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Objective The aim of the present work was to examine adult smokers' awareness of and receptivity to an electronic nicotine delivery system (ENDS) television advert, and whether viewing the advert influenced urge to smoke and intention to try ENDS. Methods A television advert for ENDS brand blu eCigs was shown to an online convenience sample of 519 Florida adult smokers. We measured current smokers' awareness of and receptivity to the advert, and whether seeing the advert influenced their thoughts about smoking or quitting, urge to smoke and intention to try ENDS. Results were stratified by prior ENDS use. Results Approximately 62.3% of current smokers were aware of the advert. Smokers found the advert informative (73.8%), attention grabbing (67.5%) and innovative (64.5%), with prior ENDS users rating the advert more favourably than non-users. Seeing the advert elicited an urge to smoke (mean 42.1, SD=1.9) and thoughts about smoking cigarettes (75.8%) as well as quitting (74.6%). Prior END users were significantly more likely than non-users to report thinking about smoking cigarettes after seeing the advert (P<0.05). Most smokers said ENDS were ‘made for people like them' (88.6%) and they would try ENDS in the future (66.0%). Conclusions Smokers are receptive to ENDS television adverts and report intention to try ENDS after viewing the advert. Future studies should monitor ENDS advertising and examine how exposure to ENDS adverts influences smokers' use of ENDS, dual use with cigarettes and cessation behaviour. [ABSTRACT FROM AUTHOR]

Purpose Although tablet computers offer advantages in data collection over traditional paper-and-pencil methods, little research has examined whether the 2 formats yield similar responses, especially with underserved populations. We compared the 2 survey formats and tested whether participants' responses to common health questionnaires or perceptions of usability differed by survey format. We also tested whether we could replicate established paper-and-pencil findings via tablet computer. Methods We recruited a sample of low-income community members living in the rural southern United States. Participants were 170 residents (black = 49%; white = 36%; other races and missing data = 15%) drawn from 2 counties meeting Florida's state statutory definition of rural with 100 persons or fewer per square mile. We randomly assigned participants to complete scales (Center for Epidemiologic Studies Depression Inventory and Regulatory Focus Questionnaire) along with survey format usability ratings via paper-and-pencil or tablet computer. All participants rated a series of previously validated posters using a tablet computer. Finally, participants completed comparisons of the survey formats and reported survey format preferences. Findings Participants preferred using the tablet computer and showed no significant differences between formats in mean responses, scale reliabilities, or in participants' usability ratings. Conclusions Overall, participants reported similar scales responses and usability ratings between formats. However, participants reported both preferring and enjoying responding via tablet computer more. Collectively, these findings are among the first data to show that tablet computers represent a suitable substitute among an underrepresented rural sample for paper-and-pencil methodology in survey research. [ABSTRACT FROM AUTHOR]

Age-Friendly Health Systems (AFHS) commit to providing evidence-based, low-risk, coordinated care centered on what matters most to older adults, their families, and caregivers. Nova Southeastern University's South Florida Geriatric Workforce Enhancement Program (NSU SFGWEP) has partnered with primary care clinics to provide AFHS training and support to promote AFHS transformation in Broward and Miami-Dade Counties. NSU SFGWEP provides face-to-face and virtual training for AFHS and Electronic Health Record (EHR) documentation as part of the initiative. This project focuses on a group of primary care clinics in Broward County, Florida. In this paper, we evaluate the progress of AFHS transformation through six e-clinical measures that collectively provide indicators of the 4 M framework of AFHS (What Matters, Medication, Mentation, and Mobility). We used provider feedback and e-clinical measures aligned with the Center for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS) to measure clinic outcomes. From Jan 1– Dec 31, 2019, to Jan 1–Dec 31, 2020, the clinics improved high-risk medication management (0–3.71%), advanced care planning (6.79%–20.74%), and fall risk assessment (no data- 46.72%). Results demonstrate some success and ongoing opportunities to continue and expand AFHS interventions for sustainability. [ABSTRACT FROM AUTHOR]

Despite increased access to and improvements in contraceptives, unintended pregnancy continues to be a problem globally and is associated with adverse outcomes for mothers and infants. This paper seeks to unravel the mediators of intended versus unintended pregnancies among Black women living with HIV. The paper draws on survey data from a broader multi-country mixed methods study that used a community-based participatory research approach to investigate the psychosocial experiences of Black mothers living with HIV. The study participants were Black mothers living with HIV drawn through venue-based sampling from Ottawa, Canada (n = 89), Port Harcourt, Nigeria (n = 400), and Miami, Florida, United States (n = 201). We used Hierarchical Binary Logistic Regression Modelling (HBLM) to estimate the independent associations of pregnancy intention (intended versus unintended) with blocks of predictor variables (sociodemographic, sociocultural, and psychosocial predictors) at alpha level of 0.5. Specifically, 44.2%, 67.3%, and 17.7% of the women had unintended pregnancies in Ottawa, Miami, and Port Harcourt, respectively. There were important results from the HBLM. The odds of intended relative to unintended pregnancies were (i) reduced in larger households (OR = 0.56, 95% CI = 0.36/0.87), but increased with employment (OR = 7.84, 95% CI = 1.52/40.54) and HIV knowledge (OR = 3.13, 95% CI = 1.42/6.90) in Ottawa; (ii) reduced with age (OR = 0.93, 95% CI = 0.88/0.98), but increased with marriage (OR = 2.90, 95% CI = 1.43/5.88) and social support (pregnancy (OR = 3.77, 95% CI = 1.98/7.19) in Port Harcourt; (iii) reduced with social support (OR = 0.95, 95% CI = 0.91/1.00) but increased with HIV status disclosure (OR = 1.73, 95% CI = 1.01/2.97) and the influence of specific referent (OR = 1.68, 95% CI = 1.13/2.52) in Miami-FL. The incidence of unintended pregnancy is more prevalent among Black women living with HIV in the North American cities relative to the African city. Also, unique combinations of sociodemographic, sociocultural, and psychosocial factors influence pregnancy intention in each city. This implies that policy and practices to address reproductive health needs of WLHIV must consider these contextual issues. [ABSTRACT FROM AUTHOR]

