An Exploration of the Supportive Care Needs of Caribbean Families of Critically Ill Adults.

ABSTRACT: Nurses care for patients of diverse cultures. Persons in and from the Caribbean region have specific needs and concerns related to the support they need when a family member is admitted to an intensive care unit (ICU). Nurses familiar with Caribbean patient culture can provide these family members with knowledgeable and culturally competent care. However, little research exists about the unique needs of this population. This pilot study explored the nursing support needs of adult Caribbean family members of patients in the ICU.

Reframing family-school partnerships to disrupt disenfranchisement of Black families and promote reciprocity in collaboration.

Research has long demonstrated the benefits of family-school partnerships. However, these benefits often fail to generalize to all families, especially Black families. A present and historical pattern of discrimination and exclusion has contributed to the lack of benefits yielded from Black family-school partnerships. A major contributing factor is the narrow way in which schools define family engagement. Such narrow definitions often marginalize families from non-dominant backgrounds, particularly Black families, and reinforce harmful narratives that Black parents and families are uninvolved in their children's education. The combination of continued discrimination and exclusion as well as harmful narratives has impacted Black family-school partnering. However, schools can work to repair harm and rebuild partnerships with Black families. In this article, we advance a framework for such work. After grounding the need for this framework in a historical context, we emphasize three essential components to forming equitable Black family-school partnerships: (a) grounding relationship building in social justice, (b) integrating reciprocity in family-school relationships, and (c) usage of multiple and non-dominant methods and modalities to build relationships.

Maori and Pacific families' experiences and perspectives of cardiovascular care; A qualitative study.

OBJECTIVE: This study aimed to understand the reasons behind evidence-practice gaps and inequities in cardiovascular care for Maori and Pacific people, as evidenced by the experiences and perspectives of patients and their families. METHODS: The research was guided by Maori and Pacific worldviews, incorporating Kaupapa Maori Theory and Pacific conceptual frameworks and research methodologies. Template analysis was used to analyse interview data from 61 Maori and Pacific people who had experienced a cardiovascular disease (CVD) risk assessment, acute coronary syndrome, and/or heart failure. RESULTS: The range of experiences relating to participants' heart health journeys are presented in five main themes: Context, Mana (maintaining control and dignity), Condition, People and Journey. CONCLUSIONS: Maori and Pacific people want to take charge of their heart health but face challenges. Participants described important obligations to family, community and tikanga (the culturally correct way of doing things). Participants described times when health care undermined existing responsibilities, their dignity and/or their mana, and they felt excluded from treatment as a result. IMPLICATIONS FOR PUBLIC HEALTH: Good reciprocal communication, stemming from a high-quality relationship is essential for successful outcomes. A workforce that is representative of the population it serves and is culturally safe lays the foundation for excellence in care.

Adult Children of the Prison Boom: Family Troubles and the Intergenerational Transmission of Criminal Justice Contact.

Intergenerational transmission processes have long been of interest to demographers, but prior research on the intergenerational transmission of criminal justice contact is relatively sparse and limited by its lack of attention to the correlated "family troubles" and familial incarceration that predate criminal justice contact. In this article, we provide a test of the intergenerational transmission of criminal justice contact after adjusting extensively for these factors that predate such contact by linking longitudinal data from the Project on Human Development in Chicago Neighborhoods with official arrest histories from 1995 to 2020. The results provide support for three conclusions. First, parental criminal justice contact is associated with a shorter time to first arrest and a larger number of arrests even after rigorously accounting for selection. Second, robustness checks demonstrate that neither the magnitude nor the significance of the findings is sensitive to model choices. Third, associations are strongest among White individuals and inconsistently significant for African American and Hispanic individuals. Despite large recent crime declines, the results indicate that parental criminal justice contact elevates the criminal justice contact of the adult children of the prison boom, independent of the often-overlooked troubles that predate criminal justice contact, and that these associations are strongest among the White population.

Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families.

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families' engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7-11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents' engagement and success in BT. Implications for cultural adaptations of BT to improve AA families' treatment experience are discussed.

Critical examination of resilience and resistance in African American families: Adaptive capacities to navigate toxic oppressive upstream waters.

