Factors associated with contraception use among postpartum or parenting Latina adolescents: A systematic review

Despite advances in effective and long-acting contraceptive methods and the introduction into health care that an initial unplanned pregnancy allows, repeat unplanned pregnancy continues to affect Hispanic adolescents at a rate higher than that of non-Hispanic whites. The current study was undertaken to identify and categorize factors associated with uptake of long acting contraception (implant or intrauterine devices) or consistent use of highly effective methods (injectable DMPA, ring, patch, or pills), among Hispanic/Latina teens who have previously given birth. ^ I searched Ovid Medline, Pubmed, CINAHL, PsychINFO, POPLINE and Scopus, and reference lists for studies in English, ≥1980, of original data from the United States on factors related to initiation, maintenance, or discontinuation of contraceptive methods in postpartum or parenting adolescent females. I then identified articles that specified the inclusion of Hispanics/Latinas in the study population and either reported findings specific to race/ethnicity or used race/ethnicity as an independent variable in analyses of contributing factors. I then extracted data for each study and categorized independent variables as predisposing, enabling, or reinforcing following the PRECEDE model.1 Factors found to be associated with contraception use or non-use were combined to create a logic model of risk. ^ Of 9 eligible studies, one solely addressed initiation; one, initiation and maintenance; two, initiation and discontinuation; three, maintenance; and two, maintenance and discontinuation. There was some overlap in the studies' assessments of maintenance and discontinuation and the author(s) often did not distinguish between the two. Nearly all (k=7) were prospective observational studies with convenience samples and bivariate analyses (k=6). One study was initially a quasi-experimental design but became a prospective cohort due to extremely high attrition. Sociodemographic characteristics and predisposing factors were studied frequently, as were reinforcing factors; enabling factors were discussed infrequently and only in studies involving focus groups or interviews. Due to a paucity of research, a consensus of factors found consistently to influence the contraception behavior of postpartum Latina teens could not be established for the overall population nor for cultural subgroups. Future research is needed that focuses on postpartum/parenting Latina teens, with subgroup identification and differentiation, to determine the prevalent and pertinent predisposing, enabling, and reinforcing factors related to effective contraception initiation and maintenance.^

Knowledge and Attitudes of Young People in Nigeria about HIV/AIDS---A systematic review

Background: HIV/AIDS has remained one of Nigeria's biggest health and social issues for decades. People aged between 10 and 24 are the most affected. Research into why this population subset is affected is very pertinent. We therefore conducted a systematic review of the Knowledge and Attitudes of young people in Nigeria about HIV/AIDS to understand where the gaps between knowledge and attitudes can be bridged. ^ Methods: We conducted searches in Medline, PubMed, African Index Medicus, Cumulative Index of Nursing and Allied Health. WHO and UNAIDS documents were also searched. Other journals were hand searched. Searches were for studies between 1986 (when HIV/AIDS was first reported in Nigeria) till date. In addition, data abstraction and quality assessment were done. ^ Results: 279 titles and abstracts were found and 33 articles in full text were appraised critically and 17 articles were selected based on our criteria. This revealed a dearth of well conducted studies in the literature despite the enormity of the HIV/AIDS epidemic. Constructs for Knowledge and attitudes were itemized on two tables for each article based on the Health Belief Model. Even though many of the studies showed high level of knowledge about HIV/AIDS, it did not impact attitudes about the disease. Also fear and anxiety prevented participants from acquiring knowledge. These recurring themes arguably were not limited to any region or area, background or group. ^ Conclusion: There is a need for future research to be culturally sensitive with a focus on attitudes and correction of misconceptions about HIV/AIDS among our youth.^

