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Against the backdrop of growing international concern for a narrowing view of early literacy, this study was initiated to determine how teachers of four-year-olds view their task of fostering early literacy. This paper reports on the first steps to design and validate an instrument which captures teachers’ perceptions of early literacy content goals; developmentally appropriate and effective pedagogical practices related to each content goal; and their own competencies to offer a suitable environment for developing early literacy. The content validity of the instrument was evaluated by an expert screening; the reliability and practicality of the instrument were assessed through a pilot study involving 20 teachers from 2 countries. Validation findings indicate that the instrument appears to be reliable. The findings from the pilot run show that teachers focus on decoding skills most; there is some attention to book orientation and understanding, and relatively little to the functions of written language. [ABSTRACT FROM AUTHOR]

Involvement in terrorism has traditionally been discussed in relatively simplistic ways with little effort spent on developing a deeper understanding of what involvement actually entails, and how it differs from person to person. In this paper, we present the results of a three-year project focused on 183 individuals associated with the global jihadist movement who were convicted in the United States, for terrorist offenses, between 1995 and 2012. These data were developed by a large-scale, open-source data collection activity that involved a coding dictionary of more than 120 variables. We identify and explore the diversity of behaviors that constitute involvement in terrorism. We also compare lone actors and those who acted as part of a group, finding that lone actors differed from group-based actors in key demographic attributes and were more likely to be involved in attack execution behaviors. Implications for counterterrorism are then discussed. [ABSTRACT FROM AUTHOR]

Submitting articles to journals has become a difficult and time-consuming process, as has reviewing and re-reviewing articles that too often get the dreaded R&R letter. The underlying problem here is as old as the discipline, particularly in American sociology. Very different criteria are used in producing scholarship and reviewing its merits for publication; and current ways of editing journals aggravate this fundamental problem. The Big Divide in sociology is between a discipline that seeks to be a science and one that does not; and there is no easy reconciliation among those on either side of this divide. In this paper, the effects of this divide on journal publishing are reviewed in terms of the consequences of the Big Divide for the discipline. A simple but radical proposal is offered at the end for how sociologists can be put out over their misery in having to deal with the consequences of this Big Divide in their departments, in professional meetings, and most importantly, in publishing their intellectual products in journals. [ABSTRACT FROM AUTHOR]

The impacts of this pandemic have not been felt equally. The current pandemic has aggravated preexisting prejudices and shed light on long-standing social, economic, and health inequities that have been and continue to be perpetuated by systems of oppression. Psychologists are in a unique position to collaboratively work with marginalized individuals navigating pandemic threat, discrimination, and oppressive systems. This paper presents best practice recommendations for U.S.-based psychologists working with marginalized populations impacted by COVID-19. Psychologists are encouraged to synchronously develop the following three areas of evidence-based practice, as they relate to the impacts of COVID-19: (a) self-reflection and self-awareness in a COVID-19 context (i.e., reflecting on one's identities and one's knowledge and attitudes toward sociohistorical inequities), (b) knowledge acquisition (i.e., adopting an attitude of cultural humility, identifying "emotional contagion," identifying impacts of systemic injustice that may be compounded by COVID-19, and recognizing racial trauma in clients of color), and (c) collaboration with clients (i.e., identify the mental health toll of oppressive systems, explore COVID-19 relevant and culturally responsive methods of healing, encourage virtual community engagement, and incorporate ethnic and racial identity development in personal and professional work). Engaging with these best practice recommendations should result in the psychologist's improved ability to identify and address the consequences of systemic oppression that have been highlighted and exacerbated by COVID-19 on their own behavior and their clients' mental health. Furthermore, psychologists engaged with these best practice recommendations should find themselves better prepared to utilize culturally responsive interventions despite barriers created by COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: To create an instrument to assess attitudes toward lesbian, gay, and bisexual (LGB) patients among random samples of athletic trainers in the United States. Methods: This was a cross-sectional study using semi-structured interviews, paper-based questionnaires, and an electronic questionnaire. Development included three phases: (1) exploratory interviews and questionnaire responses, (2) construct validity and item reduction, and (3) criterion validity. Results: Six athletic trainers completed semi-structured interviews to develop themes regarding LGB patients. Additionally, 39 students in professional and post-professional athletic training programs answered questionnaires designed to elicit statements regarding LGB patients. For item reduction, 3,000 athletic trainers were emailed a questionnaire (response rate = 17%). For validation, another sample of 3,000 athletic trainers was sent the instruments (response rate = 13%). Athletic trainer emails were obtained from the National Athletic Trainers' Association. The resultant instrument was the 15-item Attitudes Toward Lesbian, Gay, and Bisexual Patients (ATLGBP) (α =.830). There were significant correlations between the ATLGBP and subscales of the Lesbian, Gay, Bisexual–Knowledge and Attitude Scale for Heterosexuals (hate: r =.464; civil rights: r = −.683; religion: r =.532; internal: r = −.612; knowledge: r = −.430; P <.001). Conclusions: The ATLGBP assesses affective, cognitive, and behavioral expressions of LGB attitudes in settings common to clinicians. The ability to assess attitudes toward LGB patients enables clinicians to identify areas on which to focus training and education. [Athletic Training & Sports Health Care. 2021;13(4):e146–e152.] [ABSTRACT FROM AUTHOR]

This paper analyzes the relationship between individuals' attitudes towards risk and their decision to migrate. We consider migration in the United States across metropolitan statistical areas (MSAs) between 1997 and 2015, based on data from the Panel Study of Income Dynamics (PSID). Using random‐effects specifications, we find that being relatively more willing to take risks is positively and significantly related to cross‐MSA migration. For cross‐state migration and migration across larger distances, risk attitudes are slightly more important. A recursive bivariate probit model of simultaneous equations addresses the potential endogenous nature of attitudes towards risk and allows ruling out reverse causality. [ABSTRACT FROM AUTHOR]

