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• 1. [Article] Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families

  Objectives: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) ...

  Citation × Citation Citation Abstract Copy Title: Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families Author: Zuckerman, Katharine E., Lindly, Olivia J., Reyes, Nuri M., Chavez, Alison E., Macias, Kristy, Smith, Kathryn N., Reynolds, Ann Year: 2017 Objectives: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) or limited English proficiency (L-LEP). Methods: We conducted a mixed-mode survey of families of children with confirmed ASD seen at specialty clinics in 3 United States cities. Bivariate and multivariate analyses compared barriers to ASD diagnosis, current service use, and unmet therapy need among NLW, L-EP, and L-LEP families. Results: Overall, barriers to ASD diagnosis were prevalent: families (n = 352) experienced a mean of 8 of 15 barriers to ASD diagnosis. The most prevalent barriers overall were "stress of diagnostic process," "parent knowledge about ASD," and "understanding medical system." Compared with NLW families, L-LEP families were more likely to experience barriers related to knowledge about ASD and trust in providers. Children in L-LEP families also had fewer current therapy hours and more unmet therapy needs than children in NLW families. L-EP families' barriers and treatment services use profile was more similar to NLW than to L-LEP families. Conclusions: English proficiency was an important marker for barriers to ASD diagnosis and treatment in Latinos. Increasing ASD-related knowledge and provider trust may decrease disparities in the diagnosis and treatment of ASD among US Latinos. Title: Disparities in Diagnosis and Treatment of Autism in Latino and Non-Latino White Families Author: Zuckerman, Katharine E., Lindly, Olivia J., Reyes, Nuri M., Chavez, Alison E., Macias, Kristy, Smith, Kathryn N., Reynolds, Ann Year: 2017 Objectives: To compare barriers to autism spectrum disorder (ASD) diagnosis and current ASD-related service use among non-Latino white (NLW) families and Latino families with English proficiency (L-EP) or limited English proficiency (L-LEP). Methods: We conducted a mixed-mode survey of families of children with confirmed ASD seen at specialty clinics in 3 United States cities. Bivariate and multivariate analyses compared barriers to ASD diagnosis, current service use, and unmet therapy need among NLW, L-EP, and L-LEP families. Results: Overall, barriers to ASD diagnosis were prevalent: families (n = 352) experienced a mean of 8 of 15 barriers to ASD diagnosis. The most prevalent barriers overall were "stress of diagnostic process," "parent knowledge about ASD," and "understanding medical system." Compared with NLW families, L-LEP families were more likely to experience barriers related to knowledge about ASD and trust in providers. Children in L-LEP families also had fewer current therapy hours and more unmet therapy needs than children in NLW families. L-EP families' barriers and treatment services use profile was more similar to NLW than to L-LEP families. Conclusions: English proficiency was an important marker for barriers to ASD diagnosis and treatment in Latinos. Increasing ASD-related knowledge and provider trust may decrease disparities in the diagnosis and treatment of ASD among US Latinos. Close

• 2. [Article] North Douglas County Community Needs Health Assessment (Phase 1)

  Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ...

