Resource need and use of multiethnic caregivers of elders in their homes.

AIMS: The aim of this study was to predict South Florida family caregivers' need for and use of informal help or formal services, specifically, to explore the predictive power of variables suggested by the Caregiver Identity Theory and the literature and develop and test a structural model. BACKGROUND: In the USA, most of the care to older adults is given by family members. Caregivers make economic and social sacrifices that endanger their health. They feel burdened, if they receive no assistance with their tasks; however, services available are not sufficiently used. DESIGN: This cross-sectional correlational study was a survey of family caregivers in their home, using standardized and/or pre-tested scales and a cognitive status test of their patients. METHODS: A random sample of 613 multiethnic caregivers of frail elders were recruited in home care and community agencies. The interviews were held between 2006-2009. Analyses involved correlation and regression analyses and structural equation modelling. Outcome measures were need and use of family help and formal services. RESULTS/FINDINGS: The model yielded excellent fit indices replicated on three random samples of 370. The patients' functional limitations yielded the strongest predictive coefficients followed by caregiver stress. Cultural indicators played a minor role. CONCLUSION: The lack of a link between resource need and use suggested access barriers. Important for policy makers and service providers are the delivery of high-quality services and the use of a personal and individualized approach with all ethnicities. Quality service includes understanding the caregiving situations and requires a trusting relationship with family caregivers.

Domestic abuse against elder women and perceived barriers to help-seeking.

The study's (n = 447) purposes were to (1) describe relationships of abuser behavior to elder women's perception of barriers to help-seeking; (2) compare fit of model to participants' levels of abuse, race-ethnicity, age, and gender and relationship of identified close other; and (3) determine extent to which the model differentiated relationship of abuser to participant and level of abuse. Analyses identified six factors contributing to the overall barrier score, accounting for 84% of total variance (χ2/df = 1.527, CFI = .989, RMSEA = .034), including three internal and two external factors and a single abuser behavior factor that were invariant across participant characteristic; however, covariances did differ.

Patterns of caregiving of Cuban, other Hispanic, Caribbean Black, and White elders in South Florida.

Caregivers in Miami, Florida (185 Cubans, 108 other Hispanics, 229 non-Hispanic Whites, and 73 Caribbean Blacks) were described and compared along demographic and health variables, cultural attitudes, and caregiving behaviors. Participants were recruited at random through Home Health Services (61 %) and convenience sampling in the community (39 %), and interviewed at their home. Standardized instruments and measures constructed for this study were pretested. Multivariate analyses showed that the ethnic groups differed in age, education, income, and number of persons giving care, while caregiver health and patient functioning were similar. Controlling for demographics, differences in cultural variables were small. The sense of obligation, emotional attachment, openness about who should give care, spirituality, use of family help or community services were comparable in all groups. Commitment to caregiving was high, driven mainly by patient needs. Cubans had the greatest family stability, and worked the hardest, with the lowest sense of burden. Caribbean Black caregivers lived in bigger families, were youngest, and their patients had the lowest cognitive status. Burden was felt most by White caregivers who were older than the others. Professionals need to understand complex belief systems and behavior patterns to assist caregivers in mobilizing appropriate resources.

Self-regulation and eudaimonic well-being across adulthood.

UNLABELLED: BACKGROUND/STUDY CONTEXT: The authors developed and tested a model to examine the developmental self-regulatory pathways that lead to optimal eudaimonic well-being across adulthood. METHODS: Measures of goal adjustment, optimization, possible selves, and well-being were obtained from 590 adults ranging in age from 17 to 94. Structural equation modeling was used to determine the whether there were age-differential pathways among the developmental self-regulatory processes and well-being. RESULTS: The model predicts interactions among age, hoped-for possible selves, age-sensitive developmental processes (i.e., goal adjustment, optimization), and psychological well-being. Results showed direct effects of goal adjustment on well-being and indirect effects of goal adjustment and optimization on well-being through hoped-for possible selves. There were significant age differences in the indirect effects of goal adjustment on possible selves and well-being, such that, by age 55, these pathways disappear, and the role of future self-representations diminish. CONCLUSIONS: Findings indicate that the role of possible selves in regulating self-motivated development changes across the adult life span.

Health and cultural determinants of voluntary HIV testing and counseling among middle-aged and older Latina women.

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.

Field test of the feasibility and validity of using the Hoosier Assurance Plan Instrument for Adults in a state mental health program.