In this paper, we articulate a conceptual model for the process of ethnic identity development and integration among Asian American children and youth that offers potential explanations for their marginalization as they negotiate multiple facets of their identities and locate themselves in local and national contexts. The conceptual model is based on an integration of theory and empirical research on the intertwined processes of ethnic identity development and socialization of children and youth in Asian American families and is anchored in the developmental domain of identity formation and integration. We present the conceptual model as three overlapping circles to represent salient features of physical and social contexts, prevalent metanarratives that have been empirically established as salient meaning-making frames pertinent to the lived experience of Asian Americans in the United States, and the dynamic individual-context interplay and mutual adjustment that is part of developmental process. We then build on the work of scholars who have advanced the theoretical and empirical literature on the Asian American experience in the United States, to illustrate how the three components (features of context, master narratives, and developmental processes) intersect in the overlapping spaces of the model to foreground the dialectic processes whereby identity is constructed as contextualized in place. The primary contribution of the model is to facilitate generating research questions that can unravel the complexities of how specific ethnic backgrounds (e.g., immigration and settlement histories), developmental status, individual position on societal racial/ethnic hierarchy, and prevalent societal metanarratives contextualize the development of an Asian American ethnic-racial identity. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this paper was to determine the extent to which dry needling is instructed in entry-level education programs for physical therapists. Methods: Program directors from 226 entry-level education programs recognized by the Commission on Accreditation in Physical Therapy Education were recruited via e-mail to participate in an anonymous 35-item electronic survey during the 2017-2018 academic year. The survey evaluated dry needling curricula, faculty qualifications, attitudes and experience, and programs' future plans for teaching dry needling. Results: A total of 75 programs responded to the survey (response rate = 33.1%). Forty (53.3%) had integrated dry needling theory and psychomotor training into their programs and 8 (10.6%) planned to include such content in their curriculum in the future. Of the 40 respondents, 28 indicated that dry needling education was integrated into a required course, 4 indicated that dry needling was an elective course, and 8 did not specify how dry needling education was integrated. Faculty teaching dry needling appear to be well qualified, with the majority having 5-10 years of experience using dry needling in clinical practice. The primary reason for programs not teaching dry needling is that it was not considered an entry-level skill. Discussion: There appeared to be variability in how dry needling was integrated into the curricula, as well as in the depth and breadth of instruction. Our research may serve as a baseline for faculty to assess existing dry needling curricula and as a guide for developing curricula in new or existing physical therapy programs. [ABSTRACT FROM AUTHOR]

Introduction: Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV). Methods: We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021. Results: We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth. Conclusions: This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery. [ABSTRACT FROM AUTHOR]

The measurement of sexual and gender identity in the United States has been evolving to generate more precise demographic estimates of the population and a better understanding of health and well-being. Younger cohorts of sexual- and gender-diverse adults are endorsing identities outside of the lesbian, gay, bisexual, and transgender (LGBT) labels. Current population-level surveys often include a category such as "something else" without providing further details, and doing so inadequately captures these diverse identities. In this research note, our analysis of the most recent federal data source to incorporate sexual and gender identity measures-the Household Pulse Survey-reveals that younger birth cohorts are more likely to select "something else" for their sexual identity and "none of these" for their gender identity. The observed sexual and gender identity response patterns across birth cohorts underscore the importance of developing and applying new strategies to directly measure sexual- and gender-diverse adults who identify with identities outside of those explicitly captured on surveys. The integration of sexual and gender identity measures in population-level surveys carries broader implications for civil rights and for addressing health inequities and therefore must be responsive to cohort differences in identification. [ABSTRACT FROM AUTHOR]

Low HPV vaccination rates among US Hispanics/Latinos remain a public health issue. This cross-sectional study investigated the perceived barriers and recommended sources related to HPV vaccination among 209 Hispanic/Latino college students in the United States. From a self-report questionnaire, barriers were insufficient provider recommendations and not having a regular care provider. Doctors, parents, and nurses were identified as the most effective sources for recommending HPV vaccination. Uncertain effectiveness was more likely to be reported as a barrier to HPV vaccination by participants who identified as Catholic. Participants born outside the U.S. were more likely to report "no recommendation received" and "not knowing where to get vaccine." Health care providers can promote HPV vaccination by acknowledging familial allegiances of Hispanic/Latino college students. The role of religion and cultural beliefs in HPV vaccination among Hispanics/Latinos underscores the need for further research in this area. Universities could be a place of HPV awareness initiatives, as having more formal education does not translate into having more HPV knowledge. To decrease HPV vaccination barriers, the home-based vaccination program could potentially impact HPV vaccine uptake among Hispanic/Latino populations and should be further explored. [ABSTRACT FROM AUTHOR]

Intimate partner abuse (IPA) is a public health crisis that disproportionately impacts indigenous women. We know little about rates and correlates of IPA victimization (IPAV) and abuse directed at one's partner (ADP) among indigenous women caregivers (people who take care of children). The purpose of the current study was to address this critical gap in the literature. Participants were 44 indigenous women caregivers in the United States in a current relationship who completed a survey. Most women reported IPAV and ADP experiences in the past 6 months, and IPAV and ADP abuse directed at partner were positively associated. Further, IPAV was positively associated with adverse childhood experiences (ACEs), participants' engagement in harsh parenting, and depressive symptoms. IPAV was negatively associated with age, income, indigenous cultural identity, and social support. ADP was positively associated with ACEs, harsh parenting, and depressive symptoms. ADP was negatively associated with age and income. ADP was not associated with indigenous cultural identity and social support. These data suggest the urgency with which efforts are needed to prevent and respond to IPA among indigenous women caregivers, especially those who are younger and of lower income, and that culturally grounded initiatives that seek to build social support may be especially impactful. [ABSTRACT FROM AUTHOR]

