Financial worry among older people: Who worries and why?

This study sought to clarify what drives economic worries among older people. Based upon the data from a national sample of adults aged 65 and older in Israel (N = 550), we examined associations between financial worry and economic status, lifestyle, social network, concerns about functional health, long term care needs and cognition, and population group. The main financial worry was that pension funds will not suffice for one's entire life. Multivariate analysis revealed that financial worry was negatively related to perceived income adequacy and age, and positively related to concerns about care and to apprehensions regarding one's ability to make decisions. Immigrants from the former Soviet Union were found to worry less. Understanding the different sources of financial worries among older people is essential insofar as older people are increasingly expected to take personal responsibility for their financial futures. Dealing with negative outcomes that stem from financial worries are important programming and policy goals in an era of population aging.     

Factors that influence parent recruitment into prevention programs in early childhood: A concept map of parents', practitioners', and administrators' points of view

Given that parents are the main carriers of change in their child, their participation in programs for preventing behavior problems in early childhood represents a key element in ensuring the success of the intervention. That said, although at-risk families benefit the most from this type of program, they are identified as being hard to reach. This study aims at identifying the factors that influence parent recruitment based on the points of view of the actors concerned. To this end, a concept mapping operation was performed, which involved parents (n = 19), practitioners (n = 19), and administrators (n = 13) from community and public organizations. The participants generated 131 statements to complete the following sentence: In your opinion, parents would enroll more in prevention activities for their child if…. These 131 statements were classified into 12 groups representing the factors that influence parent recruitment, all of which were considered relatively important (between 3.51 and 4.42 on 5). The participants also agree on an understanding of recruitment that tends toward an ecological model. This study shows that parent recruitment into prevention programs targeting behavior problems in early childhood is complex and multifactorial (including factors that concern parents, practitioners, services, organizations, and policies). Because the map shows that the influencing factors in recruitment appear to be interrelated, they should all be considered to increase the chances of reaching at-risk families.     

Asking for Change: Feasibility,acceptability, and preliminary outcomes of a manualized photovoice intervention with youth experiencing homelessness

Photovoice is a participatory action research method that empowers participants to photograph their everyday lives as a means of documenting and advocating for their needs; it has rarely been utilized with young people experiencing homelessness. The current study examined the feasibility, accessibility, and preliminary outcomes associated with participation in Asking for Change, a manualized Photovoice intervention, among youth (ages 18–21) staying in a homeless shelter (N = 22). Multiple sources of data, including field observation, standardized pre-post measures, and qualitative exit interviews were collected across two cohorts of Asking for Change. Results suggest the intervention was feasible and highly acceptable to many young people, created new opportunities to connect with young people, and, among those surveyed pre and post intervention (n = 9), was associated with improvements in communication skills, social connectedness, resiliency, and well-being. This article discusses the challenges and benefits inherent in doing this work and outlines a robust research agenda to move this knowledge base forward.     

Association between social support and child abuse potential among Japanese mothers

Child abuse is a global public health problem and a serious social issue in Japan. Social support is beneficial for parents faced with childrearing challenges. The aim of this study was to clarify the association between social support and child abuse potential. A cross-sectional study was conducted using a structured questionnaire. The target population was mothers of children at nine public nursery schools. Bivariate and multiple linear regression analysis were performed to examine the effects of socio-demographic, social support and psychological distress factors on child abuse potential. Among 309 mothers, 29 (9.4%) had a high child abuse potential score. Bivariate analysis indicated that mothers with a higher child abuse potential score were more likely to be divorced or unmarried (P < 0.001); living in single-female-parent households (P < 0.001); have low perceived economic status (P < 0.001); have a low level of child care support (P = 0.01); have a low Multidimensional Scale of Perceived Social Support (MSPSS) score (P < 0.001); and/or a high General Health Questionnaire-12 score (GHQ-12) (P < 0.001). Important predictors of child abuse potential among the mothers surveyed included living in single-female-parent households, having low perceived economic status, low MSPSS score, and high GHQ-12 score. Improving approaches that help mothers build social support relationships and ease them into child rearing in a psychologically healthy condition is recommended to prevent child abuse.     

