Multiple Ecological Levels Research Articles

A comprehensive review of the barriers and promoters health workers experience in delivering prevention of vertical transmission of HIV services in sub-Saharan Africa

ABSTRACTDespite significant biomedical and policy advances, 199,000 infants and young children in sub-Saharan Africa (SSA) became infected with HIV in 2013, indicating challenges to implementation of these advances. To understand the nature of these challenges, we sought to (1) characterize the barriers and facilitators that health workers encountered delivering prevention of vertical transmission of HIV (PVT) services in SSA and (2) evaluate the use of theory to guide PVT service delivery. The PubMed and CINAHL databases were searched using keywords barriers, facilitators, HIV, prevention of vertical transmission of HIV, health workers, and their synonyms to identify relevant studies. Barriers and facilitators were coded at ecological levels according to the Determinants of Performance framework. Factors in this framework were then classified as affecting motivation, opportunity, or ability, per the Motivation-Opportunity-Ability (MOA) framework in order to evaluate domains of health worker performance within each ecological level. We found that the most frequently reported challenges occurred within the health facility level and spanned all three MOA domains. Barriers reported in 30% or more of studies from most proximal to distal included those affecting health worker motivation (stress, burnout, depression), patient opportunity (stigma), work opportunity (poor referral systems), health facility opportunity (overburdened workload, lack of supplies), and health facility ability (inadequate PVT training, inconsistent breastfeeding messages). Facilitators were reported in lower frequencies than barriers and tended to be resolutions to challenges (e.g., quality supervision, consistent supplies) or responses to an intervention (e.g., record systems and infrastructure improvements). The majority of studies did not use theory to guide study design or implementation. Interventions addressing health workers’ multiple ecological levels of interactions, particularly the health facility, hold promise for far-reaching impact as distal factors influence more proximal factors. Incorporating theory that considers factors beyond the health worker will strengthen endeavors to mitigate barriers to PVT service delivery.

Mapping the Views of Adolescent Health Stakeholders

PurposeHealth research that includes youth and family stakeholders increases the contextual relevance of findings, which can benefit both the researchers and stakeholders involved. The goal of this study was to identify youth and family adolescent health priorities and to explore strategies to address these concerns. MethodsStakeholders identified important adolescent health concerns, perceptions of which were then explored using concept mapping. Concept mapping is a mixed-method participatory research approach that invites input from various stakeholders. In response to prompts, stakeholders suggested ways to address the identified health conditions. Adolescent participants then sorted the statements into groups based on content similarity and rated the statements for importance and feasibility. Multidimensional scaling and cluster analysis were then applied to create the concept maps. ResultsStakeholders identified sexually transmitted infections (STIs) and obesity as the health conditions they considered most important. The concept map for STIs identified 7 clusters: General sex education, support and empowerment, testing and treatment, community involvement and awareness, prevention and protection, parental involvement in sex education, and media. The obesity concept map portrayed 8 clusters: Healthy food choices, obesity education, support systems, clinical and community involvement, community support for exercise, physical activity, nutrition support, and nutrition education. Ratings were generally higher for importance than for feasibility. ConclusionsThe concept maps demonstrate stakeholder-driven ideas about approaches to target STIs and obesity in this context. Strategies at multiple social ecological levels were emphasized. The concept maps can be used to generate discussion regarding these topics and to identify interventions.

A Mixed Methods Analysis of the Place-Related Risk and Protective Factors for Hospital Admissions and Emergency Department Visits among Children with Complex Chronic Conditions

Purpose: Children with complex chronic conditions (CCC) have high health care needs and utilization. The purpose of this study was to identify place-related risk and protective factors associated with hospital utilization among children with CCC. Methods: A mixed methods study was conducted to generate a risk profile of place-related factors associated with hospital utilization. The quantitative phase of the study consisted of retrospective review of 216 urban hospital medical records of infants and young children with CCC. The qualitative phase of the study included interviews with parents/caregivers and focus groups with health care providers (HCPs) of children with CCC. Results from multiple regression modeling and directed content analysis were merged using a side-by-side table organized by ecological level. Findings: Place-related risk and protective factors on multiple ecological levels were identified. Key place-related factors associated with hospital utilization were more complex conditions, positive relationships with HCPs, more parent/family resources, and having fewer place-related resources. Conclusions: The results of this study suggest patterns of health care utilization among infants and young children with CCC are influenced by place-related factors. Parent relationships with HCPs and comfort with care, hospital resources, and parent resources determine location of care. Results of this study also imply place-related disparities in access to care, especially among children in smaller metropolitan areas and rural-dwelling children. DOI: http://dx.doi.org/ 10.14574/ojrnhc.v15i2.364 Keywords: Rural population, Rural health services, Infant, Child, Preschool, Chronic disease

