The Effects of American Sign Language on General Self- Efficacy and Anxiety Among Mothers in a Residential Rehabilitation Facility for Drug Addiction and Substance Abuse

Globally, approximately 208 million people aged 15 and older used illicit drugs at least once in the last 12 months; 2 billion consumed alcohol and tobacco consumption affected 25% (World Drug Report, 2008). In the United States, 20.1 million (8.0%) people aged 12 and older were illicit drug users, 129 million (51.6%) abused alcohol and 70.9 million (28.4%) used tobacco (SAMHSA/OAS, 2008).Usually considered a problem specific to men (Lynch, 2002), 5.2% of pregnant women aged 15 to 44 are also illicit drug and substance abusers (SAMHSA/OAS, 2007). During pregnancy, illicit drugs and substance abuse (ID/SA) can significantly affect a woman and her infant contributing to developmental and communication delays for the infant and influencing parenting abilities (Budden, 1996; March of Dimes, 2006b; Rossetti, 2000). Feelings of guilt and shame and stressful experiences influence approaches to parenting (Ashley, Marsden, & Brady, 2003; Brazelton, & Greenspan, 2000; Ehrmin, 2000; Johnson, & Rosen, 1990; Kelley, 1998; Rossetti, 2000; Velez et al., 2004; Zickler, 1999). Parenthood is an expanded role that can be a trying time for those lacking a sense of self-efficacy and creates a high vulnerability to stress (Bandura, 1994). Residential treatment programs for ID/SA mothers and their children provide an excellent opportunity for effective interventions (Finkelstein, 1994; Social Care Institute for Excellence, 2005). This experimental study evaluated whether teaching American Sign Language (ASL) to mothers living with their infants/children at an ID/SA residential treatment program increased the mothers’ self-efficacy and decreased their anxiety. Quantitative data were collected using the General Self-Efficacy Scale and the State-Trait Anxiety Inventory showing there was both a significant increase in self efficacy and decrease in anxiety for the mothers. This research adds to the knowledge base concerning ID/SA mothers’ caring for their infants/children. By providing a simple low cost program, easily incorporated into existing rehabilitation curricula, the study helps educators and healthcare providers better understand the needs of the ID/SA mothers. This study supports Bandura’s theory that parents who are secure in their efficacy can navigate through the various phases of their child’s development and are less vulnerable to stress (Bandura, 1994).

Relationships among dietary intake, dietary patterns, dietary quality and nutrient adequacy and substance use in Latina mother/daughter dyads

This study examined the relationships among dietary intake, substance use, socioeconomic and acculturation-related factors among Latinas in Miami-Dade County. Substance abuse is rising among Latinas. A fuller understanding of this problem is needed given the rise of the Hispanic population and the role of women in Latin society. A better understanding between substance use and dietary intake can guide nutrition interventions to reduce negative substance-related health consequences. A purposeful sample of 320 Latina mother/daughter dyads were recruited and interviewed face-to-face as part of the Latino Women's Study. Dietary intake was collected via a 24-hour recall and examined by (1) nutrient intake, (2) dietary patterns using cluster analysis, (3) quality of diet using the Healthy Eating Index (HEI) and (4) the Dietary Reference Intakes to determine nutrient adequacy. Substance use was measured with the Drug Use Frequency and the Healthy and Daily Living Form. Acculturation was measured with the Cultural Identity Scale. Three dietary patterns emerged based on the number of servings from the food groups established in MyPyramid. None were associated with substance use. Latinas who reported using cannabis, cocaine, sedatives without prescription and/or more than five alcoholic drinks on an occasion at least once a month during the previous twelve months had significantly lower HEI scores (64 vs. 60; F = 7.8, p = .005) and consumed fewer fruits (F = 16, p < .001) than non-users. Latinas classified as mothers whom reported consuming cannabis at least 1-7 times a week had significantly lower HEI scores (F = 4.23, p = .015, η2 = .027) than daughters with the same frequency of substance use. One dimension of acculturation, greater familiarity with Latin culture, was associated with good dietary quality (β = .142, p = .012) regardless of any type of substance used or income level. There was a high prevalence of inadequacy of folic acid intake (50-75%) regardless of substance use. Substance users consumed significantly more energy (1,798 vs. 1,615; p = .027) than non-users. Although effect sizes were small, associations between dietary intake and substance use among Latinas deserve further exploration while acknowledging the combined association with acculturation. ^

