Bruce R. DeForge

A Randomized Clinical Trial of an HIV-Risk- Reduction Intervention Among Low-Income Latina Women

BackgroundHIV infection has increased within the Latina community more than in any other ethnic or racial group within the United States. Latinas comprise only 13% of the U.S. population, yet they account for 20% of the cumulative reported cases of AIDS. ObjectivesThe purpose of the study was to evaluate a randomized culturally tailored intervention to prevent high-HIV-risk sexual behaviors for Latina women residing in urban areas. MethodsMexican and Puerto Rican women (18–44 years of age; N = 657) who were sexually active during the previous 3 months were recruited and randomized into intervention and control groups. The intervention, facilitated by bilingual, bicultural, trained Latina women, consisted of culturally tailored sessions on understanding their bodies, HIV/AIDS and sexually transmitted diseases, condoms (myths and use), negotiating safer sex practices, violence prevention, and partner communication. Bivariate and multivariate analyses assessed changes from baseline. ResultsThe intervention improved HIV knowledge, partner communication, risk-reduction behavioral intentions, and condom use, and decreased perceived barriers to condom use. DiscussionThe efficacy of a culturally-sensitive intervention to reduce HIV/AIDS-risk behaviors in Latina women was demonstrated in the current study.

Prevalence and Characteristics of Nursing Home-Acquired Infections in the Aged

Objectives: This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out.

Brief version of the Internalized Stigma of Mental Illness (ISMI) scale: psychometric properties and relationship to depression, self esteem, recovery orientation, empowerment, and perceived devaluation and discrimination.

OBJECTIVE The internalized stigma of mental illness impedes recovery and is associated with increased depression, reduced self-esteem, reduced recovery orientation, reduced empowerment, and increased perceived devaluation and discrimination. The Internalized Stigma of Mental Illness (ISMI) scale is a 29-item self-report questionnaire developed with consumer input that includes the following subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, and Stigma Resistance. Here we present a 10-item version of the ISMI containing the two strongest items from each subscale. METHOD Participants were all outpatient veterans with serious mental illness. Following the rigorous scale-reduction methods set forth by Stanton and colleagues (2002), we selected the 10 items, tested the psychometrics of the shortened scale in the original validation sample (N = 127), and cross-checked the results in a second dataset (N = 760). RESULTS As expected, the ISMI-10 retained the essential properties of the ISMI-29, including adequate internal consistency reliability and external validity in relation to depression, self-esteem, recovery orientation, perceived devaluation and discrimination, and empowerment. The ISMI-10 scores are normally distributed and have similar descriptive statistics to the ISMI-29. The reliability and depression findings were replicated in a cross-validation sample. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We conclude that the ISMI-10 has strong psychometric properties and is a practical, reliable, and valid alternative to the original ISMI-29. Future work should test the ISMI-10 in more diverse samples. This shorter version should reduce respondent burden in program evaluation projects that seek to determine whether participation in psychosocial rehabilitation programming reduces internalized stigma.

Intolerance of ambiguity in students entering medical school

Intolerance of ambiguity is the perception of ambiguous situations as a threat. Medical students with differing levels of intolerance of ambiguity may select medical specialties based upon the amount of ambiguity existing in the practice of each specialty. A cross-sectional survey at one state university administered Budners Intolerance of Ambiguity Scale to all entering first-year medical students for four consecutive years (N = 609) to investigate patterns of intolerance of ambiguity in relationship with demographic variables and initial medical specialty preference. The medical students in this study were more intolerant of ambiguity than those first studied by Budner in 1962. Students entering in 1985 were slightly more intolerant of ambiguity than students in 1988. Students age 23 and older were less intolerant of ambiguity than students 18-22 years old. Men and students with natural/physical science undergraduate majors were more intolerant of ambiguity than their counterparts. However, medical specialty preference was not related to intolerance of ambiguity. Intolerance of ambiguity may be a personality trait or a learned characteristic, and needs further investigation.

Social Stigma and Homelessness: The Limits of Social Change

We examine the issues around the stigmatization of homelessness and how it links to capitalism. Society focuses on the individual as the cause of his or her own state of homelessness, blaming the victim rather than focusing on the larger antecedent social and economic forces, such as unemployment, limited affordable housing, and breakdowns in kinship networks. Social stigma occurs in situations where there is unequal social, economic, and political power and there is an opportunity to label, stereotype, separate (us versus them), lose status, and discriminate. Stigmatization is due, in part, when people feel threatened by another group. Society categorizes people who are homeless as no longer “useful” and/or “functional” members of capitalism, since they do not actively work and support the system. The paper ends on a discussion of the limits of social change in a capitalist society.

