Time in childhood extracurricular activity and mental health of young adults with developmental disability.

BACKGROUND: People with developmental disability have higher rates of mental health problems such as anxiety, depression, psychological distress, or a limited sense of belonging to a community. Extracurricular activity can help children and adolescents build social connections beyond family, increasing social capital, which may promote mental health in the transition into adulthood. Little is known about such associations among people with developmental disability. OBJECTIVE: To examine associations of childhood extracurricular activity with mental health in young adulthood among people with and without developmental disability. METHODS: Data: Panel Study of Income Dynamics (PSID, 1968-2017), its Child Development Supplement (1997, 2002, 2007) and its Transition into Adulthood Supplement (2005-2019) (n = 2801). Time diaries measured time in activity. Outcomes were psychological distress (Kessler K6) and flourishing (Mental Health Continuum-Short Form). Adjusted linear regressions modeled associations. RESULTS: In nationally representative results, 9.6 % (95 % confidence interval, CI 7.8, 11.4) had a disability. Children without disability reported more average weekly time in group activity, 125.1 min (CI 113.2, 136.9) vs. 93.6 (CI 55.1, 132.0; not significant at conventional levels). In adjusted results, "some" group activity (0-180 weekly minutes) was associated with greater flourishing for those with developmental disability (0.89; CI 0.16, 1.61). CONCLUSIONS: Among people with developmental disability, group activity in childhood was associated with greater flourishing in young adulthood. More research is needed to understand the complex nature of activity participation for children with developmental disabilities.

A pilot study of the adverse childhood experiences-dimensions questionnaire (ACE-DQ): Associations with depression.

BACKGROUND: Recent ACE research proposed items to assess ACE dimensions, such as the frequency or timing of adverse events, that can be added to the original ACE-Study Questionnaire. OBJECTIVE: The goal of our study was to pilot-test the refined ACE-Dimensions Questionnaire (ACE-DQ) to determine its predictive validity and compare scoring approaches. PARTICIPANTS AND SETTING: Cross-sectional online survey via MTurk with U.S. adults to collect data on the ACE-Study Questionnaire and the newly developed ACE dimension items, and mental health outcomes. METHODS: We compared ACE exposure by assessment approach and their associations with depression outcomes. We used logistic regression to compare the predictive validity of different ACE scoring approaches for depression outcomes. RESULTS: Participants (n = 450) were on average 36 years old, half were female, and the majority was White. Almost half reported depressive symptoms; approximately two-thirds had experienced ACEs. Participants reporting depression had significantly higher ACE scores. Using the ACE index, participants with ACEs were 45 % more likely to report depression symptoms than participants without ACEs (OR 1.45, 95%CI 1.33-1.58). When using perception-weighted scores, participants had smaller, yet significant odds of reporting depression outcomes. CONCLUSIONS: Our results suggest that the ACE index may overestimate the impact of ACEs and the effects of ACEs on depression. Adding the comprehensive set of conceptual dimensions to more fully weigh participants' experience of adverse events can increase the accuracy of ACE measurement but will also increase participant burden considerably. We recommend including items to assess a person's perception of each adverse event for improved screening efforts and in research focused on cumulative adversity.

The dimensionality of adverse childhood experiences: A scoping review of ACE dimensions measurement.

OBJECTIVE: Despite extensive research, the concept of adverse childhood experiences (ACEs) is not fully developed and there is low agreement on how the concept should be defined and measured. The purpose of this study was to 1) identify different conceptual dimensions associated with ACEs, such as timing or frequency; and 2) determine how these dimensions have been operationalized and analyzed to this point, in order to advance the conceptual understanding of ACEs. METHODS: We conducted a scoping review of empirical journal articles on ACEs published after the original ACE-Study in 1998 to summarize the use of dimensions for the 10 conventional ACE domains. We used a PRISMA methodology to identify articles that assessed at least two of the 10 conventional ACE domains and at least two ACE dimensions. A standardized data extraction spreadsheet was used to record basic article information and specifics on ACE domains and dimensions. RESULTS: Of 15,417 initial search results, 61 articles met all selection criteria. We identified four primary dimensions used for most ACE domains: frequency, timing, perception, and the role of the perpetrator. Additionally, we found several secondary and domain-specific dimensions, which relate to the intensity of the adverse event. DISCUSSION: We identified the most commonly used ACE dimensions, but these lack standardized phrasing of items and response options. The inclusion of ACE dimensions may increase the accuracy of the association between ACEs and health outcomes and provide for more tailored treatment plans for people who have experienced ACEs. Future research should include a more comprehensive list of ACE domains and aim to develop a clearly articulated, standardized approach to assessing and analyzing ACE dimensions.