Patriarchal ideology and frequency of partner abuse among men in batterer treatment groups

This research examined the relative influence of a number of factors, patriarchal ideology, age, socio-economic status, partner relationship, and problem behaviors on the frequency of partner abuse. Patriarchal ideology as measured by the Attitudes Toward Women Scale (AWS), and the Inventory of Beliefs about Wife Beating (IBWB) among men in batterer treatment programs did not have the strong influence expected on whether men in treatment are more frequent abusers of their partners. Instead, having a criminal record and having been identified as having a substance abuse problem stood out as being the most influential factors associated with frequent partner abuse. Questionnaires were administered to 283 men in batterer treatment programs in Dade County Florida who volunteered to participate in the study. Specifically, men in batterer groups who scored low on the AWS or high on the IBWB indicating an adherence to patriarchal ideology were predicted to report more frequent abuse of their partners. Conversely, men in treatment who scored high on the AWS or low on the IBWB indicating a tendency towards a non-patriarchal ideology were predicted to report less frequent abuse. ^

Risk factors that predict maladaptive outcomes among sexually abused girls presenting for services at a community agency

The purpose of this study was to determine which factors predicted maladaptive outcomes in sexually abused children. Key factors were aggregated into four categories: abuse characteristics risk factors, individual-level risk factors, family disruption risk factors, and social disruption risk factors. It was hypothesized that (a) individual-level risk factors (e.g., school performance, child alcohol/substance abuse) and (b) abuse characteristics risk factors (e.g., longer duration/frequency of abuse, use of force/threats of force, intrafamilial abuse) would predict higher levels of trauma symptoms. Furthermore, it was hypothesized that (a) family disruption risk factors (e.g., family alcohol/substance use, family psychopathology) and (b) social disruption risk factors (e.g., parental divorce, homelessness, witnessing homicide or violence) would moderate the impact of prior sexual abuse and predict higher levels of trauma symptoms. ^ The participants were 110 female children (5 to 18 years old) presenting for treatment for sexual abuse at a community agency (The Journey Institute) in Miami, Florida. This study conducted a retrospective analysis of an archival data set collected over a three-year period (1998–2001). The measures completed upon intake included The Journey Psychosocial Assessment and The Trauma Symptom Checklist for Children (TSCC; Briere, 1996). Using Pearson correlations and hierarchical multiple regression analysis, this study found that abuse characteristics risk factors and individual-level risk factors were predictive of maladaptive outcomes in this sample of sexually abused girls. However, no moderating effects were found for family disruption risk factors or social disruption risk factors. Therefore, the results of these analyses provided support for the contention that abuse characteristics and individual-level risk factors were appropriate targets for treatment for sexually abused girls. Moreover, limitations of this study, implications for treatment, and directions for future research were discussed. ^

A follow-up outcome evaluation of independent living services for foster care youth

