Jill A. Kuhlberg

Familism, Parent-Adolescent Conflict, Self-Esteem, Internalizing Behaviors and Suicide Attempts Among Adolescent Latinas

Adolescent Latinas continue to report higher levels of suicide attempts than their African-American and White peers. The phenomenon is still not understood and is theorized to be the result of the confluence of many cultural, familial, and individual level factors. In Latino cultures, belief in the importance of the family, the value known as familism, appears to protect youth’s emotional and behavioral health, but parent-adolescent conflict has been found to be a risk factor for suicide attempts. The role of familism in relation to parent-adolescent conflict, self-esteem, internalizing behaviors, and suicide attempts has not been studied extensively. To address this question, we interviewed 226 adolescent Latinas, 50% of whom had histories of suicide attempts. Using path analysis, familism as a cultural asset was associated with lower levels of parent-adolescent conflict, but higher levels of internalizing behaviors, while self-esteem and internalizing behaviors mediated the relationship between parent-adolescent conflict and suicide attempts. Our findings point to the importance of family involvement in culturally competent suicide prevention and intervention programs. Reducing parent-daughter conflict and fostering closer family ties has the added effect of improving self-esteem and shrinking the likelihood of suicide attempts.

A Community Based Systems Diagram of Obesity Causes

Introduction Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity. Methods Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature. Participants began this work in identifying change over time in causes and effects of childhood obesity within their community. The initial causal loop diagram was then reviewed and elaborated by 50 community leaders over a full day session. Results The process created a causal loop diagram representing community perceptions of determinants and causes of obesity. The causal loop diagram can be broken down into four separate domains; social influences; fast food and junk food; participation in sport; and general physical activity. Discussion This causal loop diagram can provide the basis for community led planning of a prevention response that engages with multiple levels of existing settings and systems.

Familism, Family Environment, and Suicide Attempts among Latina Youth

In this study, we examined the relationship between familism and family environment type as well as the relationship between family environment type and suicide attempts among Latina youth. Latina teen attempters (n = 109) and nonattempters (n = 107) were recruited from the New York City area. Latent class analysis revealed three family environment types: tight-knit, intermediate-knit, and loose-knit. Tight-knit families (high cohesion and low conflict) were significantly less likely to have teens who attempted suicide as compared with intermediate-knit families or loose-knit families. Moreover, familism increased the odds of being in a tight-knit family versus a loose-knit family and the odds of being in a tight-knit family versus a intermediate-knit. The results suggest that familism may protect against suicide behavior among Latinas via its influence on family environment.

Sacrifice for the Sake of the Family: Expressions of Familism by Latina Teens in the Context of Suicide

Familism is a core value promoted by many individuals of Hispanic or Latino descent that emphasizes the primacy of the family over the individual. This study illuminates some aspects of the relationship between familism and adolescent suicidal behavior. Qualitative data from 24 female Hispanic teens with and without a history of suicidal behaviors and their parents were analyzed to understand the ways in which familism is expressed in their lives. Both suicide attempters and nonattempters demonstrate familism by making material or emotional (or both) sacrifices for the sake of their families. However, for those attempters who expressed a clear intent to die, a third type of sacrifice emerged: Girls expressed a desire to kill themselves in order to make things better for their families, literally sacrificing themselves for the sake of family. Findings point to the complexity of familism in understanding the risks of suicide attempts among teen Latinas and to the value of mixed methods in studying deeply the cultural factors that influence problem behaviors.

Mental illness, poverty and stigma in India: a case–control study

Objective To assess the effect of experienced stigma on depth of multidimensional poverty of persons with severe mental illness (PSMI) in Delhi, India, controlling for gender, age and caste. Design Matching case (hospital)–control (population) study. Setting University Hospital (cases) and National Capital Region (controls), India. Participants A case–control study was conducted from November 2011 to June 2012. 647 cases diagnosed with schizophrenia or affective disorders were recruited and 647 individuals of same age, sex and location of residence were matched as controls at a ratio of 1:2:1. Individuals who refused consent or provided incomplete interview were excluded. Main outcome measures Higher risk of poverty due to stigma among PSMI. Results 38.5% of PSMI compared with 22.2% of controls were found poor on six dimensions or more. The difference in multidimensional poverty index was 69% between groups with employment and income of the main contributors. Multidimensional poverty was strongly associated with stigma (OR 2.60, 95% CI 1.27 to 5.31), scheduled castes/scheduled tribes/other backward castes (2.39, 1.39 to 4.08), mental illness (2.07, 1.25 to 3.41) and female gender (1.87, 1.36 to 2.58). A significant interaction between stigma, mental illness and gender or caste indicates female PSMI or PSMI from ‘lower castes’ were more likely to be poor due to stigma than male controls (p<0.001) or controls from other castes (p<0.001). Conclusions Public stigma and multidimensional poverty linked to SMI are pervasive and intertwined. In particular for low caste and women, it is a strong predictor of poverty. Exclusion from employment linked to negative attitudes and lack of income are the highest contributors to multidimensional poverty, increasing the burden for the family. Mental health professionals need to be aware of and address these issues.