  Citation × Citation Citation Abstract Copy Title: North Douglas County Community Needs Health Assessment (Phase 1) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2016 Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ages birth-to-8 and their families. The purpose of this process was to explore, understand, and integrate linkages between early learning and young child and family health; identify health-related resources currently available and accessible to NDC families; and prioritize health areas of interest to be explored during the CHNA. The North Douglas County CHNA builds on community partnerships already established in the region through initiatives that aim to coordinate and align early learning and K-12 systems. The work of Yoncalla Early Works (“YEW”, initiated in 2012 with funding from The Ford Family Foundation and Children’s Institute) and North Douglas P3 (“NDP3”, initiated in 2014 with funding from the Oregon Community Foundation) demonstrate community commitment to supporting young children and families. The work of community members through these initiatives laid the foundation for the region’s readiness to engage in a Community Health Needs Assessment (CHNA) planning process Ultimately, this first planning phase of the CHNA resulted in recommendations to conduct Phase 2 of the CHNA in North Douglas County, and is expected to get underway in summer/fall 2016 in collaboration with community members. The Community Health Needs Assessment will seek to answer the following questions: 1. What does health look like for children ages birth-to-8 and their families in North Douglas County? 2. What health services are available and accessible to children and families in North Douglas County? 3. What health services do families in North Douglas County need and want? 4. What needs to happen for health services to be available and accessible for North Douglas County children ages birth-to-8 and their families? Title: North Douglas County Community Needs Health Assessment (Phase 1) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2016 Beginning in February 2016, the North Douglas County (NDC) communities of Drain, Elkton, and Yoncalla, Oregon engaged in a Community Health Needs Assessment (CHNA) planning process, focusing on children ages birth-to-8 and their families. The purpose of this process was to explore, understand, and integrate linkages between early learning and young child and family health; identify health-related resources currently available and accessible to NDC families; and prioritize health areas of interest to be explored during the CHNA. The North Douglas County CHNA builds on community partnerships already established in the region through initiatives that aim to coordinate and align early learning and K-12 systems. The work of Yoncalla Early Works (“YEW”, initiated in 2012 with funding from The Ford Family Foundation and Children’s Institute) and North Douglas P3 (“NDP3”, initiated in 2014 with funding from the Oregon Community Foundation) demonstrate community commitment to supporting young children and families. The work of community members through these initiatives laid the foundation for the region’s readiness to engage in a Community Health Needs Assessment (CHNA) planning process Ultimately, this first planning phase of the CHNA resulted in recommendations to conduct Phase 2 of the CHNA in North Douglas County, and is expected to get underway in summer/fall 2016 in collaboration with community members. The Community Health Needs Assessment will seek to answer the following questions: 1. What does health look like for children ages birth-to-8 and their families in North Douglas County? 2. What health services are available and accessible to children and families in North Douglas County? 3. What health services do families in North Douglas County need and want? 4. What needs to happen for health services to be available and accessible for North Douglas County children ages birth-to-8 and their families? Close

• 3. [Article] Conceptualization of Autism in the Latino Community and its Relationship with Early Diagnosis

  Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. ...

  Citation × Citation Citation Abstract Copy Title: Conceptualization of Autism in the Latino Community and its Relationship with Early Diagnosis Author: Zuckerman, Katharine E., Sinche, Brianna, Cobian, Martiza, Cervantes, Marlene, Mejia, Angie, Becker, Thomas, Nicolaidis, Christina Year: 2014 Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis. Method—We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typicallydeveloping Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an ASD diagnosis. Focus groups and interviews were audio-recorded, transcribed and independently coded. Coded data were analyzed using thematic analysis. Results—Many Latino families in the study had not heard of ASD or had little information about it. Families sometimes assumed ASD red flags were normal or could be attributed to family dysfunction. Families also had concerns about provider communication and access to language services. Having a child with a developmental delay was associated with embarrassment, rejection, and family burden, making it difficult for parents to raise developmental concerns with providers. Conclusion—Pediatric providers should not assume that Latino parents have heard of ASD or know its symptoms. Providers should be aware that parents may be reluctant to mention concerns due to cultural factors. The health care system needs to improve resources for Latino parents with limited English proficiency. Policies should encourage the use of developmental screening in primary care Title: Conceptualization of Autism in the Latino Community and its Relationship with Early Diagnosis Author: Zuckerman, Katharine E., Sinche, Brianna, Cobian, Martiza, Cervantes, Marlene, Mejia, Angie, Becker, Thomas, Nicolaidis, Christina Year: 2014 Objective—Early identification of autism spectrum disorders (ASD) has been linked to improved long-term developmental outcomes. However, Latino children are diagnosed later than white non- Latino children. We aimed to qualitatively assess the understanding and conceptualization of ASD in the Latino community in order to understand potential community barriers to early diagnosis. Method—We conducted 5 focus groups and 4 qualitative interviews with 30 parents of typicallydeveloping Latino children in Oregon. Participants were asked structured questions concerning video vignettes that follow a Latina mother from the time she begins to worry about her 3-year-old son's behaviors to the time he receives an ASD diagnosis. Focus groups and interviews were audio-recorded, transcribed and independently coded. Coded data were analyzed using thematic analysis. Results—Many Latino families in the study had not heard of ASD or had little information about it. Families sometimes assumed ASD red flags were normal or could be attributed to family dysfunction. Families also had concerns about provider communication and access to language services. Having a child with a developmental delay was associated with embarrassment, rejection, and family burden, making it difficult for parents to raise developmental concerns with providers. Conclusion—Pediatric providers should not assume that Latino parents have heard of ASD or know its symptoms. Providers should be aware that parents may be reluctant to mention concerns due to cultural factors. The health care system needs to improve resources for Latino parents with limited English proficiency. Policies should encourage the use of developmental screening in primary care Close

• 4. [Article] Evaluating Knowledge of Developmental Disabilities Among WIC Participants

  Background: Children in racial/ethnic minority and low-income families are more likely to experience low rates of early developmental disability (DD) diagnosis. Racial/ethnic and language differences in ...

