Health Misinformation Exposure and Health Disparities: Observations and Opportunities.

The concepts of health misinformation and health disparities have been prominent in public health literature in recent years, in part because of the threat that each notion poses to public health. How exactly are misinformation proliferation and health disparities related, however? What roles might misinformation play in explaining the health disparities that we have documented in the United States and elsewhere? How might we mitigate the effects of misinformation exposure among people facing relatively poor health outcomes? In this review, we address such questions by first defining health disparities and misinformation as concepts and then considering how misinformation exposure might theoretically affect health decision-making and account for disparate health behavior and health outcomes. We alsoassess the potential for misinformation-focused interventions to address health disparities based on available literature and call for future research to address gaps in our current evidence base.

Impact of spirituality on resilience and coping during the COVID-19 crisis: A mixed-method approach investigating the impact on women.

Spirituality has been known to have a positive correlation to resilience during disasters. This study investigated the impact of spirituality on resilience during our current pandemic. A mixed-method approach was used to analyze correlations between spirituality and resilience of women. Correlations were noted to be statistically significant with Pearson's correlation of -.450 at 0.001, CD-RISC (M = 77.94), and DSES (M = 39.74). Thematic analysis of six open-ended questions provide depth to quantitative findings supporting the positive influence of spirituality on resilience, hope, optimism, peace, and comfort suggesting that spirituality may be an important dimension as this pandemic continues to unfold across the globe.

Decision-making processes shaping the home food environments of young adult women with and without children.

Although young adult women consume the majority of their total daily energy intake from home food sources, the decision-making processes that shape their home food environments have received limited attention. Further, how decision-making may be affected by the transformative experience of motherhood is unknown. In this study, we explore the factors that influence two key decision-making processes-food choices while grocery shopping and the use of non-home food sources-and whether there are differences by motherhood status. In-depth interviews were conducted with 40 women, aged 20-29, living in southwest Georgia. Thematic analysis was used to analyze qualitative data stratified by whether or not children were present in the home. Decision-making was affected by numerous factors, which differed across groups. In regard to grocery shopping, women with children more frequently discussed the influence of nutrition and the preferences of children, while women without children more frequently discussed the influence of taste and the preferences of other household members. Cost, convenience, weight control, and pre-planning meals emerged as salient in both groups. In regard to the use of non-home food sources, convenience and taste were discussed by both groups, while social factors were only discussed by women without children. The cost of eating out was the only reason cited for eating inside the home, and this factor only emerged among women with children. Motherhood may be an important contributor to the decision-making processes that shape young adult women's home food environments. Interventions may find success in framing messaging to emphasize factors identified as motivating healthy decisions, such as protecting the health of children, and practical strategies may be adapted from those already in use, such as pre-planning and budgeting for healthy meals.

The Daily Relationship Between Aspects of Food Insecurity and Medication Adherence Among People Living with HIV with Recent Experiences of Hunger.

BACKGROUND: Limited access to resources can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between lacking access to nutritious food and antiretroviral (ARV) medication non-adherence in a variety of social contexts. PURPOSE: This study aims to determine if several aspects of food insecurity co-occur with missed doses of medication on a daily basis among a sample of people living with HIV who have recently experienced hunger. METHODS: The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Participants were followed for 45 days and completed daily assessments of food insecurity and alcohol use via interactive text message surveys and electronic medication adherence monitoring using the Wisepill. RESULTS: Fifty-nine men and women living with HIV contributed a total of 2,655 days of data. Results showed that severe food insecurity (i.e., hunger), but not less severe food insecurity (i.e., worrying about having food), significantly predicted missed doses of medication on a daily level. Daily alcohol use moderated this relationship in an unexpected way; when individuals were hungry and drank alcohol on a given day, they were less likely to miss a dose of medication. CONCLUSIONS: Among people living with HIV with recent experiences of hunger, this study demonstrates that there is a daily relationship between hunger and non-adherence to antiretroviral therapy. Future research is needed to test interventions designed to directly address the daily relationship between food insecurity and medication non-adherence.

