Reasons for Unmet Health Care Needs Among Black, Hispanic, and White Children in the United States With or at Risk for Physical and Mental Health Conditions.

Children with special health care needs (CSHCN)-ie, children who are at increased risk for, or currently manage, persistent physical and mental health conditions-require more health care resources than children without special health care needs. Furthermore, CSHCN who identify as racial/ethnic minorities disproportionately encounter unmet needs, according to reports from their caregivers. However, the reasons for their unmet needs are relatively unknown. This study estimated and compared the US national prevalence of caregiver-reported reasons for unmet health care needs for Hispanic, non-Hispanic black, and non-Hispanic white CSHCN. The most common reasons were problems getting an appointment for black CSHCN and cost for Hispanic and white CSHCN. Issues related to transportation were significantly less likely for black than for white and Hispanic CSHCN. Cost-related issues were significantly less likely for black than Hispanic CSHCN. To address reasons for unmet needs for CSHCN, effective structural changes are needed.

Gender Differences in Drug Use among Individuals Under Arrest.

Background: Drug monitoring by drug testing of individuals under arrest provides an opportunity to detect drug use patterns within geographic areas. However, women have been omitted from large-scale monitoring efforts in criminal justice populations. The purpose of this study was to examine whether gender differences exist in drug use indicated by oral fluid collected in one U.S. jail. Methods: The study analyzed data collected in 2019-2020 from individuals under arrest (N = 191). Twenty-four percent of the sample identified as female. Oral fluid specimens were collected and then analyzed with enzyme-linked immunosorbent assay and liquid chromatography/tandem mass spectrometry. Logit regression models examined gender differences. Results: Women were more likely to test positive for methamphetamines than men (41% versus 22%, OR = 0.42, 95% CI 0.21-0.84). Significant gender differences were not found for other substances (marijuana, cocaine, and opioids), legality of drugs, or overall drug use. Conclusions: Because the National Institute on Drug Abuse aims to promote health equity, future drug monitoring in criminal justice populations should employ sampling approaches representing both women and men. This research would identify possible gender-based patterns of drug use and inform gender-based policies and clinical practices to prevent and treat drug misuse.

Teaching Trauma Content in Higher Education: A Systematic Literature Review.

Higher education must prepare future mental health providers to work with individuals who have been exposed to trauma. This is vital to the success of students' practice, many of whom would benefit from trauma reduction strategies in their own lives. The purpose of this systematic review is to summarize the knowledge base on teaching methods that may reduce the potential that trauma content in the classroom could cause: (a) re-traumatization; (b) vicarious traumatization; or (c) secondary traumatic stress (collectively "adverse consequences") in higher education students. This systematic review was conducted following PRISMA-P guidelines. A total of 27 peer-reviewed articles met the inclusion criteria, which included studies that focused on teaching methods that were used to teach trauma content for students in higher education, peer-reviewed articles, and articles published in English before February 12, 2020. Studies were identified based on key words and the full-text articles were reviewed by two authors who discussed discrepancies until consensus was obtained. Researchers recommend using a variety of teaching approaches, from teaching about self-care to journaling. However, the major findings showed that few studies analyzed the effectiveness of these methods, and that therefore, the effectiveness of various methods to address the adverse consequences of teaching trauma content is unknown. Further research is needed, including cross-sectional and longitudinal studies in this area.

Assessing for socioeconomic background diversity in behavioral health workforce development programs.

Assessing workforce diversity is an increasing area of evolution. A comprehensive assessment of socioeconomic diversity is important in that it can help identify needs and enable planned inclusion across a range of students. Subsequently, a more comprehensive set of background indicators is needed. The purpose of this brief report is to describe the approach we are using to determine socioeconomic background among individuals participating in a behavioral health workforce program. By using 3 strategies to assess background, we were able to determine that 4 individuals reported being unable to pay for housing, 3 indicated they had sold plasma, and 1 had experienced homelessness since starting graduate school. Our findings provide a starting point for using a comprehensive set of indicators to guide the recruitment and selection process in workforce development programs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adverse childhood experiences and mental health conditions among multiracial adolescents.

