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. ^

Ethnic differences in adolescents' mental distress

Objectives. The aims of this cross-sectional study were to (1) examine differences among four ethnic groups of middle school students (Anglos, African Americans [AAs], Hispanics, and Asians) on (a) three indicators of mental distress (depression, somatic symptoms, suicidal ideation) (b) social stress (general social stress, process-oriented stress, discrimination) and resources (family relationships, coping, self-esteem) and (2) identify significant risk factors and resources for each ethnic group by examining the moderating effects of ethnicity. ^ Methods. Respondents included 316 students from three schools (144 Anglos, 66 AAs, 77 Hispanics, 29 Asians/Others) who completed self-administered questionnaires. Social stress and somatic symptoms were measured by using the SAFE-C and Somatic Symptom Scale, respectively. The DSD was used to assess depression and suicidal ideation. Resources were measured by using the FES, age-appropriate adaptations of two existing coping scales, and Rosenberg's Self-Esteem Scale. For specific aims, descriptive statistics, ANOVA, ANCOVA, and logistic regression analysis were used. ^ Findings. No statistically significant ethnic group or gender differences were observed in depression and somatic symptoms, but the odds of experiencing depression symptoms were about 9.7 times greater for Hispanic females than for the referent group, Anglo males. Hispanics were also 2.04 times more likely to have suicidal ideation than Anglos ( P < 0.05). AAs and Hispanics reported significantly higher levels of stress than Anglos (OR: 2.2–4.3, 0.00 ≤ P ≤ 0.03). These findings imply that adolescents in these ethnic groups may be exposed to considerable amounts of stress even if they do not exhibit significant symptoms of mental distress yet. Negative moderating effects for ethnicity were found by the significant interaction between ethnicity and social stress in somatic symptoms among AAs and Hispanics. This finding indicates that AA and Hispanic adolescents may require higher levels of social stress to exhibit the same amount of somatic symptoms as Anglo adolescents. Observed ethnic differences in social stress and interaction between social stress and ethnicity in relation to somatic symptoms demonstrated a need for subsequent longitudinal studies, and provided a rationale for incorporating social stress as a critical component not only in research but also in culturally sensitive prevention programs. ^

Depressive symptoms and sexual risk behaviors in adolescents

The purpose of this study was to determine whether depression is a factor in explaining the difference in sex behaviors among adolescents with different ethnic backgrounds, family and school contexts. We hypothesize that adolescents with a higher number of depressive symptoms are more likely to engage in sexual risk behaviors than adolescents with fewer depressive symptoms. Further, adolescent depression and sexual behaviors are mediated or moderated by individual characteristics, family and school contexts. ^ Background. large ethnic disparities exist in adolescent engagement in risky sexual behaviors, yet, there is little in the literature that explains these disparities. Studies of sexual behavior of youths abound; yet, there is little literature on the prevalence and correlates of depression or the association between depression and sexual behaviors among different ethnic groups. Objectives. (1) To determine ethnic differences in the prevalence of depressive symptoms using data collected through the National Longitudinal Study of Adolescent Health (Add Health). (2) To determine predictors of sex risk behaviors among adolescents, including the role of depression. (3) To identify predictors of depression among these adolescents. Methods. Add Health data from wave 1 and wave 2 interviews of 7th–12th graders were analyzed using multivariate models constructed with both depression and sexual behavior as outcome variables. Logistic regression models determined whether and to what extent the independent variables, including depression, sex behaviors, demographic factors, individual and family characteristics, and school context were related to the probability of engaging in risky sexual behaviors. Results. Ethnic differences in depressive symptoms did not persist after demographic and contextual variables were included in the model. Sex behaviors all shared the hypothesized relationship with depressive symptoms. The odds of risky sex behaviors increased as number of depressive symptoms increased. Depression was predicted by marijuana use and having a serious argument with father for males at Wave 1 and by age and future orientation for females. Wave 2 depression was predicted by Wave 1 depression. ^

Back pain in migrant farmworker families and farmworker high school students from Starr County, Texas