Mortality among a national population sentenced to compulsory care for substance use disorders in Sweden: Descriptive study

Sweden's compulsory addiction system treats individuals with severe alcohol and narcotics use disorders. Merging data from three national level register databases of those sentenced to compulsory care from 2001 to 2009 (n = 4515), the aims of this study were to: (1) compute mortality rates to compare to the general Swedish population; (2) identify leading cause of mortality by alcohol or narcotics use; and (3) identify individual level characteristics associated with mortality among alcohol and narcotics users. In this population, 24% were deceased by 2011. The most common cause of death for alcohol users was physical ailments linked to alcohol use, while narcotics users commonly died of drug poisoning or suicide. Average age of death differed significantly between alcohol users (55.0) and narcotics users (32.5). Multivariable logistic regression analysis identified the same three factors predicting mortality: older age (alcohol users OR = 1.28, narcotic users OR = 1.16), gender [males were nearly 3 times more likely to die among narcotics users (p < .000) and 1.6 times more likely to die among alcohol users (p < .01)] and reporting serious health problems (for alcohol users p < .000, for narcotics users p < .05). Enhanced program and government efforts are needed to implement overdose-prevention efforts and different treatment modalities for both narcotic and alcohol users.     

Unmet legal and social advocacy needs of children with sickle cell disease: Implications for health care payer costs

Previous studies of advocacy needs faced by children and families have not differentiated needs that require attorney involvement (“legal advocacy needs”) from needs best addressed by social workers or lay advocates (“social advocacy needs”). Studies have also not examined the relationship between either type of need and health care costs. We developed a novel, replicable process to differentiate between legal advocacy needs and social advocacy needs. We then collected cross-sectional data from a sample of 52 children with sickle cell disease who were at least 1 year of age, a population with high advocacy needs and high health care costs. Mean annual health care costs to payers for children whose families had a least one legal advocacy need were $16,314, compared to $5552 for children in families with no legal advocacy needs (P = 0.007). After adjusting for covariates, the presence of a legal advocacy need was associated with $12,040 more in health care costs to payers (P = 0.02). Whether interventions to prevent and resolve legal advocacy needs can reduce health care costs by addressing the social determinants of health warrants future study.     

Services use by children and parents in multiproblem families

BackgroundMultiproblem families are multi-users of psychosocial and health care services, but little is known about factors associated with their care utilization in the general population. The aim of this study was to assess which factors were associated with the overall and psychosocial care use of two members—i.e., child and parent—of each multiproblem family.MethodsDuring well-child visits or psychosocial care, we identified 354 children and their parents who had problems in several life domains (response 69.1%). We used multivariate stepwise backward logistic regression analyses to identify the factors related to their use of overall and psychosocial care.ResultsA child's overall care use was associated with greater social support from family and friends (odds ratio, OR, 95% confidence interval, CI; OR = 1.05, CI = 1.01–1.08) compared to less perceived social support; and with more psychosocial problems in the child (OR = 1.84, CI = 1.04–3.24). Child's psychosocial care use was more likely among older children (OR = 1.94, CI = 1.20–3.15); greater social support by family and friend (OR = 1.03, CI = 1.00–1.06); more psychosocial problems (OR = 1.75, CI = 1.04–2.97); and when there were more parenting concerns (OR = 1.19, CI = 1.06–1.33). Parental overall and psychosocial care use was more likely when the family experienced a higher number of life events (OR = 1.27, CI = 1.17–1.38, and OR = 1.39, CI = 1.25–1.55).ConclusionsCare use in multiproblem families is related to family factors as well as psychosocial problems. It may be possible to use these family risk factors to identify such families early, whose intensive care use is possibly explained by the relationship with inadequate use of social support.     

A comparison of widowhood and well-being among older Greek and British-Australian migrant women

The impact of widowhood on well-being has been well-documented, but to date has not focused extensively on the experience of older migrants who have aged in a foreign land. This study aimed to examine the well-being of older migrant widows from two groups in South Australia: British-born (n = 61) and Greek-born (n = 60) Australian migrants, who had been widowed, on average, 13 years. All participants completed a self-report questionnaire in their preferred language. Three indicators of current well-being (self-rated health, depression and loneliness) as well as variables expected to differ cross-culturally, and potentially influence well-being (mourning rituals; continuing bonds to one's spouse; religiosity; social support) were measured. Greek-born widows displayed higher levels of mourning rituals, continuing bonds and religiosity than the British. Both groups perceived similarly high levels of familial social support. Greek widows also reported worse self-rated health, and increased symptoms of depression and loneliness compared to the British. This paper suggests that the detrimental impact of widowhood on well-being may be greater for non-English speaking migrants who are ageing outside of their country of origin, and who, despite residing in an English-speaking host country for several decades, have retained the linguistic, cultural and religious practices and traditions of their home country.     