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000, through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (education OR self-management OR behavioral OR technology OR trigger reduction), and the mean and/or median age of participants was between 11 and 16 years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include objective monitoring of inhaled corticosteroid adherence with allergist and/or immunologist feedback on medication-taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Novel strategies to objectively increase controller medication adherence for adolescents include allergist and/or immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills.

Migration-related detention centers: the challenges of an ecological perspective with a focus on justice

BackgroundIn recent years, border control and migration-related detention have become increasingly widespread practices affecting the lives of undocumented migrants, their families, and communities at large. In spite of the concern within academia, few studies have directly witnessed the life and experiences of people confined to migration-related detention centers. In the medical and psychological fields, a considerable body of research has demonstrated the pathogenic nature of detention in terms of mental health, showing an association between length of detention and severity of distress. Nevertheless, it was limited to the assessment of individuals’ clinical consequences, mainly focusing on asylum seekers. There currently exists a need to adopt an ecological perspective from which to study detained migrants’ experiences as context-dependent, and influenced by power inequalities. This paper addresses this gap.DiscussionDrawing upon advances in community psychology, we illustrate an ecological framework for the study of migration-related detention contexts, and their effects on the lives of detained migrants and all people exposed to them. Making use of existing literature, Kelly’s four principles (interdependence, cycling of resources, adaptation, succession) are analyzed at multiple ecological levels (personal, interpersonal, organizational, communal), highlighting implications for future research in this field. A focus on justice, as a key-dimension of analysis, is also discussed. Wellbeing is acknowledged as a multilevel, dynamic, and value-dependent phenomenon.SummaryIn presenting this alternative framework, the potential for studying migration-related detention through an ecological lens is highlighted, pointing the way for future fields of study. We argue that ecological multilevel analyses, conceptualized in terms of interdependent systems and with a focus on justice, can enhance the comprehension of the dynamics at play in migration-related detention centers, providing an effective tool to address the multi-level challenges of doing research within them. Furthermore, they can contribute to the development of policies and practices concerned with health, equality, and human rights of all people exposed to migration-related detention. Consistent with these assumptions, empirical studies adopting such a framework are strongly encouraged. These studies should use mixed and multi-method culturally situated designs, based on the development of collaborative and empowering relationships with participants. Ethnographic approaches are recommended.

Examining the Interaction of Daily Hassles Across Ecological Domains on Substance Use and Delinquency Among Low-Income Adolescents of Color

The increased risk for substance use and delinquency among adolescents of color has been partially attributed to increased exposure to daily hassles. Although a certain number of hassles are normative, especially among family and peers, adolescents of color experience more stressors in their neighborhood or directly related to fewer resources than their White counterparts. These hassles may interact across ecological systems to impact behavioral outcomes among adolescents. This may be especially true for young people living in public housing. Based on ecological systems theory, this study tests the relationship between experiences of hassles across multiple ecological levels and problem behaviors in a sample of 315 ethnically diverse early adolescents (Mage = 12; 51% female) living in public housing neighborhoods in two large metropolitan areas in the United States. A positive relationship was found between family hassles and both substance use and delinquency, as well as between school hassles and substance use. When the interactions between family, peer, school, and neighborhood/resource hassles were considered, five statistically significant interactions were found. The study results reinforce the role of contextual factors, such as living in low-income neighborhoods and the complexity of hassles interacting at multiple levels of a young person’s daily ecology, on adolescent outcomes.

Multidimensional Family Resilience Assessment: The Individual, Family, and Community Resilience (IFCR) Profile

The goal of this study was to develop a broad, multidimensional assessment of individual, family, and community resilience for use in evaluating socioeconomic mobility programs. The Individual, Family, and Community Resilience Profile (IFCR) is a broad, multidimensional measure that evaluates multiple ecological levels of resilience. Based on a sample of 650 low-income families, this study demonstrates the initial reliability of the 75-item IFCR. This evaluation tool assesses 20 separate dimensions of constructs often associated with resilience. The IFCR provided strong reliability with interitem reliability coefficients ranging from α = .71 to.93. The IFCR also showed strong predictive abilities for education levels, employment, and mental health. We also present benchmark scaling of the IFCR for use in practice and future research.

