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Objectives: This study aimed to assess the association between insurance type and permanent contraception fulfillment among those with cesarean deliveries. Additionally, we sought to examine modification by the scheduled status of the cesarean. Study Design: We used data from a multi-site cohort study of patients who delivered in 2018–2019 at Northwestern Memorial Hospital in Illinois, MetroHealth Medical System in Ohio, or University of Alabama at Birmingham in Alabama. All patients had permanent contraception as their contraceptive plan in their medical chart during delivery hospitalization. We used logistic regression to model the association between insurance type, scheduled status of cesarean and permanent contraception fulfillment by hospital discharge. The scheduled status of cesarean delivery was examined as an effect modifier. Results: Compared to patients with private insurance, those with Medicaid were less likely to have their desired permanent contraception procedure fulfilled by hospital discharge (89.3% vs. 96.8%, p < 0.001). After adjusting for covariates, patients with Medicaid had a lower odds of permanent contraception fulfillment by hospital discharge (OR: 0.41; 95% CI: 0.21, 0.77). This association was stronger among those who had unscheduled cesarean deliveries (OR: 0.29; 95% CI: 0.12, 0.74) than those with scheduled cesarean deliveries (OR: 0.77; 95% CI: 0.32, 1.88). Conclusions for Practice: Compared to patients with private insurance undergoing a cesarean delivery, those with Medicaid insurance were less likely to have their desired permanent contraception fulfilled. Physicians and hospitals must examine their practices surrounding Medicaid forms to ensure that patients have valid consent forms available at the time of delivery. Significance: What is already known about this subject?: Studies have shown that the Medicaid sterilization consent process is associated with decreased fulfillment of desired postpartum permanent contraception. Cesarean delivery is one of the strongest predictors of permanent contraception fulfillment. What this study adds?: This study found that Medicaid is associated with decreased permanent contraception fulfillment in a subset of patients who had cesarean deliveries in a national multi-center cohort. These associations were particularly strong among patients who had unscheduled, compared to scheduled, cesarean deliveries. [ABSTRACT FROM AUTHOR]

Community advisory boards (CABs) are increasingly recognized as a means of incorporating patient experience into clinical practice and research. The power of CABs is derived from engaging with community members as equals throughout the research process. Despite this, little is known of community member experience and views on best practices for running a CAB in a rare pulmonary disease. What are CAB members' views on the best practices for CAB formation and maintenance in a rare pulmonary disease? In August 2021, we formed the Cleveland Clinic Sarcoidosis Health Partners (CC-HP) as a CAB to direct research and clinic improvement initiatives at a quaternary sarcoidosis center. We collaboratively evaluated our process for formation and maintenance of the CC-HP with the patient members of the group. Through the series of reflection/debriefing discussions, CAB patient members developed a consensus account of salient obstacles and facilitators of forming and maintaining a CAB in a rare pulmonary disease. Clinician and community members of the CC-HP found published guidelines to be an effective tool for structuring formation of a CAB in a rare pulmonary disease. Facilitators included a dedicated coordinator, collaborative development of projects, and a focus on improving clinical care. Obstacles to CAB functioning were formal structure, focus on projects with academic merit but no immediate impact to patients, and overreliance on digital resources. By centering our evaluation of our CAB on community member experience, we were able to both identify facilitators and impediments to CAB as well as improve our own processes. [ABSTRACT FROM AUTHOR]

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16–30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers reported fewer access barriers, and those who perceived greater caregiver burdens (daily life disruptions, financial difficulties, and worries) reported more access barriers. Caregivers whose youth lived with them reported fewer quality barriers. Greater access–but not quality–service barriers predicted greater unmet service needs. Findings have implications for service delivery to autistic youth and specific directions for future research. Prior studies have described the roadblocks, or barriers, to needed services experienced by families with young autistic children, but less research has focused on those faced by autistic adolescents and young adults. In this study, we wished to understand the barriers to service experienced by autistic adolescents and young adults and their families. We surveyed 174 caregivers of autistic youth between 16 to 30 years old. We found that caregivers who felt more caregiving burden had more difficulty accessing services for their youth. Specifically, caregivers who felt more strongly that their daily lives had been disrupted, felt more financial strain, and worried more about their youth well-being experienced more roadblocks to getting services for the youth. Male caregivers also reported fewer difficulties related to service access. Importantly, the older the youth was when they had been diagnosed with autism, the more service barriers their caregivers reported. We did not see any differences in the level of barriers experienced by youth who lived in urban versus suburban settings, or between white and non-white families. However, when youth lived with their caregivers (rather than, for example, in a group home), fewer quality-related barriers to services were reported. Finally, greater access (but not quality) barriers were linked to youth having more unmet service needs. These findings can help to reduce the barriers to service experienced by autistic adolescents and young adults and their families. [ABSTRACT FROM AUTHOR]

