Barriers to healthcare for American Indians experiencing homelessness

Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.     

American Indian Grand-Families: Trauma and Services

Since the United States Census Bureau began collecting data regarding grandparents raising their grandchildren, the American Indian and Alaska Native (AI/AN) population has had the highest proportion of families led by grandparents as the primary caregivers of their grandchildren. Despite this, research into AI/AN grand-families is limited. To begin to fill this gap, this qualitative study of 49 AI/AN grandparents raising grand-families (GFs) was conducted in an urban area with one of the highest AI/AN populations in the United States. Results indicated that loss and trauma within the middle generation is a central theme for GF formation. Such GFs also reported using a variety of services spanning state, tribal, and urban AI/AN programs, with educational support as a primary need articulated for their grandchildren. Surprisingly, enculturation was not mentioned as a primary driver of GF formulation. The study suggests a need for further exploration of the needs of urban-based AI/AN GFs, and that service providers must be aware of such issues when working with AI/AN GFs.     

NA success linked to support by treatment

A deeply researched white paper shows how mutual support groups can assist — and have assisted — people trying to deal with their drug use. The paper summarizes research on the use of these support groups and details how Narcotics Anonymous (NA) helps drug users, in much the same way Alcoholics Anonymous helps alcohol users, but there are some important distinctions.     

Using the NIAAA brief alcohol screener in social work practice for selected prevention targeting youth

ABSTRACT

This article discusses the use of brief screeners in social work practice to identity adolescents in need of selected interventions for alcohol and other drug use problems. Brief screeners can increase access to alcohol or other drug intervention services and promote the diffusion of evidence-based interventions to underserved communities when integrated in Screening, Brief Intervention, and Referral to Treatment (SBIRT) initiatives. The two-item NIAAA Brief Alcohol Use Screener is discussed as a developmentally tailored assessment tool that can be integrated into SBIRT in social work practice to improve detection of early-stage alcohol problems among adolescents who lack routine access to preventative health care. The use of brief, empirically supported alcohol screeners in trainings for social work students and new professionals can enhance their preparation and competence to offer child and adolescent clients appropriate selected intervention options to reduce harms associated with underage alcohol use.     

The Effects of Parenting on the Development of Adolescent Alcohol Misuse: A Six‐Wave Latent Growth Model

Alcohol use increases throughout adolescence. Based on family socialization theory, it was hypothesized that family factors, particularly parental support and monitoring, would influence individual trajectories in the development of alcohol misuse. Six waves of data were analyzed, based on interviews with 506 adolescents in the general population of a northeastern metropolitan area. Using growth‐curve longitudinal analysis, results show that parenting significantly predicts adolescents' initial drinking levels (intercepts) as well as their rates of increase in alcohol misuse (slope). This study provides evidence that effective parenting is an important factor in preventing alcohol misuse.     

Urban American Indian/Alaskan Natives compared to non-Indians in out-of-home care

Historically, American Indian/Alaskan Native (AI/AN) children have been disproportionately represented in the foster care system. In this study, nationally representative child welfare data from October 1999 was used to compare urban AI/AN children to non-Indian children placed into out-of-home care. Compared to non-Indian children, urban AI/AN children were older, were more often male, came from poorer homes, and were more frequently placed into group homes/ residential placements. Urban AI/AN caregivers had a greater prevalence of alcohol abuse and mental health problems compared with non-Indian caregivers.     

Alcohol Use Among Black and White Adolescents Exploring the Influence of Interracial Friendship,the Racial Composition of Peer Groups,and Communities

Black adolescents use less alcohol, on average, than white adolescents. Prior research has struggled to explain the disparity in alcohol use between blacks and whites but not for a lack of potential mediating mechanisms. The current study draws on differential association theory and two waves of panel data (n = 1,016) to examine the influence of interracial friendship, the racial composition of peer groups, and communities on black–white differences in alcohol use. Findings indicate that (1) the racial composition of peer groups and communities influence changes in alcohol use, and (2) racial segregation contributes to racial disparities in alcohol use while interracial friendship reduces these disparities. Results suggest that the socially conservative values of the African‐American community are a strong deterrent to adolescent drinking, affecting even those adolescents who are themselves white but associate with black youth.     