Universal Design for Measurement: Centering the Experiences of Individuals With Disabilities Within Health Measurement Research.

People with disabilities comprise roughly 25% of the U.S. adult population yet remain underrepresented in mainstream public health and evaluation research. The lack of measures of common constructs that are validated in but not specific to this population may impede their inclusion. This article describes the use of Universal Design for Measurement (UDM), a novel method for developing self-report measurement instruments validated among broad populations to minimize the need for scale adaptation. We applied UDM to the development and content validation of a new body image scale. We assessed content validity by surveying subject matter experts (SMEs) and conducted a Delphi panel study to assess consensus about scale items among community women with (n = 18) and without (n = 15) disabilities. Most scale items were found acceptable by SMEs and community women. The Delphi panel study was useful toward evaluating consensus about scale items among women with and without disabilities. Findings support the use of UDM in developing inclusive and psychometrically sound measurement scales to ultimately facilitate the full inclusion of people with disabilities within health research.

Examining the Role of Childhood Adversity on Excess Alcohol Intake and Tobacco Exposure among US College Students.

BACKGROUND: Adverse childhood experiences (ACEs) are often associated with substance use behaviors such as drinking excess alcohol and tobacco use. Resilience may protect individuals from engaging in these maladaptive behaviors following ACEs. Objectives: We examined the associations between ACEs and excessive alcohol consumption, and ACEs and tobacco intake and exposure among diverse college students, and whether resilience buffered this relationship. Methods: We conducted a cross-sectional online survey in October 2018 with students at a large Southern university to assess ACEs, levels of resilience, and students' health behaviors. We used the Adverse Childhood Experiences - International Questionnaire (ACE-IQ) and the Brief Resilience Scale. Logistic regression modeled the relationship between ACEs and students' substance use behaviors. We adjusted for demographics, other health behaviors, and emotional health and we tested resilience as a possible buffer. Results: Participants (n = 568) were in their early twenties, almost three-fourths were female. We had a racially/ethnically diverse sample. Over two-thirds had experienced 1-4 ACEs. ACE exposure was not associated with excess alcohol consumption but exhibited a consistent dose-response relationship in unadjusted and adjusted models. Moderate ACEs increased the odds of tobacco exposure by 227% (OR: 3.27, 95% CI: 1.17-9.11) in adjusted models. Resilience was unrelated to either behavior. Black respondents had significantly reduced odds for both substance use outcomes. Tobacco exposure and excess alcohol intake were comorbid behaviors. Conclusion: Childhood adversity was a significant predictor for tobacco exposure among diverse US college students. Resilience did not buffer this relationship. Age, gender, and race/ethnicity were differentially associated with substance use.

The Association Between Childhood Adversity and Self-Rated Physical Health in US College Students.

PURPOSE: Adverse childhood experiences (ACEs) are related to unhealthy behaviors and poor self-rated health. Poor self-rated physical health (SRPH) is negatively associated with college students' grades and overall academic achievement. This study examined the effects of ACEs on SRPH among undergraduate and graduate students (n = 568; 18-30 years) from a public university in the southeast. METHODS: Students completed a cross-sectional online survey in October 2018. We conducted unadjusted and adjusted logistic regressions to examine the relationship between ACEs and SRPH among US college students. RESULTS: Most participants reported 1 to 4 ACEs; one-fourth reported poor SRPH. Higher ACE exposure increased the odds for poor SRPH in a curvilinear relationship. Unadjusted results indicate ACE exposure increased risk between 82% and 228%, and that higher levels of resilience and adherence to diet and physical activity guidelines reduced risk for poor SRPH. In adjusted models, moderate ACE exposure was associated with 2.46 times greater odds (95% CI = 1.28-9.34) of reporting poor SRPH. Graduate students (odds ratio [OR] = .52, 95% CI = .27-.99) and those who met healthy diet (OR = .12, 95% CI = .02-.93) and physical activity recommendations (OR = .36, 95% CI = .23-.58) had reduced odds of poor SRPH. CONCLUSIONS: Students who have experienced ACEs are at a greater risk for poor health. Student health programs on campus should take a holistic approach by screening students for childhood adversity and promoting healthy behaviors to improve physical health.