Association of coping styles & adolescent substance use

Adolescent substance use is a serious public health concern with long-lasting consequences. Although specific coping behaviors have been associated with adolescent substance use, less is known about the role of multidimensional coping styles that account for both positive and negative coping behaviors. This study examined the association of coping styles and substance use (alcohol, marijuana, and other illicit drugs) of 1,019 ethnically diverse high school students. Coping styles were categorized by high or low negative coping behaviors (e.g. distraction, social withdrawal, self-criticism, blame others, wishful thinking, resignation, and negative emotional regulation) and high or low positive coping behaviors (e.g. cognitive restructuring, problem-solving, social support, and positive emotional regulation). My hypothesis that high positive coping, regardless of the use of negative coping behaviors, would be protective against substance use was rejected. Logistic regression analyses controlling for age, gender, race, and parent education indicated that adolescents who relied primarily on adaptive coping were 45-67% less likely to report lifetime or past year substance use than any other coping style. However, mixed copers (i.e. high in both positive and negative coping behaviors) were 2 to 3 times as likely to report substance use than their adaptive coping counterparts.^

Associations of perceived body image and subjective social status with levels of physical activity in Mexican American adolescents

The current study is a secondary data analysis of a prospective cohort study that examined demographic and psychosocial variables and their associations with physical activity levels in Mexican-American adolescents in Houston, Texas. Body image, subjective social status, and anxiety were the main variables of interest. The sample included 952 unrelated Mexican-American adolescents in Houston, Texas. The majority (84.2%) of the study population did not meet physical activity standards prescribed by the CDC.^ In a multivariate model controlling for age, socioeconomic status, gender, general body image, preferred body image, subjective social status, and anxiety, gender and subjective social status were found to be the strongest determinants of physical activity levels. Males and those with a high subjective social status were more likely to participate in physical activity than those with low subjective status. Lower levels of anxiety and a more positive body image were also found to be associated with higher levels of physical activity. In multivariate analyses gender and subjective social status showed the strongest associations with physical activity.^

Something real: A social marketing approach to smoking prevention among Montevideo youth

Uruguay has some of the strictest tobacco-control laws in Latin America. Despite this, youth smoking rates in Uruguay are amongst the highest in South America. Thus, it is important to identify strategies to prevent youth smoking in Uruguay. The current qualitative research study sought to identify intrapersonal and socioenvironmental factors that are associated with smoking among middle school youth in Uruguay. It also sought to develop potential prevention strategies and media messages that would resonate with youth for a social media campaign. The study was grounded in social cognitive theory and the theory of reasoned action/planned behavior, among other behavioral science theories; anthropological perspectives were also considered. To achieve these goals, 29 group and individual structured interviews were conducted in two private middle schools catering to lower and higher SES youth in Montevideo, Uruguay during the summer of 2012. One hundred and three study participants, including students, parents, and teachers, were interviewed. The structured interviews were recorded, transcribed, translated, back translated, coded and analyzed. The study findings show that positive attitudes towards smoking (i.e. to be seen, to increase status, to ensure women's equality, to looking old, and to service as a rite of passage), delinquent behavior (i.e. transgression/deviant behavior), social norms that support smoking (i.e. peer pressure and modeling, group membership/sense of belonging, parental modeling, and family support), easy access and availability to tobacco (i.e. retails stores) were factors associated with youth smoking. Potential protective factors may include parental support, negative attitudes towards smoking, sports/music, and smoke-free environments. Because study participants are accustomed to government-sponsored strong countermarketing graphic imaging, study participants selected even stronger images and messages as the preferred way to receive tobacco prevention messages. Something Real ("Algo Real") was a theme that resonated with the participants and chosen as the name for the proposed campaign. This campaign was designed as a multiple component intervention that included mass, school base, and family based strategies to prevent tobacco use. Some intervention materials specific to these intervention components were developed to target relevant intrapersonal and socioenvironmental factors identified above. These materials will be tested in future pilot studies and larger scale evaluation with this population, outside the scope of this dissertation. ^

