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A small but growing body of research suggests that adolescents and young adults involved with the child welfare system and those transitioning out of foster care are at heightened risk of experiencing intimate partner violence (IPV). Understanding the factors that place youth at risk of IPV is central to prevention and treatment of this public health problem. However, questions remain about the prevalence and correlates of IPV among youth in foster care. Additionally, emotional abuse, a particular form of IPV in intimate partnerships, remains an understudied area in this population. This study aimed to address these gaps in research by exploring factors associated with IPV using longitudinal data from a representative sample of older youth in California Foster Care who participated in the California Youth Transitions to Adulthood Study (CalYOUTH). Our IPV outcome measures included victimization, perpetration, bidirectional IPV, and emotional abuse. Findings suggest that approximately one-fifth (20.4%) of CalYOUTH respondents had experienced some form of IPV at age 23, with emotional abuse and bidirectional violence being the most commonly reported types of IPV. Females reported emotional abuse, as well as bidirectional violence, at nearly double the rates of their male counterparts. Self-identified sexual minority youth (SMY; lesbian, gay, bisexual, transgender, queer, or questioning) were more likely to report IPV victimization, IPV perpetration, and bidirectional violence than their non-SMY peers. Youth with histories of emotional abuse, caregiver IPV victimization, sexual abuse in foster care, placement instability, substance use, anxiety, and incarceration were also at heightened risk of IPV involvement. Emotional abuse was most prevalent with SMY. The findings contribute to the growing research on IPV among transition-age foster youth with important implications for future research, practice, and policy. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this article is to describe a community-based participatory research pilot project conducted to investigate the knowledge, attitudes, and beliefs that Pacific Islanders (PIs) hold toward biospecimen collection, use, and banking, all of which will help drive higher PI participation rates in both medical and behavioral research studies. Method. Academic and community partners worked side by side to develop a conceptual model, study measures, and study protocols. PI community partners screened, recruited, and conducted data collection, which consisted of a paper-and-pencil survey and a 1-hour semistructured interview administered by trained community workers. Results. A total of 60 PI adults representing various PI ethnic groups completed the surveys and interviews. Results showed a general support for biospecimen studies that would benefit the community, and many are willing to provide their biospecimen samples if asked. Conclusion. Due to the established level of trust, community partners were able to successfully recruit and collect data for the study. Many of those interviewed also called for more outreach and education about the importance of biospecimen research in their communities. [ABSTRACT FROM PUBLISHER]

Objectives The objectives of this paper were to explore the acceptability of components of a mobile phone/pedometer-based physical activity program and to understand motivators and barriers to increase physical activity in a diverse sample of sedentary women. Design and Sample Face-to-face semi-structured interviews were conducted following a 3-week pilot mobile phone/pedometer-based physical activity intervention. Forty-one sedentary women participated in the study. Measures Subjects were interviewed using a semi-structured interview guide. A qualitative description method was used to thematically analyze the interviews. Two investigators reviewed the transcripts independently and identified codes based on the main concerns in the interview questions. Results Three themes emerged from qualitative data shedding light on the perceived acceptability and usefulness of a mobile phone/pedometer-based intervention: (1) Monitor me: mobile phone/pedometer as self-monitoring tools, (2) Motivate me: cycle of feedback in goal setting and usefulness/uselessness of daily random messages, (3) Mobilize me: engaging and adapting physical activity to fit one's own lifestyle. Conclusion Mobile phone and pedometer-based physical activity programs might be helpful in keeping sedentary women engaged and motivated to increase their physical activity. A randomized controlled trial of this intervention is warranted. [ABSTRACT FROM AUTHOR]

Black Transgender women (BTW) are subjected to race and gender-based societal oppression, which makes them vulnerable to experience violence. The purpose of this study was to examine experiences of violence among BTW by centering their narratives. Ten participants from Los Angeles County were interviewed, and data were analyzed using Consensual Qualitative Research, which yielded four domains; however, the current article focused only on the first domain, Types of Violence, and its six themes: (a) Transgender-specific microaggressions, (b) verbal harassment, (c) intimate partner violence, (d) physical violence, (e) sexual violence, and (f) incarceration. Recommendations for Transgender specific trauma-informed interventions and future directions to promote BTW healing are provided. [ABSTRACT FROM AUTHOR]

Background: Research has shown that people often need assistance from an established person who injects drugs (PWID) in order to initiate their own injection drug use. Yet, there is scant research on the injection initiation process from the perspective of established PWID who assists with initiation. In this paper, we examine the injection initiation process from the perspective of established PWID.Methods: From 2011 to 2013, we conducted qualitative life history interviews with 113 PWID in San Francisco and Los Angeles, California. Qualitative data were coded using an inductive analysis approach. Emergent themes are presented in a series of emblematic case studies that elucidate the injection initiation process from the point of view of the PWID who help people with their first injection.Results: Most participants (70%) said that they had never initiated another person into drug injection, citing negative health and social consequences of drug injection as their primary reasons. Among those PWID who had ever facilitated initiation (30%), most expressed moral ambivalence about the behaviour. Using case studies, we show how PWID engage in a complicated calculation that weighs the pros and cons of assisting someone with their first injection. Concerns about long term harms associated with injection drug use sometimes give way to short-term altruistic concerns related to self-initiation or instrumental needs on the part of the established PWID.Conclusions: Objections to facilitating initiation of injection naïve persons appear to be common among established PWID but are sometimes overridden by a need to reduce harms that can be associated with self-initiation and one's structural vulnerability. For established PWID, helping to initiate another person becomes a complex moral question with nuanced motivations. While further substantiation of this observation will require more research, it is worth considering how existing disinclination to initiating injection naïve persons can be integrated into new or existing approaches to preventing injection initiation. [ABSTRACT FROM AUTHOR]

