Transfer of Knowledge on Pneumoconiosis Care Among Rural-Based Members of a Digital Community of Practice: Cross-Sectional Study.

BACKGROUND: Given the re-emergence of coal workers' pneumoconiosis in Appalachia and Mountain West United States, there is a tremendous need to train rural professionals in its multidisciplinary management. Since 2016, the Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Program held by the University of New Mexico, Albuquerque, and Miners' Colfax Medical Center, Raton, New Mexico, provides structured longitudinal multidisciplinary telementoring to diverse professionals taking care of miners by creating a digital community of practice. Program sessions emphasize active learning through discussion, rather than didactic training. Professional stakeholder groups include respiratory therapists, home health professionals, benefits counselors, lawyers or attorneys, clinicians, and others. Rural-urban differences in knowledge transfer in such a community of practice, however, remain unknown. OBJECTIVE: We aim to evaluate the role of the rurality of the patient or client base in the transfer of knowledge to professionals caring for miners using the digital community of practice approach. METHODS: This is a cross-sectional study of 70 professionals participating in the Miners' Wellness TeleECHO Program between 2018 and 2019. Drawing insights from social network analysis, we examined the association between the rurality of participants' patient or client base and their self-reported receipt of knowledge. Our focal independent variable was the respondent's self-reported percentage of patients or clients who reside in rural areas. We measured knowledge transfer sources by asking participants if they received knowledge regarding the care of miners during and outside of TeleECHO sessions from each of the other participants. Our dependent variables included the number of knowledge sources, number of cross-stakeholder knowledge sources, number of same stakeholder knowledge sources, and range and heterogeneity of knowledge sources. RESULTS: Respondents, on average, identified 4.46 (SD 3.16) unique knowledge sources within the community, with a greater number of cross-stakeholder knowledge sources (2.80) than same stakeholder knowledge sources (1.72). The mean knowledge source range was 2.50 (SD 1.29), indicating that, on average, respondents received knowledge sources from roughly half of the 5 stakeholder groups. Finally, the mean heterogeneity of knowledge sources, which can range between 0 and 0.80, was near the midpoint of the scale at 0.44 (SD 0.30). Multivariable analyses revealed that as the rurality of patient or client bases increased, participants reported more knowledge sources overall, more knowledge sources from outside of their stakeholder groups, a higher knowledge source range, and greater heterogeneity of knowledge sources (P<.05 for all comparisons). CONCLUSIONS: Our findings suggest that participants who serve rural areas especially benefit from knowledge transfer within the TeleECHO community of practice. Additionally, the knowledge they receive comes from diverse information sources, emphasizing its multidisciplinary nature. Our results underscore the capacity of the TeleECHO model to leverage technology to promote rural health equity for miners.

Neighborhoods, Activity Spaces, and the Span of Adolescent Exposures.

Since the inception of urban sociology, the "neighborhood" has served as the dominant context thought to capture developmentally significant youth experiences beyond the home. Yet no large-scale study has examined patterns of exposure to the most commonly used operationalization of neighborhood - the census tract - among urban youth. Using smartphone GPS data from the Adolescent Health and Development in Context study (N=1405), we estimate the amount of time youth spend in residential neighborhoods and consider explanations for variation in neighborhood exposure. On average, youth (ages 11 to 17) spend 5.7% of their waking time in their neighborhood but not at home, 60% at home, and 34.3% outside their neighborhood. Multilevel negative binomial regression models indicate that residence in economically disadvantaged neighborhoods is associated with less time in neighborhood. Higher levels of local violence and the absence of a neighborhood school the youth is eligible to attend are negatively associated with time in neighborhood and mediate the concentrated disadvantage effect. Fractional multinomial logit models indicate that higher violence is linked with increased time at home while school absence is associated with increased outside-neighborhood time. Theoretical development and empirical research on neighborhood effects should incorporate findings on the extent and nature of neighborhood and broader activity space exposures among urban youth.

A virtual community-of-practice approach by rural stakeholders in managing pneumoconiosis in the USA: a cross-sectional analysis.