African American families navigate not only everyday stressors and adversities but also unique sociocultural stressors (e.g., "toxic upstream waters" like oppression). These adverse conditions are consequences of the historical vestiges of slavery and Jim Crow laws, often manifested as inequities in wealth, housing, wages, employment, access to healthcare, and quality education. Despite these challenges, African American families have developed resilience using strength-based adaptive coping strategies, to some extent, to filter these waters. To advance the field of resilience research, we focused on the following questions: (1) what constitutes positive responses to adversity?; (2) how is resilience defined conceptually and measured operationally?; (3) how has the field of resilience evolved?; (4) who defines what, when, and how responses are manifestations of resilience, instead of, for example, resistance? How can resistance, which at times leads to positive adaptations, be incorporated into the study of resilience?; and (5) are there case examples that demonstrate ways to address structural oppression and the pernicious effects of racism through system-level interventions, thereby changing environmental situations that sustain toxic waters requiring acts of resilience to survive and thrive? We end by exploring how a re-conceptualization of resilience requires a paradigm shift and new methodological approaches to understand ways in which preventive interventions move beyond focusing on families' capacity to navigate oppression and target systems and structures that maintain these toxic waters.

It's a family affair: Confucian familist philosophy's potential to improve mental health care for ethnic Chinese in Aotearoa New Zealand.

Many ethnic groups traditionally value familism, which emphasises interdependence and the extended family unit. However, Aotearoa New Zealand's health system remains largely individual-oriented, with the implementation of family-centred care remaining inconsistent. This is known to have negative effects on Maori healthcare experiences and outcomes. Our research, exploring the experiences of ethnic Chinese using mental health services in Aotearoa New Zealand, indicated that this could also be a barrier for ethnic Chinese, who have similarly strong cultural links to familism, accessing mental health care. To balance the cultural importance of family involvement with the protection of individual patient autonomy, we propose a moderate Confucian familist approach, encouraging family involvement and participation in individual patients' care, with patients' consent. The approach acknowledges individual patients as interconnected members of a wider family unit, emphasising their reciprocal, mutual responsibility in maintaining a well-functioning, harmonious family. We highlight Whanau Ora as a potential exemplar for a culturally grounded, family-centred approach to mental health care which could be feasibly implemented and deliver positive outcomes. Parallels between Maori and ethnic Chinese cultural views around whanau, community, and collectivism suggest a Kaupapa Maori approach could also be beneficial to Aotearoa New Zealand's ethnic Chinese populations. However, ethnic Chinese lack the specific legal obligations empowering the implementation of interventions such as Whanau Ora. This is an obstacle which remains to be addressed before mental health services which are sensitive to the needs of ethnic Chinese or of other ethnicities can be effectively implemented.

Family and peer ethnic-racial socialization in adolescents' everyday life: A daily transactional model with ethnic-racial identity and discrimination.

There is limited research on ethnic-racial socialization outside the family context (e.g., in peer groups). Using two-week, daily data from 177 U.S. ethnic-racial minority 9th graders in 2017-2020 (Mage = 14.48 years old; 51% females; 52% Black, 20% Latinx, 10% Asian American, 6% Native American, and 12% Other), this study tested a transactional model of family and peer ethnic-racial socialization, identity, and discrimination. Bidirectional associations were observed between family and peer cultural socialization across days (ßs = .09-.10). Peer but not family cultural socialization promoted adolescents' ethnic-racial identity on the next day (ßs = .07-.10). Ethnic-racial discrimination predicted greater next-day family ethnic-racial socialization (cultural socialization, preparation for bias; ßs = .08-.11), whereas family and peer ethnic-racial socialization predicted next-day discrimination (ßs = .11-.18). The differential roles of family and peer ethnic-racial socialization are discussed.

Pathways to emotion regulation in young Black children: An attachment perspective.