Factors associated with treatment attrition for Medicaid-enrolled youth with serious emotional disturbances

Premature discontinuation from treatment is a significant problem that undermines the delivery of effective mental health services and increases the risk for relapse and poor outcomes. However, factors associated with treatment attrition in children and adolescents are not well understood. This retrospective longitudinal cohort study examines factors associated with attrition for Medicaid-enrolled youth, aged 5 to 17 with “new episodes” of ICD-9-CM diagnosed serious emotional disturbance (N = 43,122). Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Multilevel modeling was used to assess the association between individual and contextual-level variables and attrition. Of the 43,122 youth in the study sample, 4056 (9.4%) discontinued treatment. The odds of treatment attrition were significantly higher for youth who were male (OR = 1.16, p < 0.001), black compared to white (OR = 1.19, p < 0.001), had a co-occurring substance abuse disorder (OR = 1.35, p = 0.01), and lived in a county with a larger percentage of minorities (OR = 1.02, p = 0.01). In contrast, youth diagnosed with bipolar and depressive disorders compared to ADHD (OR = 0.78, p < 0.001 and OR = 0.87, p = 0.01, respectively), with comorbid psychiatric (OR = 0.74, p < 0.001) and medical disorders (OR = 0.82, p < 0.001), and a prior history of two or more psychotropic medications compared to no medications (OR = 0.76, p < 0.001) had lower odds of attrition. Residence in a county with a larger number of pediatricians and psychologists also reduced the odds of attrition (OR = 0.97, p = 0.05 and OR = 0.99, p = 0.03 respectively). Overall, this study suggests that a combination of individual factors, demographic and clinical, and contextual factors impact attrition in children's mental health outpatient treatment.     

Expanding the conceptualization of re-entry: The inter-play between child welfare and juvenile services

Re-entry in child welfare is traditionally viewed as a child exiting to permanency and then reentering the child welfare system. Using this approach is effective for understanding child welfare practice from a single-system lens, but gives an incomplete picture of how children may move between related child serving systems. The present study expands the definition of re-entry by examining re-entry for 2259 children who either return to the child welfare system or move into the juvenile justice system after reunification from foster care. When measuring a broader concept of re-entry (into either system) the rate of re-entry went from 18% to 25% - a 33% increase. Regression analyses further suggested that many of the risk and protective factors associated with standard child welfare reentry were also predictive of multisystem re-entry such as having previous child welfare experience (OR = 1.79, p < 0.000), and child behavior as a factor at removal (OR = 1.75, p < 0.000). Findings of this study support the need to continue increasing the conceptualization of re-entry to be more inclusive of related systems as well as continuing to focus research efforts on understanding effective practices within child serving systems so that re-entry into either system is mitigated.     

Significance of action plans in the development of occupational well-being in the schools of Finland and Estonia

This article is part of a long term project “Promoting the Occupational Well-Being of School Staff—Action Research Project in Finland and Estonia, 2009–2014.” The purpose of this article is to describe the significance of action plans in the promotion of the occupational well-being of primary and upper secondary school staff in Finland and Estonia from 2010 to the turn of the year 2011–2012. An electronic open questionnaire was sent to occupational well-being groups in Finland (N = 18) and in Estonia (N = 39). In Finland, the questionnaire was responded to by 16 (n = 16) occupational well-being groups, and in Estonia, by 38 (n = 38) groups. The qualitative data were analyzed using the inductive-deductive method and content analysis. The obtained results indicate that the schools had named goals for action plans in all aspects of the promotion of occupational well-being in schools (worker and work, working conditions, professional competence, working community) and that these goals were mainly realized in the schools in a systematic way. Schools felt that the action plan for occupational well-being helped them to set goals for occupational well-being and that the planned actions were realized in a more systematic way than before.     

