• Assessing the Relationship between Adverse Childhood Experiences and Body Mass Index Trajectory of Children and Adolescents

      Park, Hyeshin; Barth, Richard P., 1952- (2017)
      Background: More than a third of American children and adolescents are overweight or obese. Because childhood obesity is a risk factor for various health, mental health, and socioeconomic problems in adulthood, health practitioners, policy makers, and researchers continue to identify growth trajectories and clarify risk factors for unhealthy growth trajectories. The purpose of this dissertation was to identify subcategories of children who follow different body mass index (BMI) trajectories, describe these groups, and explore whether adverse childhood experiences (ACEs) predict group membership. Methods: A sample of children who participated in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) study at the Eastern site (Baltimore, MD), and whose demographic and BMI data were collected at age four, were included in the study (n=201). Latent Class Growth Analysis (LCGA) was used to examine longitudinal patterns of BMI growth over a span of 14 years (4 years - 18 years). Data were assessed and the optimal number of classes to describe the growth trajectories was selected. Bivariate and multivariate data analyses were used to describe the children in each group. Multinomial logistic regression was used to examine whether the number of cumulative preschool (age 4) or school-aged ACEs (ages 4 to 14) predicted group membership. Results: Overall, the percentage of overweight/obesity increased with each additional wave. Based on z-BMI score, at age 4, 20.1% were overweight/obese. A marked increase was identified when children were 12 years old (42.0%) and then at 18 years (49.4%). Three BMI growth trajectories were identified: expected growth, emerging overweight, and increasing obesity. Most children followed an expected growth trajectory (73.6%). However, about a fifth followed a trajectory with a steep increase in BMI over time (emerging overweight = 21.9%) and a small percentage of the children exhibited a high initial BMI as well as a high rate of increase (increasing obesity = 4.5%). Ages 8 to 12 and ages 16 to 18 had especially steep slopes when it came to BMI increase in the emerging overweight and increasing obesity trajectories. A higher preschool ACEs score was associated with a low odds ratio of being in the emerging overweight group compared to the expected growth group; school aged ACEs score did not predict membership to a particular class. Female children and those with a higher primary maternal caregiver BMI when the children were 4 years old predicted being in the emerging overweight group compared to the expected growth group. Implications: The time periods that are especially sensitive to steeper weight gain are likely to be the time periods when interventions should be targeted for children in a low income, urban, largely African American community. The current study had results that were divergent from the hypothesis in that children who had higher ACEs at age four were less likely to have an obesity-prone BMI trajectory. Reasons and implications are discussed. The child's gender and the child's maternal caregiver's weight status should provide some guidance in intervention and treatment decisions.
    • Child sexual abuse and the subsequent adolescent sexual, family planning, and fertility patterns of low-income women

      Castle-Young, Brenda G.; Crymes, Joseph T. (1992)
      This study compares the adolescent sexual behaviors, fertility patterns and family planning behaviors of low socioeconomic, single parent women who reported a history of child sexual abuse (N = 38) with those who did not (N = 437). All questions on sexual behaviors, family planning behaviors, and fertility patterns were taken verbatim from the National Survey of Family Growth Cycle 3, (1981) from the National Center on Health Statistics. The data for this study was gathered in a survey conducted from September 1984 to June 1985. This secondary analysis of 475 cases began with a simple bivariate analysis of CSA related to each of the hypothesized outcomes. Subsequently, for each hypothesized outcome a regression analysis was conducted which included child sexual abuse (CSA) and the control variables race, age at time of interview, years of school achieved, and parenting support. The findings revealed that women who reported CSA had their first intercourse at an earlier age, had more sexual partners, had less committed relationships, had a greater number of live births, and were less likely to have had an abortion than women who reported CSA. However, there was inadequate support for the hypotheses which predicted differences between the two groups on age at first live birth, contraception patterns, opinion of responsibility for contraception, or percent of unwanted live births. Additionally, several of the situational factors had impact on some of these behavioral outcomes. Increased frequency of CSA increased the number of sexual partners, decreased the use of contraception, and increased the percent of unwanted live births. As the severity of CSA increased, the age at first intercourse was younger. The earlier age that CSA began and the greater the number of perpetrators, the greater the number of sexual partners that were reported. The greater the number of perpetrators, the less likely a CSA victim was to use contraceptives between first intercourse and first pregnancy. If the perpetrator was a family member, opinion of self-responsibility for contraception decreased. These consequences of CSA likely lead to decreased life chances and serious health problems.
    • The effectiveness of social group work with head trauma rehabilitation patients