Back symptoms are a major global public health problem with the lifetime prevalence ranging between 50-80%. Research suggests that work-related factors contribute to the occurrence of back pain in various industries. Despite the hazardous nature, strenuous tasks, and awkward postures associated with farm work, little is known about back injury and symptoms in farmworker adults and children. Research in the United States is particularly limited. This is a concern given the large proportion of migrant farmworkers in the United States without adequate access to healthcare as well as a substantial number of youth working in agriculture. The present study describes back symptoms and identifies work-related factors associated with back pain in migrant farmworker families and farmworker high school students from Starr County, TX. Two separate datasets were used from two cohort studies "Injury and Illness Surveillance in Migrant Farmworkers (MANOS)" (study A: n=267 families) and "South Texas Adolescent Rural Research Study (STARRS)" (study B: n=345). Descriptive and inferential statistics including multivariable logistic regression were used to identify work-related factors associated with back pain in each study. In migrant farmworker families, the prevalence of chronic back pain during the last migration season ranged from 9.5% among youngest children to 33.3% among mothers. Chronic back pain was significantly associated with increasing age; fairly bad/very bad quality of sleep while migrating; fewer than eight hours of sleep at home in Starr County, TX; depressive symptoms while migrating; self-provided water for washing hands/drinking; weeding at work; and exposure to pesticide drift/direct spray. Among farmworker adolescents, the prevalence of severe back symptoms was 15.7%. Severe back symptoms were significantly associated with being female; history of a prior accident/back injury; feeling tense, stressed, or anxious sometimes/often; lifting/carrying heavy objects not at work; current tobacco use; increasing lifetime number of migrant farmworker years; working with/around knives; and working on corn crops. Overall, results support that associations between work-related exposures and chronic back pain and severe back symptoms remain after controlling for the effect of non-work exposures in farmworker populations. ^

The contribution of change in ethnic composition to prevalence of obesity and overweight

Objective. The prevalence of overweight and obesity differs substantially among children of different ethnic origin in the United States. The objective of this project is to estimate to what extent changes in ethnic composition since 1980 have contributed to the current general “obesity epidemic” in the childhood population of the United States.^ Methods. Populations by single year of age, 0 to 19, male and female, for Hispanics, non-Hispanic whites, and non-Hispanic blacks, from the US Census’ July estimates for 1985, 1990, 1995, 2000 and 2005 were taken and compared to the population and percentage of those groups from 1980. Age, sex, and ethnicity specific prevalence rates for overweight in 1980 were then applied to the populations by age for the specified year and differences in expected and actual overweight populations were assessed.^ Result. The results from this investigation provide estimates of the contribution that different ethnic groups have made to the overall prevalence of overweight and obesity in the childhood population of the United States. Assuming that the 1976-1980 prevalence rates had remained unchanged, and then comparing the population had there been no change in ethnic composition with the population given the actual change in ethnicity, the percentage increase was 1.06% in 1985, 1.72% in 1990, 2.57% in 1995, 3.95% in 2000, and 4.39% in 2005.^ Conclusion. The changes in ethnic composition of the population, independent of changes in ethnicity-specific prevalence, have contributed substantially to the current overall prevalence of obesity in the United States childhood population. There are a number of factors that may be responsible for the apparent susceptibility of Mexican-Americans and non-Hispanic blacks to overweight and obesity. Further research is needed on specific characteristics of those populations.^

Information sources influencing urban Mexican-American women's cancer screening participation

