Changes in Self-Rated Health During the Transition to Retiring Living Among Medicare Managed-Care Recipients

ABSTRACT

Moving into a retirement community may be precipitated by or bring about changes in health status. We hypothesized that moving into a retirement community would be associated with a decline in self-rated health (SRH), but that health-related factors would mitigate this association. We analyzed data from 58,272 participants in Cohort 3 of the Medicare Health Outcome Survey. Individuals answered questions regarding living status in 2000 and 2002. Those who moved into a retirement community were compared with those who did not. The primary outcome was change in SRH. We created adjusted and unadjusted models. A total of 2,520 participants (4.4%) moved into retirement communities between 2000 and 2002. There were no substantial differences in the mean change in SRH between those who moved and those who did not. In adjusted and unadjusted models, moving was not significantly associated with changes in SRH. In an analysis stratified by SRH, only those with the best SRH had a significant decline in SRH during the move. SRH mainly remained stable for most people regardless of moving into a retirement community. These findings argue against environmental context being a main determinant of self-perceived health status among older adults.     

Values and happiness among Asian adolescents: a cross-national study

Despite policy efforts to increase adolescent happiness, their impact has been unsatisfactory. Their limited impact may be rooted from a discrepancy between values that adolescents pursued and those that the policies were based on. To provide policy implications, our study aims to identify prevailing values for South Korean, Japanese, and Chinese adolescents and to examine the relationship between the values and self-rated happiness (SRH). A cross-sectional study was conducted using survey data collected on approximately 2000 middle and high school students (7th to 12th school grade) from each country in 2008. Firstly, an explanatory factor analysis was conducted to identify salient adolescent values from each country. Subsequently, a multiple logistic regression analysis was conducted for each population group to examine the relationship between the identified values and adolescent SRH after controlling for sociodemographic characteristics. We found that benevolence and altruism were positively associated with adolescent SRH in all three population groups. Patriarchy was associated with SRH positively in Chinese yet inversely in Japanese. Success pursuit was inversely associated with SRH in Korean. Policy efforts based on values of communities or social harmony may benefit adolescents’ SRH in these three countries.     

Using video vignettes in research and program evaluation for people with intellectual and developmental disabilities: A case study of the Leadership for Empowerment and Abuse Prevention (LEAP) project

People with intellectual and developmental disabilities (IDD) are often excluded from meaningful participation in research and program evaluation for various reasons, including protocols and measures that are inaccessible for people with varying cognitive and communication abilities. Emancipatory research models emphasize the importance of inclusive research practices. Video vignettes are a promising tool for research and program evaluation with people with IDD because they are standardized, they use visual imagery rather than relying on written or verbal communication, and they allow for distance from sensitive topics. The Leadership for Empowerment and Abuse Prevention (LEAP) project used video vignettes to evaluate a healthy relationship program for people with IDD. The authors discuss the process of piloting various protocols and measures, which then ultimately led to the use of video vignettes in the evaluation.     

Parenting and child-caretaking among black men who have sex with men and associated sexual and reproductive health factors: a brief report

Abstract

The purpose of this exploratory study was to examine the prevalence of parenting and child-caretaking among a sample of black men who have sex with men (MSM), as well as associations between parenting roles and sexual and reproductive health (SRH) factors. Parenting and SRH data were derived from a survey of 199 black MSM. Nearly half of the sample reported being a father or father-figure (44.4%), almost a third indicated serving as caretaker of a child (29.1%), and one in five have a biological child (20.1%). Over half of the sample reported at least one of these three parenting/child-caretaking roles (52.5%). Two significant differences were observed for sexual health variables: men with biological children were significantly more likely to report using condoms inconsistently (55.0% vs. 35.7%, p = .026) and engaging in transactional sex work (36.8% vs. 21.0%, p = .041). Given the observed prevalence, parenting and child-caretaking among black MSM warrant further inquiry as factors that may influence SRH outcomes and care utilization. Services and interventions tailored to black MSM should consider these men’s potential roles and responsibilities as parents and caretakers of children.     

Constructing case vignettes for evaluating clinical judgment: An empirical model

Studies of clinical judgment are frequently based on analogue research, which uses experimenter-controlled stimuli to elicit judgments. The stimuli may be live models, audio- or video-taped models, or written case vignettes describing a clinical encounter. A major challenge of analogue research is to construct stimuli that maintain a balance between experimental rigor and clinical reality. An ideal set of case vignettes, for example, will contain summaries that resemble actual case histories and that are varied only on the specific clinical factors being studied. The model presented here demonstrates the empirical development of written case analogues in which several variables are studied simultaneously. The model can be adapted to any setting in which professionals are required to make judgments or decisions about individuals. The vignettes described here have been used in a variety of clinical settings to assess the reliability of clinicians'judgments and to aid in evaluation and program planning.     

