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Public health agencies face difficult decisions when allocating scarce resources to control the spread of HIV/AIDS. Decisions are often made with few local empirical data. We demonstrated the use of the robust decision making approach in Los Angeles County, an approach that is data driven and allows decision makers to compare the performance of various intervention strategies across thousands of simulated future scenarios. We found that the prevailing strategy of emphasizing behavioral risk reduction interventions was unlikely to achieve the policy goals of the national HIV/AIDS strategy. Of the alternative strategies we examined, those that invested most heavily in interventions to initiate antiretroviral treatment and support treatment adherence were the most likely to achieve policy objectives. By employing similar methods, other public health agencies can identify robust strategies and invest in interventions more likely to achieve HIV/AIDS policy goals. [ABSTRACT FROM AUTHOR]

We conducted interviews with 27 health care personnel in Bogotá, Colombia, to examine provider barriers and facilitators to screening for intimate partner violence (IPV). We used systematic qualitative analysis to identify the range and consistency of beliefs. We found that respondents did not routinely screen for IPV. Providers listed numerous barriers to screening. Ways to improve screening included increased clinician training, installing systematic IPV screening, providing patient education, and implementing health care setting interventions. Improving the care for IPV survivors will involve translating health care personnel preferred solutions into more systematic IPV screening interventions. [ABSTRACT FROM AUTHOR]

The article reports on results of a study of characteristics of the original patient navigation programs to reduce disparities in the diagnosis and treatment of breast cancer. A description of the experimental set-up and measurement method is provided. The study concludes that programs combined community and culturally sensitive care-coordination with aspects of disease management programs to reduce racial, ethnic and poverty-driven disparities in care.

Abstract: Consumers often turn to complementary and alternative medicine (CAM) and use it concurrently with conventional medicine to treat illnesses and promote wellness. However, prior studies demonstrate that these two paradigms are often not combined effectively. Consumers often do not tell physicians about CAM treatments or CAM practitioners about conventional treatments that they are using. This can lead to inefficient care and/or adverse interactions. There is also a lack of consensus about the structure and practice of integrative medicine among the various types of practitioners. This qualitative study aimed to identify key domains and develop a conceptual model of integrative medicine at the provider level, using a grounded theory approach. Purposive sampling was used to select 50 practitioners, including acupuncturists, chiropractors, internists/family practitioners, and physician acupuncturists in private practice and at academic medical centers in Los Angeles. We conducted semi-structured, in-depth interviews with practitioners and then identified core statements that describe practitioners′ attitudes and behaviors toward integrative medicine. Core statements were free pile sorted to ascertain key domains of integrative medicine. Four key domains of integrative medicine were identified at the provider level: attitudes, knowledge, referral, and practice. Provider age, training, and practice setting also emerged as important factors in determining clinicians’ “orientation” toward integrative medicine. “Dual-trained” practitioners, such as physician acupuncturists, exemplified clinicians with a greater orientation toward integrative medicine. They advocated an open-minded perspective about other healing traditions, promoting co-management with and making referrals to practitioners of other paradigms, and treating patients with both CAM and conventional healing modalities. [Copyright &y& Elsevier]

Although lifestyle factors and routinization of daily activities are emerging as important variables in understanding and improving medication adherence, measures of these constructs remain crude and rudimentary. This study evaluated whether a brief, yet more comprehensive measure of the routinization of daily behaviors and activities is predictive of medication adherence. Participants with HIV and histories of drug dependency completed a 2-week practice trial that mimicked highly active antiretroviral therapy (HAART) (phase 1), followed by a 2-week observation of adherence to HAART (phase 2) for those who started antiretroviral therapy during the study. Fifty-one participants completed the study. Average electronic monitored adherence rate (proportion of prescribed doses taken) in the practice trial was 67% (standard deviation [SD] = 24), which was significantly correlated (r = 0.50; p< 0.05) with adherence to HAART. A high frequency of four daily activities (eating breakfast, watching favorite television program, attending meetings, sleeping at home) was associated with higher adherence, whereas a low frequency of having friends over to visit was associated with higher adherence; the composite score that combined these five activities, and represented the extent to which a patient's daily routine incorporated these specific behaviors, was highly correlated (r = 0.63, p < 0.001) with adherence. In a stepwise multiple regression analysis with several adherence correlates included as independent variables, the composite score was the best independent predictor of adherence, accounting for over one third (36%) of the variance. These findings suggest that the extent to which one's daily life is structured and routinized is an important factor in understanding medication adherence. The individual items of this scale as well as a composite measure may be used to predict adherence and inform strategies to enhance adherence via recommended changes in the patient's daily routine. [ABSTRACT FROM AUTHOR]