Ecodevelopmental predictors of early initiation of alcohol, tobacco, and drug use among Hispanic adolescents

The purpose of this cross-sectional study was to test the transactional relationships of risk and protective factors that influence initiation of alcohol, tobacco, and drug use among Hispanic youth. Ecodevelopmental theory was used to identify factors at multiple ecological levels with a focus on four school-level characteristics (i.e. school socioeconomic status, school climate, school acculturation, and school ethnic composition). A sample of 741 Hispanic adolescents (M age=13.9, SD=.67) and their caregivers were recruited from 18 participating middle schools in Miami-Dade County, FL. Structural equation modeling was used to test the hypothesized ecodevelopmental model of early substance use, accounting for school clustering effects. Results provided strong support for the model (CFI=.95; RMSEA=.03). School SES was indirectly related to the likelihood of starting substance use through perceived peer use norms (β=.03, p<.02). Similarly, school climate had an indirect effect on substance use initiation through family functioning and perceptions of peer use norms (β=−.03, p<.01). Neither school ethnic composition nor school acculturation had indirect effects on initiation of substance use. Results highlight the importance of the interplay of risk and protective factors at multiple ecological levels that impact early substance use initiation. Further, findings underscore the key role of school level characteristics on the initiation of substance use and present opportunities for intervention.

Community-level impacts of white-tailed deer on understorey plants in North American forests: a meta-analysis.

The impacts of introduced or overabundant large herbivores are a concern for the conservation of forest plant communities and the sustainability of ecosystem function. White-tailed deer (Odocoileus virginianus) are considered ecologically overabundant in much of North America. Previous work suggests that impacts of deer overabundance are broadly negative and are consequently degrading forests at multiple ecological and taxonomic levels. However, no quantitative synthesis currently exists to verify the generality or magnitude of these impacts. Here, we report the results of a meta-analysis quantifying the effects of deer exclusion on the diversity, cover and abundance of woody, herbaceous and whole community components of forest understories in North America. In addition, we explore the relationships of environmental and experimental factors on the direction and magnitude of plant community outcomes using meta-regression. Using 119 calculated effect sizes sourced from 25 peer-reviewed articles, we constructed 10 community-specific data sets and found strongly positive diversity, cover and abundance responses of the woody community to deer exclusion, but no significant effects for the herbaceous or whole community components of forest understories. Local deer density and time since exclusion were significant moderators of both whole community and woody community richness. Local deer density also moderated the effects of deer exclusion on whole community cover. Plot area, in contrast, showed no relationship to any of the community response outcomes. We suggest that the use of inadequate diversity indices, non-native species replacement or legacy effects of chronic deer overabundance might explain why the herbaceous and whole community components of forest understories showed no diversity or cover responses to deer exclusion. We also suggest some strategies to increase opportunities for future quantitative syntheses of deer impacts on forests, including providing better access to existing and future data. Ultimately, we show that white-tailed deer have strongly negative impacts on forest understorey plant communities in North America, but these impacts are not ubiquitous for all components of the plant community.

Abstract A38: High levels of breast cancer mortality: Social determinants of health impact rural African American women and how they conceptualize health in the Arkansas Delta

Abstract We know that certain components including demographics, cultural background, lifestyle choices and lack of access to health care contribute strongly to health disparities in rural regions of the United States. This paper explores perceptions of health, the environment, and the relationships between them that impact breast cancer mortality in the Arkansas Delta. The social-ecological model provides a conceptual approach to relate social determinates to health disparities. This exploratory study blended a community-based, qualitative approach with ecological theory. Our objective was to identify potential social determinants of health which impact these women's ability to seek medical advice or engage in breast cancer prevention in a timely manner. Methods: Qualitative data were gathered with (n=79) women, ranging in age from 18 to 84, who were residents of 3 rural Arkansas Delta communities. Respondents poignantly described issues that affect health disparities in their communities. Conclusions: The study identified potential social determinants of health, at multiple ecological levels, among African American women in three communities in the Arkansas Delta. The social determinants identified had the ability to impact a variety of health behaviors and health outcomes. Our findings show the value of qualitative approaches for exploring the complexities of rural breast cancer mortality. Citation Format: Nancy J. Greer-Williams, Kimberely S. Enoch, Athena Starlard-Davenport, Brandon Booth, Thomas Kieber-Emmons, Gloria E. Sarto, Ronda Henry-Tillman. High levels of breast cancer mortality: Social determinants of health impact rural African American women and how they conceptualize health in the Arkansas Delta. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A38. doi:10.1158/1538-7755.DISP13-A38

An ecological model of intimate partner violence perpetration at different levels of severity.