We examined the influence of racial and ethnic identity of residents and housing market economic conditions on redlining. Data were extracted from archival area description forms from the Home Owners' Loan Corporation for 568 Ohio neighborhoods from 1934–1940. Logistic regression analysis was used to analyze the relationships between neighborhood characteristics and redlining. Bivariate results indicated a strong association between the presence of African American residents and neighborhood redlining (OR = 40.9, 95% CI 22.9-72.8). Multivariable analysis demonstrated that some neighborhood characteristics were contributors to the decision to redline, including homes in poor condition (OR = 4.3, 95% CI 1.2-15.1), home vacancy (OR = 1.4, 95% CI 1.1-1.6), and housing prices (per thousand dollars) (OR = 0.7, 95% CI 0.4-1.2). Adjusting for these and other factors, the presence of African American residents remained a powerful predictor of redlining (OR = 13.8, 95% CI 4.4-42.8). Racial discrimination was the overriding factor in decisions to redline neighborhoods. [ABSTRACT FROM AUTHOR]

Background: Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. Methods: In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR‐documented dementia diagnosis or dementia‐related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing‐risk regression analysis, with non‐dementia‐related death as the competing risk. Fine‐Gray sub‐distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Results: Increasing neighborhood disadvantage was associated with increased risk of EHR‐documented dementia diagnosis or dementia‐related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69–1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Conclusion: Neighborhood disadvantage is related to the risk of EHR‐documented dementia diagnosis or dementia‐related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders. [ABSTRACT FROM AUTHOR]

Healthcare systems are increasingly investing in approaches to address social determinants of health and health disparities. Such initiatives dovetail with certain approaches to neighborhood development, such as the EcoDistrict standard for community development, that prioritize both ecologically and socially sustainable neighborhoods. However, healthcare system and community development initiatives can be untethered from the preferences and lived realities of residents in the very neighborhoods upon which they focus. Utilizing the go‐along approach to collecting qualitative data in situ, we interviewed 19 adults to delineate residents' community health perspectives and priorities. Findings reveal health priorities distinct from clinical outcomes, with residents emphasizing social connectedness, competing intra‐ and interneighborhood perceptions that potentially thwart social connectedness, and a neighborhood emplacement of agency, dignity, and self‐worth. Priorities of healthcare systems and community members alike must be accounted for to optimize efforts that promote health and social well‐being by being valid and meaningful to the community of focus. Highlights: Health system investments in social determinants are often untethered from neighborhood preferences.Go‐along interviews efficiently ascertain community priorities for neighborhood transformation.Neighborhood residents articulate social connectedness as a key meaning of health.Participants described neighborhood emplacement of self‐worth from internalizing outsiders' views.Community development interventions should include resident voices in planning and evaluation. [ABSTRACT FROM AUTHOR]

Despite having a higher prevalence and severity of obstructive sleep apnea (OSA), African Americans have lower adherence to continuous positive airway pressure (CPAP) compared to other groups. Information regarding challenges faced by African Americans prescribed CPAP are lacking. To determine the barriers and facilitators to optimal management of OSA with CPAP among African Americans and to understand the role bed partners may play. We conducted semi-structured in-depth interviews via video conferencing with African American patients of an urban safety-net health care system with OSA prescribed CPAP and their bed partners. Recruitment continued until theoretical saturation was achieved. Verbatim transcripts were analyzed using the principles of thematic analysis. 15 patients (12 women) diagnosed with OSA and prescribed CPAP a mean 2.6 years prior along with 15 bed partners (3 women) were individually interviewed. Four themes emerged regarding impediments to CPAP use: 1) inadequate education and support, 2) CPAP maintenance and hygiene, 3) inconvenient design of CPAP interfaces, and 4) impediment to intimacy. Four themes emerged as facilitators to CPAP use: 1) provider and technical support, 2) properly fitted CPAP masks, 3) active support from partner and family, and 4) experiencing positive results from CPAP. African American patients with OSA and their bed partners identified several unique barriers and facilitators to CPAP use. Active involvement by bed partners was considered by both patients and partners as helpful in improving CPAP adherence. Interventions to improve OSA outcomes in this population should focus on patients and their bed partners. [ABSTRACT FROM AUTHOR]