Self-Report Depression Scales in the Elderly: The Relationship between the CES-D and ZUNG

Depression is one of the most common mental health problems in the elderly, but there is little consensus about the best way to assess depression in the aged. The relationship between the CES-D and the ZUNG self-report depression scales was investigated in seventy-eight elderly people with osteoarthritis (mean age 71). The correlation between the scales was r = .69, with the CES-D classifying 15 percent of the participants as depressed, as compared to 6 percent by the ZUNG. Psychological symptoms had the strongest relationship with overall depression scores on both scales. No sex differences were found on psychological items on either scale, but females reported more somatic symptoms on the ZUNG. People over age seventy-four reported more psychological symptoms than their younger counterparts.

Social Determinants of Breast Cancer Screening in Urban Primary Care Practices: A Community-Engaged Formative Study

BACKGROUND The recent decline in the breast cancer mortality rate can be attributed to intensive screening and early detection efforts. However, studies have documented a decline in self-reported recent mammography use and interventions to enhance mammography utilization have yielded modest improvements. To address the root causes of breast cancer disparities and improve mammography use, interventions need to address multiple layers of patient, provider, and health system factors. OBJECTIVE Using community-based participatory research principles, we sought to learn from women receiving care through urban primary care practices about issues surrounding mammography screening and strategies to increase screening. METHODS We conducted five focus groups among 41 eligible women who were predominantly African American, recruited using nonprobability purposive sampling methods from urban community health centers in Baltimore, Maryland. Data are reported from three focus groups (n = 28) that provided usable data. We used the social determinants of health perspective to conduct a qualitative content analysis and interpretation of the data. RESULTS Major obstacles to obtaining a screening mammogram were individual-level (i.e., pain from the procedure) and structural-level factors (i.e., cost, geography, convenience). Strategies to overcome obstacles could include the creation of structural mechanisms whereby women can receive a host of services during one visit to a healthcare professionals office. Important promoters of screening behavior included social-level factors such as social support, hope, and positive treatment outcomes. CONCLUSION The social determinants of health perspective provided a unique perspective to frame barriers and promoters of mammography utilization and insights to develop interventions aimed at improving cancer control among women receiving care at urban primary care health centers.

Family Capital: Implications for Interventions with Families

Social capital has been extensively discussed in the literature as building blocks that individuals and communities utilize to leverage system resources. Similarly, some families also create capital, which can enable members of the family, such as children, to successfully negotiate the outside world. Families in poverty confront serious challenges in developing positive family capital, because of lack of resources. For those families that are successful in developing positive family capital, family capital can help to create positive outcomes for family interactions. Thus, family capital can provide information about opportunities, exert influence on agents who make decisions involving the actor, provide social credentials that indicate a connection to a social network, and reinforce the actors identity and recognition, which maintains access and entitlement to these social resources.

RELIABILITY OF BUDNER'S INTOLERANCE OF AMBIGUITY SCALE IN MEDICAL STUDENTS

Intolerance of ambiguity is the perception of ambiguous situations as threatening. It has often been measured using Budners 1962 intolerance of ambiguity scale in studies of medical students and physicians. To examine the test-retest reliability of the scale among that population, we administered it to all 171 entering medical students at one medical school immediately prior to beginning classes and readministered it to them six to nine weeks later with an 81% follow-up rate. The Pearson correlation between the first and second administrations was .64, showing moderate reliability during this stressful period in medical socialization. The internal reliability of the scale remained constant; the alpha was .64 at the first administration and .63 at follow-up. These data indicate moderate reliability of Budners intolerance of ambiguity scale when respondents are medical students.

Personal Resources and Homelessness in Early Life: Predictors of Depression in Consumers of Homeless MultiService Centers

This study explored the relationship between personal resources and previous adverse life events such as homelessness and depression. Participants were recruited from two church sponsored multisite social service centers in Anne Arundel County, Maryland. The interview included demographics and several standardized scales to assess history of homelessness, medical history, personal resources, and depressive symptoms. A hierarchical multiple regression analysis revealed that participants with higher levels of depressive symptoms were older, had a history of homelessness, had more health problems, had a history of mental illness, and had lower self-esteem, mastery, and mattering. A subanalysis indicated that individuals who had experienced homelessness at or before age 21 had higher levels of depressive symptoms than those who were first homeless as an adult. Previous history of homelessness, especially before age 21, and lack of personal resources may place individuals at risk for psychological distress, including higher levels of depressive symptoms.