Breast and cervical cancer, though less common in Mexican-American than in Anglo women, are more likely to go undetected in Mexican-American women, leaving them more vulnerable to advanced disease and death. Although highly effective screening tests--the Pap smear and the mammogram--can detect these cancers early, many Mexican-American women do not regularly undergo these preventive screening tests.^ To explore the differential influence of encouraging sources of health information, this investigation examined the relationship between encouragement from a "peer"--husband or partner, child or children, other family members, or close friends--and a "health professional"--a doctor, a nurse, or another health professional--on Mexican-American women's cancer screening intentions and behaviors. Furthermore, this research explored whether the sources' influence on cancer screening intentions and behaviors differed depending on level of acculturation.^ One thousand seven hundred eleven surveys of Mexican-American women were analyzed to identify the source that most effectively encourages these women to participate in cancer screening. The data provided evidence that health professionals strongly influenced this population's cancer screening intentions and behaviors. Evidence for peer influence was also found; however, it was usually weaker, and, in some cases, negligible. Peer encouragement was related to Pap test behaviors and mammogram intentions, but not to Pap test intentions or mammogram behaviors. Consistently, women reported greater intentions and screening behaviors when encouraged from a health professional than from a peer. Acculturation was not found to be a modifying variable related to the relationship between sources of information and Pap test or mammogram intentions and behaviors.^ Because health professionals were identified as strongly influencing both intentions and behaviors for Pap tests and mammograms, further efforts should be undertaken to urge them to encourage their clients to obtain cancer screening. Failure to provide this encouragement leads to missed opportunities. Enlisting support from peers also may help to increase cancer screening participation in urban Mexican-American women; however, the consistently greater intentions and behaviors related to a health professional's encouragement indicated the greater power of the latter. ^

Hispanic incorporation and access to health care in Houston and Harris County, Texas: Adopting an Hispanic perspective to the Aday and Andersen model

This study examines Hispanic levels of incorporation and access to health care. Applying the Aday and Andersen framework for the study of access, the study examined the relationship between two levels of Hispanic incorporation into U.S. society, i.e., mainstream versus ethnic, and potential and realized measures of access to health care. Data for the study were drawn from a 1992 telephone survey of 600 randomly selected Hispanics in Houston and Harris County.^ The hypotheses tested were: (1) Hispanics who are incorporated into mainstream society are more likely to have better potential and realized access to health care than those who are incorporated into ethnic-group enclaves regardless of their socioeconomic status (SES), health status and health needs, and (2) there is no interaction between the levels of incorporation (mainstream or ethnic) and SES, health status, and health needs in predicting potential and realized access.^ The data analysis supported Hypothesis One for the two measures of potential access. The results of bivariate and multiple logistic regression analyses indicated that for Hispanics in Houston and Harris County, being in the "mainstream" incorporation category increased their potential access to care, having "health insurance" and a "regular place of care". For the selected measure of realized access, having a "regular check-up", the analysis did not demonstrate statistically significant differences in having a regular check-up among Hispanics incorporated in the ethnic or mainstream incorporation categories.^ Hypothesis Two, that there is no interaction between the levels of incorporation and socioeconomic characteristics, health status, and health needs in predicting potential and realized access among Hispanics was supported by the data. The results of the logistic regression analysis showed that, after adjusting for socioeconomic status, health status, and health needs, the association between "level of incorporation" and the two measures of potential access ("health insurance" and having a "usual place of care") was not modified by the control variables nor by their interaction with level of incorporation. That is, the effect of incorporation on Hispanics' health insurance coverage, and having a usual place of care, was homogenous across Hispanics with different SES and health status.^ The main research implication of this dissertation is the employment of a theoretical framework for the assessment of cultural factors essential to research on migrating heterogeneous subpopulations. It also provided strategies to solve practical and methodological difficulties in the secondary analyses of data on these populations. ^

Comparison of health behaviors of Mexican American and non -Hispanic White females: Implications for health promotion programs