A PARTIAL INDEPENDENCE ITEM RESPONSE MODEL FOR SURVEYS WITH FILTER QUESTIONS

In many surveys, responses to earlier questions determine whether later questions are asked. The probability of an affirmative response to a given item is therefore nonzero only if the participant responded affirmatively to some set of logically prior items, known as "filter items." In such surveys, the usual conditional independence assumption of standard item response models fails. A weaker "partial independence" assumption may hold, however, if an individual's responses to different items are independent conditional on the item parameters, the individual's latent trait, and the participant's affirmative responses to each of a set of filter items. In this paper, we propose an item response model for such "partially independent" item response data. We model such item response patterns as a function of a person-specific latent trait and a set of item parameters. Our model can be seen as a generalized hybrid of a discrete-time hazard model and a Rasch model. The proposed procedure yields estimates of (1) person-specific, interval-scale measures of a latent trait (or traits), along with person-specific standard errors of measurement; (2) conditional and marginal item severities for each item in a protocol; (3) person-specific conditional and marginal probabilities of an affirmative response to each item in a protocol; and (4) item information and total survey information. In addition, we show here how to investigate and test alternative conceptions of the dimensionality of the latent trait(s) being measured. Finally, we compare our procedure with a simpler alternative approach to summarizing data of this type.     

Multilevel models for social networks: Hierarchical Bayesian approaches to exponential random graph modeling

In many applications, researchers may be interested in studying patterns of dyadic relationships that involve multiple groups, with a focus on modeling the systematic patterns within groups and how these structural patterns differ across groups. A number of different models – many of them potentially quite powerful – have been developed that allow for researchers to study these differences. However, as with any set of models, these are limited in ways that constrain the types of questions researchers may ask, such as those involving the variance in group-wise structural features. In this paper, we demonstrate some of the ways in which multilevel models based on a hierarchical Bayesian approach might be used to further develop and extend existing exponential random graph models to address such constraints. These include random coefficient extensions to the standard ERGM for sets of multiple unconnected or connected networks and examples of multilevel models that allow for the estimation of structural entrainment among connected groups. We demonstrate the application of these models to real-world and simulated data sets.     

Homogamy and Intermarriage of Japanese and Japanese Americans With Whites Surrounding World War II

Although some sociologists have suggested that Japanese Americans quickly assimilated into mainstream America, scholars of Japanese America have highlighted the heightened exclusion that the group experienced. This study tracked historical shifts in the exclusion level of Japanese and Japanese Americans in the United States surrounding World War II with homogamy and intermarriage with Whites for the prewar (1930-1940) and resettlement (1946-1966) marriage cohorts. The authors applied log-linear models to census microsamples (N = 1,590,416) to estimate the odds ratios of homogamy versus intermarriage. The unadjusted odds ratios of Japanese Americans declined between cohorts and appeared to be consistent with the assimilation hypothesis. Once compositional influences and educational pairing patterns were adjusted, however, the odds ratios increased and supported the heightened exclusion hypothesis.     

Ready for Qualified Practice? A Comparative Study of Capability for Critical Reflection and Analysis of MA Social Work and MA Step Up to Social Work Students at the End of Second Placement

Social Work education is faced with substantial changes. New programmes like Step Up to Social Work have emerged and were evaluated in relation to intake, programme development and subjective student experiences. The lack of evidence on outcomes of such programmes was addressed in this study. In a comparative study of a MA in Social Work and a MA in Step Up to Social Work, the authors analysed students' capability to critically reflect on and analyse social work practice scenarios at the end of their final placement at one university. The PCF domain ‘Critical Reflection and Analysis’ was operationalised and the study design employed qualitative and quantitative data analysis. Demographic data, academic marks achieved during social work education and written reflections on case vignettes from the two programmes were analysed statistically. The findings suggest that, while there are some differences in outcomes between the programmes, they are not statistically significant. However, reflections on children and family vignettes were significantly better (U = 185, p = 0.008). Thematic analysis revealed considerable variation in the levels of curiosity and critical thinking and those respondents who framed their answers with reference to policy guidance, theory and research often extended their critical thinking.     