Objectives: Despite the seriousness of influenza and pertussis, availability of safe and effective vaccines against them, and long-standing maternal vaccination recommendations, US maternal influenza and Tdap vaccination rates have been low. To increase vaccination rates in obstetric offices, it is important to understand clinician perspectives and office processes. We conducted in-depth interviews with nurses and providers on these topics. Methods: Interviewees worked in obstetric offices in one-of-four participating health systems in NY and CA. We audio-recorded and transcribed 20–30-min interviews. We used predetermined categories to code interviews with Dedoose, then iteratively refined codes and identified themes. Results: We conducted 20 interviews between 4/2020 and 9/2020: 13 providers (physician or nurse midwife) (5 NY, 8 CA); 7 office nurses (6 NY, 1 CA). In almost all offices, patient refusal of influenza vaccine was considered the major vaccination barrier; Tdap was often deferred by patients until post-delivery. Nurse-only visits for either vaccine were rare. Vaccination outside the office was uncommon; few offices systematically documented vaccines given elsewhere in a retrievable manner. Participants emphasized patient education as key to prenatal care, but the number of topics left little time for immunizations. Few interviewees could identify an office "immunization champion," knew their office vaccination rates, or had participated in vaccination quality improvement. Several interviewees indicated that they or another provider were good at persuading hesitant patients, but their method had not been shared with other clinicians. Conclusions for Practice: Multiple practical barriers and maternal vaccine hesitancy limit maternal vaccination. Quality improvement strategies are needed. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the social factors that contribute to the mental health challenges that Somali young adults endure. In a two-phase qualitative approach carried-out in the San Diego area, in phase-I, we conducted exploratory interviews with key-informants including clinicians and local Somali leaders (n = 7) who are familiar with the challenges of young Somalis. This information was then augmented through a focus group discussion with Somali young adults (n = 4) to gain further contextual knowledge and for access to the larger community of young people for phase-II. In this second phase, we carried-out individual interviews with 21 Somali young adults. Interviews covered topics including the social factors influencing their mental health, typical strategies for coping with psychological distress, barriers to seeking professional mental health services, and suggestions for combating mental health problems affecting young Somalis. Participant narratives indicate that psychological distress (depression and posttraumatic stress disorder) are highly pervasive, and that shame, acculturative stress and ethnic discrimination as well as parents' dismissive reactions to their children's emotional problems perpetuate mental health problems. Coping strategies included support from friends, religious activities, and playing soccer. Suggestions for addressing their challenges centered on engagement from their own community to advocate for mental health. Implications of this study are discussed in the context of bridging intergenerational and acculturation divides to deliver culturally competent interventions that improve the mental health and well-being of Somali young adults and aid them in their adjustment to the U.S. [ABSTRACT FROM AUTHOR]

This research reports information from semi-structured interviews with 14 northern California Filipino Americans to explore how social connections are associated with methamphetamine use. The interviews examine how the social connections of Filipino American methamphetamine users are influenced by class and generational status. I hypothesize that drug users become involved in social networks that facilitate drug use and that cases of recovery occur among users when they change their social networks. Generational differences in age of first methamphetamine use suggest that drug usage among first generation users may be a way of coping with social class disadvantages. User social networks within social class groups generate ethnic solidarity and highlight the existence of a shared culture that plays an adaptive role in aiding survival, but such support does not appear to help Filipinos stop methamphetamine use. The realization by users that their networks have enabled and reinforced their drug usage serves as a major turning point in helping them “break free” from the social ties that foster continued usage. Those that maintain their ties to user networks tend to remain users. [ABSTRACT FROM AUTHOR]

Background: Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives.Methods: Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers.Results: Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth's life choices.Conclusion: Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents. [ABSTRACT FROM AUTHOR]

Adult day centers (ADCs) are nonresidential settings that support the health and social needs of vulnerable older adults. Due to ADCs' congregate nature and participants' compromised health status, many ADCs have been forced to close during the COVID-19 pandemic. It is unknown how closures have impacted service delivery at ADCs. Guided by the Resiliency Activation Framework, we (a) identified consequences resulting from closures of ADCs during the COVID-19 pandemic and (b) described factors that have enabled the ADC community to remain resilient in the wake of challenges brought on by the pandemic. We conducted 2 focus groups in California (n = 12), and individual interviews with ADC staff members (n = 8) in 7 other states. The results of a directed content analysis revealed perceived declines in physical, cognitive, and mental health of ADC users and increased caregiver strain. Access to human, social, economic, and political capital were essential for supporting ADCs in buffering the impacts of the pandemic on the older adults they serve but were not consistently available. Research is urgently needed that quantifies the impacts of the pandemic on ADC users and their caregivers to inform policy and advocacy efforts in the wake of the pandemic. [ABSTRACT FROM AUTHOR]

Latino immigrant families in the child welfare system are more likely than their U.S. born peers to experience barriers to the supportive services their families need. These clients must engage with their social workers to overcome obstacles including communicative challenges, cultural differences, limited Spanish language referral services, ineligibility for public programs, and fear of government authorities. This study used interviews with Spanish speaking clients and social workers in one child welfare agency to examine clients' and workers' perceptions of their relationships and the barriers and facilitators of their work together. Our findings suggest that child welfare agencies might better support Spanish speaking clients and workers by adopting strategies to strengthen workers' cultural competency, to reduce barriers to referral services, and to provide appropriate supervision to Spanish speaking workers. These institutional supports are needed to support client-worker engagement and enhance service delivery for Latino immigrant families. [ABSTRACT FROM AUTHOR]