Background: Community members may provide useful perspectives on manuscripts submitted to medical journals. Objective: To determine the impact of community members reviewing medical journal manuscripts. Design: Randomized controlled trial involving 578 original research manuscripts submitted to two medical journals from June 2018 to November 2021. Participants: Twenty-eight community members who were trained, supervised, and compensated. Interventions: A total of 289 randomly selected control manuscripts were reviewed by scientific reviewers only. And 289 randomly selected intervention manuscripts were reviewed by scientific reviewers and one community member. Journal editorial teams used all reviews to make decisions about acceptance, revision, or rejection of manuscripts. Main Measures: Usefulness of reviews to editors, content of community reviews, and changes made to published articles in response to community reviewer comments. Key Results: Editor ratings of community and scientific reviews averaged 3.1 and 3.3, respectively (difference 0.2, 95% confidence interval [CI] 0.1 to 0.3), on a 5-point scale where a higher score indicates a more useful review. Qualitative analysis of the content of community reviews identified two taxonomies of themes: study attributes and viewpoints. Study attributes are the sections, topics, and components of manuscripts commented on by reviewers. Viewpoints are reviewer perceptions and perspectives on the research described in manuscripts and consisted of four major themes: (1) diversity of study participants, (2) relevance to patients and communities, (3) cultural considerations and social context, and (4) implementation of research by patients and communities. A total of 186 community reviewer comments were integrated into 64 published intervention group articles. Viewpoint themes were present more often in 66 published intervention articles compared to 54 published control articles (2.8 vs. 1.7 themes/article, difference 1.1, 95% CI 0.4 to 1.8). Conclusions: With training, supervision, and compensation, community members are able to review manuscripts submitted to medical journals. Their comments are useful to editors, address topics relevant to patients and communities, and are reflected in published articles. Trial Registration: ClinicalTrials.gov NCT03432143 [ABSTRACT FROM AUTHOR]

Purpose: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with higher recurrence rates and poorer prognoses and most prevalent among non-Hispanic Black women. Studies of multiple health conditions and care processes suggest that neighborhood socioeconomic position is a key driver of health disparities. We examined roles of patients' neighborhood-level characteristics and race on prevalence, stage at diagnosis, and mortality among patients diagnosed with BC at a large safety-net healthcare system in Northeast Ohio. Methods: We used tumor registry to identify BC cases from 2007 to 2020 and electronic health records and American Community Survey for individual- and area-level factors. We performed multivariable regression analyses to estimate associations between neighborhood-level characteristics, measured by the Area Deprivation Index (ADI), race and comparative TNBC prevalence, stage at diagnosis, and total mortality. Results: TNBC was more common among non-Hispanic Black (53.7%) vs. non-Hispanic white patients (46.4%). Race and ADI were individually significant predictors of TNBC prevalence, stage at diagnosis, and total mortality. Race remained significantly associated with TNBC subtype, adjusting for covariates. Accounting for TNBC status, a more disadvantaged neighborhood was significantly associated with a worse stage at diagnosis and higher death rates. Conclusion: Our findings suggest that both neighborhood socioeconomic position and race are strongly associated with TNBC vs. other BC subtypes. The burden of TNBC appears to be highest among Black women in the most socioeconomically disadvantaged neighborhoods. Our study suggests a complex interplay of social conditions and biological disease characteristics contributing to racial disparities in BC outcomes. [ABSTRACT FROM AUTHOR]

Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood. [ABSTRACT FROM AUTHOR]