Factors influencing the development of psychiatric disorders in the victims of sexual abuse: A study on Turkish children

The purpose of this study is to test empirically whether there are sex differences in childhood sexual abuse characteristics and psychiatric disorders, and there is an association with sexual abuse characteristics and psychiatric disorders caused by abuse. Files of 482 cases referred to the Child Surveillance Center due to sexual abuse between September 2012 and September 2014, for whom legal reports were prepared, were investigated retrospectively. Of the abused children, 82.2% (n = 396) were girls and 17.8% (n = 86) were boys. The mean age of girls was 14.1 ± 2.9 years, while that of boys was 11.6 ± 3.8 years. The most common type of abuse was sexual touching in girls, while it was anal penetration in boys. The rate of being diagnosed with at least one psychiatric disorder was found to be 68.9% (n = 273) in girls, while it was 38.4% (n = 33) in boys. When the abuser was from the family or someone close to the victim, when the numbers of abuse incidents and abusers were greater than one, and in cases of force and violence, the rate of being diagnosed with a psychiatric disorder was found to be higher. With greater duration of time passing after the abuse, in those who became pregnant due to abuse, and in those who did not tell their parents about the incident, the rate of psychiatric diagnosis was significantly higher. In addition, it was found that when there were more than one abused people in the same event, the rate of psychiatric diagnosis was lower. Among all these variables, independent variables affecting the development of psychiatric disorders in victims were gender, number of abuse, presence of force and physical violence, and presence of more than one abuse victim in the same event. Because of high rates of psychiatric disorders in children exposed to sexual abuse, it is crucial to evaluate these children in a careful and closely manner by clinicians.     

Diabetes education program for people with type 2 diabetes: An international perspective

BackgroundIn the Palestinian community, lifestyle changes, rapid urbanization and socioeconomic development, stress, smoking, and changes in food habits has increased the risk of non-communicable diseases especially diabetes mellitus. Diabetes complications can be prevented if the glycemic status of patients with diabetes is maintained within a nearly normal range. Therefore, patient education is critical in controlling blood glucose levels within the normal range.ObjectiveThis study aimed at measuring the effect of diabetes educational intervention program for patients suffering from type 2 diabetes attending the Diabetes Clinic in Tulkarim Directorate of Health.MethodsA short duration observational study involving pre- and post-test educational intervention program was carried out on a relatively small number of type 2 diabetes patients at the Diabetes Clinic in Tulkarim Directorate of Health. In total, 215 patients attended a group-based 4 h educational intervention session about diabetes. The program included explaining diabetes mellitus-symptoms, risk factors, types, treatment and complications and main aspects of self-care of the disease (foot care, eye care, and blood glucose monitoring), main aspects of dietary management, weight reduction, blood pressure, smoking cessation, periodic investigations, home monitoring and importance of physical activity. Knowledge evaluation questionnaire were evaluated pre- and post-study. Anthropometric measurements such as body weight (WT), body mass index (BMI) and laboratory tests such as fasting blood glucose (FBG), hemoglobin A1C (HbA1c), cholesterol (Chol), and triglycerides (TG) were measured both at the beginning and at the end of the study. Significance of the results was assessed by paired t-test at 95% confidence interval.ResultsThe participant’s mean age was 51.07 that ranged between 31 and 70 years. For a total of 215 participants, 41.4% were males and 58.6% were females. The mean weight before educational intervention was 80.81 ± 14.95 kg (82.6 kg for males and 79.5 kg for females) that decreased to 78.9 ± 14.33 kg (81.1 kg for males and 77.3 kg for females) after educational intervention program. The BMI also decreased significantly after educational intervention. The mean fasting blood sugar was 188.65 ± 71.45 mg/dL before educational intervention that decreased to 177.7 ± 66.11 mg/dL after the educational intervention (p = 0.049). The mean glycosylated hemoglobin was 8.57 ± 1.21 before educational intervention that decreased to 7.95 ± 1.42 after educational intervention. The mean value of cholesterol before educational intervention was 183.27 ± 37.74 mg/dL that decreased to 169.57 ± 34.23 mg/dL after educational intervention. The mean triglycerides value decreased after educational intervention from 209.85 ± 171.04 mg/dL to 183.28 ± 152.4 mg/dL (p = 0.025). The mean score of knowledge questionnaire before educational intervention was 60.6 ± 20.65 that increased to 78.1 ± 13.4 after conducting educational intervention.ConclusionsDiabetes education was found to be effective on BMI, FBG, HbA1c, Chol, TG, and knowledge.RecommendationsDiabetes education is a cornerstone in the management and care of diabetes and should be an integral part of health planning involving patient’s family, diabetes care team, community, and decision makers in the education process.     