Attachment theory proposes that a central function of caregivers is to provide protection and co-regulation of children's distress in the context of threat, and that children's secure attachment (confidence in a secure base/safe haven when needed) precipitates positive developmental cascades in part by supporting children's emotion regulation. Yet the field of attachment has rarely considered the unique experiences of African American families, including the context of systemic racism in which caregivers must provide physical and emotional protection for their children, and in which children must learn to regulate emotion across different sociocultural contexts (emotional flexibility and "code-switching"; Dunbar et al., 2022a; Lozada et al., 2022; Stern et al., 2022b). This chapter brings attachment theory into conversation with the field of positive Black youth development to explore pathways to emotion regulation in African American children during early childhood. In doing so, we (a) highlight the strengths of African American caregivers in providing unique and specific forms of protection via racial and emotional socialization; (b) review research on predictors and consequences of secure caregiver-child relationships in Black families, with a focus on the outcome of child emotion regulation; (c) present a theoretical framework for understanding cascades of positive Black youth development via healthy relationships and emotion regulation; and (d) outline promising new directions for more inclusive and just attachment research.

Perceived stress among Hispanic young adults: Impact of the coping with work and family stress program.

Objective: To examine the effect of an evidence-based curriculum on stress perceptions across time. Participants: Hispanic college students from a Hispanic-serving institution in a U.S. southern border city. Methods: A permuted block design with repeated measures was used. Participants were randomly assigned to treatment and control groups. The treatment group received the Coping with Work and Family Stress (CWFS) evidence-based curriculum while the control group did not receive any programming. Data were collected from both the groups at baseline, exit, and at 3-month follow-up. Results: Stress reduction was observed among program participants however an unintended negative consequence of the intervention was found among those who experience intimate partner violence. Conclusion: The CWFS evidence-based intervention may be appropriate to use in reducing general types of stress but perhaps not stress resulting from intimate partner violence.

The influence of Latino cultural values on the perceived caregiver role of family members with Alzheimer's disease and related dementias.

OBJECTIVES: We explored how Latino cultural values play a role in perceived caregiving experiences. DESIGN: We conducted a qualitative study that used individual, in-depth, semi-structured interviews with middle-aged and older Latinos who were primary caregivers of family members with Alzheimer's disease and related dementias (ADRD). The interview guide consisted of questions about participants' perceptions of family caregiving and interrelationships between the caregiver and care recipient. The interviews were recorded, translated, and transcribed verbatim. We performed direct content analysis. RESULTS: Participants were caregivers, 50-75 years old (n = 16), and the majority were female. We identified four cultural values that were salient to participants' caregiving experiences: (a) familismo, (b) fatalismo (c) marianismo, and (d) machismo. CONCLUSION: Latino cultural values influenced the role of caregiving and caregiving roles of family members with ADRD. Future research should consider these values as they affect different familial and health dynamics.

Fatores associados ao nível de segurança alimentar e nutricional no município e estado de São Paulo e no Brasil: uma análise dos resultados obtidos pela escala brasileira de insegurança alimentar / Food and nutritional security level associated factors in the city and state of São Paulo and in Brazil: an analysis of obtained results from the Brazilian food insecurity scale