Background: Electronic health records (EHRs) provide researchers with abundant sample sizes, detailed clinical data, and other advantages for performing high-quality observational health research on diverse populations. We review and demonstrate strategies for the design and analysis of cohort studies on neighborhood diversity and health, including evaluation of the effects of race, ethnicity, and neighborhood socioeconomic position on disease prevalence and health outcomes, using localized EHR data. Methods: Design strategies include integrating and harmonizing EHR data across multiple local health systems and defining the population(s) of interest and cohort extraction procedures for a given analysis based on the goal(s) of the study. Analysis strategies address inferential goals, including the mechanistic study of social risks, statistical adjustment for differences in distributions of social and neighborhood-level characteristics between available EHR data and the underlying local population, and inference on individual neighborhoods. We provide analyses of local variation in mortality rates within Cuyahoga County, Ohio. Results: When the goal of the analysis is to adjust EHR samples to be more representative of local populations, sampling and weighting are effective. Causal mediation analysis can inform effects of racism (through racial residential segregation) on health outcomes. Spatial analysis is appealing for large-scale EHR data as a means for studying heterogeneity among neighborhoods even at a given level of overall neighborhood disadvantage. Conclusions: The methods described are a starting point for robust EHR-derived cohort analysis of diverse populations. The methods offer opportunities for researchers to pursue detailed analyses of current and historical underlying circumstances of social policy and inequality. Investigators can employ combinations of these methods to achieve greater robustness of results. Highlights: EHR data are an abundant resource for studying neighborhood diversity and health. When using EHR data for these studies, careful consideration of the goals of the study should be considered in determining cohort specifications and analytic approaches. Causal mediation analysis, stratification, and spatial analysis are effective methods for characterizing social mechanisms and heterogeneity across localized populations. [ABSTRACT FROM AUTHOR]

Over 25% of youth in the United States are estimated to witness intimate partner violence (IPV) at some point during childhood. Research has synthesized the physical and behavioral health consequences of children's IPV exposure, but evidence of links between witnessing IPV and children's physiological functioning has yet to be integrated. The primary aim of this systematic review is to delineate the patterns by which variation in children's physiological functioning has been measured to associate with IPV exposure. This study was one component of a broader Evidence and Gap Map (EGM) consolidation of how witnessing IPV affects children's wellbeing. Seven bibliographic databases were systematically searched through August 2020 and, of 381 total EGM-included citations, 23 examined children's physiological functioning in the context of IPV exposure. Research evidences a directly deleterious effect of IPV exposure for children's endocrine, nervous, cardiovascular, and immune functioning and a vulnerability effect of physiological dysregulation across other domains of children's wellbeing. Additional research on how specific aspects of IPV exposure affect children's physiologies and wellbeing across time is critical. Future inquiry measuring dynamic associations between various physiological responses in the aftermath of witnessing IPV is needed. Further elucidating the physiological context of children's IPV exposure is important for developing and implementing interventions that maximize children's opportunities for resilience. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on the impact of intimate partner violence (IPV) on child behavior. Topics mentioned include the use of an evidence and gap map, the physical health and medical engagement of children exposed to IPV, the adolescent dating violence victimization and perpetration, and IPV acceptance and appraisal.

Among children exposed to intimate partner violence (IPV), their appraisals and beliefs about IPV have been identified as key cognitive factors that may explain the linkage between IPV exposure and other adjustment outcomes. Grounded in the cognitive-contextual framework, this systematic review summarizes empirical studies examining child IPV exposure, acceptance of IPV, and appraisals of IPV, including perceived threat, self-blame attributions, and coping efficacy. This study is part of a broader evidence and gap map (EGM) that systematically searched seven databases for quantitative studies examining the effects of IPV exposure on all potential child outcomes. Studies were screened and coded for inclusion if they focused on IPV-exposed children 17 years and younger, used a validated or reliable scale to measure child outcomes, and utilized a comparison group. This review examined a subset of 13 studies measuring children's acceptance and/or appraisals of IPV. Findings suggest that children exposed to IPV tend to have stronger beliefs that the use of violence in intimate relationships is acceptable, with important implications for adolescent dating violence. Additionally, children's appraisals of threat and self-blame regarding their parents' IPV acted as a key variable for understanding links between children's IPV exposure and outcomes such as internalizing problems, social anxiety, and self-efficacy. Few studies examined coping efficacy. This review highlights the importance of children's acceptance and appraisals of IPV as an outcome of IPV exposure, and as an intervening factor between IPV exposure and other adjustment outcomes. Implications for intervention and future research are discussed. [ABSTRACT FROM AUTHOR]

