Rethinking the Concept of Acculturation Schwartz, Seth J; Unger, Jennifer B; Zamboanga, Byron L ...
American psychologist/The American psychologist,
05/2010, Volume:
65, Issue:
4
Journal Article
Peer reviewed
Open access
This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the ...confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the "immigrant paradox," whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Opioid use and opioid-related overdose continue to rise among racial/ethnic minorities. Social determinants of health negatively impact these communities, possibly resulting in poorer treatment ...outcomes. Research is needed to investigate how to overcome the disproportionate and deleterious impact of social determinants of health on treatment entry, retention, drug use and related outcomes among racial/ethnic minorities. The current commentary provides recommendations that may help researchers respond more effectively to reducing health disparities in substance use treatment. We begin with recommendations of best research practices (e.g., ensuring adequate recruitment of racial/ethnic minorities in research, central components of valid analysis, and adequate methods for assessing effect sizes for racial/ethnic minorities). Then, we propose that more NIDA research focuses on issues disproportionately affecting racial/ethnic minorities. Next, techniques for increasing the number of underrepresented racial/ethnic treatment researchers are suggested. We then recommend methods for infusing racial/ethnic expertise onto funding decision panels. This commentary ends with a case study that features NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN).
The proposed recommendations can serve as guidelines for substance use research funders to promote research that has the potential to reduce racial/ethnic disparities in substance use treatment and to increase training opportunities for racial/ethnic minority researchers.
Prior studies suggest that exposure to the natural environment may be important for optimal mental health. The present study examines the association between block-level greenness (vegetative ...presence) and mental health outcomes, in a population-based sample of 249,405 U.S. Medicare beneficiaries aged ≥65 years living in Miami-Dade County, Florida, USA, whose location did not change from 2010 to 2011. Multilevel analyses examined relationships between greenness, as measured by mean Normalized Difference Vegetation Index from satellite imagery at the Census block level, and each of two mental health outcomes; Alzheimer's disease and depression, respectively, after statistically adjusting for age, gender, race/ethnicity, and neighborhood income level of the individuals. Higher block-level greenness was linked to better mental health outcomes: There was a reduced risk of Alzheimer's disease (by 18%) and depression (by 28%) for beneficiaries living in blocks that were 1 SD above the mean for greenness, as compared to blocks that were 1 SD below the mean. Planned post-hoc analyses revealed that higher levels of greenness were associated with even greater mental health benefits in low-income neighborhoods: An increase in greenness from 1 SD below to 1 SD above the mean was associated with 37% lower odds of depression in low-income neighborhoods, compared to 27% and 21% lower odds of depression in medium- and high-income neighborhoods, respectively. Greenness may be effective in promoting mental health in older adults, particularly in low-income neighborhoods, possibly as a result of the increased opportunities for physical activity, social interaction, or stress mitigation.
Background Nature exposures may be associated with reduced risk of heart disease. The present study examines the relationship between objective measures of neighborhood greenness (vegetative ...presence) and 4 heart disease diagnoses (acute myocardial infarction, ischemic heart disease, heart failure, and atrial fibrillation) in a population-based sample of Medicare beneficiaries. Methods and Results The sample included 249 405 Medicare beneficiaries aged 65 years and older whose location ( ZIP +4) in Miami-Dade County, Florida, did not change from 2010 to 2011. Analyses examined relationships between greenness, measured by mean block-level normalized difference vegetation index from satellite imagery, and 4 heart disease diagnoses. Hierarchical regression analyses, in a multilevel framework, assessed the relationship of greenness to each heart disease diagnosis, adjusting successively for individual sociodemographics, neighborhood income, and biological risk factors (diabetes mellitus, hypertension, and hyperlipidemia). Higher greenness was associated with reduced heart disease risk, adjusting for individual sociodemographics and neighborhood income. Compared with the lowest tertile of greenness, the highest tertile of greenness was associated with reduced odds of acute myocardial infarction by 25% (odds ratio, 0.75; 95% CI , 0.63-0.90), ischemic heart disease by 20% (odds ratio, 0.80; 95% CI , 0.77-0.83), heart failure by 16% (odds ratio, 0.84; 95% CI , 0.80-0.88), and atrial fibrillation by 6% (odds ratio, 0.94; 95% CI , 0.87-1.00). Associations were attenuated after adjusting for biological risk factors, suggesting that cardiometabolic risk factors may partly mediate the greenness to heart disease relationships. Conclusions Neighborhood greenness may be associated with reduced heart disease risk. Strategies to increase area greenness may be a future means of reducing heart disease at the population level.
