Lifetime trauma exposure profiles and alcohol use over time among U.S. Reserve and National Guard soldiers.

Although trauma exposure is a recognized risk factor for alcohol use, research on military populations has emphasized combat exposure, with minimal consideration of exposure to other potentially traumatic events (PTEs). We aimed to (a) identify, characterize, and quantify subgroups of service members based on PTE patterns; (b) examine associations between trauma exposure subgroups and alcohol use; and (c) examine these associations longitudinally. Data were drawn from Operation: SAFETY, a longitudinal study of health and well-being among U.S. Army Reserve/National Guard soldiers (N = 478). Exposure to 15 PTEs, including childhood maltreatment, noninterpersonal events (e.g., natural disasters, accidents), interpersonal trauma, and military-related exposures, was assessed at baseline. Latent profile analysis was conducted to characterize mutually exclusive trauma profiles; profile membership was used to longitudinally predict alcohol use in generalized estimating equation models. Four exposure profiles were identified: intimate partner violence (IPV)/combat trauma (8.4%, n = 40), combat trauma (24.7%, n = 118), childhood trauma (8.4%, n = 40), and low trauma (58.6%, n = 280). In adjusted models, compared to the low trauma profile, IPV/combat profile membership was longitudinally associated with alcohol problems, OR = 2.44, p =.005. Membership in other trauma profiles was not associated with alcohol use. Within the IPV/combat profile, men had a higher risk of frequent heavy drinking than women. Results suggest a need to comprehensively screen for lifetime PTE exposure, particularly IPV, in military populations. Given the high prevalence of nonmilitary PTEs, an inclusive, trauma-informed approach to health care and service provision is warranted.

Maternal behavioral health symptom profiles in early family life: complexity and context.

Behavioral health problems affect at least 15% of mothers, but few studies have examined how different problems cluster together. Characterizing symptom profiles and their correlates early in the family life cycle can extend existing understanding beyond that provided by studies based on single problems. Mothers in the Fragile Families and Child Wellbeing study, a national birth cohort of racially diverse and mostly unmarried mothers (N = 4205), reported depression, anxiety, and substance dependence symptoms. Latent class analysis (LCA) identified mothers' symptom profiles in their children's third year. We explored associations between symptom profiles and demographics, reproductive health outcomes, functional limitations, and postpartum behavioral health. LCA identified five profiles: (1) Depression only (14.5% of sample), (2) Severe depression and anxiety (5.3%), (3) Anxiety only (2.2%), (4) Depression and substance use (1.4%), and (5) Currently symptom free (76.6%). Depressive symptoms were more moderate when co-occurring with substance dependence and more severe when co-occurring with anxiety. Postpartum depression, postpartum anxiety, and smoking during pregnancy were the most robust correlates of being symptomatic in year 3. Mothers in the "Severe depression and anxiety" group were more likely to be in that profile if they reported functional impairment and/or relationship dissolution. Mothers in the "Depression only" profile were more likely to have higher parity and/or functional impairment. A quarter of mothers of young children had significant behavioral health symptoms, with most reporting depression symptoms. Psychosocial and physical health factors in the pregnancy and postpartum periods were associated with future symptoms, warranting obstetrician and pediatrician attention.

Association between maternal and child mental health among US Latinos: variation by nativity, ethnic subgroup, and time in the USA.

Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007-2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5-17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p < 0.01). In adjusted models, there was an 8.5-point (95% CI 5.1, 11.8) increased prevalence of child impairment associated with mother's probable mental illness among mainland US-born youth and mothers and a 6.0-point (95% CI 3.7, 8.3) increased prevalence among US-born youth of foreign/island-born mothers. There was no significant difference in the prevalence of youth impairment associated with maternal mental illness when both youth and mother were born outside of the mainland US. For the Puerto Rican subgroup, the association between maternal and youth mental health was greatest among island-born mothers and mainland US-born youth; for the Mexican subgroup, the link was strongest among US-born mothers and youth. While there were large point differences between those groups, the difference was not statistically significant. This study suggests a protective effect of island/foreign-born nativity on symptom association between Latino mothers and children. Considerations for future research and practice stemming from this finding are discussed.

Building a Foundation for Family Health Measurement in National Surveys: A Modified Delphi Expert Process.