Sophisticated text management software is currently available for doing thematic or code-based analysis, the principal procedural approach to qualitative data analysis. Such packages allow researchers to tag and retrieve contiguous blocks of data, maintain complex codebooks, manage large corpora of data, and display search results in interesting ways. For simple projects, however, with a few themes and a small number of texts, a complex program that requires a large investment of time to learn may be more technology than one needs. This article provides tips for making better use of the humble word processor, in this case, Microsoft Word. The use of text-formatting features, find-and-replace command, and Microsoft Word's macro programming language can be used to mark themes in texts and retrieve exemplars of themes on demand. [ABSTRACT FROM AUTHOR]

Describes the techniques to identify themes in qualitative research. Sources of themes; Ways to identify themes; Evaluation of the techniques.

Presents a study that examined children's home activities among low-income Latino immigrant families, using a combination of longitudinal ethnographic data and experience-sampling methods. Examination on the connections between home and school in terms of complementaries, continuities and discontinuities; Examples of complementaries; Findings on patterns of family management in low-income neighborhoods.

Shows how multiple free lists can be linked together in a single interview. Incorporation of the technique into naturally occurring conversation; Description of free listing and formal frame substitute techniques; Use of data from an ethnomedical study of childhood diarrhea in Zaire.

Features a study which investigated the gender-specific descriptions and perceptions of slasher or horror films among Euro-American male and female university students. Perceptual and emotional effects of slasher films; Methodology of the study; Results and discussion; Conclusion.

Examines sequences of health-related behaviors from a small Kom-speaking village in Cameroon. Details on the seven health actions considered by local resident; Suggestions based on the analysis of treatment sequence; Details on the findings outlined in data collected from 88 randomly selected compounds.

Objectives: To better understand impacts of the COVID-19 pandemic and resulting economic and social disruptions on families, we analyzed qualitative data capturing perspectives from parents of young children. Methods: This study analyzes interviews of parents of children aged 1-3.5 years at enrollment, recruited from four primary care systems serving mainly lower-income Hispanic families in Los Angeles, California. Interviews were conducted over 15 months beginning September 2020. Analyses focused on the open-ended question: Please describe in your own words how the COVID-19 pandemic has affected you and your family. We used iterative, multi-step processes to identify emergent qualitative themes. Results: A total of 460 parent responses were collected and coded. Key themes and subthemes were tested for interrater reliability, with Kappa ranging from 0.74 to 0.91. Thematic analysis revealed two groups of responses, one emphasizing stress and one emphasizing "silver linings." Parents cited a range of stressors, from fear of COVID-19 to social isolation. Those emphasizing "silver linings" also referenced formal or informal supports – especially government/community assistance programs and childcare access – that enabled stronger family ties and positive lifestyle modifications. Conclusions for Practice: Experiences of families with young children during COVID-19 were not uniform. Economic stability and reliable childcare may be critical mediators of family stress. Results affirm that the pandemic's impacts were distributed through channels largely built on, and possibly exacerbating, existing disparities. For lower-income families with young children, funding for public and private programs that target economic stability and childcare assistance may merit prioritization in future socio-economic disruptions. Significance: Most qualitative studies on this topic rely on small cohorts of families from Europe and Canada. This study contributes to the knowledge base by capturing perspectives from 460 parents of young children, in mainly low-income, Hispanic households, in Los Angeles, California. [ABSTRACT FROM AUTHOR]