Despite a dramatic increase in Asian-White biracial individuals in the US, there is still a lack of research on this population. Using phenomenology, the purpose of this study was to delve into the lived experiences of Asian-White interracial couples and their experiences raising their biracial children. A total of 10 couples participated, and they reported on their perception of their children's racial/ethnic identity, their children's understanding of race, the types of racial and cultural socialization practices in which they engaged, cultural differences within their family, and differential treatment based on their children's appearance. [ABSTRACT FROM AUTHOR]

Distrust and partisan identity are theorized to undermine health communications. We examined the role of these factors on the efficacy of discussion groups intended to promote vaccine uptake. We analyzed survey data from unvaccinated Facebook users (N = 371) living in the US between January and April 2022. Participants were randomly assigned to Facebook discussion groups (intervention) or referred to Facebook's COVID-19 Information Center (control). We used Analysis of Covariance to test if the intervention was more effective at changing vaccination intentions and beliefs compared to the control in subgroups based on participants' partisan identity, political views, and information trust views. We found a significant interaction between the intervention and trust in public health institutions (PHIs) for improving intentions to vaccinate (P =.04), intentions to encourage others to vaccinate (P =.03), and vaccine confidence beliefs (P =.01). Among participants who trusted PHIs, those in the intervention had higher posttest intentions to vaccinate (P =.008) and intentions to encourage others to vaccinate (P =.002) compared to the control. Among non-conservatives, participants in the intervention had higher posttest intentions to vaccinate (P =.048). The intervention was more effective at improving intentions to encourage others to vaccinate within the subgroups of Republicans (P =.03), conservatives (P =.02), and participants who distrusted government (P =.02). Facebook discussion groups were more effective for people who trusted PHIs and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views. [ABSTRACT FROM AUTHOR]

A dramatic rise in mass shootings in the twenty-first century has compelled divisive political and legal agendas predicated on the Second Amendment and mental health. Challenges to absolute autonomy of firearm possession have broad policy implications, and given the enormous cultural entrenchment regarding private gun ownership in the United States, arouse intense objections to government invasion on a fundamental right. While the related legislative process, criminal justice and mental health research has accumulated, there is a lack of any data on the perspective of the sub-group perhaps most qualified to opine on the issue. This paper presents the perspective of veterans of combat from World War Two, Vietnam and the Middle East Wars (Iraq and Afghanistan) on the scope of civilian gun privilege. Older veterans of both earlier wars were unanimously against unlimited firearm ownership while younger veterans were equally divided. Given that military veterans and particularly older ones are reliably very conservative politically, these findings might be unexpected. But for three exceptions all veterans endorsed strict policies on criminal and mental background checks. The discussion examines the core factor of combat experience as the basis for the findings and illuminates considerations for policy decisions. [ABSTRACT FROM AUTHOR]

Background: Adaptive designs have been increasingly used in the pharmaceutical and device industries, but adoption within the academic setting has been less widespread - particularly for confirmatory phase trials. We sought to understand perceptions about understanding, acceptability, and scientific validity of adaptive clinical trials (ACTs).Methods: We used a convergent mixed methods design using survey and mini-focus group data collection procedures to elucidate attitudes and opinions among "trial community" stakeholders regarding understanding, acceptability, efficiency, scientific validity, and speed of discovery with adaptive designs. Data were collected about various aspects of ACTs using self-administered surveys (paper or Web-based) with visual analog scales (VASs) with free text responses and with mini-focus groups of key stakeholders. Participants were recruited as part of an ongoing NIH/FDA-funded research project exploring the incorporation of ACTs into an existing NIH network that focuses on confirmatory phase clinical trials in neurological emergencies. "Trial community" representatives, namely, clinical investigators, biostatisticians, NIH officials, and FDA scientists involved in the planning of four clinical trials, were eligible to participate. In addition, recent and current members of a clinical trial-oriented NIH study section were also eligible.Results: A total of 76 stakeholders completed the survey (out of 91 who were offered it, response rate 84 %). While the VAS attitudinal data showed substantial variability across respondents about acceptability and understanding of ACTs by various constituencies, respondents perceived clinicians to be less likely to understand ACTs and that ACTs probably would increase the efficiency of discovery. Textual and focus group responses emerged into several themes that enhanced understanding of VAS attitudinal data including the following: acceptability of adaptive designs depends on constituency and situation; there is variable understanding of ACTs (limited among clinicians, perceived to be higher at FDA); views about the potential for efficiency depend on the situation and implementation. Participants also frequently mentioned a need for greater education within the academic community. Finally, the empiric, non-quantitative selection of treatments for phase III trials based on limited phase II trials was highlighted as an opportunity for improvement and a potential explanation for the high number of neutral confirmatory trials.Conclusions: These data show considerable variations in attitudes and beliefs about ACTs among trial community representatives. For adaptive trials to be fully considered when appropriate and for the research enterprise to realize the full potential of adaptive designs will likely require extensive experience and trust building within the trial community. [ABSTRACT FROM AUTHOR]