Staff and youth views on autonomy and emancipation from residential care: A participatory research study

The use of participatory approaches in designing services is still relatively uncommon. In this study, we helped design a service to support the transition of youth from residential care to independent living by exploring the perspectives of staff and of youth regarding: (a) the concept and development of autonomy; and (b) key factors in developing this type of service. We gathered the data through 10 interviews with staff (n = 10) and 4 focus groups with youth (n = 21), and subjected the data to a thematic content analysis. Staff defined autonomy as self-regulation and self-care, and identified three paths to foster autonomy – a sense of normality, meaningful relationships, and planning for emancipation. The staff and youth identified the following important aspects in designing the service: achieving normality (e.g. limited number of residents), promoting youth capacity (e.g. skill-building activities), providing social support (e.g. trust and respect between residents), and assuring guidance and boundaries (e.g. supervision of youth).     

Aggressive and stressed? Youth's aggressive behaviors in light of their internet use,sensation seeking,stress and social feelings

Aggressive behavior and its consequences are a serious mental health problem for youth all over the world. In this study we investigated how problematic internet use, sensation seeking and social/dispositional factors are related to three forms of aggression: physical, verbal, and anger in a sample of Hungarian youth. In total 408 (50% females) aged between 14 and 24 years (M = 20.8 years, SD = 2.6) completed an online survey (between January and June 2014; different online social networking sites and online forums, such as university groups on Facebook and Hungarian writing sites) assessing these constructs. Multiple linear regression analyses (stepwise method) revealed a mixed pattern of predictors of each type of aggression, with boredom, age (as negative predictor), stress, lack of shyness and internet-associated neglect accounting for significant variance in verbal aggression. Obsessive internet use, disinhibition, stress and loneliness each accounted for significant variance in anger. Finally, after controlling for gender, internet-associated neglect, disinhibition and loneliness were associated with physical aggression. These findings suggest that interventions targetting aggression need to focus on different behaviors and attributes, depending on the type of aggression exhibited. Learning effective aggression management techniques should be a part of complex health education programs that would help with prevention of social conflicts, substance use, problem behavior, psychological and mental health problems as well as problematic internet use.     

Planning an organizational wellness initiative at a multi-state social service agency

Increasingly, organizations in general, and social service organizations, specifically, are recognizing the importance of planning and evaluating organizational wellness initiatives. Yet, few participatory models for carrying out these aims exist. For this study, researchers utilized concept mapping (CM) to explicate a conceptual framework for planning, and subsequently evaluating, a wellness initiative at a multi-state social service organization. CM is a participatory approach that analyzes qualitative data via multi-dimensional scaling and hierarchical cluster analyses. Outputs include a number of visual depictions that allow researchers to explore complex relationships among sets of the data. Results from this study indicated that participants (N = 64), all of whom were employees of the agency, conceptualized organizational wellness via an eight-cluster solution, or Concept Map. Priority areas of this framework, specifically importance and feasibility, were also explored. After a brief review of pertinent literature, this article explicates the CM methodology utilized in this study, describes results, discusses lessons learned, and identifies apt areas for future research.     

Development of an innovative process evaluation approach for the Families Improving Together (FIT) for weight loss trial in African American adolescents

This study demonstrates how a multi-theoretical, multilevel process evaluation was used to assess implementation of the Families Improving Together (FIT) for weight loss intervention. FIT is a randomized controlled trial evaluating a culturally tailored, motivational plus family-based program on weight loss in African American adolescents and their parents. Social Cognitive, Self Determination, Family Systems theories and cultural tailoring principles guided the conceptualization of essential elements across individual/family, facilitator, and group levels. Data collection included an observational rating tool, attendance records, and a validated psychosocial measure.ResultsAttendance records (0 = absent, 1 = present, criteria = ≥70%) indicated that 71.5% of families attended each session. The survey (1 = false, 6 = true, criteria = ≥4.5) indicated that participants perceived a positive group climate (M = 5.16, SD = 0.69). A trained evaluator reported that facilitator dose delivered (0 = no, 1 = yes, criteria = ≥75%) was high (99.6%), and fidelity (1 = none to 4 = all, criteria = ≥3) was adequate at facilitator (M = 3.63, SD = 0.41) and group levels (M = 3.35, SD = 0.49). Five cultural topics were raised by participants related to eating (n = 3) and physical activity (n = 2) behaviors and were integrated as part of the final curriculum.DiscussionResults identify areas for program improvement related to delivery of multi-theoretical and cultural tailoring elements. Findings may inform future strategies for implementing effective weight loss programs for ethnic minority families.     

Risky sexual behavior and substance use among adolescents: A meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were the smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.