Development of the Emergency Department Senior Abuse Identification (ED Senior AID) tool

Emergency departments (EDs) are an important health care setting for the identification of elder abuse (EA). Our objective was to develop an ED-based tool to identify EA. The initial tool included a brief cognitive assessment, questions to detect multiple domains of EA, and a physical examination. Refinement of the tool was based on input from clinical experts and nurse and patient feedback. The revised tool, which included 15 questions about EA, was then tested in an academic ED. We calculated the inter-rater reliability, sensitivity, and specificity of individual EA questions. Among ED patients age≥65 (N = 259), 17 (7%) screened positive for suspicion of EA. We identified a combination of six questions that cover the included domains of EA, demonstrated good or excellent inter-rater reliability, and had a sensitivity and specificity of 94% (95% confidence interval (CI) 71–100%) and 90% (95% CI 85–93%), respectively. These results inform a proposed screening tool for multisite validation testing.     

Differing Relationship Outcomes When Sex Happens Before,On, or After First Dates

While recent studies have suggested that the timing of sexual initiation within a couple's romantic relationship has important associations with later relationship success, few studies have examined how such timing is associated with relationship quality among unmarried couples. Using a sample of 10,932 individuals in unmarried, romantic relationships, we examined how four sexual-timing patterns (i.e., having sex prior to dating, initiating sex on the first date or shortly after, having sex after a few weeks of dating, and sexual abstinence) were associated with relationship satisfaction, stability, and communication in dating relationships. Results suggested that waiting to initiate sexual intimacy in unmarried relationships was generally associated with positive outcomes. This effect was strongly moderated by relationship length, with individuals who reported early sexual initiation reporting increasingly lower outcomes in relationships of longer than two years.     

Those They Leave Behind: Paternal Incarceration and Maternal Instrumental Support

As the American imprisonment rate has risen, researchers have become increasingly concerned about the implications of mass imprisonment for family life. The authors extend this research by examining how paternal incarceration is linked to perceived instrumental support among the mothers of inmates' children. Results from the Fragile Families and Child Wellbeing Study (N = 4,132) suggest that recent, but not current, paternal incarceration is independently associated with less maternal perceived instrumental support and that this association persists after adjusting for a rich set of control variables, including prior perceived instrumental support. For families of recently incarcerated men, incarceration may be a double strike, simultaneously increasing the need for instrumental support while decreasing its availability when incarcerated fathers return to the community.     

Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model

We used data from a randomized controlled study of Oxford House (OH), a self-run, self-supporting recovery home, to conduct a cost-benefit analysis of the program. Following substance abuse treatment, individuals that were assigned to an OH condition (n = 68) were compared to individuals assigned to a usual care condition (n = 61). Economic cost measures were derived from length of stay at an Oxford House residence, and derived from self-reported measures of inpatient and outpatient treatment utilization. Economic benefit measures were derived from self-reported information on monthly income, days participating in illegal activities, binary responses of alcohol and drug use, and incarceration. Results suggest that OH compared quite favorably to usual care: the net benefit of an OH stay was estimated to be roughly $29,000 per person on average. Bootstrapped standard errors suggested that the net benefit was statistically significant. Costs were incrementally higher under OH, but the benefits in terms of reduced illegal activity, incarceration and substance use substantially outweighed the costs. The positive net benefit for Oxford House is primarily driven by a large difference in illegal activity between OH and usual care participants. Using sensitivity analyses, under more conservative assumptions we still arrived at a net benefit favorable to OH of $17,830 per person.     

The effects of teenage fatherhood on young adult outcomes

This paper uses national longitudinal data and several new empirical strategies to examine the consequences of teenage fatherhood. The key contribution is to compare economic outcomes of young fathers to young men whose partners experienced a miscarriage rather than a live birth. The results suggest that teenage fatherhood decreases years of schooling and the likelihood of receiving a high school diploma and increases general educational development receipt. Teenage fatherhood also appears to increase early marriage and cohabitation, and has mixed short-term effects on several labor market outcomes.     

