Person-centered Methods Research Articles

Intersecting racism and homonegativism among sexual minority men of color: Latent class analysis of multidimensional stigma with subgroup differences in health and sociostructural burdens

RationaleApplying an intersectional framework to quantitative public health research among Black and Latino sexual minority men requires analysis that considers interlocking, multidimensional systems of racist and homonegative oppression that fundamentally subvert health. In this study, person-centered methods reflected the complexity of intersecting stigma and how subgroups experience that intersection differently. MethodsData were from a cohort of 435 Black and Latino sexual minority young men (mean age = 22.3 years) in the Healthy Young Men's Cohort Study in Los Angeles, United States. Participants provided data semiannually on five occasions spanning 24 months from 2016 to 2019. The marginal approach to longitudinal latent class analysis was used to identify latent classes indicated by multidimensional experiences of racism (e.g., police harassment, workplace discrimination, sexual objectification) and homonegativism (e.g., violence, family rejection, identity concealment) during the transition to adulthood. Associations between sociostructural burdens (e.g., socioeconomic status, food insecurity, unstable housing) and class incidents were investigated. Prevalence of mental health care needs, chronic health conditions, and overall self-reported health were compared among classes. ResultsFive latent classes were identified: Minimal Stigma (26% of person records), Select Social Stigma (22%), Homonegativism (17%), Multiform Racism (24%), and Compound Stigma (11%). Sociostructural burdens were generally associated with 1.69–3.75 times higher odds of Select Social Stigma, Homonegativism, Multiform Racism, and Compound Stigma class incidents relative to Minimal Stigma. The Compound Stigma class had the greatest sociostructural burden, highest mental health care needs, and highest odds of sleep and gastrointestinal disorders, but classes did not differ in overall self-reported health. ConclusionThese results exemplify how sociostructural burdens are interconnected with intersectional stigma experiences that together erode the health of Black and Latino sexual minority young men.

Into the heart of darkness: A person-centered exploration of the Dark Triad

Previous research has sought to leverage person-centered methods (i.e., latent profile analysis; LPA) to examine the Dark Triad, which has aimed to illuminate subgroups of individuals who demonstrate distinct patterns of the Dark Triad variables. However, past research has predominantly concluded that variable-centered analyses may be better suited for the Dark Triad. Yet, other research has described how advanced factor analyses can more comprehensively identify the complex and nuanced multidimensionality and sources of variance underlying the Dark Triad. This study applies these modern factor analysis methods, namely bifactor exploratory structural equation modeling (B-ESEM), which subsequently facilitates the more effective extraction of unique, configurationally-distinct profiles of the Dark Triad. In particular, across two large datasets (n = 13,271 and 1042), results showed evidence for four distinct profiles and highlight relations with several theoretically interesting covariates, thereby providing evidence of construct validity of the Dark Triad profiles. Person-centered approaches may, therefore, be viable for future Dark Triad research. However, it is recommended that factor scores from the B-ESEM, if identified as optimal, be used as input for the person-centered analyses.

