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Background: The behavioral model of health service use identified health needs, service preferences (predispositions), and service availability (enabling factors) as important predictors, but research has not conceptualized consistently each type of influence nor identified their separate effects on use of substance abuse and mental health services or their value in predicting service outcomes. Objectives: To test hypotheses predicting use of substance abuse and mental health services and residential stability and evaluate peer specialists’ impact. Research Design: Randomized trial of peer support added to standard case management in VA-supported housing program (Housing and Urban Development-VA Supportive Housing program). Subjects: One hundred sixty-six dually diagnosed Veterans in Housing and Urban Development-VA Supportive Housing program in 2 cities. Measures: Average VA service episodes for substance abuse and mental illness; residential instability; preferences for alcohol, drug, and psychological services; extent of alcohol, drug, and psychological problems; availability of a peer specialist. Results: Self-assessed health needs, mediated by service preferences, and assignment to a peer specialist predicted use of VA behavioral health services and residential stability, as did chronic medical problems, sex, and race. Conclusions: The behavioral model identifies major predictors of health service use and residential stability, but must recognize the mediating role of service preferences, the differing effects of alcohol and drug use, the unique influences of social background, and the importance of clinical judgment in needs assessment. Service availability and residential stability can be increased by proactive efforts involving peer specialists even in a health care system that provides services without a financial barrier.

In sociology’s formative period between 1830 and 1930, evolutionary analysis organized much theorizing and research. This line of work ended abruptly in the 1920s but, over the last decades, has come back into the discipline somewhat piecemeal with the reintroduction of more sophisticated stage models of societal evolution, functional analysis, human ecological analysis, and other new lines of evolutionary inquiry outlined in this paper. Our goal is to demonstrate that revitalized paradigms of the past can still be useful with modest reconceptualization, while at the same time new intellectual movements in the other social sciences, especially economics and psychology, incorporating evolutionary ideas from biology provide sociology with an opportunity to develop its own approach to evolutionary analysis that avoids the problems that let to the demise of this line of inquiry in the 1920s, as well as the problems of other social sciences applying their more narrowly focus models to sociological problems. Indeed, sociology can become a leader in the social sciences in developing more sophisticated theoretical and methodological approaches to incorporating biology and evolutionary analysis into the social sciences. When presented in a new, more sophisticated guise, old approaches like functionalism, stage models of societal evolution, and ecological models can be seen as still having a great deal of explanatory power, while revealing a progressive and future orientation that should appeal to all contemporary sociologists. It is time, then, for sociology to remember its past in order to move into the future.

BackgroundYouth in communities with high rates of crime and low rates of collective efficacy are at risk of depression, substance abuse, and other types of delinquency.ObjectiveThis article presents a formative evaluation of an empowerment-oriented program intended to reduce depression and risky behaviors by improving social support, providing adult mentors, and facilitating prosocial action.MethodsQualitative interviews and observations are used to describe program delivery and a quantitative survey is used to identify correlates of program participation.FindingsQualitative data describe a systematic process of program engagement that supported individual and group empowerment. The analysis of quantitative survey results identifies an association of program participation with less depression and more self-esteem—with reduced feelings of loneliness as the mechanism of these effects—although without comparable patterns for substance abuse and other risky behaviors.ConclusionsEmpowerment-oriented programs that involve young people in supportive peer teams should be developed to help foster constructive social change.

The New Evolutionary Sociology offers a comprehensive review of the history of evolutionary analysis in sociology that demonstrates its present value ‘once old biases and prejudices are mitigated and, eventually, eliminated’ (p. 14). In the book’s first part, the authors highlight the prominence of evolution in the theorizing of sociology’s founders and the reaction against this approach when it was used to support ethnocentrism, racism, and fascism. The second part describes non-sociologists’ attempts to reconnect evolutionary biology and social science through sociobiology and evolutionary psychology. The book’s last part presents new evolutionary approaches within sociology, focusing primarily on comparative research with primates and a neurosociological explanation of the evolution of the human brain.