The Relationship between Patient-Centered Medical Home Characteristics and Patient Dissatisfaction at a Federally Qualified Health Center.

This cross-sectional study examined the relationship between patients' assessment of patient-centered medical home (PCMH) characteristics and patient experiences at a federally qualified health center. The survey was based on the Consumer Assessment of Health care Providers and Systems (CAHPS) instrument. Patient-centered medical home characteristics include access to care and coordination, provider communication, office staff helpfulness, and discrimination. Outcomes were related to patient experiences reflecting their dissatisfaction and lack of trust. Our sample (N = 257) was 76% female, 39% older than 50, 40% with college education, and 84% African American. We performed multiple logistic regression to examine the association between PCMH characteristics and patient dissatisfaction, adjusting for demographics. Approximately 26% of the participants reported dissatisfaction with at least one outcome. Effective provider communication was the primary contributor to decreased odds of patient dissatisfaction and lack of trust. The study highlights the prominence of provider communication for patients using safety-net providers.

Body image, self-esteem, and behavioral risk for chronic disease among college students: Additional evidence for integrated prevention.

Objective: To examine associations between two body image constructs (body appreciation and body satisfaction) and five health behaviors (diet, physical activity, weight management, tobacco exposure, and alcohol intake) associated with risk for chronic disease, controlling for self-esteem. Participants: Three hundred and forty-four college students enrolled at a large, public university in the southeastern US. Methods: Students completed an online survey composed of measures of body appreciation, body satisfaction, self-esteem, and frequency of engagement in preventive health behaviors. Hierarchical linear regression models were used to assess relationships between constructs. Results: Body appreciation, but not body satisfaction or self-esteem, significantly and positively predicted engagement in diet-, physical activity-, and weight-related health behaviors. No associations were found for substance use outcomes. Conclusions: Results illuminate health risks among college students and provide additional evidence to support the development of holistic preventive interventions that simultaneously address aspects of mental and physical health among college students.

Relative and Cumulative Effects of Hypertension Self-Care Behaviors on Blood Pressure.

New recommendations for hypertension (HTN) diagnosis and treatment highlight the role of self-care activities in managing blood pressure (BP). This cross-sectional study investigated the predictive validity of the Hypertension Self-Care Activity Level Effects (H-SCALE) measure and examined the relative and cumulative effects of HTN self-care adherence on BP. We pooled baseline data from three studies (N = 79), resulting in a gender and racially balanced sample. Partial correlations determined the relative effects of individual self-care behaviors on BP. We modeled the relationship between adherence to self-care behaviors and BP control using logistic regression. Physical activity had the greatest correlation with systolic BP. Adherence to each additional self-care behavior increased the odds of systolic BP control by 88% (95% confidence interval (CI) = [1.20, 2.96]) and diastolic BP control by 74% (95% CI = [1.10, 2.75]). Results provide further evidence that the H-SCALE is a valid assessment tool and should be adopted by clinicians to aid in improving BP management.

"It's very valuable to me that I appear capable": A qualitative study exploring relationships between body functionality and appearance among women with visible physical disabilities.