Hispanics form the second-largest minority group in the United States totaling 22 million people. Health data on this population are sparse and inconsistent. This study seeks to determine use of preventative services and risk factor behaviors of Mexican American and non-Hispanic White females residing in South Texas.^ Baseline data from female respondents in household surveys in six South Texas counties (Ramirez and McAlister, 1988; McAlister et al., 1992) were analyzed to test the following hypotheses: (1) Mexican American and Non-Hispanic White females exhibit different patterns of health behaviors; (2) Mexican American females will exhibit different health behaviors regardless of age; and (3) the differences between Mexican American women and non-Hispanic White females are due to education and acculturation factors.^ Over the past decade, the traditional behaviors of Mexican American females have begun to change due to education, acculturation, and their participation in the labor force. The results from this study identify some of the changes that will require immediate attention from health care providers. Results revealed that regardless of ethnicity, age, education, and language preference, non-Hispanic White females were significantly more likely to participate in preventive screening practices than were Mexican American females. Risk factor analysis revealed a different pattern with Mexican American females significantly more likely to be non-smokers, non-alcoholic drinkers, and to have good fat avoidance practices compared to non-Hispanic White females. However, compared to those who are less-educated or Spanish-speaking, Mexican American females with higher levels of education and preference for speaking English only showed positive and negative health behaviors that were more similar to the non-Hispanic White females. The positive health behaviors that come with acculturation, e.g., more participation in preventive care and more physical activity, are welcome changes. But this study has implications for global health development and reinforces a need for "primordial" prevention strategies to deter the unwanted concomitants of economic development and acculturation. Smoking and drinking behaviors among Mexican American females need to be kept at low levels to prevent increased morbidity and premature deaths in this population. ^

Medical social work in tax-supported health and welfare services; a report of the Joint Committee of the American Association of Medical Social Workers and the American Public Welfare Association,

Mode of access: Internet.

Using structural equation modeling to assess two theoretical models that explain dropout

This study evaluated the relative fit of both Finn's (1989) Participation-Identification and Wehlage, Rutter, Smith, Lesko and Fernandez's (1989) School Membership models of high school completion to a sample of 4,597 eighth graders taken from the National Educational Longitudinal Study of 1988, (NELS:88), utilizing structural equation modeling techniques. This study found support for the importance of educational engagement as a factor in understanding academic achievement. The Participation-Identification model was particularly well fitting when applied to the sample of high school completers, dropouts (both overall and White dropouts) and African-American students. This study also confirmed the contribution of school environmental factors (i.e., size, diversity of economic and ethnic status among students) and family resources (i.e., availability of learning resources in the home and parent educational level) to students' educational engagement. Based on these findings, school social workers will need to be more attentive to utilizing macro-level interventions (i.e., community organization, interagency coordination) to achieve the organizational restructuring needed to address future challenges. The support found for the Participation-Identification model supports a shift in school social workers' attention from reactive attempts to improve the affective-interpersonal lives of students to proactive attention to their academic lives. The model concentrates school social work practices on the central mission of schools, which is educational engagement. School social workers guided by this model would be encouraged to seek changes in school policies and organization that would facilitate educational engagement. ^

Historical development of residential segregation and black housing quality in Dade County

This paper examines the relationship between the historical development of residential segregation in Black areas of Dade County and the level of housing quality in those areas. Previous literature studies the effect of hypersegregation on housing quality. Instead, this paper analyzes the nature of each Black community and the social process by which they became segregated in contrast with only hypersegregation being considered. Data were drawn from the 1990 Census of Housing and Population at the block group level for Dade County. Two indicators for housing quality were considered: crowding and rent. Six categories for Black areas in Dade County and one residual category were developed for the analysis. Regression's results show that the effect of each community on housing quality varies. For example, overcrowding goes down in first-ghetto areas when compared to second-ghetto areas, although the percentage of Blacks in both communities is about the same. ^

Equity policy, educational practice, and limited English proficient (LEP) students in two high schools in Miami

Most studies of language minority students' performance focus on students' characteristics. This study uses qualitative methodology to examine instead how educational policies and practices affect the tracking of language minority students who are classified as limited English proficient (LEP). The placement of LEP students in core courses (English, Math, Social Studies, and Science) is seen as resulting from the interaction between school context and student characteristics. The school context includes factors such as equity policy requirements, overcrowding, attitudes regarding immigrants' academic potential, tracking, and testing practices. Interaction among these factors frequently leads to placement in lower track courses. It was found that the absence of formal tracks could be misleading to immigrant students, particularly those with high aspirations who do not understand the implications of the informal tracking system. Findings are discussed in relation to current theoretical explanations for minority student performance. ^