  Citation × Citation Citation Abstract Copy Title: Evaluating Knowledge of Developmental Disabilities Among WIC Participants Author: Regalado Murillo, Carolina, Zuckerman, Katharine, Dr., Chavez, Alison, Reeder, Julie A, Dr. Year: 2017 Background: Children in racial/ethnic minority and low-income families are more likely to experience low rates of early developmental disability (DD) diagnosis. Racial/ethnic and language differences in parent information about DDs could contribute to diagnostic delays, but little is known about differences in parent DD familiarity. Objectives: To assess DD knowledge and information in a sample of low-income families. Methods: We conducted a self-administered survey on 539 parents attending their child’s appointment at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in six Oregon counties. Survey items assessed familiarity with early signs of DDs, self-reported knowledge about DDs, and having a friend or family member with ASD. Bivariable and multivariable analyses assessed differences in outcomes for following ethnicity/language groups: non-Latino white [white], Latino-English proficient [Latino-EP], Latino-limited English proficient [Latino-LEP], and non-Latino other race English proficient [other race]. Results: Overall, participants correctly identified 64.7% of early signs of DDs. White participants correctly identified the most signs after adjustment for socio-demographic differences. Latino-LEP and other race participants more likely to have never heard of several prevalent DDs, and were also less likely to have a friend or family member with a DD compared to white families. Conclusions: Low-income parents, particularly Latino-LEP and other race parents, have relatively little familiarity or personal experience with DDs, and are less aware of DD early signs. Study findings suggest that interventions to reduce disparities in DD diagnosis and treatment should include increasing information transfer to parents in low-income and racial/ethnic minority communities. Title: Evaluating Knowledge of Developmental Disabilities Among WIC Participants Author: Regalado Murillo, Carolina, Zuckerman, Katharine, Dr., Chavez, Alison, Reeder, Julie A, Dr. Year: 2017 Background: Children in racial/ethnic minority and low-income families are more likely to experience low rates of early developmental disability (DD) diagnosis. Racial/ethnic and language differences in parent information about DDs could contribute to diagnostic delays, but little is known about differences in parent DD familiarity. Objectives: To assess DD knowledge and information in a sample of low-income families. Methods: We conducted a self-administered survey on 539 parents attending their child’s appointment at the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in six Oregon counties. Survey items assessed familiarity with early signs of DDs, self-reported knowledge about DDs, and having a friend or family member with ASD. Bivariable and multivariable analyses assessed differences in outcomes for following ethnicity/language groups: non-Latino white [white], Latino-English proficient [Latino-EP], Latino-limited English proficient [Latino-LEP], and non-Latino other race English proficient [other race]. Results: Overall, participants correctly identified 64.7% of early signs of DDs. White participants correctly identified the most signs after adjustment for socio-demographic differences. Latino-LEP and other race participants more likely to have never heard of several prevalent DDs, and were also less likely to have a friend or family member with a DD compared to white families. Conclusions: Low-income parents, particularly Latino-LEP and other race parents, have relatively little familiarity or personal experience with DDs, and are less aware of DD early signs. Study findings suggest that interventions to reduce disparities in DD diagnosis and treatment should include increasing information transfer to parents in low-income and racial/ethnic minority communities. Close

• 5. [Article] North Douglas County Community Needs Health Assessment (Phase 2)

  Beginning in August 2016, Phase 2 of the North Douglas County (NDC) Community Health Needs Assessment (CHNA) built on work completed in the Phase 1 planning process, and engaged the communities of Drain, ...