INTRODUCTION: The re-emergence of pneumoconiosis, particularly among coal miners (ie black lung), in the USA is a challenge for rural communities because more miners require specialized care while expertise is scarce. The Miners' Wellness TeleECHO (Extension for Community Health Outcomes) Clinic, jointly held by the University of New Mexico and a community hospital in New Mexico, provides structured telementoring to professionals caring for miners, including clinicians, respiratory therapists, home health professionals, benefits counselors, lawyers/attorneys and others, forming a virtual 'community of practice'. This approach has not been utilized and evaluated previously. METHODS: The study's bimonthly program uses the ECHO telementoring model, which uses technology to leverage scarce mentoring resources; uses a disease-management model that is proven to improve outcomes in other disease states, by reducing variation in processes of care and sharing best practices; uses the principle of case-based learning with highly contextualized discussions, which fulfils key learning theory principles; creates a virtual community of practice; and uses an internet-based database to monitor outcomes. This 1-year cross-sectional study from September 2018 to September 2019 used geographical mapping of all attendee locations, web-based continuing medical education surveys completed by attendees using iECHO software, and a Research Electronic Data Capture-based survey of a convenience sample of participants, which obtained detailed information on demographics, knowledge, self-efficacy and collective efficacy. Knowledge sharing among participants was examined using insights and methods from social network analysis. Subgroup analysis involved comparisons between clinical and non-clinical professional groups, and between new and existing participants. Groups were compared using Fisher's exact test for categorical variables, and non-parametric Wilcoxon ranked sum test or student's t-test for continuous variables. RESULTS: Participants were largely located in pneumoconiosis mortality hotspots of the USA. In a convenience sample of 70 participants, clinical professional groups such as clinicians (29%), home health professionals (20%) and respiratory therapists (17%) constituted the majority of the stakeholders. Participants demonstrated the lowest knowledge score on 'legal pneumoconiosis' among the knowledge areas questioned; reported low self-efficacy with respect to managing miners' conditions and interpreting test results; and rated the learning community highly in terms of trust (86%), willingness to help each other (93%) and being closely knit (87%). Analysis of knowledge sources indicated that participants receive substantial proportions of knowledge from individuals outside of their stakeholder and professional groups, but proportions differ among clinical and non-clinical professional groups, as well as among 'fresh' and existing participants. CONCLUSION: The present study demonstrates the successful creation of a virtual multidisciplinary community of practice in pneumoconiosis mortality hotspot rural regions of the USA, with participants reporting multidisciplinary knowledge transfer. The community is regarded highly by participants in relation to trust, willingness to help and being closely knit. This innovative educational approach may help ensure the delivery of high-quality interdisciplinary care to rural miners in pneumoconiosis mortality hotspots in the USA.

Telementoring of Healthcare Teams in the Care of Miners.

Background: Given the reemergence of pneumoconiosis in the United States, there is a tremendous need to train rural professionals in its multidisciplinary management. The Miners' Wellness TeleECHO (Telementoring Extension for Community Health Outcomes) Program in New Mexico, United States, provides longitudinal multidisciplinary telementoring to professionals taking care of miners. The impact of this approach has not been previously evaluated.Objective: To examine the change in self-efficacy of professionals taking care of miners and participating in the TeleECHO Program.Methods: This is a 12-month longitudinal study involving clinical and nonclinical professionals caring for miners. The study outcome was the change in self-efficacy scores, using a customized instrument of 14 measures grouped into three domains: clinical, medicolegal, and soft skills. The primary outcome used a retrospective pre-post design that collects "pretest" data at the postintervention timeframe.Results: Participants reported significant improvements in 10 of 14 items (P < 0.05) and a significant decline in 1 of 14 items (with respect to their ability to interpret pulmonary function test results, P < 0.001) since their start dates in the program. Subjects also reported significant improvement with respect to their scores for all three domains and for the 14-item total score (P ⩽ 0.01). Existing participants and clinical professional groups demonstrated greater improvement in selected items than fresh participants and nonclinical professional groups, respectively.Conclusion: This study is the first in a stepwise approach to determine the benefit of participating in a multidisciplinary telementoring intervention by improving participant self-efficacy in caring for miners with complex mining-related diseases. Our study finding represents a potential solution to a growing access-to-care gap for miners with pneumoconiosis.

Girls' self-efficacy in the context of neighborhood gender stratification.