The effect of an HIV diagnosis on subsequent behavior of men who have sex with men (MSM) remains unclear. From 2009 to 2012 the NIDA funded Metromates Study enrolled and followed for one year MSM seeking testing for HIV in Los Angeles, assessing those with new HIV diagnoses for acute/recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 321 men of whom 125 were classified as recently HIV infected, 91 as not recently HIV infected, and 105 as HIV-negative. Differences over time between those with recent HIV infection, not recent HIV infection, and no HIV were evaluated using bivariate and multivariable analyses for repeat measures to assess associations between HIV group, behaviors and condomless receptive (CRAI), intersertive (CIAI), or any condomless anal intercourse (CAI). Participants were mostly young (59% < 30 years of age) and minority. Median number of partners reported in past year dropped significantly over time among recently infected MSM (10 to 5) and HIV negative men (5 to 3) but not for not recently HIV infected. No changes comparing baseline to follow-up were noted in reports of CAI within each HIV-group. Based on GEE multivariable analyses adjusting for age, and race/ethnicity after HIV testing recently HIV infected and not recently HIV infected men practiced more CAI within serodiscordant partnerships than HIV negative MSM: more CRAI than the HIV negatives (AOR = 4.90; 95% CI 1.80-13.29 and AOR = 5.01; 95% CI 1.77-14.16 among recently infected and not recently infected, respectively) but only more CIAI among not recently infected (AOR 3.48; 95% CI 1.31-9.24) when compared to HIV negatives. For MSM seeking HIV testing in Los Angeles at that time, there was little indication of behavior change following HIV diagnosis and continued CAI, suggesting that without rapid linkage to care and viral suppression significant transmissions may have been ongoing. [ABSTRACT FROM AUTHOR]

This study explored perceptions of community informants on socioenvironmental factors that explain why rates of child maltreatment reporting are different in neighborhoods with similar population characteristics. This study used data from the SoCal Neighborhoods and Child Welfare study, a multiphase, mixed-methods study of neighborhoods in Los Angeles and San Diego counties. Semistructured qualitative interviews with key informants ( N = 28) in 22 census tracts explored factors that account for differences in maltreatment rates among sociodemographically similar neighborhoods. Thematic content analysis revealed three themes regarding neighborhood contributors to maltreatment behaviors and reporting: (a) community norms and values, (b) community resources and providers, and (c) housing dynamics and built environment. Findings indicate complexity in forces that affect maltreatment behavior and reporting. Adding to research on neighborhood social dynamics and child maltreatment, findings suggest that composite indicators of maltreatment within neighborhoods are affected by maltreatment behaviors and the definition, recognition, and reporting of maltreatment. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Schools can address critical sexual and reproductive health (SRH) issues among youth. However, little is known about SRH education being implemented in charter schools. Thus, our purpose was to explore implementation of SRH education in charter schools. METHODS Using purposive sampling, semistructured telephone interviews were conducted with 20 charter school principals in San Diego County, California. Questions were guided by the Kaiser Family Foundation National Survey of Public Secondary School Principals. Analyses followed a case-oriented approach, examining aspects within each case (ie, a principal), and then a comparative analysis of a small number of cases (ie, all principals). RESULTS Overall, 17 principals acknowledged offering sexuality education in the previous 2 years. Over half of these schools had provided content on: sexually transmitted diseases/human immunodeficiency virus/acquired immune deficiency syndrome (STDs/HIV/AIDS), reproduction/pregnancy/birth, pregnancy prevention methods, delaying sex, and managing sexual pressure. Condom use, sexual assault, sexual orientation, talking with partners about STD/pregnancy prevention, talking with parents about relationships/sex, and using/where to get contraception were less commonly taught. Abortion was not addressed. When asked the grade they would assign to their schools' sexuality/HIV instruction, principals assigned 1 A, 7 Bs, 7 Cs, and 1 D. CONCLUSIONS Consistency between our findings and what has been reported elsewhere varies. As charter schools often have greater curricular flexibility than traditional schools, this study provides unique preliminary data to inform future innovative, or strengthen existing, SRH programming. [ABSTRACT FROM AUTHOR]

Spirituality is important to holistic health, yet little is known about its impact on young people with HIV. To address this knowledge deficit, a grounded theory study used semi-structured interviews of 20 Christian-identified adolescent and emerging adult gay males and one perinatally infected male. This study revealed that, to cope with HIV health issues, participants used a process of reconnecting with their spirituality. In order to successfully reconnect with their spirituality, study participants reported a need to re-embrace and re-engage in spiritual practices, hold onto hope, believe they are normal, and commit to beliefs and practices despite rejection from the church. [ABSTRACT FROM AUTHOR]

Objectives:The current practice of prescribing psychotropic medication for the management of dementia-related behavioral disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. We hypothesized that caregiving burden and patient characteristics, particularly behavior disturbances and pain, would be positively associated with psychotropic medication use. Methods:Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N= 598). Caregiver characteristics, such as confidence managing problematic behaviors, and care recipient characteristics including pain, problem behaviors, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. Results:Contrary to our hypothesis, behavioral disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. Conclusion:These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community. [ABSTRACT FROM AUTHOR]

Aims To determine the prevalence of depression and diabetes distress in adults with Type 1 diabetes and the rate of false-positives when compared with rates of major depressive disorder. Methods The sample consisted of 368 individuals with Type 1 diabetes, aged > 19 years. Individuals completed: the eight-item Patient Health Questionnaire depression scale (PHQ8), which was coded using four scoring criteria (scores > 10, >12 and >15, and Diagnostic and Statistical Manual of Mental Disorders 5 ( DSM) algorithm scores); the Type 1 Diabetes Distress Scale; and the Structured Clinical Interview for DSM Disorders (SCID) to assess major depressive disorder. Results The prevalence rates of depression according to the eight-item Patient Health Questionnaire were: score >10, 11.4%; score >12, 7.1%; score >15, 3.8%; and positive algorithm result, 4.6%. The prevalence of major depressive disorder was 3.5%; and the prevalence of at least moderate diabetes distress was 42.1%. Depending on the criterion used, the false-positive rate when using the Patient Health Questionnaire compared with the results when using the SCID varied from 52 to 71%. Of those classified as depressed on the PHQ-8 or Structured Clinical Interview for DSM Disorders, between 92.3 and 96.2% also reported elevated diabetes distress. No significant association was found between any group classed as having depression according to the PHQ8 or the SCID and HbA1c concentration. Depression was significantly associated with more other life stress, more complications and a lower level of education. Conclusions We found an unexpectedly low rate of current depression and major depressive disorder in this diverse sample of adults with Type 1 diabetes, and a very high rate of false-positive results using the Patient Health Questionnaire. Considering the high prevalence of diabetes distress, much of what has been considered depression in adults with Type 1 diabetes may be attributed to the emotional distress associated with managing a demanding chronic disease and other life stressors and not necessarily to underlying psychopathology. [ABSTRACT FROM AUTHOR]

