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The differential treatment of youth of color in schools perpetuates disparities in academic outcomes. Alternative education programs may represent a constructive approach to preventing or mitigating these disparities. This study examines the outcomes of an urban alternative education program in the United States. Secondary analysis of demographic, psychosocial, and academic data from all program participants (N = 232) during a 3-year study period was conducted. Descriptive statistics summarize demographic characteristics, and bivariate analyses examine the strength of association and interrelationships among individual variables, program retention, and educational attainment. Results show grade-level advancement, employability, and, therefore, decreased risk for justice involvement, regardless of students' histories of lower academic performance, unemployment, behavioral health conditions, and justice system or child protective services contact. This evaluation offers a framework for replication and recommendations for future research examining alternative education programs.

Alternative education programs can prevent disparities in academic outcomes among marginalized youth. This descriptive study examines the results of an alternative education program with nondiscrimination policies and staff training related to supporting the inclusion of lesbian, gay, bisexual, and transgender (LGBT) youth. Secondary analysis of demographic, psychosocial, academic, and grade level data for participants (N = 232) was completed. The study included analysis of data describing participant and program characteristics, and an assessment of the program's impact on student outcomes. Findings indicate that LGBT youth perform equally well as compared to non-LGBT counterparts and excel even while entering the program with a psychosocial history that differs from their peers. This study offers a framework for replication to other community-based alternative education programs supporting LGBT youth.

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice. [ABSTRACT FROM AUTHOR]

WeChat is the largest social media platform in China, yet few WeChat-based smoking cessation interventions have been investigated to date. The objective of this study was to develop and test the feasibility of a WeChat-based smoking cessation intervention for smokers in China. Participants were recruited using WeChat and were then randomized into one of three groups: the Standard Group, the Enhanced Group, and the wait-list Control Group. Feasibility indicators including program reach, recruitment rate, recruitment efficiency, cost per person, attrition rate, intervention message exposure, group discussion utilization rate, intervention message engagement, satisfaction, and the likelihood of recommending to others were measured with assessed. Analyses included Chi-square and Fisher exact test, as well as analysis of variance test. A responsive participant is defined as a participant that responded to a certain assessment. A total of 1,132 individuals connected with ("friended") our project on WeChat between July 1 and August 5, 2019. Of these, 403 were eligible to participate, consented, and completed the baseline assessment. As a result, 136, 135, and 132 smokers were randomly assigned to the Standard Group, the Enhanced Group, and the Control Group, respectively. The total program recruitment rate was 35.6% and the attrition rate was 46.4%. The program cost was $0.85 per person. All responsive participants read at least one message during the intervention and engaged with intervention messages 56.8% of the time. Most responsive participants reported being very or somewhat satisfied, highly or somewhat engaged, and were willing to recommend our program to others. This study demonstrated the feasibility of a smoking cessation interventions using WeChat. The program could be expanded to deliver smoking cessation interventions to a large population of smokers. [ABSTRACT FROM AUTHOR]

This study examines client and parent/guardian perceptions of holistic juvenile public defense. A total of 66 subjects responded to a structured survey measuring satisfaction with holistic representation. Differences between perceptions were analyzed using paired T -tests and the Pearson's correlation coefficient was used to analyze strength of association and interrelationships among variables and satisfaction. Qualitative data were collected through open-ended survey questions. The findings of this study indicate that holistic defense was perceived positively as measured by high client satisfaction. Further empirical research is necessary to evaluate the outcomes of holistic models and offer comparison to traditional models. [ABSTRACT FROM AUTHOR]

The article describes how social workers within a school-based health center implemented a virtual relationship-mapping program to promote social-emotional learning (SEL) among children through the case of a middle school in Louisiana. Topics include the critical practices for SEL, the study results which offer initial evidence to support a virtual relationship-mapping intervention in the school setting and how unfamiliarity of remote mentorship may deter students from establishing contact.