Correlates of prenatal care initiation among low -income Hispanic women

Because Hispanic women are even less likely than women of other ethnic groups to receive early prenatal care, the purpose of this study was to identify factors that may influence these women to initiate care. After giving consent, 300 Hispanic women (100 who initiated first trimester care, 100 who initiated second trimester care, and 100 who initiated third trimester care or received no care) were interviewed in the post partum unit of a local public hospital. The interview included recollection of events leading to the first prenatal appointment, including first physical indicators of pregnancy, confirmation of pregnancy, feelings about the pregnancy, appointment making behavior, and system barriers encountered. The Health Belief Model was used as the theoretical framework for determining psychosocial variables. Using this model, perceived susceptibility to problems during pregnancy, perceived seriousness of possible problems, perceived benefits of prenatal care, perceived barriers to care, and cues to action were assessed. Time of entry into prenatal care was assessed by interview.^ In this sample of low-income Hispanic women, a higher perception of barriers to care was associated with later initiation of care and non-use of care, higher perceived benefits of care for the baby were associated with earlier care, especially in women without a card to access hospital district services, and having a card to access hospital district services was associated with earlier care. Several barriers to care were mentioned by women on open-ended questioning including long waiting times, embarrassment, and lack of transportation.^ Recommendations for practice included decreasing the number of visits for low-risk women while increasing the time spent with the provider, decreasing the number of vaginal exams for low-risk women, increasing the use of midwives, training lay workers to do risk assessment, giving specific messages about benefits of care to baby, and increasing general health motivation through community intervention methods. More research on the psychosocial and cultural factors associated with initiation of care is needed. In the meantime, the recommendations for practice can be implemented now to increase the use of prenatal care by low-income Hispanic women. ^

Ethnic comparisons of adolescent sexual risk -taking and preventive behavior

For adolescents, unprotected sexual intercourse is the primary cause of sexually transmitted disease (STD), including Human Immunodeficiency Virus (HIV) infection (virus which causes Acquired Immunodeficiency Syndrome (AIDS)), and pregnancy. Although many studies on adolescent sexual behavior have addressed racial/ethnic differences, few studies have examined the relation between race/ethnicity while controlling for other sociocultural and psychosocial variables. The purpose of this study is to examine the relationship between racial/ethnic categories and selected sociocultural and psychosocial variables, with reported adolescent sexual risk-taking and preventive behavior.^ A self-administered questionnaire was used to collect information from 3132 students in a Texas school district (Section 3.5.2). The instrument contained approximately 100 questions on demographic characteristics, sexual behavior, and psychosocial determinants of sexual behavior. Based on the findings of this study, the following major conclusions are made: (1) There are differences in reported sexual risk-taking and preventive behavior among Black, Hispanic and White adolescents in this study. The stratified analysis by gender further suggests significant gender differences in reported sexual behavior among the three racial/ethnic groups. (2) Gender, living arrangement, academic grades, and language spoken at home modified the association between reported sexual risk-taking and preventive behavior and race/ethnicity in this study. This suggests that these sociocultural variables should be considered in future research and practice involving multicultural populations. (3) There are differences in selected psychosocial determinants among the three racial/ethnic groups and between males and females. These differences were consistent with the reported sexual risk-taking and preventive behaviors among race/ethnicity and gender for adolescents in this study. The findings support the consideration of psychosocial determinants in research and interventions addressing adolescent sexual behavior among different racial/ethnic groups.^ Based on the results of this study, two recommendations for practice are made. First, health professionals developing interventions for adolescents from different cultural backgrounds and gender need to be familiar with the specific sociocultural and psychosocial factors which will reduce risky sexual behavior, and promote protective behavior. Second, the need for immediate, realistic, and continuous HIV/STD and pregnancy prevention programs for children and adolescents should be considered. ^