  Citation × Citation Citation Abstract Copy Title: North Douglas County Community Needs Health Assessment (Phase 2) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2017 Beginning in August 2016, Phase 2 of the North Douglas County (NDC) Community Health Needs Assessment (CHNA) built on work completed in the Phase 1 planning process, and engaged the communities of Drain, Elkton, and Yoncalla, Oregon in the development and administration of a regional health services survey. The purpose of the survey was to learn from families with children ages 0-8 in the NDC region in order to: • Identify service needs across a range of health service types, e.g., dental care, immunizations, prenatal care, well-child care, primary care, and mental health; • Identify barriers to access; • Prioritize the programs and resources families most need to be able to support their and their children’s health; • Learn about preferred ways families would like to access these services; and • Recommend strategies to address the prioritized issues, needs, and barriers that emerge from the survey findings. Title: North Douglas County Community Needs Health Assessment (Phase 2) Author: Lambarth, Callie H., Reid, Diane, Green, Beth L. Year: 2017 Beginning in August 2016, Phase 2 of the North Douglas County (NDC) Community Health Needs Assessment (CHNA) built on work completed in the Phase 1 planning process, and engaged the communities of Drain, Elkton, and Yoncalla, Oregon in the development and administration of a regional health services survey. The purpose of the survey was to learn from families with children ages 0-8 in the NDC region in order to: • Identify service needs across a range of health service types, e.g., dental care, immunizations, prenatal care, well-child care, primary care, and mental health; • Identify barriers to access; • Prioritize the programs and resources families most need to be able to support their and their children’s health; • Learn about preferred ways families would like to access these services; and • Recommend strategies to address the prioritized issues, needs, and barriers that emerge from the survey findings. Close

• 6. [Article] Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries

  Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central ...

  Citation × Citation Citation Abstract Copy Title: Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries Author: Whetten, Kathryn, Ostermann, Jan, Pence, Brian W., Whetten, Rachel A., Messer, Lynne C., Ariely, Sumedha, O'Donnell, Karen, Wasonga, Augustine l., Vann, Vanroth, Itemba, Dafrosa, Eticha, Misganaw, Madan, Ira, Thielman, Nathan M., Positive Outcomes for Orphans (POFO) Research Team Year: 2014 Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutional dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting. Title: Three-Year Change in the Wellbeing of Orphaned and Separated Children in Institutional and Family-Based Care Settings in Five Low- and Middle-Income Countries Author: Whetten, Kathryn, Ostermann, Jan, Pence, Brian W., Whetten, Rachel A., Messer, Lynne C., Ariely, Sumedha, O'Donnell, Karen, Wasonga, Augustine l., Vann, Vanroth, Itemba, Dafrosa, Eticha, Misganaw, Madan, Ira, Thielman, Nathan M., Positive Outcomes for Orphans (POFO) Research Team Year: 2014 Background: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers. Methods: A two-stage random sampling methodology identified community representative samples of 1,357 institutional dwelling orphaned and separated children (OSC) and 1,480 family-dwelling OSC aged 6–12 from 5 low and middle income countries. Data were collected from children and their primary caregivers. Survey-analytic techniques and linear mixed effects models describe child wellbeing collected at baseline and at 36 months, including physical and emotional health, growth, cognitive development and memory, and the variation in outcomes between children, care settings, and study sites. Findings: At 36-month follow-up, institution-dwelling OSC had statistically significantly higher height-for-age Z-scores and better caregiver-reported physical health; family-dwelling OSC had fewer caregiver-reported emotional difficulties. There were no statistically significant differences between the two groups on other measures. At both baseline and follow-up, the magnitude of the differences between the institution- and family-dwelling groups was small. Relatively little variation in outcomes was attributable to differences between sites (11–27% of total variation) or care settings within sites (8–14%), with most variation attributable to differences between children within settings (60–75%). The percent of variation in outcomes attributable to the care setting type, institution- versus family-based care, ranged from 0–4% at baseline, 0–3% at 36-month follow-up, and 0–4% for changes between baseline and 36 months. Interpretation: These findings contradict the hypothesis that group home placement universally adversely affects child wellbeing. Without substantial improvements in and support for family settings, the removal of institutions, broadly defined, would not significantly improve child wellbeing and could worsen outcomes of children who are moved from a setting where they are doing relatively well to a more deprived setting. Close

• 7. [Article] The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes

  The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving ...