Substance Use Among Rural African American Adolescents: Identifying Risk and Protective Factors

Substance use continues to be a significant problem among youth in our society, particularly in rural communities. The purpose of the current study was to identify the possible risk and protective factors that may be affecting the rates of alcohol and illegal drug use among a population of African American adolescents living in a rural, southern community. The following were identified as possible risk factors: (1) Being an older adolescent (15 years of age or older); (2) Spending afternoons after school with friends; (3) Having friends or family members who use alcohol or illegal drugs; (4) Being raised by non-family members; and (5) Having plans to enter military after high school. The following characteristics were associated with less alcohol and illegal drug use, and were identified as possible protective factors: (1) Being raised by parent(s) or other family members; (2) Spending afternoons after school with parents; (3) Having parents who talk to youth about dangers of drug and alcohol use; (4) Having parents who disapprove of their child using drugs or alcohol; (5) Being involved in extra-curricular church-related activities; and (6) Having plans to work, or attend college or technical school after high school. Characteristics that have been associated with drug and alcohol in previous research that were not associated with use in the current study include: (1) Being male; (2) Peer pressure to use alcohol or illegal drugs; (3) Grades in school; and (4) Involvement in extra-curricular activities. Implications for developing effective community programs aimed at reducing substance use among our youth are discussed.     

A review of environmental-based community interventions

Alcohol use and related problems can be influenced by a wide variety of prevention interventions, including efforts that focus on changing the community alcohol environment-for example, by reducing underage access to alcohol, decreasing alcohol availability among adults, and increasing awareness of alcohol-related issues. Examples of environmental-based community interventions that focus on reducing alcohol use and related problems are Communities Mobilizing for Change on Alcohol, the Community Prevention Trial, the Sacramento Neighborhood Alcohol Prevention Project, Saving Lives, Operation Safe Crossing, and Fighting Back. Evaluations of these programs found that programs that change the community environment can reduce alcohol use and related problems among both youth and adults, even in communities with relatively low readiness to address alcohol issues. Research also has identified particular settings and situations where alcohol environmental changes are particularly needed as well as factors influencing the effectiveness of certain strategies. Despite the progress made, additional questions still need to be addressed in future research to maximize the benefits associated with environmental-based community interventions.     

Implications of urbanism for the use of local news media: effects of population concentration on types of news acquisition in Japan

The Internet, a global computer network enabling people to send and receive information anywhere in the world, also functions as a local medium of communication. This study focuses on the role of the Internet in transmitting local news and examines the effects of community population concentrations as socio-ecological environments on the use of local news media consumed online and offline. Data from 1367 respondents across 156 Japanese communities were used to analyze the relationships between type of community and type of news source. The findings suggest that people who live in highly populated communities tend more often to use the Internet to access local news, whereas those in less populated communities tend to use more traditional mass media. However, the results of this study did not show a relationship between population concentrations within communities and the acquisition of international news, nor did the social features of residents adequately explain the effects of population concentration on the acquisition of local news. These results are consistent with theoretical predictions based on network externalities, urbanism, and collective action. The findings indicate that local news consumption is embedded in local social contexts in a way that international news is not, reinforcing the importance of urbanism in the information age.     

The determinants of breastfeeding for Mexican migrant women

This article develops an economic model for assessing Mexican agricultural migrants' decision to breastfeed in a sample of 137 women in 3 agricultural communities in California. The resulting hypotheses from the model are linked to health care and welfare program access, cultural factors, and employment. Using a probit analysis of the variables, a major finding is that non-traditional practices such as out-of-home child care, birth control, and alcohol use have a negative impact on the probability of breastfeeding. These findings were consistent with the hypothesis that women with more traditional values would be more likely to breastfeed. The authors also found that working women in the sample population were less likely to breastfeed.     

Sexual victimization and substance abuse in psychiatrically hospitalized adolescents

This article investigates the relationship between substance abuse and sexual abuse in a population of 260 psychiatrically hospitalized adolescents. Seven hypotheses are set forth to test a model that uses parental alcohol abuse, sexual abuse status, and gender as exogenous variables, perceived benefit of alcohol or drugs as an endogenous mediating variable, and substance abuse as the dependent variable. Using these variables, a path model was constructed and revised based on empirical testing. The revised model achieved an adjusted R2 of .38, thus explaining 38 percent of the variance in this sample's abuse of alcohol or drugs. The model suggests that within clinical populations, sexually abused adolescents should be screened for substance abuse, and attention should be given to parental alcohol abuse as well as the degree to which adolescents perceive benefits from their alcohol or drug use.     

Factors predicting placement of urban American Indian/Alaskan Natives into out-of-home care

American Indian/Alaskan Native children have disproportionately been placed into out-of-home care compared to White children in the child welfare system. What were the factors that child protective services (CPS) workers considered when deciding to remove a child from the home? Utilizing data from the National Survey of Child and Adolescent Well-Being, this study examined out-of-home care factors for 2215 urban American Indian/Alaskan Native (AI/AN) and White children. In the urban sample, children from White families were younger and were more likely to be investigated for lack of supervision, while AI/AN families were investigated for physical neglect. In the placement regression models, urban AI/AN children came from homes where caregivers had greater alcohol, drug and mental health problems. Decisions by CPS workers to place AI/AN children may have been influenced by racial bias. A CPS system that acknowledges culture and race may reduce overrepresentation in placement. Efforts to work with AI/AN families prior to a child's removal may prove to be beneficial and less expensive.     