Objectives: We investigated coronavirus disease 2019 (COVID-19) opinions, experiences, and willingness to accept COVID-19 vaccination during pregnancy at two prenatal clinics in early 2021 and early 2022. Materials and Methods: Paper questionnaires were distributed to pregnant women at prenatal care facilities in Virginia and Florida between January and April 2021 and January and April 2022. Questions regarding acceptance and opinions of the influenza vaccine served as a baseline to assess COVID-19 vaccine opinions. Associations between demographic parameters and vaccine opinions and acceptance were examined using Chi-square. A COVID-19 concern score was constructed by principal component analysis with differences between groups assessed by analysis of variance (ANOVA) and analysis of covariance (ANCOVA). Results: Many participants (40.6%) reported that the COVID pandemic had affected their pregnancy. Main themes were problems with social networks, increased stress/anxiety, and being more cautious. In 2021, 19.5% reported they would accept a COVID-19 vaccination during their pregnancy, which increased to 45.8% in 2022. Vaccine hesitancy did not vary by race or between sites, but educational attainment was significant (p < 0.001). Women with a higher concern score were more likely to report they would accept a COVID-19 vaccine. Women who would accept COVID vaccination had a positive opinion regarding the influenza vaccine. Main themes for refusing COVID-19 vaccination were concerns about side effects, lack of research/data, and mistrust of vaccines. Conclusions: The proportion of women willing to accept COVID-19 vaccination increased but remained below 50%. Willingness to accept vaccination during pregnancy was associated with higher education, higher concern about COVID-19, and a positive opinion of the influenza vaccine. [ABSTRACT FROM AUTHOR]

Latinos are more likely to delay HIV testing, present to care with an AIDS defining illness, and die within one year of learning their HIV-positive status than non-Latino blacks and whites. For this paper, we explore the role of partner-relationship characteristics and health behaviors, in predicting HIV testing among Latina adult women who engaged in risky sexual behaviors (i.e., unprotected vaginal and/or anal sex). Data from a convenience sample of 168 Latina adult women who engaged in risky sexual behavior in the year prior to assessment were analyzed for this paper. Rates and predictors of HIV testing among this sample were assessed after a five-year follow-up. Descriptive and analytical estimates include incidence rates and adjusted odds ratios (AOR) from multilevel models. At five-year follow-up, 63.7% (n = 107) women reported having been tested for HIV, of whom 12.2% (n = 13) were women who never tested before. Main reasons for not having been tested at follow-up included: low risk perception (62.1%) and trusting their partner(s)/being in a monogamous relationship/knowing their partner's HIV status (17.2%). Predictors of HIV testing included: age (AOR: 0.96; 95% CI = 0.92–0.99), provider endorsement of HIV testing (AOR: 4.59; 95% CI = 1.77–11.95), poor quality of their romantic relationships (AOR: 1.12; 95% CI = 1.03–1.26), and knowing the HIV sero-status of sexual partner (AOR: 3.61; 95% CI = 1.46–8.95). This study characterizes a group of Latina women at high risk for HIV infection and their HIV testing behaviors. Our findings underscore the need of increasing access to quality health-care services and HIV behavioral interventions, and to strengthen the adherence to HIV/sexually transmitted disease testing recommendations and guidelines among local health-care providers serving the Latino community in South Florida. [ABSTRACT FROM PUBLISHER]

Although the use of technology in the K12 classroom has been shown to have a positive impact, research on the use of open education resources (OER) is relatively limited, especially research focusing on low‐achieving students. The present study examines the relationship between usage of Algebra Nation, a self‐guided system that provided instructional videos and practice problems, and the performance of students who had failed the state‐administered Algebra I end‐of‐course (EOC) assessment the previous year. Indicators of usage of Algebra Nation consisted of logins, video views, and practice questions answered. Path analyses and logistic regressions were used to evaluate relationships between usage indicators and algebra scores, controlling for number of absences, free/reduced lunch eligibility, Hispanic/Latino origin, race, and gender. The results indicate that higher levels of logins, video views, and practice questions answered were related to higher scores when the students re‐took the assessment. Logins and practice questions were also related to increases in odds of passing the Algebra I EOC assessment, but not video views. The results suggest that there may be benefits to technology use in the form of an OER adopted by students and teachers on an informal basis and link self‐regulated learning strategies to student achievement. Lay Description: What is already known about this topic: Algebra courses typically have a high failure rate.Repeating algebra is costly for the education system and for the student.Open education resources could potentially be an effective and cost‐efficient approach to algebra instruction. What this paper adds: This study shows that logins, video views, and practice questions answered in an open education resource were positively related to scores on a state‐administered,high‐stakes algebra assessment.The study indicates that the relationship between a self‐regulated learning strategy (i.e., practice questions answered) and student algebra scores is stronger than that between video views and algebra scores.This study shows that student‐driven ad hoc use of online tutoring programme is associated with higher passing rates on the algebra exam. Implications for practice and/or policy: This study demonstrates that informal use of an open education resource with videos and a practice question system can be effective in increasing student scores on algebra assessments.Future research is needed to connect diverse types of student self‐regulated use of open education resources to academic achievement and on how to design resources that encourage effective self‐regulation. [ABSTRACT FROM AUTHOR]

Service dog programs are increasingly being explored as complementary or alternative interventions for military veterans with posttraumatic stress disorder (PTSD). This paper details the results of a control group, pre-and-post pilot investigation evaluating the use of a 14-week service dog training program for veterans in central Florida. Thirty veterans diagnosed with PTSD, 15 in the intervention group and 15 in the waitlist controlled group, completed all pretests and posttests measures, consisting of the 136-item Trauma Symptom Inventory-2 and the 36-item World Health Organization-Disability Assessment Schedule 2.0. Compared to demographically similar veterans in the control group, participants who completed the service dog training program demonstrated significant decreases in posttraumatic symptomatology, intra/interpersonal difficulties associated with psychological trauma, and in disabilities secondary to their PTSD. Study findings, in combination with results from two other recently published controlled investigations, provide evidence supporting the endorsement and use of service dog programs as helpful complementary or alternative treatment options for some veterans. Social work practitioners may want to consider referring their veteran clients with PTSD to qualified service dog programs for adjunctive support when they are having difficulty engaging with or benefiting from office-based traditional therapy approaches. [ABSTRACT FROM AUTHOR]

Abstract The purpose of the paper is to examine the effectiveness of a six-week, culturally sensitive, church-based health-promotion intervention in increasing nutrition label health literacy and health-promoting behaviors (i.e. healthy eating, healthy drinking, and physical activity) and improving weight and blood pressure among Black adults. Study participants are a sample of 321 Black adult churchgoers (N = 321) who were divided between an intervention group (N = 172) and a wait-list control group (N = 149). The health-promotion intervention program is informed by Health Self-Empowerment Theory. At post-test, the participants in the intervention group demonstrated significantly greater increases in nutrition label health literacy, overall level of engagement in health-smart behaviors, and levels of engagement in two specific health-smart behaviors (i.e. healthy eating and healthy drinking) compared with those in the wait-list control group. Implications of these findings for future similar health-promotion intervention programs and research are discussed. [ABSTRACT FROM AUTHOR]