The current paper reports on the feasibility of using the HAPI-A, an instrument designed to assess a person's level of functioning in the community: (1) to help determine eligibility to receive behavioral health services, (2) to assign reimbursement case rates; and (3) to provide data for a service provider report card. A 3-year field study of the use of the instrument across an entire state mental health system explored the effectiveness of methods to enhance data accuracy, including annual training and a professional clinical record audit, and the ability of the test to detect differences in improvement rates within risk-adjusted groupings. The combination of training and auditing produced statistically significant, cumulative reductions in data errors across all 3 years of the field test. The HAPI-A also was sensitive in detecting differences among service providers in outcome improvements for six of six risk-adjusted groups rated at the moderate level of impairment and for five of six groups rated at the mild level of impairment, but was inconsistent in detecting outcome differences for persons rated at the severe level of impairment.

Randomized controlled trial to determine the effectiveness of an interactive multimedia food safety education program for clients of the special supplemental nutrition program for women, infants, and children.

BACKGROUND: Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections. OBJECTIVE: To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients. DESIGN: A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention. SUBJECTS/SETTING: Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic. INTERVENTION: Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk. MAIN OUTCOME MEASURES: Change from pre- to postintervention food safety scores. STATISTICAL ANALYSES PERFORMED: A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance. RESULTS: Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score. CONCLUSIONS: The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Psychosocial outcomes in later life: a multivariate model.

A conceptual model was developed to identify developmental self-regulatory pathways to optimal psychosocial outcomes in adulthood. The model delineates influences among age, possible selves, developmental processes (i.e., coping, control), and well-being. Results showed age effects on all constructs except selective control. Three consistently common predictors of well-being (i.e., goal pursuit, goal adjustment, and optimization) emerged. The effects of age on well-being were differentially mediated by developmental processes. Specifically, negative age-related changes in offensive processes (i.e., goal attainment) were offset by positive influences of defensive processes (i.e., goal adjustment), which had the net effect of preserving well-being. The model demonstrates a more optimistic pattern of aging in which gains offset losses leading to positive outcomes and highlights the importance of examining both independent and combined influences of age, self, and developmental processes on psychosocial outcomes.

Food safety practices among pregnant women and mothers in the women, infants, and children program, Miami, Florida.

Pregnant women and infants are two groups at the highest risk of severe outcomes from foodborne illnesses. We surveyed adult clients of a Women, Infants, and Children (WIC) clinic serving predominately African Americans in inner-city Miami, Florida, to assess food safety practices. Eligible and consenting women completed a 23-item self-administered survey with questions concerning food handling practices around the Partnership for Food Safety Education's Fight BAC! campaign constructs of "clean", "separate" (not cross-contaminated), "cook", and "chill". Of 342 eligible clients, 299 (87.4%) consented to participate. In general, the clients' food safety practices were most problematic in the cook and chill constructs. Using a cooking thermometer, refrigerating foods within 2 h, and thawing them safely were the least commonly reported safe practices. Women who were pregnant with their first child had the lowest food safety practice scores. Of the 62 pregnant participants, 32 (51.6%) reported eating hot dogs or deli meats without first reheating them some of the time or more often, and 22 (35.5%) reported eating soft cheeses and blue-veined cheeses some of the time or more often, putting the women at risk of listeriosis. Although all women in the WIC program could benefit from food safety education, these findings indicate that women during their first pregnancy should especially be targeted for food safety education.

Planning for long-term care: concept, definition, and measurement.

PURPOSE: This study explores the development and testing of an instrument to measure long-term-care planning behavior. DESIGN AND METHODS: Researchers operationalized proposed constructs and response styles as statements in a questionnaire. A telephone survey involved 150 randomly selected residents of Miami-Dade County, Florida who were between the ages of 55 and 70. Responses underwent exploratory and confirmatory factor analyses and reliability testing. RESULTS: The trimmed long-term-care planning instrument of 23 items had five subscales with high internal reliability (coefficients >.70), a comparative fit index of.987, and a root mean square error of approximation of.050. Responses involved making choices about housing, readiness to use help from family and friends, maintaining one's health, saving and investing money, and not accepting the need to ask for help. IMPLICATIONS: Future research of long-term-care planning behaviors can use the instrument. Practitioners may use the instrument as a diagnostic inventory, alone or in combination with personalized educational interventions aimed at increasing awareness of and planning for future dependency and long-term-care assistance.

Longitudinal Analysis when the Experimenter does not Determine when Treatment Ends: What is Dose-Response?

The most appropriate amount of psychotherapy to address a particular problem is of interest to clinicians, consumers and those responsible for funding of care. The dose-response relationship has been examined within the context of randomized clinical trials, meta-analysis as well as naturalistic studies; however, each of these approaches has limits. Many of these approaches have conceptually blurred two distinct concepts: do participants with different characteristics need different amounts of therapy and do otherwise equal participants show different outcomes when given different levels of (a particular type of) therapy? For any study design, if the experimenter does not determine the duration of therapy, then the length of therapy is said to be endogenous. This endogeneity can bias any attempt to untangle the answer to these two questions. An extension of the biasing effect of this endogeneity involves the choice of times to assess outcome; if outcome assessment depends on when therapy is terminated (rather than exogenously chosen) then estimates of the trajectory of outcome may be biased. Design considerations to minimize this effect are discussed.