Objectives: The treatment goals of patients successfully using ongoing provider-based care for chronic spinal pain can help inform health policy related to this care. Design: Multinomial logistical hierarchical linear models were used to examine the characteristics of patients with different treatment goals for their ongoing care. Settings/Location: Observational data from a large national sample of patients from 125 chiropractic clinics clustered in 6 U.S. regions. Subjects: Patients with nonwork-injury-related nonspecific chronic low-back pain (CLBP) and chronic neck pain (CNP). Interventions: All were receiving ongoing chiropractic care. Outcome measures: Primary outcomes were patient endorsement of one of four goals for their treatment. Explanatory variables included pain characteristics, pain beliefs, goals for mobility/flexibility, demographics, and other psychological variables. Results: Across our sample of 1614 patients (885 with CLBP and 729 with CNP) just under one-third endorsed a treatment goal of having their pain go away permanently (cure). The rest had goals of preventing their pain from coming back (22% CLBP, 16% CNP); preventing their pain from getting worse (14% CLBP, 12% CNP); or temporarily relieving their pain (31% CLBP, 41% CNP). In univariate analysis across these goals, patients differed significantly on almost all variables. In the multinomial logistic models, a goal of cure was associated with shorter pain duration and more belief in a medical cure; a goal of preventing pain from coming back was associated with lower pain levels; and those with goals of preventing their pain from getting worse or temporarily relieving pain were similar, including in having their pain longer. Conclusions: Although much of health policy follows a curative model, the majority of these CLBP and CNP patients have goals of pain management (using ongoing care) rather than "cure" (care with a specific end) for their chiropractic care. This information could be useful in crafting policy for patients facing provider-based nonpharmacologic care for chronic pain. [ABSTRACT FROM AUTHOR]

Studies of homeless individuals typically sample subjects from few types of sites or regions within a metropolitan area. This article focuses on the biases that can result from such a practice. We obtained a probability sample of 419 homeless youth from 41 sites (shelters, drop-in centers, and streets) in four regions of Los Angeles County (LAC). We found that restricting the frame to only certain types of sites or geographic regions biased the sample in terms of demographic and background characteristics as well as rates of risky behaviors. For example, homeless youth who can be found in shelters (vs. those who do not use shelters) and Hollywood (vs. other regions of LAC) tend to be younger, minorities, and engage less in risky behaviors. Recommendations are provided for evaluating the trade-offs between bias and cost in selecting a sampling strategy for studies of homeless individuals. [ABSTRACT FROM AUTHOR]

Poor sleep is common among older adults, affecting a wide range of health outcomes. However, little is known about sleep issues among older Korean immigrants, the fastest growing Asian American subgroup in the United States. We aimed to explore multiple factors associated with sleep among this group. We analyzed cross-sectional survey data from 43 older immigrants living in two large Korean communities in Southern California. Perceived sleep quality was significantly associated with gender, living arrangement, employment status, mental health, and sleep-related beliefs (all p-values < 0.05). Living with someone and being employed for wages were significantly uniquely associated with better sleep quality, accounting for demographic and health-related factors (R2 = 51.8%, adjusted R2 = 38.7%, p = 0.002). These findings suggest a potential role of sociocultural factors on sleep. Further studies are needed to confirm these findings and to inform a sleep intervention program tailored to the characteristics of older Korean immigrants. [ABSTRACT FROM AUTHOR]