Expert-mediated literature searching, a keystone service in biomedical librarianship, would benefit significantly from regular methodical review. This article describes the novel use of Research Electronic Data Capture (REDCap) software to create a database of literature searches conducted at a large academic health sciences library. An archive of paper search requests was entered into REDCap, and librarians now prospectively enter records for current searches. Having search data readily available allows librarians to reuse search strategies and track their workload. In aggregate, this data can help guide practice and determine priorities by identifying users’ needs, tracking librarian effort, and focusing librarians’ continuing education. [ABSTRACT FROM PUBLISHER]

Latinos/as, the fastest-growing ethnic group in the United States, experience high cancer rates. Factors contributing to treatment decisions among Latinos diagnosed with cancer must be studied. This paper aims to identify treatment decisions among Latinos with cancer and examine factors influencing these decisions. A qualitative exploratory study using semi-structured interviews of 60 Latino/as diagnosed with cancer was conducted. Close-ended responses were analyzed using percentages and frequency distributions, while open-ended responses were analyzed using open coding and thematic categorization. Surgery was the most commonly chosen treatment among participants because it was perceived as providing the highest chance of prolonging life. Only 57% of participants were provided with treatment options. Latinos/as typically prefer modest, paternalistic patient-physician relationships. Therefore, providing culturally appropriate information is valuable. This study underscores the need for health providers to present all available treatment options to enhance cancer treatment outcomes [ABSTRACT FROM AUTHOR]

This study examined the heterogeneity of literacy profiles for adolescents with and without a specific learning disability (SLD) in the U.S. state of Florida Student subgroups displaying common patterns of performance in word-level skills and reading comprehension were identified through latent profile analysis. Results indicate most of the total sample demonstrated below-average performance in one or both areas with word-level skill difficulties being more common than difficulties in reading comprehension alone. Changes in reading performance by profile over time (Grades 6–8) were examined through a latent transition analysis revealing consistent patterns in the SLD sample and variable patterns in the typically developing sample. Resulting profiles were utilized to predict performance on an end-of-year broad reading comprehension measure indicating very little change in performance over time. Findings suggest large numbers of adolescents with concurrent word-level and reading comprehension difficulties likely need sustained intervention in word-level skills to support their reading comprehension. [ABSTRACT FROM AUTHOR]

Introduction: Identifying effective strategies to enroll African American, Caribbean, and Hispanic/Latino adults ≥65 years of age in health research is a public health priority. This study aimed to explore intergenerational influence (IGI) among these populations living throughout Florida. Methods: African American, Caribbean, and Hispanic/Latino adults ≥65 years of age and a trusted family member/friend between 25–64 years participated in virtual listening sessions (LS). Culturally matched facilitators used a semi-structured guide to lead LS that was recorded, transcribed, and uploaded into NVivo©. The constant comparative method was used for analysis. Results: 363 African American, Caribbean, and Hispanic/Latino participated in LS. Five (5) themes relate to IGI emerged: (1) parent-child relationships; (2) family caregiving/parental illness experiences; (3) historical research maltreatment; (4) transfer of cultural knowledge; and (5) future generations. Discussion: Our findings support that IGI can be leveraged to increase the participation of African American, Caribbean, and Hispanic/Latino older adults in health research. [ABSTRACT FROM AUTHOR]

Background: Depression is characterized by abnormalities in emotional processing, but the specific drivers of such emotional abnormalities are unknown. Computational work indicates that both surprising outcomes (prediction errors; PEs) and outcomes (values) themselves drive emotional responses, but neither has been consistently linked to affective disturbances in depression. As a result, the computational mechanisms driving emotional abnormalities in depression remain unknown. Methods: Here, in 687 individuals, one-third of whom qualify as depressed via a standard self-report measure (the PHQ-9), we use high-stakes, naturalistic events – the reveal of midterm exam grades – to test whether individuals with heightened depression display a specific reduction in emotional response to positive PEs. Results: Using Bayesian mixed effects models, we find that individuals with heightened depression do not affectively benefit from surprising, good outcomes – that is, they display reduced affective responses to positive PEs. These results were highly specific: effects were not observed to negative PEs, value signals (grades), and were not related to generalized anxiety. This suggests that the computational drivers of abnormalities in emotion in depression may be specifically due to positive PE-based emotional responding. Conclusions: Affective abnormalities are core depression symptoms, but the computational mechanisms underlying such differences are unknown. This work suggests that blunted affective reactions to positive PEs are likely mechanistic drivers of emotional dysregulation in depression. [ABSTRACT FROM AUTHOR]

Background: Pitch counts are only one measure of the true workload of baseball pitchers. Newer research indicates that workload measurement and prevention of injury must include additional factors. Thus, current monitoring systems gauging pitcher workload may be considered inadequate. Purpose/Hypothesis: The purpose of this study was to develop a novel method to determine workload in baseball pitchers and improve processes for prevention of throwing-related injuries. It was hypothesized that our pitching workload model would better predict throwing-related injuries occurring throughout the baseball season than a standard pitch count model. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective observational study was conducted at an academic medical center and community baseball fields during the 2019 to 2023 seasons. Pitchers aged 13 to 18 years were monitored for pitching-related injuries and workload (which included pitching velocity; intensity, using preseason and in-season velocity as a marker of effort; and pitch counts). Results: A total of 71 pitchers had 313 recorded pitcher outings, 11 pitching-related injuries, and 24,228 pitches thrown. Gameday pitch counts for all pitchers ranged from 19 to 219 (mean, 77.5 ± 41.0). Velocity ranged from 46.8 to 85.7 mph (mean, 71.3 ± 5.8 mph). Intensity ranged from 0.7 to 1.3 (mean, 1.0 ± 0.08). The mean workload was 74.7 ± 40.1 for all pitchers. Risk factors significant for injury included throwing at a higher velocity in game (P =.001), increased intensity (eg, an increase in mean velocity thrown from preseason to in-season; P <.001), and being an older pitcher (P =.014). No differences were found for workload between injured and noninjured pitchers because the analysis was underpowered. Conclusion: Our workload model indicated that throwing at a higher velocity, throwing at a higher intensity, and older age were risk factors for injury. Thus, this novel workload model should be considered as a means to identify pitchers who may be at greater risk for injury. [ABSTRACT FROM AUTHOR]