Context There exists a disparity between the views of physicians and the views of their patients on end-of-life decisions. However, the timing of when the end-of-life preferences of physicians and non-medically-trained individuals diverge is currently unknown. The objective of this paper is to characterise how preferences for medical interventions change throughout medical education and residency or fellowship training when confronted with scenarios of critical or terminal illness. Methods This is a single-centre cross-sectional study that enrolled medical students at Sidney Kimmel Medical College and residents and fellows at Thomas Jefferson University Hospital. Through an online survey we determined the preferences of medical trainees for specific interventions throughout medical training when presented with different clinical scenarios. Interventions were organised into three categories: standard, intermediate and aggressive. We analysed responses to questions regarding different scenarios in separate repeated measures logistic regression models. The probability of declining medical interventions was modelled, and significant predictors of refusal of interventions were identified. Results Years of training was a significant predictor of declining interventions for several scenarios. When faced with permanent physical disability, increased years of training led to a higher rate of refusal of intermediate ( OR = 1.14 [1.02-1.28], p = 0.02) and aggressive interventions ( OR = 1.15 [1.03-1.28], p = 0.01). For the scenario of terminal illness with associated physical disability, years of training significantly influenced refusal of intermediate ( OR = 1.14 [1.04-1.26], p = 0.006) and aggressive ( OR = 1.20 [1.08-1.34], p = 0.001) interventions. For the scenario of permanent cognitive impairment, increased years of training led to a higher rate of refusal of standard ( OR = 1.14 [1.01-1.29], p = 0.03), intermediate ( OR = 1.30 [1.13-1.50], p < 0.001) and aggressive ( OR = 1.38 [1.14-1.66], p = 0.001) interventions. Conclusion Changes in end-of-life preferences occur throughout medical training. Years of training influenced the likelihood of declining medical interventions when faced with scenarios of terminal illness and physical or cognitive disability. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients.Design/methodology/approach: The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups.Findings: The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities.Research Limitations/implications: The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997).Practical Implications: With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers.Social Implications: The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider.Originality/value: Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as to what are effective and ineffective behaviors in healthcare. [ABSTRACT FROM AUTHOR]

When does Congress repeal laws enacted by prior generations? Although the substantial body of work on policy creation provides tentative explanations, we believe repeals represent an alternative way of examining the effects of congressional organization on legislative behavior. In this paper, we develop hypotheses based on both the conditional nature of party power and the location of pivot points, and test these hypotheses with a new data set of repeals from 1877 to 2012. We find that the largest effects on Congress’s capacity to repeal legislation are variation in the majority’s positive agenda control and shifts in the gridlock interval. We also find that when the majority claims control of both chambers after a long stretch in the minority, there is an increased likelihood of repeal beyond what is predicted by conditional party government alone. Because the partisan factors in our model have the largest substantive effects, and because repeals do not occur automatically in productive Congresses, we characterize repeals as long-term contests between two great “teams” over the location of the status quo. [ABSTRACT FROM AUTHOR]

Condorcet polling provides additional information about pairwise rankings often obscured in standard polls when there are three or more candidates. This paper analyzes an original dataset collected from Duke University students in North Carolina concerning the 2014 Senate race, wherein a Democrat, a Republican, and a Libertarian contested the election. The results illustrate that Condorcet polling is feasible in such a context, and that the information provided changes the strategic calculus of voters in ways that may have a positive impact on the way votes are cast and choices considered. [ABSTRACT FROM AUTHOR]

Career research has focused on the changing structures of careers, mainly in the private sector. Recent literature on employment patterns in the public sector suggests that career structures are evolving, gradually moving away from their signature traditional structures to contemporary ones. However, empirical evidence of this change is scarce and inconclusive. This qualitative study examines the changes currently unfolding in the career structure of the civil service by eliciting the experiences and views of senior Foreign Offices (FOs) staff in four countries: 198 state ambassadors from the United States, the United Kingdom, Israel, and Denmark were interviewed about their career trajectories. The data were analyzed using a thematic analysis framework. The findings revealed a gradual breakdown of the structures and policies that support traditional careers, and the emergence of new principles and practices that characterize contemporary careers. However, as they were captured midway through the process of change, all FOs display a combination of traditional and contemporary career structures at this point. The findings offer unique insights into the drivers of this evolution and highlight some of the consequences. [ABSTRACT FROM AUTHOR]

Successfully incorporating social determinants of health (SDH) screening into clinic workflows can help care teams provide targeted care, appropriate referrals, and other interventions to address patients' social risk factors. However, integrating SDH screening into clinical routines is known to be challenging. To achieve widespread adoption of SDH screening, we need to better understand the factors that can facilitate or hinder implementation of effective, sustainable SDH processes. The authors interviewed 43 health care staff and professionals at 8 safety net community health center (CHC) organizations in 5 states across the United States; these CHCs had adopted electronic health record (EHR)-based SDH screening without any external implementation support. Interviewees included staff in administrative, quality improvement, informatics, front desk, and clinical roles (providers, nurses, behavioral health staff), and community health workers. Interviews focused on how each organization integrated EHR-based SDH screening into clinic workflows, and factors that affected adoption of this practice change. Factors that facilitated effective integration of EHR-based SDH screening were: (1) external incentives and motivators that prompted introduction of this screening (eg, grant requirements, encouragement from professional associations); (2) presence of an SDH screening advocate; and (3) maintaining flexibility with regard to workflow approaches to optimally align them with clinic needs, interests, and resources. Results suggest that it is possible to purposefully create an environment conducive to successfully implementing EHR-based SDH screening. Approaching the task of implementing SDH screening into clinic workflows as understanding the interplay of context-dependent factors, rather than following a step-by-step process, may be critical to success in primary care settings. [ABSTRACT FROM AUTHOR]

Building on intersectional awareness literature, this paper examines how another individual difference regarding one's perception of identity intersections — bicultural identity conflict (BII-C)— predicts immigrants' interpretations of their social environment and general orientation to take action to support immigrants from one's heritage group (GOA-I). While previous research has shown that BII-C, or perceived conflict (vs. harmony) between multiple cultural identities, is related to negative intergroup outcomes, we extend this research to examine how BII-C relates to social change actions that promote a more equitable society. An experimental study with 165 first- and second-generation immigrants living in the United States found support for a moderated mediation model. BII-C moderated the relationship between discrimination and the degree to which participants attributed discrimination to societal factors. These attributions were associated with GOA-I. Future research should consider additional individual differences, beyond intersectional awareness and BII-C, to see how these orientations may also act as a lens through which people interpret their social environment and are willing to take action to change it. [ABSTRACT FROM AUTHOR]