A falta de segurança alimentar e nutricional (SAN) consiste em um fenômeno multifatorial, que pode afetar o estado nutricional do indivíduo por ela acometido de diversas maneiras e em qualquer faixa etária. A falta de SAN pode desencadear tanto desnutrição, como obesidade e assim favorecer o aumento da prevalência de doenças crônicas não transmissíveis, o que diminui a qualidade de vida e se constitui um importante problema de saúde pública. Objetivo: Analisar e comparar a força da associação dos fatores socioeconômicos e demográficos à segurança alimentar e nutricional (SAN) no Brasil e áreas geográficas selecionadas. Metodologia: Trata-se de um estudo ecológico, transversal e analítico, que utilizou como base os microdados da Pesquisa de Orçamento Familiar (POF/IBGE), realizada nos anos de 2017-2018, envolvendo 757 famílias residentes no município de São Paulo (MSP), 3.406 famílias do estado de São Paulo (ESP) e 49.365 famílias do Brasil. Utilizou-se a técnica de regressão logística multinomial, do tipo ordinal, para o processamento do modelo de associação entre o nível de SAN (nSAN) e as variáveis demográficas, socioeconômicas e clínicas, utilizando o módulo survey do Stata versão 14. Adotouse o nível de significância estatística de 5% e o odds ratio proporcional para descrever as associações. Resultados: A grande maioria dos indivíduos de referência dos domicílios componentes da amostra é do sexo masculino, adulta, com obesidade, sem seguro saúde e que não fazem nenhum tipo de dieta, variando as características de raça/cor e escolaridade entre as três localidades analisadas. Para as três localidades estudadas, encontrou-se proporções elevadas da população com segurança alimentar e nutricional garantida (acima de 59%). As associações encontradas demonstraram que as famílias com pessoas de referência do sexo feminino apresentam maior chance de piora do nSAN, bem como aquelas com menores níveis de saneamento básico e estratos de renda mais pobres, para os quais a chance de piora do nSAN em relação aos estratos de renda mais ricos se eleva em até 12 vezes. Ser de raça branca foi fator protetor à IAN, bem como ter idade mais avançada e mais anos de escolaridade. Conclusão: As características sociodemográficas sexo, raçacor, idade e escolaridade, e socioeconômicas, renda e presença de saneamento básico, apresentam importante associação ao nível de SAN das famílias, quando este é analisado por meio da Escala Brasileira de Insegurança Alimentar (EBIA). Entretanto, faz-se necessária a construção de um instrumento que avalie todas as dimensões da SAN

Lack of food and nutrition security (FNS) is a multifactorial phenomenon, which can impact the nutritional status of individual affected by it in different ways and in any age group. The lack of FNS can trigger both malnutrition and obesity and thus favor the prevalence increase of chronic non-communicable diseases, which reduces lifes quality and constitutes an important public health problem. Objective: To analyze and compare the strength of association of socioeconomic and demographic factors with FNS in Brazil and selected geographical areas. Methodology: Ecological, crosssectional, and analytical study, which used the microdata of the Research as a basis Family Budget (POF / IBGE), carried out in 2017-2018, involving 757 families residing in São Paulo city (SPC), 3,406 families from São Paulo state (SPS) and 49,365 families from Brazil. Multinomial logistic regression technique, of the ordinal type, was used to process the association model between the FNS level (FNSl) and the demographic, socioeconomic and clinical variables, using the survey module of Stata version 14. It was adopted statistical significance of 5% and proportional odds ratio to describe the associations. Results: Most reference individuals in the sample's households are male, adult, obese, without health insurance and who do not follow any type of diet, varying the characteristics of race / color and education between the three locations analyzed. For the three locations studied, high proportions of the population were found with guaranteed FNS (above 59%). Associations found showed that families headed by female individuals are more likely to worsen FNSl, as well as those with lower levels of basic sanitation and poorer income strata, for which the chance of worsening FNSl in relation to strata wealthier income rises to 12 times. Being white was a protective factor for food insecurity, as well as being older and with more years of schooling. Conclusion: Sociodemographic characteristics of sex, race-color, age and education, and socioeconomic, income and presence of basic sanitation, present important association at the FNSl of families, when this is analyzed through the Brazilian Food Insecurity Scale (EBIA). However, it is necessary to build an instrument that assesses all dimensions of the FNS

Being alone together: yoga, bodywork, and intimate sociality in American households.

Using ethnographic data from Providence County, Rhode Island, this paper explores yoga as a bodywork practice that is part of everyday health and wellbeing routines in middle class households. In this context, participants define their bodywork practices as individual activities that answer health and wellbeing needs, but notably discuss bodywork in terms of their everyday social experience. Along with other bodywork activities, yoga emerges as a shared social practice that links participants to their partners, children, and other intimates, facilitating a sense of togetherness by allowing time and space for autonomy. By giving atmospheric and sensory attention to the ethnographic data, the paper further reveals how domestic intimacy is cultivated via the generation of bodily heat and positive energies and that yoga may tacitly facilitate such atmospheres. In this way, yoga can help households meet an American need for self-development and autonomy while still facilitating a far more enduring human need for intimate connection. Ultimately yoga is characterized as a pragmatic bodywork practice that blends self-development and social intimacy through shared energetic encounters.

The Burden of Elders: Anxiety, Depression, and Personal Networks in Two African Slums.