This study explored low-income older adults' willingness to (i) complete advance directives, legal documents, whereby an individual designates decision-makers in the event that they cannot make their own decisions about end-of-life treatment preferences, and (ii) the role of social support and other predictors that impact their willingness. This study was conducted as part of a larger study exploring behaviours of advance care planning among low-income older adults. Out of a total of 255 participants from the original study, this study included 204 participants who did not complete an advance directive for data analysis. A cross-sectional study using probability random sampling stratified by ethnicity was used. Older adults residing in two supportive housing facilities or who were members of a senior centre in San Diego, California, USA, were interviewed in person between December 2010 and April 2011. Hierarchical logistic regression analysis revealed that the majority of participants (72.1%) were willing to complete advance directives and the factors significantly predicting willingness to complete included self-rated health, attitudes towards advance decision-making and social support. Participants with a poorer health status ( OR = 1.43, 95% CI = 1.07-1.90) were more willing to complete advance directives. Conversely, participants with higher positive attitudes ( OR = 1.18, 95% CI = 1.00-1.39) and greater social support ( OR = 1.07, 95% CI = 1.00-1.15) were also more willing to complete advance directives. The findings suggest the importance of ongoing support from healthcare professionals in end-of-life care planning. Healthcare professionals can be a source of support assisting older adults in planning end-of-life care. Initiating ongoing communication regarding personal value and preference for end-of-life care, providing relevant information and evaluating willingness to complete as well as assisting in the actual completion of advance directives will be necessary. [ABSTRACT FROM AUTHOR]

Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient–provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n = 27) from four geographically diverse HIV and community care clinics in the US that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda setting prior to a visit; and reduction of social desirability bias in patient–provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are (1) tailored to be the most clinically relevant to their population; (2) well integrated into clinic flow; and (3) easy to interpret, highlighting chief patient concerns and changes over time. [ABSTRACT FROM AUTHOR]

Rapid proliferation of smartphone ownership and use among Latinos offers a unique opportunity to employ innovative visually enhanced low-text (VELT) mobile health applications (mHealth app) to promote health behavior change for Latinos at risk for lifestyle-related diseases. Using focus groups and in-depth interviews with 16 promotores and 5 health care providers recruited from California clinics, this qualitative study explored perceptions of visuals for a VELT mHealth app promoting physical activity (PA) and limiting sedentary behavior (SB) for Latinos. In this Phase 1 study, participants endorsed visuals portraying PA guidelines and recommended visuals depicting family and socially oriented PA. Overall, participants supported a VELT mHealth app as an alternative to text-based education. Findings will inform the future Phase 2 study development of a culturally appropriate VELT mHealth app to promote PA for Latinos, improve health literacy, and provide an alternative to traditional clinic text-based health education materials. [ABSTRACT FROM AUTHOR]

For social workers striving for cultural competency and strength-based approaches with refugees resettled in the West, attention to the role of religion and faith as potential resources is particularly vital. With rising numbers of refugees fleeing from Islamic societies to Western host countries over the past two decades, social work research has articulated Islam as a source of strength and group solidarity, as well as the trigger for anti-Islam bias and discrimination. However, Muslims are not a monolithic group. This article reports on a qualitative study with fourteen Muslims seeking US asylum due to persecution based upon their gender role non-conforming behaviours. Findings suggest that, for persons in this category, relationships to religion and faith may be complex, and potentially traumatic. Creating opportunities for gender role non-conforming refugees from Islamic societies to discuss religion and spirituality, with appropriate psychological support and without judgements from co-ethnic others or service providers, is an important clinical intervention for social workers to consider. [ABSTRACT FROM AUTHOR]

According to recent estimates, over 1 million Operation Iraqi Freedom/Operation Enduring Freedom Veterans are utilizing the post-9/11 GI Bill to pursue higher education. Data collected by the Department of Defense suggests that greater than 17% of returning Veterans may experience mental and physical health disorders, which can negatively affect school performance. The current study explored student Veterans' perceived facilitators and barriers to achieving academic goals. Thirty-one student Veterans completed self-report measures and interviews. Results suggested that Veterans who were reporting problems or symptoms in one mental or physical health domain were likely to be reporting symptoms or problems in others as well. The interview data were coded, and three overarching themes related to barriers and facilitators emerged: person features (e.g., discipline and determination, symptoms and stressors), institutional structure (i.e., what schools and the Department of Veterans Affairs do that was perceived to help or hinder student Veteran success), and policy concerns (i.e., how the structure of the GI Bill affects student Veteran school experience). Results from this research indicate the need for larger studies and program development efforts aimed at enhancing academic outcomes for Veterans. [ABSTRACT FROM AUTHOR]