Scholars have linked neighborhood characteristics to self-efficacy, but few have considered how gender factors into this association. We integrate literature on neighborhoods, gender stratification, and self-efficacy to examine the association between women's relative resources among neighborhood residents and adolescents' self-efficacy. We hypothesize that girls report more self-efficacy when they reside in neighborhoods where women have more socioeconomic resources relative to men. We test this hypothesis using data from the Project on Human Development in Chicago Neighborhoods and the 1990 Census. Results from multilevel regression models with gender-interacted effects indicate the neighborhood level of women's relative resources was not associated with boys' self-efficacy. However, girls reported higher self-efficacy when women's relative resources in their neighborhoods were greater. This association persisted after including potential individual- and neighborhood-level confounding variables. Our study underscores the importance of attending to gendered processes when understanding how neighborhoods impact youth.

Ecological Networks and Community Attachment and Support Among Recently Resettled Refugees.

Interventions aimed at enhancing mental health are increasingly centered around promoting community attachment and support. However, few have examined and tested the specific ecological factors that give rise to these key community processes. Drawing from insights from the ecological network perspective, we tested whether spatial and social overlap in routine activity settings (e.g., work, school, childcare) with fellow ethnic community members is associated with individuals' attachment to their ethnic communities and access to social resources embedded in their communities. Data on routine activity locations drawn from the Refugee Well-Being Project (based in a city in the Southwestern United States) were used to reconstruct the ecological networks of recently resettled refugee communities, which were two-mode networks that comprise individuals and their routine activity locations. Results indicated that respondents' community attachment and support increased with their ecological network extensity-which taps the extent to which respondents share routine activity locations with other community members. Our study highlights a key ecological process that potentially enhances individuals' ethnic community attachment that extends beyond residential neighborhoods.

The Influence of Women's Neighborhood Resources on Perceptions of Social Disorder.

Research links neighborhood social disorder with poorer health. But factors beyond observed disorder may influence perceptions that social disorder is problematic. This study investigates whether women's aggregate socioeconomic resources relative to men's in the broader neighborhood context attenuate the extent to which more prevalent observed social disorder within the immediate residential neighborhood contributes to perceptions of more problematic social disorder. This attenuation likely is pronounced among women, for whom sexual harassment in public spaces is a more salient concern compared to men. Using data from the Project on Human Development in Chicago Neighborhoods, multilevel models analyze individual perceptions of problematic social disorder (N=3,107) regressed on the interactive effect of observed social disorder within the census block group (N=525) and women's relative resources within the neighborhood cluster (N=80). The results show that women's relative resources within the broader neighborhood context protect against women's perceptions that typically undesirable neighborhood conditions are problematic.

Sexual intercourse, romantic relationship inauthenticity, and adolescent mental health.

Numerous studies indicate sexual intercourse, especially when it occurs early in adolescence, increases youths' risk of mental health problems. However, no research has examined whether the association between sexual intercourse and mental health varies by romantic relationship inauthenticity, or the level of incongruence between thoughts/feelings and actions within romantic relationships. Using data from a subset of romantically-involved Add Health respondents, we measured sexual involvement in romantic relationships and applied sequence analysis to reports of ideal and actual romantic relationship to measure inauthenticity within adolescent romances. Regressions of depression symptoms indicate that the magnitude of the positive associations between sexual intercourse and girls' mental health is most pronounced in relationships characterized by high levels of relationship inauthenticity and that there is no association between sexual intercourse and girls' depression at low levels of relationship inauthenticity. Having sexual intercourse is positively associated with depression symptoms among boys, but relationship inauthenticity does not alter this association. We discuss the implications of these findings for research on adolescent sexuality and programs aimed at enhancing youth sexuality development.

Ecological Networks and Neighborhood Social Organization.

Drawing on the social disorganization tradition and the social ecological perspective of Jane Jacobs, the authors hypothesize that neighborhoods composed of residents who intersect in space more frequently as a result of routine activities will exhibit higher levels of collective efficacy, intergenerational closure, and social network interaction and exchange. They develop this approach employing the concept of ecological networks-two-mode networks that indirectly link residents through spatial overlap in routine activities. Using data from the Los Angeles Family and Neighborhood Survey, they find evidence that econetwork extensity (the average proportion of households in the neighborhood to which a given household is tied through any location) and intensity (the degree to which household dyads are characterized by ties through multiple locations) are positively related to changes in social organization between 2000-2001 and 2006-2008. These findings demonstrate the relevance of econetwork characteristics-heretofore neglected in research on urban neighborhoods-for consequential dimensions of neighborhood social organization.

