Preventing Substance Abuse Among African American Children and Youth: Race Differences in Risk Factor Exposure and Vulnerability

The accurate identification of risk factors is central to the development of effective efforts to prevent young people from using alcohol, tobacco and other substances. To date, a key limitation of the prevention literature has been the paucity of research that examines the extent to which substance use risk factors identified in studies of white adolescents generalize to African American (and other non-white) youth. In the absence of research on race differences in risk factor exposure and vulnerability, current preventive interventions are based on the implicit assumptions that 1) the risk factors for African American and white adolescents' substance use are identical; and 2) that African American and white adolescents are equally exposed and equally vulnerable to these risk factors. The purpose of the present study was to begin to examine empirically the equal exposure and vulnerability” assumption. Specifically, the paper used Hawkins, Catalano and Millers' widely cited 1992 article on risk and protective factors for adolescent and young adult substance use as a framework within which to review past risk factor research and as a guide to identify risk factors to examine for race differences in exposure and/or vulnerability. Based upon our review of the existing literature and our analysis of data from the University of Michigan's Monitoring the Future study, we conclude that the simple assumption that African American and white youth are equally exposed and vulnerable to the same risk factors is not correct. In fact, we found that African American and white seniors' differed significantly in their exposure to more than half of the 55 risk factors examined. Similarly, nearly one third of the 165 tests for race differences in vulnerability were highly significant (i.e., p < .01). While it is possible that some of the differences we identified resulted from chance, their consistency across variables, within the same risk factor domain, and across drug categories, makes the likelihood that our findings are primarily statistical artifacts unlikely. Based upon the results of this study it is clear that additional theoretically and empirically rigorous race-specific research is needed to better understand the etiology of substance use among African American adolescents. Further research is also needed to identify those risk factors that are most salient for African American adolescents and most amenable to change through well designed, and perhaps, culturally tailored preventive interventions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45093/1/10935_2004_Article_365228.pd

Clinical decision-making in psychiatric emergency services (PES).

Prior research suggests that stereotypes and bias may affect psychiatric diagnoses and disposition decisions. Findings are variable concerning the role of patient sociodemographic characteristics in clinical decisionmaking. Research on clinician characteristics is sparse. According to social-psychological and cognitive theories, patient and clinician characteristics may influence clinicians' tendencies to stereotype, especially under conditions of limited time and high patient pressures. Cognitive load refers to the magnitude of demands imposed within specific time constraints and limitations that restrict the amount of available cognitive resources that can be dedicated to a particular task. This study investigated the effects of clinician and patient sociodemographic factors on Psychiatric Emergency Service (PES) decisions, made under high and low levels of cognitive load. Patterns of decisionmaking were examined through retrospective record reviews of 1240 psychiatric patients, treated by 75 clinicians in an urban PES in the Mid-west, and interviews with a sub-sample of clinicians. Patient records were randomly sampled according to the clinician's level of cognitive load, controlling for the average number of patients typically seen and the actual volume of patients seen by the particular clinician during that shift. Multinomial logistic-regression analyses replicated previous diagnostic trends with Black and male patients receiving higher rates of Psychotic Disorder, and White and female patients receiving higher rates of Bipolar Disorder. Results suggest that cognitive load may affect PES decisionmaking, especially the assignment of bipolar disorder, no psychiatric dispositions, and scheduled PES followups. Effects of patient gender and clinician gender, race/ethnicity, and professional experience were accentuated under cognitive load, over and beyond the effects of clinical factors. Contrary to chart-review results, interviewed clinicians emphasized patient clinical factors versus non-psychiatric factors as most important to their decisionmaking. Past studies may have shown varying results because contextual factors, like cognitive load, were not controlled. When clinicians have heavy patient loads and are busy, social stereotypes may be more likely to influence their decisions---even outside the awareness and conscious intent of the clinician. Inappropriate clinical decisions may result in negative long-term effects on patients. Further examination of these factors is critical to the delivery of quality mental health care across all subgroups of patient populations.Ph.D.Clinical psychologyHealth and Environmental SciencesMental healthPsychologySocial SciencesSocial workUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/124519/2/3150052.pd

Is Psychiatric Research Stigmatized? An Experimental Survey of the Public

Although decisional incapacity can be caused by various medical conditions, incapacity due to mental illness is often singled out for scrutiny in research ethics policy debates. We assessed whether there is a general discriminatory perception of mental illness research and, if so, aimed to characterize the nature of that perception. We conducted an experimental, randomized Internet survey of the general public. We recruited 3140 adults through a web-research survey panel, with oversampling of racial and ethnic minorities and the elderly. Willingness to allow medical versus mental illness research was compared by randomly assigning the respondents to 1 of 7 web-based experimental scenarios depicting a subject being considered for research participation. Respondents were more willing to allow research with medically ill than the mentally ill subjects, even when ethically relevant factors were equal. This difference was mediated through the respondents' tendency to view mentally ill subjects as more decisionally incapable than medically ill subjects, even when they were told that the subjects portrayed were in fact competent. Discriminatory perception of mental illness research exists and is mediated by an outdated view of mental illness and decisional capacity. Policymakers and institutional review board members may need to guard against its influence in their deliberations

A Spanish Translation of the Hoarding Rating Scale: Differential Item Functioning and Convergent Validity

Hoarding disorder (HD) involves extreme difficulties discarding possessions and significant clutter in living areas. Although hoarding occurs worldwide, cross-cultural research remains in nascent stages, hampered in part by a lack of validated measures in non-English languages. We aimed to validate a Spanish translation of the Hoarding Rating Scale (HRS), a widely used measure of core HD symptoms. Our sample ( N  = 736) included participants responding in English ( n  = 548; 45.4% female; 7.9% Latinx) or Spanish ( n  = 188; 46.3% female; 79.9% Latinx) to questionnaires via Amazon’s Mechanical Turk. An item response theory (IRT) approach was used to test differential item functioning (DIF) of the English and Spanish HRS. We also examined convergent validity of each language version with other HD. Initial comparisons revealed that hoarding symptoms were elevated in the Spanish-speaking sample compared to the English-speaking sample. DIF tests flagged the clutter item for potential bias (McFadden’s β = .069), but closer examination revealed that the impact was negligible. The Spanish HRS was significantly linked with other hoarding measures (Saving Inventory-Revised: β  = .497, p  < .001; Obsessive–Compulsive Inventory-Revised–Hoarding Subscale: β  = .329, p  = .008), controlling for mood, anxiety, stress, and non-hoarding OCD symptoms. However, the Spanish HRS was not significantly associated with Clutter Image Rating scores. Findings supported the utility of the HRS to measure of HD symptoms in Spanish speakers, though cross-linguistic assessment of clutter and the applicability of clinical cutoffs with Spanish-speaking samples merits further study