INTRODUCTION: Families are the most proximal and powerful context for the development, promotion, and disruption of health of individuals across the life course. Despite families' critical role in health, U.S. nationally representative health surveys lack comprehensive and standardized assessments of family health and functioning. METHODS: To foster research on family health in population surveys, we developed a conceptualization of family health using a modified Delphi process with family health experts. Experts responded online to produce consensus definitions of 'family' and 'family health.' Guided by these definitions, they responded to a survey to create a list of concepts for measurement of family health and ranked the importance and measurability of those concepts. RESULTS: We achieved consensus among 15 family health experts on definitions of 'family' and 'family health.' Thirty-one family health concepts were organized into six domains, then ranked by relevance and importance as follows: (1) "Family relationships" and "family social context" tied for first priority, (2) "family member health, (3) "family health-related practices," (4) "family health resources," and (5) "management of time and activities." DISCUSSION: Social relationships and social environment were prioritized as more essential than other aspects of family environments typically assessed in population surveys, such as health practices and family members' illness and disease. This study develops the scientific groundwork needed to advance routine monitoring of family health in national health surveys and in child/family performance measures.

Beyond screening: a review of pediatric primary care models to address maternal depression.

Depression is one of the most debilitating chronic disorders in the United States, affecting 15 million children in homes with depressed mothers, many of whom endure household chaos, inconsistent nurturing, inadequate safety practices, and harsh discipline. Depressed mothers are under diagnosed and undertreated, yet there is broad consensus about the importance of identifying and managing maternal depression, as reflected in recommendations by pediatric and obstetric professional organizations to routinely screen for perinatal depression. Screening was shown to be acceptable to women and most pediatric providers, and adding a screening component need not impair clinic efficiency. Screening, however, is not sufficient, and there are few models in the literature to guide medical practices in implementing successful interventions to identify, treat, and prevent maternal depression, particularly in the pediatric setting. We reviewed the literature and identified six studies that evaluated models for screening and managing mothers' depression in pediatric primary care settings. Some of these interventions have promise, but no studies characterized health outcomes of the depressed mothers and children. We discuss the components of these models, their implementation, and the practice and research needed to create effective pediatrics-based systems to reduce the negative effects of maternal depression on mothers, children, and families.

Predictors of Postoperative Patient-Reported Outcome Measure Response Rates Among Patients With Rotator Cuff Repair.

BACKGROUND: Patient-reported outcome measures (PROMs) contribute to evaluating and improving the quality of patient care. Patient outcomes after rotator cuff repair (RCR) have been researched; however, the relationship between PROM response rates and individual and health care correlates has not been thoroughly investigated. PURPOSE: To examine differences in individual and health care factors among patients who had undergone RCR based on their PROM response rates. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Shoulder-specific and general PROMs were solicited via email and text message of all patients who underwent RCR between 2016 and 2020. Three subgroups were classified: (1) complete responders completed all 1-year postoperative PROMs, (2) partial responders answered enough questions to produce ≥1 usable score, and (3) nonresponders did not respond to a single measure. Correlates were assessed using analysis of variance and chi-square tests. Adjusted multinomial logistic regression models identified predictors of 1-year PROM response. RESULTS: Of 2195 patients included at the 1-year follow-up, 34% were complete responders; 11%, partial responders; and 55%, nonresponders. Patients had a mean age of 61.8 years, 63% were men, and 90% were White. Pre- and postoperative PROM scores were similar across responder groups. In stepwise selection, 1-year responses (complete or partial) were associated with older age, later year of surgery, White race, and having workers' compensation insurance. The strongest predictor of PROM response was having workers' compensation insurance. CONCLUSION: Patients with workers' compensation insurance compared with other insurance types responded to PROMs at disproportionately higher rates. This could distort postoperative PROM scores in the population studied because there are known differences among patients with this insurance status.

Item-Specific Knee Injury and Osteoarthritis Outcome Score Characterization of Patients With Medial Meniscus Root Tear.