Promoting Policy and Environmental Change in Faith-Based Organizations: Outcome Evaluation of a Mini-Grants Program.

High rates of heart disease, cancer, and stroke exist in rural South Georgia where the Emory Prevention Research Center's Cancer Prevention and Control Research Network provided mini-grant funding to six churches to implement policy and environmental change to promote healthy eating and physical activity. This study sought to determine whether perceptions of the health promotion environment changed over time and whether perceived environmental change was associated with healthy behavior at church and in general. This study used a single-group pre-post design with 1-year follow-up. Parishioners (N = 258) completed self-administered questionnaires assessing perceptions of the church health promotion environment relative to healthy eating and physical activity, eating behavior and intention to use physical activity facilities at church, and eating and physical activity behaviors generally. Results indicate that perceived improvements in church nutrition environments were most strongly associated with decreases in unhealthy food consumed and stronger intentions to use physical activity resources at church (ps ≤ .05). Perceived changes in the physical activity environment were unrelated to church or general behavior. Findings suggest that church environments may play an important role in supporting healthy eating and physical activity at church; however, whether the influence of the church environment extends to other settings is unknown.

The Columbia Academy for Psychoanalytic Educators: A Pilot Program for Developing Analysts and Supervisors of Analytic Candidates.

The Columbia Academy for Psychoanalytic Educators supports graduate analysts' professional development at the Columbia University Center for Psychoanalytic Training and Research. In 2018, a pilot program was launched for faculty interested in analyzing and supervising candidates, whose aim is to support and educate those interested in taking on these essential training functions. The focus is on educating the educators, which is a significant departure from the historical focus on evaluation, vetting, and faculty hierarchies. In the process of developing and piloting the program, complex and long debated issues in psychoanalytic education and development were considered that are relevant to many institutes, including training of supervisors and analysts of candidates, addressing problematic faculty hierarchies, creating safety for those presenting clinical work to colleagues, building professional peer relationships, and engagement of faculty in time consuming and nonremunerative activities. The authors report on their experience developing and evaluating this pilot program.

Becoming a Training and Supervising Analyst: Interviews from the Columbia Postgraduate Analytic Practice Study.

Although much has been written about the training and supervising analyst system (TSA), its role in analysts' professional development has not been empirically studied. The Columbia Psychoanalytic Practice Study (CPAPS) is a longitudinal study of the careers of graduates from the Columbia Center for Psychoanalytic Training and Research. Interviews with 29/37 (78%) analysts graduating from 2003-2009 were analyzed using grounded theory. Our research question was: Are Columbia Center graduates interested in becoming TSAs and what factors influence their success in reaching this goal?Many analysts express interest in pursuing TSA appointment (22/29, 76%), however, a vast majority (26/29, 90%) experience challenges with finding cases, finances, and the work involved at a life stage with competing priorities. Fewer graduates become TSAs than express initial interest, suggesting that graduates find alternate pathways for professional development. While it is vital that institutes mentor graduates to take on a variety of postgraduate roles as educators, researchers, clinicians and scholars, our findings suggest that if the TSA qualification process were more user-friendly (less time-consuming, financially viable, and in step with current practice norms) more graduate analysts would sustain their interest in this career path.

Professional and Personal Development After Psychoanalytic Training: Interviews with Early Career Analysts.

After analytic training, graduates position their newly acquired identity as "psychoanalyst" in the context of their broader career, contemplating whether to start new analytic cases, adapting their new knowledge base to psychotherapy practice, and deciding how to focus their professional and personal interests going forward. Using questionnaires and interviews, the Columbia Postgraduate Analytic Practice Study (CPAPS) has prospectively tracked the career trajectory of 69 of 76 graduates (91%) from the Columbia University Center for Psychoanalytic Training and Research since 2003. In this paper grounded theory is used to identify developmental themes in interviews with analysts who have been followed for at least ten years. Recent graduates are negotiating the following challenges: developing a sense of competence, navigating relationships with colleagues and former supervisors as situations change and roles shift, transitioning into becoming mentors, and balancing the competing responsibilities of professional and personal life. Disillusionment about aspects of training, analytic practice, analysis as a treatment, institute politics, and the field in general emerges as a stark reality, despite a high level of career satisfaction. Educational recommendations include making career development opportunities available and providing a realistic view of both practice realities and expectations of analytic treatment outcome.