This study aimed to evaluate the effectiveness of the Independent Living (IL) program targeting foster youths to prepare them for effective adulthood. The study employed a pre-post, two-group comparative research design. The IL group was composed of 49 young adults who participated in the IL or SIL (subsidized IL) program prior to their emancipation from foster care (mean age, 20.6 years). The comparison was made up of 18 young adults who experienced foster care but never participated in the IL or SIL programs (mean age, 20.2 years). Data were collected via a mailed survey that included the Daniel Memorial Independent Living Assessment (DMILA) and an additional questionnaire developed by the researcher. The study also examined: (1) why youth in foster care do not participate in IL programs, (2) how participating youth evaluate IL services and what recommendations they make to improve services, and (3) the internal consistency of the DMILA. Results suggest that the DMILA assessment has mediocre reliability. IL program participation is associated with better educational, employment, income, housing, early parenting-prevention, transportation, anger control, criminal-prevention, and self-evaluation outcomes. However, IL participation is not associated with better social support, perceived parenting competence, substance abuse-prevention, sexual risk-prevention outcomes, increased knowledge in money management skills, job seeking and job maintenance skills, interpersonal skills, or lower depression. Results also suggest that the outreach activities of the IL program may be flawed. IL participants reported the IL program was doing best in educational preparation, criminal involvement prevention, and money management preparation and least well in parenting preparation, housing preparation, employment preparation, and substance abuse prevention. To improve services, youths recommended primarily that IL counselors develop closer relationships with youths, that IL training better address organizational skills, and that monthly subsidy be raised and SIL eligibility requirements softened. The study's political context and limitations are also discussed and implications are derived regarding prevention, intervention, outreach, mentorship, empowerment, cross-systems collaboration, and future research. ^

A meta -analysis of empirical research studies on resilience among students at -risk for school failure

Being at-risk is a growing problem in the U.S. because of disturbing societal trends such as unemployment, divorce, substance abuse, child abuse and neglect, and the new threat of terrorist violence. Resilience characterizes individuals who rebound from or adapt to adversities such as these, and academic resilience distinguishes at-risk students who succeed in school despite hardships. ^ The purpose of this research was to perform a meta-analysis to examine the power of resilience and to suggest ways educators might improve academic resilience, which was operationalized by satisfactory test scores and grades. In order to find all studies that were relevant to academic resilience in at-risk kindergarten through 12th-grade students, extensive electronic and hardcopy searches were conducted, and these resulted in a database of 421 articles. Two hundred eighty seven of these were rejected quickly, because they were not empirical research. Upon further examination, another 106 were rejected for not meeting study protocol criteria. Ultimately, 28 studies were coded for study level descriptors and effect size variables. ^ Protective factors for resilience were found to originate in physical, psychological, and behavioral domains on proximal/intraindividual, transitional/intrafamilial, or distal/extrafamilial levels. Effect sizes (ESs) for these were weighted and the means for each level or category were interpreted by commonly accepted benchmarks. Mean effect sizes for proximal (M = .27) and for transitional (M = .15) were small but significant. The mean effect size for the distal level was insignificant. This supported the hypotheses that the proximal level was the source of most protective factors for academic resilience in at-risk students followed by the transitional level. The distal effect size warranted further research particularly in light of the small number of studies (n = 11) contributing effect sizes to that category. A homogeneity test indicated a search for moderators, i.e., study variables affecting outcomes, was justified. “Category” was the largest moderator. Graphs of weighted mean effect sizes in the physical, psychological, and behavioral domains were plotted for each level to better illustrate the findings of the meta-analysis. Suggestions were made for combining resilience development with aspects of positive psychology to promote resilience in the schools. ^

HIV infection and drugs of abuse: role of acute phase proteins

Background HIV infection and drugs of abuse such as methamphetamine (METH), cocaine, and alcohol use have been identified as risk factors for triggering inflammation. Acute phase proteins such as C-reactive protein (CRP) and serum amyloid A (SAA) are the biomarkers of inflammation. Hence, the interactive effect of drugs of abuse with acute phase proteins in HIV-positive subjects was investigated. Methods Plasma samples were utilized from 75 subjects with METH use, cocaine use, alcohol use, and HIV-positive alone and HIV-positive METH, cocaine, and alcohol users, and age-matched control subjects. The plasma CRP and SAA levels were measured by ELISA and western blot respectively and the CD4 counts were also measured. Results Observed results indicated that the CRP and SAA levels in HIV-positive subjects who are METH, cocaine and alcohol users were significantly higher when compared with either drugs of abuse or HIV-positive alone. The CD4 counts were also dramatically reduced in HIV-positive with drugs of abuse subjects compared with only HIV-positive subjects. Conclusions These results suggest that, in HIV-positive subjects, drugs of abuse increase the levels of CRP and SAA, which may impact on the HIV infection and disease progression.

