The power of siblings and caregivers: under-explored types of social support among children affected by HIV and AIDS.

Children affected by HIV and AIDS have significantly higher rates of mental health problems than unaffected children. There is a need for research to examine how social support functions as a source of resiliency for children in high HIV-prevalence settings such as South Africa. The purpose of this research was to explore how family social support relates to depression, anxiety, and post-traumatic stress (PTS). Using the ecological model as a frame, data were drawn from a 2011 cross-sectional study of 1380 children classified as either orphaned by AIDS and/or living with an AIDS sick family member. The children were from high-poverty, high HIV-prevalent rural and urban communities in South Africa. Social support was analyzed in depth by examining the source (e.g. caregiver, sibling) and the type (e.g. emotional, instrumental, quality). These variables were entered into multiple regression analyses to estimate the most parsimonious regression models to show the relationships between social support and depression, anxiety, and PTS symptoms among the children. Siblings emerged as the most consistent source of social support on mental health. Overall caregiver and sibling support explained 13% variance in depression, 12% in anxiety, and 11% in PTS. Emotional support was the most frequent type of social support associated with mental health in all regression models, with higher levels of quality and instrumental support having the strongest relation to positive mental health outcomes. Although instrumental and quality support from siblings were related to positive mental health, unexpectedly, the higher the level of emotional support received from a sibling resulted in the child reporting more symptoms of depression, anxiety, and PTS. The opposite was true for emotional support provided via caregivers, higher levels of this support was related to lower levels of all mental health symptoms. Sex was significant in all regressions, indicating the presence of moderation.

The health and social consequences of adverse childhood experiences (ACE) across the lifespan: an introduction to prevention and intervention in the community.

This introduction to the themed issue overviews of the Adverse Childhood Experiences (ACE) Study and discusses prevention and intervention with ACE and their consequences in communities. A commentary by Dr. Robert Anda, an ACE Study Co-Principal Investigator, is incorporated within this introduction. Implications of articles within the issue are addressed, and next steps are explored.

Mobilizing resilience and recovery in response to adverse childhood experiences (ACE): a Restorative Integral Support (RIS) case study.

The Restorative Integral Support (RIS) model is a comprehensive, whole person approach to addressing adversity and trauma. The Adverse Childhood Experiences (ACE) Study conducted by the Centers for Disease Control (CDC) and Kaiser Permanente reveals a relationship between childhood trauma and adult health and social problems. The current empirical case study presents the Committee on the Shelterless (COTS), in Petaluma, CA, as an example of one social service agency employing RIS to break cycles of homelessness. By applying RIS, research-based programming is offered within a culture of recovery that mobilizes resilience through social affiliations. The authors recommend RIS model implementation and research in programs serving populations with ACE backgrounds.

Impact of the level of state tax code progressivity on children's health outcomes.

This research study examines the impact of the level of state tax code progressivity on selected children's health outcomes. Specifically, it examines the degree to which a state's tax code ranking along the progressive-regressive continuum relates to percentage of low birthweight babies, infant and child mortality rates, and percentage of uninsured children. Using data merged from a number of public data sets, the authors find that the level of state tax code progressivity is a factor in state rates of infant and child mortality. States with lower median incomes and regressive tax policies have the highest rates of infant and child mortality.With regard to the percentage of children 17 years of age and below who lack health insurance, it is found that larger states with regressive tax policies have the largest percentage of uninsured children. In general, more heavily populated states with more progressive tax codes have healthier children. The implications of these findings are discussed in terms of tax policy and the well-being of children as well as for social work education, social work practice, and social work research.

Program and client characteristics as predictors of the availability of social support services in community-based substance abuse treatment programs.

Recent emphases on increasing accountability, using less intensive settings, and implementing evidence-based services helped to focus the research community on the structure, processes, and outcomes of services delivered to substance abuse clients. Considerably less attention has been given to understanding how to structure services to enhance engagement and retention leading to treatment continuity. This study examined structural characteristics of community-based treatment facilities in relationship to the availability of supportive services within a sample of 1,332 substance abuse treatment programs surveyed through the Alcohol and Drug Services Study in 1996 and 1997. Structural and client characteristics are important predictors of added supportive services. Furthermore, a program with a broader and established set of core services is more likely to have expanded supportive services. These findings have implications for public health professionals, both in terms of ensuring sustainable service programming for these chronic clients and in identifying services to adopt or discard to meet a population with multiple needs.

The impact of changes in employment status on psychosocial well-being: a study of breast cancer survivors.

Recent developments in the treatment of cancer have resulted in an increase in the number of cancer survivors. With this increase in the survival rate comes an increase in questions as to how a diagnosis of cancer and its treatment affects survivors and their well-being. Research has emphasized the impact that medical factors related to cancer have on the well-being of cancer survivors. However, the literature also suggests that socioeconomic factors may affect cancer survivors; well-being. This study focuses on the role that employment status plays in relationship to the levels of psychosocial well-being of women diagnosed with and treated for breast cancer. This study was a cross-sectional design utilizing secondary data analysis. The sample consisted of 369 breast cancer survivors from four cancer treatment facilities in the Mid-Atlantic region. The independent variable was employment status during and after treatment and the dependent variables were psychological distress, physical and mental functioning and quality of life. Utilizing analysis of covariance, controlling for age at diagnosis and stage of cancer it was found that there was a statistically significant difference in the dependent variables by employment status. These findings are discussed in terms of clinical and policy implications.

Expanding the role of health services research as a tool to reduce the public health burden of alcohol use disorders.

The public and private cost of "heavy alcohol use" is estimated to be more than 187 billion in lost productivity, health care and criminal justice expenditures, and other costs. This does not include the emotional and psychological costs to family, friends, and the community. Investments by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have led to a number of important advances in pharmacological and behavioral treatments for alcohol disorders. Yet, there continues to be a significant gap between research findings and progress in community-based care. Additionally, limited capacity, a lack of acknowledged standards, and a separation between the specialty substance use treatment sector and general medical practice contribute to this gap. As part of its ongoing efforts to encourage translation from clinical research to practice, NIAAA undertook a review of its alcohol related health services research program for the purpose of creating a vision for the next 10 yr that is sensitive to the changing needs of both the clinical and research communities. Central to the development of a new research agenda is a reconceptualization of alcohol use and misuse along a continuum that takes into account quantity and frequency of use as well as the consequences from "heavy use" and misuse of alcohol. This public health approach recommends a number of high priority areas to expand and improve the system of care for "heavy alcohol users" who may be at-risk or who may have developed an alcohol use disorder. These recommendations include research on dissemination and implementation of evidence-based practices, and improving access and utilization to care for individuals who are "heavy users." The paper concludes by outlining some of the steps taken by NIAAA to further the continuing development of alcohol health services research.