Predicting smokeless tobacco cessation in a blue -collar population

The use of smokeless tobacco products is undergoing an alarming resurgence in the United States. Several national surveys have reported a higher prevalence of use among those employed in blue-collar occupations. National objectives now target this group for health promotion programs which reduce the health risks associated with tobacco use.^ Drawn from a larger data set measuring health behaviors, this cross-sectional study tested the applicability of two related theories, the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), to smokeless tobacco (SLT) cessation in a blue-collar population of gas pipeline workers. In order to understand the determinants of SLT cessation, measures were obtained of demographic and normative characteristics of the population and specific constructs. Attitude toward the act of quitting (AACT) and subjective norm (SN) are constructs common to both models, perceived behavioral control (PBC) is unique to the TPB, and the number of past quit attempts is not contained in either model. In addition, a self-reported measure was taken of SLT use at two-month follow-up.^ The study population was comprised of all male SLT users who were field employees in a large gas pipeline company with gas compressor stations extending from Texas to the Canadian border. At baseline, 199 employees responded to the SLT portion of the survey, 118 completed some portion of the two-month follow-up, and 101 could be matched across time.^ As hypothesized, significant correlations were found between constructs antecedent to AACT and SN, although crossover effects occurred. Significant differences were found between SLT cessation intenders and non-intenders with regard to their personal and normative beliefs about quitting as well as their outcome expectancies and motivation to comply with others' beliefs. These differences occurred in the expected direction, with the mean intender score consistently higher than that of the non-intender.^ Contrary to hypothesis, AACT predicted intention to quit but SN did not. However, confirmatory of the TPB, PBC, operationalized as self-efficacy, independently contributed to the prediction of intention. Statistically significant relationships were not found between intention, perceived behavioral control, their interactive effects, and use behavior at two-month follow-up. The introduction of number of quit attempts into the logistic regression model resulted in insignificant findings for independent and interactive effects.^ The findings from this study are discussed in relation to their implications for program development and practice, especially within the worksite. In order to confirm and extend the findings of this investigation, recommendations for future research are also discussed. ^

The impact of school year work on adolescent *development

In recent decades, work has become an increasingly common feature of adolescent life in the United States. Once assumed to be an inherently positive experience for youth, school year work has recently been associated with several adverse effects, especially as the number of hours of weekly work increases. The purpose of this dissertation was to describe the impact of school year work on adolescent development in a sample of high school students from rural South Texas, an area where economically-disadvantaged and Hispanic students are heavily represented.^ The first study described the prevalence and work circumstances of 3,565 10$\rm\sp{th}$ and 12$\rm\sp{th}$ grade students who responded to anonymous surveys conducted in regular classrooms. The overall prevalence of current work was 53%. Prevalence differed by grade, college-noncollege-bound status, and parent education. Fifty percent of employed students worked to support consumer spending.^ The second study examined the effects of four levels of work intensity on the academic, behavioral, social, mental and physical health of students. The following negative effects of intense work were reported: (1) decreased engagement in school, satisfaction with leisure time, and hours of weeknight and weekend sleep, and (2) increased health risk behaviors and psychological stress. The negative effects of intense work differed by gender, grade, ethnicity, but not by parent education.^ The third study described the prevalence of injury in the study population. A dose response effect was observed where increasing hours of weekly work were significantly related to work-related injury. The likelihood of being injured while employed in restaurant, farm/ranch, and construction work was greater than the probability of being injured while working in factory/office/skilled, yard, or retail work when compared to babysitting. Cuts, shocks/burns and sprains were the most common injuries in working teens.^ Students, parents, educators, health professionals and policymakers should continue to monitor the number of weekly hours that students work during the school year. ^

Quality of life and functional status in a low -income, multiethnic HIV -positive population