This article presents the qualitative results of semi-structured interviews with five established couples where one individual was diagnosed with early stage Alzheimer’s disease (AD). The interviews were designed to explore the effects of the initial diagnosis, the felt experience of the disease by both members of the couple, and the resulting impact on the couple’s dynamics. The aim of the study was to discover the issues unique to this situation, what successful management strategies these couples may have found, and thus to inform the future provision of couples therapies where AD is present. The primary findings support results found in other recent studies of couples encountering AD with some additional insights: (a) The actual diagnosis was very difficult to hear. An unexpected finding in this study was that the way the diagnosis was delivered was often more traumatic than the diagnosis itself. (b) All couples reported challenging issues of increasing dependency and marked changes in the balance of independent action for each partner versus shared responsibilities. In addition, couples shared their individual experiences of anger as a response to unfulfilled performance expectations, both by the AD patient and the well spouse. (c) This small study group saw travel, a common activity for older people, as maintaining “couplehood” in addition to its other benefits. [ABSTRACT FROM PUBLISHER]

We present findings from two exploratory studies of San Francisco Bay Area women involved in illicit drug sales who saw both advantages and disadvantages to being women in traditionally male-dominated drug economies. We interviewed 160 sellers of street drugs and 50 sellers of prescription drugs during 2006-2009. Women perceived gender as a cover and managed their vulnerabilities by performing gendered actions and at times going against traditional gender expectations to protect themselves in harsh drug markets. The intersecting factors of race and type of drug sold played a crucial role, revealing the complex nature of women's social location in their drug-selling worlds. Study limitations are noted. [ABSTRACT FROM AUTHOR]

The present study evaluated the ability of males with fragile X syndrome (FXS), nonsyndromic autism spectrum disorder (ASD), or typical development to learn new words by using as a cue to the intended referent an emotional reaction indicating a successful (excitement) or unsuccessful (disappointment) search for a novel object. Performance for all groups exceeded chance-levels in both search conditions. In the Successful Search condition, participants with nonsyndromic ASD performed similarly to participants with FXS after controlling for severity of ASD. In the Unsuccessful Search condition, participants with FXS performed significantly worse than participants with nonsyndromic ASD, after controlling for severity of ASD. Predictors of performance in both search conditions differed between the three groups. Theoretical and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives. Health care decision makers require public input to incorporate diverse values into programs and policies. Deliberation, one method for obtaining input, seeks to apply inclusive principles wherein diverse groups provide perspectives to inform decisions. We evaluate whether participants of different racial, ethnic, and educational backgrounds show differences in the effect of deliberation and the value placed on deliberation participation. Methods. We surveyed 907 participants before and after deliberation. Regression models examined associations between demographics and change in knowledge and attitudes, and perceived impact. Results. Changes in knowledge about using medical evidence in decisionmaking were not associated with race, ethnicity, or education. Changes in attitudes were not associated with these characteristics with one exception. African American, Hispanic, and participants with lower educational attainment reported more perceived impact. Conclusion. Similar results across demographic groups suggest deliberations promise for obtaining input from a diverse public to inform health programs and policies. [ABSTRACT FROM AUTHOR]

A multi-site study was conducted to assess HPV vaccine initiation and correlates of initiation among Latina adolescents. The study was a collaboration of the CDC/NCI-funded Cancer Prevention and Control Research Network. Data were collected in 2009 from caregivers of Latina adolescents recruited from Los Angeles Country (n = 274), Washington State (Yakima Valley region; n = 90), and Texas (Houston, n = 38; Lower Rio Grande Valley, n = 42). A set of 24 survey items assessed use of the HPV vaccine and awareness, attitudes and barriers to vaccination. Moderate levels of vaccine awareness among caregivers and low uptake of the vaccine (26-37 %) among girls were observed. Attitudinal barriers such as concerns about negative effects of the vaccine on daughter's sexual behavior, fertility, and future health were infrequently endorsed. Efforts to understand regional similarities and differences may help inform interventions. [ABSTRACT FROM AUTHOR]

Few studies have examined the role of religion and spirituality among African American breast cancer patients. This study explored how African American women cope with breast cancer through religious and spiritual practices. Forty-seven African American women who had completed treatment for breast cancer participated in in-depth interviews about their experiences. The majority of the women mentioned using both individual and communal religious and spiritual practices to cope with their breast cancer diagnosis and treatment. The main themes that emerged in terms of the types of religious and spiritual practices included: (1) attendance at religious services, (2) comfort through prayers of others, and (3) encouragement through reading Biblical scriptures. These practices helped women 'trust in the Lord' throughout the many challenges of cancer from diagnosis through survivorship. Although this study is exploratory, the findings illustrate how African American women with breast cancer use religious and spiritual practices to cope with their diagnosis and treatment. For clinicians, the findings provides an understanding of spiritual and religious needs in diverse populations and the importance of referring patients onto spiritual and religious resources and support. [ABSTRACT FROM AUTHOR]

Latino migrant day laborers (LMDLs) live under challenging conditions in the San Francisco Bay Area. This study explored day laborer alcohol use guided by a structural vulnerability framework, specifically problem vs. non-problem drinking as perceived by LMDLs and how they cope with or try to avoid problem drinking given their broader environment. The study utilized ethnographic methods including in-depth semi-structured qualitative interviews with 51 LMDLs. Findings revealed the considerable challenge of avoiding problem drinking given socio-environmental factors that influence drinking: impoverished living and working conditions, prolonged separation from home and family, lack of work authorization, consequent distress and negative mood states, and peer pressure to drink. While participants shared strategies to avoid problem drinking, the success of individual-level efforts is limited given the harsh structural environmental factors that define day laborers' daily lives. Discussed are implications for prevention and intervention strategies at the individual, community, national and international levels. [ABSTRACT FROM AUTHOR]