Background: Substance use disorders (SUDs) in the United States cause many preventable deaths each year. Finding effective ways to manage SUDs is vital to improving outcomes for individuals seeking treatment. This has increased interest in using e-health technologies in behavioral healthcare settings. This research is part of a larger study evaluating the efficacy of the NIATx coaching intervention for implementing RISE Iowa, an e-health patient recovery app, in SUD treatment organizations and seeks to examine clinician perspectives of the barriers and facilitators to its implementation. Method: Semi-structured qualitative interviews were conducted with 13 clinicians from 9 different intervention sites involved in the study. Results: Major barriers to implementing e-health technology include inability to access the technology, lack of time for both patients and clinicians, and a perceived lack of patient motivation to make changes. Facilitators to implementation include collaboration with other staff using e-health technology and integrating technology use into typical workflows. Conclusions: Implementation of e-health technology in SUD treatment will require integrating the technology into clinical workflows and improving patient access to the technology. [ABSTRACT FROM AUTHOR]

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]

This paper reports on research into undergraduate students' engagement with university library social media. Social media (SM) applications enable university libraries to reach users in ways that may better meet their needs and preferences, but evidence suggests that undergraduate students' engagement with library social media is limited. This raises the question of whether libraries have a good understanding of student preferences for library SM content and approaches and whether students want to engage with the library at all through SM applications. This research aimed to identify if, how and why undergraduate students in select Nigerian universities engage with their library's SM through a questionnaire survey drawing on the Elaboration Likelihood Model (ELM) of persuasive communication. The results indicate that most students are unaware of university library SM posts. Those who are aware prefer content related to events and happenings on campus as well as news about library service developments. Results of the multiple regression reveal that students attach importance to the content of SM posts suggesting that the university library may still be able to reach them through social media for more meaningful interactions. Recommendations for the management of the content and approach to SM communications for university libraries are provided. [ABSTRACT FROM AUTHOR]

This paper tests core tenets of the theory of African-American offending proposed by Unnever and Gabbidon. Their theory posits that African-Americans have a common worldview on matters of race that is related to their offending. However, Unnever and Gabbidon further hypothesize that immigrant blacks do not fully embrace the worldview shared by US-born blacks. Using a 2008 national Gallup poll, we examine whether US-born blacks share a common worldview and whether foreign-born blacks differ in their opinions on key issues including: criminal injustices, the state of American race relations, attitudes towards immigration and illegal immigrants, and the perception of mobility within American society. The results partially confirm their two key hypotheses; there are no entrenched differences in the public opinions of US-born blacks on race-related matters while immigrant blacks do not wholly endorse their worldview. We discuss the implications of these two findings in relation to how scholars conceptualize offending among blacks. [ABSTRACT FROM PUBLISHER]

The most recent internationally widespread disease outbreak occurred during the flu season of 2009 and 2010. On April 2009, the first cases of influenza A (H1N1) (Popularly called, Swine Flu) were confirmed in the USA and UK following a novel virus that was first identified in Mexico. As the virus spread rapidly, the risk of morbidity and mortality increased in several countries. In this paper, we rely on the social cognitive theory of risk to assess the willingness of the US public to comply with vaccination and reduce the risk of sickness and death from the flu. We conduct a secondary data analysis of the Pew Research for the People and Press October 2009 and investigate the factors associated with willingness to take the swine flu vaccine (n = 1000). The findings indicate that the decision to take the swine flu vaccination was highly polarized across partisan lines. Controlling for education, income and demographic factors, the likelihood of taking the vaccine was associated with party identification. Individuals that identified themselves as Democrats were more likely to be willing to take the swine vaccine than individuals that identify themselves as Republicans and Independents. Confidence in the ability of the government to deal with the swine flu crisis seems to explain party identification differences in the willingness to take the vaccine. The implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

International social work (ISW) has gained traction across the USA with a number of schools taking the lead in promoting the values of social work through exchange programs, service learning, and volunteerism. The internalization of campus through the proactive action of institutions to incorporate global perspectives into teaching, learning, and research in order to build intercultural competence among students, faculty, and staff has received little attention. This paper assesses the level of interest of social work students at a large urban university in the southwestern USA in embracing ISW and how they conceptualized their learning needs. Using a self-administered web-based survey offered to a total of 1,500 social work students with 18% respondent rate, the research determined through a chi-square test that students in Bachelor of Social Work, Master of Social Work, and PhD programs had a significant difference in preferences in areas of interests (χ2 = 153,p ≤ 0.000). Overall, students demonstrated interest in direct practice (74.3%) and community and administrative practice (16.6%). Students also differed in their level of interest in participating in international exchange programs (χ2 = 9.6,p = 0.047). Discussions address specific and unique interests categorized broadly as ‘globalized social worker,’ ‘humanitarian social worker,’ and ‘policy social worker,’ each of which requires specific skillsets and advanced behavior skills. [ABSTRACT FROM PUBLISHER]