Community integration is important to address among homeless‐experienced individuals. Little is known about helping veteran families (families with a parent who is a veteran) integrate into the community after homelessness. We sought to understand the experiences of community integration among homeless‐experienced veteran families. We used a two‐stage, community‐partnered approach. First, we analysed 16 interviews with homeless‐experienced veteran parents (parents who served in the military; n = 9) living in permanent housing and providers of homeless services (n = 7), conducted from February to September 2016, for themes of community integration. Second, we developed a workgroup of nine homeless‐experienced veteran parents living in a permanent housing facility, who met four times from December 2016 to July 2017 to further understand community integration. We audio‐recorded, transcribed and analysed the interviews and workgroups for community integration themes. For the analysis, we developed community integration categories based on interactions outside of the household and built a codebook describing each topic. We used the codebook to code the individual interviews and parent workgroup sessions after concluding that the workgroup and interview topics were consistent. Findings were shared with the workgroup. We describe our findings across three stages of community integration: (a) first housed, (b) adjusting to housing and the community, and (c) housing maintenance and community integration. We found that parents tended to isolate after transitioning into permanent housing. After this, families encountered new challenges and were guarded about losing housing. One facilitator to community integration was connecting through children to other parents and community institutions (e.g. schools). Although parents felt safe around other veterans, many felt judged by non‐veterans. Parents and providers reported a need for resources and advocacy after obtaining housing. We share implications for improving community integration among homeless‐experienced veteran families, including providing resources after obtaining housing, involving schools in facilitating social connections, and combating stigma. [ABSTRACT FROM AUTHOR]

Objective. Patients in the U.S. often turn to complementary and alternative medicine (CAM) and may use it concurrently with conventional medicine to treat illness and promote wellness. However, clinicians vary in their openness to the merging of treatment paradigms. Because integration of CAM with conventional medicine can have important implications for health care, we developed a survey instrument to assess clinicians' orientation toward integrative medicine. Study Setting. A convenience sample of 294 acupuncturists, chiropractors, primary care physicians, and physician acupuncturists in academic and community settings in California. Data Collection Methods. We used a qualitative analysis of structured interviews to develop a conceptual model of integrative medicine at the provider level. Based on this conceptual model, we developed a 30-item survey (IM-30) to assess five domains of clinicians' orientation toward integrative medicine: openness, readiness to refer, learning from alternate paradigms, patient-centered care, and safety of integration. Principal Findings. Two hundred and two clinicians (69 percent response rate) returned the survey. The internal consistency reliability for the 30-item total scale and the five subscales ranged from 0.71 to 0.90. Item-scale correlations for the five subscales were higher for the hypothesized subscale than other subscales 75 percent or more of the time. Construct validity was supported by the association of the IM-30 total scale score (0–100 possible range, with a higher score indicative of greater orientation toward integrative medicine) with hypothesized constructs: physician acupuncturists scored higher than physicians (71 versus 50, p<.001), dual-trained practitioners scored higher than single-trained practitioners (71 versus 62, p<.001), and practitioners' self-perceived “integrativeness” was significantly correlated ( r=0.60, p<.001) with the IM-30 total score. Conclusion. This study provides support for the reliability and validity of the IM-30 as a measure of clinicians' orientation toward integrative medicine. The IM-30 survey, which we estimate as requiring 5 minutes to complete, can be administered to both conventional and CAM clinicians. [ABSTRACT FROM AUTHOR]

CONTEXT: Parents can play a significant role in promoting healthy sexual development and risk reduction among adolescents, but many are uncertain about how to talk with their adolescents about sex. Worksites provide an untapped but promising setting in which to reach parents to help them develop parenting and communication skills. METHODS: Focus groups with 33 employed parents of adolescents and 41 high school students, and interviews with seven worksite executives, explored the desire for worksite-based parenting programs, how best to implement programs and recommendations for content. Standard qualitative analysis techniques were used to identify major themes in participants' comments. RESULTS: Parents and employers were enthusiastic about worksite-based parenting programs. Parents reported that adolescents are reluctant to talk with them, but acknowledged their own inexperience talking about sex. Their suggestions included that programs be held at lunchtime, give participants opportunities to interact with each other and with facilitators, and give participants exercises to practice at home. Employers described potential benefits (e.g., improved employee morale) and challenges (e.g., privacy concerns) of programs. Teenagers said that their parents made false assumptions about their sexual activity if they asked about sex. Participants suggested that parenting programs cover adolescent development, sex, abstinence and communication (e.g., how to start conversations). CONCLUSIONS: A worksite-based program designed to help parents of adolescents develop communication and parenting skills could provide a way to reach busy parents. Recommendations from parents, employers and teenagers can be used to make such a program appealing and effective. [ABSTRACT FROM AUTHOR]