The introduction of new medical treatments in recent years, commonly referred to as highly active antiretroviral therapy, has greatly increased the survival of patients with HIV/AIDS. As patients with HIV/AIDS continue to live longer, other important health-related outcomes, such as quality of life (QOL), should be thoroughly studied. There is also evidence that racial/ethnic minorities are disproportionately affected by HIV/AIDS, but potential health disparities among individuals already infected with HIV/AIDS have not been adequately examined in ethnically diverse populations. The purpose of this dissertation was to: (1) examine the impact of both demographic and behavioral variables on functional status and overall QOL among a population of ethnically diverse and economically disadvantaged HIV/AIDS patients; (2) examine the psychometric properties of a functional status measure—the Household and Leisure Time Activities questionnaire (HLTA); and (3) assess a proximal-distal theoretical framework for QOL using a full structural equation model in a population of patients with HIV/AIDS. Analyses were performed using data collected in the fall of 2000 from the project, Health and Work-Related Quality of Life and Health Risk Behaviors in a Multiethnic HIV-positive Population . Investigators from The University of Texas M.D. Anderson Cancer Center, The University of Texas-Houston Medical School, and The University of Texas School of Public Health conducted this project. The study site was the Thomas Street Clinic (TSC), a comprehensive HIV/AIDS care facility funded by the Harris County Hospital District (HCHD). TSC provides HIV/AIDS care to a diverse population of approximately 4000 medically indigent residents of Harris County. A systematic, consecutive sampling procedure yielded a sample size of 348 patients. Findings suggested that overall QOL, work-role functioning, household functioning, and leisure time functioning were impaired in this patient population. Results from the psychometric evaluation indicated that the HLTA was a reliable and valid measure of household and leisure time functioning status in a low-income multiethnic HIV-positive population. Finally, structural equation modeling of the proximal-distal QOL model suggested that this model was not a viable representation of the relationship between the study variables in this patient population. ^

Subjective well -being as predictor of mortality, heart disease, and obesity: Prospective evidence from the Alameda County Study

Based on the World Health Organization's (1965) definition of health, understanding of health requires understanding of positive psychological states. Subjective Well-being (SWB) is a major indicator of positive psychological states. Up to date, most studies of SWB have been focused on its distributions and determinants. However, study of its consequences, especially health consequences, is lacking. This dissertation research examined Subjective Well-being, as operationally defined by constructs drawn from the framework of Positive Psychology, and its sub-scores (Positive Feelings and Negative Feelings) as predictors of three major health outcomes—mortality, heart disease, and obesity. The research used prospective data from the Alameda County Study over 29 years (1965–1994), based on a stratified, randomized, representative sample of the general public in Alameda County, California (Baseline N = 6928). ^ Multivariate analyses (Survival analyses using sequential Cox Proportional Hazard models in the cases of mortality and heart disease, and sequential Logistic Regression analyses in the case of obesity) were performed as the main methods to evaluate the associations of the predictors and the health outcomes. The results revealed that SWB reduced risks of all-cause mortality, natural-cause mortality, and cardiovascular mortality. Positive feelings not only had an even stronger protective effect against all-cause, natural-cause and cardiovascular mortality, but also predicted decreased unnatural-cause mortality which includes deaths from suicide, homicide, accidents, mental disorders, drug dependency, as well as alcohol-related liver diseases. These effects were significant even after adjusted for age, gender, education, and various physical health measures, and, in the case of cardiovascular mortality, obesity and health practices (alcohol consumption, smoking, and physical activities). However, these two positive psychological indicators, SWB and positive feelings, did not predict obesity. And negative feelings had no significant effect on any of the health outcomes evaluated, i.e., all-cause mortality, natural- and unnatural-cause mortality, cardiovascular mortality, or obesity, after covariates were controlled. These findings were discussed (1) in comparison with relevant existing studies, (2) in terms of their implications in health research and promotion, (3) in terms of the independence of positive and negative feelings, and (4) from a Positive Psychology perspective and its significance in Public Health research and practice. ^

Survey of shift and work tolerance of City of Houston emergency medical service personnel

