THE HEALTH OF YOUNG ADULTS WITH DISABILITIES IN THE UNITED STATES: THE COLLECTIVE ROLES OF RISK FACTORS IN SOCIAL ECOLOGIC FRAMEWORK

Background: Over the last few decades, the prevalence of young adults with disabilities (YAD) has steadily risen as a result of advances in medicine, clinical treatment, and biomedical technologythat enhanced their survival into adulthood. Despite investments in services, family supports, and insurance, they experience poor health status and barriers to successful transition into adulthood. Objectives: We investigated the collective roles of multi-faceted factors at intrapersonal, interpersonal and community levels within the social ecological framework on health related outcome including self-rated health (SRH) of YAD. The three specific aims are: 1) to examine sociodemographic differences and health insurance coverage in adolescence; 2) to investigate the role of social skills in relationships with family and peers developed in adolescence; and 3) to collectively explore the association of sociodemographic characteristics, social skills, and community participation in adolescence on SRH. Methods: Using longitudinal data (N=5,020) from the National Longitudinal Transition Study (NLTS2), we conducted multivariate logistic regression analyses to understand the association between insurance status as well as social skills in adolescence and YAD’s health related outcomes. Structural equation modeling (SEM) assessed the confluence of multi-faceted factors from the social ecological model that link to health in early adulthood. Results: Compared with YAD who had private insurance, YAD who had public health insurance in adolescence are at higher odds of experiencing poorer health related outcomes in self-rated health [adjusted odds ratio (aOR=2.89, 95% confidence interval (CI): 1.16, 7.23), problems with health (aOR=2.60, 95%CI: 1.26, 5.35), and missing social activities due to health problems (aOR=2.86, 95%CI: 1.39, 5.85). At the interpersonal level, overall social skills developed through relationship with family and peers in adolescence do not appear to have association with health related outcomes in early adulthood. Finally, at the community level, community participation in adolescence does not have an association with SRH in early adulthood. Conclusions: Having public health insurance coverage does not equate to good health. YAD need additional supports to achieve positive health outcomes. The findings in social skills and community participation suggest other potential factors may be at play for health related outcomes for YAD and the need for further investigation.

The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans

African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.

EXPLORING THE EFFECTS OF THE RELATIONSHIP BETWEEN SCHOOL CHARACTERISTICS, TEACHER CHARACTERISTICS, ADMINISTRATIVE SUPPORT, AND SCHOOL CLIMATE ON VOLUNTARY INTRA-DISTRICT TEACHER MIGRATION

This quantitative research study utilized a binary logistic regression in a block design to investigate exogenous and endogenous factors influencing a teacher’s decision to make an intra-district move. The research focused on the following exogenous factors: classroom characteristics (size of class, percent minority, percent of students with an individualized education plan, and percent of students that are English language learners) and teacher characteristics (experience and gender). The following endogenous factors were examined: direct administrative influence (administrative support, rules enforced, school vision, teacher recognition, and job security) and indirect administrative influence (school climate, student misbehavior, parental support, materials, staff collaboration). The research was conducted by using information available from the National Center for Educational Statistics, the SASS from 2011-2012 and TFS from 2012-2013. The 2012-2013 Teacher Follow-up Survey identified 60 teachers who made a voluntary intra-district move. Results illustrate there is a statistically significant relationship between percentage of English Language Learners and overall job satisfaction and teachers choosing to make an intra-district move.

School Development in Urbanizing Areas

Good schools are essential for building thriving urban areas. They are important for preparing the future human resource and directly contribute to social and economic development of a place. They not only act as magnets for prospective residents, but also are necessary for retaining current population. As public infrastructure, schools mirror their neighborhood. “Their location, design and physical condition are important determinants of neighborhood quality, regional growth and change, and quality of life.”2 They impact housing development and utility requirements among many things. Hence, planning for schools along with other infrastructure in an area is essential. Schools are very challenging to plan, especially in urbanizing areas with changing demographic dynamics, where the development market and housing development can shift drastically a number of times. In such places projecting the future school enrollments is very difficult and in case of large population influx, school development can be unable to catch up with population growth which results in overcrowding. Typical is the case of Arlington County VA. In the past two decades the County has changed dramatically from a collection of bedroom communities in Washington DC Metro Region to a thriving urban area. Its metro accessible urban corridors are among most desired locations for development in the region. However, converting single family neighborhoods into high density areas has put a lot of pressure on its school facilities and has resulted in overcrowded schools. Its public school enrollment has grown by 19% from 2009 to 2014.3 While the percentage of population under 5 years age has increased in last 10 years, those in the 5-19 age group have decreased4. Hence, there is more pressure on the elementary school facilities than others in the County. Design-wise, elementary schools, due to their size, can be imagined as a community component. There are a number of strategies that can be used to develop elementary school in urbanizing areas as a part of the neighborhood. Experimenting with space planning and building on partnership and mixed-use opportunities can help produce better designs for new schools in future. This thesis is an attempt to develop elementary school models for urbanizing areas of Arlington County. The school models will be designed keeping in mind the shifting nature of population and resulting student enrollments in these areas. They will also aim to be efficient and sustainable, and lead to the next generation design for elementary school education. The overall purpose of the project is to address barriers to elementary school development in urbanizing areas through creative design and planning strategies. To test above mentioned ideas, the Joint-Use School typology of housing +school design has been identified for elementary school development in urbanizing areas in this thesis project. The development is based on the Arlington Public School’s Program guidelines (catering to 600 students). The site selected for this project is Clarendon West (part of Red Top Cab Properties) in Clarendon, Arlington County VA.

The Influence of Pre-Migration Factors and Post-Migration Climate of the Receiving Community on the Psychological Distress of Latino Immigrants

Over forty million foreign-born residents currently live in the United States. Latinos make up the largest population of immigrants living in the U.S. Previous research suggests that Latino immigrants often experience pre-migration stressors, such as traumatic experiences, political upheaval, and unplanned migration. These stressors may have a negative impact on immigrants’ post-migration mental health. Research also suggests that the post-migration climate of the receiving community may inform the connection between pre-migration experiences and post-migration mental health. The current study examined the relationship between Latino immigrants’ reasons for migration, migration planning, and pre-migration experience of political and/or interpersonal violence, and post-migration symptoms of psychological distress. In addition to examining the effect of these pre-migration factors, the current study also examined the community “climate” experienced by Latino immigrants post-migration by assessing the influence of three post-migration factors: 1) community support and engagement, 2) discrimination, and 3) employment. The study was a secondary analysis of data collected for the National Latino and Asian American Study, which focused on the mental health and service utilization of Latinos and Asian Americans. Participants included 1,629 Latino immigrants from across the United States. Results indicated that pre-migration experience of political and/or interpersonal trauma, post-migration experience of discrimination, and female sex were positively associated with psychological distress. Post-migration employment was negatively associated with psychological distress. In addition, discrimination modified the association between unplanned migration and psychological distress; the relationship between unplanned migration and psychological distress decreased for participants who reported more discrimination. Furthermore, employment modified the association between political and/or interpersonal trauma and psychological distress; the connection between trauma and psychological distress increased among those who reported having less employment. Recommendations for further research were presented. Policy and clinical practice implications were discussed, particularly given the current climate of high anti-immigrant sentiment and hostility in the U.S.