PERSONALITY PROFILES IN A SWEDISH LONG-TERM UNEMPLOYED SAMPLE

Background: Long-term unemployment is associated with psychiatric problems, higher risk of suicide, low levels of well-being, and high levels of burnout. In this context, among other factors such as sociodemographic status and IQ, specific personality traits are important for individuals’ chances to finding a job, getting hired, and retaining that job, as well as for coping with the mental health risks related to long-term unemployment. Thus, in order to use person-centered methods to promote public health and sustainable employment during the current and future challenges of the 21st century, an important research area is the mapping and understanding of personality profiles of individuals who are unemployed. 
 Objectives: We mapped the personality traits and profiles in a sample of Swedish long-term unemployed (i.e., ≥ 6 months without work) in relation to a control group from the Swedish general population.
 Method: 245 long-term unemployed individuals (136 men and 157 women, range 18 to 60 years; M = 25.7; SD = 9.6) were recruited at the beginning of different well-being and employment projects in Blekinge, Sweden. The participants reported gender, age, and other basic demographics, as well as their personality using the Temperament and Character Inventory (TCI). We calculated the T-scores and percentiles for the personality traits using the Swedish normative data (N = 1,948) and clustered participants in different temperament (high/low novelty seeking: N/n, high/low harm avoidance: H/h, high/low reward dependence: R/r) and character profiles (high/low self-directedness: S/s, high/low cooperativeness: C/c, high/low self-transcendence: T/t).
 Results: Compared to the general population, the long-term unemployed were extremely higher in harm avoidance (> 1.5 standard deviation), moderately lower in persistence (> 0.5 standard deviation), extremely lower in self-directedness (> 2 standard deviations), and moderately lower in novelty seeking (> 0.5 standard deviation). That is, consistent with past research, our study shows that the personality of long-term unemployed is denoted by being pessimistic, fearful, easily fatigable, underachieving, blaming, helpless, and unfulfilled (i.e., high harm avoidance, low persistence, and low self-directedness), but also by being reserved and rigid (i.e., low novelty seeking). Furthermore, within the unemployed population, as much as 71.60% reported a methodical (nHr) or cautious profile (nHR), and as much as 64.00% reported an apathetic (sct) or a disorganized profile (scT). Moreover, the profile analyses allowed us to show that, within this unemployed population and in relation to each individual’s own profile, about 91.70% were high in harm avoidance, 98.60% were low in self-directedness, 64.00% were low in cooperativeness, and 44.40% low in self-transcendence.
 Conclusions: These results indicate a high predictive value by the TCI, especially regarding the specific basic health-related traits or abilities (i.e., self-directedness, cooperativeness, and self-transcendence) needed to cope with the risks related to unemployment. Specifically, long-term unemployed populations have temperament profiles that present difficulties for them to adapt to the circumstances of unemployment, but also finding, getting, and retaining a job and character profiles that diminish their possibilities to self-regulate the emotions derived from their temperament through self-directed choices that improve their health and all aspects of their lives. Hence, evidence-based interventions targeting stress reduction and the development of health-related traits or abilities (i.e., self-directedness, cooperativeness, and self-transcendence) are urgently needed.

Person-centered data analysis with covariates and the R-package confreq

Configural Frequency Analysis (CFA) is a useful statistical method for the analysis of multiway contingency tables and an appropriate tool for person-oriented or person-centered methods. In complex contingency tables, patterns or configurations are analyzed by comparing observed cell frequencies with expected frequencies. Significant differences between observed and expected frequencies lead to the emergence of Types and Antitypes. Types are patterns or configurations which are significantly more often observed than the expected frequencies; Antitypes represent configurations which are observed less frequently than expected. The R-package confreq is an easy-to-use software for conducting CFAs; another useful shareware to run CFAs was developed by Alexander von Eye. Here, CFA is presented based on the log-linear modeling approach. CFA may be used together with interval level variables which can be added as covariates into the design matrix. In this article, a real data example and the use of confreq are presented. In sum, the use of a covariate may bring the estimated cell frequencies closer to the observed cell frequencies. In those cases, the number of Types or Antitypes may decrease. However, in rare cases, the Type-Antitype pattern can change with new emerging Types or Antitypes.

Polyvictimization and Psychosocial Outcomes Among Trauma-Exposed, Clinic-Referred Youth Involved in the Juvenile Justice System

Polyvictimization is a robust predictor of emotional and behavioral problems and is linked to involvement in juvenile justice and other public sector systems. This study extends prior research by employing person-centered methods for identifying polyvictimization patterns among trauma-exposed, clinic-referred, justice-involved youth (n = 689; ages 12-18 years) and how identified classes differ on psychosocial outcomes and demographic characteristics. Most participants had experienced multiple traumatic event (TE) types. Latent class analyses identified three classes: mixed trauma/bereavement exposure group (55.1%; Mean = 3.0 TE types); maltreatment polyvictimized group (29.3%; Mean = 5.7 TE types); and maltreatment plus extreme violence polyvictimized group (15.7%; Mean = 9.3 TE types). Polyvictimized youth were more likely to be female, in out-of-home placements, and experiencing negative psychosocial outcomes (e.g., Posttraumatic Stress Disorder). Hispanic/Latino youth were overrepresented in the extreme polyvictimized subgroup. Results underscore the need for cross-system coordination of trauma-informed, comprehensive services for clinic-referred, justice-involved youth.