OBJECTIVE: The objective of this study was to verify the factor structure of the household dysfunction type of ACE using data from the National Survey of Children's Health (NSCH), and then examine whether household dysfunction (measured as a latent construct) was associated with mental health conditions among multiracial adolescents. DESIGN: We used cross-sectional data collected in 2016 from caregivers who completed the NSCH and analyzed data from a subpopulation of adolescents (12-17) who reported more than one race (n = 1,231). Mplus 8.4 was used to conduct confirmatory factor analysis and probit models from a structural equation modeling framework. RESULTS: Results from this study indicated that the household dysfunction type of ACE, as a latent construct, had good model fit and was significantly associated with depression [standardized coefficient [B] = .50, 95% confidence interval [CI] .36, .65], anxiety [B = .61, 95% CI .48, .73], behavior problems [B = .58, 95% CI .44, .72], and ADHD [B = .54, 95% CI .38, .69] for multiracial adolescents. CONCLUSIONS: Household dysfunction may result in adolescents being separated (physically or emotionally) from their caregivers, which may hinder adolescents' ability to establish or maintain one of the most important relationships needed to promote racial/ethnic identity development and mental health. Implications for advancements in theory and NSCH are presented.

Inclusion of Older Adults Who Experience Homelessness in Laboratory-Based Audiology Research: a Feasibility Study.

OBJECTIVES: The objective of this study was to recruit older adults who experience homelessness into a feasibility study on laboratory-based audiology research. DESIGN: Using best practices for recruiting individuals who experience homelessness into research, we aimed to recruit 25 participants over the course of six months. The protocol included hearing health history and hearing test. Individuals were also referred to services if needed and requested. RESULTS: Among the 11 study participants recruited, almost half of the individuals did not meet the inclusion criteria due to severe hearing loss, neurological disorders, and difficulty staying alert. CONCLUSIONS: We identified a few barriers to including older adults who experience homelessness in laboratory-based audiology research and discussed potential strategies. Our findings provide lessons for future audiology research on including a population of individuals who may be vulnerable to health disparity and often omitted from research.

Perceived changes in social interactions following military psychiatric hospitalization for a suicidal crisis.

Introduction Changes in social interactions following psychiatric hospitalization, a period characterized by heightened suicide risk, are important to understand. OBJECTIVE: We qualitatively explored perceived changes in social interactions one month after inpatient psychiatric discharge following a suicidal crisis. METHODS: A total of 113 United States Service members, recruited in the context of a psychotherapy randomized controlled trial, described the extent to which social interactions with family members, peers, and military commanders had changed. RESULTS: Most participants (82.3%) reported at least some change in social interactions, conveying six common themes. Showing more care and checking in more were frequently reported for family (24.8%, 20.4%), commanders (23.0%, 16.8%), and by peers (12.4%, 10.6%). Showing more concern was most frequently reported for family (13.3%) followed by peers (6.2%) and commanders (6.2%). Participants reported showing more caution from peers (14.2%), commanders (13.3%) and family (6.2%). Acting more distant was reported from commanders (7.1%), peers (7.1%), and family (5.3%). Showing negative reaction(s) was reported from commanders (8.0%), family (3.5%) and rarely for peers (0.9%). CONCLUSION: Inpatient providers are encouraged to prepare patients for potential changes in social interactions following psychiatric discharge and how to best respond to these changes.

Surveillance by oral fluid of drugs subject to misuse among individuals under arrest.

Background: Between 1988 and 2013 the U.S. government conducted surveillance of national drug misuse use trends by collecting voluntary urine specimens from individuals under arrest in major counties. It was discontinued for financial reasons. The program was the only national survey that used a bioassay to measure drug use. Other national drug surveys continue to be based entirely on self-reports of drug use.Objective: Given the current opioid and incipient methamphetamine epidemics, this study aimed to demonstrate the feasibility of surveilling drugs subject to misuse among individuals under arrest using oral fluid collected anonymously by jail staff in one U.S. county. This method has never been previously employed with an offender population.Methods: The subjects were adults arrested for any reason and booked in one Midwest county jail in the U.S. between July 2019 - January 2020 (N = 196; 145 males). Oral fluid specimens were provided for research purposes voluntarily and anonymously.Results: 79% of individuals approached consented to participation. The most frequently detected drugs were cannabis (53%), methamphetamine (27%), cocaine (9%) and opioids (11%). Further, 74% tested positive for at least one drug; 36% tested positive for at least one illegal drug, 10% tested positive for at least one possibly illegal drug, and 54% tested positive for at least one legal drug (predominantly cannabis). (Tests for nicotine and ethanol were not included.)Conclusion: The feasibility of collecting oral fluid from individuals under arrest in a jail setting to measure the prevalence of drugs subject to misuse was demonstrated.