Introduction. Racial/ethnic minority older adults in low-income status might be at a greater risk than others of developing chronic illness. We sought to examine the effects of race/ethnicity on end-of-life (EOL) treatment preference among low-income older adults. Methods. A cross-sectional study surveyed 256 low-income older adults (90 Whites, 82 Hispanics, 84 Blacks) in a California city. Results. Hierarchical multiple regression results showed that participants with greater religiosity (p < .01) or more frequent doctors' visits (p < .05) had greater preference for life-sustaining treatments during the final phase of life. Conversely, those with greater comfort about death (p < .01) or a belief that life and death are predestined (p < .05) preferred life-sustaining treatments less often. Race/ethnicity had no significant relationship with EOL treatment preference after accounting for other factors. Conclusion. Race/ethnicity encompasses multiple life contexts. Understanding the influences of both cultural beliefs and individual circumstances on EOL treatment preference is imperative. [ABSTRACT FROM AUTHOR]

Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic-community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization. [ABSTRACT FROM AUTHOR]

While anger is a common problem for veterans returning from wars in Afghanistan and Iraq, veterans' understanding of the causes, course, and consequences of anger has not been explored. We conducted this qualitative study to learn veterans' perspectives about their anger problems. We identify and describe three distinct patterns of anger problems that emerged as a consequence of (a) loss of structure during reintegration to civilian life, (b) moral injury sustained through a wartime experience, and (c) posttraumatic stress disorder (PTSD). While anger problems tended to be short lived for those experiencing loss of structure, problems persisted for years for those with moral injury or PTSD. Anger following all three patterns negatively impacted veterans' experiences with reintegration. We discuss the implications of these findings. [ABSTRACT FROM PUBLISHER]

Previous research documents that street-involved youth experience rates of trauma and posttraumatic stress disorder (PTSD) that are significantly higher than their housed counterparts. Trauma and PTSD are of particular concern for homeless youth as they can negatively affect youths’ ability to function adaptively and to transition off the streets. This mixed-methods study investigates the intricacies of trauma experienced by homeless youth across three U.S. cities. Qualitative interviews were conducted with a sample of 145 homeless youth in Los Angeles (n = 50), Denver (n = 50), and Austin (n = 45) to explore youths’ perspectives on the definition of trauma and the contexts associated with victimization. Quantitative standardized assessments investigated youths’ trauma experiences before and after becoming homeless. Trauma screening identified high rates of trauma incidents (78%), with 28% of participants meeting criteria for PTSD. Participants reported various traumatic experiences that occurred before leaving home and while on the streets, and high rates of polyvictimization. Qualitative themes describe particular people and places most vulnerable on the streets. Implications for services to prevent and treat trauma among homeless youth are discussed. [ABSTRACT FROM AUTHOR]

Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers, reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care, warranting further study and policy support. [ABSTRACT FROM AUTHOR]

Researchers have become increasingly interested in the link between spirituality and the use and misuse of drugs as well as intervention. First, studies have pointed to spirituality and religious involvement as a protective factor against substance use. Second, the quest for spirituality can play a role in drug use. This article has two aims. First, it seeks to examine the features of spirituality connected with both recovery from drug misuse and psychoactive drug use. Second, it seeks to understand the latter in the context of contemporary youth culture. We draw from our comparative study on club drug use among young people in two cultural locales-San Francisco and Hong Kong, where two different drugs, ecstasy and ketamine, have become associated in different dance party settings with a spiritual awakening of self-awareness and liberation. [ABSTRACT FROM AUTHOR]

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10-13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families' needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child's therapist. Parents' report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth's treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research. [ABSTRACT FROM AUTHOR]

Homeless youth have elevated risk of HIV through sexual behavior. This project investigates the multiple levels of influence on unprotected sex among homeless youth, including social network, individual, and partner level influences. Findings are based on analyses of an exploratory, semi-structured interview ( n = 40) and a structured personal network interview ( n = 240) with randomly selected homeless youth in Los Angeles. Previous social network studies of risky sex by homeless youth have collected limited social network data from non-random samples and have not distinguished sex partner influences from other network influences. The present analyses have identified significant associations with unprotected sex at multiple levels, including individual, partner, and, to a lesser extent, the social network. Analyses also distinguished between youth who did or did not want to use condoms when they had unprotected sex. Implications for social network based HIV risk interventions with homeless youth are discussed. [ABSTRACT FROM AUTHOR]

Latino immigrant day laborers, also termed jornaleros or contingent workers , compose a significant segment of the millions of undocumented, temporary workers in our urban centers. These laborers largely work without benefit of health insurance in occupations that are unmonitored, unprotected, and often unsafe. This study utilized semi-structured interviews to explore the perceived health status and resources for health care in one group of 20 Latino day laborers in southern California. Results suggest a population that is largely in undocumented immigrant status with few health care resources other than emergency care centers and clinics provided for the homeless population. With close to 12 million undocumented workers currently residing in the US, this population bears additional scrutiny both for humanitarian reasons and for public health policy considerations. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 698-710 Context Traditional block clerkship (BC) structures may not optimally support medical student participation in the workplace, whereas longitudinal integrated clerkship (LIC) structures seem more conducive to students' active engagement in patient care over time. Understanding the ways in which these two clerkship models influence students' roles and responsibilities can inform clinical learning programme design. Methods This was a multicentre qualitative study. We conducted semi-structured interviews with LIC and BC medical students at three institutions early and late in the core clinical year to explore their experiences with patients and the roles they served. Using the framework of 'workplace affordances', qualitative coding focused on students' roles and qualities of the learning environment that invited or inhibited student participation. We compared transcripts of early- and late-year interviews to assess students' changing roles and conducted discrepant case analysis to ensure that coding fit the data. Results Fifty-four students participated in interviews. They described serving three major roles in clinical care that respectively involved: providing support to patients; sharing information about patients across health care settings, and functioning in a doctor-like role. Both LIC and BC students served in the providing support and transmitting information roles both early and late in the year. By contrast, LIC students commonly served in the doctor-like role in managing their patients' care, particularly late in the year, whereas BC students rarely served in this role. Continuity in settings and in supervisors, and preceptors' endorsement of students' legitimate role afforded opportunities for students to participate actively in patient care. Conclusions Although both LIC and BC students reported serving in important roles in supporting their patients and sharing information about their care, only LIC students consistently described opportunities to grow into a doctor role with patients. The high level of integration of LIC students into care systems and their deeper relationships with preceptors and patients enhanced their motivation and feelings of competence to provide patient-centred care. [ABSTRACT FROM AUTHOR]

