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Background: Caregivers to intensive care unit survivors are vulnerable to caregiver burden, which has been demonstrated to have consequences to patients' and caregivers' mental and physical health. Potentially modifiable factors should be explored so that interventions may be developed. Methods: Ninety-one anticipated caregivers were prospectively assessed both at a southwestern trauma intensive care unit during their patient's admission and at home via remote interview 3 months after intensive care unit admission. Caregiver depression, posttraumatic stress symptoms, experiences, and perceived burden were assessed. Results: At follow up, there was a significant negative correlation between caregiver burden and understanding of their patient's condition (P < 0.001) and intensive care unit events (P = 0.008). Caregivers with lower understanding of their patient's injury/illness had significantly greater depressive symptoms (P = 0.04). Conclusions: Education and knowledge of intensive care unit events regarding their patient may influence perceived burden among caregivers. Interventions to orient caregivers to intensive care unit events are suggested to reduce caregiver and healthcare system burden. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic has had a significant impact on mental health, and individuals with certain preexisting morbidities—such as obesity—may have disproportionately experienced pandemic-related stress. We aimed to examine whether being obese or overweight was associated with worse mood and trauma among those infected with COVID-19. Methods: Data were collected as part of a larger longitudinal survey study (n = 591) examining the psychological impact of COVID-19. Complete baseline data for those who reported testing positive from April 2020 through June 2021 were examined. Results and conclusions: Body mass index was correlated with depression (r = 0.13, P <.01) and generalized anxiety disorder (r = 0.10, P =.02), but not with posttraumatic stress disorder (r = 0.06, P =.16). Multivariable analyses revealed that body mass index was no longer a unique predictor, except for those with a body mass index >40 kg/m2, suggesting that other sociodemographic factors, not obesity, were driving mood symptoms for those infected with COVID-19. [ABSTRACT FROM AUTHOR]

Adapt and validate the Mayo Leadership Impact Index (MLII) for settings with matrixed leadership structures. Design: A psychometric validation study utilizing classical test theory and item response theory. Setting: A tripartite hospital system in the southwestern US. Participants: Physician-respondents to a 2023 cross-sectional survey. Main Outcomes and Measures: After pilot testing, the adapted MLII was examined using a unidimensional graded response model and confirmatory factor analyses. Convergent validity was investigated via correlations with professional fulfillment, perceived autonomy support, self-valuation, and peer connectedness/respect. Divergent validity was tested via correlations with burnout. Results: Of the three candidate revisions of the MLII, the 9-item adaptation was selected for its superior validity/reliability indices. Standardized Cronbach's and Ordinal alpha coefficients were 0.958 and 0.973, respectively. CFA loadings exceeded 0.70 (p < 0.001), and coefficients of variation (R2) exceeded 0.60 for all items. GRM slope parameters indicated "high" to "very high" item discrimination. Items 2, 5, and 8 were the most informative. Positive correlations of the adapted MLII with professional fulfillment, perceived autonomy support, and peer connectedness/respect were observed, supporting convergent validity. Negative correlation with overall burnout supports divergent validity. Conclusions and Relevance: The findings provide evidence of the adapted MLII's validity, reliability, and appropriateness for implementation within matrixed leadership settings. Prior to this study, no leadership support measure had been validated for use among the growing number of healthcare systems with matrixed leadership reporting structures. Plain Language Summary: Question : What is the validity and reliability of a well-being centered leadership measure adapted for use in healthcare systems with matrixed, multiform reporting structures? Findings : Classical test theory and item response theory analyses of cross-sectional survey data from 158 physician-respondents supported the adapted measure's construct validity. All reliability coefficients were strong. Leadership ratings positively correlated with professional fulfillment, autonomy support, self-valuation, and peer connectedness/respect, and negatively correlated with burnout. Meaning : Findings support the adapted measure's validity and reliability. This study is the first to demonstrate a valid empirical measure of well-being centered leadership behaviors in settings with multiform, matrixed leadership structures. [ABSTRACT FROM AUTHOR]