Intimate partner violence (IPV) is a significant public health concern. This study proposed and tested an ecological model of both general and clinically significant (i.e., injurious or fear-evoking) IPV perpetration (IPVPerp). Risk and promotive factors from multiple ecological levels of influence (i.e., individual, family, workplace, community) were hypothesized to be important in the prediction of IPVPerp. Although clinically significant IPVPerp and general IPVPerp were hypothesized to relate, specific risks for clinically significant IPVPerp were hypothesized. U.S. Air Force active duty members and civilian spouses (N = 34,861 men; 24,331 women) from 82 sites worldwide completed the 2006 Community Assessment, an anonymous online survey assessing IPVPerp along with a variety of potential risk and promotive factors. Final structural equation models for men and women, cross-validated in holdout samples, clearly supported the relevance of an ecological approach to IPVPerp. Factors from all 4 levels were associated with both general IPVPerp and clinically significant IPVPerp, with relatively distal community and workplace factors operating via more proximal individual and family level variables (e.g., relationship satisfaction). The results suggest a variety of both established and novel potential targets for indirectly targeting general and clinically significant IPVPerp by improving risk profiles at the individual, family, workplace, and community levels.

Process evaluation outcomes from a global child obesity prevention intervention.

BackgroundWhile it is acknowledged that child obesity interventions should cover multiple ecological levels (downstream, midstream and upstream) to maximize their effectiveness, there is a lack of evaluation data to guide the development and implementation of such efforts. To commence addressing this knowledge gap, the present study provides process evaluation data relating to the experiences of groups implementing the EPODE approach to child obesity prevention in various locations around the world. The aim of this exploratory study was to investigate the barriers and facilitators to program implementation in program sites around the world to assist in developing strategies to enhance program outcomes.MethodsAn online survey that included open-ended questions was distributed to the 25 EPODE programs in operation at the time of the survey (May 2012). The survey items asked respondents to comment on those aspects of program implementation that they found challenging and to suggest areas for future improvement. Eighteen programs representing 14 countries responded to the request to participate in the survey, yielding a 72% response rate. The responses were analyzed via the constant comparative method using NVivo qualitative data analysis software.ResultsThe main concerns of the various EPODE programs were their ability to secure ongoing funding and their access to evidence-based intervention methods and policy advice relating to relationships with third parties. These issues were in turn impacted by other factors, including (i) access to user-friendly information relating to the range of intervention strategies available and appropriate evaluation measures; (ii) assistance with building and maintaining stakeholder relationships; and (iii) assurance of the quality, independence, and transparency of policies and practices.ConclusionsThe findings are facilitating the ongoing refinement of the EPODE approach. In particular, standardized and tailored information packages are being made available to advise program members of (i) the various evaluation methods and tools at their disposal and (ii) methods of acquiring private partner support. Overall, the study results relating to the types of issues encountered by program members are likely to be useful in guiding the future design and implementation of multi-level initiatives seeking to address other complex and intractable health-related problems.

Creating Settings for Youth Empowerment and Leadership: An Ecological Perspective

Youth development programs are increasingly focusing on youth empowerment and leadership, a shift which often requires adult staff to adopt new roles and practices. This article explores staff practice in the context of a multisite initiative designed to engage marginalized youth in social change through youth-led grants. Interviews with youth workers and managers revealed practices at multiple ecological levels. Individual-level practices supported youths’ capacities to participate. Group-level practices fostered social interactions and activities that actualized the youth-led approach. Setting-level practices created structures that supported and protected group activities while organization-level practices promoted a favorable environment for youth leadership. Analyzed from an ecological and activity settings perspective, these results contribute to understanding the multifaceted and complex nature of youth work in power-sharing practice models. Practice implications include identifying training needs to help practitioners navigate across multiple ecological levels and suggesting reflection questions for practitioners.

Transactional sex involvement: exploring risk and promotive factors among substance-using youth in an urban emergency department.