Patterns of Child Maltreatment and the Development of Conflictual Emerging Adult Romantic Relationships: An Examination of Mechanisms and Gender Moderation.

Individuals who experienced child maltreatment are at heightened risk for involvement in conflictual romantic relationships. The aim of this study was to examine the effect of patterns of child maltreatment on the development of maladaptive romantic relationships in emerging adulthood (EA), as well as to determine whether childhood physical aggression and disinhibition mediate this risk. Utilizing a longitudinal sample of emerging adult participants (N = 398 emerging adults; Mage = 19.67 years) who took part in a summer research camp as children (Mage = 11.27 years), we employed a combination of person-centered and variable-centered methods to test study aims. Significant differences in child behavior and developmental pathways emerged not only between those who experienced maltreatment and those who did not, but also among maltreated individuals with different constellations of maltreatment experiences. Specifically, childhood aggression was a robust mechanism underlying the risk associated with chronic/multi-subtype maltreatment, and the risk associated with neglect only, for involvement in dysfunctional EA romantic relationships. Together, these findings highlight the utility of person-centered methods for conceptualizing maltreatment, identify childhood aggression as a pathway of risk, and the underscore the criticality of prevention and early intervention to interrupt the intergenerational transmission of high conflict and aggression within families.

Are There Cognitive Profiles Unique to Students With Learning Disabilities? A Latent Profile Analysis of Wechsler Intelligence Scale for Children–Fourth Edition Scores

It is often assumed that children with learning disabilities (LD) exhibit unique profiles of ability scores that reflect idiosyncratic cognitive strengths and weaknesses. Interpretation of cognitive ability profiles initially focused on visual inspection of subtest scores followed by statistical comparisons to identify significant cognitive strengths and weaknesses. However, subsequent research demonstrated that these subtest profiles lacked sufficient reliability, validity, and diagnostic utility. Profile research typically utilized variable-centered methods, but person-centered methods might be more appropriate. The present study utilized latent profile analysis (LPA), a person-centered method that is model-based and flexible, with 1,830 school-identified students with LD and 2,200 simulated normative participants. Four broad ability score profiles distinguished by level rather than shape emerged. Thus, this latent mixture model analysis found no mixture of subpopulations, suggesting that WISC-IV score variation was due to underlying continuous latent factors rather than a typology unique to LD. Supplemental data for this article is available online at https://doi.org/10.1080/2372966X.2021.1919923 Impact Statement It is often assumed that children with learning disabilities (LD) exhibit unique profiles of ability test scores that reflect idiosyncratic cognitive strengths and weaknesses. However, this person-centered analysis found no profile of ability scores distinctive of children with LD. These results suggest that cognitive test scores may vary due to underlying continuous latent factors rather than a typology unique to LD.

Profiles of Working Moms' Daily Time Use: Exploring Their Impact on Leisure.

This paper identified latent profiles depending on the patterns of daily time usage amongst working moms in Korea and tested their relations to family- and work-related characteristics. The consequent differences in the levels of leisure attributes were further investigated. Taking a holistic approach, latent profile analysis, one of the person-centered methods, was conducted using data drawn from the seventh year of the Korean Longitudinal Survey of Women and Families (KLoWF), with a sample of 1074 women. The results of this study indicate that three different subtypes of individuals emerged: a low-level care group (82.1%), a medium-level care group (13.8%), and a high-level care group (4.1%). The factors determining the classification for the profiles were the existence of preschool children, household income, gender role attitudes, and domestic help. Work-related factors proved to have no significant effect on time-use patterns. Profile membership was related to leisure attributes as perceived by working moms: the low-level care group reported the highest level of leisure time adequacy and leisure satisfaction, while the high-level care group presented the lowest level of sufficiency and satisfaction in their leisure time. Based on these findings, the article discusses the practical implications for enhancing the quality of life of working mothers.