Theory-driven intervention improves calcium intake, osteoporosis knowledge, and self-efficacy in community-dwelling older Black adults.

OBJECTIVE: To assess the effectiveness of an osteoporosis education program to improve calcium intake, knowledge, and self-efficacy in community-dwelling older Black adults. DESIGN: Randomized repeated measures experimental design. SETTING: Churches and community-based organizations. PARTICIPANTS: Men and women (n = 110) 50 years old and older from 3 south Florida counties. INTERVENTION: Participants randomly assigned to either of 2 groups: Group 1 (experimental group) or Group 2 (wait-list control group). Group 1 participated in 6 weekly education program sessions immediately following baseline assessment, and Group 2 started the program following Group 1's program completion. A tested curriculum was adapted to meet the needs of the target population. MAIN OUTCOME MEASURES: Dietary calcium intake, osteoporosis knowledge, health beliefs, and self-efficacy. ANALYSIS: Descriptive and summary statistics, repeated measures analysis of variance, and regression analysis. RESULTS: Of the total participants, 84.6% completed the study (mean age = 70.2 years). Overall, an educational program developed with a theoretical background was associated with improvement in calcium intake, knowledge, and self-efficacy, with no effect on most health belief subscales. Assigned group was the major predictor of change in calcium intake. CONCLUSIONS AND IMPLICATIONS: A theory-driven approach is valuable in improving behavior to promote bone health in this population. Health professionals should consider using more theory-driven approaches in intervention studies.

Food safety education using an interactive multimedia kiosk in a WIC setting: correlates of client satisfaction and practical issues.

OBJECTIVE: To assess acceptability of food safety education delivered by interactive multimedia (IMM) in a Supplemental Nutrition Program for Women, Infants and Children Program (WIC) clinic. METHODS: Female clients or caregivers (n=176) completed the food-handling survey; then an IMM food safety education program on a computer kiosk. Satisfaction with program, participant demographics, and change in food-handling behavior were assessed by univariate analyses. RESULTS: Over 90% of the participants enjoyed the kiosk, and most (87.5%) reported using computers a lot. Compared with participants with education beyond high school, participants with less education were more likely to report enjoying the kiosk (98.2% vs 88.1%, P = .007), preferred learning with the kiosk (91.7% vs 79.1%, P = .02), and would like to learn about other topics using IMM (95.4% vs 86.6%, P = .04). CONCLUSIONS AND IMPLICATIONS: Food safety education delivered by IMM was well accepted by inner-city WIC clinic clients, including those with less education.

Diarrheal illness among women, infants, and children (WIC) program participants in Miami, Florida: implications for nutrition education.

OBJECTIVE: To assess risk factors for diarrheal illness among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Miami, FL. DESIGN: A cross-sectional survey with questions about demographics, food safety practices, and diarrheal illness. SETTING: WIC clinic operated by the Miami-Dade County Health Department in Florida. WIC is a national program for nutritionally at-risk, low-income young children and pregnant or postpartum women. PARTICIPANTS: WIC female clients at least 18 years of age who are able to read and speak English (n = 299). MAIN OUTCOME MEASURE: Diarrheal illness, defined as having at least 3 loose stools for 2 or more consecutive days during the previous 30 days. ANALYSIS: Univariate and multiple logistic regression analyses. RESULTS: Food safety behaviors significantly associated with diarrheal illness included not washing hands before preparing meals (P = .048) and baby bottles (P = .045) or after changing diapers (P = .009) and not washing all items that touched raw meat before preparing the next food item (P = .023). In general, pregnant women reported less frequent hand washing and had a lower food safety score than nonpregnant women (P = .002). CONCLUSIONS AND IMPLICATIONS: These findings suggest that interventions to improve food handling practices such as proper hand washing are needed for WIC clients, particularly pregnant women.

The relationship of built environment to perceived social support and psychological distress in Hispanic elders: the role of "eyes on the street".

BACKGROUND: Research on contextual and neighborhood effects increasingly includes the built (physical) environment's influences on health and social well-being. A population-based study examined whether architectural features of the built environment theorized to promote observations and social interactions (e.g., porches, windows) predict Hispanic elders' psychological distress. METHODS: Coding of built environment features of all 3,857 lots across 403 blocks in East Little Havana, Florida, and enumeration of elders in 16,000 households was followed by assessments of perceived social support and psychological distress in a representative sample of 273 low socioeconomic status (SES) Hispanic elders. Structural-equation modeling was used to assess relationships between block-level built environment features, elders' perceived social support, and psychological distress. RESULTS: Architectural features of the front entrance such as porches that promote visibility from a building's exterior were positively associated with perceived social support. In contrast, architectural features such as window areas that promote visibility from a building's interior were negatively associated with perceived social support. Perceived social support in turn was associated with reduced psychological distress after controlling for demographics. Additionally, perceived social support mediated the relationship of built environment variables to psychological distress. CONCLUSIONS: Architectural features that facilitate direct, in-person interactions may be beneficial for Hispanic elders' mental health.

