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Item 80. Disparities in Perceived Vulnerability to COVID-19 Consequences Among U.S. Adolescents and Young Adults: Findings from a Nationally Representative Survey(Elsevier, 2021-02) Hensel, Devon J.; Rosenberg, Molly; Luetke, Maya; Herbenick, Debby; Pediatrics, School of MedicinePurpose: Global research has documented the adverse impact of COVID-19 on the health and well-being of adolescents and young adults (AYA). Pandemic conditions can increase AYA vulnerability to COVID-19-related health (e.g. getting sick or missing medical appointments), social (e.g. not having enough to eat) and economic (e.g. job loss) consequences. Structural inequalities may further exacerbate exposure to these outcomes. We used nationally representative data to examine AYA perceived vulnerability to health/social outcomes early in the COVID-19 pandemic. Methods: Data were the 2020 National Survey of Sexual and Reproductive Health during COVID-19 (Ipsos Research: Menlo Park, CA, USA), an online, nationally representative survey of COVID-19 experiences and knowledge among noninstitutionalized adults in the United States (all 50 states and District of Columbia). Of all individuals recruited (N=1632; 18-94 years), 1010 (62%) completed the survey. We retained a subsample of participants 18-25 years of age (N=106; 10.1% of the larger study) for our current analytic sample. Participants rated the next 12-week occurrence likelihood of eight COVID consequences (all dichotomized for analsis: no chance + low chance – 25% vs. medium chance – 25% to 75% + high chance - >75%). Illness consequences were: being exposed to COVID-19, getting an infection from COVID-19, being hospitalized from COVID-19, knowing someone with COVID-19, knowing someone who has died from COVID-19. Social/economic consequences were: losing job, partner/spouse losing job, not having enough to eat, parent(s) losing their job, missing important healthcare appointments/treatments. Structural variables were: gender (male/female), age (18-21/22-25), sexual identity (heterosexual/sexual minority [SM]) and race/ethnicity (White/BIPOC). We evaluated the prevalence heterogeneity across structural variables using nonparametric McNemar tests. All estimates were adjusted using Ipsos provided weights to account for sampling differences and/or nonresponse. Results: The majority of AYA in the United States (85%) believed they were vulnerable to 2+ health or social/economic consequences. Significantly more SM (36.4%-57.5%) than heterosexual (23.2%-37.0%; p<.001 both) AYA perceived vulnerability to being exposed to and/or getting an infection from COVID-19. A significantly greater number of BIPOC (16.2%-38.7%) than White (11.4%-18.8%; p<.001 both) believed they were vulnerable to COVID19-associated hospitalization or job loss. More SM (26.4%) than heterosexual (22.4%; p<.001) AYA estimated a medium-to high likelihood they would know someone who died of COVID-19. Significantly more BIPOC than White AYA felt high vulnerability to personal job loss (38.7% vs. 18.8%; p=.015), parent job loss (19.0% vs. 16.3%; p<.001) and not having enough to eat (16.3% vs. 10.0%; p<.001). Conclusions: Nationally, many AYA – particularly sexual minority and BIOPC youth – believe they are highly vulnerability to COVID-19 associated consequences. Professionals who work with youth may consider including screening for COVID-19 worries during clinical/educational interactions as a means of both understanding and normalizing AYA’s experiences, as well as helping them devise support or coping mechanisms, during this unprecedented time. These “check-ins” may be particularly where long-term worry about COVID-19 could exacerbate existing disparities in mental and physical health among marginalized AYA.Item Addressing Pollution-Related Global Environmental Health Burdens(AGU, 2018-02-19) Filippelli, Gabriel M.; Taylor, Mark P.; Earth Sciences, School of ScienceNew analyses are revealing the scale of pollution on global health, with a disproportionate share of the impact borne by lower‐income nations, minority and marginalized individuals. Common themes emerge on the drivers of this pollution impact, including a lack of regulation and its enforcement, research and expertise development, and innovative funding mechanisms for mitigation. Creative approaches need to be developed and applied to address and overcome these obstacles. The existing “business as usual” modus operandi continues to externalize human health costs related to pollution, which exerts a negative influence on global environmental health.Item Adverse Childhood Experiences (ACEs) and Their Impact on Substance Misuse & Overall Health(The Center for Health Policy, 2018-03-01) Balio, Casey; Greene, Marion S.Adverse childhood experiences (ACEs) encompass a wide variety of distressing events, including emotional, physical, or sexual abuse; witnessing maternal domestic violence; or living with a household member who has a substance use disorder, is mentally ill or suicidal, or is currently or was ever incarcerated during the first 18 years of a child’s life. According to most recent estimates, nearly half of Indiana’s youth have experienced at least one ACE in their life. ACEs are linked to many risk behaviors, including substance use, which can adversely affect health outcomes.Item Aging With Incarceration Histories: An Intersectional Examination of Incarceration and Health Outcomes Among Older Adults(Oxford, 2023-05) Latham-Mintus, Kenzie; Deck, Monica M.; Nelson, Elizabeth; Sociology, School of Liberal ArtsObjectives Experiences with incarceration are linked to poor mental and physical health across the life course. The purpose of this research is to examine whether incarceration histories are associated with worse physical and mental health among older adults. We apply an intersectionality framework and consider how the intersection of sexism and racism leads to unequal health