Introduction: Sleep hygiene education (SHE) consists of environmental and behavioral practices primarily intended to reduce sleep problems. Currently considered ineffective as a stand-alone treatment, the manner in which the education is typically delivered may be ineffective for the acquisition of new knowledge. The purpose of this study was to determine if a more engaging teaching medium may improve the efficacy of sleep hygiene education. This study examined the use of game-based learning to teach SHE to individuals with sleep problems. Methods: 35 participants played the SHE games for 30 days. Differences in preand post-state anxiety and sleep quality measures were examined. Results: Participants had significant improvements in sleep quality and state anxiety after using the app for 30 days, although scores for the majority of patients remained elevated. Discussion: This pilot investigation provides initial evidence for the efficacy of a game-based approach to SHE. [ABSTRACT FROM AUTHOR]

This paper evaluates the content of the syllabi of postgraduate courses on public health ethics (PHE) within accredited schools and programs of public health (PH) in the United States in order to gain an awareness of the topics addressed within these courses. Methods: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health for 2012. The 'Epidemiology and PHE Syllabi' project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. Results: Data was obtained from 25 schools (52%) and 36 accredited programs (42%); 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. Conclusions: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi. [ABSTRACT FROM AUTHOR]

Prior studies indicate that anti-LGBTQ+ legislation has negative consequences for the well-being of LGBTQ+ people, their families, and their communities. In July of 2022, Florida's Parental Rights in Education Act, also called the "Don't Say Gay" bill, was signed into law. The law aimed to limit K–3 instruction and discussion related to sexuality and gender, encompassing LGBTQ+ identities. The present study surveyed 113 LGBTQ+ parents in Florida about their experiences and perceptions related to the Parental Rights in Education Act. Qualitative content analysis revealed five major themes and 14 subthemes, including: (a) living in Florida: pros and cons; (b) initial reactions to the law; (c) feelings over time; (d) coping with worries; and (e) beyond "coping": considering the future and possibility of relocation. Recommendations center on the need for counseling psychologists to use their privilege and training to advocate on behalf of LGBTQ+ parents, families and others impacted by this legislation. [ABSTRACT FROM AUTHOR]

The National Criminal Justice Drug Abuse Treatment Studies research program conducted cluster randomized trials to test an organizational process improvement strategy for implementing evidence-based improvements in HIV services for preventing, detecting, and/or treating HIV for individuals under correctional supervision. Nine research centers conducted cluster randomized trials in which one correctional facility used a modified Network for Improvement of Addiction Treatment (NIATx) change team approach to implementing improved HIV services and the other facility used their own approach to implement the improved HIV services. This paper examines whether the intervention increased the perceived value of HIV services among staff of correctional and community HIV organizations. Baseline and follow-up measures of the perceived acceptability, feasibility, and organizational support for implementing HIV service improvements were collected from correctional, medical, and community HIV treatment staff. Results indicated that the perceived acceptability and feasibility of implementing HIV services improved among staff in the facilities using the modified NIATx change team approach as compared to staff in the comparison facilities. [ABSTRACT FROM AUTHOR]

Recruiting and enrolling low income, racially and ethnically diverse adolescents into research studies can be a challenge. This paper details our research team's methodology in the recruitment and enrollment of low income and racially/ethnically diverse adolescents in three cities as part of a broader study to understand adolescent perceptions of a health risks. Our team used Florida's Medicaid and Children's Health Insurance Plan administrative databases to identify a sample of adolescents for focus group participation. Utilizing geographic information systems software we generated maps of racial and ethnic group clusters in three cities and identified community centers within each cluster to hold the focus groups. We mailed initial focus group introduction letters, conducted follow-up phone calls for recruitment and further implemented techniques to optimize participant confidentiality and comfort. We enrolled 35 participants for eight focus groups in three cities at a total cost of $264 per participant, including personnel, materials, travel, and incentives costs. As a result of our efforts, groups were fairly evenly distributed by both race and gender. Administrative databases provide opportunities to identify and recruit low income and racially/ethnically diverse adolescents for focus groups that might not otherwise have the opportunity to participate in research studies. It is important that researchers ensure these populations are represented when conducting health assessment tool evaluations. [ABSTRACT FROM AUTHOR]

Lack of paternal involvement has been shown to be associated with adverse pregnancy outcomes, including infant morbidity and mortality, but the impact on health care costs is unknown. Various methodological approaches have been used in cost minimization and cost effectiveness analyses and it remains unclear how cost estimates vary according to the analytic strategy adopted. We illustrate a methodological comparison of decision analysis modeling and generalized linear modeling (GLM) techniques using a case study that assesses the cost-effectiveness of potential father involvement interventions. We conducted a 12-year retrospective cohort study using a statewide enhanced maternal-infant database that contains both clinical and nonclinical information. A missing name for the father on the infant's birth certificate was used as a proxy for lack of paternal involvement, the main exposure of this study. Using decision analysis modeling and GLM, we compared all infant inpatient hospitalization costs over the first year of life. Costs were calculated from hospital charges using department-level cost-to-charge ratios and were adjusted for inflation. In our cohort of 2,243,891 infants, 9.2 % had a father uninvolved during pregnancy. Lack of paternal involvement was associated with higher rates of preterm birth, small-for-gestational age, and infant morbidity and mortality. Both analytic approaches estimate significantly higher per-infant costs for father uninvolved pregnancies (decision analysis model: $1,827, GLM: $1,139). This paper provides sufficient evidence that healthcare costs could be significantly reduced through enhanced father involvement during pregnancy, and buttresses the call for a national program to involve fathers in antenatal care. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper describes a program that was established by Florida Medicaid to improve the quality of prescribing of psychotherapeutic medications. It relates the process used for defining quality medication treatment including the definitions of unusual psychotherapeutic medication indicators (UPMI). It details the results of analysis of FY 2007-2008 pharmacy claims data using these indicators that enabled the Program to identify practices and prescribers that required targeted interventions. The most frequently triggered UPMI for adults involved the use of 2 or more antipsychotics for greater than 60 days; high doses of psychotherapeutic medications was the indicator most frequently triggered for children closely followed by the use of 2 or more antipsychotics for more than 45 days. Prescriptions that triggered UPMI were concentrated in a small number of prescribers. These results led to the Program focusing on these high frequency practices and on the prescribers most associated with them. They also led to the implementation of new quality improvement initiatives like the implementation of a psychiatric telephone consultation line for pediatricians who are treating children with serious emotional disturbances who do not have access to child psychiatrists. [ABSTRACT FROM AUTHOR]