A current hypothesis is that women who learn to focus on their body's functionality versus appearance may experience improved body image outcomes. This research is underdeveloped in considering the perspectives of women with visible physical disabilities (WPD), who have differences in body functionality and appearance that influence their body image. Our study aimed to understand how WPD conceptualize body image and body functionality and to clarify relationships between these constructs. We conducted semi-structured interviews with 15 women representing a range of ages (21-53 years) and disabilities. We used a constructivist grounded theory approach, applying the constant comparative method and engaging in reflexivity throughout the research process. We interpreted themes and subthemes based on their emergence across and explanatory value within cases to develop a conceptual model of the findings. Four major themes emerged: meanings and definitions, body image stability, factors that influence body image, and the interaction of appearance and body functionality. A new concept, "functional-aesthetic body image," emerged describing women's perceptions about the appearance of their body when engaged in functions or activities. Results may stimulate advancements in body image theory and measurement, and guide further exploration of the complex appearance-functionality relationship and its links with holistic health outcomes.

Patient-centered communication: dissecting provider communication.

PURPOSE: The purpose of this paper is to examine the relationship between patients' provider communication effectiveness and courteousness with patients' satisfaction and trust at free clinics. DESIGN/METHODOLOGY/APPROACH: This cross-sectional survey (n=507), based on the Consumer Assessment of Healthcare Providers and Systems instrument, was conducted in two Southeastern US free clinics. Latent class analysis (LCA) was used to identify patient subgroups (clusters) with similar but not immediately visible characteristics. FINDINGS: Across the items assessing provider communication effectiveness and courteousness, five distinct clusters based on patient satisfaction, trust and socio-demographics were identified. In clusters where communication and courteousness ratings were consistent, trust and satisfaction ratings were aligned with these domains, e.g., 54 percent rated communication and courteousness highly, which was associated with high patient satisfaction and trust. When communication effectiveness and courteousness ratings diverged (e.g., low communication effectiveness but high courteousness), patient trust and satisfaction ratings aligned with communication effectiveness ratings. In all clusters, the association was greater for communication effectiveness than for provider courteousness. Thus, provider courteousness was important but secondary to communication effectiveness. PRACTICAL IMPLICATIONS: Investment in patient-centered communication training for providers will improve patient satisfaction and trust. ORIGINALITY/VALUE: The study is the first to examine individual provider communication components and how they relate to patient satisfaction and trust in free clinics. LCA helped to more fully examine communication constructs, which may be beneficial for more nuanced quality improvement efforts.

Yoga is for Every (Able) Body: A Content Analysis of Disability Themes within Mainstream Yoga Media.

Yoga is increasingly being recommended as a health self-management strategy for people with a range of disabilities. Mainstream yoga media have been criticized for limited representation of racial/ethnic, gender, age, and body size diversity within their publications; however, it is not known how these media outlets include visual representations of or textual information relevant for people with disabilities (PWDs). The purpose of this research was to understand if and how mainstream yoga media visually represent and include information for PWDs. We conducted a content analysis of the "Yogapedia" section of each Yoga Journal magazine published in 2015 and 2016 (n = 17). Two independent coders rated all of the images and text in these sections. Data were analyzed using a thematic approach informed by a prominent theoretical model of disablement. Results suggest that images contained no representation of disability. In contrast, magazine text included an abundance of references to disability; however, these mentions predominately aligned with constructs found early in the disablement process and strongly focused on physical and mobility limitations. These findings expand upon previous research examining the underrepresentation of marginalized groups within yoga media and illuminate a paucity of relevant information for individuals with disabilities who are interested in and may benefit from yoga practice.

ECHO: A Pilot Health Literacy Intervention to Improve Hypertension Self-Care.