ABSTRACT: Although anxiety and depression have been central topics for scholars and clinicians in the United States, few studies have examined their correlates in sub-Saharan Africa and none have examined large urban slums. Using face-to-face interviews in two African cities, we analyze self-reported symptoms of anxiety and depression in a community-based sample (n = 495). Ordinary least squares regression was used to analyze a variety of demographic and social predictors including sex, child-rearing, marital status, education, income, age, and neighborhood for residents of Agbogbloshie (Accra, Ghana) and Kangemi (Nairobi, Kenya). Controlling for other factors, two personal network dimensions were significant. Total network size is positively associated with symptoms of anxiety and depression in Kenya but not in Ghana. However, one factor was predictive of symptoms of anxiety and depression in both locations: the reported percentage of ties with older persons. Higher levels of anxiety and depression are associated with a larger share of older individuals in one's personal network.

Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians.

BACKGROUND: Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. OBJECTIVE: Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. METHODS: We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer's and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. RESULTS: Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 -1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 -1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. CONCLUSION: Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.

Validation of the factors influencing family consent for organ donation in the UK.

Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47-1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23-0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22-0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.

Gateway to Global Aging Data: Resources for Cross-National Comparisons of Family, Social Environment, and Healthy Aging.

OBJECTIVES: The Gateway to Global Aging Data (Gateway; g2aging.org) is a data and information platform developed to facilitate cross-country analyses on aging, especially those using the international family of Health and Retirement studies. We provide a brief introduction to the Gateway to Global Aging Data, discussing its potential for cross-national comparisons of family, social environment, and healthy aging. METHODS: We summarize the survey metadata, study characteristics, and harmonized data available from the Gateway, describing the population represented in each study. We portray cohort characteristics and key measures of health and social environment from 37 countries in North America, Europe, and Asia using harmonized data. RESULTS: Significant cross-country heterogeneity was observed in many measures of family, social environment, and healthy aging indicators. For example, there was a threefold difference in coresidence with children, ranging from 14% in Sweden to over 46% in Spain and Korea in 2014. From 2002 to 2014, the difference between informal care receipt in individuals of low and high wealth decreased by 6% in the United States and remained unchanged in England. The percentage of individuals aged 50-59 living alone in 2012 varied 15-fold, from a low of 2% in China to a high of 30% in Mexico. DISCUSSION: By partnering with nationally representative studies around the globe, the Gateway to Global Aging Data facilitates comparative research on aging through the provision of easy-to-use harmonized data files and other valuable tools.

Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial.

INTRODUCTION: The technologies used to treat the millions who receive care in intensive care unit (ICUs) each year have steadily advanced. However, the quality of ICU-based communication has remained suboptimal, particularly concerning for Black patients and their family members. Therefore we developed a mobile app intervention for ICU clinicians and family members called ICUconnect that assists with delivering need-based care. OBJECTIVE: To describe the methods and early experiences of a clustered randomized clinical trial (RCT) being conducted to compare ICUconnect vs. usual care. METHODS AND ANALYSIS: The goal of this two-arm, parallel group clustered RCT is to determine the clinical impact of the ICUconnect intervention in improving outcomes overall and for each racial subgroup on reducing racial disparities in core palliative care outcomes over a 3-month follow up period. ICU attending physicians are randomized to either ICUconnect or usual care, with outcomes obtained from family members of ICU patients. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 3 days post-randomization. Secondary outcomes include goal concordance of care and interpersonal processes of care at 3 days post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use hierarchical linear models to compare outcomes between the ICUconnect and usual care arms within all participants and assess for differential intervention effects in Blacks and Whites by adding a patient-race interaction term. We hypothesize that both compared to usual care as well as among Blacks compared to Whites, ICUconnect will reduce unmet palliative care needs, psychological distress and healthcare resource utilization while improving goal concordance and interpersonal processes of care. In this manuscript, we also describe steps taken to adapt the ICUconnect intervention to the COVID-19 pandemic healthcare setting. ENROLLMENT STATUS: A total of 36 (90%) of 40 ICU physicians have been randomized and 83 (52%) of 160 patient-family dyads have been enrolled to date. Enrollment will continue until the end of 2021.