      Futeral, Susan Todd; Ephross, Paul H. (1993)
      This study investigated the relationship between the use of social group work methods and self-esteem of closed-head injured adolescents and young adults. Head injury is damage to the brain as a result of traumatic injury. There are approximately 3 million head injuries each year, resulting in 30,000 deaths. Head injuries are often caused by vehicular accidents, falling objects, gunshot wounds, sharp instruments, or projectiles. The lengthy psychosocial rehabilitation period of head injured persons is often complicated by the combined effects of the pre-injury history as well as the post-trauma physical and psychological changes. The study was conceptualized as action research. The design of this study was a pre-test/post-test design using multiple group comparisons. Trained social workers collected data in group interviews, and patients completed self-report questionnaires. The instruments used were the Rosenberg Self-Esteem Scale, the Piers-Harris Self-Concept Scale, and an exit interview. The sample size was 25 outpatients and 25 community persons, which had sustained head injuries. The theoretical frameworks are symbolic interactionism and social group work theory. The study sought to develop findings which may contribute to clinical social work practice, theory, group work, and related fields. The goal of the study was to add to the present body of knowledge about effective treatment of head trauma patients. The experimental and comparison group members were matched on demographic variables of age, race, gender, residence, etc. One of the most significant differences of the demographic variables studied was the level of education, specifically that the participants in the comparison group completed more years of formal education than the participants in the experimental group. Both groups were matched similarly in their pre-test scores on the Piers-Harris and Rosenberg scales and both groups showed improvement in the desired direction over time. Using T tests to compare the pre-test to post-test scores, the following differences were statistically significant: the total Piers-Harris score, three subscales of the Piers-Harris (the Behavior, Intelligence and Anxiety subscales), and the Rosenberg scale. Overall the hypothesis that group work enhances self-esteem was supported by this study. In conclusion, this author advocates the use of group work for head trauma recoveries as an effective therapeutic intervention to increase group members' self-esteem. This study has implications for future research for inpatient and outpatient settings.
    • Psychiatric readmission of adolescents in the public mental health system

      Fontanella, Cynthia A.; Zuravin, Susan J., 1944-; Burry, Caroline Long (2003)
      The growth of Medicaid managed care in the 1990s has led to substantial changes in the financing and delivery of behavioral health services for children and adolescents. Despite the rapid shift to managed care, few studies have investigated the effect of these changes on service provision to children with serious emotional disturbances. The primary aim of this study was to evaluate the effect of Maryland's Medicaid behavioral health plan on patterns of psychiatric readmission of adolescents. Specific objectives were: (1) to determine whether the rates and frequency of readmissions differed before (Fiscal year 1997) and after (Fiscal year 1998) the implementation of Maryland's Medicaid managed care program; (2) to identify factors that predicted readmission; and (3) to determine the relationship between neighborhood risk factors and readmission. To achieve study objectives, a non-concurrent prospective design was used. The sampling frame consisted of 881 Medicaid-eligible adolescents consecutively admitted to three private psychiatric hospitals between July 1, 1996 and June 30, 1998. Adolescents were followed up for a one year period past their index admission to determine whether they were readmitted to any psychiatric hospital in Maryland. Data was drawn from hospital case records, Medicaid claims data files, and the Area Resource File. While the study findings indicated that there were no significant differences in the overall rates of readmission for the two years, adolescents admitted after the implementation of the managed care program were far more likely to experience multiple readmissions. The cumulative one year rate of readmission was 33% for fiscal year 1997 and 38% for fiscal year 1998. The highest risk period for both years was within the first 30 days post-discharge (14% in 1997 and 13% in 1998). Rates of readmission also varied considerably across hospital providers. Adolescents were more likely to be readmitted if they were younger, had more severe emotional and behavioral disturbances and/or comorbid mental retardation, came from high risk families and had histories of childhood abuse. Type of aftercare services and living arrangements were also important determinants of readmission. Finally, the results indicated that two of the four neighborhood factors (family structure and residential mobility) examined were significantly associated with readmission for the Baltimore sample. Findings revealed that youths who came from areas characterized by high residential mobility, a predominantly African American population, female-headed households, and a high child/adult ratio were less likely to be readmitted. While these findings are counterintuitive, they may suggest racial disparities in access to health care.
    • The System of Care Mental Health Service Experience: Differences in Perceptions between African American and Caucasian Youth and its Impact on Service Use and the Relationship between Receipt of Services and Emotional and Behavioral Symptoms

      Williams, Crystal; Harrington, Donna (2012)
      Racial disparities in adolescent mental health services remain an unrelenting public health problem. The purpose of this study was to understand the differential system of care service utilization patterns and associated symptoms among African American and Caucasian adolescents with serious emotional disturbances (N = 655; M age = 13.7, 60% Caucasian, 63% male). The primary objectives were to: (1) explore differences in perceptions of mental health service experiences at 6-months by race; (2) examine race as a moderator between perceptions of service experiences and receipt of services between 6 and 12 months; and (3) explore mental health symptoms at 12 months as a function of race. Mental health symptoms for a subsample of youth (N = 548) with elevated symptoms were also examined. A secondary data analysis using data from the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHI) and generalized estimating equation (GEE) analyses indicated that (1) African American and Caucasian adolescents did not differ in their overall perceptions of their service experience, (2) race did not moderate perceptions and receipt of services, and (3) race moderated the relationship between receipt of family therapy and externalizing symptoms. The results also showed that use of individual therapy was predicted by race (Caucasian) and greater emotional/behavioral symptoms at baseline, while group therapy was predicated by gender (male) and greater functional impairment at baseline. Adolescents' perceived social support from adults (not peers) predicted fewer internalizing symptoms, and Caucasian adolescents experienced fewer externalizing symptoms. The examination of mental health symptoms for the subsample revealed that race did not moderate receipt of services and symptoms. Instead, perceived social support from adults (not peers) predicted fewer internalizing symptoms, and clinician-client racial match predicted fewer externalizing symptoms. The findings suggest that African American and Caucasian adolescents share similar perceptions of their service experience, yet disparities in service use and symptomatology persist. Further, youth with perceived social support and a clinician-client racial match experience fewer mental health symptoms. Practitioners should assess adolescent's perceived social support upon receipt of treatment, discuss clinician preferences, and explore opportunities to engage African American families in family therapy.
    • The tripartite model of anxiety and depression: Role of the factors of anxiety sensitivity in anxiety and depression