Type 1 diabetes self-management behaviors among emerging adults: Racial/ethnic differences.

BACKGROUND: Emerging adulthood is a vulnerable period for poor blood glucose control and self-management behaviors (SMBs) among individuals with type 1 diabetes. Racial/ethnic minority young adults have poorer glycemic outcomes than non-Hispanic whites; however, little is known about possible racial/ethnic differences in frequency of SMBs among emerging adults (EAs). OBJECTIVE: To examine racial/ethnic differences in SMBs and to determine associations between SMBs and blood glucose control. METHODS: A sample of EAs (ages 18-25 years; N = 3456) from the type 1 diabetes exchange registry was used to conduct multivariate analyses to examine (a) racial/ethnic differences in SMBs and (b) associations between SMBs and blood glucose control for each racial/ethnic group. RESULTS: Compared to non-Hispanic whites, African Americans and Hispanics less frequently took an insulin bolus for snacks, less frequently checked blood glucose with a meter, and were more likely to not use insulin to carbohydrate ratios. African Americans also less frequently checked blood glucose prior to mealtime boluses and more frequently missed insulin doses. SMBs that were associated with blood glucose control across groups were frequency of checking blood glucose at mealtime, missing an insulin dose, and checking blood glucose with a meter. CONCLUSIONS: Promoting two SMBs: checking blood glucose and taking insulin doses as needed among African American EAs may be important to address racial disparities in glycemic outcomes. Future research should evaluate possible social and contextual mechanisms contributing to low engagement in these behaviors among African Americans to inform strategies to address racial differences in glycemic outcomes.

Youth Access to Medical Homes and Medical Home Components by Race and Ethnicity.

OBJECTIVES: Medical homes are an effective model of primary care. Historically, however, racial and ethnic minorities have not had equal access to medical homes. The present study estimated the national prevalence of youth's access to a medical home and its components by race and ethnicity. METHODS: We conducted secondary data analysis using the 2016-2017 National Survey of Children's Health, a nationally representative, cross-sectional survey of U.S. youth age 0-17 years (N = 62,308). We obtained weighted and unweighted descriptive statistics and conducted multivariate logit regression models. RESULTS: Although 49% of the total sample had access to a medical home, 57.1% of white youth had access compared to 37% of Hispanic youth and 39.7% of black youth. Among youth without a medical home, black youth had less access than white youth to a usual place for care (64.7% vs. 55.3%, adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI] 0.69-0.97) and family-centered care (78.1% vs. 66.7%, aOR = 0.64, 95% CI 0.52-0.79). Hispanic youth (68.2%) also had less access to family-centered care than white youth (aOR = 0.73, 95% CI 0.60-0.89). White youth were less likely to have access to effective care coordination, when needed, than Hispanic youth (46.2% vs. 53.5%, aOR = 1.35, 95% CI 1.09-1.66). CONCLUSIONS FOR PRACTICE: Our findings suggest racial/ethnic disparities exist in youth's access to a medical home and its components. We posit the need for continued efforts to enhance access to medical homes for all youth. Future studies need to examine systemic barriers to youth's access to medical homes.

Uncovering Profiles of Economic, Social, and Cultural Capital to Explore Depression Across Racial Groups.

Research exploring the association between socio-economic status (SES) and depression is limited by conceptualizations of SES and conflicting findings across racial groups. We broaden previous research by (1) reconceptualizing SES through the lens of Bourdieusian theory to identify profiles of economic, social, and cultural capital; (2) investigating whether these profiles differ for Black and white adults; and (3) exploring whether specific profiles of capital are associated with increased depression scores. This study analyzed secondary data from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of US individuals. A sub-population of the sample was used, which was comprised of 4339 Black and white participants from wave IV. To address the study aims, we used the new three-step approach to conducting latent class analysis. We identified five profiles of capital, the composition of which varied by race. Compared to Blacks, whites were more likely to be in the "cultural-economic capital" (14% vs. 10%), "elevated overall capital" (35% vs. 14%), and "social-economic capital" (13% vs. 10%) profiles, whereas Blacks were more likely to be in the "limited overall capital" (35% vs. 16%) and "moderate economic capital" (32% vs 22%) profiles. Profiles differed in risk for depression; the "limited overall capital" profile had the highest depression scores, whereas the "elevated overall capital" profile had the lowest depression scores. This research has the potential to reduce health disparities, by providing policy makers and researchers with information that will allow them to target populations that are most at risk for depression.

