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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.

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., Author(s): Kylie E. Evans [sup.1] , Hyunjune Lee [sup.1] , Katie N. Russell [sup.1] , Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.2] , Anna E. Bender [sup.1] [...]

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., Author(s): Jamie Cage [sup.1] , Julia M. Kobulsky [sup.2] , Sherise J. McKinney [sup.3] , Megan R. Holmes [sup.4] , Kristen A. Berg [sup.4] [sup.5] , Anna E. Bender [sup.4] [...]

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., Author(s): Anna E. Bender [sup.1] , Sherise J. McKinney [sup.2] , Megan M. Schmidt-Sane [sup.3] , Jamie Cage [sup.4] , Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.5] [...]

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., Author(s): Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.2] , Anna E. Bender [sup.1] , Kylie E. Evans [sup.1] , Julia M. Kobulsky [sup.3] , Alexis P. Davis [...]

Author(s): Megan R. Holmes [sup.1] , Kristen A. Berg [sup.1] [sup.2] , Anna E. Bender [sup.1] , Kylie E. Evans [sup.1] , Kari O'Donnell [sup.1] , Emily K. Miller [sup.1] [...]

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., Author(s): Kylie E. Evans [sup.1] , Megan M. Schmidt-Sane [sup.2] , Anna E. Bender [sup.1] , Kristen A. Berg [sup.1] [sup.3] , Megan R. Holmes [sup.1] Author Affiliations: (1) grid.67105.35, [...]

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., Author(s): Kristen A. Berg [sup.1] [sup.2] , Kylie E. Evans [sup.2] , Gregory Powers [sup.2] , Scott E. Moore [sup.3] , Stacey Steigerwald [sup.4] , Anna E. Bender [sup.2] , [...]

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]

OBJECTIVE: To evaluate the association among race, ethnicity, insurance type, and fulfillment of permanent contraception requests. METHODS: This is a secondary analysis of a retrospective cohort of patients who delivered at 20 or more gestational weeks in a 2-year time period at four hospitals across the United States: University of California San Francisco, Northwestern Memorial Hospital, MetroHealth Medical Center in Cleveland, and University of Alabama at Birmingham. All patients included had permanent contraception documented as their postpartum contraceptive plan. We used modified Poisson models to estimate the associations among race and ethnicity, insurance type, and fulfillment of permanent contraception before hospital discharge, within 6 weeks of delivery, and within 1 year of delivery, adjusting for age, parity, gestational age, delivery type, marital status, body mass index, insurance type, adequacy of prenatal care, and hospital site. RESULTS: Of 2,945 people in our cohort, 1,243 (42.2%) were non-Hispanic Black, and 820 (27.8%) were Hispanic, and 882 (30.0%) were non-Hispanic White. Overall, 1,731 of 2,945 patients (58.2%) who desired postpartum permanent contraception received it before hospital discharge, 1,746 of 2,945 (59.3%) received it within 6 weeks of delivery, and 1,927 of 2,945 (65.4%) received it within 1 year of delivery. Across all racial and ethnic groups, patients with Medicaid insurance were less likely to have their desired postpartum permanent contraception procedure fulfilled compared with patients with private insurance. In unadjusted models, non-Hispanic Black patients were less likely to have their desired postpartum permanent contraception procedure fulfilled. In an examination of interaction with insurance type, non-Hispanic Black patients with private insurance were less likely to have permanent contraception fulfilled compared with non-Hispanic White patients with private insurance before adjustment. After adjustment, there were no significant associations between race and postpartum permanent contraception fulfillment among those with Medicaid or private insurance. CONCLUSION: In unadjusted models, we find marked racial disparities in fulfillment of permanent contraception. Controlling for individual- and facility-level factors eliminated associations among race, ethnicity, insurance type, and fulfillment, likely because covariates are mediators on the pathway between racism and fulfillment. [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]

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., Author(s): Megan R. Holmes [sup.1] , Francisca G. C. Richter [sup.1] , Mark E. Votruba [sup.2] , Kristen A. Berg [sup.1] , Anna E. Bender [sup.1] Author Affiliations: (Aff1) 0000 [...]

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]

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]

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]

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]

Arrhythmogenic right ventricular cardiomyopathy is a predominantly inherited structural disease with a heterogeneous set of implicated genetic defects. For those patients not identified by targeted population screening programs, ventricular tachycardia can be their first presentation. We report a case of a female from the genetically isolated Hutterite colonies who presented with recurrent ventricular tachycardia. She was found to be homozygous for a truncated desmocollin-2 gene, with both severe right ventricular dysfunction and left ventricular involvement. Her medical management was complicated by the finding of concomitant pre-term pregnancy. Management options for arrhythmia suppression and treatment are reviewed taking into account her decompensated biventricular dysfunction and possible fetal effects. [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]

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]

Bowen-Conradi syndrome (BCS) is a common lethal condition amongst infants of Hutterite ancestry. We describe a newborn infant with features of BCS, which may mimic trisomy 18 and other conditions such as cerebro-oculo-facial syndrome (COFS) and CHARGE syndrome. We describe the constellation of clinical findings in BCS. We believe this is the first case of BCS clinically confirmed by molecular testing for mutation in the EMG1 gene. [ABSTRACT FROM AUTHOR]