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Objective:Problem behavior theory hypothesizes that adolescent attitudinal tolerance of deviance (ATD) precedes health risk behaviors. We examined ATD patterns among early adolescents with prenatal drug exposure and associated the patterns with subsequent risk behaviors. The ATD patterns were further characterized by concurrent developmental contexts. Method:Participants were 306 urban adolescents (51% girls), primarily African American and of low socioeconomic status, from a prospective birth-cohort study on the effects of prenatal cocaine exposure. ATD was assessed at age 12. Substance use, via self-report and biologic assays, and sexual intercourse before age 15 were assessed at age 15. Adolescents reported on measures assessing their family, peer, and neighborhood environments at age 12. Results:Latent class analysis identified three patterns: intolerance(G1; 59%), tolerance of relational deviance(G2; 30%), and tolerance of all deviance(G3; 11%). The patterns with tolerant attitudes (G2, G3) and the intolerance pattern (G1) were differentially related to subsequent alcohol use and sexual risk behaviors. Adolescents’ current developmental contexts were distinctively associated with the ATD patterns, demonstrating the validity of the extracted patterns. Conclusions:Identifying ATD patterns in early adolescence may facilitate etiology research and prevention strategies among at-risk urban adolescents with prenatal drug exposure.

Patient experiences with the health-care system are increasingly seen as a vital measure of health-care quality. This study examined whether workplace social capital and employee outcomes are associated with patients’ perceptions of care quality across multiple clinic sites in a diverse, urban safety net care setting. Data from clinic staff were collected using paper and pencil surveys and data from patients were collected via a telephone survey. A total of 8392 adult primary care patients and 265 staff (physicians, nurses, allied health, and support staff) were surveyed at 10 community health clinics. The staff survey included brief measures of workplace social capital, burnout, and job satisfaction. The patient-level outcome was patients’ overall rating of the quality of care. Factor analysis and reliability analysis were conducted to examine measurement properties of the employee data. Data were aggregated and measures were examined at the clinic site level. Workplace social capital had moderate to strong associations with burnout (r= −0.40, P< .01) and job satisfaction (r= 0.59, P< .01). Mean patient quality of care rating was 8.90 (95% confidence interval: 8.86-8.94) ranging from 8.57 to 9.18 across clinic sites. Pearson correlations with patient-rated care quality were high for workplace social capital (r= 0.88, P= .001), employee burnout (r= −0.74, P< .05), and satisfaction (r= 0.69, P< .05). Patient-perceived clinic quality differences were largely explained by differences in workplace social capital, staff burnout, and satisfaction. Investments in workplace social capital to improve employee satisfaction and reduce burnout may be key to better patient experiences in primary care.

Purpose: This study compared a novel self-management (TargetEd MAnageMent Intervention [TEAM]) versus treatment as usual (TAU) to reduce stroke risk in African American (AA) men.Design: Six-month prospective randomized controlled trial with outcomes evaluated at baseline, 3 months, and 6 months.Setting: Academic health center.Participants: Thirty-eight (age < 65) AA men who had a stroke or transient ischemic attack and a Barthel index score of >60 were randomly assigned to TEAM (n = 19) or TAU (n = 19).Intervention: Self-management training, delivered in 1 individual and 4 group sessions (over 3 months).Measures: Blood pressure, glycosylated hemoglobin (HbA1c), lipids, medication adherence, weight, and standardized measures of health behaviors (diet, exercise, smoking, substances), depression, and quality of life. Qualitative assessments evaluated the perspectives of TEAM participants.Analysis: Ttests for paired differences and nonparametric tests. Thematic content qualitative analysis.Results: Mean age was 52.1 (standard deviation [SD] = 7.4) and mean body mass index was 31.4 (SD = 7.4). Compared to TAU, TEAM participants had significantly lower mean systolic blood pressure by 24 weeks, and there was also improvement in HbA1cand high-density lipoprotein cholesterol (P= .03). Other biomarker and health behaviors were similar between groups. Qualitative results suggested improved awareness of risk factors as well as positive effects of group support.

This study was conducted to identify oral health factors that are important to people who are elderly. By identifying factors valued by patients who are older, dental professionals can gain better insights into the preferences and priorities that patients use in making dental treatment decisions. To determine which factors are important to this population, we compiled a list of oral health goals identified through a literature review. To supplement this initial list, we undertook line‐by‐line (open) coding of transcripts of two sets of semi‐structured interviews. The first set of interviews explored the decision of older adults to seek treatment in response tooth pain. The second set of interviews elicited anticipated responses to three scenarios involving extensive restoration and one scenario involving extraction and prosthetic replacement among older patients at a dental school.