It's "not black and white": Students' perceptions of "altruism" content in preclinical medical education.

OBJECTIVE: This study investigated how students as stakeholders viewed behavioral and social science (BSS) content in a preclinical longitudinal course entitled "Medicine, Body, and Society" (MBS) at UT Health San Antonio Long School of Medicine (LSOM). We present students' perceptions of successes and challenges tied to "altruism" and other non-biomedical objectives outlined by this institution. METHODS: We conducted a qualitative thematic analysis of MBS course evaluation data. Two researchers independently performed initial coding followed by interrater reliability checks to revise codes and a final MAXQDA lexical search to refine three themes. RESULTS: Three major themes emerged: (1) Students shared pedagogical preferences strongly favoring stories. (2) Students detected deficits in the module content tied to identities. (3) Students labelled BSS content as "soft," "subjective," and "siloed" which confounded its role in the course. CONCLUSIONS: Advancing altruism aligned with BSS content in preclinical medical education remains a challenge. A closer review of student evaluations framed as learner-centeredness is key to a greater understanding and resolution of competency issues in preclinical curriculum and its impact on mastery in subsequent clinical education and practice.

The Stress of Motherhood and Intimate Partner Violence during Emerging Adulthood.

Intimate partner violence is a serious social and public health problem for women. Researchers have shown the context in which intimate partner violence occurs matters, yet, prior work has not examined specifically whether motherhood, and the relationship context of motherhood, are associated with physical violence. Drawing on the Toledo Adolescent Relationships Study (TARS) (n = 492), and the stress process framework, we compared emerging adult mothers' (mothers with one child and mothers with multiple children) and non-mothers' reports of physical violence. Using negative binomial regression models, we found that mothers with multiple children compared with non-mothers reported more instances of relationship violence. We also found women in dating relationships with one child compared to non-mothers reported substantially more physical violence. These findings underscore the nature of stress and motherhood during emerging adulthood and the need for intervention strategies that target new mothers.

Two Decades of Change in Living Arrangements and Health of Middle-Aged and Older Adults in the U.S., 1997-2018.

Although living arrangements of American adults have changed significantly over the past decades, we know little about changes in the association between living arrangements and health. This study uses pooled data from 1997 to 2018 National Health Interview Survey to examine trends in living arrangements and health among middle-aged (ages 40-64) and older adults (ages 65-84). The results show that increasing share of middle-aged and older adults are living with persons other than their spouses or cohabiting partners, and this living arrangement is increasingly associated with poor health. Co-residence with persons other than spouses or cohabiting partners is particularly related to serious psychological distress among older adult women. Living alone in midlife is increasingly associated with poor health, but there has been little change in health of older adults living alone. The findings call for targeted policies and programs to address the needs of middle-aged and older adults in diverse living arrangements.

Strained Dating Relationships, A Sense of Mattering and Emerging Adults' Depressive Symptoms.

Dating relationships become increasingly important as individuals transition into young adulthood. Such relationships often involve positive and negative interactions, which may have implications for psychological well-being. We analyzed data from the fourth interview of the Toledo Adolescent Relationships Study (TARS), when respondents were ages 18-24, to assess the influence of relationship dynamics on depressive symptoms. Using ordinary least squares regression models, among individuals currently dating (n=422), we first examined the influence of a sense of mattering as well as strained dynamics of dating relationships (e.g., communication awkwardness, conflict, sexual non-exclusivity and influence attempts) as correlates of depressive symptoms. Next, we tested whether these correlates differed for male and female daters. We found that a sense of mattering, communication awkwardness, conflict, sexual non-exclusivity and influence attempts were significant correlates of depressive symptoms. However, gender interactions were not significant suggesting that these same correlates were associated with depressive symptoms in a similar manner for both men and women in dating relationships. We also found that a sense of mattering mediated the relationship between conflict and depressive symptoms, and partially mediated the relationship between communication awkwardness, partner sexually non-exclusivity and partner influence dynamics and depressive symptoms. This suggested that feeling that one matters is important in dating relationships and may reduce the risk of depressive symptoms.

Unpacking the "Black Box" of Race-Ethnic Variation in Fertility.

Race-ethnic differences in a range of childbearing behaviors are long-standing and well-documented, and these differences are attenuated, but not eliminated, when accounting for socioeconomic disparities. The residual differences are often attributed to vague and untested variation across race-ethnic groups in knowledge, attitudes, psychological attributes, normative beliefs, and social context. We use the longitudinal Toledo Adolescent Relationship Study (TARS), which contains a rich set of such factors measured in early adolescence, to assess whether they contribute to race-ethnic differences in having a birth among men and women ages 17-24 (n=1,042). Specifically, we test whether individual attitudes, religiosity, and academic behaviors; knowledge and behaviors regarding sex and dating; peer normative context; and parental communication about sex account for variation in the risk of an early birth. We find that socioeconomic factors attenuate but do not reduce differences between Black, Hispanic, and White respondents. Including adolescent academic performance and early entry into sex reduces the Black-White difference in the odds of early fertility to nonsignificance; however, beyond socioeconomic status, none of the broad range of factors further attenuate Hispanic-White differences, which remain large and statistically significant.