Adverse Childhood Experiences and Healthcare Costs in Adult Life

ABSTRACT

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women’s Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996–2015) from the cohort born 1973–1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.     

Age Variation in Performance Among Preschool Children in a Sexual Abuse Prevention Program

The purpose of this study was (a) to determine whether preschool age children could be taught sexual abuse prevention skills and concepts, and (b) to determine if any variation in performance exists as a function of the age of the child. Over 1300 preschool children ages 3-to-6-years were pretested and either participated in the prevention program or a control program. Children were posttested on knowledge and skill gains. Children who participated in the prevention program demonstrated greater knowledge of prevention skills and concepts compared to age matched controls. The benefits of participation in prevention program varied across age groups. Multiple comparison of posttest means indicated that trained 4-, 5-, and 6-year-olds demonstrated significantly greater knowledge of prevention skills and concepts than 3-year-olds. Trained 6-year-olds demonstrated significantly greater knowledge than trained 4-year-olds. The results indicate that preschool age children can be taught prevention skills and concepts. However, benefit from participation in prevention programs varies with age.     

“No strings attached”: A qualitative exploration of gay and bisexual men’s motivations for and attitudes toward engaging in casual sex while on vacation

Prior quantitative research with gay and bisexual men (GBM) has documented high rates of sexual risk behavior during recreational travel. Although some associations are known (e.g., substance use at the tourist destination is associated with sexual risk), less is known about GBM’s motivations for travel and the cognitive and attitudinal factors that influence their sexual behavior while vacationing. In the present study, we conducted qualitative interviews with 46 GBM recruited from three popular gay tourist destinations. Using the Health Belief Model (HBM) as a guiding theoretical framework, the findings of the study revealed that the gay-friendly, tropical, relaxing environments resulted in men letting their guard down and engaging in more risk than when they are at home. Various barriers such as peer pressure and substance use affect GBM’s ability to engage in healthier behaviors while traveling, with condom negotiation and HIV status disclosure as additional issues that impact the sex practices of this population. Results highlight the applicability of HBM constructs to provide insight for intervention development for this population.     

Shattering the Myth of Invulnerability: Exploring the Prevention Needs of Sexual Minority Women Living with HIV/AIDS

Developing effective safer-sex programs for women living with HIV/AIDS (WLH/A) is a national HIV prevention priority. Existing programs focus predominantly on heterosexual women's experiences and ignore the needs of sexual minority women (SMW). Thus, we conducted semi-structured interviews with 16 sexual minority WLH/A to better understand their sexual risk behaviors and corresponding HIV prevention needs. Most of the interviewees were African American (75%) and poor (75%). We used strategies of Grounded Theory to code the interviews for key themes, which included the following: differences between relationships, risk, and protective behaviors in male and female relationships; links between substance abuse and unsafe sex; need for safer-sex or prevention programs to address SMW-specific skills and topics; and the importance of addressing women's resiliency and the social context of women's risk in prevention programs. Conclusions include concrete suggestions to make safer-sex programs more responsive to the needs of SMW.     

Exploring the Role of Being Out on a Queer Person's Self-Compassion

Recent changes in societal attitudes toward lesbian, gay, and bisexual identities have resulted in more people openly identifying with sexual minority status. Due to research on the effects of denying one's sexual orientation and the negative effects of this, many have advocated for more openness in queer sexual orientation. Compassion means connecting to the suffering of others not by avoiding their pain but instead by identifying it so that the feeling of kindness may emerge. Self-compassion, therefore, involves being touched by and open to one's own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one's suffering and to heal oneself with kindness. The purpose of the research is to understand the impact that being out has on a queer person's self-compassion. The Self-Compassion Scale (SCS) is a 26-item, 5-point Likert measure, where a higher score equated to higher self-compassion and looked at how a person showed loving kindness to one's self through the six dimensions of self-compassion. The six dimensions of self-compassion are mindfulness, over-identification, self-kindness, self-judgment, common humanity, and isolation. Results showed that those who are totally out have a higher sense of self-compassion. Implications for practitioners working with the queer population are also discussed.     

Lesbian,Gay, Bisexual,Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences

The goal of this study was to explore attitudes, health knowledge, and experiences with health care setting and providers among lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals and to identify areas for improvement. Members of Equality Florida? residing in the five counties of the Tampa Bay region were recruited through e-mail invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with health care providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. A total of 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants were White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the health care setting (<10%). Health care settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. Results show high rates of sexual orientation disclosure, greater acceptance from providers of LGBTQ status, and the need for examination of hospital policies and improved cultural competency.     

Health and Aging-in-Place: Implications for Community Practice

ABSTRACT

There is increasing interest in helping elders to remain independent in their homes. As the nation experiences the unprecedented growth among its oldest residents, public and private efforts are emerging to facilitate aging-in-place. However older people, particularly the oldest old, experience a myriad of issues impacting their health and ability to remain at home. This article presents the findings from a needs assessment of a Naturally Occurring Retirement Community (NORC) (n?=?114) that revealed multiple health-related issues among older people residing in high-need neighborhoods. The study utilized a holistic perspective of health to measure physical, mental, and social well-being among the older residents. Implications for community-based health interventions to enhance aging-in-place are discussed.     

A Model for Change: Legislative Advocacy to Improving Access for the Uninsured and Underinsured in New York State 1

Advocates can successfully improve access to health care for people without health insurance. This article demonstrates the success of what began as a local advocacy effort to improve access to health care on Long Island, which later grew to become a major statewide advocacy movement. It explores the process taken by local coalition members to successfully fight for monumental public health legislation—first locally then statewide—to improve access to hospital care for the medically indigent. Using New York State as a model, it includes several approaches that could facilitate the enactment of legislation in other states. The experiences of New York advocates suggest that with focused collaborative efforts it is feasible to promote significant changes to public health laws to benefit the uninsured and underinsured.