Background: At the same time that federal policymakers have enforced restrictive immigration policies, healthcare systems across the USA are developing, and have implemented, interventions aimed at addressing immigration-related stressors faced by immigrant communities. Yet, little is known about the contextual determinants that influence their implementation success. Using the Consolidated Framework for Implementation Research (CFIR), this study identifies factors enabling or challenging the implementation of interventions aimed at mitigating immigration-related stressors in the healthcare context. Methods: We used a qualitative research design to conduct 38 semi-structured interviews with stakeholders involved in implementation of interventions at 25 healthcare facilities across 5 states with the highest undocumented immigrant populations (California, Texas, New York, Florida, and Illinois). Interviews were conducted from May through August 2018. Constant comparative analysis was used to identify barrier and facilitator themes. Deductive coding was thereafter used to categorize themes according to CFIR domain. Results: Barriers to implementation included perceptions of legal complexity and challenges to adopting such systemic strategies. Facilitators included a national policy climate that had brought immigrant health to the forefront, allowing for leveraging momentum towards institutional change; communication among healthcare personnel; existing community partnerships with immigrant rights and service organizations; and a shared sense of mission centering health equity. Local variation in immigration-related policies (e.g., local law agencies enforcing federal immigration laws) and heterogeneity of local immigrant communities also impacted implementation. Champions and informal leaders were integral to institutional efforts but not sufficient for sustainability. Perceived urgency to act superseded evaluation considerations, with all interventions in initial phases of implementation. Future iterations and evaluations of these interventions are needed to establish best practices and implementation determinants. Conclusion: This is the first systematic study describing implementation determinants of immigration-related interventions across health systems. Identifying these determinants provides guidance to other healthcare organizations to effectively strategize and ensure implementation success. [ABSTRACT FROM AUTHOR]

Background: Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective-i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered.Methods: We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain.Results: The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate.Conclusions: This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials. [ABSTRACT FROM AUTHOR]

Objectives: We sought to understand the stressors, the parent-child relationship and family processes, and experiences with services among families experiencing parental substance use disorders (SUDs) and homelessness. Methods: We conducted a total of 41 in-depth semistructured interviews with parents with a history of SUDs and homelessness (n = 16) and housing support staff (n = 25) from May 2017 until January 2018. Participants were recruited from transitional housing facilities across the Los Angeles metropolitan area, which served families experiencing homelessness and parental SUDs. The interviews were audio-recorded, transcribed, and themes coded with Dedoose. Results: We found a high burden of trauma and guilt among parents, and a fear of SUD disclosure. We found challenges with family processes important for SUD prevention, including communication, discussion of substance use, and family and youth goal setting. We also discovered unique stressors related to navigating housing and services within the community. Conclusion: Our findings demonstrate the need for a family-based SUD-preventive intervention for youth growing up in families with parental SUDs and experiencing homelessness, to address the heightened SUD risk. In addition, findings from our study can inform clinical and housing services for this important population. [ABSTRACT FROM AUTHOR]