This study of ambulance workers for the emergency medical services of the City of Houston studied the factors related to shiftwork tolerance and intolerance. The EMS personnel work a 24-hour shift with rotating days of the week. Workers are assigned to A, B, C, D shift, each of which rotate 24-hours on, 24-hours off, 24-hours on and 4 days off. One-hundred and seventy-six male EMTs, paramedics and chauffeurs from stations of varying levels of activity were surveyed. The sample group ranged in age from 20 to 45. The average tenure on the job was 8.2 years. Over 68% of the workers held a second job, the majority of which worked over 20 hours a week at the second position.^ The survey instrument was a 20-page questionnaire modeled after the Folkard Standardized Shiftwork Index. In addition to demographic data, the survey tool provided measurements of general job satisfaction, sleep quality, general health complaints, morningness/eveningness, cognitive and somatic anxiety, depression, and circadian types. The survey questionnaire included an EMS-specific scaler of stress.^ A conceptual model of Shiftwork Tolerance was presented to identify the key factors examined in the study. An extensive list of 265 variables was reduced to 36 key variables that related to: (1) shift schedule and demographic/lifestyle factors, (2) individual differences related to traits and characteristics, and (3) tolerance/intolerance effects. Using the general job satisfaction scaler as the key measurement of shift tolerance/intolerance, it was shown that a significant relationship existed between this dependent variable and stress, number of years working a 24-hour shift, sleep quality, languidness/vigorousness. The usual amount of sleep received during the shift, general health complaints and flexibility/rigidity (R$\sp2$ =.5073).^ The sample consisted of a majority of morningness-types or extreme-morningness types, few evening-types and no extreme-evening types, duplicating the findings of Motohashi's previous study of ambulance workers. The level of activity by station was not significant on any of the dependent variables examined. However, the shift worked had a relationship with sleep quality, despite the fact that all shifts work the same hours and participate in the same rotation schedule. ^

Evaluation of a date rape prevention program for new students in a university setting

The purpose of this study was to design, implement and evaluate the effectiveness of a date rape prevention program among new students at Rice University. Six-hundred and fifteen new students were randomly assigned to one of eight residential colleges or dormitories. The distribution of students to each of the dormitories was carried out in accordance with a stratified random sampling procedure. The study population was divided into strata based on ethnicity, gender, geographical region, and academic major. The number of students randomly assigned to each of the eight dormitories was approximately 75. After this procedure was completed, each of the colleges was randomly selected to either the intervention or control group. A randomized pretest and posttest control group design was used to assess changes in attitudes, self-efficacy, and behavior with regard to date rape. All participants were given an anonymous pretest and posttest measuring attitudes, self-efficacy, and behavior immediately prior to and following the intervention. The intervention group attended the play Scruples, designed to promote date rape prevention, after which they were immediately posttested. After this initial posttest the intervention group also participated in an interactive group role-playing activity led by trained peer instructors. The control group was pretested and subject to the placebo intervention of a multiculturalism play and was posttested immediately afterwards. Later in the week this group saw the Scruples play only. Both control and intervention groups were sent a two month follow-up survey questionnaire, to measure any changes in attitudes, self-efficacy, and behavior over time. As hypothesized students who saw the play Scruples showed a change in attitudes immediately posttest but no difference in self-efficacy or behavior. The two month follow-up survey showed no change in attitudes, self-efficacy, or behavior. There was a difference at pretest in males and females attitudes, with males showing significantly more rape tolerant attitudes than females. Thus, the proposed research findings will provide a better understanding of the attitudes that perpetuate date rape, and will inform strategies for prevention programs. ^

Middle managers' attitudes toward employee assistance programs in the corporate setting