Emergency Remote Training in Psychoanalysis and Psychotherapy: An Initial Assessment from Columbia.

The Covid-19 pandemic and the social distancing required to combat it have set in motion an experiment in psychoanalytic education of unprecedented scope. Following an abrupt shift from in-person study to remote classes, supervision, clinical work, and training analyses, the Columbia University Center for Psychoanalytic Training and Research polled its psychotherapy and psychoanalysis trainees to assess their initial experience of remote training. Most candidates found the technical aspects of online learning easy and were satisfied with remote training overall. Across all programs, most trainees considered class length and reading load about right and felt their class participation was unaffected, though they found it harder to concentrate. Most found it no harder to start a training case, felt the shift to remote supervision had no negative effect, and were satisfied with seeing their training analyst remotely. Most trainees preferred in-person classes, clinical work, and training analyses to those offered remotely, yet in light of the health risks they said they were less likely to continue training in fall 2020 if in-person work resumed. Trainees suggested several modifications of teaching techniques to improve their participation and concentration in class. These findings' implications for the debate regarding remote training in psychoanalysis are explored.

Beyond Progression: Devising a New Training Model for Candidate Assessment, Advancement, and Advising at Columbia.

Research over several decades has identified significant problems with the progression model-the traditional approach to assessment and advancement of psychoanalytic candidates-including candidates' anxiety and uncertainty about the methods and fairness of their assessment, avoidance of conflictual issues with patients in order to keep cases, and reluctance to share their challenges with supervisors and advisors. In light of these findings, the Columbia Center for Psychoanalytic Training and Research restructured its psychoanalytic training programs. The progression committee, the progression advisor role, candidate application to advance through the program, and routine committee discussion of candidates were eliminated and replaced by confidential mentorship and a clear and predictable system of trainee advancement. Analytic competency-a requirement for graduation-is now determined solely from detailed written feedback regarding the candidate's achievement of the Center's learning objectives. The number of months of supervised analysis required for graduation has been reduced, as has the required length of the candidate's longest case; in addition, three-times-weekly analyses are now accepted for credit. These changes are meant to increase the transparency, objectivity, and predictability of the training experience and reduce the pressure on clinical decision making and communication between trainees and faculty. An extensive evaluation of the impact of these innovations is currently under way.

A prospective study of career development and analytic practice: the first five years.

To better understand the professional development of early career analysts, the Columbia University Center for Psychoanalytic Training and Research initiated a prospective longitudinal study of its graduates beginning in June 2003. Twenty-six of 29 graduates (90%) have completed confidential baseline questionnaires focusing on four domains: experience in analytic training, current private practice, postgraduate activities, and career goals. Participants are followed longitudinally with annual follow-up questionnaires and interviews. Of the cohort of graduates from 2003-2007, 58% were female, compared to 20% female in the cohort of graduates from 1973-1977. A bimodal distribution emerges wherein half of all graduates continue to sustain immersion of at least three ongoing cases in analysis at a four-times-weekly frequency. The other half do not maintain this immersion in four-times-a-week treatment; they primarily apply their training to psychotherapy practice. The more immersed group indicate significantly stronger interest in pursuing training analyst appointment as a primary career goal. The nonimmersed group conduct psychotherapy, feel positive about their training experience, teach at the institute, and have high morale, yet do not consider being a psychoanalyst their primary career identity. Thus, by five years, two viable and satisfying career paths emerge among our graduates. These data are important for training programs, both in preparing their graduates for future practice and in supporting their postgraduate experience.

A cross-sectional survey of child and adolescent analysts in New York City.

