Time Use and Well-Being in Older Widows: Adaptation and Resilience

Research on widowhood mostly emphasizes negative outcomes, but some studies suggest widows are resilient. This study evaluated the in-depth daily experiences of older widows compared to married women. Participants included 75 widows and 125 married women from the National Study of Daily Experiences II, who completed daily diaries over 8 days. For long-term widows, there were no differences compared to married women in daily and general well-being, and a few differences in time use. Results add to the literature by using daily diary data to illustrate the general resilience of older women many years after the death of a spouse.     

Racial contestation and the emergence of populist nationalism in the United States

Much of the discussion surrounding nationalism still revolves around the ethnic versus civic nation divide. For purposes of this paper it is more useful to view the United States from the tri-modal perspective offered by Anderson, in which the United States is a creole (or settler) nation. All of Anderson's types can be seen as variants of ethnic nationalism. Kaufmann argues that the US evolved from ethnic to civic nationalism by the 1960s. This argument overlooks the importance of phenotype-based racism in the evolution of creole, or white settler colonial nationalism. We want to argue that US nationalism evolved from ethnic, to white racial nationalism in the interwar years. Since the 1920s, the political establishment has opted for civic nationalism that is based upon ‘white assimilationism’. This civic nationalism has been challenged by multiculturalism since the 1960s. In the context of a democratic political culture, the content of American nationalism has become ‘populist’ in the sense that it has come under popular contestation from the assimilationist right and the multiculturalist left. This populist nationalism includes aspects of ethnic and civic nationalism. Racial formation theory will be used to show that national identity may remain under ‘relatively permanent political contestation’ with racial cleavage as a major fault line in that contest. The issues of immigration and the treatment of Muslims since 9/11 will be addressed in order to make the case.     

Gender and geographic differences in Medicare service utilization during the last six months of life

ABSTRACT

End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence as a factor for health-care utilization among Medicare beneficiaries during the last six months of life has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality. The sample was restricted to fee-for-service Medicare beneficiaries who died between July 1, 2013, and December 31, 2013 (n = 39,508). The odds of rural beneficiaries using home health (aOR 0.87; 95% CI 0.81–0.93) and/or hospice (aOR 0.82; 95% CI 0.77–0.87) in the last six months of life were lower than urban beneficiaries. Female beneficiaries were more likely to use support services such as hospice (aOR 1.24; 95% CI 1.18–1.29) and/or home health services (aOR 1.07; 95% CI 1.02–1.13) than male beneficiaries. The odds of female beneficiaries using inpatient (aOR 1.14; 95% CI 1.08–1.20) and/or outpatient (aOR 1.06; 95% CI 1.01–1.12) were higher than male beneficiaries. This research is important as we examine the range of health services used during the last six months of life, by gender and rurality. Future research is needed to understand how access to health services, residential isolation, and age- and disease-related factors relate to women’s observed greater use of inpatient, outpatient, hospice, and home health services in the last six months of life.     

The truncation-by-death problem: what to do in an experimental evaluation when the outcome is not always defined

Although experiments are viewed as the gold standard for evaluation, some of their benefits may be lost when, as is common, outcomes are not defined for some sample members. In evaluations of marriage interventions, for example, a key outcome--relationship quality--is undefined when a couple splits up. This article shows how treatment-control differences in mean outcomes can be misleading when outcomes are not defined for everyone and discusses ways to identify the seriousness of the problem. Potential solutions to the problem are described, including approaches that rely on simple treatment-control differences-in-means as well as more complex modeling approaches.     

Cross-system data linkage for treatment outcome evaluation: lessons learned from the California Treatment Outcome Project

Using administrative data to evaluate health care outcomes has become increasingly common, but the reliability and validity of outcome measures based on cross-system data linkage have been little scrutinized. Applying a deterministic data matching methodology, we linked 6545 Californians admitted to 43 substance abuse treatment programs between 2000 and 2001 to administrative data acquired from three state agency databases. We compared self-reported treatment outcome measures to equivalent measures derived from official records on motor vehicle driving incidents, criminal history, and mental health services utilization. Administrative data provided analogous results in some measures (e.g., percent of people using mental health services, percent ever arrested) and more accurate results in others (e.g., frequency of service utilization, and frequency of arrests). Similar to findings based on the interview data, the administrative data also revealed improvements in several domains 1-year post-treatment compared to 1-year pre-treatment. Experiences with data linkage procedures and strategies for enhancing record linkage accuracy are discussed. Findings illustrate the value of using administrative records for substance abuse treatment outcome evaluation, while highlighting areas for improvement for future cross-system data linkage efforts.     

Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.     

Parenting practices as potential mechanisms for child adjustment following mass trauma

Trauma research has identified a link between parental adjustment and children's functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma.     

Clinicians' perspectives on motivational interviewing-based brief interventions in college health

Brief interventions based on motivational interviewing (MI) are emerging as effective strategies for behavior change in college students. However, implementation of MI-based brief interventions may be challenging in the college health environment, and their practicality is controversial. The author explored college health clinicians' perspectives on the use of MI brief interventions in a college health study to reduce alcohol harms among high-risk college students. The author describes the challenges, benefits, and practicality of using this health promotion strategy in college health. Although MI-based brief interventions may be adapted and implemented and are beneficial in the college health setting, clinician education and further research is warranted.