Several studies have shown that successful Employee Assistance Programs (EAPs) have strong management endorsement. Strong management endorsement is defined as positive support in utilizing EAP services for themselves and their employees. This study focuses solely on middle management as opposed to upper or general management support. The study further examines success or lack of success of an EAP by the utilization rate defined as the number of employees over a year period who access EAP services.^ A analytical cross-sectional design was used to compare and observe differences between two groups of middle managers (utilizers and nonutilizers). Middle manager data was collected through a mail questionnaire. The study focused on identifying predictors that influence middle managers' utilization rate specifically: attitude toward EAPs, EAP knowledge level, attitude toward mental health professionals, age, gender, years worked as a middle manager, education level, training, and other possible predictors of utilization. The overall hypothesis states middle manager utilizers of EAP services have more positive attitudes and a better understanding of their EAP than middle management nonutilizers.^ As predicted, nonparametric bivariate results showed significant differences between the two groups. Middle managers in the utilization group (n = 473) tended to show more positive attitudes toward their EAP and mental health professionals and demonstrated greater EAP knowledge compared to the nonutilization group (n = 154). These findings support past studies on variables that influence EAP utilization rates.^ Further variables found to influence middle management utilization were identified by multivariate logistic regression results. These variable were gender (female supervisors), educational levels of employees supervised (employees with lower levels of education), number of employees supervised (greater the number supervised, more likely to utilize), managerial EAP training (trained supervisors) and awareness that problems do influence an employee's productivity.^ These findings strengthen the assertion that middle management's attitudes, as well as other variables may influence utilization. Study findings add new information about important variables specifically influencing middle management who utilize EAPs. An understanding of these variables is essential in developing competent EAP program training and orientation programs for middle managers. ^

An evaluation of a community-based program for homeless adults with mental disorders and comorbid alcohol drug and mental disorders

Limited research has been conducted evaluating programs that are designed to improve the outcomes of homeless adults with mental disorders and comorbid alcohol, drug and mental disorders. This study conducted such an evaluation in a community-based day treatment setting with clients of the Harris County Mental Health and Mental Retardation Authority's Bristow Clinic. The study population included all clients who received treatment at the clinic for a minimum of six months between January 1, 1995 and August 31, 1996. An electronic database was used to identify clients and to track their program involvement. A profile was developed of the study participants and their level of program involvement included an examination of the amount of time spent in clinical, social and other interventions, the type of interventions encountered and the number of interventions encountered. Results were analyzed to determine whether social, demographic and mental history affected levels of program involvement and the effects of the levels of program involvement on housing status and psychiatric functioning status.^ A total of 101 clients met the inclusion criteria. Of the 101 clients, 96 had a mental disorder, and five had comorbidity. Due to the limited numbers of participants with comorbidity, only those with mental disorders were included in the analysis. The study found the Bristow Clinic population to be primarily single, Black, male, between the ages of 31 and 40 years, and with a gross family income of less than $4,000. There were more persons residing on the streets at entry and at six months following treatment than in any other residential setting. The most prevalent psychiatric diagnoses were depressive disorders and schizophrenia. The Global Assessment of Functioning (GAF) scale which was used to determine the degree of psychiatric functioning revealed a modal GAF score of 31--40 at entry and following six months in treatment. The study found that the majority of clients spent less than 17 hours in treatment, had less than 51 encounters and had clinical, social, and other encounters. In regard to social and demographic factors and levels of program involvement, there were statistically significant associations between gender and ethnicity and the types of interventions encountered as well as the number of interventions encountered. There was also a statistically significant difference between the amount of time spent in clinical interventions and gender. Relative to outcomes measured, the study found female gender to be the only background variable that was significantly associated with improved housing status and the female gender and previous MHMRA involvement to be statistically associated with improvement in GAF score. The total time in other (not clinical or social) interventions and the total number of encounters with other interventions were also significantly associated with improvement in housing outcome. The analysis of previous services and levels of program involvement revealed significant associations between time spent in social and clinical interventions and previous hospitalizations and previous MHMRA involvement.^ Major limitations of this study include the small sample size which may have resulted in very little power to detect differences and the lack of generalizability of findings due to site locations used in the study. Despite these limitations, the study makes an important contribution to the literature by documenting the levels of program involvement and the social and demographic factors necessary to produce outcomes of improved housing status and psychiatric functioning status. ^