We combined survey, mobility, and infections data in greater Boston, MA to simulate the effects of racial disparities in the inclination to become vaccinated on continued infection rates and the attainment of herd immunity. The simulation projected marked inequities, with communities of color experiencing infection rates 3 times higher than predominantly White communities and reaching herd immunity 45 days later on average. Persuasion of individuals uncertain about vaccination was crucial to preventing the worst inequities but could only narrow them so far because 1/5th of Black and Latinx individuals said that they would never vaccinate. The results point to a need for well-crafted, compassionate messaging that reaches out to those most resistant to the vaccine.

Although peer specialists play an increasing role in mental health service delivery, little is known about the best program structures for maximizing effective service delivery. This study reports on qualitative data from a larger study on peer specialists working with veterans in a Veterans Affairs homelessness program who were dually diagnosed with substance abuse and mental health concerns. Peer specialists were trained to deliver a recovery support program that is carried out weekly over 9 months and includes 20 structured sessions using a workbook and 20 unstructured, individually planned sessions. A sample of 20 veterans who were in the program were interviewed, along with 8 case managers and 3 peer specialists involved with the program. Interview transcripts were coded for 3 elements of program structure: time, content, and delivery. Results show that the program structure allowed flexibility for individual needs and that the workbook sessions were useful. Veterans ascribed value to the peer specialist delivering the content, compared to working alone on the material. Deliberate use of unstructured time with the peer specialist was seen as reducing isolation, increasing community integration, and encouraging recovery activities. The weekly, dependable nature of the program was seen as highly positive, whereas the 9-month duration was seen as too short. All groups interviewed expressed satisfaction with the program, although the case managers reported some reservations related to supervision and boundaries. Results suggest that, compared to completely structured or unstructured approaches that are common for peer specialist services, a middle level of structure for peer specialist programs could be a useful alternative. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Despite long-standing prejudices against doing so, it is time for sociology to reconnect with its roots in biological and evolutionary thinking. Sociology emerged as a discipline when the notion of evolution was actively used in biology, geology, and emerging social sciences. Throughout the nineteenth century, many of the most prominent early European sociologists examined the social universe from an evolutionary perspective; and this perspective was borrowed in much of early American sociology in the last decades of the nineteenth century and in the first decades of the twentieth century. By the end of the second decade of the twentieth Century, however, evolutionary analysis was rapidly disappearing in sociology in the United States, and by the 1930s, it was pretty much dead. And for the remainder of the twentieth century, it was viewed with a great suspicion, especially evolutionary approaches that sought to incorporate ideas from biology into the field. Despite the revival of stage models of societal evolution and the emergence of new ecological approaches in the 1960s and 1970s, evolutionary ideas from biology were still rejected by most American sociologists though much of the twentieth century. In this paper, we first present the history of this rejection of evolutionary, with the goal of encouraging sociologists today to recognize the distortions and misrepresentations of Darwinian and Spencerian ideas that fueled intellectual prejudices for so many decades. These prejudices only get in the way of sociology in the twenty-first century, where biological ideas have begun to pervade the social sciences. Thus, American sociologists should now take stock and reconsider how much evolutionary and biological analysis can help sociology and, equally if not more important, how an informed evolutionary sociology can influence those in the other social sciences and even those in the biological sciences.