Health and social disparities are widespread among men who have sex with men (MSM). Although literature indicates that Black MSM (BMSM) are no more likely than other MSM to report sexual risk behaviors, such as unprotected anal intercourse, studies have reported that buying and trading sex appear to be important risk factors for BMSM. Substance use generally is not significantly greater among BMSM than other MSM, studies have found that BMSM report more powder and crack cocaine use than other MSM. The lack of adequate coping skills and social support for BMSM has also been documented. This paper examines differences in substance use, sexual risk behaviors and social support among Black and non-black MSM, in a sample of 515 men participating in a randomized intervention trial. BMSM reported higher rates of substance dependence (72.2 vs. 59.5 %, P = .015) and buying sex (49.1 vs. 17.4 %, P < .000) than non-Black MSM. BMSM also reported lower levels of social support than other MSM on all measures included in the study; e.g., getting help and emotional support from others (38.0 vs. 52.8 %, P < .006). Mediation analyses showed that BMSM's higher rates of substance dependence and buying sex are partially mediated by lower levels of social support. Our data appear to show that lack of social support is an important influence on risk behaviors among BMSM. Qualitative data also supported these findings. Sexual risk and substance use prevention interventions should address BMSM's capacity to build adequate and supportive relationships. [ABSTRACT FROM AUTHOR]

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Instrumental variables (IVs) enable causal estimates in observational studies to be obtained in the presence of unmeasured confounders. In practice, a diverse range of models and IV specifications can be brought to bear on a problem, particularly with longitudinal data where treatment effects can be estimated for various functions of current and past treatment. However, in practice the empirical consequences of different assumptions are seldom examined, despite the fact that IV analyses make strong assumptions that cannot be conclusively tested by the data. In this paper, we consider several longitudinal models and specifications of IVs. Methods are applied to data from a 7-year study of mental health costs of atypical and conventional antipsychotics whose purpose was to evaluate whether the newer and more expensive atypical antipsychotic medications lead to a reduction in overall mental health costs. [ABSTRACT FROM AUTHOR]

This paper focuses on the importance of family member closeness as a protective factor against domestic abuse. We explore the link between long-lasting relations within the family and intra-familial violence perpetrated against women in Latino households in South Florida. We use data from an Inter-generational Transmission of Drug Use between Latina Mothers and Daughters (ITDMD) study. The study includes data on family relations and domestic abuse. We estimate a series of multivariate regressions to obtain the probability of abuse against women, the types of abuse inflicted and the relationship with the abusers. Our results indicate that among abused women, the effects of long-lasting relations within the family differ depending on the type of relationship between the abuser and the victim and the degree of closeness the victim feels towards other family members. Given these findings, there is a need to further study family relations and abuse in Latino households. [ABSTRACT FROM AUTHOR]

Objective. Recovery narratives describe the culturally shared understandings about the ideal or desirable way to recover from an illness experience. This paper examines ethnic differences in recovery narratives among women participating in breast cancer support groups in Central Florida, USA. It compares groups serving African-American, Latina, and European American women, with the objective of better understanding the appeal of ethnic-specific illness support groups for culturally diverse populations. Design. A mixed-method study design combined qualitative and quantitative measures, including in-depth interviews, participant observation at support group meetings, collection of printed documents, and a structured survey. Results. Core elements of the recovery narrative drew from the dominant societal cancer discourse of optimism and personal transformation through adversity; however, important ethnic differences were evident in the meaning assigned to these themes. Groups gave distinctive salience to themes of faith and spirituality, empowerment through the migration experience, and becoming a better person through the journey of recovery. Conclusion. The findings suggest that ethnic cancer support groups draw upon dominant societal discourses about cancer, but they espouse distinctive recovery narratives that are consonant with the groups’ cultural models of illness. Similarity between ethnic members’ individual recovery narratives and that of the group may contribute to the appeal of ethnic illness support groups for culturally diverse populations. [ABSTRACT FROM PUBLISHER]

The important goals of Magnet® hospitals are to create supportive professional nursing care environments. A recently published paper found little difference in work environments between Magnet and non-Magnet hospitals. The aim of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. A secondary analysis of data from a 4-state survey of 26,276 nurses in 567 acute care hospitals to evaluate differences in work environments and nurse outcomes in Magnet and non- Magnet hospitals was conducted. Magnet hospitals had significantly better work environments (t = -5.29, P < .001) and more highly educated nurses (t = -2.27, P < .001). Magnet hospital nurses were 18% less likely to be dissatisfied with their job (P <.05) and 13% less likely to report high burnout (P < .05). Magnet hospitals have significantly better work environments than non-Magnet hospitals. The better work environments of Magnet hospitals are associated with lower levels of nurse job dissatisfaction and burnout. [ABSTRACT FROM AUTHOR]

Previous patient-centered concept models of Angelman syndrome (AS) are integral in developing our understanding of the symptoms and impact of this condition with a holistic perspective and have highlighted the importance of motor function. We aimed to develop the motor and movement aspects of the concept models, to support research regarding motor-related digital outcomes aligned with patients' and caregivers' perspectives. We conducted a qualitative analysis of semi-structured interviews of 24 caregivers to explore AS motor-related features, factors influencing them and their impact on patients and caregivers.The most impacted motor features were gait, walking and stair-climbing. Half of caregivers ranked motor symptoms as one of the most burdensome symptoms of AS. Caregivers frequently reported physical therapy, motivation, medical management and age as factors influencing motor function in AS and reported that impaired motor function affected both patients and caregivers. Measures of lower-limb motor function were identified as relevant to monitor drug effectiveness in AS. Caregivers discussed expected benefits of a digital outcome and potential issues with wearable technology in the context of AS. We propose a new motor function patient-centered concept model, providing insights for the development of relevant, motor-related, digital outcomes in AS. [ABSTRACT FROM AUTHOR]

Home visitation programs offer a unique opportunity to implement a novel digital early childhood obesity prevention program. Evaluate usability of a digital infant feeding nutrition education module with key stakeholders (N=21) of a home visiting program in Florida. Home visitors (n=11) and enrolled mothers (n=10) of a home visiting program in Florida participated in a one-time, 45-minute qualitative interview via Zoom with a trained researcher using a semi-structured script based on constructs from the Technology Acceptance Model (TAM) and Social Cognitive Theory (SCT). Participants also completed a modified version of the mHealth App Usability Questionnaire (MAUQ). Interviews were audio-recorded, deidentified, transcribed verbatim and coded by two trained researchers using an inductive thematic analysis approach based on TAM and SCT constructs to develop themes. MAUQ subscales were analyzed using descriptive statistics. Most participants noted that they liked the digital format, and specifically mentioned the visual or interactive components, convenience and accessibility of the information, and general preference for digital information over paper handouts. Home visitors were interested in content related to food allergies and readiness for solid foods, whereas mothers were interested in all of the infant feeding topics. Nonetheless, the majority (90%) reported that they would be very likely to use information in the learning modules as part of home visits. Usability of the module was high across all three MAUQ subscales (mean ratings out of 7±SD: ease of use = 6.88±0.2, interface and satisfaction = 6.90±0.4, usefulness = 6.78±0.1). Limited access to technology by parents, compatibility of the module with various phone types, and necessity of keeping information updated were mentioned by home visitors as limitations that may impact usability. The results revealed that a digital nutrition education module to prevent early childhood obesity was deemed usable by both staff and parents of a home visiting program. Future research is needed to determine impact on parental feeding behaviors and child health outcomes. University of Florida Mowery Innovative Research Fund [ABSTRACT FROM AUTHOR]