MEASURING HAPPINESS IN SURVEYS: A TEST OF THE SUBTRACTION HYPOTHESIS

Responses to an item on general happiness can change when thatitem follows one on marital happiness. Asking about maritalhappiness first sometimes reduces reported levels of overallhappiness. This reduction may result from a change in the interpretationof the general happiness item. According to this hypothesis,when the general item follows the item on marital happiness,respondents take the item to ask about aspects of their livesother than their marriages-in effect, the respondents subtracttheir (mostly happy) marriages in answering the general item.The study reported here tests this subtraction hypothesis byasking versions of the general happiness item that correspondto the different interpretations. A version of the general itemthat asked about general happiness "aside from your marriage"yielded responses that were quite similar to those given tothe standard item when it followed the item on marital happiness.Another version that asked about general happiness "includingyour marriage" elicited responses quite similar to those elicitedby the standard item when it preceded the marital happinessitem. However, reanalysis of the studies that originally demonstratedthe impact of the order of the two happiness items casts doubton the subtraction hypothesis and related models as explanationsof the earlier findings.     

A randomized field trial in Oakland, California

This study evaluates the impact of a civil remedy program (Beat Health) on drug and disorder problems under experimental field trial conditions. Using calls for service data, the authors find statistically significant differences between the control and experimental groups, when drug problem calls prior to the start of the intervention were compared to drug calls during a 12-month follow-up period. The Beat Health sites, especially the residential sites, improved relative to the control sites. By contrast, the control treatment (patrol response) led to significant increases in drug problems, particularly at the commercial properties included in this study. The authors also examined the spatial influences of the Beat Health and patrol responses in catchment areas surrounding each of the 100 study sites. The results show some improvement in the experimental residential sites. The authors found, however, a possible displacement of drug problems in and around both the commercial experimental and control sites. They show that the displacement effect is most notable in the commercial control sites.     

Innovative Moments in Career Construction Counseling: Proposal for an Integrative Model

This article advances understanding of career construction counseling (CCC) by viewing it through the lens of the innovative moments model (IMM) of how clients construct change. The IMM conceives clients’ narrative transformations as resulting from counselors prompting and clients reflecting on exceptions to a problematic self‐narrative (i.e., innovative moments; IMs) that emerges in counseling dialogues. On the basis of intensive IMM analysis of CCC case studies, the authors propose an integration of the 2 models that describes the sequence of client change in IMs across the 3 phases of CCC. This proposal provides both conceptual and assessment tools that make it possible to describe and analyze the process of client change through life‐designing dialogues. The authors illustrate the integrated framework with vignettes from case studies and conclude by suggesting research to examine the validity and usefulness of the client change sequence and interventions for using this pattern of change to foster client transformation.     

Empowering Lesbian and Gay Foster Adolescents Through Mentoring Relationships

This article discusses a mentoring model as a resource for lesbian and gay adolescents in foster care. Interview data collected in a national study of foster adolescent mentoring programs led to the identification of elements of succesful programs. The authors apply these elements to the design of a model mentoring program for lesbian and gay adolescents. Such a model program would help to alleviate problems that are related to isolation, stigmatization, and lack of positive lesbian and gay role models. Selected lesbian and gay youth vignettes are described and implications drawn for program development.     

Development and Validation of a Scale to Measure Adolescent Sexual and Reproductive Health Stigma: Results From Young Women in Ghana

Young women’s experiences with sexual and reproductive health (SRH) stigma may contribute to unintended pregnancy. Thus, stigma interventions and rigorous measures to assess their impact are needed. Based on formative work, we generated a pool of 51 items on perceived stigma around different dimensions of adolescent SRH and family planning (sex, contraception, pregnancy, childbearing, abortion). We tested items in a survey study of 1,080 women ages 15 to 24 recruited from schools, health facilities, and universities in Ghana. Confirmatory factor analysis (CFA) identified the most conceptually and statistically relevant scale, and multivariable regression established construct validity via associations between stigma and contraceptive use. CFA provided strong support for our hypothesized Adolescent SRH Stigma Scale (chi-square p value < 0.001; root mean square error of approximation [RMSEA] = 0.07; standardized root mean square residual [SRMR] = 0.06). The final 20-item scale included three subscales: internalized stigma (six items), enacted stigma (seven items), and stigmatizing lay attitudes (seven items). The scale demonstrated good internal consistency (α = 0.74) and strong subscale correlations (α = 0.82 to 0.93). Higher SRH stigma scores were inversely associated with ever having used modern contraception (adjusted odds ratio [AOR] = 0.96, confidence interval [CI] = 0.94 to 0.99, p value = 0.006). A valid, reliable instrument for assessing SRH stigma and its impact on family planning, the Adolescent SRH Stigma Scale can inform and evaluate interventions to reduce/manage stigma and foster resilience among young women in Africa and beyond.     