The current study aims to evaluate individual, relational, and community-level risk and promotive factors for transactional sex involvement among substance-using youth. Youth (ages 14-24 years) presenting for care in an urban emergency department, who reported drug use within the past 6 months, were surveyed as part of a larger study assessing violence. Of the 600 youth enrolled in this study, 350 presented to the emergency department with violent injury. Based on youth presenting with violent injury, a proportionally selected (age and gender) comparison group of youth (n = 250) presenting without violent injury were enrolled. Participants were queried about both risk and promotive factors at the individual, relational, and community levels. Of the sample, 7.3% reported involvement in transactional sex within the past month. Regression analyses indicated that being African American or other race (as compared with White), having more than one sexual partner, depressive symptoms, negative peer influence, and substance use treatment utilization were positively associated with transactional sex involvement. Increased school involvement was negatively related to involvement in transactional sex. Drug-using youth who reported recent transactional sex involvement are more likely to experience increased HIV risk, depressive symptoms, and negative peer influence and are less likely to experience the promotive factors of school involvement. Future research is needed to better understand the bidirectional relationship between transactional sex involvement and both risk and promotive factors at multiple ecological levels.

The value of grounded theory for disentangling inequalities in maternal-child healthcare in contexts of diversity: A psycho-sociopolitical approach

Adopting a psycho-sociopolitical approach, the present paper describes the results of a community-based participatory needs assessment focusing on the perceived needs of women of reproductive age as users of primary healthcare in contexts of migration-driven diversity and socioeconomic vulnerability in the Metropolitan Area of Lisbon. The investigation comprised 64 in-depth interviews with women, including natives and immigrants to Portugal from the main origin countries in the context under study (Brazil, Cape Verde, and other Portuguese-speaking African countries) and a survey of 125 women, again natives and immigrants from these countries. The central role of qualitative methodology and grounded theory, in the framework of a multi-method research, allowed understanding the needs of women as embedded in contexts characterized by asymmetrical power relations, in terms of unequal opportunities and resources, at multiple interrelated ecological levels (personal, relational, organizational, community, socioeconomic, health system/policy, cultural/migration). The priority perceived needs of women were primarily related to socioeconomic disadvantage, severely aggravated in the current contexts of crisis; and factors at the health system level, mainly unequal access to family doctors, excessive waiting lists, and increases in the direct costs of healthcare. Results allow questioning the adequacy of cultural competence approaches for the reduction of inequalities in maternal-child healthcare in the context under study, showing the critical and innovative value of qualitative methodology and grounded theory in research on social justice and health in contexts of diversity characterized by unequal power dynamics.

Identifying unique and shared risk factors for physical intimate partner violence and clinically-significant physical intimate partner violence.

Intimate partner violence (IPV) is a significant public health concern. To date, risk factor research has not differentiated physical violence that leads to injury and/or fear (i.e., clinically significant IPV; CS-IPV) from general physical IPV. Isolating risk relations is necessary to best inform prevention and treatment efforts. The current study used an ecological framework and evaluated relations of likely risk factors within individual, family, workplace, and community levels with both CS-IPV and general IPV to determine whether they were related to one type of IPV, both, or neither for both men and women. Probable risk and promotive factors from multiple ecological levels of influence were selected from the literature and assessed, along with CS-IPV and general IPV, via an anonymous, web-based survey. The sample comprised US Air Force (AF) active duty members and civilian spouses (total N = 36,861 men; 24,331 women) from 82 sites worldwide. Relationship satisfaction, age, and alcohol problems were identified as unique risk factors (in the context of the 23 other risk factors examined) across IPV and CS-IPV for men and women. Other unique risk factors were identified that differed in prediction of IPV and CS-IPV. The results suggest a variety of both established and novel potential foci for indirectly targeting partner aggression and clinically-significant IPV by improving people's risk profiles at the individual, family, workplace, and community levels. Aggr. Behav. 41:227-241, 2015. © 2014 Wiley Periodicals, Inc.

Physically Abused Children's Adjustment at the Transition to School: Child, Parent, and Family Factors.