Study Design: A prospective observational study.Objective: The aim of this study was to evaluate group-level and individual-level change in health-related quality of life among persons with chronic low back pain or neck pain receiving chiropractic care in the United States.Summary Of Background Data: Chiropractors treat chronic low back and neck pain, but there is limited evidence of the effectiveness of their treatment METHODS.: A 3-month longitudinal study of 2024 patients with chronic low back pain or neck pain receiving care from 125 chiropractic clinics at six locations throughout the United States was conducted. Ninety-one percent of the sample completed the baseline and 3-month follow-up survey (n = 1835). Average age was 49, 74% females, and most of the sample had a college degree, were non-Hispanic White, worked full-time, and had an annual income of $60,000 or more. Group-level (within-group t tests) and individual-level (coefficient of repeatability) changes on the Patient-Reported Outcomes Measurement Information System (PROMIS-29) v2.0 profile measure was evaluated: six multi-item scales (physical functioning, pain, fatigue, sleep disturbance, social health, emotional distress) and physical and mental health summary scores.Results: Within-group t tests indicated significant group-level change (P < 0.05) for all scores except for emotional distress, and these changes represented small improvements in health (absolute value of effect sizes ranged from 0.08 for physical functioning to 0.20 for pain). From 13% (physical functioning) to 30% (PROMIS-29 v2.0 Mental Health Summary Score) got better from baseline to 3 months later according to the coefficient of repeatability.Conclusion: Chiropractic care was associated with significant group-level improvement in health-related quality of life over time, especially in pain. But only a minority of the individuals in the sample got significantly better ("responders"). This study suggests some benefits of chiropractic on functioning and well-being of patients with low back pain or neck pain.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population. [ABSTRACT FROM AUTHOR]

Background: Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect. Methods: To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis. Results: We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances. Conclusions: Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs. [ABSTRACT FROM AUTHOR]

Background Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youth's condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect. Methods To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis. Results We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances. Conclusions Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs. [ABSTRACT FROM AUTHOR]

In personal network studies, respondents (egos) are asked to report information about members of their personal network (alters); egos respond based on their perceptions. Previous studies of informant accuracy present a varied picture: Some find egos’ reporting on their relationships with alters to be accurate; others do not. In our study of people living with HIV/AIDS in Uganda, egos were asked to invite up to four alters named during their interview to answer questions about their relationship with ego. Using Gower’s general coefficient of similarity, we calculated a measure of accuracy both by variable and by alter. Our analysis by variable tends to confirm informant accuracy research, while our analysis by alter adds to the literature by identifying how accurate a particular ego is when discussing an alter and what characteristics might be associated with accuracy or inaccuracy. [ABSTRACT FROM AUTHOR]

Background: Latino youth in low-income households have a higher likelihood of poor educational and health outcomes than their peers. Protective factors, such as parental support, improve chances of success for youth. A community–academic partnership used community-based participatory research principles to examine perceptions of resilience among Latino young people in low-income households. Methods: Semi-structured qualitative interviews were conducted in 2007 with Latino young people living in an urban low-income housing complex (n=20); their parents (n=10); and representatives from local community-based organizations (n=8) to explore their definitions of youth “success,” and barriers to and facilitators of success. Interviews were audiotaped, transcribed, coded, and analyzed using content-analysis and grounded theory in 2007. Results: Participants identified self, family, and community factors as potential sources of support. Parents appeared to de-emphasize community resources, expressing that success resulted primarily from a child''s individual desire, bolstered by family support. All stakeholder groups perceived peers more as potential barriers to achieving success than as potential sources of support. Conclusions: These findings raise the possibility that in this community, low-income Latino parents'' beliefs about community resources may act as a barrier to seeking assistance outside the family. Results also suggest that Latino youth recognize the benefits of interacting with adults outside the family and are accepting of help from the community. Resilience promotion programs in this population may benefit from engaging parents and community members in addition to young people. Parent-focused programs could explore parental beliefs about youth success, and youth programs could engage adult community members to generate positive interactions and messages. [Copyright &y& Elsevier]