  Citation × Citation Citation Abstract Copy Title: The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes Author: Green, Beth L., Ayoub, Catherine, Bartlett, Jessica Dym, Ende, Adam Von, Furrer, Carrie Jeanne, Chazen-Cohen, Rachel, Vallotton, Claire, Klevens, Joanne Year: 2014 The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse. Title: The Effect of Early Head Start on Child Welfare System Involvement: A First Look at Longitudinal Child Maltreatment Outcomes Author: Green, Beth L., Ayoub, Catherine, Bartlett, Jessica Dym, Ende, Adam Von, Furrer, Carrie Jeanne, Chazen-Cohen, Rachel, Vallotton, Claire, Klevens, Joanne Year: 2014 The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse. Close

• 8. [Article] Consequences of Runaway and Thrownaway Experiences for Sexual Minority Health During the Transition to Adulthood

  Sexual minority youth are more likely to run away from home or experience homelessness, leaving them at increased risk of victimization and negative health outcomes. In this study, the authors use a developmental ...

  Citation × Citation Citation Abstract Copy Title: Consequences of Runaway and Thrownaway Experiences for Sexual Minority Health During the Transition to Adulthood Author: Pearson, Jennifer, Thrane, Lisa, Wilkinson, Lindsey Year: 2017 Sexual minority youth are more likely to run away from home or experience homelessness, leaving them at increased risk of victimization and negative health outcomes. In this study, the authors use a developmental perspective that considers both vulnerable beginnings in families and the risky trajectories that follow to explore the connections between running away or being thrown out by parents and sexual minority women's and men's health in adulthood. Using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the authors consider multiple dimensions of health and several potential intervening mechanisms. Findings suggest that runaway and thrownaway experiences have persistent negative effects on health into adulthood, in part because of their association with sexual victimization, educational attainment, and relationships with parents. Sexual minority men who have been thrown out by parents report a greater likelihood of suicidal ideation, smoking, and substance use into adulthood. Sexual minority women with runaway experiences have poorer health and increased depressive symptoms, while women with thrownaway experiences engage in more health risk behaviors. Sexual victimization stands out as a key mechanism for sexual minority women's health, as more than half of these young women report experiences of sexual victimization. © 2017 Taylor & Francis. Title: Consequences of Runaway and Thrownaway Experiences for Sexual Minority Health During the Transition to Adulthood Author: Pearson, Jennifer, Thrane, Lisa, Wilkinson, Lindsey Year: 2017 Sexual minority youth are more likely to run away from home or experience homelessness, leaving them at increased risk of victimization and negative health outcomes. In this study, the authors use a developmental perspective that considers both vulnerable beginnings in families and the risky trajectories that follow to explore the connections between running away or being thrown out by parents and sexual minority women's and men's health in adulthood. Using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the authors consider multiple dimensions of health and several potential intervening mechanisms. Findings suggest that runaway and thrownaway experiences have persistent negative effects on health into adulthood, in part because of their association with sexual victimization, educational attainment, and relationships with parents. Sexual minority men who have been thrown out by parents report a greater likelihood of suicidal ideation, smoking, and substance use into adulthood. Sexual minority women with runaway experiences have poorer health and increased depressive symptoms, while women with thrownaway experiences engage in more health risk behaviors. Sexual victimization stands out as a key mechanism for sexual minority women's health, as more than half of these young women report experiences of sexual victimization. © 2017 Taylor & Francis. Close

• 9. [Article] The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings

  Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of ...

  Citation × Citation Citation Abstract Copy Title: The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings Author: Campbell, Jeffrey I., Aturinda, Isaac, Mwesigwa, Evans, Burns, Bridget, Santorino, Data, Haberer, Jessica E., Bangsberg, David, Holden, Richard J., Ware, Norma C., Siedner, Mark J. Year: 2017 Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention’s acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system’s ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included (1) the importance of confidentiality, disclosure, and stigma, and (2) the barriers and facilitators downstream from the intervention that impacted achievement of the system’s target outcome. The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM-RLS may serve as a useful tool to guide design and implementation of mHealth interventions. Title: The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings Author: Campbell, Jeffrey I., Aturinda, Isaac, Mwesigwa, Evans, Burns, Bridget, Santorino, Data, Haberer, Jessica E., Bangsberg, David, Holden, Richard J., Ware, Norma C., Siedner, Mark J. Year: 2017 Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource-limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention’s acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability. Interviews guided development of a proposed conceptual framework, the technology acceptance model for resource-limited settings (TAM-RLS). This framework incorporates both classic technology acceptance model categories as well as novel factors affecting use in this setting. Participants described how SMS message language, phone characteristics, and experience with similar technologies contributed to the system’s ease of use. Perceived usefulness was shaped by the perception that the system led to augmented HIV care services and improved access to social support from family and colleagues. Emergent themes specifically related to mHealth acceptance among PLWH in Uganda included (1) the importance of confidentiality, disclosure, and stigma, and (2) the barriers and facilitators downstream from the intervention that impacted achievement of the system’s target outcome. The TAM-RLS is a proposed model of mHealth technology acceptance based upon end-user experiences in rural Uganda. Although the proposed model requires validation, the TAM-RLS may serve as a useful tool to guide design and implementation of mHealth interventions. Close