10567 Background: Asian Americans are the fastest-growing immigrant group in the U.S. As the oldest immigrant group on average, they are at heightened risk for cancer and other diseases. This study explored whether the risk is mitigated by the healthy immigrant effect (HIE), an epidemiological phenomenon that has been well documented among Latino immigrants. Evidence of a healthy immigrant effect among Asians as a whole or in specific Asian subgroups is limited, and almost none focus on the elderly with a cancer diagnosis. This original research study examines the evidence for an HIE in a large ethnically diverse sample of elderly persons with a cancer diagnosis. Methods: This is a retrospective observational study utilizing data collected across 14 regions of the U.S. SEER-Medicare Health Outcomes Survey (SEER-MHOS), a linked dataset sponsored by the NCI and the Center for Medicare & Medicaid Services. Logistic regression analyses were conducted to examine HIE among Asians in the aggregate and subgroups of Asians for smoking and body mass index (BMI), using survey language and ethnic concentration as proxies for nativity. Results: Asians, in the aggregate, had comparable social backgrounds and had better health behaviors (i.e., lower smoking and BMI) than non-Hispanic Whites. When Asians were disaggregated, Hawaiians and Japanese had higher smoking and obesity rates than Chinese. A protective effect was observed among Asians in the aggregate living in an ethnic enclave with lower smoking prevalence and lower BMI. Chinese respondents opting to complete surveys in their native language or living in ethnic enclaves were less likely to be overweight, but no significant associations were found in relation to their smoking. Conclusions: Support for a healthy immigrant effect was largely consistent for Asians in the aggregate with respect to both language and ethnic concentration, but support was mixed among subgroups of Chinese patients. The presence of the HIE suggests that the health status and needs of recent Asian immigrants seeking oncologic care may be different than Asians who have been in the U.S. longer. These findings suggest a need for community-based efforts to encourage preservation of a healthier living style observed among first-generation immigrants.

Peer specialists are individuals with mental illness and substance use disorders trained to use their experiences to help others with similar disorders. Evidence for the effectiveness of peer specialist services has been mixed in previous randomized trials using intent-to-treat analyses, possibly because of variation in the intensity of treatment delivered. This study, which was part of a larger randomized trial, assessed whether level of peer specialist engagement was associated with reliable positive change on measures of psychiatric symptoms and hope.The Reliable Change Index was used to compute whether veterans (N=140) achieved reliable positive change on standardized baseline-to-posttest assessments of psychiatric symptoms and hope. Logistic regression analyses were conducted to predict positive change in symptoms and hope by level of peer specialist engagement, with controls for relevant demographic factors, several baseline mental health and substance abuse measures, and service use during the study.Logistic regression models showed that veterans with higher peer specialist engagement were more likely than those in a control group to show reliable positive change in psychiatric symptoms but not in hope. Compared with the control group, those with lower peer specialist engagement did not show positive change on either measure. White veterans were less likely than those from minority groups to exhibit positive change in psychiatric symptoms.Results suggest that peer specialists can benefit those with mental illnesses and substance use disorders who engage in more frequent interactions. Studies are needed to further assess the circumstances under which peer specialists can be effective.

Evidence in support of the healthy immigrant effect (HIE) has been mixed and explanations for it divergent. Research on the HIE is reviewed and seven explanatory hypotheses are presented. Support f...

Objectives This study tested the impacts of peer specialists on housing stability, substance abuse, and mental health status for previously homeless Veterans with cooccurring mental health issues and substance abuse. Methods Veterans living in the US Housing and Urban Development-Veterans Administration Supported Housing (HUD-VASH) program were randomized to peer specialist services that worked independently from HUD-VASH case managers (ie, not part of a case manager/peer specialist dyad) and to treatment as usual that included case management services. Peer specialist services were community-based, using a structured curriculum for recovery with up to 40 weekly sessions. Standardized self-report measures were collected at 3 timepoints. The intent-to-treat analysis tested treatment effects using a generalized additive mixed-effects model that allows for different nonlinear relationships between outcomes and time for treatment and control groups. A secondary analysis was conducted for Veterans who received services from peer specialists that were adherent to the intervention protocol. Results Treated Veterans did not spend more days in housing compared with control Veterans during any part of the study at the 95% level of confidence. Veterans assigned to protocol adherent peer specialists showed greater housing stability between about 400 and 800 days postbaseline. Neither analysis detected significant effects for the behavioral health measures. Conclusions Some impact of peer specialist services was found for housing stability but not for behavioral health problems. Future studies may need more sensitive measures for early steps in recovery and may need longer time frames to effectively impact this highly challenged population.

Public health policy goals of engaging underserved communities and countries more effectively, with a diverse workforce, challenge adherence to a traditional health-care delivery model. Mixed methods were used to compare patient navigators and case managers after reorganising a traditional public health programme in a US state to improve services with patient navigators and holistic care. Findings indicate patient navigators’ value for diversifying the workforce and increasing engagement with diverse patients, but also reveal overlap with case managers in roles and orientations. Conclusions emphasise challenges of patient engagement, needs for flexibility in case manager and patient navigator roles, and the potential for workforce expansion.