Background: Medication adherence and diet and weight control are essential contributors to blood pressure management. Low health literacy is also associated with poor health behaviors and outcomes among adults with hypertension. Objective: This study aims to pilot test the acceptability and feasibility of a brief health literacy intervention focused on hypertension self-care and to assess changes in self-care activities. Methods: We recruited patients with hypertension who were treated at a low-cost clinic. A 2-hour evidence-based class was delivered in Spanish and English, and a telephone follow-up survey was conducted 1 month later. Intervention content included health literacy activities, nutrition education, and medication use. Participants engaged in reading, writing, a group activity, and critical discussion. Health literacy was measured using the Newest Vital Sign and the Test of Functional Health Literacy in Adults. Key Results: The intervention was delivered to 52 English- (52%) and Spanish-speaking adults (48%) with a mean age of 52.3 years (SD 7.9). More than one-half had Stage 1 or 2 hypertension (54%), and 56% had inadequate health literacy. At 1-month follow-up, participants showed improvement on all self-care measures with significant mean differences (p < .05) on diet adherence and weight management activities. These improvements were largely among Hispanics and those with low health literacy. Conclusions: Results suggest that teaching targeted self-care skills in a brief health literacy intervention can be effective in improving self-care activities relating to diet and weight management among vulnerable populations. [HLRP: Health Literacy Research and Practice. 2019;3(4):e259-e267.]. Plain Language Summary: This study explored the effects of a 2-hour health education class on self-care behaviors. At the follow-up, participants reported better self-care behaviors. Effects were more pronounced among those with low health literacy, suggesting brief exposure to health education may improve high blood pressure in this population.

A comparison of blood pressure reductions following 12-weeks of isometric exercise training either in the laboratory or at home.

Isometric exercise training (IET)-induced reductions in resting blood pressure (RBP) have been achieved in laboratory environments, but data in support of IET outside the laboratory are scarce. The aim of this study was to compare 12 weeks of home-based (HOM) IET with laboratory-based, face-to-face (LAB) IET in hypertensive adults. Twenty-two hypertensive participants (24-60 years) were randomized to three conditions: HOM, LAB, or control (CON). IET involved isometric handgrip training (4 × 2 minutes at 30% maximum voluntary contraction, 3 days per week). RBP was measured every 6 weeks (0, 6, and 12 weeks) during training and 6 weeks after training (18 weeks). Clinically meaningful, but not statistically significant reductions in RBP were observed after 12 weeks of LAB IET (resting systolic blood pressure [SBP] -9.1 ± 4.1; resting diastolic blood pressure [DBP] -2.8 ± 2.1; P > .05), which was sustained for 6 weeks of detraining (SBP -8.2 ± 2.9; DBP -4 ± 2.9, P > .05). RBP was reduced in the HOM group after 12 weeks of training (SBP -9.7 ± 3.4; DBP -2.2 ± 2.0; P > .05), which was sustained for an additional 6 weeks of detraining (SBP -5.5 ± 3.4; DBP -4.6 ± 1.8; P > .05). Unsupervised home-based IET programs present an exciting opportunity for community-based strategies to combat hypertension, but additional work is needed if IET is to be used routinely outside the laboratory.

Translation and pilot testing of a measure to assess hypertension self-care activities among Hispanics.

OBJECTIVE: Hispanics in the US have high rates of uncontrolled hypertension in comparison to non-Hispanic whites. This pilot study reports on the translation of a validated measure, the Hypertension Self-Care Activity Level Effects (H-SCALE), for use with Spanish speakers. The H-SCALE assesses Hispanics' adherence to lifestyle activities that contribute to primary and secondary risk reduction of high blood pressure. DESIGN: Cross-sectional data were collected from Hispanic primary care patients attending a free health clinic in Charlotte, NC. We performed basic psychometric tests and calculated descriptive statistics to assess adherence rates to recommended hypertension self-care behaviors. RESULTS: Participants were primarily female, under age 50 and had a high-school education or less; 48% were from Mexico. Internal consistency of all H-SCALE subscales was acceptable to good. Most participants were non-smokers (80%) and alcohol abstainers (85%). Participants had low adherence to weight management practices, physical activity and healthy eating habits. One-third of those with hypertension were adherent to medication regimens. CONCLUSION: The Spanish version of the H-SCALE is a reliable and useful tool for clinicians working with Hispanic adults. Based on these findings, all adult Hispanics need lifestyle behavior counseling for primary and secondary prevention of hypertension and other chronic diseases. The H-SCALE can provide valuable information to clinical and public health practitioners focused on chronic disease prevention and management.

Downward dog becomes fit body, inc.: A content analysis of 40 years of female cover images of Yoga Journal.