This study investigates whether self-reported racial discrimination is related to poor health-related quality of life (HRQoL). Analyses focused on Whites (n = 52,571), Blacks (n = 4,343), Mexicans (n = 12,336), Central Americans (n = 1,504), Multi-ethnic Latinos (n = 1,102), and Other Latinos (n = 1,828) who participated in the 2003 and 2005 California Health Interview survey. Logistic and negative binomial regression was used to examine the association between HRQoL (assessed with the CDC unhealthy days measures) and self-reported racial discrimination. Discrimination was reported by 10% of Whites, 57% of Blacks, and 24-31% of the Latino groups. These reports were associated with increased number of unhealthy days, disability days, and poor self-rated health, even after, controlling for education and other factors. This association did not consistently vary by race/ethnicity. Racial discrimination may be a risk factor for poor HRQoL among diverse groups. Future research should examine the factors that may reduce potential exposure to racial discrimination. [ABSTRACT FROM AUTHOR]

The present study examined the relationship between religiosity/spirituality and treatment response to antidepressant medication (citalopram). One-hundred and forty-eight Caucasian and African-American adults with uncomplicated major depression were treated with citalopram (20-60 mg/day) over an eight-week period in a prospective multi-site clinical trial. Treatment response was assessed weekly with the Hamilton Rating Scale for Depression. Religiosity (i.e., religious behaviours) and spirituality (i.e., spiritual well-being) were assessed at week 3. No significant associations between spirituality and treatment response were found; however, there was a strong curvilinear relationship between religiosity and treatment response. Compared to lower or higher levels of religiosity, a moderate level of religiosity was significantly associated with a higher likelihood of remission and greater reduction in severity of depression. This association was independent of social support, ethnicity, gender, education, and baseline depression severity. A moderate amount of religiosity appears to be independently associated with an enhanced treatment response to citalopram. [ABSTRACT FROM AUTHOR]

Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care ( n=100) with a reference population of HIV-positive persons currently in care ( n=115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [AOR]=0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR=0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR=0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR=0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR=0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR=3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations. [ABSTRACT FROM AUTHOR]

Although Synanon has been extensively studied, attention has seldom been paid to the question of how the many ex-members who left Synanon before or at its dissolution 'survived' their community and indoctrination, and how they now evaluate their involvement. This article explores how ex-members react to their previous affiliation to Synanon, the cradle of the therapeutic community (TC) for addiction. A series of critical incidents, following Synanon's public proclamation restyling itself as a religion, which led to the dismantlement of Synanon, are highlighted and contrasted with the achievements of the movement. For this research study, we used a social constructivist methodology. Following qualitative snowball targeted sampling, open interviews and text analysis, 14 statements, representing the main reactions, were retained. These served as the basis for a web-based survey. It was found that ex-Synanon members still believe in the positive realizations of their experience. On the other hand, they are not blind to the negative aspects of this time but tend to deny, or perhaps do not know, that the proclamation to become a religion was in fact initiated by the inner circle and that this was the start of the dismantling of the organization's value system and the introduction of strange and inappropriate behaviour. The article emphazises the potential powerful and long-lasting effects of 'community as method' as a means of indoctrination of values. It endorses the opinion that the drug-free concept-based TC operates within the framework of an effective belief system that encourages and reinforces behavioural change. It is therefore critically important to ensure that present-day TCs remain open to the views and expectations of society. [ABSTRACT FROM AUTHOR]

Participation of different community sectors, including the private business sector, is necessary to fight the HIV/AIDS epidemic. Local businesses may be reluctant to participate in HIV prevention because of fear of negative customer reactions and loss of revenue. This study examines the extent to which residents of two communities in San Diego, California, would support HIV prevention initiatives in local businesses. A population-based household survey (N = 200) is conducted in two communities with higher versus lower risk for HIV. The survey includes questions regarding the acceptability of HIV prevention activities, such as condom and brochure distribution in businesses, and history of exposure to HIV prevention activities in local businesses. Most residents agree that (a) business involvement in prevention activities would reduce HIV (92%), (b) free or low-cost condoms available in businesses could prevent the spread of HIV (90.9%) and increase condom accessibility (87%), and (c) they would prefer to shop at businesses that supported HIV prevention versus those that did not (87.4%). These findings suggest that HIV prevention in local businesses would be supported by residents and would be unlikely to adversely affect business profits. This information could be used to design interventions to engage local businesses in HIV-prevention efforts. [ABSTRACT FROM PUBLISHER]

The study examines the relationship between adolescent geographic access (distance, travel time, density) to Family Planning Clinics and adolescent sexual behaviors, including sexual initiation, number of partners and condom use. This cross-sectional study, conducted in 2005 in 10 California counties, utilized data from NICHD-funded study on adolescent sexual behavior ( n = 921), geospatial coordinates of publicly-funded FPCs, and neighborhood characteristics. A series of regression models were used to assess the relationship between FPC distance, and density (number of FPCs within 1- and 3- mile radii of each adolescent's home), and adolescent sexual behaviors. Significant main effects between access measures of FPC and sexual behavior did not emerge. However, among older youth a significant inverse relationship emerged between number of FPCs within a 1-mile radius and initiating sexual intercourse. While not significant at α = .10, the results also indicate a negative relationship between density of FPCs and sexual partners ( b = −.22, p < .15) among older youth. Access to FPCs was not associated with condom use. Conclusions: Results suggest that increased options for family planning services may lead to less risky sexual behaviors among older youth. This finding has significant implications with regards to making family planning resources more readily available to older adolescents. [ABSTRACT FROM AUTHOR]