Estimated Prevalence of Psychiatric Comorbidities in U.S. Adolescents With Depression by Race/Ethnicity, 2011-2012.

PURPOSE: Comorbid psychiatric conditions in adolescents with depression are a public health concern. However, little is known about the prevalence of comorbidities in separate racial/ethnic groups. This study estimated the national prevalence of comorbidities for black, Hispanic, and white adolescents separately, and compared the prevalence of comorbidities between adolescents with and without depression. METHODS: This secondary analysis used data from the 2011-2012 National Survey of Children's Health, a nationally representative, cross-sectional survey of U.S. youth. We restricted the sample to 12-17 year olds, and obtained unweighted and weighted descriptive statistics. Using weighted probit regression models, we examined differences in prevalence of comorbidities by adolescents with and without depression for each racial/ethnic group. RESULTS: For black, Hispanic, and white adolescents with depression, the prevalence of comorbidities ranged from 8% to 61% and varied by race/ethnicity (e.g., depression and anxiety were comorbid for 47% of black, 54% of Hispanic, and 59% of white adolescents). For all racial/ethnic groups, adolescents with depression had a higher prevalence of attention deficit hyperactivity disorder than adolescents without depression. However, only black and Hispanic adolescents with depression had a significantly higher prevalence of anxiety and behavior problems than their counterparts without depression. In each racial/ethnic group, the prevalence of autism spectrum disorder did not differ between adolescents with and without depression. CONCLUSIONS: This study detected important differences in the prevalence of comorbid psychiatric conditions by race/ethnicity. Findings highlight the need for targeted interventions for black and Hispanic adolescents with depression that concurrently treat anxiety and behavior problems.

Diabetes-Specific and General Life Stress and Glycemic Outcomes in Emerging Adults With Type 1 Diabetes: Is Race/Ethnicity a Moderator?

Objective: This study examines whether race/ethnicity moderates relationships of (a) diabetes stress and general life stressors with (b) diabetes outcomes of glycemic control and diabetic ketoacidosis (DKA) among emerging adults (aged 18-25 years) with type 1 diabetes (T1D). Method: Using a T1D Exchange Registry sample of non-Hispanic White, African American, and Hispanic emerging adults (N = 3,440), multiple group analyses were used to determine whether race/ethnicity moderates the relationships between stress and diabetes outcomes. Results: The relationships between the two stress types and glycemic control did not differ between African American and non-Hispanic Whites. However, as compared with non-Hispanic Whites, the association between higher diabetes-specific stress and poorer glycemic control was significantly stronger for Hispanics, and Hispanics had poorer glycemic control when they experienced a relatively fewer number of general life stressors than non-Hispanic Whites. The relationships between the type of stress (diabetes-specific and general stress) and DKA did not differ across racial/ethnic groups. Conclusions: Future research should evaluate possible mechanisms that contribute to the different relationships of stress with glycemic control among Hispanics compared with non-Hispanic Whites.

Developmental Trajectories of Suicidal Thoughts and Behaviors From Adolescence Through Adulthood.

OBJECTIVE: Little is known about the patterns among individuals in the long-term course of suicidal thoughts and behaviors (STBs). The objective of this study was to identify developmental trajectories of STBs from adolescence through young adulthood, as well as risk and protective covariates, and nonsuicidal outcomes associated with these trajectories. METHOD: A total of 180 adolescents (ages 12-18 years at recruitment) were repeatedly assessed over an average of 13.6 years (2,273 assessments) since their psychiatric hospitalization. Trajectories were based on ratings of STBs at each assessment. Covariates included psychiatric risk factors (proportion of time in episodes of psychiatric disorders, hopelessness, trait anxiety, impulsivity, and aggression in adulthood, sexual and physical abuse, parental history of suicidal behavior), protective factors (survival and coping beliefs, social support in adulthood, parenthood), and nonsuicidal outcomes (social adjustment and functional impairment in adulthood, school drop-out, incarcerations). RESULTS: Using a Bayesian group-based trajectory model, 4 trajectories of STBs were identified: an increasing risk class (11%); a highest overall risk class (12%); a decreasing risk class (33%); and a low risk class (44%). The 4 classes were associated with distinct patterns of correlates in risk and protective factors and nonsuicidal outcomes. CONCLUSION: Adolescents and young adults have heterogeneous developmental trajectories of STBs. These trajectories and their covariates may inform strategies for predicting STBs and targeting interventions for individuals at risk for suicidal behavior.