Neighborhoods and adolescent health-risk behavior: an ecological network approach.

This study integrates insights from social network analysis, activity space perspectives, and theories of urban and spatial processes to present an novel approach to neighborhood effects on health-risk behavior among youth. We suggest spatial patterns of neighborhood residents' non-home routines may be conceptualized as ecological, or "eco"-networks, which are two-mode networks that indirectly link residents through socio-spatial overlap in routine activities. We further argue structural configurations of eco-networks are consequential for youth's behavioral health. In this study we focus on a key structural feature of eco-networks--the neighborhood-level extent to which household dyads share two or more activity locations, or eco-network reinforcement--and its association with two dimensions of health-risk behavior, substance use and delinquency/sexual activity. Using geographic data on non-home routine activity locations among respondents from the Los Angeles Family and Neighborhood Survey (L.A.FANS), we constructed neighborhood-specific eco-networks by connecting sampled households to "activity clusters," which are sets of spatially-proximate activity locations. We then measured eco-network reinforcement and examined its association with dimensions of adolescent health risk behavior employing a sample of 830 youth ages 12-17 nested in 65 census tracts. We also examined whether neighborhood-level social processes (collective efficacy and intergenerational closure) mediate the association between eco-network reinforcement and the outcomes considered. Results indicated eco-network reinforcement exhibits robust negative associations with both substance use and delinquency/sexual activity scales. Eco-network reinforcement effects were not explained by potential mediating variables. In addition to introducing a novel theoretical and empirical approach to neighborhood effects on youth, our findings highlight the importance of intersecting conventional routines for adolescent behavioral health.

Moving Beyond Neighborhood: Activity Spaces and Ecological Networks As Contexts for Youth Development.

Many scholars, policy analysts, and practitioners agree that neighborhoods are important contexts for urban youth. Yet, despite decades of research, our knowledge of why and how neighborhoods influence the day-to-day lives of youth is still emerging. Theories about neighborhood effects largely assume that neighborhoods operate to influence youth through exposure-based mechanisms. Extant theoretical approaches, however, have neglected the processes by which neighborhood socioeconomic contexts influence the routine spatial exposures-or activity spaces-of urban residents. In this article, we argue that exposure to organizations, institutions, and other settings that characterize individual activity spaces is a key mechanism through which neighborhoods influence youth outcomes. Moreover, we hypothesize that aggregate patterns of shared local exposure-captured by the concept of ecological networks-are influenced by neighborhood socioeconomic characteristics and are independently consequential for neighborhood youth. Neighborhoods in which residents intersect in space more extensively as a result of routine conventional activities will exhibit higher levels of social capital relevant to youth well-being, including (1) familiarity, (2) beneficial (weak) social ties, (3) trust, (4) shared expectations for pro-social youth behavior (collective efficacy), and (5) the capacity for consistent monitoring of public space. We then consider the implications of ecological networks for understanding the complexities of contextual exposure. We specifically discuss the role of embeddedness in ecological communities-that is, clusters of actors and locations that intersect at higher rates-for understanding contextual influences that are inadequately captured by geographically defined neighborhoods. We conclude with an overview of new approaches to data collection that incorporate insights from an activity-space and ecological-network perspective on neighborhood and contextual influences on youth. Our approach offers (1) a new theoretical approach to understanding the links between neighborhood socioeconomic characteristics and youth-relevant dimensions of neighborhood social capital; (2) a basis for conceptualizing contextual influences that vary within, or extend beyond, traditionally understood geographic neighborhoods; and (3) a suite of methodological tools and resources to address the mechanisms of contextual influence more precisely. Research into the causes and consequences of urban neighborhood routine activity structures will illuminate the social processes accounting for compromised youth outcomes in disadvantaged neighborhoods and enhance the capacity for effective youth-oriented interventions.

Legal Cynicism and Parental Appraisals of Adolescent Violence.