People living with HIV (PLWH) experience a higher rate of age-related comorbidities at younger ages. Understanding common comorbidities among PLWH and their relationship to one another could be significant in improving aging for PLWH. The goal of the present study is to identify the most common comorbidities among PLWH and the relationship between them using network analysis. We used abstracted electronic medical record (EMR) data of PLWH from the Florida Cohort study, a prospective cohort study conducted in eight cities in Florida, USA. We used International Classification of Diseases (10th revision, ICD-10) code to classify comorbidities and organ systems. Network analysis was conducted to determine the degree and betweenness centrality among comorbidities. We included 756 PLWH with an average age of 46.4 years (SD 11.3) in the analysis. Infectious diseases (A00–B99, 50.8%), mental and behavioural (F01–F99, 47.0%), endocrine, nutritional and metabolic (E00–E88, 45.2%), and circulatory (I00–I99, 39%) disorders were the most prevalent system comorbidities among PLWH. Hypertensive disorder (I10–I1635.8%), dyslipidaemia (E78, 25.7%) and major depressive disorder (F32–F33, 23.9%) were the most common non-infectious conditions affecting PLWH. Viral hepatitis (B15–B19, 17.1%) and syphilis (A15–A53, 12%) were the most common coinfections among PLWH. Hypertension, dyslipidaemia and major depressive disorder were the most central of the comorbidities among PLWH. Comorbidities among PLWH were most prevalent for chronic disease and mental illness. Targeting shared disease risk factors in addition to monitoring known pathological pathways may prevent comorbidities among PLWH. [ABSTRACT FROM AUTHOR]

Background: Clinical alarms are designed to signal an unsatisfactory patient physiological state and alert staff members to malfunctioning medical equipment. Alarm desensitization and fatigue can occur when clinicians are exposed to an overwhelming number of clinical alarms, particularly nonactionable alarms. Local Problem: Alarm fatigue and alarm management competency related to use of Philips monitoring systems were noted to be problematic among nurses working in the 27-bed surgical intensive care unit of a teaching hospital in northeastern Florida. Methods: A quality improvement project was conducted to reduce alarm fatigue and improve nursing competency in managing alarms. The CEASE (Communication, Electrodes, Appropriateness, Setup, and Education) evidence-based alarm management bundle was implemented on the unit, and a representative from the alarm manufacturer conducted in-service training sessions. A clinical alarms survey developed by the Healthcare Technology Foundation was distributed both before and after the intervention to 115 nurses working in the unit. Descriptive and inferential statistics were used to assess for differences between the preintervention and postintervention periods. Results: Nurse participants demonstrated improved alarm management competency, resulting in significant improvements in their perceptions of alarm functionality, settings, response time, and policy adherence. There was a statistically significant decrease in self-reported alarm fatigue, and the CEASE bundle was found to influence nursing practice. Conclusions: The Joint Commission's 2022 goal of improving clinical alarm safety remains a top priority nationwide. Implementation of the CEASE alarm management bundle was effective in reducing surgical intensive care unit nurses' alarm fatigue and improving their alarm management practices. [ABSTRACT FROM AUTHOR]

This secondary analysis of cross-sectional baseline data from an intervention trial study examines demographics, sexually transmitted infection (STI) history, substance use and sexual risk behaviors among young adult nightclub participants who do (n = 79) and do not (n = 419) frequent "strip" or adult entertainment clubs (AECs) in Miami, Florida. AEC patrons were older, and more likely to identify as Black race and report STI history. Compared to those who do not, AEC patrons also reported greater recent (past 90-day) frequencies of alcohol and ecstasy use, higher numbers of recent sex partners and were more likely to report recently being high during sex a majority of the time. Increased HIV/STI prevention efforts among young adult AEC patrons appear warranted. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic profoundly impacted psychological well-being worldwide. Oncology health care professionals' (OHCPs') perceptions of psychological effects of COVID-19 among people in active cancer treatment were explored. Semi-structured interviews with a purposive sample of OHCPs actively providing care were conducted. Interviews were audio-recorded, transcribed, and coded using Atlas.ti v8 and thematic analysis. In total, 30 OHCPs participated. Most were registered nurses (70%), worked in outpatient setting (56.7%) and were in their current position 1–5 years (53.3%). Overarching themes are as follows: (a) cancer treatment disrupted due to patients' fear of exposure to COVID-19; (b) social distancing restrictions caused discontinued social support and supportive services that exacerbated psychological distress; (c) pandemic-related stressors led to overwhelmed coping skills; and (d) OHCPs played a vital role in providing emotional support and connecting patients with family/friends through technology. Behavioral health interventions should focus within the "new world of COVID-19" of reduced face-to-face support and increased online support for patients. [ABSTRACT FROM AUTHOR]

Conceptualizations of developmental trends are driven by the particular method used to analyze the period of change of interest. Various techniques exist to analyze developmental data, including individual growth curve analysis in observed and latent frameworks, cross-lagged regression to assess interrelations among variables, and multilevel frameworks that consider time as nested within individual. In this paper, we report on findings from a latent change score analysis of oral reading fluency and reading comprehension data from a longitudinal sample of approximately 16,000 students from first to fourth grade. Results highlight the utility of latent change score models compared to alternative specifications of linear and nonlinear quadratic latent growth models as well as implications for modeling change with correlated traits. [ABSTRACT FROM AUTHOR]