      Dia, David A.; Harrington, Donna (2006)
      Anxiety disorders are a common and can cause significant impairment in an adolescent's life (Last et al., 1997). Psychosocial treatments, particularly cognitive behavioral therapy, are effective in treating anxiety disorders, but there are many adolescents who have participated in empirically-based psychosocial treatment approaches who are still not improving (Bernstein & Kinlan, 1997; In-Albon & Schneider, 2004). The tripartite model of anxiety and depression was developed to try to account for the high comorbidity between anxiety and depression. The models states that there is a common component to anxiety and depression, which is negative affectivity, and unique components to anxiety, physiological arousal, and depression, low positive affectivity or anhendonia. The purpose of this dissertation study was to increase the knowledge base on the phenomenology of anxiety disorders. The objectives were to: (1) examine gender and ethnic differences in positive and negative affectivity and depressive and anxiety symptomology; and (2) to clarify the relationship between anxiety and the components of anxiety sensitivity within the tripartite model of anxiety and depression. This study consisted of mailed survey to a simple random sample of 315 adolescents between the ages of 12 and 18 who were in treatment for an anxiety and/or depressive disorder. A total of 187 completed surveys were returned for a 61.1% response rate. Adolescents filled out the Positive and Negative Affectivity Scale, Childhood Anxiety Sensitivity Index, and the Revised Child Anxiety and Depression Scale. There was not a statistically significant difference found between the ethnic subgroups (i.e., Hispanic/Latino or any ethnic subgroup) and the Caucasian subgroup on positive and negative affectivity and anxiety and depression. There was also no statistically significant difference found between males and females on negative and positive affectivity and anxiety and depression. A modified tripartite model of anxiety and depression fit the data the best with negative affectivity being related to anxiety and depression, low positive affectivity being related to depression, and physiological arousal being related to anxiety, and anxiety being related to depression. Another modified tripartite model, which examined the specific components of anxiety sensitivity related to specific anxiety disorders, did not fit the data as well as the earlier model. This study did find difference between ethnic subgroups and Caucasian adolescents or between males and females, which suggests there are more similarities than difference between these various subgroups. Additionally, the modified tripartite model supported the role of negative affectivity being related to anxiety and depression and there are unique components, physiological arousal and anhendonia, related to anxiety and depression. This study uniquely found that anxiety was related to depression, suggesting a mixed anxiety and depressive state.
    • Understanding American Muslim Youth of Arab and South Asian Ancestries: An Exploratory Study on the Factors Related to Risk Behaviors among Child Immigrants and Children of Immigrants

      Mirza, Fatima; DePanfilis, Diane (2014)
      Literature about the relationship between health risk behavior and identity among South Asian and Arab Muslim American adolescents is limited. Past studies suggest that cultures of origin, social support, and high religiosity may serve as protective factors while trauma, poor mental health, and social stigma may encourage engagement in health risk behaviors. The primary aim of this dissertation was to describe risk behaviors among Muslim American youth of Arab and South Asian ancestry and to explore the degree to which risk behaviors were related to demographics, personal history factors, identity, social support, trauma, religiosity, and/or spirituality. Fifty-seven 12 to 17 year old youths recruited from Muslim communities on the East Coast completed an in-person, computer assisted survey that explored life experiences, identity, social support, mental health, religiosity, spirituality, and behavior. The majority of participants were masjid-affiliated (mosques). Respondents reported low engagement in health risk behaviors. The number of trauma experiences was positively related to self-reports of risk behaviors, while pride in American identity and racial/ethnic identity were related to fewer self-reports of risk behaviors. No other variables were significantly associated with risk behaviors. None of the youth reported clinical levels of depression, anxiety, or trauma symptoms. When all findings were examined together, they indicated that young people who were more isolated, had experienced more stressors and had parents who immigrated with less social support were more likely to engage in health risk behaviors. Social Workers are uniquely equipped to identify, assess, and respond to factors related to youth engagement in risk behaviors. Results may support using Problem Behavior Theory, specifically the Protection-Risk Model, to conceptualize risk behavior among Muslim American youth. For example, findings confirmed a relationship between both high support protection and low vulnerability risk with low self-reported risk behaviors. However, findings of this dissertation study are limited due to its small, convenience sample. Future studies should continue to explore factors related to health risk behaviors among Muslim American youth. In particular, studies should recruit youth unaffiliated with mosques, Muslims of other ethnicities, and Muslims who have been in the United States for multiple generations.