Both in the United States and across the world, intimate partner violence (IPV) is a widespread social problem. It often occurs in households with children, and IPV exposure during childhood is associated with negative sequelae across developmental domains. This systematic review synthesizes the literature on the effects of IPV exposure on social-emotional competence (i.e., social competence, empathy, emotion regulation) from infancy through late adolescence. Seven bibliographic software databases were searched for relevant citations up to August 2020, and a total of 15,354 citations were identified after deduplication. Following a screening process by two research assistants, 381 citations were included in a broader Evidence and Gap Map. Data extraction was completed for included citations, and all were coded into child outcome categories and subcategories. Twenty-six studies examined social-emotional competence. Across studies examining social competence, a majority found that IPV-exposed children demonstrated lower levels of social competence and emotional regulation than a comparison group. Limited evidence was found to indicate that IPV-exposed children also exhibited fewer empathic skills compared with non-exposed peers. Social-emotional competence was additionally identified to significantly mediate and/or moderate the association between IPV exposure and other outcomes (e.g., aggressive behaviors, psychological distress), underscoring that social-emotional competence may be a malleable factor that could promote resilience among children exposed to IPV. These findings highlight the need to further explore the associations between social-emotional competence and other child adjustment outcomes, and develop and implement programming to foster social-emotional competence among IPV-exposed children. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) exposure threatens healthy child development by compromising outcomes across a range of domains including academic functioning. However, research suggests variability in the strength and nature of the association between IPV exposure and academic functioning, and the extent to which it varies by different academic outcomes and co-occurring risk factors (e.g., child maltreatment). This systematic review seeks to clarify the relation between IPV exposure and academic functioning by distilling overall outcome trends and critically assessing the existing literature's strengths and limitations. Seven databases were searched to identify relevant articles published through August 2020. Studies were included if (a) at least 80% of the sample were from birth to 18 years of age; (b) valid tools were used to measure outcome variables, and (c) outcomes of children exposed to IPV were compared with children who experienced other forms of violence and/or no violence exposure. After screening, the review yielded 13 articles examining academic functioning. The majority (76.9%, n = 10) of the studies found a negative association between IPV exposure and academic functioning, but results varied among subdomains of academic functioning (subjective performance, objective performance, and conduct). Findings from several studies indicate that the combined experience of IPV exposure and maltreatment negatively affects academic functioning. Results highlight the need for: 1) additional research examining IPV exposure and academic functioning 2) early detection of IPV-exposed children, and 3) the development and implementation of evidence-based interventions to support academic functioning. [ABSTRACT FROM AUTHOR]

An estimated 15.5 million children in the United States are exposed to intimate partner violence (IPV) in their homes each year. Empirical data suggest that childhood IPV exposure is associated with a plethora of adverse outcomes such as poor behavioral regulation, reduced cognitive functioning, and greater aggressive behavior. Within this body of research, it has been suggested that IPV-exposed children are more likely to both perpetrate and fall victim to bullying than non-exposed children. This systematic review explores the relationship between IPV exposure and bullying perpetration and victimization in the existing literature and includes a discussion of individual- and family-level factors that have been considered in the association between IPV exposure and bullying perpetration and victimization. Building upon findings from a broader Evidence and Gap Map, this systematic literature review identified 14 articles that examined the association between IPV exposure and bullying perpetration and victimization. Of these 14 articles, 12 assessed the relationship between youth IPV exposure and bullying perpetration, and 75.0% of these articles (n = 9) found a significant relationship between IPV exposure and bullying perpetration. Ten of the 14 articles examined youth IPV exposure and bullying victimization, with 70.0% of the articles (n = 7) supporting this association. Individual- and broader family-level characteristics, including gender, race/ethnicity, mental health symptoms, other types of adversities, and parenting were also examined. The article addresses implications for research and practice, including methodological suggestions for future studies and avenues for potential intervention for IPV-exposed children experiencing bullying victimization and perpetration. [ABSTRACT FROM AUTHOR]