Work Methods for Nursing Care Delivery.

This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods—management theories and theoretical nursing concepts—are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.

A latent class analysis of alcohol and posttraumatic stress symptoms among offspring of parents with and without alcohol use disorder

The co-occurrence of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is widely known, yet few studies have examined whether and how AUD symptoms co-occur with PTSD symptom clusters of hypervigilance, avoidance/numbing, and re-experiencing. The purpose of this study was to examine potential overlap between AUD and posttraumatic stress symptomatology, and to characterize the resultant latent classes in terms of demographics, drinking behaviors, parental AUD, and specific traumas experienced (physical violence, sexual violence, and non-assaultive trauma). We hypothesized that classes would be differentiated by type and severity of AUD and PTS symptoms. Drawing from a sample of white and Black participants from the Collaborative Study on the Genetics of Alcoholism (COGA), we examined young adults between the ages of 18–35 who had experienced trauma (N = 2478). A series of LCA models based on the type of trauma experienced, posttraumatic stress symptoms and problematic alcohol use were then fitted to the data. A four-class solution provided the best fit, consisting of a low symptom class (N = 1134), moderate alcohol/low PTS severity (N = 623), mild alcohol/high PTS severity (N = 544), and high symptom severity (N = 177). Higher prevalence of sexual assault was associated with membership in high PTS severity classes, and parent AUD was associated with membership in each class, particularly when the mother or both parents had the disorder. Using person-centered methods such as LCA is a commonsense approach to understanding the heterogeneity of symptoms, trauma types, and individual-level characteristics associated with trauma-exposed individuals and comorbid AUD-PTSD, and our study is one of relatively few to empirically ascertain the co-occurrence of alcohol and PTS symptoms in a high-risk family sample.

Person-Centered Approaches in Management: Methodological Insights and Substantive Examples

In response to the call for person-centered methods from ORM in 2018, this symposium seeks to provide substantive examples of person-centered methodology in practice. The first paper conducts a systematic review of the person-centered literature in careers research and discusses how the use of these methods is important for answering relevant questions. The second paper explores a novel person-centered method, the latent profile exploratory factor analysis, and discusses how this method may be useful in answering questions related to performance, personality and emotions. The final three papers provide substantive examples of profiling in management research and focus on topics such as job embeddedness, job crafting and employee engagement. Person-centered methods in vocational behavior research: A systematic review Presenter: Joeri Hofmans; Vrije U. Brussel Presenter: Bart Wille; Ghent U. Presenter: Bert Schreurs; Vrije U. Brussel Latent Profile Exploratory Factor Analysis: A Novel Two-Part Procedure for a New Era of Big Data Presenter: Matt Caleb Howard; U. of South Alabama Are People Embedded Differently? A Person-Centered Approach to Embeddedness Presenter: James Rigby; U. of Houston Presenter: Caitlin M. Porter; U. of Memphis Profiles of Job Crafting Strategies and Their Antecedents: Longitudinal Person-Centered Approach Presenter: Anne Mäkikangas; Tampere U. Presenter: Jaana Minkkinen; Tampere U. Presenter: Jessica De Bloom; U. of Groningen Presenter: Miika Kujanpää; Tampere U. Presenter: Ulla Kinnunen; Tampere U. A Person-Centered Analysis of the Antecedents of Employee Engagement Presenter: Sydney Reichin; Pennsylvania State U. Presenter: Susannah Ivory; Pennsylvania State U. Presenter: Kayla Walters; Pennsylvania State U. Presenter: Terri Frasca; Pennsylvania State U. Presenter: Anthony Roberson; Pennsylvania State U. Presenter: Samuel T. Hunter; Pennsylvania State U. Presenter: Sarah Coley; BB&T Leadership Institute Presenter: Patrick Gallagher; BB&T Leadership Institute

Continuity and change in anger and aggressiveness from infancy to childhood: The protective effects of positive parenting.