In this paper, we provide one of the first systematic analyses of gender's effect on trade attitudes. We draw on a unique representative national survey of American workers that allows us to evaluate a variety of potential explanations for gender differences in attitudes toward free trade and open markets more generally. We find that existing explanations for the gender gap, most notably differences between men and women in economic knowledge and differing material self-interests, do not explain the gap. Rather, the gender difference in trade preferences and attitudes about open markets is due to less favorable attitudes toward competition among women, less willingness to relocate for jobs among women, and more isolationist non-economic foreign policy attitudes among women. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to investigate cultural variations in the qualities that White Americans and Hispanic Americans believe power-holders should embody, and the situations in which these norms influence consumer satisfaction. Design/methodology/approach – Two experimental studies (n1=130 and n2=121) and one field study (n=241) were conducted with White American and Hispanic participants. Results were analysed using ANOVA and regression. Findings – White Americans are predisposed to apply to power-holders injunctive norms of treating others justly and equitably, whereas Hispanics are predisposed to apply injunctive norms of treating others compassionately. These cultural variations in the use of injunctive norms were more evident in business or service contexts in which power was made salient, and emerged in the norms more likely to be endorsed by White American and Hispanic participants (Study 1), their approval of hypothetical negotiators who treated suppliers equitably or compassionately (Study 2), and their evaluations of powerful service providers in a real-life, on-going and consequential interaction (Study 3). Research limitations/implications – This research suggests key implications for our theoretical understanding of the role of social norms in carrying cultural patterns, as well as for cross-cultural theories of consumer satisfaction with service providers. Practical implications – Marketers should pay attention to signals of fairness (compassion) in their services, as perceptions of fairness (compassion) by White American (Hispanic) consumers can boost satisfaction ratings. This is particularly important in service encounters that might be characterized by power differentials, such as those in health care and financial services. Originality/value – As consumer markets grow more culturally diverse, it is important for marketers to understand how distinct notions of power impact the attitudes and behaviors of consumers from different cultures. This research investigates the implications of distinct power concepts for multi-cultural consumers’ evaluations of service providers, an important and under-researched area with implications for global service management. [ABSTRACT FROM AUTHOR]

This article presents emerging findings from the first year of a two-year study, which employed ethnographic methods to explore the culture of interprofessional collaboration (IPC) and family member involvement in eight North American intensive care units (ICUs). The study utilized a comparative ethnographic approach - gathering observation, interview and documentary data relating to the behaviors and attitudes of healthcare providers and family members across several sites. In total, 504 hours of ICU-based observational data were gathered over a 12-month period in four ICUs based in two US cities. In addition, 56 semi-structured interviews were undertaken with a range of ICU staff (e.g. nurses, doctors and pharmacists) and family members. Documentary data (e.g. clinical guidelines and unit policies) were also collected to help develop an insight into how the different sites engaged organizationally with IPC and family member involvement. Directed content analysis enabled the identification and categorization of major themes within the data. An interprofessional conceptual framework was utilized to help frame the coding for the analysis. The preliminary findings presented in this paper illuminate a number of issues related to the nature of IPC and family member involvement within an ICU context. These findings are discussed in relation to the wider interprofessional and health services literature. [ABSTRACT FROM AUTHOR]

Background A growing number of smokers support smoke-free laws. The theory of self-control provides one possible explanation for why smokers support laws that would restrict their own behaviour: the laws could serve as a self-control device for smokers who are trying to quit. Objective To test the hypothesis that support for smoke-free laws predicts smoking cessation. Methods We used longitudinal data (1999-2000) from a US national sample of adult smokers (n=6415) from the Current Population Survey, Tobacco Use Supplements. At baseline, smokers were asked whether they made a quit attempt in the past year. They were also asked whether they thought smoking should not be allowed in hospitals, indoor sporting events, indoor shopping malls, indoor work areas, restaurants, or bars and cocktail lounges. At 1-year follow-up, smokers were asked whether they had quit smoking. Findings Smokers who supported smoke-free laws were more likely to have made a recent quit attempt. At 1-year follow-up, those who supported smoke-free laws in 4-6 venues were more likely to have quit smoking (14.8%) than smokers who supported smoke-free laws in 1-3 venues (10.6%) or smokers who supported smoke-free laws in none of the venues (8.0%). These differences were statistically significant in multivariate analyses controlling for demographics. Conclusions Support for smoke-free laws among smokers correlates with past quit attempts and predicts future quitting. These findings are consistent with the hypothesis that some smokers support smoke-free laws because the laws could help them quit smoking. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to contribute to assertiveness research and assess the differences in assertiveness as it relates to gender, national culture, and ethnicity. Design/methodology/approach -- The data for the study are from 231 undergraduate students majoring in business at one of four academic institutions: three in the USA and one in the Republic of Vietnam. Students completed the 30-item Rathus Assertiveness Schedule. Findings -- This research suggests that individuals who are alike in level of education and status demonstrate similar levels of assertiveness, regardless of gender, national culture, or ethnicity. However, differences were seen as the data show white American males to be the most assertive, with African American females next. White females ranked third, followed by Vietnamese females, concluding with Vietnamese males. Research limitations/implications -- Although the sample size is small, the intent of this research was never to have the subjects represent the general population in terms of the variables used. Instead, the authors attempted to control for gender, culture, and ethnicity variables by using a sample of college students who were similar in relation to education and social status. Future research could more fully research the findings from this study which suggest that African American women are more assertive than all other groups with the exception of white males. Originality/value -- This study also gives credence to the suggestion that the global manager, in order to become more effective, needs to fully understand employee differences as represented by gender, national culture, and ethnicity. [ABSTRACT FROM AUTHOR]

Elected leaders delegate rulemaking to federal agencies, then seek to influence rulemaking through top-down directives and statutory deadlines. This paper documents an unintended consequence of these control strategies: they reduce regulatory agencies' ability and incentive to conduct high-quality economic analysis to inform their decisions. Using scoring data that measure the quality of regulatory impact analysis, we find that hastily adopted 'interim final' regulations reflecting signature policy priorities of the two most recent presidential administrations were accompanied by significantly lower quality economic analysis. Interim final homeland security regulations adopted during the G.W. Bush administration and interim final regulations implementing the Affordable Care Act in the Obama administration were accompanied by less thorough analysis than other 'economically significant' regulations (regulations with benefits, costs, or other economic impacts exceeding $100 million annually). The lower quality analysis apparently stems from the confluence of presidential priorities and very tight statutory deadlines associated with interim final regulations, rather than either factor alone. [ABSTRACT FROM AUTHOR]