outcomes following incarceration among women and people of color. Methods We employ 2 measures of health (i.e., number of depressive symptoms and physical limitations) to broadly capture mental and physical health. Using data from Waves 11 and 12 of the Health and Retirement Study, we estimated a series of general linear models to analyze differences in health by incarceration history, gender/sex, and race/ethnicity. Results Findings suggest that experiences with incarceration are associated with a greater number of physical limitations and more depressive symptoms among older men and women, net of sociodemographic characteristics, early-life conditions, and lifetime stressful events. Formerly incarcerated women, particularly women of color, had more physical limitations and depressive symptoms relative to other groups. Discussion These findings suggest that incarceration histories have far-reaching health implications. Older women of color with incarceration histories experience markedly high levels of physical limitations and depressive symptoms in later life.Item American Muslim Well-Being in the Era of Rising Islamophobia: Mediation Analysis of Muslim American Social Capital and Health(2023-04) Miller, Keith Matthew; Kondrat, David; Khaja, Khadija; Fukui, Sadaaki; Latham-Mintus, KenzieThis study aims to examine American Muslim well-being and social capital in the face of Islamophobia. Ecological frameworks and social capital theory were synthesized to provide an approach for research, analysis, and social work practice. A mediation analysis was conducted to test the mediating effect of cognitive social capital on the relationship between structural social capital and distress. The paths of structural social capital, cognitive social capital, and distress were conceptualized using the ecological framework of Berkman and colleagues. Special attention was paid to how experiences of Islamophobic discrimination affect cognitive social capital and distress. Structural social capital was operationalized as the number of active memberships in civic organizations; Cognitive social capital was operationalized as trust in major institutions such as schools and the local police and Distress was operationalized using the Kessler Distress Scale. It was hypothesized that an increase in structural social capital would show a decrease in distress with cognitive social capital mediating the path. Results showed that cognitive social capital mediates the relationship between structural social capital and distress. However, an inconsistent mediation was found where an increase in cognitive social capital shows a decrease in distress, but higher levels of structural social capital show an increase in distress. Lastly, the results of the analysis were interpreted to inform current interventions with the American Muslim community through a social work lens.Item Barriers and Facilitators of Health and Well-Being in Informal Caregivers of Dementia Patients: A Qualitative Study(MDPI, 2023-02-28) Duplantier, Sally C.; Williamson, Francesca A.; Pediatrics, School of MedicineBackground: Given the dramatic projected increase in Alzheimer's disease globally and the increased risk of morbidity and mortality for family caregivers of these patients, there is an urgent need to provide more targeted, timely resources to support the health and well-being of these informal caregivers. Few studies have investigated the barriers to health and well-being and potential strategies to facilitate better self-care from the unique perspective of the caregivers themselves. Purpose: This qualitative study aimed to identify barriers and facilitators to health and well-being for informal caregivers of family members with Alzheimer's. Method: We conducted semi-structured interviews with eight informal caregivers, including daughters, wives, and one husband, ages 32 to 83. Using Reflexive Thematic Analysis, we identified three main themes and subthemes across caregivers' experiences. Findings: We found that caregivers (1) prioritized mental and social well-being over physical health or health behaviors; (2) characterized the subjective burden of caregiving as a "mantle of responsibility" that could not easily be shed due to the complex subjective burden of loss, grief, guilt, resentment, isolation, loneliness, and lack of agency; (3) sought to be recognized as "additional patients", instead of being viewed as invisible patients, with support services tailored to their life stage and challenges. Conclusions: The findings suggest that the subjective burden of strain experienced by family caregivers of Alzheimer's patients has a profound impact on their health and well-being, even more so than the objective burden of strain that is the result of their day-to-day caregiving activities.Item "Churches in the Vanguard:" Margaret Sanger and the Morality of Birth Control in the 1920s(2015-03-30) Maurer, Anna C.; Robertson, Nancy Marie; Cramer, Kevin; Lantzer, Jason S.Many religious leaders in the early 1900s were afraid of the immoral associations and repercussions of birth control. The Catholic Church and some Protestants never accepted contraception, or accepted it much later, but many mainline Protestants leaders did change their tune dramatically between the years of 1920 and 1931. This investigation seeks to understand how Margaret Sanger was able to use her rhetoric to move her reform from the leftist outskirts and decadent, sexual connotations into the mainstream of family-friendly, morally virtuous, and even conservative religious approval. Securing the approval of religious leaders subsequently provided the impetus for legal and medical acceptance by the late-1930s. Margaret Sanger used conferences, speeches, articles, her magazine (Birth Control Review), and several books to reinforce her message as she pragmatically shifted from the radical left closer to the center and conservatives. She knew the power of the churches to