Introduction Rates of electronic cigarette (e-cigarette) use have increased quickly among US adults (3.3% in 2010 to 8.5% in 2013) and youth (4.5% in 2013 to 13.4% in 2014). As state and local governments consider regulatory policies, understanding what smokers believe about e-cigarettes and how they value e-cigarettes is important. Methods Using data from a convenience sample of Florida adult smokers (N=765), we investigated the value smokers place on specific attributes of e-cigarettes (availability of flavours, effectiveness of e-cigarettes as a cessation aid, healthier alternative to regular cigarettes, ability to use e-cigarettes in public places) by asking smokers how much they would be willing to pay for e-cigarettes with and without each of these attributes. Results For cigarette-only and dual users, losing the ability to use an e-cigarette as a quit aid and losing the harm reduction of an e-cigarette significantly reduced the price respondents were willing to pay for an e-cigarette. For cigarette-only users, not being able to use an e-cigarette indoors and losing flavours also significantly reduced the price respondents were willing to pay for an e-cigarette. Conclusion Our results suggest that smokers value multiple attributes of e-cigarettes. Our valuation measures also appear to align with smokers' beliefs about e-cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: Technology has transformed our lifestyles in dramatic and significant ways, including new and less expensive options for recruiting study participants. This study examines cost and participant differences between two recruitment sources, Craigslist (CL), and print newspapers (PNs). This paper also reviewed and compared studies involving clinical trials published since 2010 that recruited participants using CL alone or in combination with other methods.Method: Secondary data analyses from a parent study involving a randomized controlled trial of a mail-based intervention to promote self-change with problem drinkers.Results: Significant differences were found between CL and PN participants on most demographic and pretreatment drinking variables. While all participants had AUDIT scores suggestive of an alcohol problem and reported drinking at high-risk levels, CL participants had less severe drinking problem histories, were considerably younger, and had a higher socioeconomic status than PN participants. The total advertising costs for the 65 CL ads ($275) were significantly less than the 69 PN ads ($33, 311). The recruiting cost per eligible participant was vastly less expensive using CL ($1.46) compared to print newspaper ads ($116.88).Conclusions: Using CL is a viable recruitment method for soliciting participants, particularly those that are younger, for alcohol intervention studies. It is also less expensive than newspaper ads. When CL participants were recruited, they reported being slightly more confident to change their drinking than PN participants. Limitations of using CL are discussed, including that some initial ad responders gave inconsistent answers to similar questions and a few tried to enter the study more than once. [ABSTRACT FROM AUTHOR]

The rapidly growing racially diverse ageing population in the United States presents unique challenges for the country's social, economic, and healthcare systems. Rising health care costs, increased patient cost-sharing, and limited financial resources make this generation of older Americans susceptible to large medical bills or debt, which disproportionally impacts older adults who are from racial/ethnic minority communities. Cost of care (CoC) conversations between patients and healthcare providers is one recommended approach for containing healthcare costs and alleviating patients' financial burden of care. The current study used focus group methods to qualitatively explore the contextual factors that influence CoC conversations in a diverse sample of older adults (N = 27). Three focus groups were held with non-Hispanic White (n = 10), Black/African American (n = 9), and Hispanic (n = 8) participants. Thematic analysis yielded four broad themes. The results suggest that CoC conversations do not occur with physicians. The facilitators of CoC conversations included positive provider affect, rapport/relationship building, and communication. Barriers included lack of physician training, wait time, lack of focus on the patient, language, provider preferences, fear of physicians, and religion. There were significant differences in the facilitators and barriers across racial/ethnic groups. It is critical for physicians to have the tools and training to successfully discuss CoC with older patients. Cultural competency training and provider awareness of patient preferences and expectations may be important when it comes to enhancing rapport and increase the likelihood of these important conversations within racial/ethnic minority communities. [ABSTRACT FROM AUTHOR]

There is a limited understanding of how toxic exposures to agrichemicals vary relative to international migration over the life course. A life history calendar (LHC) was piloted to explore sequences of agrichemical exposure relative to international migration. LHCs were administered to 41 foreign born individuals from Mexico and Central America who had agricultural work experience during their lifetime and who were living in South Florida. Social sequence analysis was used to explore occupation-by-agrichemical events relative to migration. A three-cluster solution was used to classify low, moderate, and high lifetime exposure sequences. The odds of any perceived effects of agrichemicals on the body increased with time prior to migration in the moderate and high exposure sequence clusters and continued to increase 20% with each year following migration in the moderate exposure cluster. Workers with high lifetime agrichemical exposures prior to migrating internationally showed lower likelihoods of a perceived effect on the body following migration despite continued exposure. Further research on instrument validity is warranted. [ABSTRACT FROM AUTHOR]

Behavioral health issues are prevalent among child welfare-involved parents. Despite associations with parenting challenges and maltreatment, parents' behavioral health conditions often go untreated. In this study, we explore challenges with addressing behavioral health needs of parents involved in the child welfare system. Focus groups with child welfare and behavioral health providers were conducted to explore gaps and opportunities to enhance behavioral health care for child-welfare involved parents. Three themes were identified: parental motivation and buy-in, behavioral health assessments and screenings, and communication and service coordination. Implications for policy and practice include increased training on measurement-based care and effective cross-system collaboration. [ABSTRACT FROM AUTHOR]

Objectives: To inform updates to the Pregnancy Risk Assessment Monitoring System (PRAMS) design and processes, African American/Black and Hispanic/Latina women in Florida provided feedback on their awareness and perceptions of the PRAMS survey, and preferences for survey distribution, completion, design and content. Methods: Focus groups were conducted in English and Spanish with 29 women in two large metropolitan counties. Participants completed a brief survey, reviewed the PRAMS questionnaire and recruitment materials, engaged in discussion, and gave feedback directly onto cover design posters. Results: Participants reported limited awareness of PRAMS. Preferences for survey distribution and completion varied by participant lifestyle. Interest in topics covered by PRAMS was as a motivator for completion, while distrust and confidentiality concerns were deterrents. Participants were least comfortable answering questions about income, illegal drug use, and pregnancy loss/infant death. Changes to the length of the survey, distribution methods, and incentives/rewards for completion were recommended. Conclusions for Practice: Results highlight the need to increase PRAMS awareness, build trust, and consider the design, length and modality for questionnaire completion as possible avenues to improve PRAMS response rates. [ABSTRACT FROM AUTHOR]

To inform the development of a combined diabetes prevention and self-management intervention in partnership with church communities, this study sampled African American church leaders and members ( N = 44) to qualitatively study religious beliefs and practices, diabetes prevention and self-management behaviors, and related community actions. Prior to commencing the study, internal review board approval was obtained. Although not required, community consent was officially provided by the church pastors. Individual consent was subsequently obtained from eligible community members who expressed an interest in participating in the study. Following a participatory action research approach, the inquiry group method was used. Qualitative data were analyzed with content analysis. Findings revealed Christian worldview, medical distrust and self-management as prominent themes. Findings suggest that diabetes providers address religious orientation in the provision of care with attention to rebuilding trust with the African-American community to improve health outcomes. [ABSTRACT FROM AUTHOR]