Background: Most studies regarding medial meniscus posterior root tear (MMPRT) report total Knee injury and Osteoarthritis Outcome Score (KOOS) subscale values as important patient-reported outcomes, but there are few symptom-specific characterizations of patients with MMPRT. Purpose/Hypothesis: The purpose of this study was to characterize the prevalence and severity of symptoms and functional limitations among patients with MMPRT based on item-level KOOS responses. It was hypothesized that patients with MMPRT would show similar symptoms to those of other meniscal tear types, with items from the KOOS pain subscale forming a majority of the most severe and prevalent symptoms. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The records of 1466 patients with medial meniscus root tear between January 2017 and December 2021 at a single institution were reviewed. KOOS subscale scores and item-specific responses from initial evaluation were collected for each patient. Each KOOS item was scored on a scale from 1 (none/least severe) to 5 (extreme/most severe). Median and mean item-level responses were calculated and ranked in order of most to least severe. For statistical analysis, item-level prevalence rates were calculated as the proportion of patients reporting at least mild symptoms and ranked from most to least prevalent. Results: Included were 61 patients with MMPRT verified on magnetic resonance imaging (MRI). The most severe items according to item-level KOOS response were as follows: awareness of knee problem (mean, 4.62 [95% CI, 4.47-4.78]), difficulty jumping (mean, 4.06 [95% CI, 3.73-4.39]), difficulty twisting or pivoting (mean, 4.04 [95% CI, 3.76-4.32]), difficulty kneeling (mean, 3.98 [95% CI, 3.65-4.31]), and modification of lifestyle (mean, 3.94 [95% CI, 3.69-4.20]). The most prevalent items were knee stiffness later in the day, pain going up- or downstairs, difficulty ascending stairs, difficulty getting in and out of the car, difficulty twisting or pivoting, awareness of knee problem, and modification of lifestyle, with all patients reporting at least mild symptoms for each. Of the 11 most severe and prevalent symptoms, 8 came from the KOOS-Pain item-specific responses. Conclusion: Pain-related items made up a majority of the most severe and most prevalent symptoms as identified by the item-specific KOOS responses. However, meniscal symptoms commonly seen in other tear types, such as clicking and knee stiffness, were still quite prevalent in patients with MMPRT.

Factors Associated With Awareness, Adoption, and Implementation of Anterior Cruciate Ligament Injury Prevention in Youth Sports.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are among the most common injuries in adolescent athletes and result in significant financial and physical morbidity. Evidence-based programs designed to prevent ACL injury are effective. However, their adoption remains low. We sought to evaluate the awareness, evidence-based implementation, and barriers to implementation of ACL injury prevention programs (ACL-IPP) among youth athletic coaches. HYPOTHESIS: Higher education level of the coach, higher level of training, number of teams coached, and coaching female teams would be associated with ACL-IPP implementation. STUDY DESIGN: Cross-sectional survey. LEVEL OF EVIDENCE: Level 4. METHODS: We conducted an email survey sent to all 63 school districts within Section VI of the New York State Public High School Athletic Association. We employed descriptive statistics and tests of correlation to identify factors associated with ACL-IPP implementation. RESULTS: A total of 73% of coaches said they were aware of ACL-IPP, and only 12% of coaches implemented ACL-IPP according to best evidence. Coaches of higher competitive levels were more likely to adopt ACL-IPP (P = 0.01), more likely to use them multiple times per week (P = 0.03), and for ≥1 seasons (P = 0.02). Coaches of multiple teams were more likely to adopt ACL-IPP (P = 0.01). There were no differences in evidence-based implementation of ACL-IPP with gender coached or level of education of the coach. CONCLUSION: Overall awareness, adoption, and evidence-based implementation of ACL-IPP remain low. These results suggest that coaches at higher levels of play and multiple teams tend to use ACL-IPP more often. Gender coached and level of education do not appear to be associated with awareness or implementation. CLINICAL RELEVANCE: Evidence-based ACL-IPP implementation remains low. Targeting coaches of younger athletes and fewer teams with local outreach programs and ACL-IPP may increase the implementation of ACL-IPP.

Group well-child care model for Latino children in immigrant families: Adapting to and learning from the coronavirus disease 2019 (COVID-19) context.

INTRODUCTION: Group well-child care (GWCC) is an alternative to traditional pediatric well-child care designed to increase parental social support and peer learning. This mixed methods study explored the adaptation and implementation of GWCC to a virtual format during coronavirus disease 2019 (COVID-19 pandemic) among Spanish-speaking Latino immigrant families. METHOD: Interviews were conducted with eight providers and 10 mothers from May through September 2020. Qualitative analyses used a priori codes based on an implementation science framework. Quantitative data included demographics, the COVID-19 Impact Scale, and virtual group attendance. Bivariate analyses identified correlates of virtual visit attendance. RESULTS: Eighty percent of mothers reported the pandemic had moderately or extremely impacted at least one major life domain such as daily life, food security, or family conflict. Of 27 mothers offered virtual groups, 67% attended. Mothers who attended virtual groups reported lower English proficiency (p = .087) and fewer friends and family members with COVID-19 (M = 1.0 vs. 5.1, p < .05) than those who did not attend. Women described virtual GWCC as acceptable and a source of social support. Some described differences in group dynamics compared with in-person groups and had privacy concerns. Providers noted scheduling and billing challenges affecting feasibility and sustainability. They reported that visits with good attendance were productive. Mothers and pediatric providers offered recommendations to improve feasibility and privacy and address sustainability. DISCUSSION: Competing demands for those most impacted by COVID-19 may outweigh benefits of attendance. Virtual Spanish language GWCC appears acceptable and feasible for Spanish speaking Latina mothers. Thematic analysis and recommendations identify areas of improvement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Malaise, motivation and motherhood: predictors of engagement in behavioral interventions from a randomized controlled trial for HIV+ women in drug abuse recovery.