The quality of adolescent dating relationships is an outcome of developmental importance for young people exposed to intimate partner violence (IPV) in childhood. As adolescents explore romantic interests for the first time, it is important to consider whether youth who have witnessed IPV have an increased likelihood of adolescent dating violence (ADV) victimization and/or perpetration. This systematic review seeks to synthesize empirical literature on ADV victimization and perpetration outcomes in youth exposed to IPV, examine mechanisms that may explain ADV outcomes in IPV-exposed youth, and summarize methodological factors that influence interpretation of findings. Seven bibliographic databases were searched through August 2020 for a broader evidence and gap mapping (EGM) project examining published empirical studies on child outcomes of IPV exposure. Following de-duplication, 350 empirical studies on child IPV exposure outcomes were identified and categorized into child outcome themes, including 29 studies that examine ADV victimization and/or perpetration among IPV-exposed youth. The association between IPV exposure and ADV perpetration and victimization varies widely, with factors such as gender, mental health symptoms, beliefs about violence, and emotion regulation differentially influencing outcomes. Inconsistencies in measurement of IPV, ADV, and sample ages make cross-study comparisons challenging. Practice and research implications are addressed, including the importance of examining strengths-based youth assets and resilient trajectories of healthy dating relationships among IPV-exposed youth. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) exposure continues to be a pervasive problem for children. Although the impact of IPV exposure on children's mental health has been well-documented, the impact of IPV exposure on children's physical health, as well as families' engagement with the medical system for their children's physical health needs (e.g., contact with primary care pediatricians, emergency room visits) remains under-studied. The purpose of this systematic review was to synthesize quantitative studies examining the association between IPV exposure and (a) medical system engagement and (b) physical health outcomes, and to examine methodological factors that may influence findings. A systematic review was conducted using seven electronic bibliographic databases to identify research examining outcomes of IPV-exposed children up to August of 2020. Citations were coded by two independent researchers to determine inclusion and exclusion, and then coded again to identify studies examining medical system engagement and physical health outcomes. A total of 31 citations were included. Consistent results were found across studies in that, compared with non-exposed children, IPV-exposed children were less likely to be up to date on immunizations, had an increased rate of emergency room visits, had more contact with primary care pediatricians, were more likely to have an increased risk of poor lung functioning, obesity, and nutritional deficiencies, and reported more general physical health problems. In addition to further research in this area, this study identifies the need for training healthcare providers to implement consistent IPV screening and provide IPV-exposed children and families with referrals to trauma-informed, community-based interventions. [ABSTRACT FROM AUTHOR]

Police-initiated post-traumatic stress symptomatology (PI-PTSS) refers to post-traumatic stress symptoms that are rooted in interactions with police officers. Research on PI-PTSS is scarce, though results typically suggest that invasive police behaviors are associated with higher levels of PI-PTSS. However, this research utilizes a general measure of PI-PTSS, failing to account for unique profiles of PI-PTSS that may be present in the data. Further, research has yet to the relationship between PI-PTSS and co-morbidities. The present study utilizes latent class analysis (LCA) to identify profiles of PI-PTSS, tests predictors of latent class membership, and tests latent classes as predictors of depressive symptomatology among a sample of 816 youth in the Fragile Families and Child Wellbeing Study. Findings from identified three profiles of PI-PTSS: low PI-PTSS, avoidance, and high PI-PTSS. The odds of belonging to the high PI-PTSS are greater for youth in low-income households, black youth, and youth who have been stopped by the police multiple times. Membership in the high PI-PTSS class is also associated with higher levels of depressive symptomatology. Our findings highlight the need to develop tactics that minimize the negative impact that police can have when responding to crime, and create mechanisms that increase the effectiveness of police when responding to non-crime situations that require a social service response. [ABSTRACT FROM AUTHOR]

Research suggests that police encounters can be a traumatic experience for youth. These experiences may result in trauma symptomatology and co-occurring mental health issues like depression and anxiety. However, studies exploring the relationships between trauma symptomatology, depression and anxiety do not typically focus on trauma that is rooted in experiences with the police. The present study utilizes exploratory and confirmatory factor analysis to examine the relationships among police-initiated post-traumatic stress symptoms, depression and anxiety. Exploratory and confirmatory factor analysis examines the factor structure of police-initiated post-traumatic stress symptoms, depression and anxiety. Results suggest that police-initiated post-traumatic stress symptomatology is two factors that are distinguishable from anxiety and depression. Our findings highlight the need to develop methods of disentangling the relationships between police-initiated post-traumatic stress symptomatology and co-occurring mental health symptoms, and advocating for policies and practices that can reduce negative police-youth interactions. [ABSTRACT FROM AUTHOR]