Rastafarianism and the Nation of Islam as institutions for group-identity formation among blacks in the United States: A case study comparing their approaches

This dissertation explores the Rastafari movement and the Nation of Islam as institutions that provide a group-identity for their adherents. The study seeks to determine the characteristics of the identity that is institutionalized by each movement, and the nature of the institutionalization process. The research was conducted primarily in South Florida where both movements exist. An extensive literature review in conjunction with in-depth field interviews were used as the primary research methodologies. What was of particular interest were the reasons that the members of the movements chose one movement over the other, also the similarities and dissimilarities between the movements in their role as institutions for group-identity formation. The research showed that both movements imbued their members with a sense of pride, high self-esteem and a strong sense of race consciousness. In addition, it showed that there was significant variation in identity orientation within the Rastafari Movement, which contrasted with the Nation of Islam where the identity variations within the movement were negligible. This was due largely to the difference in structure between the movements, the Nation of Islam being a centrally organized movement with one leader while the Rastafari movement is a decentralized polycephalous one. ^ Both movements were found to be millenarian in nature, essentially because of the significant utility of the concept that their members would rise to prominence through God's grace. Additionally, both movements were identified as expressive social movements, since they were determined as being primarily concerned with changing the attitudes of their members rather than effecting structural social change. ^

Invisible but not forgotten: The Afro-Argentine and Afro-Uruguayan experience from the sixteenth to the twentieth centuries

The problem to be examined in this thesis involves the supposedly overlooked history and contributions of Africans and their descendants in the River Plate countries of Argentina and Uruguay. Therefore, the primary purpose of the study is to narrate the social history of Afro-Argentines and Afro-Uruguayans from the sixteenth to the twentieth century. A secondary purpose, moreover, is to synthesize the academic literature on Blacks in the Rio de la Plata and their many cultural and other contributions to the current nation-states of Argentina and Uruguay. This thesis thereby challenges the regnant historiographical argument that African Argentines and African Uruguayans have been “forgotten” as historical actors by scholars both inside and outside the Rio de la Plata. By synthesizing the large body of historical and social science scholarship on Africans in the River Plate, as well as providing a thorough bibliography on the subject, this study attempts to proffer (to borrow the subtitle of Marvin Lewis' 1996 study of Afro-Argentine literature) “another dimension of the Black Diaspora” to the Americas. ^

The academic orientation of first and second generation Nicaraguan immigrant adolescents

The rise in diversity and numbers of U.S. immigrants since 1965 has spawned a number of studies about the education of these immigrants and their children. Most of this research finds that school-age immigrants arriving in the last 20 years have the highest drop-out rates, lowest test scores, and are less likely than their native born peers to go to college. This dissertation examines the experiences of Nicaraguan immigrant youth living in Miami and the factors that make some of these adolescents feel positive about education, while others have negative attitudes about education. The method for this study combined structured and unstructured interviews, participant observation, focus groups, and data collected from a larger data set to understand the academic orientation of 25 Nicaraguan youths over a 4-year period. One of the independent variables is length of time in the United States. During the time of my initial contact with the subjects, 6 had been living in the United States for less than 3 years, 14 had been living in the United States between 6 and 12 years, and 6 had been living in the in the United States most or all of their lives (either they were born in the United States or had resided here for over 12 years). ^ Results are based on the students' particular experiences, which influence the dependent variable, academic orientation. Besides length of time, the independent variables also include ethnic self-identity, perceived discrimination, social capital in Miami, and peer influence. The study finds that those who are very recent arrivals have a “dual frame of reference,” that is, they directly compare their educational opportunities here in the United States, with their prior, often less favorable, situation in their homeland. Many of those who were born in Nicaragua, but have been residing in Miami most of their lives, have a less favorable view of education based on a higher degree of perceived discrimination. However, those who are second generation Nicaraguans deliberately take advantage of the strength inherent in their co-ethnic community unique to Miami. Recognition of this ethnic community prompts them to perceive education as worthwhile. ^