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One of the four overarching goals of Healthy People 2020 is to achieve health equity, eliminate health disparities, and improve the health of all groups, including the health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations. In 2011, the Institute of Medicine (IOM) released a report that drew attention to the unique health disparities experienced by sexual minorities and underscored the need for a comprehensive approach to sexual minority health research. This article proposes a new model of LGBTQ health to help measure, explore, explain, and predict the impact of sexual minority status on health outcomes. The Intersectional Ecology Model of LGBTQ Health (IEM) demonstrates how the relentless hypervigilance of LGBTQ individuals in a heteronormative society impacts health outcomes through the primary vehicles of stigma and chronic, elevated stress. The purpose of the IEM is to guide future research and enhance public health practice for LGBTQ populations. © 2014 Taylor & Francis Group, LLC.

Background: Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African American women approach family planning. Study Design: Structured focus groups were held with adult, low-income, nonpregnant, African American women in Connecticut. Data were collected using a standardized discussion guide, audio-taped and transcribed. Four independent researchers coded the transcripts using the constant comparative method. Codes were organized into overarching themes. Results: Contraceptive knowledge was limited, with formal contraceptive education often occurring after sexual debut. Attitudes about contraception were overtly negative, with method effectiveness being judged by the presence of side effects. Family and friends strongly influence contraceptive decisions, while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible, although compliance is considered a barrier. Conclusions: Contraception education should occur before sexual debut, should involve trusted family and community members and should positively frame issues in terms of achieving life goals. (C) 2013 Elsevier Inc. All rights reserved.

Purpose: The study examined the barriers faced, the goals selected, and the optimization and compensation strategies of older workers in relation to career change. Method: Thirty open-ended interviews, 12 in the United States and 18 in New Zealand, were conducted, recorded, transcribed verbatim, and analyzed for themes. Results: Barriers to finding and maintaining work included task difficulty, problems with coworkers and management, lack of self-confidence, health/physical limitations, ageism, and stereotyping. Respondents' most frequently selected goals for a new career were the desire to help others, work satisfaction, and acquisition of learning. Seventy-five percent of respondents in paid employment had earning an income as a goal. Optimization strategies included drawing on past experience, assessing skills, seeking careers/organizations that fitted their values, and a willingness to accept lower pay or unpaid work. Attitudinal strategies included focus and persistence, optimism, and positive attitudes toward change. The compensation strategies reported were on-the-job training; help from coworkers, clients, or customers; friends and family social support; and professional networks. Management practices considered helpful were flexible work schedules, supervisors' patience, and formal recognition of the value of older workers. Conclusion: This qualitative study, using the SOC framework, showed that evaluating one's skills and values, being positive about change, and being part of a supportive work environment were key contributors to adaptive competence. © 2012 © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The present study examined how exposure to traumatic events impacts children with severe emotional disturbance who are being served in a school-based system of care. Multilevel growth curve models were used to examine the relationships between a child's history of traumatic events (physical abuse, sexual abuse, or domestic violence) and behavioral and emotional strengths, internalizing problem behaviors, or externalizing problem behaviors over 18 months. Results indicate that children receiving services (N = 134) exhibited increased emotional and behavioral strengths and decreased internalizing and externalizing problem behaviors from enrollment to 18 months follow-up. Children with a history of traumatic events improved more slowly than children without such a history on both strengths and internalizing problem behaviors, even after controlling for dosage of services received and other characteristics previously found to predict outcomes. Gender was also related to improvement in internalizing symptoms. Results highlight the continued need to assess the impact of exposure to traumatic events for children served in a system of care.

The present study examines the impact of child and family risk factors on service access for youth and families in a school-based system of care. Regression analyses examined the relationships between risk factors and services recommended, services received, and dosage of services received. Logistic regression analyses examined the relationship between risk factors and whether or not youth received specific types of services within the system of care. Results revealed that youth with a personal or family history of substance use had more services recommended than youth without these risk factors, while youth with a family history of substance use received more services. Youth with a history of substance use received a significantly higher dosage of services overall. Finally, history of family mental illness was associated with receiving mental health and operational services (e.g., family advocacy, emergency funds). Implications and limitations are discussed.

Background: During Drosophila development, titers of the steroid ecdysone trigger and maintain temporal and tissue specific biological transitions. Decades of evidence reveal that the ecdysone response is both unique to specific tissues and distinct among developmental timepoints. To achieve this diversity in response, the several isoforms of the Ecdysone Receptor, which transduce the hormone signal to the genome level, are believed to interact with tissue specific cofactors. To date, little is known about the identity of these cofactor interactions; therefore, we conducted a bioinformatics informed, RNAi luciferase reporter screen against a subset of putative candidate cofactors identified through an in silico proteome screen. Candidates were chosen based on criteria obtained from bioinformatic consensus of known nuclear receptor cofactors and homologs, including amino acid sequence motif content and context. Results: The bioinformatics pre-screen of the Drosophila melanogaster proteome was successful in identifying an enriched putative candidate gene cohort. Over 80% of the genes tested yielded a positive hit in our reporter screen. We have identified both cell type specific and common cofactors which appear to be necessary for proper ecdysone induced gene regulation. We have determined that certain cofactors act as co-repressors to reduce target gene expression, while others act as co-activators to increase target gene expression. Interestingly, we find that a few of the cofactors shared among cell types have a reversible roles to function as co-repressors in certain cell types while in other cell types they serve as co-activators. Lastly, these proteins are highly conserved, with higher order organism homologs also harboring the LXXLL steroid receptor interaction domains, suggesting a highly conserved mode of steroid cell target specificity. Conclusions: In conclusion, we submit these cofactors as novel components of the ecdysone signaling pathway in order to further elucidate the dynamics of steroid specificity. © 2011 Davis et al; licensee BioMed Central Ltd.