Research suggests that legal cynicism-a cultural frame in which the law is viewed as illegitimate and ineffective-encourages violence to maintain personal safety when legal recourse is unreliable. But no study has tested the impact of legal cynicism on appraisals of violence. Drawing from symbolic interaction theory and cultural sociology, we tested whether neighbourhood legal cynicism alters the extent to which parents appraise their children's violence as indicative of aggressive or impulsive temperaments using data from the Project on Human Development in Chicago Neighborhoods. We find that legal cynicism attenuates the positive association between adolescent violence and parental assessments of aggression and impulsivity. Our study advances the understanding of micro-level processes through which prevailing cultural frames in the neighbourhood shape violence appraisals.

Caught in a bad romance: adolescent romantic relationships and mental health.

Integrating insights from cultural sociology and identity theory, I explore the mental health consequences of adolescent romantic relationship inauthenticity--incongruence between thoughts/feelings and actions within romantic contexts. Applying sequence analysis to National Longitudinal Study of Adolescent Health data, I measure relationship inauthenticity by quantifying the extent to which the ordering of events of actual romantic relationships (e.g., holding hands, saying "I love you") diverges from the sequence of events within idealized relationship scripts among 5,316 adolescents. I then test its association with severe depression, suicide ideation, and suicide attempt. I find that romantic relationship inauthenticity is positively associated with the risk of all three markers of poor mental health, but only for girls. This study highlights the importance of gender and culture in determining how early romantic involvement influences psychological well-being.

Anticipating early fatality: friends', schoolmates' and individual perceptions of fatality on adolescent risk behaviors.

Past research indicates that anticipating adverse outcomes, such as early death (fatalism), is associated positively with adolescents' likelihood of engaging in risky behaviors. Health researchers and criminologists have argued that fatalism influences present risk taking in part by informing individuals' motivation for delaying gratification for the promise of future benefits. While past findings highlight the association between the anticipation of early death and a number of developmental outcomes, no known research has assessed the impact of location in a context characterized by high perceptions of fatality. Using data from Add Health and a sample of 9,584 adolescents (51% female and 71% white) nested in 113 schools, our study builds upon prior research by examining the association between friends', school mates', and individual perceptions of early fatality and adolescent risk behaviors. We test whether friends' anticipation of being killed prior to age 21 or location in a school where a high proportion of the student body subscribes to attitudes of high fatality, is associated with risky behaviors. Results indicate that friends' fatalism is positively associated with engaging in violent delinquency, non-violent delinquency, and drug use after controlling for individual covariates and prior individual risk-taking. Although friends' delinquency accounts for much of the effect of friends' fatalism on violence, none of the potential intervening variables fully explain the effect of friends' fatalism on youth involvement in non-violent delinquency and drug use. Our results underscore the importance of friendship contextual effects in shaping adolescent risk-taking behavior and the very serious consequences perceptions of fatality have for adolescents' involvement in delinquency and drug use.

Gender, Friendship Networks, and Delinquency: A Dynamic Network Approach.

Researchers have examined selection and influence processes in shaping delinquency similarity among friends, but little is known about the role of gender in moderating these relationships. Our objective is to examine differences between adolescent boys and girls regarding delinquency-based selection and influence processes. Using longitudinal network data from adolescents attending two large schools in AddHealth (N = 1,857) and stochastic actor-oriented models, we evaluate whether girls are influenced to a greater degree by friends' violence or delinquency than boys (influence hypothesis) and whether girls are more likely to select friends based on violent or delinquent behavior than boys (selection hypothesis). The results indicate that girls are more likely than boys to be influenced by their friends' involvement in violence. Although a similar pattern emerges for nonviolent delinquency, the gender differences are not significant. Some evidence shows that boys are influenced toward increasing their violence or delinquency when exposed to more delinquent or violent friends but are immune to reducing their violence or delinquency when associating with less violent or delinquent friends. In terms of selection dynamics, although both boys and girls have a tendency to select friends based on friends' behavior, girls have a stronger tendency to do so, suggesting that among girls, friends' involvement in violence or delinquency is an especially decisive factor for determining friendship ties.

Structuring the Future: Anticipated Life Events, Peer Networks, and Adolescent Sexual Behavior.