As shown by COVID-19, infectious diseases with a pandemic potential present a grave threat to health and wellbeing. Although the International Health Regulations provide a framework of binding legal ...obligations for pandemic prevention, preparedness, and response, many countries do not comply with these regulations. There is a need for a renewed framework for global collective action that ensures conformity with international regulations and promotes effective prevention and response to pandemic infectious diseases. This Health Policy identifies the necessary characteristics for a new global public health security convention designed to optimise prevention, preparedness, and response to pandemic infectious diseases. We propose ten recommendations to strengthen global public health governance and promote compliance with global health security regulations. Recommendations for a new global public health security convention include greater authority for a global governing body, an improved ability to respond to pandemics, an objective evaluation system for national core public health capacities, more effective enforcement mechanisms, independent and sustainable funding, representativeness, and investment from multiple sectors, among others. The next steps to achieve these recommendations include assembling an invested alliance, specifying the operational structures of a global public health security system, and overcoming barriers such as insufficient political will, scarcity of resources, and individual national interests.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Most people with opioid use disorder (OUD) never receive treatment. Medication treatment of OUD in primary care is recommended as an approach to increase access to care. The PRimary Care Opioid Use ...Disorders treatment (PROUD) trial tests whether implementation of a collaborative care model (Massachusetts Model) using a nurse care manager (NCM) to support medication treatment of OUD in primary care increases OUD treatment and improves outcomes. Specifically, it tests whether implementation of collaborative care, compared to usual primary care, increases the number of days of medication for OUD (implementation objective) and reduces acute health care utilization (effectiveness objective). The protocol for the PROUD trial is presented here.
PROUD is a hybrid type III cluster-randomized implementation trial in six health care systems. The intervention consists of three implementation strategies: salary for a full-time NCM, training and technical assistance for the NCM, and requiring that three primary care providers have DEA waivers to prescribe buprenorphine. Within each health system, two primary care clinics are randomized: one to the intervention and one to Usual Primary Care. The sample includes all patients age 16-90 who visited the randomized primary care clinics from 3 years before to 2 years after randomization (anticipated to be > 170,000). Quantitative data are derived from existing health system administrative data, electronic medical records, and/or health insurance claims ("electronic health records," EHRs). Anonymous staff surveys, stakeholder debriefs, and observations from site visits, trainings and technical assistance provide qualitative data to assess barriers and facilitators to implementation. The outcome for the implementation objective (primary outcome) is a clinic-level measure of the number of patient days of medication treatment of OUD over the 2 years post-randomization. The patient-level outcome for the effectiveness objective (secondary outcome) is days of acute care utilization e.g. urgent care, emergency department (ED) and/or hospitalizations over 2 years post-randomization among patients with documented OUD prior to randomization.
The PROUD trial provides information for clinical leaders and policy makers regarding potential benefits for patients and health systems of a collaborative care model for management of OUD in primary care, tested in real-world diverse primary care settings. Trial registration # NCT03407638 (February 28, 2018); CTN-0074 https://clinicaltrials.gov/ct2/show/NCT03407638?term=CTN-0074&draw=2&rank=1.
This manuscript illustrates methods for utilizing measurements of individuals to identify group contextual effects on individual outcomes. Contextual effects can be identified by 1 of 3 methods: (1) ...divergence of the simple within‐ and between‐group regression coefficients, (2) the presence of a cross‐level interaction of the within‐ and between‐group predictor variable, or (3) the effect of discrepancies within the group. These methods can be used to incorporate group context into an individual model and can be utilized for any individual process variable that might be affected by a group context. Example data include measures of hassles and coping adequacy of inner city, poor, African American new mothers, and their family members.
RESUMEN
En este manuscrito se describen métodos para utilizar evaluaciones de personas con el fin de reconocer los efectos contextuales de un grupo sobre los criterios de valoración de cada uno de sus integrantes. Los efectos contextuales pueden reconocerse mediante uno de los siguientes tres métodos: 1) divergencia de los coeficientes de regresión simple dentro de un mismo grupo y entre distintos grupos, 2) la presencia de una interacción internivel de la variable predictora dentro del mismo grupo y entre distintos grupos ó 3) el efecto de las discrepancias dentro del grupo. Estos métodos pueden utilizarse para incorporar el contexto grupal en un modelo individual y para cualquier variable de proceso individual que podría estar afectada por un contexto grupal. El ejemplo incluye valoraciones de problemas y de la capacidad de sobrellevarlos que tienen las madres primerizas afroamericanas de barrios marginados y sus familiares.
Palabras clave: multinivel, estrés, sobrellevar, efecto contextual, familia
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Purpose: The majority of persons with Alzheimer's disease (AD) are cared for at home by a family member such as a spouse or daughter. Caregiving places enormous demands on these caregivers, and the ...negative consequences associated with caregiving are well documented. This paper reports results from the Miami site of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms (according to the Center for Epidemiological Studies Depression scale) among family caregivers of AD patients at 6 months and 18 months follow-up. Design and Methods: There were 225 White American and Cuban American caregivers that were randomized into a structural ecosystems therapy, structural ecosystems therapy + computer–telephone integrated system, or minimal support control condition. Results: Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months. The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husband and daughter caregivers. Implications: The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers. The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver–patient relationship.
Objective This study examined predictors of engagement and retention into a parent-centered, ecodevelopmental HIV preventive intervention for Hispanic adolescents and their families. The influence of ...retention on changes in adolescent HIV-risk attitudes was also examined. Methods Participants in this study were 91 Hispanic adolescents and their primary parents. Structural equation modeling was used to identify (a) predictors of initial engagement, (b) the effects of group processes on retention, and (c) the effects of retention on change HIV-risk attitudes in adolescents. Results Although some participant characteristics predicted engagement, the parent–facilitator relationship quality at the initial contact was found to be the strongest predictor of engagement. Furthermore, within-group processes such as group cohesion positively predicted retention. Finally, parent retention predicted decreases in adolescent HIV-risk attitudes. Conclusions The results may have important implications for engagement and retention in parent-centered interventions, as well as for reducing risks for HIV transmission in Hispanic adolescents. Implications for services research are also discussed.
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