Understanding consumer service preferences is important for recovery-oriented care.To test the influence of perceived service needs on importance attached to treatment for alcohol, drug, mental health, and physical health problems and identify the influence of service needs and preferences on service use.Formerly homeless dually diagnosed Veterans in supported housing were surveyed in three waves for 1 year, with measures of treatment interests, health problems, social support, clinician-assessed risk of housing loss, and sociodemographics. Multiple regression analysis was used to identify independent influences on preferences in each wave. Different health services at the VA were distinguished in administrative records and baseline predictors for services used throughout the project were identified with multiple regression analysis.Self-assessed problem severity was associated with the importance of treatment for alcohol, drug, mental health, and physical health problems. Social support also had some association with treatment interest for alcohol abuse, as did baseline clinician risk rating at the project's end. Preferences, but not perceived problem severity, predicted the use of the corresponding health services.The health beliefs model of service interests was supported, but more integrated service delivery models may be needed to strengthen the association of health needs with service use.

Peer specialists are individuals with behavioral disorders who complete training to use their experiences to help others with similar disorders. Recent analyses have suggested that greater engagement with peer specialist services is associated with fewer psychiatric symptoms. This study assessed predictors of engagement with peer specialist services.Using the Andersen model of health service utilization with a sample of veterans (N=71) receiving housing support, investigators constructed a negative binomial regression model to evaluate the association between peer specialist service engagement and the model's three factors assessed at baseline of a larger trial: predisposing (personal demographic and social variables); enabling (support variables), and need (perceived and evaluated health problems). Demographic characteristics and behavioral health service use six months before baseline were also predictors.Greater hope (predisposing), psychiatric symptoms (need), and service utilization significantly predicted greater peer specialist engagement.These results suggest subpopulations with whom peer specialists would be most likely to engage successfully, perhaps improving their efficiency.

Objectives Patterns and predictors of engagement in peer support services were examined among 50 previously homeless veterans with co-occurring mental health conditions and substance use histories receiving services from the Veterans Health Administration supported housing program. Method Veteran peer specialists were trained to deliver sessions focusing on mental health and substance use recovery to veterans for an intended 1-hr weekly contact over 9 months. Trajectories of peer engagement over the study's duration are summarized. A mixed-effects log-linear model of the rate of peer engagement is tested with three sets of covariates representing characteristics of the veterans. These sets were demographics, mental health and substance use status, and indicators of community participation and support. Results Data indicate that veterans engaged with peers about once per month rather than the intended once per week. However, frequency of contacts varied greatly. The best predictor of engagement was time, with most contacts occurring within the first 6 months. No other veteran characteristic was a statistically significant predictor of engagement. Older veterans tended to have higher rates of engagement with peer supporters. Conclusions and implications for practice Planners of peer support services could consider yardsticks of monthly services up to 6 months. Peer support services need a flexible strategy with varying levels of intensity according to need. Peer support services will need to be tailored to better engage younger veterans. Future research should consider other sources of variation in engagement with peer support such as characteristics of the peer supporters and service content and setting. (PsycINFO Database Record

Prior research indicates that probation programs that include efforts to change cognitive orientations and social patterns can enhance their effectiveness. This article reports an evaluation of an ...

Purpose Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients. Methodology/approach A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified. Findings The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs. Research limitations/implications While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation. Practical implications The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill. Originality/value A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.

Differences in health care satisfaction can alter patterns of health care utilization and so affect health outcomes, but little is known about variation in satisfaction in relation to immigration status. Health care satisfaction is analyzed with survey data from state public health program patients. Overall health care satisfaction is higher for first generation Hispanic immigrants and lower among those in the second generation compared to white Americans-consistent with the pattern termed the "healthy migrant effect." This pattern is more pronounced for Portuguese-speaking immigrants and is not explained by self-reported health, communication ability or acculturation. Satisfaction with specific aspects of health care follows different patterns that may be explained by differences in experiences and culture. As anticipated by segmented assimilation theory, we find variation in cross-generational patterns of health care satisfaction both within and between ethnic groups. This variation indicates the importance of distinguishing Portuguese-speakers from Spanish-speakers and of taking into account differences in the ways they are able to communicate with health care providers as well as differences in their orientations toward health care. Our disparate findings with other immigrant groups also reinforce limiting expectations of a "healthy migrant effect" to Latinos. Finally, the variable influences on different satisfaction measures indicate the importance of considering the relative influence of culturally-based orientations and health care experiences on the specific outcomes measured, with particular sensitivity to acceptance of individualized standards of care.