Acculturation and Hispanic identity/ethnicity as a predictor of change on the brief situational confidence questionnaire

The purpose of this study was to investigate whether level of acculturation among Hispanic adolescent males (n = 174) influenced treatment outcome in a substance abuse program, specifically on the Brief Situational Confidence Questionnaire (BSCQ) which measures relapse confidence. It was hypothesized that lower levels of acculturation were likely to be predictive of positive change, whereas higher levels of acculturation were likely to be predictive of no change or negative change. It was found that adolescents changed over time in BSCQ scores regardless of which acculturation variable was measured. Contrary to expectations, for those adolescents placed in family treatment, place of birth was not significantly associated with treatment response. However, both, U.S. and non-U.S. born adolescents demonstrated a change over time when receiving family treatment, suggesting that the family substance abuse treatment utilized in this intervention effected change over time.

The Influence of Neurocognitive Impairment, Alcohol and other Drug (AOD) Use, and Psychosocial Factors on Antiretroviral Treatment Adherence, Service Utilization and Viral Load Among HIV-Seropositive Adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

Maltreatment, psychiatric symptoms and human immunodeficiency virus/sexual transmitted infection risk behavior among youth with alcohol and other drug use problems: A person-centered analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). ^ LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth. ^

Qualitative Responses to Pre-employment Drug Testing in the Foodservice Industry

Employee substance abuse has long time been a topic of concern for the hospitality industry. Operating under the assumption that drug-users, and associated undesirable behavior, can be eliminated from the hiring process, many operations have adopted pre-employment drug-testing policies. Despite being represented across the industry as a major target of effort and resources, it is suggested that the perceived sensitive-nature of the subject has somewhat hindered access to qualitative information. The purpose of this research was to assess and explore the attitudes, beliefs and perceptions of both management and employees in the foodservice industry regarding pre-employment drug-testing and its impact on work performance. Through the use of a phenomenological survey, qualitative data was collected then used to identify themes in participants’ perceptions of such screening policies and their effects. Results and implications of these findings are discussed.

Influence of gender and life stressors on longitudinal depression treatment outcomes among older primary care patients

Purpose: Depression in older females is a significant and growing problem. Females who experience life stressors across the life span are at higher risk for developing problems with depression than their male counterparts. The primary aim of this study was (a) to examine gender-specific differences in the correlates of depression in older primary care patients based on baseline and longitudinal analyses; and (b) to examine the longitudinal effect of biopsychosocial risk factors on depression treatment outcomes in different models of behavioral healthcare (i.e., integrated care and enhanced referral). Method: This study used a quantitative secondary data analysis with longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study. A linear mixed model approach to hierarchical linear modeling was used for analysis using baseline assessment, and follow-up from three-month and six-month. Results: For participants diagnosed with major depressive disorder female gender was associated with increased depression severity at six-month compared to males at six-month. Further, the interaction between gender and life stressors found that females who reported loss of family and friends, family issues, money issues, medical illness was related to higher depression severity compared to males whereas lack of activities was related to lower depression severity among females compared to males. Conclusion: These findings suggest that gender moderated the relationship between specific life stressors and depression severity similar to how a protective factor can impact a person's response to a problem and reduce the negative impact of a risk factor on a problem outcome. Therefore, life stressors may be a reliable predictor of depression for both females and males in either behavioral health treatment model. This study concluded that life stressors influence males basic comfort, stability, and survival whereas life stressors influence females' development, personal growth, and happiness; therefore, life stressors may be a useful component to include in gender-based screening and assessment tools for depression. ^