Since its development, Singh's 2003 Area Deprivation Index (ADI) has been routinely used by researchers to measure a global construct of neighborhood socioeconomic deprivation and to investigate how living in neighborhoods of different levels of socioeconomic deprivation affects individuals' health. We empirically tested the ADI's dimensionality, using 2013–2017 American Community Survey tract-level estimates (N = 73,056), and the stability of its performance across time and place. Factor analysis findings illuminated three distinct dimensions, the ADI-3, consisting of neighborhood financial strength, economic hardship and inequality, and educational attainment. The prior-assumed unidimensional ADI measure fails standard tests of construct validity. Findings from multigroup structural equation modeling across 2009 and 2017 and between New York and Minnesota suggest that the ADI performs with only partial stability across time and place. In order to most precisely understand the complex role of neighborhood socioeconomic position in health, public health researchers must integrate construct-valid and regionally and temporally relevant measures. [ABSTRACT FROM AUTHOR]

Healthcare workers have been on the front lines throughout the COVID-19 pandemic, treating affected patients and navigating overwhelmed healthcare systems. Emotional connection has been associated with resilient outcomes following collective trauma. This qualitative study examined how healthcare workers define emotional connectedness during the COVID-19 pandemic and their adaptive emotional connection strategies. Data were gathered through the first wave of the online COVID-19 Pandemic and Emotional Well-Being study, a prospective panel study of the psychological impact of COVID-19 on frontline workers and the general public. This study focused on three extended-response questions about definitions of and strategies for emotional connectedness. Data were analyzed using reflexive thematic analysis. Participants conceptualize emotional connectedness as having empathy and value, help and support, presence, and vulnerability. They also describe emotionally connected relationships as being characterized by mutuality and frequent contact. Participants identify current behavioral strategies for cultivating emotional connectedness, such as using technology, providing instrumental help or sending gifts via mail, and building quality time within their households. They also report challenges in maintaining these connections. Future research must contribute knowledge about effective interventions for essential healthcare workers in the aftermath of COVID-19. Specific recommendations for social work practitioners are also discussed. [ABSTRACT FROM AUTHOR]

The authors discuss a study by J. B. Lusk and colleagues, published in the issue, which provided evidence for the connection between neighborhood conditions and health. Topics include powerful determinants of pulmonary health outcomes, evidence suggesting a relationship between neighborhood factors and individual health and disease, and research finding on differences in major health outcomes and survival.

Background: Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. Objective: To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. Design: Observational cohort study. Setting: Outpatient and emergency care. Patients: 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. Interventions: Nasopharyngeal PCR test for SARS-CoV-2 infection. Measurements: Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. Results: We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91–3.59] times (at age 20) to 2.37 [1.54–3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. Limitations: Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. Conclusion: Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates. [ABSTRACT FROM AUTHOR]

Firearm-related violence is a significant threat to public health and safety in America. However, research highlights a critical disparity in firearm-related deaths by race. Researchers often cite racial bias as a contributing factor for the racial disparity in firearm-related deaths. To provide a foundation for potential social work interventions, the present article discusses the results of an assessment of whether explicit racial biases toward four racial and ethnic groups (white, black, Asian, Hispanic/Latino), fear of crime, and the quantity and quality of interactions with neighbors of a different race are predictors of gun ownership. Findings suggest that explicit racial bias toward black, Asian, and Hispanic/Latino individuals is a significant predictor of gun ownership. Fear of crime and more frequent interactions with neighbors of a different race are also significant predictors of gun ownership. Taken as a whole, findings suggest that gun owners are more likely to be more vigilant toward people of color because of stereotypical assumptions that racial and ethnic minorities are more likely to be involved with crime. Social work practice and policy implications include developing interventions aimed at reducing implicit bias and identifying policies that are associated with lower levels of implicit bias among gun owners. [ABSTRACT FROM AUTHOR]

While quantitative studies have described foreclosure's correlates, and qualitative work has shed light on homeowners' experiences in general, research has not focused specifically on how families with children younger than 18 years experience foreclosure. This study was an exploratory qualitative examination of families' experiences with home foreclosure, focusing especially on the meaning(s) the foreclosure had for them. In-depth interviews were conducted with 29 adult homeowners living with children younger than 18 years during their foreclosures. The analysis revealed key themes of foreclosure threatening personal and social identity, family relationships and routines, and emotional attachment and experiences of loss. Adults tended to blame themselves for the foreclosures as opposed to seeing structural forces as responsible for their predicaments. The findings help illuminate some of the potential mechanisms underlying the negative impact of foreclosure. Understanding families' experiences is critical to formulating services and policies to help affected families regain stability. [ABSTRACT FROM AUTHOR]