Early signs of anger and aggression can be identified in infancy. Our aim was to use person-centered methods to identify which infants were most at risk for clinically significant behavioral problems by age 3 and diagnoses of ODD/CD by 7 years, while considering the role of family risk factors and positive parenting. A representative British community sample of 304 infants was assessed by multiple informants at mean ages of 6, 21, and 36 months of age. Latent Transition Analysis (LTA) identified three ordered subgroups at each age, with one subgroup (18%) displaying high levels of physical force as well as anger. These angry aggressive infants were at elevated risk for behavioral problems in early childhood and diagnoses of conduct disorder (CD) and/or oppositional defiant disorder (ODD) at 7 years of age. After other risk factors were taken into account, parents' beliefs in warm parenting and their observed positive affect while interacting with their infants were protective factors. These findings indicate the significance of very early manifestations of angry aggressiveness and have relevance for developmental theories of aggression and prevention strategies.

M150. RELATIVES EXPERIENCES OF THE EARLY SIGNS ACTION PLAN

BackgroundIn the recent years person-centered methods have been developed to involve relatives in the care of their next of kin. The Early Signs Action Plan (ESAP) was developed to facilitate relatives’ participation in the care of their next of kin in psychiatric outpatient units specialized in the treatment of persons with schizophrenia and similar disorders. The aim was to investigate relatives’ experiences regarding the activation of the action plan for their next of kin.MethodsThe study is a qualitative interview study using a semi-structured interview guide. The interviews were conducted with relatives (N=13) to outpatients whose Early Signs Action Plan had been activated. The interviews were digitally recorded and transcribed verbatim. The material was then analyzed with qualitative content analysis.ResultsESAP was positively received by the relatives and most of them experienced that they were participating in the planning of the care of their next of kin’s. Participating in the care also implied a feeling of security and awareness about their next of kin’s early warning signs and what to do in case of a relapse.Relatives also indicated that the ESAP is vulnerable during on call time and during vacation periods. Outdated paths to get in contact with psychiatric services on call time were reported as problematic since this information is crucial for getting in touch with care outside of office hours.DiscussionESAP seems to be a useful tool for the involvement of relatives in the care of their next of kin.

Children's Exposure to Violence across Contexts in Relation to Posttraumatic Stress Symptoms.

Children in low-income, urban neighborhoods are at high risk of exposure to violence (ETV) across settings and subsequent posttraumatic stress symptoms (PTSS). Little research has examined how multiple forms of ETV co-occur and relate to variations in children's posttraumatic responses. Furthermore, previous research primarily uses variable-centered methods, which can obscure person-level differences. The current study used person-centered methods to derive commonly occurring patterns of ETV by examining frequency of witnessing and victimization across family, school, and community contexts. The current study related profiles of ETV to demographic variables and PTSS, with the goal of obtaining nuanced representations of urban children's experiences of, risk factors for, and responses to violence. Patterns of ETV were examined in a sample of 239 African American 7th grade youth using latent profile analysis. Profiles were related to demographic variables and PTSS using logistic regression. Results showed three profiles: Low (N = 130, 54.4%), Moderate (N = 87; 36.4%), and High (N = 22; 9.2%) Exposure groups. The High Exposure group showed the highest levels of PTSS. The Moderate group showed the lowest levels of all PTSS, except dissociation. In contrast, the Low Exposure group showed significantly higher numbing and hypervigilance than the Moderate Exposure group. Results support a dose-response model of ETV and PTSS, but implicate situational factors (e.g., setting) as important in understanding posttraumatic responses. The systematic variation in ETV and subsequent differences in PTSS expression illustrate the need for individualized trauma-informed intervention and thorough screenings in low-income, urban neighborhoods.