Drug abuse has serious consequences for the wellbeing of persons with HIV/AIDS but suboptimal rates of client engagement limit the efficacy of interventions. The present study examines and compares client characteristics that predicted engagement (defined as attendance at two or more sessions) in a family intervention (SET) and a group intervention within a randomized trial aimed at preventing relapse and improving medication adherence for 126 predominantly African American HIV+ women in drug abuse recovery. Intervention engagement (60% overall) was not significantly different across the two interventions. Fewer physical and mental symptoms (malaise) (P < 0.05), living independently (P < 0.05), living with children (P < 0.05), and readiness to change (P < 0.05) were associated with engagement across the two interventions. Results from this study can be used to inform outreach and engagement approaches for women dually affected by drug abuse and HIV/AIDS.

Variation of Behavioral Health Care by Behavioral Health Symptom Profile Among a Diverse Group of Pregnant and Parenting Mothers.

This study examines the association between behavioral health symptoms and use of behavioral health care (BHC; i.e., past year counseling and/or regular use of psychiatric medication) among a diverse group of mothers of toddlers. Data were from the Fragile Families and Child Wellbeing study (N = 4205 mothers). The association between symptom profiles (i.e., depressive, anxiety, and alcohol and drug dependence) and use of BHC was estimated with logistic regression models. Potential moderation by race/ethnicity was examined. Complex symptom profiles, older age, functional limitations, prior behavioral health symptoms, and having Medicaid were associated with increased BHC use. While BHC use varied by symptom profile (but not by race/ethnicity), BHC use was low across profiles. Pregnant women and women of color were most likely to have unmet needs, underscoring the need to improve screening and management systems for these populations.

Families as a Cornerstone in 21st Century Public Health: Recommendations for Research, Education, Policy, and Practice.

Families are vastly overlooked in US initiatives to promote population health and health equity despite being the most proximal context for health across the life course. We urge the public health sector to take the lead in recognizing families as essential for promoting 21st century population health. We highlight ways families influence health by providing context, care, continuity, and connections. The dual private and public aspect of families has contributed to how they have been overlooked in the public health sector. We provide recommendations for better integrating families into population health initiatives through national health goals, research, education, policy, and practice.

The Family Health Scale: Reliability and Validity of a Short- and Long-Form.

Families strongly influence the health of communities and individuals across the life course, but no validated measure of family health exists. The absence of such a measure has limited the examination of family health trends and the intersection of family health with individual and community health. The purpose of this study was to examine the reliability and validity of the Family Health Scale (FHS), creating a multi-factor long-form and a uniform short-form. The primary sample included 1,050 adults recruited from a national quota sample Qualtrics panel. Mplus version 7 was used to analyze the data using a structural equation modeling framework. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) confirmed a 32-item, 4-factor long-form scale. The four factors included (1) family social and emotional health processes; (2) family healthy lifestyle; (3) family health resources; and (4) family external social supports. A 10-item short-form of the FHS was also validated in the initial sample and a second sample of 401 adults. Both the long-form and short-form FHS correlated in the expected direction with validated measures of family functioning and healthy lifestyle. A preliminary assessment of clinical cutoffs in the short-form were correlated with depression risk. The FHS offers the potential to assess family health trends and to develop accessible, de-identified databases on the well-being of families. Important next steps include validating the scale among multiple family members and collecting longitudinal data.

Evaluating the educational component of a hospital-based child passenger safety program.