Because the effects of children’s exposure to intimate partner violence (IPV) carry long lasting consequences for the affected children, IPV exposure may impose a significant economic burden to localities, states, and society at large, made explicit over the victim’s lifetime and over a wide range of behaviors and outcomes, including use of social services, health and healthcare utilization, educational outcomes, workforce productivity, and criminal behavior. While much research has been conducted on the effect of IPV exposure on multiple short- and long-term outcomes, no research to date has examined the economic burden associated with IPV exposure. Using an incidence-based approach, we estimated the aggregate discounted costs associated with healthcare spending, criminal behavior, and labor market productivity accrued by a 20-year-old victim in 2016 projected to the age of 65, applying a 3% discount rate. The average lifetime costs derived from childhood IPV exposure are estimated to be over $50,000 per victim (2016 U.S. dollars) due to increased healthcare costs ($11,000), increased crime costs ($14,000), and productivity losses ($26,000). Over an annual birth cohort of young adults, these costs amount to over $55 billion nationwide. IPV exposure imposes a substantial economic burden to society at large in the form of increased healthcare costs, increased crime costs, and reduced productivity. This study offers an explicit quantification of substantial lifetime costs, which should encourage policy makers to redouble efforts to reduce the incidence of IPV and successfully ameliorate its effects on IPV-exposed children. [ABSTRACT FROM AUTHOR]

Reimbursement for genetic counseling services was examined at a single institution. Patient encounters utilizing the 96040 CPT® code from 7/31/2009 through 7/31/2013 were reviewed. Exclusion criteria included billing records of patients seen by a physician the same day, self-pay, Medicaid, and Medicare patients. Of the 8,630 encounters with a genetic counselor, 582 encounters were eligible for review. Descriptive statistics (i.e., percentage of encounters receiving some level of reimbursement, average reimbursement rate, number of third party payors providing any level of reimbursement, and number of ICD-9 codes receiving any level of reimbursement) depicted reimbursement of the 96040 CPT® code for the encounters analyzed. Statistical analysis found a significant difference in reimbursement between third party payors that do and do not credential genetic counselors ( p < .0001). There was no statistically significant difference between reimbursement rates for primary diagnostic ICD-9 codes when compared to primary diagnostic ICD-9 V codes used. Results will provide a useful baseline for local and national comparisons due to the paucity of data regarding CPT® 96040. [ABSTRACT FROM AUTHOR]

Research on Americans' retirement readiness indicates a wide range of preparedness for the golden years. Called a "crisis" by researchers, retirement for some may include significant choices: continued employment or utilization of social welfare services. This article describes factors contributing to the retirement crisis and roles social workers can play in assisting older retirees. Disparity in household retirement savings exists by ethnicity. On the front lines serving aging individuals and their families, social work professionals are well situated to collaborate with individuals, and other providers, to address financial, social and emotional pillars necessary in facilitating a safe and secure retirement. [ABSTRACT FROM AUTHOR]

A substantial body of literature has documented the negative effects of intimate partner violence (IPV) on a wide range of children's developmental outcomes. However, whether a child's exposure to IPV leads to increased adjustment difficulties is likely to depend on a variety of factors, including the caregiver's mental health and the developmental time period when IPV exposure occurs. The present study seeks to improve our understanding of the long-term effects of IPV exposure and maternal depression on the development of children's overt aggressive behavior. Longitudinal analyses (i.e., latent growth curve modeling) examining three time points (toddler: age 2-3 years, preschool/kindergarten: age 4-5 years, and elementary school: age 6-8 years) were conducted using 1,399 at-risk children drawn from the National Survey of Child and Adolescent Well-Being (NSCAW-I). IPV exposure during age 2-3 years was significantly related to concurrent aggressive behavior and aggressive behavior during age 4-5 years. At all three time points, IPV was significantly associated with maternal depression, which in turn, was significantly related to higher levels of aggressive behavior. There was also a significant indirect lagged effect of IPV exposure at age 2-3 years through maternal depression on aggressive behavior at age 4-5 years. Results indicated that maternal depression was a strong predictor of increased reports of overt aggressive behavior, suggesting that interventions to buffer the effects of IPV exposure should focus on relieving maternal depression and fostering productive social behavior in children. Aggr. Behav. 43:375-385, 2017. © 2017 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Lenore Manderson and Carolyn Smith-Morris, New Brunswick, NJ: Rutgers University Press. ISBN-13 978-0813547466 320 pages, $29.95 (paperback) [ABSTRACT FROM AUTHOR]