Can Better Mother-Daughter Relations Reduce the Chance of a Suicide Attempt among Latinas?

National surveys and other research on adolescent Latinas show that adolescent females have higher rates of suicidal ideation, planning, and attempts than other ethnic and racial minority youth. Internalizing behaviors and family conflicts are commonly associated with suicidality in research on adolescents. In the case of Latinas, we explore the connection between adolescent Hispanic cultural involvement, mother-adolescent mutuality, internalizing behaviors, and suicidality. This paper presents data from a study of 232 Latinas, some with a recent history of suicide attempts (n = 122). The results show that higher adolescent Hispanic cultural involvement was associated with greater mother-daughter mutuality and thus led to reduction in the likelihood of suicide attempts. The relationship between mother-daughter mutuality and suicide attempts among Latinas is mediated by specific internalizing behaviors (withdrawn depressive). Our findings highlight the positive effect that Latino cultural values have in the relationship between Latina adolescent and their mothers and confirm the importance that internalizing behaviors and the mother-daughter relationship have for suicide attempters.

Family Relationships and Latina Teen Suicide Attempts: Reciprocity, Asymmetry, and Detachment

Using qualitative data collected from adolescent Latinas and their parents, this article describes ways in which family relationships are organized within low-income Latino families (n = 24) with and without a daughter who attempted suicide. Based on a family-level analysis approach, we present a framework that categorizes relationships as reciprocal, asymmetrical, or detached. Clear differences are identified: Families of nonattempters primarily cluster in reciprocal families, whereas families with an adolescent suicide attempter exhibit characteristics of asymmetrical or detached families. Our results highlight the need for detailed clinical attention to family communication patterns, especially in Latino families. Clinicians may reduce the likelihood of an attempt or repeated attempts by raising mutual, reciprocal exchanges of words and support between parents and daughter.

Multidimensional poverty in Afghanistan: who are the poorest of the poor?

Abstract Taking a capability approach perspective, our paper aims at advancing our understanding of poverty in Afghanistan, and at identifying the most deprived, including persons with disabilities, in order to address the first Sustainable Development Goal to eradicate poverty in all its forms. We used data from a national survey carried out in Afghanistan in 2005. We calculated one index using two weights structures, the adjusted headcount ratio, part of the multidimensional poverty measures. Following a participatory process, we identified and validated 13 indicators clustered in seven dimensions of poverty, including three usually neglected dimensions. Findings suggest that exploring various domains of deprivation would better inform poverty eradication policies than an approach focused only on income. Our results also demonstrate that nearly all Afghan adults are deprived in at least one dimension and those residing in rural areas, from minority ethnic groups, women, elderly people and persons disabled at birth or of an unknown cause are the poorest of the poor. Efforts to improve well-being must acknowledge these inequalities so that public policies in Afghanistan aiming at alleviating poverty take these disparities into account, when facing a reduction in available resources.

A systems approach to reducing maternal obesity: The Health in Preconception, Pregnancy and Postbirth (HIPPP) Collaborative

Obesity in our childbearing population has increased to epidemic proportions in developed countries; efforts to address this issue need to focus on prevention. The Health in Preconception, Pregnancy and Postbirth (HIPPP) Collaborative – a group of researchers, practitioners, policymakers and end‐users – was formed to take up the challenge to address this issue as a partnership. Application of systems thinking, participatory systems modelling and group model building was used to establish research questions aiming to optimise periconception lifestyle, weight and health. Our goal was to reduce the burden of maternal obesity through systems change.

Open Streets Initiatives in the United States: Closed to Traffic, Open to Physical Activity

BACKGROUND The ciclovía, or open streets concept, is a community-level physical activity (PA) promotion strategy where streets are closed to motorized traffic and open for individuals to engage in PA. This paper presents an overview of such initiatives in the United States (US) to understand their potential in PA promotion, comparing event and city characteristics. METHODS We searched ciclovía and open streets initiatives held in 2011 in the US using internet searches, publication databases, social media, and personal contacts. We extracted data on the each initiatives frequency, route length, attendance, evaluation procedures, and sociodemographic characteristics of host cities. RESULTS Our search yielded 47 US cities with open streets in 2011. Cities were diverse in sociodemographic characteristics. Route lengths ranged from a few blocks to 51 miles and event frequency ranged from annual to monthly. Reporting number of participants for events was sporadic. Few events conducted formal evaluations. CONCLUSION The number of US cities hosting open streets is increasing. The sociodemographics of the host cities suggest a potential to increase physical activity in populations at risk for developing chronic diseases through these initiatives. However, further evaluation is required. Identifying successful promotion and evaluation tactics would boost the health promotion potential of these initiatives.