While prior research has established associations between individual expectations of future events and risk behavior among adolescents, the potential effects of peers' future perceptions on risk-taking have been overlooked. We extend prior research by testing whether peers' anticipation of college completion is associated with adolescent sexual risk-taking. We also examine whether adolescents' perceptions of the negative consequences of pregnancy and idealized romantic relationship scripts mediate the association between peers' anticipation of college completion and sexual risk-taking. Results from multivariate regression models with data from the National Longitudinal Study of Adolescent Health (Add Health) indicate peers' anticipation of college completion is negatively associated with a composite measure of sexual risk-taking and positively associated with the odds of abstaining from sexual intercourse and only engaging in intercourse with a romantic partner (compared to having intercourse with a non-romantic partner). In addition, perceptions of the negative consequences of pregnancy and sexualized relationship scripts appear to mediate a large portion of the association between peers' anticipation of future success and sexual risk-taking and the likelihood of abstaining (but not engaging in romantic-only intercourse). Results from our study underscore the importance of peers in shaping adolescent sexual behavior.

"Feeling disorder" as a comparative and contingent process: gender, neighborhood conditions, and adolescent mental health.

We explore the effects of neighborhood social disorder on internalizing symptoms among urban youth by focusing on three questions. First, we ask whether the impact of social disorder on internalizing symptoms results from comparisons with conditions measured locally or across the entire city. Second, we consider whether neighborhood collective efficacy modifies disorder's effect on internalizing symptoms. Finally, we assess whether these effects vary by gender. Analyses of survey data on 2,367 youth from the Project on Human Development in Chicago Neighborhoods indicate that social disorder is positively associated with girls' internalizing symptoms when measured as a deviation from a neighborhood cluster (NC--two to three census tracts) mean. High collective efficacy within girls' NCs attenuates disorder effects on their internalizing symptoms. We find no evidence of disorder or collective efficacy effects on boys' internalizing symptoms.

Thizzin'-Ecstasy use contexts and emergent social meanings.

The drug "Ecstasy" has been most commonly associated with raves, or electronic music dance events, and attributed with sexual disinhibition. In an ethnographic investigation of drug use among second-generation Southeast Asian youth in Northern California (2003), respondents described little use of or interest in using Ecstasy; yet in a second study, Ecstasy was the fourth most commonly-used substance. This paper investigates the social contexts for this change in use patterns. Respondents were second-generation Southeast Asian youths and young adults between the ages of 15 and 26 who were currently or recently drug-involved. We compared qualitative data from the two studies and found emerging patterns of meaning and context related to the observed change in use patterns. Ecstasy use among co-resident African American youth within the context of the local "hyphy" hip-hop music subculture had influenced Southeast Asian youths' uptake of the drug, known as "thizz." Respondents referred to the effects of the drug as "thizzin'," described as energizing, disinhibiting, numbing, and emotion enhancing. Reported consequences of "thizzin'" included violence and aggression as well as fun, while sexual disinhibition was rarely mentioned. The meanings assigned to drugs, including the effects ascribed to them, may be relative to the social contexts within which users are exposed to and consume drugs. The findings indicate the susceptibility of youths to local trends in drug use, particularly associated with popular cultural movements and music. Second-generation youths may be particularly susceptible relative to the conditions of their immigration and processes of identity formation unique to them.

Drug-Intake Methods and Social Identity: The Use of Marijuana in Blunts Among Southeast Asian Adolescents and Emerging Adults.

This article examines why Southeast Asian American adolescents and emerging adults in two urban settings prefer to use "blunts," or hollowed-out cigars filled with marijuana, over other methods of drug intake. Rationales for preferring blunts were both instrumental and social. Blunts allowed users to more easily share marijuana, the preferred drug among their peers, and protected against potential adverse effects associated with the "high." Blunts also allowed users to identify with the dominant style of drug use and differentiate themselves from users of stigmatized drugs such as crack cocaine and methamphetamine. This article highlights the importance of drug-intake methods in the formation and performance of drug-using behaviors among adolescents, emerging adults, and members of ethnic minority subgroups.

Optical vector network analyzer for single-scan measurements of loss, group delay, and polarization mode dispersion.

We present a method for measuring the complete linear response, including amplitude, phase, and polarization, of a fiber-optic component or assembly that requires only a single scan of a tunable laser source. The method employs polarization-diverse swept-wavelength interferometry to measure the matrix transfer function of a device under test. We outline the theory of operation to establish how the transfer function is obtained. We demonstrate the enhanced accuracy, precision, and dynamic range of the technique through measurements of several components.