• 10. [Article] Civic Engagement Among Orphans and Non-Orphans in Five Low- and Middle-Income Countries

  Background: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans ...

  Citation × Citation Citation Abstract Copy Title: Civic Engagement Among Orphans and Non-Orphans in Five Low- and Middle-Income Countries Author: Gray, Christine L., Pence, Brian W., Messer, Lynne C., Ostermann, Jan, Whetten, Rachel A., Thielman, Nathan M., O'Donnell, Karen, Whetten, Kathryn Year: 2016 Background: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in resource-poor settings. Understanding whether and how OSC are engaged in civic activities is important for community and world leaders who need to provide care for OSC and ensure their involvement in sustainable development. Methods: The Positive Outcomes for Orphans study (POFO) is a multi-country, longitudinal cohort study of OSC randomly sampled from institution-based care and from family-based care, and of non-OSC sampled from the same study regions. Participants represent six sites in five low-and middle-income countries. We examined civic engagement activities and government trust among subjects > =16 years old at 90-month follow-up (approximately 7.5 years after baseline). We calculated prevalences and estimated the association between key demographic variables and prevalence of regular volunteer work using multivariable Poisson regression, with sampling weights to accounting for the complex sampling design. Results: Among the 1,281 POFO participants > =16 who were assessed at 90-month follow-up, 45 % participated in regular community service or volunteer work; two-thirds of those volunteers did so on a strictly voluntary basis. While government trust was fairly high, at approximately 70 % for each level of government, participation in voting was only 15 % among those who were > =18 years old. We did not observe significant associations between demographic characteristics and regular volunteer work, with the exception of large variation by study site. Conclusion: As the world’s leaders grapple with the many competing demands of global health, economic security, and governmental stability, the participation of today’s youth in community and governance is essential for sustainability. This study provides a first step in understanding the degree to which OSC from different care settings across multiple low- and middle-income countries are engaged in their communities. Title: Civic Engagement Among Orphans and Non-Orphans in Five Low- and Middle-Income Countries Author: Gray, Christine L., Pence, Brian W., Messer, Lynne C., Ostermann, Jan, Whetten, Rachel A., Thielman, Nathan M., O'Donnell, Karen, Whetten, Kathryn Year: 2016 Background: Communities and nations seeking to foster social responsibility in their youth are interested in understanding factors that predict and promote youth involvement in public activities. Orphans and separated children (OSC) are a vulnerable population whose numbers are increasing, particularly in resource-poor settings. Understanding whether and how OSC are engaged in civic activities is important for community and world leaders who need to provide care for OSC and ensure their involvement in sustainable development. Methods: The Positive Outcomes for Orphans study (POFO) is a multi-country, longitudinal cohort study of OSC randomly sampled from institution-based care and from family-based care, and of non-OSC sampled from the same study regions. Participants represent six sites in five low-and middle-income countries. We examined civic engagement activities and government trust among subjects > =16 years old at 90-month follow-up (approximately 7.5 years after baseline). We calculated prevalences and estimated the association between key demographic variables and prevalence of regular volunteer work using multivariable Poisson regression, with sampling weights to accounting for the complex sampling design. Results: Among the 1,281 POFO participants > =16 who were assessed at 90-month follow-up, 45 % participated in regular community service or volunteer work; two-thirds of those volunteers did so on a strictly voluntary basis. While government trust was fairly high, at approximately 70 % for each level of government, participation in voting was only 15 % among those who were > =18 years old. We did not observe significant associations between demographic characteristics and regular volunteer work, with the exception of large variation by study site. Conclusion: As the world’s leaders grapple with the many competing demands of global health, economic security, and governmental stability, the participation of today’s youth in community and governance is essential for sustainability. This study provides a first step in understanding the degree to which OSC from different care settings across multiple low- and middle-income countries are engaged in their communities. Close