective. This study examines the extent to which optimism, control beliefs and motivation, and downward social comparison contribute independently to the maintenance of older adults positive self-evaluations in a functional domain. Method. Adaptive resources/strategies and life satisfaction were measured in personal interviews with 164 community-dwelling older adults. Participants judged their physical activity compared with the average person of their age and wore an accelerometer for 24 hours. Commonality analysis was used to estimate unique versus shared effects of the resource/strategy variables on a residual measure of self-enhancement, obtained by adjusting the comparative judgments for participants' age and objectively measured physical activity. Results. Self-enhancement was positively related to life satisfaction. Perceived control and optimism had shared positive effects on self-enhancement, whereas downward social comparison had a unique positive effect. Discussion. Self-enhancement of physical activity plays a part in at least two adaptive profiles with implications for older adults' well-being and health.

Perceived control and risk characteristics as predictors of older adults' health risk estimates.

Overestimating one's own health risks is associated with negative affect and decreased well-being. To identify psychosocial factors that reduce pessimistic risk estimates, the authors examined global perceived (primary and secondary) control as a predictor of health risk (hip fracture) estimates among 222 community-dwelling older adults. To determine whether characteristics of the health risk moderated the effects of perceived control on risk estimates, the authors manipulated risk level (low, high) and risk attribution (controllable, uncontrollable). The effects of perceived control differed as a function of risk attribution: Regardless of implied risk level, perceived primary control significantly predicted lower risk estimates in the controllable condition but not in the uncontrollable condition. In contrast, perceived secondary control significantly predicted lower risk estimates in the uncontrollable condition but not in the controllable condition, emphasizing its importance when direct influence is not feasible. The authors discuss implications for anticipating how older adults estimate their health risks.

Paradoxical Effects of Perceived Control on Survival.

Objectives: Appraising health as controllable is typically thought to be adaptive, but recent evidence suggests the paradoxical possibility that perceived control (PC) can be detrimental. We considered the premise that high PC should have a survival benefit when it is part of an adaptive mindset involving high value (importance) for health, but it might be detrimental when it is part of a mindset comprised of low health value (HV). In addition, we examined whether the survival consequences of PC and HV vary with advancing age. Method: Interviews were conducted with a heterogeneous sample of community-dwelling adults (n = 341; 72-99 years) to assess appraisals of control and value in the domain of health. Mortality data were obtained over 12 years from a provincial health registry. Results: Both age and HV moderated the PC effect on mortality. The predicted beneficial and detrimental PC effects emerged at younger ages: higher PC predicted longer survival times when health was highly valued but shorter survival times when health was less highly valued. Discussion: These findings deepen the knowledge regarding the conditions under which PC is or is not adaptive, suggesting the consequences depend on age and the extent to which health is valued.

Detrimental effects of falling on health and well-being in later life: the mediating roles of perceived control and optimism.

Falling is common among older adults, often resulting in decreased functional ability and quality of life. To understand processes underlying the fall/health and well-being relationship, it is important to identify psychosocial mediators. The current study examined the impact of falling on subsequent physical health, negative emotions and physical activity among 231 young-old (<85) and old-old (85+) community-dwelling adults, and the mediating effects of global perceived control (PC) and optimism. Regression results indicated that falling predicted poorer physical health, greater negative emotions and less physical activity among old-old but not young-old adults. Falling negatively predicted PC and optimism, which mediated the effects of falling on health and well-being among the old-old group. Findings have implications for enhancing recovery from falling via bolstering PC and optimism.

Comparative risk and perceived control: implications for psychological and physical well-being among older adults.

As older adults become more susceptible to certain health crises, their preoccupation with their risk of suffering such events increases. Understanding the implications of risk perceptions is critical because they may have consequences for psychological and physical well-being in later life. In the present study of older adults living in the community, the authors examined participants' comparative risk estimates (CREs)--their perceptions of their own risk relative to a similar other's risk--of suffering a hip fracture. Using multiple regression analyses, the authors examined the role of CREs on psychological well-being (negative emotions, life satisfaction) and self-rated physical well-being (general physical health, recent physical health). The authors expected perceived control (PC) to moderate the relationship between CREs and well-being. The predicted interaction did occur: Among individuals with high PC, comparative optimism (perceiving a comparatively low risk) was associated with better psychological well-being (fewer negative emotions and greater life satisfaction) and better physical well-being (general and recent physical health) relative to comparative pessimism (perceiving a comparatively high risk). Among individuals with low PC, there were no differences in well-being between comparative optimists and comparative pessimists. These findings suggest that the protective effect of comparative optimism on well-being is limited to older adults who have a strong sense of control.