Ethnic differences in participation in cancer clinical trials slow advances in medical knowledge that can reduce health care disparities. Community health workers (CHWs) are an increasingly important bridge between the health care system and underserved communities and could play an important role in increasing rates of clinical trial participation. We investigated community health workers' orientations to medical research and cancer clinical trials with a mixed methods design: two focus groups, 11 intensive interviews, and a structured survey of 76 CHW training workshop participants. CHWs demonstrated high levels of commitment to improving the health of community members but considerable distrust of researchers' motives, low levels of knowledge about cancer clinical trials, and frequent perceptions of bias in the health care system. Support for research is associated with more research experience, self-assessed knowledge, and Hispanic ethnicity, but with less seniority as a CHW. Neither actual knowledge of cancer clinical trials nor perceptions of bias in the health care system were related to degree of support for medical research. Community health workers perceive bias in the health care system but recognize the importance of medical research and are interested in learning more about cancer clinical trials. Research experience increases support for medical research; education increases perceptions of health care system bias.

Previous research on housing loss among severely mentally ill persons who have been placed in housing after being homeless has been largely atheoretical and has yielded inconsistent results. We develop a theory of housing loss based on identifying fundamental causes—problems in motives, means and social situation—and test these influences in a longitudinal, randomized comparison of housing alternatives. As hypothesized, individuals were more likely to lose housing if they had a history of alcohol or drug abuse, desired strongly to live independently contrary to clinician recommendations, or were African Americans placed in independent housing. Deficits in daily functioning did not explain these influences, but contributed to risk of housing loss. Our results demonstrate the importance of substance abuse, the value of distinguishing support preferences from support needs, and the necessity of explaining effects of race within a social context and thus should help to improve comparative research.

Personal empowerment is a guiding philosophy of many mental health service programs, but there has been little empirical research on the empowerment process in these programs. The authors examine social processes and consumer orientations within a self-help drop-in center for individuals with psychiatric disabilities, using intensive interviews and focus groups. They investigate motives for consumer involvement, bases for program retention, and processes of participant change. Motives for involvement in the center were primarily instrumental, whereas the bases of retention were more often maintaining social support and developing self-esteem. Participants valued the center's nonstigmatizing environment and its supportive consumer staff. Some used the opportunity to become a staff member to move into a more normalized social role; all seemed to derive benefits from helping peers. There were indications of some staff members adopting a more authoritarian posture, but participants repeatedly lauded most staff for their supportive orientation. The authors conclude that the “helper/therapy” process was a key to successful empowerment. © 2009 Wiley Periodicals, Inc.

Effective translation of research results into programmatic change continues to be the exception to the norm, in spite of increasing recognition to the importance of translational efforts and innovative approaches to the translation proc- ess. We focus attention in this article on a participatory expert panel approach that can improve translation of research into practice by engaging a wide range of stakeholders in reviewing research results and program operations. We demonstrate how we used this process to improve the translation of research concerning the Massachusetts Women's Health Net- work—a state- and federally-funded program that offers screening services to low income women at risk of breast and cervical cancer who lack health insurance. Interviews with selected participants provide insight into the expert panel proc- ess and help to indicate its effectiveness. We conclude with suggestions for improving this approach to translation and of- fer some cautions based on the Massachusetts experience.