Pregnant women who use drugs are more likely to receive little or no prenatal care. This study sought to understand how drug use and factors associated with drug use influence women's prenatal care use. A total of 20 semi-structured interviews and 2 focus groups were conducted with a racially/ethnically diverse sample of low-income women using alcohol and drugs in a California county. Women using drugs attend and avoid prenatal care for reasons not connected to their drug use: concern for the health of their baby, social support, and extrinsic barriers such as health insurance and transportation. Drug use itself is a barrier for a few women. In addition to drug use, women experience multiple simultaneous risk factors. Both the drug use and the multiple simultaneous risk factors make resolving extrinsic barriers more difficult. Women also fear the effects of drug use on their baby's health and fear being reported to Child Protective Services, each of which influence women's prenatal care use. Increasing the number of pregnant women who use drugs who receive prenatal care requires systems-level rather than only individual-level changes. These changes require a paradigm shift to viewing drug use in context of the person and society and acceptance of responsibility for unintended consequences of public health bureaucratic procedures and messages about effects of drug use during pregnancy. [ABSTRACT FROM AUTHOR]

Latinos in the United States are an ethnically diverse group disproportionately affected by HIV/AIDS. We describe HIV seroprevalence, HIV risk behaviors and utilization of health services among Mexican American injection drug users (IDUs) in California ( n = 286) and compare them to White ( n = 830) and African American ( n = 314) IDUs. Study participants were recruited from syringe exchange programs ( n = 24) in California. HIV seroprevalence among Mexican Americans (0.5%) was dramatically lower than Whites (5%) and African Americans (8%). Mexican Americans reported fewer sex-related risks than Whites and African Americans though injection-related risks remained high. Compared to Whites, Mexican Americans were more likely to participate in drug treatment during a 6 month period (AOR 1.5, 95% CI 1.1, 2.0) but less likely to receive any health care (AOR 0.6, 95% CI 0.5, 0.8). Exploring cultural and structural factors among Mexican American IDUs may offer new insights into how to maintain low rates of HIV seroprevalence and reduce barriers to health care utilization. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) testing is increasingly being used to determine the optimal cervical cancer screening interval in older women. Little is known about women's attitudes toward HPV testing or how these attitudes may influence medical discussions about cervical cancer screening.Methods: Preferences for HPV and concomitant Papanicolaou (Pap) testing were assessed through in-person interviews with diverse women aged 50 to 80 years recruited from community and university-based practices.Results: Eight hundred and sixty-five women (257 White, 87 African American, 149 Latina, and 372 Asian) were interviewed. Approximately 60% of participants wanted to be tested for HPV and another 15% would undergo testing if recommended by their physician. Among those wanting HPV testing, 94% would want more frequent than annual Pap tests if they had a positive HPV test and a normal Pap test. Two thirds of those under age 65 would be willing to switch to triennial Pap testing, and half of those aged 65 and older would be willing to discontinue Pap testing, if they had a negative HPV test and normal Pap test. Preferences for testing varied by ethnicity, age, place of birth, and cancer history.Conclusions: The majority of older women were willing to use HPV testing to make decisions about frequency and duration of cervical cancer screening, but up to one third would want at least annual, ongoing screening regardless of HPV test results. Efforts should be made to ensure that HPV testing is used to reinforce appropriate utilization of screening tests. [ABSTRACT FROM AUTHOR]

Much recent research on sexual minorities has used couples-based samples, which--by construction--provide no information on nonpartnered individuals. We present the first systematic empirical analysis of partnership and cohabitation among self-identified gay men and lesbians using two independent, large, population-wwbased data sources from California. These data indicate that 37%-46% of gay men and 51%-62% of lesbians aged 18-59 are in cohabiting partnerships (compared with 62% of heterosexual individuals in coresidential unions at comparable ages). Unlike previous research, we find that white and highly educated gay men and lesbians are more likely to be partnered, and we confirm that same-sex cohabiting partners in our data have demographic characteristics that are similar to California same-sex couples from Census 2000. We also present the first detailed analysis of officially registered domestic partnerships in California. We find that almost half of partnered lesbians are officially registered with the local or state government, while less than a quarter of partnered gay men are officially registered. We conclude with implications of our findings for couples-based research on gay men and lesbians, as well as recommendations for survey data collection. [ABSTRACT FROM AUTHOR]

Background: Language and culture relate in complex ways. Addressing this complexity in the context of language translation is a challenge when caring for patients with limited English proficiency (LEP).Objective: To examine processes of care related to language, culture and translation in an LEP population is the objective of this study.Design: We used community based participatory research to examine the experiences of Russian-speaking cancer patients in San Francisco, California. A Russian Cancer Information Taskforce (RCIT), including community-based organizations, local government, and clinics, participated in all phases of the study.Participants: A purposeful sample of 74 individuals were the participants of the study.Approach: The RCIT shaped research themes and facilitated access to participants. Methods were focus groups, individual interviews, and participant observation. RCIT reviewed data and provided guidance in interpreting results.Results: Four themes emerged. (1) Local Russian-language resources were seen as inadequate and relatively unavailable compared to other non-English languages; (2) a taboo about the word "cancer" led to language "games" surrounding disclosure; (3) this taboo, and other dynamics of care, reflected expectations that Russian speakers derived from experiences in their countries of origin; (4) using interpreters as cultural brokers or establishing support groups for Russian speakers could help address barriers.Conclusions: The language barriers experienced by this LEP population reflect cultural and linguistic issues. Providers should consider partnering with trained interpreters to address the intertwining of language and culture. [ABSTRACT FROM AUTHOR]