influence their members, and since the United States population had undeniably a Judeo-Christian base, this power could be harnessed in order to achieve success for the birth control movement, among the conservative medical and political communities and the public at large. Despite the clear consensus against birth control by all mainline Christian churches in 1920, including Roman Catholics and Protestants alike, the decade that followed would bring about a great divide that would continue to widen in successive decades. Sanger put forward many arguments in her works, but the ones which ultimately brought along the relatively conservative religious leaders were those that presented birth control not as a gender equity issue, but rather as a morally constructive reform that had the power to save and strengthen marriages; lessen prostitution and promiscuity; protect the health of women; reduce abortions, infanticide, and infant mortality; and improve the quality of life for children and families. Initially, many conservatives and religious leaders associated the birth control movement with radicals, feminists, prostitutes, and promiscuous youth, and feared contraception would lead to immorality and the deterioration of the family. Without the threat of pregnancy, conservatives feared that youth and even married adults would seize the opportunity to have sex outside of marriage. Others worried the decreasing size of families was a sign of growing selfishness and materialism. In response, Sanger promoted the movement as a way for conservatives to stop the rising divorce rates by strengthening and increasing marriages, and to improve the lives of families by humanely increasing the health and standard of living, for women and children especially. In short, she argued that birth control would not lead to deleterious consequences, but would actually improve family moral values and become an effective humanitarian reform. She recognized that both liberals and conservatives were united in hoping to strengthen the family, and so she emphasized those virtues and actively courted those same conservative religious leaders that had previously shunned birth control and the movement. Throughout the 1920s, she emphasized the ways in which birth control could strengthen marriages and improve the quality of life of women and children, and she effectively won over the relatively conservative religious leaders that she needed to bring about the movement’s public, medical, and political progress.Item A Cluster Randomized Trial of Adding Peer Specialists To Intensive Case Management Teams in the Veterans Health Administration(Springer, 2015-01) Chinman, Matthew; Oberman, Rebecca S.; Hanusa, Barbara H.; Cohen, Amy N.; Salyers, Michelle P.; Twamley, Elizabeth W.; Young, Alexander S.; Psychology, School of ScienceUse of Peer Specialists (PSs)—individuals with serious mental illness who use their experiences to help others with serious mental illness—is increasing. However, their impact on patient outcomes has not been demonstrated definitively. This cluster randomized, controlled trial within the Veterans Health Administration compared patients served by three intensive case management teams that each deployed two PSs for one year, to the patients of three similar teams without PSs (Usual Care). All patients (PS group=149, Usual Care=133) had substantial psychiatric inpatient histories and a primary Axis 1 psychiatric disorder. Before and after the year PSs worked, patients were surveyed on their recovery, quality of life, activation (health self-management efficacy), interpersonal relations, and symptoms. Patients in the PS group improved significantly more (z=2.00, df=1, p=0.05) than those receiving Usual Care on activation. There were no other significant differences. PSs helped patients become more active in treatment, which can promote recovery.Item Community Conditions Favorable for Substance Use(The Center for Health Policy, 2018-04-01) Jacinto, Corey; Greene, Marion S.The probability of whether an individual engages in substance use is associated with several risk and protective factors. Effective prevention requires understanding these factors. The social-ecological model considers the complex interactions between individual, relationship, community, and societal factors. This can help us understand substance use in a public health context and design strategies to address the problem across multiple levels.Item Distressed family caregivers of lung cancer patients: an examination of psychosocial and practical challenges(Springer, 2013-02) Mosher, Catherine E.; Jaynes, Heather A.; Hanna, Nasser; Ostroff, Jamie S.Purpose: Lung cancer and its treatment impose many demands on family caregivers, which may increase their risk for distress. However, little research has documented aspects of the caregiving experience that are especially challenging for distressed caregivers of lung cancer patients. This study aimed to explore caregivers' key challenges in coping with their family member's lung cancer. Methods: Single, semi-structured qualitative interviews were conducted with 21 distressed family caregivers of lung cancer patients. Results: Caregivers described three key challenges in coping with their family member's lung cancer. The most common challenge, identified by 38 % of caregivers, was a profound sense of uncertainty regarding the future as they attempted to understand the patient's prognosis and potential for functional decline. Another key challenge, identified by 33 % of caregivers, involved time-consuming efforts to manage the patient's emotional reactions to the illness. Other caregivers (14 %) characterized practical tasks, such as coordinating the patient's medical care, as their greatest challenge. Conclusions: Results suggest that clinical efforts are needed to assist distressed caregivers in providing practical and emotional support to the patient and attending to their own emotional needs.