Diversity Within Diversity

Summary

Asian American elderly form a heterogeneous group with respect to immigration history, ethnic/cultural background, socioeconomic position, and health and mental health status. This paper provides an overview of the internal heterogeneity within the Asian American elderly population and identifies those who experience multiple stressors affecting their quality of life. Then it discusses barriers to formal service utilization as well as strengths and deficits of informal support systems. To better serve Asian American elders with their multiple needs for health, mental health, and social services, increased funding is recommended for research on this group, diversification of social service programs in coethnic communities, and increased cultural competence in non-Asian social service agencies.     

Alaskan villagers' views on problem drinking: "those who forget"

Statewide statistics suggest that problems relating to alcohol abuse represent a major public health problem for Native Alaskans but very little is known about alcohol use on a community level, due to deficient reporting mechanisms and a lack of relevant research. The research reported here was designed to begin to fill this stated need. Alcohol use patterns, the extent of drinking, and associated problems as perceived by residents of two Alaskan Eskimo villages are documented. The structure and effects of alcohol programs in the villages, which represent local attempts to manage alcohol, are also examined. The research demonstrates that it cannot be assumed that all Native Alaskan communities have the same scale of drinking and consequent problems. Differential response to alcohol programs, which have essentially the same structure, is demonstrated and related to the recent development of contrasting levels of community organization in the two villages, which share a common cultural tradition. The utility of a comparative case study approach in examining alcohol problems in Native American communities and the need for expanded research for informed alcohol program planning and implementation are emphasized.     

The Community Readiness Survey. Development and initial validation

This article reports on the development and evaluation of a mail survey measuring population attitudes toward substance use of potential receptivity of communities to different prevention efforts. The Community Readiness Survey was designed through a series of prevention practitioner and consultant meetings and focus groups. Psychometric evaluation revealed five distinct domains: perception of alcohol, tobacco, or other drug problem; support for prevention; permissive attitudes toward teen substance use; perception of adolescent access; and perception of community commitment. Evidence of construct validity was demonstrated by the small but significant relationships between selected scale scores and community readiness as evaluated by prevention planners.     

Recovery Schools Rise to the Challenge: Shifting Alcohol Norms and Behaviors in Youth and Emerging Adults

Alcohol is a huge challenge for youth and therefore for the field of social work. The confluence of biopsychosocial factors place youth at risk. Early initiation to alcohol use is a serious risk factor for depression, anxiety, and suicide. The focus of this article is on the collaborative use of resources and evidence-based practices and innovative mechanisms for shifting youth mores around alcohol and providing alternative peer groups, especially in abstinence-hostile settings, such as high schools and college campuses. Recovery schools are drawing national attention and becoming a part of the fabric of the advancing recovery movement for youth. This article discusses the Recovery School movement; its impact on youth, families, and communities; and the impact it can have on the Social Work Grand Challenges. It culminates with a case study of a university community that demonstrates how lives and norms around alcohol can shift for youth and young adults.     

College Student Behavior: A Ten-Year Look

Abstract

Lester and Perez¹ have suggested that student behavior can be usefully construed in terms of a traditional-hedonic, implicit value system. They demonstrated that drug use and sexual activity provide simple behavioral anchors for this dimension, and observed an increasingly hedonic orientation among students. Ten years after their initial study, the student population at the same institution was again sampled using an anonymous questionnaire. The 1980 sample included 208 subjects, and these were compared with 688 subjects who responded to the 1970 survey. This comparison was supplemented by an intensive week-long study of 53 students within one campus living unit.

Significant increases in pre-college sexual activity were noted for both men and women. Marijuana use in high school also increased for both men and women during this period, while alcohol use increased only among women. Previously observed differences between male and female pre-college sexual activity and marijuana use had largely disappeared by 1980. Significant increases in sexual activity while in college were found for women but not for men. For men, overall marijuana and alcohol use in college did not change during the study period, but there was an increase in the frequent use of these drugs. Increases in all categories of marijuana use were noted among women, along with overall increases in their alcohol use. The significant differences between male and female marijuana use noted in the 1970 study were absent in 1980. The intensive week-long study revealed that alcohol use was part of the daily lives of one-third to two-thirds of the students sampled, although they reported interpersonal conflicts, absences from class, accidents, and injuries among the consequences of their drinking. A significant inverse relationship between sleep and alcohol use was observed among women, but not among men.

These data suggest that student behavior has become increasingly hedonic during the past ten years, with women in particular closing the gap which previously differentiated their behavior from that of their male peers. Institutions of higher learning must take these changes into account in the planning of academic programs, residential life, and health services.