Childhood physical abuse predicts emotional/behavioral, self-regulatory, and social problems. Yet factors from multiple ecological levels contribute to children's adjustment. The purpose of this study was to examine the degree to which the social-emotional adjustment of physically abused children in first grade would be predicted by a set of child-, parent-, and family-level predictors in kindergarten. Drawing on a short-term longitudinal study of 92 physically abused children and their primary caregivers, the current study used linear regression to examine early childhood child (i.e., gender, IQ, child perceptions of maternal acceptance), parent (i.e., parental mental health), and family relationship (i.e., sensitive parenting, hostile parenting, family conflict) factors as predictors of first grade internalizing and externalizing symptomatology, emotion dysregulation, and negative peer interactions. We used a multi-method, multi-informant approach to measuring predictors and children's adjustment. Internalizing symptomatology was significantly predicted by child IQ, parental mental health, and family conflict. Externalizing symptomatology and emotion dysregulation were predicted by child IQ. Although a large proportion of variance in measures of adjustment was accounted for by the set of predictors, few individual variables were unique predictors of child adjustment. Variability in the predictors of adjustment for physically abused children underscores the need for individualized treatment approaches.

Factors influencing hospital admissions and emergency department visits among children with complex chronic conditions: a qualitative study of parents’ and providers’ perspectives

Children with complex chronic conditions (CCC) have greater health care needs and use rates than children in general. Elevated health care use includes more frequent hospital admissions, longer hospital stays, and greater health care expenses. Prior studies have examined population characteristics associated with increased hospital admissions, emergency department (ED) use, and general healthcare use, yet few studies have investigated these events from the parents’ or health care providers’ point of view. The purpose of this study was to explore parents/caregivers’ and health care providers’ perceptions of the factors placing infants and young children with CCC at risk for or protecting them against hospital admissions and ED visits. Parents or primary caregivers participated in interviews, and health care providers in pediatric acute care, pediatric primary care, and emergency care participated in focus groups. Interview and focus group data were analyzed using directed content analysis and an ecological risk and protective factors model. The analysis revealed that parents/caregivers and health care providers described risk factors and protective factors on multiple ecological levels surrounding the child with CCC. This article presents these findings, which add to current knowledge of factors influencing hospital admissions and ED visits and may be used to inform interventions addressing high health care utilization in this population. This article concludes with the implications of the findings for future research and nursing practice.

Perceived discrimination, family functioning, and depressive symptoms among immigrant women in Taiwan

This study examined the moderating effect of family functioning on the relationship between perceived discrimination and depressive symptoms in immigrant women. A total of 239 immigrant women were selected from four administrative regions in Central Taiwan. Questionnaires concerning perceived discrimination, family functioning (including family cohesion and family adaptability), depressive symptoms, and demographic characteristics were completed by either women themselves (N = 120) or their husbands (N = 119). The moderating effect of family functioning on the relationship between perceived discrimination and depression symptoms was analyzed using multiple regression analysis. Findings showed that a higher level of perceived discrimination among immigrant women is associated with more severe depressive symptoms. Family functioning serves as a moderator between the relationship of perceived discrimination and depressive symptoms, but the moderating effect of family adaptability was evident only in data reported by immigrant women. The results indicate that perceived discrimination has negative mental health implications, and also point to the importance of family functioning for depression. Findings suggest that providers should consider addressing immigrant women's mental health needs through declining their psychosocial distress at multiple ecological levels.

Conduits from community violence exposure to peer aggression and victimization: Contributions of parental monitoring, impulsivity, and deviancy.

Community violence exposure results in heightened risk for engaging in and being a victim of interpersonal violence. Despite this robust literature, few studies have specifically examined how the relation between community violence exposure, peer aggression, and victimization is modified by individual, peer, and familial influences (considered jointly). In the current study, we used risk and resiliency theory to examine links between community violence exposure and peer aggression and victimization. Impulsivity and parental monitoring were examined as potential moderators of the link between community violence exposure and outcomes, both directly and indirectly via deviant behavior. Survey data on bullying involvement, fighting, deviancy, parental monitoring, and impulsivity were collected on 3 occasions over an 18-month period among a large cohort of adolescents (N = 1,232) in 5th-7th grades. Structural equation modeling suggests that for both male and female adolescents, impulsivity exacerbates the effects of community violence exposure by increasing involvement in deviant behavior. Parental monitoring buffered the effects of community violence exposure on perpetration and victimization (for males and female adolescents) via reduced involvement in deviant behavior. Findings suggest that impulsivity and parental monitoring are implicated in modifying the effects of community violence exposure on both victimization and perpetration through deviancy, although deviancy is not as potent of a predictor for victimization. Thus, prevention efforts would seem to be optimally targeted at multiple ecological levels, including parental involvement and peer networks.