The field of child and adolescent psychoanalysis has been considered an endangered specialty for many decades. This study surveyed the nature of the practice of child and adolescent analysts (graduates and candidates) affiliated with three institutes accredited by the American Psychoanalytic Association in the New York City area. Sixty-one percent of those surveyed (63 of 103) responded. The child and adolescent analysts in this cohort treat a total of 201 adult, child, and adolescent analytic cases (M = 3.2, SD = 2.6). Of these cases, 17% are at a three-times-weekly frequency. Child and adolescent analytic practice is small, with a total of 56 analytic cases (M = .9, SD = 1.2). While 64% of these analysts have no child or adolescent analytic cases currently in treatment, 24% have very active child and adolescent analytic practices, conducting 73% of all the child and adolescent analyses reported. Implications of these findings and recommendations for future work are discussed.

Promoting Policy and Environmental Change in Faith-Based Organizations: Description and Findings From a Mini-Grants Program.

PURPOSE: The Emory Prevention Research Center's Cancer Prevention and Control Research Network mini-grant program funded faith-based organizations to implement policy and environmental change to promote healthy eating and physical activity in rural South Georgia. This study describes the existing health promotion environment and its relationship to church member behavior. DESIGN: Cross-sectional. SETTING: Data were obtained from parishioners of six churches in predominantly rural South Georgia. SUBJECTS: Participants were 319 church members with average age of 48 years, of whom 80% were female and 84% were black/African-American. MEASURES: Questionnaires assessed perceptions of the existing church health promotion environment relative to nutrition and physical activity, eating behavior and intention to use physical activity facilities at church, and eating and physical activity behaviors outside of church. ANALYSIS: Multiple regression and ordinal logistic regression using generalized estimating equations were used to account for clustered data. RESULTS: Results indicate that delivering messages via sermons and church bulletins, having healthy eating programs, and serving healthy foods are associated with participants' self-reported consumption of healthy foods at church (all p values ≤ .001). Serving more healthy food and less unhealthy food was associated with healthier eating in general but not to physical activity in general (p values ≤ .001). CONCLUSION: The church environment may play an important role in supporting healthy eating in this setting and more generally.

The impact of graduation from psychoanalytic training.

To examine candidates' experience of graduation from psychoanalytic training, 1997-2001 graduates of the Columbia University Center for Psychoanalytic Training and Research were sent a confidential questionnaire about their first year after analytic training. Of this group, 72 percent (23/32) returned the survey. Questions focused on the impact of graduation on time availability, net income, professional advancement, and sense of personal and professional autonomy. Graduates from analytic training were found to have more income in their first postgraduate year, a mean increase of 30,000 dollars, and more available time, a mean increase of sixteen hours. Increased earnings came primarily from seeing more patients during the time made available with the end of classes. In addition, graduates did not terminate their control cases or stop supervision. Graduates most valued their sense of professional accomplishment and ability to spend more time with their families. Although graduates also experienced relief from evaluation pressure, they did not rank this high in importance. For candidates, graduation profoundly impacts the structure of professional and personal life, but does not mean an end to learning.

Psychoanalytic practice in the early postgraduate years.

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.

A prospective study of psychoanalytic practice and professional development: early career interviews.

In 2003 the Columbia Center for Psychoanalytic Training and Research began a prospective study of graduates designed to both describe and understand their professional trajectory. The study has two components: a quantitative component based on an anonymous comprehensive questionnaire given analysts yearly starting with their graduation, and a qualitative component comprising analyst interviews beginning at the end of the first postgraduate year and repeated every two years. Analysis of the first six years of the qualitative study shows that analysts will talk openly about their practice and careers and that when they do, practical issues are a dominant concern. Analysts both immersed and not immersed in four-times-weekly analytic cases experiment with adapting skills developed in training to treat cases in analysis seen less frequently. Analysts without four-times-weekly case immersion are engaged in analytic careers, participate as faculty at the institute, and report a high degree of career satisfaction. The major findings of this study compel changes in psychoanalytic training programs. The field would do well to address actual clinical practice experience in institute curricula and training programs, thus making analytic training more relevant.