Objective: To test the influence of neurocognitive functioning on community functioning among formerly homeless persons with serious mental illness and to determine whether that influence varies with social context, independent of individual characteristics. Methods: In metropolitan Boston, 112 persons in Department of Mental Health shelters were administered a neuropsychological test battery and other measures and then randomly assigned to empowerment-oriented group homes or independent apartments, as part of a longitudinal study of the effects of housing on multiple outcomes. Subjects’ case managers completed Rosen's 5-dimensional Life Skills Inventory at 3, 6, 12, and 18 months and subjects reported on their social contacts at baseline, 6, 12, and 18 months. Subject characteristics are controlled in the analysis. Results: Three dimensions of neurocognitive functioning—executive function, verbal declarative memory, and vigilance—each predicted community functioning. Better executive function predicted improved self-care and less turbulent behavior among persons living alone, better memory predicted more positive social contacts for those living in a group home, and higher levels of vigilance predicted improved communication in both housing types. Conclusion: Neurocognition predicts community functioning among homeless persons with severe mental illness, but in a way that varies with the social context in which community functioning occurs.

The social environment of service programs—the context for treatment delivery rather than the treatment itself—is often neglected in evaluations of treatment outcomes. This research paper uses Moos's [Moos, R. H. (1997). Evaluating treatment environments: The quality of psychiatric and substance abuse programs (2nd ed.). New Brunswick, NJ: Transaction] measure of level of program involvement to identify variation in the social environment of a multi-site transitional program for homeless veterans that included both work and residential components. The transitional program, the Veterans Health Administration Compensated Work Therapy/Transitional Residence program (CWT/TR) provides a unique opportunity to test the simultaneous influence of the social environment in work and housing. Three hypotheses were tested concerning the impact of the social environment on three health outcomes and three functional outcomes. We find that programs with higher average involvement levels tended to produce more improvement among participants, particularly for those who were more impaired at baseline. Identifying the influence of the social environment within this program required assessment of both the work and residential environments and tests for their conjoint influence, as well multiple tests of person–environment fit with multiple outcomes.

Research into vocational rehabilitation (VR) consumer service preferences has been limited. The current study describes the self-reported goals of 228 applicants to a VR program sponsored by the Veterans Administration (VA) and documents the relationship of those goals to participant background variables and outcomes. Participants endorsed a wide variety of goals for participation, including clinical and practical goals. Competitive employment was a goal of only 53% and was the primary goal of only 5%. The apparent contrast between the diversity of VA participant goals and the growing focus by VA rehabilitation professionals on competitive employment suggests that greater dialogue is needed between providers and consumers.

Archival data from 17,929 homeless adults entering the Veterans Health Administration's Healthcare for Homeless Veterans program were analyzed to identify whether the rate of referral and admission to vocational rehabilitation differed between adults with psychiatric disorders alone and those with psychiatric disorders with a coexisting substance-use disorder (SUD). Participants with an SUD had an 11% greater chance of being referred to vocational rehabilitation than did those with a psychiatric disorder alone. Of the participants referred to vocational rehabilitation, those with an SUD were almost twice as likely to participate. Those with an SUD also had a higher rate of employment prior to evaluation than did those with a psychiatric disorder alone. These advantages were significant after covarying for demographic variables, specific psychiatric diagnosis, and Addiction Severity Index (McLellan, Luborsky, & Woody, 1980) psychiatric composite score. These findings fail to support the hypothesis that there is a bias in the process of referral or admission into vocational rehabilitation and suggest that work and participation in work rehabilitation are not negatively affected by a coexisting SUD.

The authors tested the hypotheses that neuropsychological functioning would improve after homeless persons with severe and persistent mental illness were provided with housing and that executive functioning would improve more among those placed in group homes than among those placed in independent apartments. A total of 114 persons with serious and persistent mental illness who were stable residents of homeless shelters completed neuropsychological testing and were randomly assigned to group homes or independent apartments; 91 participants (52 assigned to group homes and 39 assigned to independent apartments) were retested after 18 months. Overall neuropsychological functioning improved significantly across the full study sample. Executive performance, measured by the Wisconsin Card Sorting Test, decreased significantly among persons assigned to independent apartments and increased, but not significantly, among those assigned to group homes. The findings suggest that providing housing for persons who have severe and persistent mental illness improves cognitive functioning but that independent living may diminish executive functioning.