The Relationship between Child and Adolescent Risk and Protective Factors and Racial Microagression, Ethnic Identity, and Well-Being in Young Adulthood

Session 4: Risk and Protective Factors in Adolescent and Young Adults. Presenter: Shandra Forrest-Bank, University of Denver (2012) - "The Relationship between Child and Adolescent Risk and Protective Factors and Racial Microagression, Ethnic Identity, and Well-Being in Young Adulthood".The Ohio State University College of Social Wor

The Relationship Between Risk and Resilience, Racial Microaggression, Ethnic Identity, and Well-Being in Young Adulthood

Young adulthood is the developmental period characterized by the transition from adolescence to the roles and responsibilities of adulthood. While most young adults experience positive growth and accomplishments, many others struggle, especially those with disadvantaged childhoods who lack financial, social, and emotional resources. Substance abuse, crime, educational failure, unemployment, and mental health problems are common among young adults. Unfortunately, many of these problems occur at disproportionately high rates for young people of color. Considerable knowledge of the child and adolescent risk and protective factors that contribute to the onset of problem behavior or to well-being during adolescence has been developed. However, evidence from longitudinal studies spanning childhood, adolescence, and adulthood indicates that little is known about the influence of early risk and protective factors on the onset, remittance, or persistence of problem behavior or well-being during adulthood. In addition, few studies have examined the effects of racial discrimination and ethnic identity on problem behavior and well-being. This study examined the relationship between child and adolescent risk and protective factors for problem behavior, perceived racial and ethnic microaggression, ethnic identity, and the young adult outcomes of self-efficacy, substance abuse, and criminal intention. Data were collected from a randomly selected sample of college students (N=486; Mean Age=24) attending an urban college in Denver, Colorado. Findings from structural equation modeling revealed that the early onset of problem behavior was significantly related to both substance abuse and criminal intentions during young adulthood. Childhood school engagement was positively related to college self-efficacy, and negatively related to criminal intentions. Perceived racial microaggression and ethic identify were significantly related to academic self-efficacy. One-way analysis of variance tests revealed significant differences in mean scores on the microaggression and ethnic identity scales between racial and ethnic groups. All nonwhite groups reported significantly higher levels of microaggression than their white peers. Mean cognitive ethnic identity scores were significantly higher for black and Latino/Hispanic subjects compared to Asian and white participants. The implications of these findings for practice, policy, and research with young adult populations are identified

Understanding Appalachian Microaggression from the Perspective of Community College Students in Southern West Virginia

The term Appalachian is wrongly understood to represent a single culture of rural White poverty (Keefe, 2005). This conception contains stereotypical images that obscure hardships many rural White Central Appalachians face. Similar to other oppressed minorities in the U.S., what it means to be Appalachian is a social construction based on what differs them from the White hegemony. Recent scholarship on discrimination recognizes the importance of microaggression, small insults and slights experienced frequently by people from minority groups (Sue, et. al., 2007). Microaggression may be an especially insidious mechanism in the oppression of Appalachian people, since the derogatory stereotypes are broadly accepted while their oppressed status tends to not be acknowledged. This study applied qualitative focus group methodology to understand perceptions of microaggression and oppression among a sample of college students living in rural Central Appalachia. Results reveal themes of microaggression. Identifying Appalachian microaggression provides evidence of marginalized status and offers a framework for understanding how the social construction of White Appalachian perpetuates reduced status, stereotypes, and prejudice. Implications are discussed to consider how to foster resilience to oppression among rural White Central Appalachian people

Clean birth kits to improve birth practices: development and testing of a country level decision support tool

Background: Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Methods: Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. Results: The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Conclusion: Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be replicated and to identify how the tool can be adapted to meet country specific needs

Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study

Background: Nepal has made significant progress with regard to reducing the maternal mortality ratio but a major challenge remains the under-utilisation of skilled birth attendants who are predominantly facility based. Studies have explored women's views of the barriers to facility birth; however the voices of staff who offer services have not been studied in detail. This research explores the views of staff as to the key reasons why pregnant women do not give birth in a maternity-care facility. Methods: This mixed methods study comprised qualitative interviews and non-participant observation. The study was conducted in two small non-governmental hospitals, one semi-rural and one urban, in Kathmandu Valley. Twenty interviews were conducted with health care providers and other staff in these hospitals. The interviews were undertaken with the aid of a Nepali translator, with some interviews being held in English. Twenty-five hours of non-participant observation was conducted in both maternity hospitals . Both observation and interview data were analysed thematically. Ethical approval was granted by the Nepal Research Health Council and Bournemouth University's Ethics Committee. Results: Key themes that emerged from the analysis reflected barriers that women experience in accessing services at different conceptual levels and resembled the three phases of delay model by Thaddeus and Maine. This framework is used to present the barriers. First Phase Delays are: 1) lack of awareness that the facility/services exist; 2) women being too busy to attend; 3) poor services; 4) embarrassment; and 5) financial issues. Themes for the second Phase of Delay are: 1) birthing on the way; and 2) by-passing the facility in favour of one further away. The final Phase involved: 1) absence of an enabling environment; and 2) disrespectful care. Conclusion: This study highlights a multitude of barriers, not all of the same importance or occuring at the same time in the pregnancy journey. It is clear that staff are aware of many of the barriers for women in reaching the facility to give birth, and these fit with previous literature of women's views. However, staff had limited insight into barriers occuring within the facility itself and were more likely to suggest that this was a problem for other institutions and not theirs

Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal.

Background: Pregnancy and childbirth are socio-cultural events that carry varying meanings across different societies and cultures. These are often translated into social expectations of what a particular society expects women to do (or not to do) during pregnancy, birth and/or the postnatal period. This paper reports a study exploring beliefs around childbirth in Nepal, a low-income country with a largely Hindu population. The paper then sets these findings in the context of the wider global literature around issues such as periods where women are viewed as polluted (or dirty even) after childbirth. Methods: A qualitative study comprising five in-depth face-to-face interviews and 14 focus group discussions with mainly women, but also men and health service providers. The qualitative findings in Nepal were compared and contrasted with the literature on practices and cultural beliefs related to the pregnancy and childbirth period across the globe and at different times in history. Results: The themes that emerged from the analysis included: (a) cord cutting & placenta rituals; (b) rest & seclusion; (c) purification, naming & weaning ceremonies and (d) nutrition and breastfeeding. Physiological changes in mother and baby may underpin the various beliefs, ritual and practices in the postnatal period. These practices often mean women do not access postnatal health services. Conclusions: The cultural practices, taboos and beliefs during pregnancy and around childbirth found in Nepal largely resonate with those reported across the globe. This paper stresses that local people’s beliefs and practices offer both opportunities and barriers to health service providers. Maternity care providers need to be aware of local values, beliefs and traditions to anticipate and meet the needs of women, gain their trust and work with them