Research supports that office referral data is useful in informing programmatic decisions and planning interventions such as Positive Behavior Supports (PBS). Knowledge of patterns of office referrals may facilitate development of interventions that target specific groups. This study examines patterns in office referrals within an urban district by gender, race/ ethnicity and grade. Findings reveal that there are differences by grade that appear to be related to developmental level, with more referrals for aggression in younger students (grades K-6), disrespectful behavior in middle school students (grades 7-8), and attendance problems in high school students. Gender differences in the rate and type of referrals were found, with significantly more referrals for boys' delinquent/aggressive behavior, which may relate to how schools define unacceptable behavior and the data collection method. Finally, there were significantly more referrals for African American/black students than Hispanic students, suggesting that schools consider racial differences when developing behavioral expectations.

This study identified the types of caregiver stress and the caregiver and care management characteristics that are associated with this stress. 169 caregivers were recruited from a variety of community settings that cater to caregivers in a New England metropolitan area. They completed the Zarit Burden Interview (ZBI) and a questionnaire concerning their care recipient and caregiving arrangements. Principal Components Analysis on the ZBI resulted in five factors: personal strain/loss, uncertainty/inadequacy, social strain/embarrassment, anger, and dependency. The average age of the caregiver was 59.95 years (SD = 11.75) and the average age of the CR was 83.44 years (SD = 7.88). Of the 169 caregivers, 82% were women, 61.5% daughters/in-law or wives (12.9%), 34.3% were solo caregivers; 16.8% little or no burden, 39.9% reported mild to moderate burden, 35% moderate to severe burden, and 8.4% had severe burden. Dependency (22.4%) and personal strain/loss (13.7%) had the highest proportions reported as “often” to “nearly always.” The ZBI was predicted by only two caregiver characteristics, indicating that it is not sensitive to the experiences of different types of caregivers. Caregivers experience different types of burden depending on their gender, kinship roles, and levels of involvement in the care of their older relative. Solo caregiver status and age (younger) significantly predicted most if not all 5 burden types. Solo and young caregivers experienced the highest levels of caregiver burden. Social work practice must identify the caregiver’s life stage and other and self-expectations in relation to dependency, personal loss, embarrassment, anger, or uncertainty. © 2016 Taylor & Francis.

The Reconceptualized Uncertainty in Illness Theory (RUIT) was used to investigate antecedents to, appraisals of, and ways of coping with stressful caregiving. Four focus groups with caregivers (8 males and 16 females) of relatives with dementia were conducted; 15 cared for their parents and the remainder cared for their spouses. They were recruited from an adult care center and other community settings in a metropolitan area in New England. The discussions were audiotaped and transcribed verbatim. Two researchers independently coded the transcripts. Thematic analysis was structured according to the RUIT. The study is unique in its application to caregivers as opposed to patients and to all of the elements of the RUIT. Caregivers experience uncertainty in similar ways to patients with life-altering illness. Symptom severity--lack of personal boundaries, repetitive and aggressive behaviors, and the need for constant care--was the most frequent source of stress. The appraisals were mostly negative and included feelings of resentment, a lack of support from family members, financial strains, and loss of freedom. Self-improvement and self-care were important aspects of coping. Spirituality and humor were other coping skills that respondents used. Not all respondents said they were coping and some also reported that support from health care providers was not always helpful. Nurses can help improve coping by explaining the factors that contribute to caregiver strain and uncertainty, and by assisting caregivers to anticipate the effects of the caregiving role.

OBJECTIVE: This study examined alcohol consumption patterns and trends at a public university in the Northeast from 2002 to 2008., PARTICIPANTS: Stratified random sampling was used to select undergraduate students enrolled in courses during spring semesters in 2002, 2004, 2006, and 2008., METHODS: Data were collected during regularly scheduled classes for 4 measures of alcohol consumption and 5 demographic categories using the Core Alcohol and Drug Survey., RESULTS: Four groups showed significant increases in both frequency and volume of alcohol consumption-students who were female, over 21 years of age or over, living off-campus, or performing well academically. There were no decreasing trends for any demographic group. These results differ from national college health surveys, which have shown alcohol use remaining steady during this period., CONCLUSIONS: Campus-specific trend data can provide unique perspectives and guide programming efforts. These trends suggest a need for new intervention strategies on this campus.

Background: Fast food establishments are available on many college campuses and, as a result, many students consume foods that are high in calories and contribute to unhealthy weight gain. Purpose: This study measured college students' knowledge of the calorie content for fast food items and whether the provision of calorie information for those foods influenced their future purchasing intentions. Method: Randomly selected undergraduate college students (N = 201) completed an online survey that measured baseline knowledge of calorie content for a fast food item and intention to purchase that item in the future. After provision of accurate calorie information, students were posttested for intention to purchase that item in the future. Results: The majority of students underestimated calorie content for fast food items. After receiving accurate calorie information, those who initially underestimated calorie content were significantly more likely to change their intention to purchase that food item in the future. Discussion: Many college students are interested in avoiding high-calorie fast food items but are uninformed about calorie content. Translation to Health Education Practice: Colleges should provide calorie information for fast food items at the point of purchase so that students can make informed decisions that will promote their health. © 2015, Copyright © SHAPE America.