Barriers to help-seeking for older women who experience intimate partner violence: a descriptive model.

PURPOSE: The paper describes a model of barriers to help-seeking (MBHS) for older women who experience domestic violence (DV). DESIGN AND METHODS: Data were collected from 134 women ages 45 to 85 years in 21 focus groups. Computer-assisted qualitative data analysis software (ATLAS.ti) was used to organize transcript analysis and provided access to the quotations upon which codes, themes, relationship maps, and other elements of the analysis were constructed. RESULTS: Twelve themes emerged that showed strong relationships with experience of DV and barriers to help-seeking concepts. The resulting model of barriers to help-seeking (MBHS) illustrates how identified internal and external factors interrelate with each other and with an abuser's behaviors to create help-seeking barriers. The model also reflects the determination that, for study participants, there was no discernable point where characteristics of the experience of DV ended and resistance to help-seeking began. IMPLICATIONS: Development of services specifically suitable to the needs and desires of older women who experience DV is vital. Professionals in all service segments must more fully understand the help-seeking barriers that older DV victims face. To this end, the research community is challenged to replace myths and stereotypes about the nature and prevalence of DV among older people with empirically derived knowledge.

The Hoosier Assurance Plan Instrument for Adults (HAPI-A): the psychometric properties of a level of functioning assessment instrument designed for use in a state managed care mental health program.

The psychometric properties of the HAPI-A were examined at intake and 90-day follow-up in consumers with mental illness (MI) or chronic addiction (CA) being served at one of 11 treatment facilities (n = 1168). A 4-factor subscale structure was confirmed and factor invariance tests indicated a single model for the CA and MI samples. Internal consistency and inter-rater reliability were good (ICCs = 0.72-0.88). Factor scores correlated with GAF ratings and predicted membership in severity/cost groupings proposed for setting reimbursement rates. Sensitivity to change was confirmed for all four factors for the CA sample and for three of four factors for the MI sample.

Internal barriers to help seeking for middle-aged and older women who experience intimate partner violence.

There has been relatively little qualitatively or quantitatively published research to guide the field in identifying and addressing barriers to seeking help for older women who experience domestic violence. Women over the age of 45 have seldom been participants in research on domestic violence. This paper describes results from a qualitative study that focused on reactions to and internalization of abusive behaviors of an intimate partner. Twenty-one focus groups were conducted with 134 middle- aged and older women. Analysis of the data identified six factors that describe reactions to abusive behavior that become barriers to help seeking, including self-blame, powerlessness, hopelessness, the need to protect family, and the need to keep such abuse secret from others. These.

Equivalence to normal?

The two articles discussed are integral ingredients of a greater whole Ken Howard envisioned. The first (Saunders, Howard, & Newman, 1988) refined our understanding of clinical significance, challenging researchers to clearly define the character and range of behaviors identified as normal or nonclinical for a specific population. The second (Rogers, Howard, & Vessey, 1993) focused on tests of equivalency between two experimental groups. Both were part of a general theme: A study's outcome requires a careful delineation of the norms and "normality" for that population as well as to whether the differences or equivalencies of the outcomes from these norms are important to the client, to the client's family, or to the community/society in which the client is to function. Ken's second authorship, typical on his many publications, honored his dedication to mentoring those who would improve upon what is currently understood.

Familias Unidas: the efficacy of an intervention to promote parental investment in Hispanic immigrant families.

This paper reports a test of the efficacy of Familias Unidas, a Hispanic-specific, ecologically focused, parent-centered preventive intervention, in promoting protection against and reducing risk for adolescent behavior problems. Specifically, the intervention was designed to foster parental investment, reduce adolescent behavior problems, and promote adolescent school bonding/academic achievement, all protective factors against drug abuse and delinquency. One-hundred sixty seven Hispanic families of 6th and 7th grade students from three South Florida public schools were stratified by grade within school and randomly assigned to intervention and no-intervention control conditions. Results indicated that Familias Unidas was efficacious in increasing parental investment and decreasing adolescent behavior problems, but that it did not significantly impact adolescent school bonding/academic achievement. Summer-vacation rates of adolescent behavior problems were six times higher in the control condition than in the intervention condition. Furthermore, change in parental investment during the intervention was predictive of subsequent levels of adolescent behavior problems. The findings suggest that Familias Unidas is efficacious in promoting protection and reducing risk for adolescent problem behaviors in poor immigrant Hispanic families.