This study describes the results of an evaluation of a holistic defense model for juvenile clients. Longitudinal, retrospective analysis of de‐identified data from clients (N = 308) measured individual variable outcomes, relationships, and project performance. Bivariate and multivariate analyses examined the strength of association and interrelationships among client and defense team variables. Findings indicate that holistic defense was significantly associated with improved outcomes among juvenile clients, including increased mental health assessment resulting in treatment, increased employment and educational attainment, and decreased odds of recidivism. Favorable court or dispositional outcomes, including lower adjudication or early termination from custody, were also reported. Further practice‐level, controlled research is necessary to evaluate these models and offer comparison to other models for holistic defense. [ABSTRACT FROM AUTHOR]

Background: This study examined the moderating role of social support in the acculturation-obesity/central obesity relationship in Mexican American (MA) men and women. Methods: Data from NHANES 1999–2008 were used. Acculturation derived from language use, country of birth and length of residence in the U.S. Social support assessed emotional and financial support. BMI (≥30) and waist circumference (≥88 cm for women; ≥102 cm for men) measured obesity and central obesity, respectively. Weighted multivariate logistic regression models were used to describe associations. Results: Compared to less acculturation, more acculturation was associated with higher odds of obesity (ORs 2.48; 95% CI 1.06–5.83) and central obesity (2.90; 1.39–6.08) among MA men with low/no social support, but not among MA men reporting high social support. The modifying effects was not observed among women. Conclusion: Higher amounts of social support appeared to attenuate the risk of obesity/central obesity associated with acculturation. Interventions enhancing social support maybe effective among acculturated MAs, particularly among men. [ABSTRACT FROM AUTHOR]

Objectives. To understand changes in behavioral health services utilization and expenditures before and after natural disaster with an adult Medicaid population affected by the Baton Rouge, Louisiana–area flood (August 2016). Methods. We examined de-identified behavioral health claims data for Medicaid-insured adults in the affected region for 10 months before and after flooding (October 2015–June 2017). This constituted 273 233 provider claims for 22 196 individuals. Claims data included patient gender, behavioral health diagnoses, treatment dates, and costs. We made adjustments for Medicaid expansion by using monthly enrollment data. Results. Overall, most male patient behavioral health care visits were for substance use disorders (33.6%) and most female patient behavioral health care visits were for depression-related disorders (30%). Both diagnostic categories increased after the flood by 66% and 44%, respectively. Expansion accounted for a 4% increase in claims. Postflood claims reflected 8% to 10% higher costs. Conclusions. Greater amounts of behavioral health care services were sought in all 10 months of the postflood study period. We observed gender differences in use of services and diagnoses. Behavioral health care services following natural disasters must be extended longer than traditionally expected, with consideration for specific population needs. [ABSTRACT FROM AUTHOR]

Objective: Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women.Design: Cross-sectional data from NHANES 1999-2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity.Setting: National Health and Nutrition Examination Survey (NHANES) 1999-2012.Subjects: A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status.Results: Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women.Conclusions: HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity. [ABSTRACT FROM AUTHOR]

There is a general agreement in the literature concerning what works and what does not work in reducing delinquent behavior with juvenile offenders in communities; however, this knowledge has had limited penetration into general public, political, and policymaking venues, as it is reported that less than 10% of juvenile offenders are afforded evidence-based community services. This article describes how Louisiana, through a combination of state, local, university, and national partnerships, adopted a community development model that has led to a 27% increase in juvenile-justice-involved youth having access to evidence-based services while the state witnessed a simultaneous 46% drop in juvenile arrests between 2006 and 2010. [ABSTRACT FROM AUTHOR]