The Effects of First Occupation on Long Term Health Status: Evidence from the Wisconsin Longitudinal Study

In this paper, we use a longitudinal survey that has collected information for 50 years on a large cohort of Wisconsin high school graduates and their siblings to examine the long term impact of early occupational choice on health status. We find evidence that beginning a career in a blue collar occupation is correlated with several measures of poor health outcomes at ages 50–65. Since our dataset includes usually unobserved pre-labor market characteristics, including IQ and childhood health status, we can show that controlling for these variables is important for many results and suggests a high level of selection into occupation based on health and ability. We also provide evidence of gender differentials in the association between first occupation and later health. Then, we replace our basic measure of occupational categories with summary measures of job characteristics and find that employment at “bad jobs” at the beginning of an individual’s career predicts later health outcomes. Finally, we use sibling information in the dataset to show that unmeasured family background factors explain a large share of the effects of occupation on later health. Overall, the evidence points to limited, though heterogeneous, long term effects of health from blue collar employment.     

Raising awareness of psychosocial factors in the occurrence of low back symptoms in developing countries

Although there is strong evidence that single physical, psychosocial and organisational risk factors are each independent predictors of low back symptoms (LBS), little is known about their combination/interaction, particularly in those working in developing countries. A total of 1294 Indonesian coal mining industry workers reported information about physical, psychosocial, and organisational factors using self-reported questionnaires and were placed into one of four combination exposure groups: 1) high physical (working with bent trunk; whole body vibration exposure; lifting) and high psychosocial (high effort; low reward; work stress), 2) high physical and low psychosocial, 3) low physical and high psychosocial, and 4) low physical and low psychosocial (as the reference group). The odds of LBS in the high physical and high psychosocial group was 5.15 times (95% confidence interval 2.69-9.86) that of the reference group. Psychosocial factors played a more important role than physical factors in increasing the likelihood of reporting LBS. Permanent and night shift workers were more likely to report LBS. These findings imply that efforts to reduce LBS in this workplace should address both psychosocial and physical factors but psychosocial factors should be the priority, with a special focus on permanent and night shift workers.     

The effects of family stressors on substance use initiation in adolescence

Smoking and drinking are critical problems in adolescence that have long-term adverse impacts on health and socio-economic factors. We examine the extent to which family stresses influence the timing of initiation of smoking and drinking. Using national panel data from the National Educational Longitudinal Study (NELS) we capitalize on the survey design and use school-level fixed effects that control for the local environments, including prices of cigarettes and alcohol. In addition, we narrow our control group to classmates who will experience a similar stressor in the future. We find that a composite measure of family stressors when young increases the likelihood of initiating tobacco and alcohol use, with much of the impact attributable to parental divorce. In our baseline estimates, the composite stress measure is associated with a 30% increase in the likelihood of smoking and a 20% increase in drinking. When we control for multiple sources of confounding, the impact shrinks and remains significant for smoking but not for drinking. We conclude that studies which do not control for confounding are likely to significantly overestimate the impact of family stress on substance use. Our approach helps to move the literature forward by separating causal results from spurious associations.     

Municipal Law Enforcement Policy on Illegal Immigration Stops: Do Social Factors Determine How Aggressively Local Police Respond to Unauthorized Immigrants?

The devolution of immigration law has increased local police involvement in the enforcement of federal immigration law. But only some departments have responded by implementing policies that restrict their officers' involvement in order to protect residents from overzealous policing. We test theories of economic and ethnic threat to explore the structural characteristics of cities that explain this variation. Multiple regression results show that the most unequal cities that have large Hispanic populations are less likely to have a policy. Hispanic white segregation and high unemployment also reduce the likelihood of policy implementation. We discuss theoretical and policy implications.     

“I Had to Go to the Streets to Get Love”: Pathways From Parental Rejection to HIV Risk Among Young Gay and Bisexual Men

Young, gay, and bisexual men (YGBM) are at increased risk of family rejection, which is related to HIV infection. What remains unknown is how family rejection leads to HIV risk. In this exploratory study, qualitative interviews were conducted with 21 HIV-positive YGBM aged 18 to 24. Most participants reported family rejection, which decreased instrumental and emotional support and resulted in participants using riskier ways to support themselves, such as engaging in survival sex. Conceptualizing the findings using a family systems framework, we present a tentative conceptual model to describe the potential relationships between family rejection and HIV risk for YGBM.