Wildland fire affects both public and private resources throughout the United States. A century of fire suppression has contributed to changing ecological conditions and accumulated fuel loads. Managers have used a variety of approaches to address these conditions and reduce the likelihood of wildland fires that may result in adverse ecological impacts and threaten communities. Public acceptance is a critical component of developing and implementing successful management programs. This study examines the factors that influence citizen support for agency fuel reduction treatments over time-particularly prescribed fire and mechanical vegetation removal. This paper presents findings from a longitudinal study examining resident beliefs and attitudes regarding fire management and fuels treatments in seven states: Arizona, Colorado, Oregon, Utah, Michigan, Minnesota, and Wisconsin. The study was implemented in two phases over a 6-year period using mail surveys to residents of communities adjacent to federal lands in each location. Questions replicated measures from the original project as well as some new items to allow a more in-depth analysis of key concepts. The study design enables comparisons over time as well as between locations. We also assess the factors that influence acceptance of both prescribed fire and mechanical vegetation removal. Findings demonstrate a relative stability of attitudes toward fuels management approaches over time and suggest that this acceptance is strongly influenced by confidence in resource managers and beliefs that the treatments would result in positive outcomes. [ABSTRACT FROM AUTHOR]

The civil war in Somalia forced many Somalis to migrate to other countries where they had to adapt to new cultures and learn new languages. At the same time, they retained the identity and culture that were important to them throughout the process of migration. These first-generation Somali immigrants may feel strong allegiance to their country of origin along with a “sense of belonging” to their clan/kinship. They may also hope that one day they will be able to return “home”. But do second-generation Somalis feel the same way? This paper is based on 23 interviews with Somali immigrants in Australia, the UK and the USA. Out of the 23 participants, two were first-generation and the rest were second-generation. I seek to understand the participants' identity and their sense of belonging to their ethnicity and host country in the wake of pertinent moments of local, national and international anxiety. [ABSTRACT FROM PUBLISHER]

Previous research has shown that racial or ethnic prejudice is one of the most influential antecedents of opposition to more expansive immigration policies. In this paper, we explore whether a theoretical perspective derived from the group position model might represent an additional and complementary explanation for immigration attitudes. We also compare how well the prejudice and group position models explain immigration attitudes among both White and Black Americans. Most of the previous work in this literature focuses solely on Whites’ attitudes, and it remains unclear how well models designed with this group in mind might also apply to African Americans. We rely upon the 2004–2005 National Politics Study to explore the power of these models. In general, we find that measures derived from the group position model account for immigration attitudes even after controlling for various forms of out-group prejudice. The pattern of results also differs considerably across the two racial groups in our study. [ABSTRACT FROM PUBLISHER]

Purpose: This paper investigates consumer attitudes and behavioural intentions related to direct-to-consumer advertising (DTCA) as influenced by the health locus of control and selfefficacy of the consumer. This study examines how consumers' health locus of control and selfefficacy influence their attitude toward a pharmaceutical advertisement and their subsequent intention to obtain a medical prescription. Design/methodology/approach: Using ordinary least squares and Chronbach's alpha, this study measures the attitude towards advertisement and side effects of drugs in advertising. 128 responses of individuals who are in good health comprised the sample size. Findings: The results indicate that attitude toward the advertisement for both benefits and side effects of the DTCA for a specific prescription drug was a determinant in the intentions to seek medical advice. Results also show a strong correlation between HLOC and attitude toward the ad in both benefits and side effects; however, self-efficacy was not significantly correlated to attitude toward the advertisement. Practical/social implications: Pharmaceutical advertisers can adjust and alter ads based on attitudes towards drug side effects. Further research can be done via focus groups and surveys to find what words or alterations may have a positive effect on these attitudes. Originality: This research is unique in that there are no prior studies that examine consumer attitudes toward drug side effects using the General Self Efficacy Scale. [ABSTRACT FROM AUTHOR]

Objective: To determine factors and barriers associated with scholarly activity among faculty members at urology residency programs in the United States.Methods: An online survey was sent to all 134 urology residency program directors. The survey assessed program characteristics including size, location and definition of scholarly activity. It assessed available support for and barriers to resident scholarly activity, faculty participation in scholarly activity and mentorship of residents. Linear regression analysis was used.Results: We had a 40% response rate (N = 40). Faculty attitudes toward conducting scholarly activity (P < .001) and lack of a research curriculum (P = .05) were barriers to the outcome 'participation in scholarly activity'. Faculty attitudes toward conducting scholarly activity was also a barrier to the outcomes 'mentorship of residents' (P = .004) and 'publication of at least 1 paper' (P = .004). Available statistician was positively associated with the outcomes 'publications' (P = .062) and 'presentations' (P = .032). A minimum requirement of a local presentation (P=0.04) and chairman support (P = .015) were positively associated with the outcome 'presentation at a conference.'Conclusion: Training residents in research matters for the resident, the institution and future generations of surgeon scientists. Higher levels of faculty scholarly activity were associated with a minimum requirement for residents to submit a manuscript for publication, strong chairman support for resident research, and the availability of a statistician. A common barrier to faculty scholarly activity, publications, and resident mentorship was faculty attitudes toward resident scholarly activity. Urology residency programs seeking to prioritize scholarly activity among faculty should consider these factors. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of microlaryngeal teaching course in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology residency programs in an effort to evaluate the nature, perceived value and barriers to implementation of microlaryngeal courses. Method: A 14-question survey to all ACGME-accredited otolaryngology programs in the United States. Result: Out of 119 ACGME-accredited otolaryngology programs identified on the ACGME Fellowship and Residency Electronic Interactive Database, responses were received from 67 programs (56%). Although 90% of respondents indicated that instruction courses in one discipline or another existed at their institution for their otolaryngology residents, only 33% indicated that their program offers a hands-on instruction course in microlaryngeal surgery. Of those programs that offered a microlaryngeal surgery course, 100% felt the residents appreciated the course; 95% of those programs that did not have a course felt their residents would appreciate a microlaryngeal course at their institution if they were able to offer one. Among programs without a microlaryngeal teaching course, the largest perceived barriers were cost and availability of appropriate equipment. Conclusion: Microlaryngeal courses for otolaryngology residency training are limited in availability in the United States, and there is variability in training across the country. All respondents in our survey indicated the value in these courses for microlaryngeal surgical skill training. There is a clear role for increasing availability of low-cost microlaryngeal stations and courses. [ABSTRACT FROM AUTHOR]