To examine health-related self-efficacy for individuals following acquired brain or spinal cord injury prior to enrollment in a weight-loss intervention and associations with demographics, injury characteristics, and additional physiologic variables. Cross-sectional analysis of baseline data for community-dwelling adults following stroke (CVA), traumatic brain injury (TBI), or spinal cord injury (SCI) across three disability-adapted weight-loss interventions. Overall results suggest a significant difference between injury type and self-efficacy as measured by the Self Rated Abilities for Health Practices (SRAHP) scale. On average, individuals with SCI had the lowest overall perceived self-efficacy of the three groups (11.2-unit difference; (CI: −17.4, −5.0), followed by those with TBI (9.5-unit difference; (CI: −16.7, −2.4). There were also differences between groups in age, number of household members, time since injury, sex, race, marital status, physiological measures, and employment status. Results suggest that individuals with different disabilities following neurological injuries have different baseline perceptions in their ability to eat a healthy diet and exercise regularly. Health interventions should be tailored for these groups based on disability-specific barriers and should include components to enhance health-related self-efficacy to address weight management among these populations. Evidence suggests that health-related self-efficacy may differ following different injury types and level of disability may impact one's ability to maintain health-related behaviors Results suggest that individuals with a spinal cord injury may have different baseline perceptions of self-efficacy related to their ability to eat a healthy diet and exercise regularly compared to those with a traumatic brain injury or stroke. Health interventions should be tailored to encompass disability-specific barriers which may impact an individual's health-related self-efficacy. [ABSTRACT FROM AUTHOR]

Objective: The authors assessed changes in state insurance laws related to coverage for substance use disorder treatment across public and private insurance sectors from 2006 through 2020 in all 50 U.S. states. Methods: Structured policy surveillance methods, including a coding protocol with duplicate coding and quality controls, were used to track changes in state laws during the 2006–2020 period. The legal database Westlaw was used to identify relevant statutes within each state's commercial insurance (large group, small group, and individual), state employee health benefits, and Medicaid codes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definition of substance use disorders, and enforcement and compliance. Scores were calculated to reflect the comprehensiveness of states' laws and to interpret changes in scores over time. Results: Comprehensiveness scores across all sectors (on a 0–9 scale) increased, on average, from 1.47 in 2006 to 2.84 in 2020. In 2006, mean scores ranged from 0.47 (state employee sector) to 2.80 (large-group sector) and in 2020, from 1.22 (state employee) to 4.26 (large group). Conclusions: Comprehensiveness of state insurance laws in relation to substance use disorder treatment improved across all insurance sectors in 2006–2020. The State Substance Use Disorder Insurance Laws Database created in this study will aid future legal epidemiology studies in assessing the cumulative effects of parity-related insurance laws on outcomes of substance use disorder treatments. [ABSTRACT FROM AUTHOR]

Objective: The transition to college is marked by poorer eating behaviors, making emerging adulthood a particularly salient intervention point for improving lifelong health. The present study aims to better understand what psychosocial factors predict eating behaviors of college students using the Theory of Planned Behavior (TPB). Participants & Methods: Dietary recalls were analyzed the Healthy Eating Index (HEI)-2015 scoring system for 67 university students between the ages of 18 and 25 (70.1% female; 49.3% White, 20.9% Black/African American, 13.4% Asian). Results: Haye's PROCESS Model 6 was used. The full model accounted for a significant amount of variance in HEI-2015 scores (F[3, 63] = 3.09, p =.033, R2 =.12). The final model suggested a significant indirect effect of PBC on the relation between ATT and HEI-2015 (β =.859, SE =.637, 95% CI [.009, 2.482]). Conclusions: Although some college students might have favorable attitudes, only those who believe this is within their control actually ate a (somewhat) healthier diet. [ABSTRACT FROM AUTHOR]

In 2020, the Office of Minority Health (OMH) funded the establishment of the National COVID-19 Resiliency Network (NCRN) to engage priority communities that included African American, American Indian, Alaska Native, Asian, Hispanic, Native Hawaiian, and Pacific Islander persons to aggregate culturally relevant messages, education tools, and national data sources. A mobile application and Web site supported a culturally sensitive, equity-focused communication and dissemination initiative to link communities to COVID-19 clinical, social, and behavioral health services to address health determinants. ( Am J Public Health . Published online ahead of print October 16, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307813).