Impact of patients' psychiatric hospitalization on caregivers: a systematic review.

OBJECTIVE: A systematic literature review was conducted to assess the impact of patients' psychiatric hospitalizations on caregivers. METHODS: A systematic search of the Web of Knowledge, PsycINFO, and MEDLINE (PubMed) was conducted for peer-reviewed articles published in English before August 31, 2013. Qualitative, quantitative, and mixed-methods studies were included if they focused on the outcomes of caregivers of either adult or youth patients and presented data collected directly from caregivers of patients who had been psychiatrically hospitalized. RESULTS: Twenty-nine articles met the inclusion criteria. The review found that caregivers are heterogeneous in their reaction to patients' psychiatric hospitalization; however, many report distress. Many caregivers have reported experiencing stigma, disruptions in daily life, worse general medical health, economic strain, and changes in relationships after hospitalization. Negative reactions to the hospitalization may decrease over time, but distress can remain elevated compared with the general population. Nonetheless, many caregivers have also reported experiencing positive changes as a result of the hospitalization. The reaction of caregivers may be influenced by the severity of the patient's psychiatric problems as well as the caregiver's demographic characteristics and style of coping. CONCLUSIONS: Caregivers experience a range of reactions to psychiatric hospitalizations. Providing caregivers with psychoeducation about their possible reaction to hospitalization and teaching them coping techniques may improve clinical outcomes for patients. Future research is needed to understand the heterogeneity in caregivers' reactions to patients' psychiatric hospitalization.

Profiles of Malawian adolescents at risk for HIV infections: implications for targeted prevention, policy, and practices.

Young people are at the center of the HIV epidemic. In fact, HIV has been referred to as a "youth-driven disease" worldwide. This cross-sectional study identified a typology of risk for HIV among Malawian adolescents, examined the distribution of HIV status within each group in the typology, and tested the association between class membership and changes in sexual behaviors to avoid HIV. The sample was restricted to males and females between the ages of 15 and 18 from three regions in Malawi who reported never having been married. Latent Class Analysis was conducted to examine youth population clusters based on shared characteristics. A chi-squared test was used to test whether class membership was associated with changes in sexual behaviors to avoid HIV. The study results indicate that two classes of risk exist among Malawian youths in this sample: At High Risk class and At Risk class. Individuals in the At High Risk class were significantly more likely than the At Risk class to perceive themselves as currently infected with HIV. The At High Risk class was not significantly less likely than the At Risk class to report changes in their sexual behaviors to avoid HIV. Findings are discussed and recommendations are suggested for clinicians to consider the heterogeneity among Malawi adolescents and tailor services accordingly. We provide suggestions on potential interventions that target the specific needs for the two groups to mitigate the spread of HIV among adolescents in Malawi.

SOCIAL ENVIRONMENTAL RISK AND PROTECTION: A TYPOLOGY WITH IMPLICATIONS FOR PRACTICE IN ELEMENTARY SCHOOLS.

Social environmental assessments can play a critical role in prevention planning in schools. The purpose of this study was to describe the importance of conducting social environmental assessments, demonstrate that complex social environmental data can be simplified into a useful and valid typology, and illustrate how the typology can guide prevention planning in schools. Data collected from 532 3(rd) through 5(th) graders using the Elementary School Success Profile were analyzed in the study. A latent profile analysis based on eight child-report social environmental dimensions identified five patterns of social environmental risk and protection. The classes were labeled High Protection, Moderate Protection, Moderate Protection/Peer Risk, Little Protection/Family Risk, and No Protection//School Risk. Class membership was significantly associated with measures of well-being, social behavior and academic performance. The article illustrates how the typology can be used to guide decisions about who to target in school-based preventions, which features of the social environment to target, and how much change to seek. Information is provided about online resources for selecting prevention strategies once these decisions are made.