Exploring college students’ sexual and reproductive health literacy

Abstract

Objective: To assess college students’ sexual and reproductive health (SRH) literacy experiences, specific to contraception use and STI prevention. Participants: In Spring 2015, participants (n?=?43) from a large institution participated in six focus groups (two male and four females groups). Methods: Focus groups were guided by the health literacy domains (access; understand; appraise; apply); data were analyzed in MaxQDA using the constant comparative method. Results: The Internet was the most commonly accessed source for SRH information. Participants discussed facilitators (eg, use of visuals) and barriers (eg, medical jargon) to understanding information; and personal lifestyle, advice from family/friends, symptoms, and sexual partners as appraisal factors. Participants applied information by communicating with friends/providers and seeking healthcare. However, findings were not linear nor mutually exclusive, representing the interaction of health literacy skills. Conclusion: Findings suggest that a patient-centered intervention capitalizing on technology and trusted individuals (providers/peer educators) may facilitate college students’ SRH literacy.     

A group‐based module for adolescents to improve motivation to change sexually abusive behaviour

This article describes a group‐based intervention for adolescents specifically designed to improve motivation to change sexually abusive behaviour. The intervention is intended to be used as a single module within a comprehensive treatment programme based on cognitive behavioural and relapse prevention principles. It utilizes the Prochaska and DiClemente ( 1983 , 1986 ) model of the stages of change and Morrison's ( 1998 ) seven steps in contemplating change. We have combined these two models to produce ‘11 Steps of Motivation and Action in Changing Sexually Abusive Behaviour’. These 11 steps form the foundation of the intervention. In this paper we describe how we use the 11 steps, with accompanying illustrative vignettes and question cards describing juvenile sexual abusers at various points along the continuum of change, in order to promote the acceptance of responsibility for abusive behaviour and the development of skills to prevent reoffending. Examples of the vignettes are provided, along with a discussion of how they can be used to motivate change, develop healthy group norms in treatment and set individual goals for clients. Finally, we highlight the possibility of future applications of this intervention with male adult abusers, adolescent and adult female abusers, parents groups, significant other groups, individual clients and children with sexually aggressive behaviour. Copyright © 2001 John Wiley & Sons, Ltd.     

Multicultural education in Cyprus: A pot of multicultural assimilation?

In this paper, we attempt to answer the question: "is the Cypriot educational system a melting pot of every alien civilization and a kettle of cultural assimilation that perpetuates biases, clichés, racist behaviours and cultivates the idea that the different have no place among us?" We closely examine the case of a girl from Iran in a Cypriot primary school, using naturalistic observation models of research. Through the analysis of two vignettes, we attempt to answer the question posed above. We simultaneously reflect critically on the situation of multicultural education in Cyprus, while presenting its prospects for the future.     

Which Diagnostic Criteria are Most Useful in Discriminating Between Social Gamblers and Individuals with Gambling Problems? An Examination of DSM-IV and DSM-5 Criteria

The current study sought to identify which diagnostic criteria for gambling disorder have the greatest ability to differentiate between social and problem gamblers. This study was conducted on a sample of male and female college student athletes across the U.S. (n = 8674). Classification and regression tree analysis represents an appropriate technique when addressing the question of an item’s diagnostic value, as it sequentially selects variables to isolate sets of observations with similar outcomes. The current results suggest that the item related to preoccupation (“Have there been periods in the past year where you spent a lot of time thinking about gambling?”) was the DSM-5 item best able to differentiate between male and female social and problem gamblers in this sample. When considering only the nine criteria retained in the DSM-5, three criteria were identified as key for distinguishing between social and disordered gamblers among men, and one criterion was identified for distinguishing between groups of women. In addition, these results do not support the notion that the illegal acts criterion has a particularly low base rate and found that it can be an important indicator of disordered gambling in a college-aged sample.     

Trust, child care technology choice and female labor force participation

In this paper we investigate whether trust has an effect on the choice of child care technology and on female labor force participation. Mothers with less trust in others may decide to stay at home with their child instead of working. To do this, we sketch a simple model to show why this effect may be taking place, we measure trust using the European Social Survey and we test its influence on the choice of child care technology. To measure trust, we use the methodology proposed by Spady (Semiparametric methods for the measurement of latent attitudes and the estimation of their behavioural consequences. To measure trust, we use a recent semiparametric item response model. Compared to other measures of trust, using this technique has several advantages: it allows the aggregation of information from several questions and exploits additional information from personal and demographic characteristics. It also imposes very few parametric assumptions. The results show that trust matters for the degree of externalness of the child care technology people choose. It can therefore be a possible explanation for differences in female labor force participation across countries and across sociological groups.