BACKGROUND: Interventions that combine educational programs and discounted child safety seats have been demonstrated to improve parental child passenger safety knowledge and practices. An educational component consisting of an hour-long bilingual (English/Spanish) class for parents was added to a hospital-based safety seat program. Researchers sought to evaluate participant knowledge retention and safety practices after the class and to identify parental motivators and barriers for correct safety seat use. In particular, researchers were interested in evaluating a child passenger safety program that includes both individualized and group-based educational components in addition to a giveaway seat program, and also serves a subset of Latinos, mostly from the Dominican Republic and the Guatemala, that is less frequently studied. METHODS: A 15-minute telephone survey was conducted in English or Spanish with past participants (n = 79) of the program. Descriptive statistics and odds ratios were generated to determine statistical significance. Qualitative data from open-ended questions were coded and grouped categorically. RESULTS: The final sample (n = 79) was mostly women (93.7%), Hispanic (78.5%), and foreign-born (77.2%). Six months after participating in the program, there was a statistically significant decrease in parental knowledge regarding appropriate safety seat transitions to booster seats and correct knowledge of the state child safety seat law-with odds ratios of 0.35 (95% CI: 0.13-0.93) and 0.16 (0.04-0.54), respectively. Most commonly reported motivators were safety and fear of police enforcement. Most commonly reported barriers to safety seat use were parents not understanding the importance of safety seats and being in a rush. CONCLUSIONS: Parents surveyed > or =6 months after receiving the child passenger safety program displayed less correct safety seat knowledge compared with parents surveyed <6 months after participating in the program. Parents noted multiple barriers to safety seat use. Programmatic changes that merit future study include (1) sending reminders to parents to refresh safety seat transition knowledge, particularly for older children, and (2) incorporating curriculum components that address the parental motivators and barriers to correct safety seat use in the class.

Factors related to loss of child custody in HIV+ women in drug abuse recovery.

BACKGROUND: Mothers who are dually-diagnosed with HIV/ AIDS and drug abuse are particularly burdened and vulnerable to loss of child custody. OBJECTIVES: This study explores factors associated with child custody loss among HIV+ women in drug abuse recovery, and compares mothers who have custody of their children to mothers who do not have custody of all of their children. METHODS: Descriptive analyses were conducted on 68 HIV+ mothers in drug recovery, 46% who had custody of all of their children, and 54% who did not. RESULTS: The lost-custody group was less likely to be employed and had more history of violent impulses and arrest, particularly on drug charges. The groups reported similar recent and lifetime drug use patterns, but the custody group had received more drug treatment. Post-hoc analyses found the lost-custody group had lower rates of participation in the interventions offered in the parent clinical trial and higher avoidant coping. CONCLUSIONS: The sample in the current study supports that HIV+ women in drug recovery are at high risk of loss of child custody. Non-adherence to available treatment seems to be associated with loss of child custody. SCIENTIFIC SIGNIFICANCE: RESULTS suggest the need for further research and active treatment outreach for this population.

Examining family networks of HIV+ women in drug recovery: challenges and opportunities.

HIV/AIDS is recognized as affecting and being affected by the family. HIV+ women in drug recovery and their families are particularly at risk due to family disruption and stigma. Yet family research with HIV+ adults is hampered by the challenges of defining the family, engaging family members into research, and tracking changes in family composition. In this paper we describe the family context of 144 HIV+ women in drug abuse recovery who are enrolled in a randomized trial of a family intervention to improve medication adherence and reduce relapse. Family was defined to include the women's household members, romantic partners, children and their caregivers, and others identified as a major source of support. The women reported on a total of 651 family members. We describe the family and household networks, romantic partnerships, and parenting arrangements of our participants. We also describe family member enrollment in the research study and the stability of romantic partnerships, parenting, and living arrangements over 1 year. We conclude with methodological implications for future family based clinical research with HIV+ adults.

Structural Ecosystems Therapy for recovering HIV-positive women: child, mother, and parenting outcomes.

This study presents results of a subgroup analysis from a randomized trial to examine whether Structural Ecosystems Therapy (SET), a family intervention intended to improve medication adherence and reduce drug relapse of HIV-seropositive (HIV+) women recovering from drug abuse, provided benefits for families with children. Data from 42 children and 25 mothers were analyzed at baseline, and 4, 8, and 12 months post-baseline. Results of longitudinal Generalized Estimating Equations analyses suggested that SET was more efficacious than the Health Group (HG) control condition in decreasing children's internalizing and externalizing problems and reducing mothers' psychological distress and drug relapse. Children in SET reported improvements in positive parenting as compared to the children in HG, but there were no differences in mother-reported positive parenting, or parental involvement as reported by either the children or mothers. These findings suggest that family interventions such as SET may be beneficial for mothers and children. An adaptation of SET specifically for families with children could further enhance benefits and improve acceptability and cost-effectiveness.