Purpose/objective: Individuals with a spinal cord injury (SCI) may experience posttraumatic stress disorder (PTSD) at a higher rate, which is associated with worse psychiatric comorbidity, decreased quality of life, and greater disability. Yet, effective PTSD interventions remain understudied for individuals with SCI. We conducted the first randomized controlled trial (RCT) of an evidence-based psychotherapy (prolonged exposure [PE]) with survivors of SCI during acute rehabilitation. We examined the efficacy, feasibility, and secondary outcomes., Research Method/design: Participants ( n = 29) were adults recruited from 2018 to 2021 1-month postinjury with PTSD randomized into either PE therapy or treatment as usual. The primary outcome was PTSD assessed at baseline, 6, 10, and 32 weeks postenrollment., Results: An overall group-by-time interaction was not statistically significant ( p = .102), but effect sizes demonstrated moderate and large improvements in PTSD for the PE group at 6 (-19.4 vs. -9.7) and 10 (-25.8 vs. -5.7), respectively. Similarly, moderate to large effect sizes were observed for depression, maladaptive posttraumatic cognitions, disruptive nocturnal behaviors, SCI-related quality of life, and risky alcohol consumption. Low rates of enrollment (50%) and treatment completion (25%) suggest feasibility challenges; however, treatment completers did report high satisfaction (100%)., Conclusions/implications: Results suggest that individuals who received PE had a quicker and clinically meaningful reduction in PTSD symptoms, but delivery during acute rehabilitation is not feasible for many individuals. Future research should examine abbreviated versions of PE for PTSD to enhance the feasibility of treatment in this setting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: The COVID-19 pandemic has had a significant impact on mental health, and individuals with certain preexisting morbidities-such as obesity-may have disproportionately experienced pandemic-related stress. We aimed to examine whether being obese or overweight was associated with worse mood and trauma among those infected with COVID-19., Methods: Data were collected as part of a larger longitudinal survey study ( n  = 591) examining the psychological impact of COVID-19. Complete baseline data for those who reported testing positive from April 2020 through June 2021 were examined., Results and Conclusions: Body mass index was correlated with depression ( r  = 0.13, P  < .01) and generalized anxiety disorder ( r  = 0.10, P  = .02), but not with posttraumatic stress disorder ( r  = 0.06, P  = .16). Multivariable analyses revealed that body mass index was no longer a unique predictor, except for those with a body mass index >40 kg/m 2 , suggesting that other sociodemographic factors, not obesity, were driving mood symptoms for those infected with COVID-19., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Background: Caregivers to intensive care unit survivors are vulnerable to caregiver burden, which has been demonstrated to have consequences to patients' and caregivers' mental and physical health. Potentially modifiable factors should be explored so that interventions may be developed., Methods: Ninety-one anticipated caregivers were prospectively assessed both at a southwestern trauma intensive care unit during their patient's admission and at home via remote interview 3 months after intensive care unit admission. Caregiver depression, posttraumatic stress symptoms, experiences, and perceived burden were assessed., Results: At follow up, there was a significant negative correlation between caregiver burden and understanding of their patient's condition ( P  < 0.001) and intensive care unit events ( P  = 0.008). Caregivers with lower understanding of their patient's injury/illness had significantly greater depressive symptoms ( P  = 0.04)., Conclusions: Education and knowledge of intensive care unit events regarding their patient may influence perceived burden among caregivers. Interventions to orient caregivers to intensive care unit events are suggested to reduce caregiver and healthcare system burden., Competing Interests: The author reports no funding or conflicts of interest. The study was funded by the Collaborative Faculty Research Investment Program (CFRIP), sponsored jointly by Baylor Scott & White Health, Baylor University, and Baylor College of Medicine., (Copyright © 2024 Baylor University Medical Center.)

The objective of this study was to determine whether exposure to structural racism-related state laws is associated with cardiovascular health among a racially and ethnically diverse sample of US adults. Data were from the Database of Structural Racism-Related State Laws and the Behavioral Risk Factor Surveillance System (BRFSS). The sample included 958,019 BRFSS 2011 and 2013 respondents aged 18+ from all 50 US states. The exposure was a summary index of 22 state laws related to the criminal legal system, economics and labor, education, healthcare, housing, immigration, and political participation. The outcome was the American Heart Association's Life's Simple 7 (LS7), a summary index of seven cardiovascular health indicators. Linear regression models included fixed effects for year and state to control for time trends and unmeasured time-invariant state-level contextual factors. In the full sample, a one standard deviation increase in the structural racism state legal index was associated with a 0.06-unit decrease in the LS7 (b=-0.06; 95% CI:-0.09, 0.02; p=0.001), controlling for individual- and state-level covariates. Contrary to expectations, stratified models revealed no statistically significant differences by race and ethnicity in the association between the structural racism state legal index and the LS7., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

There is an unmet need for mental health policies that are culturally competent, engaging, and equitable for Black youth. This paper describes a youth-adult partnership advisory council approach to identify, assess, and measure the effectiveness of innovative policy solutions to promote Black youth mental health in Georgia.