Identity, purpose, and well-being among emerging adult Hispanic women

Few studies apply the Eriksonian model of identity formation to cross-cultural samples (3), even though issues of ethnicity and culture may inform a Hispanic woman's self-concept (Phinney, 1996). Hispanic women may also be influenced by traditional gender role behaviors such as passivity or dependence that are outlined by marianismo (Stevens, 1973). A recent study of a multiethnic sample of emerging adult women and men found that purpose commitment mediated the effects of identity commitment on hope and life satisfaction (Burrow & Hill, 2011). The current research consists of two studies that replicate and expand upon the work of Burrow and Hill (2011). Study I replicated the work of Burrow and Hill (2011) among a sample of emerging adult Hispanic women, in order to assess the extent to which the original findings would replicate in a culturally distinct sample. Study II examined the role of marianismo, ethnic identity, and acculturation on identity commitment among emerging adult Hispanic women. Both studies utilized a sample of 532 female undergraduate psychology students, age 18 to 25, who self-identified as Hispanic and submitted data via online surveys. Both studies used self-report, quantitative data, which was analyzed using structural equation modeling. Results from Study I indicated good model fit and replicated the findings from Burrow and Hill (2011). Specifically, the direct effect of identity commitment on hope was fully contingent upon an individual's level of purpose commitment, while the effect of identity commitment on life satisfaction was not contingent upon an individual's level of purpose commitment. Results from Study II indicated that marianismo, Spanish proficiency, familiarity with Latino culture, and familiarity with American culture demonstrated statistically significant direct effects on identity commitment among emerging adult Hispanic women. Results indicated cultural convergence regarding the association of an individual's identity with well-being through a sense of purpose. Findings also revealed the role of cultural factors in the extent to which Hispanic women commit to a personal identity. Future studies should employ mixed method research designs as a means to better ascertain implications of findings. ^

Maltreatment, Psychiatric Symptoms and Human Immunodeficiency Virus/Sexual Transmitted Infection Risk Behavior Among Youth with Alcohol and Other Drug Use Problems: A Person-Centered Analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth.

Identity, Purpose, and Well-Being Among Emerging Adult Hispanic Women

Few studies apply the Eriksonian model of identity formation to cross-cultural samples (3), even though issues of ethnicity and culture may inform a Hispanic woman’s self-concept (Phinney, 1996). Hispanic women may also be influenced by traditional gender role behaviors such as passivity or dependence that are outlined by marianismo (Stevens, 1973). A recent study of a multiethnic sample of emerging adult women and men found that purpose commitment mediated the effects of identity commitment on hope and life satisfaction (Burrow & Hill, 2011). The current research consists of two studies that replicate and expand upon the work of Burrow and Hill (2011). Study I replicated the work of Burrow and Hill (2011) among a sample of emerging adult Hispanic women, in order to assess the extent to which the original findings would replicate in a culturally distinct sample. Study II examined the role of marianismo, ethnic identity, and acculturation on identity commitment among emerging adult Hispanic women. Both studies utilized a sample of 532 female undergraduate psychology students, age 18 to 25, who self-identified as Hispanic and submitted data via online surveys. Both studies used self-report, quantitative data, which was analyzed using structural equation modeling. Results from Study I indicated good model fit and replicated the findings from Burrow and Hill (2011). Specifically, the direct effect of identity commitment on hope was fully contingent upon an individual’s level of purpose commitment, while the effect of identity commitment on life satisfaction was not contingent upon an individual’s level of purpose commitment. Results from Study II indicated that marianismo, Spanish proficiency, familiarity with Latino culture, and familiarity with American culture demonstrated statistically significant direct effects on identity commitment among emerging adult Hispanic women. Results indicated cultural convergence regarding the association of an individual’s identity with well-being through a sense of purpose. Findings also revealed the role of cultural factors in the extent to which Hispanic women commit to a personal identity. Future studies should employ mixed method research designs as a means to better ascertain implications of findings.