Objective: Childhood abuse has been linked to negative sequelae for women later in life including drug and alcohol use and violence as victim or perpetrator and may also affect the development of women's social networks. Childhood abuse is prevalent among at-risk populations of women (such as the homeless) and thus may have a stronger impact on their social networks. We conducted a study to: (a) develop a typology of sheltered homeless women's social networks; (b) determine whether childhood abuse was associated with the social networks of sheltered homeless women; and (c) determine whether those associations remained after accounting for past-year substance abuse and recent intimate partner abuse. Methods: A probability sample of 428 homeless women from temporary shelter settings in Los Angeles County completed a personal network survey that provided respondent information as well as information about their network members’ demographics and level of interaction with each other. Cluster analyses identified groups of women who shared specific social network characteristics. Multinomial logistic regressions revealed variables associated with group membership. Results: We identified three groups of women with differing social network characteristics: low-risk networks, densely connected risky networks (dense, risky), and sparsely connected risky networks (sparse, risky). Multinomial logistic regressions indicated that membership in the sparse, risky network group, when compared to the low-risk group, was associated with history of childhood physical abuse (but not sexual or emotional abuse). Recent drug abuse was associated with membership in both risky network groups; however, the association of childhood physical abuse with sparse, risky network group membership remained. Conclusions: Although these findings support theories proposing that the experience of childhood abuse can shape women's social networks, they suggest that it may be childhood physical abuse that has the most impact among homeless women. Practical implications: The effects of childhood physical abuse should be more actively investigated in clinical settings, especially those frequented by homeless women, particularly with respect to the formation of social networks in social contexts that may expose these women to greater risks. [Copyright &y& Elsevier]

Objective: To compare mothers' assessments of nutritional status with anthropometric measures and gain further insights into mothers' reasons for their judgment. Design: Each mother was asked to assess the nutritional status of her child and 2 other children and to compare all 3. Rates for "hits" and "misses" between mothers' assessment and physical anthropometry were analyzed using the binomial test. The rationale for the mothers' assessments was explored through open-ended questions. Setting: A rural clinic in an indigenous area of Mexico. Participants: 31 mothers of children 1-5 years of age. Main Outcome Measures: Physical anthropometry and mothers' assessments. Results: A significant proportion (P ≤ .01) of mothers matched the anthropometry on weight for age and weight for height but not on height for age; only when assessing their own child, and when comparing weight for age of their own child with the first child used for comparison. Mothers based their assessment on the child's physical appearance, energy, eating behavior, and on their own performance as caregivers. Conclusions and Implications: Mothers' assessments were better than mere guesses. Their understanding of children's nutritional status in particular and health in general should be used to design more effective and sustainable communication messages, properly combining mothers' and health providers' constructs. It is also important to find ways to make mothers recognize stunting as a nutrition-related problem. [ABSTRACT FROM AUTHOR]

Background: School nutrition policies are gaining support as a means of addressing childhood obesity. Community-based participatory research (CBPR) offers an approach for academic and community partners to collaborate to translate obesity-related school policies into practice. Site visits, in which trained observers visit settings to collect multilevel data (e.g., observation, qualitative interviews), may complement other methods that inform health promotion efforts. This paper demonstrates the utility of site visits in the development of an intervention to implement obesity-related policies in Los Angeles Unified School District (LAUSD) middle schools. Methods: In 2006, trained observers visited four LAUSD middle schools. Observers mapped cafeteria layout; observed food/beverage offerings, student consumption, waste patterns, and duration of cafeteria lines; spoke with school staff and students; and collected relevant documents. Data were examined for common themes and patterns. Results: Food and beverages sold in study schools met LAUSD nutritional guidelines, and nearly all observed students had time to eat most or all of their meal. Some LAUSD policies were not implemented, including posting nutritional information for cafeteria food, marketing school meals to improve student participation in the National School Lunch Program, and serving a variety of fruits and vegetables. Cafeteria understaffing and costs were obstacles to policy implementation. Conclusions: Site visits were a valuable methodology for evaluating the implementation of school district obesity-related policies and contributed to the development of a CBPR intervention to translate school food policies into practice. Future CBPR studies may consider site visits in their toolbox of formative research methods. [Copyright &y& Elsevier]