Background: Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and implants. Inadequate reimbursement for long-acting reversible contraceptive devices may be an access barrier to long-acting reversible contraceptive uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring long-acting reversible contraceptive devices to the wholesale acquisition cost.Objective: To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive device reimbursement rate to the wholesale acquisition cost (ie, price set by the manufacturers) on long-acting reversible contraceptive uptake among women at risk for unintended pregnancy.Materials and Methods: This retrospective, repeated cross-sectional study used 2013-2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and long-acting reversible contraceptive uptake among contraceptive users (N = 193,623) using bivariate and logistic regression analyses.Results: After long-acting reversible contraceptive reimbursement increased, there was a 2-fold likelihood increase in use in 2015 vs 2013 (odds ratio, 2.08; 95% confidence interval, 1.69-2.55). Long-acting reversible contraceptive uptake was more likely across all patient and provider subgroups in 2015 vs 2013 but notably among patients receiving contraceptive care from family planning clinics (odds ratio, 3.93; 95% confidence interval, 2.34-6.62).Conclusion: Removal of a provider-level financial barrier to long-acting reversible contraceptive provision was associated with increased long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. Efforts to improve long-acting reversible contraceptive access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women. [ABSTRACT FROM AUTHOR]

Background: Physically-traumatic injuries result in PTSD for approximately 10% of Americans, and this rate is higher among individuals of color and those living in poverty. Individuals of color living in poverty experience lower access to PTSD and other mental health services. Untreated PTSD is associated with increased risk of trauma recidivism, but it is unknown if provision of treatment is actually associated with a subsequent reduction in recidivism risk.Methods: For this observational cross-sectional study, data were collected retrospectively from the Trauma Registry of a level one trauma center, safety-net hospital in New Orleans between 2018 and 2020. Receipt of outpatient PTSD treatment at this same hospital was evaluated via chart review of the electronic health record. Propensity score matching was used to balance confounding variables of trauma type (assault vs. non-assault), gender, and race. McNemar test and Cox proportional hazard model were used with the propensity-balanced dataset to assess differences in trauma recidivism according to PTSD treatment status.Results: Among 5916 trauma activations that occurred in the study period, 92 instances of recidivism occurred. 91 pairs were established after balancing with the propensity score. 1-year recidivism was 2.2% (n = 2) of all treated individuals versus 15.4% (n = 14) of non-treated individuals (p < 0.0001). The marginal risk from the Cox proportional hazard model demonstrated an 82% reduction in risk of recidivism (p = 0.02).Conclusions: This study demonstrated that mental health treatment can be used to reduce trauma recidivism. These data were shown among a high-risk population of disproportionately Black men living in a low-income community. Ensuring access to quality mental health care is one way to address the health disparities associated with physically-traumatic injuries. [ABSTRACT FROM AUTHOR]

While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses ( n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.

WeChat is the largest social media platform in China, yet few WeChat-based smoking cessation interventions have been investigated to date. The objective of this study was to develop and test the feasibility of a WeChat-based smoking cessation intervention for smokers in China. Participants were recruited using WeChat and were then randomized into one of three groups: the Standard Group, the Enhanced Group, and the wait-list Control Group. Feasibility indicators including program reach, recruitment rate, recruitment efficiency, cost per person, attrition rate, intervention message exposure, group discussion utilization rate, intervention message engagement, satisfaction, and the likelihood of recommending to others were measured with assessed. Analyses included Chi-square and Fisher exact test, as well as analysis of variance test. A responsive participant is defined as a participant that responded to a certain assessment. A total of 1,132 individuals connected with ("friended") our project on WeChat between July 1 and August 5, 2019. Of these, 403 were eligible to participate, consented, and completed the baseline assessment. As a result, 136, 135, and 132 smokers were randomly assigned to the Standard Group, the Enhanced Group, and the Control Group, respectively. The total program recruitment rate was 35.6% and the attrition rate was 46.4%. The program cost was $0.85 per person. All responsive participants read at least one message during the intervention and engaged with intervention messages 56.8% of the time. Most responsive participants reported being very or somewhat satisfied, highly or somewhat engaged, and were willing to recommend our program to others. This study demonstrated the feasibility of a smoking cessation interventions using WeChat. The program could be expanded to deliver smoking cessation interventions to a large population of smokers., (© Society of Behavioral Medicine 2022. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic., Methods: Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review., Results: Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States., Conclusions: A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context., (Copyright © 2021 Elsevier Inc. All rights reserved.)