The present paper examines the link between language and cultural identity by exploring the language-related attitudes, policies and ideologies as reflected in the written records of the U.S. Federal Congress from 1789 until roughly the end of the “Second War of Independence” in 1815. The results are compared and contrasted with the findings of a previous study which examined the founding documents of the United States from a similar perspective. The most salient language policy development of the post-1789 period is the overall shift from the symbolic, general language-related remarks towards the formulation of more substantive and general policies. [ABSTRACT FROM AUTHOR]

Vaccine hesitancy has, for a considerable time, been a significant risk to global health. As an integral part of disease prevention, vaccines have become a public health matter which is often debated among the community in spite of proven scientific evidence of their efficiency. A questionnaire was designed to evaluate the perception and knowledge of a population and compare it with behavior in order to assess a demographic within a sample population of 245 individuals selected at random within the United States, Here, we aim to clarify the difference between vaccine opinion among the general public as compared to vaccination status. Chi-squared analysis was done with the categorical data showing a statistically significant result when comparing parents versus non-parents, and Asian/Asian Americans against other ethnicities. All other comparisons were statistically insignificant. When looking at participant responses, PCPs did not discuss vaccines at all with 32% of the sample. The need for PCPs to provide educational information to certain ethnicities may play an important role in public health. [ABSTRACT FROM AUTHOR]

Prior work on Muslims' mental health help-seeking factors has emphasised their rejection attitudes, religious and cultural beliefs, and familiarity with mental health. However, no research has examined differences in these factors across different Muslim ethnic groups, and particularly among Muslim women. A sample of 1214 Muslim women living in the USA completed online questionnaires. Data was stratified based on history of mental health visits to control for previous service utilisation. MANOVAs assessed ethnic group differences in beliefs, familiarity, and rejection attitudes toward professional mental healthcare. Results revealed significant differences between ethnic groups in all three factors; these differences depended on the women's history of service utilisation. Findings suggest that barriers to accessing professional mental healthcare differ among Muslim ethnic groups. Results are discussed in light of clinical implications and other contributing factors to the underutilisation of professional mental healthcare among ethnically diverse American Muslim women. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to assess the knowledge, attitudes, and awareness of pharmacy students toward marijuana use. Methods: Pharmacy students were asked to complete a survey that assess students' knowledge, attitudes, and awareness toward marijuana use. This study also compared students' awareness about the harmful effects of marijuana in comparing with alcohol and smoking tobacco. Participants were asked about the possibilities of marijuana-induced cancer and addiction. Results: Twenty-three percent of pharmacy students reported having used marijuana at some point in their lives. In comparison with tobacco and alcohol, most of the students agreed that tobacco (49%) and alcohol (42%) are more harmful than marijuana (P <.0001). More than sixty percent of students considered marijuana as an addictive substance (P <.02). A 45% of students opposed the possibility of marijuana-induced cancer. Thirty-six percent of the students agreed that marijuana should be legalized for both medical and recreational use with a similar percentage of the students (30 – 32%) believed that marijuana should be legalized for medical use only. Conclusion: With the prevalence of marijuana use and discrepancy among pharmacy students' responses regarding knowledge, attitudes, and awareness pharmacy schools need to adopt educational activities about the benefits and risks of marijuana. [ABSTRACT FROM AUTHOR]

Doula care improves maternal care, yet barriers exist to incorporating doula care. The purpose of this study was to evaluate interest and barriers to doula care. Overall, 508 women, 26–35 years of age (54.5%), White/Caucasian (89.8%), and married (88.6%), completed this study. Most reported ≥1 previous birth (97.6%). Respondents would "feel comfortable" (73.2%) and "more confident" (54.9%) with doula care at birth, and 57.9% reported their provider would be supportive of doula care. Only 39.0% expressed benefits to doula care during pregnancy compared to 72.6% at birth and 68.1% during postpartum. Most would hire a doula if health insurance covered some of the costs. Despite the recognized benefits and support of doula care, cost-associated barriers exist to the incorporation of doula care. [ABSTRACT FROM AUTHOR]

According to data analyzed from the Gallup Daily Tracking Politics and Economy survey between 2015 and 2017, nearly half (46.7%) of LGBT adults in the U.S. are religious, and just over half (53.3%) of LGBT adults are not religious. The majority who identified as religious attend Protestant churches. The Pentecostal church is a member of the Protestant Christian tradition. In a Constructivist Grounded Theory study of six U.S. gay male, Pentecostal Christians, our study excavates and chronicles their journey toward wholeness. Three major themes emerged from our study: embracing the journey, belonging to a community, and living unapologetically. From these themes, we learned that wholeness becomes possible when gay male Christians can form identities that are uniquely and holistically their own. We used these themes as a clarion call for clinicians who engage with clients encountering a conflict between their religious/spiritual tradition and their sexual orientation to actively assist their clients with reducing the dissonance they experience. [ABSTRACT FROM AUTHOR]