Gender,Racial, and Ethnic Disclosure in NIH K-Award Funded Diabetes and Obesity Clinical Trials∗

In 1993, the National Institutes of Health (NIH) passed The Revitalization Act (Subtitle B) which mandated that all NIH funded clinical trials have “appropriate representation” of minority and women subjects. Our aim was to evaluate the impact of the mandate by examining the reporting and inclusion of minority and female subjects into NIH K-Award funded clinical trials, addressing the minority predominant diagnoses of diabetes and clinical obesity. Using the CRISP search engine and PUBMED, we selected publications published by the National Institute on Aging (NIA) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) K-grant recipients during 1989–2004, associated with all the diabetes and obesity clinical trials. Studies were stratified into three timeline categories (1989–1993, pre-mandate; 1993–1996, post-mandate, and 1997–present, well past mandate) to evaluate trends in the recruiting of minorities and women before, during, and after the passing of the Revitalization Act. Of the 165 papers, only 37% disclosed race, a number that did not improve over time (p = .15), whereas 92% disclosed gender. Clinical trials that focused on females increased across the 3 timeframes (p < .001) for diabetes studies but not obesity studies. Overall, disclosure of race declined over the 3 timeframes whereas individually, the disclosure of African Americans improved.     

Sexual behaviour in aids‐related research: Reliability and validity of recall and diary measures

In order to assess the reliability and validity of two data collection instruments for measuring sexual practices in homosexual men, we administered a recall data collection instrument to 30 sexually active men, and a diary instrument to a subset of 19 participants. Each instrument covered a period of one month. For the recall instrument, the correlation coefficients between the test‐retest showed a good level of reliability for a number of infrequent sexual practices but was poor for frequent sexual practices. Correlation coefficients were calculated for sexual practices recorded in the first two and the second two weeks for both the recall and the diary. Generally, the level of agreement between the first and second two weeks for sexual practice data recorded in the diary was lower than the recall questionnaire. While the reliability of the recall method was found to be limited to certain sexual practices, it was concluded to be the most reliable and efficient method presently available for the collection of important high‐risk AIDS‐related sexual activities for a one‐month period.     

Crack ‘Hos and Skeezers: Traumatic experiences of women crack users

The involvement of women in crack cocaine abuse has had a severe impact on their health, the health of their children and the stability of their communities. Of particular concern has been the development of a system of barter in which crack‐for‐sex exchanges are the means through which women obtain the drug. Earlier studies have suggested that drug abuse may be related to and exacerbated by trauma. In the project described herein, we interviewed women crack users in Harlem to study the relationship between trauma, crack use, and crack‐related sexual behavior. Results suggested the existence of three types of trauma: (1) traumas that predate the respondent's onset of crack use; (2) traumas that were the direct sequelae of crack use; and (3) stigma trauma, that is, trauma that results from membership in a despised or oppressed group. We observed a complex inter‐relationship involving crack use, crack‐for‐sex transactions, and these three types of trauma. Treatment of the eventual co‐morbidity of trauma and addiction is an urgent challenge.     

Evaluation of school‐based AIDS education curricula in San Francisco

Students in 3 middle (n=385) and 3 high schools (n=254) in the San Francisco Unified School District participated in the evaluation of an AIDS education curriculum. Classes within‐schools were designated as either intervention classes or nonintervention classes. Students in intervention classes received 3 class periods of AIDS instruction with a newly developed curriculum. Students in nonintervention classes did not receive any special AIDS instruction. All students completed a pretest and posttest AIDS knowledge and attitude survey. The results indicated that AIDS instruction classes demonstrated a significant knowledge‐advantage, as well as change in attitudes (e.g., reflecting greater tolerance for attending class with students who may have AIDS or HIV infection).     

Amanda Smith Barusch. Love Stories of Later Life: A Narrative Approach to Understanding Romance

There is a sparsity of research about women in midlife career transitions. This study focuses on the career patterns of twenty-nine first and second year MSW women students (ages 27-60). Previous professional career events, role models and other factors most affecting career change are examined. The findings identify frustrated relationship needs, barriers to achievement in previous careers, and the attraction of social work produced incentives for change. Women in the oldest age group (over 50) appear to have the most din~culti me adapting to the student lie.     

On some generalized orderings: In the spirit of relative ageing

ABSTRACT

We introduce some new generalized stochastic orderings (in the spirit of relative ageing) which compare probability distributions with the exponential distribution. These orderings are useful to understand the phenomenon of positive ageing classes and also helpful to guide the practitioners when there are crossing hazard rates and/or crossing mean residual lives. We study some characterizations of these orderings. Inter-relations among these orderings have also been discussed.     

Experiences of child welfare social workers in addressing substance use among maltreated young mothers to prevent child maltreatment

Substance use during the perinatal period and while parenting can pose a significant risk to children's safety and well-being. Mothers who have experienced child maltreatment are more likely to use substances than mothers without a history of maltreatment. This study explores how child welfare social workers experience supporting young, maltreated mothers struggling with substance use to prevent the intergenerational transmission of child maltreatment. Semi-structured in-depth interviews were conducted with four social workers working with young mothers with a history of maltreatment and substance use. Interpretative Phenomenological Analysis revealed two themes: (1) grappling with system challenges and (2) supporting strategies for disrupting intergenerational transmission of child maltreatment. The results highlight the need for systemic changes around support for social workers who work with young mothers who use substances and have a history of maltreatment, and substance use treatment and mental health programs themselves. Mothers need access to prenatal programs that are trauma-informed, non-judgemental and that support participants' basic needs and parenting skills.     

Connecting and engaging with health and social care: Exploring the core components of a telephone and web-mediated family navigation prevention service

Early engagement with health care, mental health care, and social services can promote the well-being of children and families. How practitioners can best support family engagement with these services however remains largely unknown. To address this gap in knowledge, data from a voluntary 12-week telephone and web-mediated family navigation preventive intervention called Navigate Your Way were subject to mixed-methods analysis. Twenty-nine caregivers and five family navigators contributed data to the study. Thematic analysis of weekly navigator check-ins, participant closing interviews, navigator discharge notes, and lab meeting notes was conducted and followed by quantitative analysis of navigator effort across project activities. Results were then mixed to illuminate the essential conditions for supporting family connection to health care, mental health care, and social services. Qualitative analysis identified themes related to empathic engagement and person-centred navigation as central to connecting families to needed services. Quantitative analysis of navigator effort identified participant outreach, weekly check-ins, service identification, and ongoing supervision as essential navigation activities. Together, providing an environment that is supportive, consistent, flexible, person-centred and tailored to families' specific needs are important for connecting to health and social care.