The present analysis investigated temporal trends in physical appearance attributes and attire worn by female cover models of Yoga Journal magazine between the years 1975-2015. Covers featuring a single female model (N=168) were coded for: pose activity, amount of body visibility, perceived body size, body shape, breast size, skin exposure, and revealing or form-fitting attire. When collapsed across all decades, the majority of cover models was actively posed with high body visibility, rated as at most low normal weight, possessed either a "thin/lean" or "skinny/boney" body shape, and were "flat-chested" or "small-breasted". Greater body visibility, pose activity, thinness/leanness, skin exposure, and form-fitting attire were featured on more recent years' covers. Findings suggest that the female "yoga body" conforms to the contemporary thin- and-toned media fitness ideal, particularly recently, which may promote objectified body competence, an unhealthy drive for leanness, and dissuade higher weight women from considering yoga practice.

Got yoga?: A longitudinal analysis of thematic content and models' appearance-related attributes in advertisements spanning four decades of Yoga Journal.

Yoga has become an increasingly common health practice among U.S. adults over the past decade. With this growth in popularity, yoga-related print media have been criticized for shifting away from yoga's traditional philosophies and promoting a thin, lean ideal physique representing the "yoga body." The purpose of this study was to (a) analyze the presence and content of advertisements over the 40-year publication history of Yoga Journal magazine and (b) explore female advertisement models' socio-demographic and appearance-related attributes over time. Results suggested that Yoga Journal now contains significantly more advertisements for food, nutritional supplements, and apparel and fewer advertisements for meditation and nutritional practices than in its early years of publication. Models were more frequently rated as White and in their 20s and 30s in recent years of publication. Trends in model body size matched shifts in culturally dominant body ideals over time. Implications and future research directions are considered.

Pediatric Inpatient Nurses' Perceptions of Child Maltreatment.

PURPOSE: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. DESIGN AND METHODS: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. RESULTS: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. CONCLUSIONS: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. PRACTICE IMPLICATIONS: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses.

Psychometric Validation of a Brief Self-report Measure of Diet Quality: The DASH-Q.

OBJECTIVE: The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for primary and secondary prevention of cardiovascular chronic diseases. This study describes the development, internal consistency, and validation (predictive and convergent) of a population-based, self-report measure (the DASH Quality [DASH-Q]) to assess adherence to the DASH diet among adults. DESIGN: Cross-sectional online surveys to evaluate the psychometric properties of the DASH-Q. PARTICIPANTS: US adults consisting of a national sample (n = 407) and a Southern university sample (n = 405). MAIN OUTCOME MEASURES: Diet quality scores. ANALYSIS: Item and scale psychometric properties were examined using corrected item total correlations and principal component analysis. The authors validated the DASH-Q by examining associations with an existing self-report nutrition scale and other nutrition-related behaviors. RESULTS: The DASH-Q yielded acceptable internal consistency (α = .77-.83) in both samples. The DASH-Q scores correlated moderately to strongly with all nutrition-related criteria (P < .01), suggesting evidence of predictive and convergent validity. Less than 15% of either sample reported high diet quality. CONCLUSIONS AND IMPLICATIONS: The DASH-Q had sufficient psychometric robustness for use as a population-based measure. The DASH-Q is recommended as an easily used measure of DASH adherence for populations that need to modify their diet to manage chronic illness.

Is the "Yoga Bod" the new skinny?: A comparative content analysis of mainstream yoga lifestyle magazine covers.

As yoga has gained popularity in Western culture, concerns have been raised about its increased commercialization and assimilation into the predominantly appearance-focused exercise and fitness culture. In this context, the present study examined the physical appearance-related characteristics (e.g., race/ethnicity, body size, shape, objectifying apparel) of 142 female models and the media frames of 567 captions (e.g., commercialism, body competence, health, weight/physical appearance) featured on the covers of three Westernized yoga lifestyle magazines published between 2010-2015. Results indicated that most models were White, embodying the contemporary "thin-and-lean" media fitness aesthetic. Models were actively posed with high body visibility; an appreciable minority was partially-clad in skin-revealing or form-fitting upper-body attire. Media frames conveying commercialism and body competence were equally present. The pattern of effects tended to reflect the strength of the magazine title's endorsement of exercise and fitness cultural values. Clinical and public health implications along with future research directions are discussed.