Few empirical studies have evaluated how perceptions of the patient-provider relationship affect health care seeking among Haitian immigrants. In this cross-sectional study, we examined whether perceptions of practitioner support for patient autonomy facilitate or hinder health care seeking among Haitian women enrolled in a cervical self-sampling trial. Perceived autonomy support was measured using an adapted health care climate questionnaire. Associations between perceived autonomy support and health care seeking were modeled using logistic regression and classification and regression trees. Covariates included socioeconomic and structural access indicators. Dependent variables included receipt of any medical care in the past year and delayed health care seeking. Having a usual source of care was strongly associated with both dependent variables. Lower perceived autonomy support was associated with delayed health care seeking in regression models and classification and regression trees. Addressing the capacity of health workers to deliver autonomy-supportive care is essential for improving health services utilization in vulnerable populations. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has showcased the United States' reliance on essential workers, or those deemed necessary to continue critical societal functions. Black women remain overrepresented in essential positions and are on the frontlines of two pandemics: COVID-19 and racism. Using a phenomenological research design, we conducted semi-structured interviews to examine the experiences of 22 Black women essential workers navigating these dual pandemics. Salient themes of these experiences included: desire to and fear of protest; navigating extreme emotions; mixed levels of understanding from colleagues; and a rise in blatantly racist confrontations in the workplace. Further reflection is needed to understand the complex dynamics these women faced. [ABSTRACT FROM AUTHOR]

While a variety of disciplines regularly use fidelity monitoring in order to understand a program's efficacy, few examples of fidelity monitoring exist within the field of child welfare. This study provides an example of a fidelity-monitoring measure used the Critical Ongoing Resource Family Education (CORE) Teen, a training program for prospective and current resource parents of teenagers. The fidelity-monitoring tool provided valuable insights into the strengths and weaknesses of the training program as well as possible explanations for changes (and lack thereof) in participants' competency levels. While the lack of diverse trainers limits the generalizability of the findings, this tool provides a promising start to fidelity monitoring in the child welfare field. [ABSTRACT FROM AUTHOR]

Purpose of the study: To examine (a) whether the content of caregiving tasks (i.e., nursing vs. personal care) contributes to variation in caregivers’ strain and (b) whether the level of complexity of nursing tasks contributes to variation in strain among caregivers providing help with such tasks. Design and methods: The data came from the Cash and Counseling Demonstration and Evaluation study conducted in Arkansas, Florida, and New Jersey. The paper analyzes the physical and emotional strain of 1,926 paid American caregivers who helped adult Medicaid recipients with personal and nursing care in the home. Results: Over 80% of home caregivers were providing assistance with nursing care, and over 50% of those were providing help with moderate or high complexity tasks. Caregivers who were providing any type of nursing care reported significantly more strain than caregivers who were providing only personal care. Those providing highly or moderately complex nursing care exhibited more caregiver strain than did those providing low-complexity nursing care. Implications: Medical complexity is an important contributor to caregiver strain. Policymakers should consider medical complexity in the development of practices to assist the caregivers of Medicaid long-term care recipients, especially through consumer-directed supportive service programs. [ABSTRACT FROM PUBLISHER]

Client-perpetrated violence (CPV) against child protective services (CPS) workers is prevalent and problematic for workers and clients leading to psychological distress, physical injury, and compromised service delivery. With accumulating evidence of prevalence and detrimental consequences, few studies examine the characteristics of violent incidents among CPS workers. This study explores how CPS workers perceive CPV through exploring characteristics of incidents that they experienced. We applied components of the stress process model to consider the importance of workers' perspectives when interpreting violence and its effects. We used inductive, thematic analysis to analyze interview data focused on workers' experiences with CPV during their first 3 years as CPS workers. The qualitative subsample (N = 34) was drawn from the Florida Study of Professionals for Safe Families (FSPSF), a statewide, longitudinal sample of recently hired frontline child welfare workers. With few exceptions, workers experienced a variety of physical and nonphysical violence. Some experienced more frequent exposure than others, particularly those who defined yelling as violent. Workers identified predictable patterns of violent circumstances and people, and commonly felt that their agencies treated violence as "business as usual." The high prevalence of violence, often predictable, indicates the importance of promoting a violence-free workplace through agency culture and responding to workers' reports of CPV with empathy and support. In addition, given workers' diverse perceptions of CPV, a manual could provide definitions of CPV, procedures to increase worker safety, and procedures to respond effectively to violence. Skill-based trainings can support workers at all levels to minimize, yet prepare for and handle, violence. [ABSTRACT FROM AUTHOR]

Parents play a critical role in the progression and outcomes of juvenile dependency (child welfare court) cases. Yet, very little is known about these parents' knowledge, attitudes, and experiences. We examined legal understanding and attitudes among 201 parents involved in ongoing dependency cases in California and Florida via semi-structured, in-person interviews. We expected parents' understanding to be low and attitudes to be negative, particularly among parents of color and low SES parents. We expected greater dependency understanding to be related to more positive justice attitudes, and procedural and distributive justice attitudes to be indistinguishable in this population. Findings partially confirmed expectations. Parents' understanding of the system was low, especially among parents of color and less educated parents. Parents felt less than satisfied about the fairness of procedures and decisions. However, procedural and distributive justice attitudes were distinguishable. Finally, and unexpectedly, parents' knowledge and attitudes were negatively related. The consistently low levels of knowledge across CA and FL suggest the critical need to increase parental knowledge. It is also important to promote fair court procedures and decision-making to improve parents' attitudes about procedural and distributive justice, which were found to be distinct and important factors among parents navigating juvenile dependency cases. [ABSTRACT FROM AUTHOR]

Hepatitis B (HBV) is endemic in Haiti, therefore Haitian immigrants should be screened to identify and link affected individuals to care. Current screening approaches are ineffective. We assessed the acceptability and feasibility of home-based screening among Haitian immigrants using community health workers (CHWs). We recruited participants exiting a pragmatic trial evaluating strategies to improve care delivery (NCT02970136). Participants completed an acceptability questionnaire. Blood drawn by CHWs at participants' homes or community sites was tested for hepatitis B surface antigen, hepatitis B surface antibody and hepatitis B core antibody. Of 60 participants, 59 found screening acceptable; 53 had blood drawn. Of those, 45.3% had HBV previously, 49.1% remained susceptible and 5.7% were vaccinated. Respondents cited various reasons community members might find screening unacceptable. The high prior HBV rate highlights the need for effective outreach programs. Home-based HBV screening was both acceptable and feasible among Haitian immigrants. [ABSTRACT FROM AUTHOR]