Differential typologies of current substance use among Black and White high-school adolescents: A latent class analysis

Black and White adolescents demonstrate different prototypical profiles (i.e., typologies) of substance use, with Blacks demonstrating lower risk for concurrent use of two or more substances. Despite knowledge of these differences, typologies of adolescent substance use identified by person-centered methods, such as latent class analysis, have not characterized profiles by racial group. The current study examined typologies of substance use among Black and White youth separately using person-centered methods to identify common patterns of substance use among subjects. Data were drawn from a 5-year parent study examining adolescent health outcomes. The current study examined high-school aged White (n = 7271, 45.4% male) and Black youth (n = 1301, 40.1% male) who reported past-30-day frequency of cigarette, alcohol, marijuana, inhalant, and other drug use. Latent class analysis was used to examine substance use typologies among each group adjusting for grade and sex. Black and White youth demonstrated different typologies such that four typologies emerged among Blacks: Non-Use (87.8%), Alcohol and Marijuana Use (6.3%), Alcohol, Marijuana, and Cigarette Use (3.8%), and Frequent Polysubstance Use (2.0%). Conversely, five typologies emerged among Whites: Non-Use (73.4%), Predominant Alcohol Use (13.9%), Alcohol, Marijuana, and Cigarette Use (9.4%), Moderate Polysubstance Use (1.6%), and Frequent Polysubstance Use (1.7%). Findings suggest that Black and White youth engage in similar rates of concurrent substance use. Given that Black youth face greater risk for adverse consequences from substance use, prevention efforts are needed to prevent related health disparities related to concurrent substance use.

How adolescents define their home neighborhoods conceptually and spatially.

To advance person-centered methods of operationalizing youths' social environment, we explored adolescents' definitions of "home neighborhood" by integrating narrative data with geographic information systems. We gathered data using semi-structured interviews and sketch maps with 55 adolescents aged 11-19 (78% African-American) in urban neighborhoods. We analyzed transcripts for themes through an iterative coding process and geocoded neighborhood sketches and activity locations using ArcGIS software. Thematic analyses revealed that adolescents identify their home neighborhood based on relationships with residents, personal histories, and positive cognitive or affective responses to the area. Participants rarely drew polygons to represent neighborhoods, and their activities were often located outside of self-identified boundaries. Their views on the "home neighborhood" construct did not predict their strategies for defining spatial boundaries. Overall, the results suggest that adolescents hold idiosyncratic perspectives on their neighborhood spaces, shaped by their experiences and social identities, that have implications for place-based research and initiatives targeting youth.

Examining Mobile Technologies to Support Older Adults With Dementia Through the Lens of Personhood and Human Needs: Scoping Review.

BackgroundWith the world’s rapidly growing older adult population, there is an increase in the number of people living with dementia. This growth leads to a strain on their caregivers and our health care system and to an increased attention on mitigating strain by using mobile technology to sustain the independence of people with dementia. However, less attention is given to whether these technologies meet the stated and unstated needs of people with dementia.ObjectiveThe aim of this study was to provide an overview of the current research on mobile technologies for people with dementia, considering the current research through the lens of personhood and human needs, and to identify any gaps that represent research opportunities.MethodsWe performed a systematic search in Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, PsycINFO, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), and the Cochrane Central Register of Controlled Trials (CENTRAL) in October 2018. We screened 5560 articles and identified 24 that met our inclusion and exclusion criteria. We then performed thematic analysis to organize the articles by the types of support mobile technologies provide and mapped those types of support to human needs to identify the gaps in support.ResultsArticles described research on mobile technologies that support people with dementia to (1) perform daily activities, (2) maintain social interaction, (3) aid memory, (4) engage in leisure activities, (5) track location, and (6) monitor health. At least one type of support mapped to each human need, with most supporting lower-level needs such as physiological and safety needs. Little attention seems to be paid to personhood.ConclusionsMobile technologies that support daily activities, relationships, memory, leisure activities, health, and safety can partially compensate for decreased function owing to dementia, but the human needs of people with dementia are often not adequately considered. Most technologies support basic physiological and safety needs, whereas many pay little attention to higher-level needs such as self-esteem and agency. Important research opportunities include using person-centered methods to develop technology to meet higher-level needs and to preserve personhood by incorporating human and psychological needs of people with dementia along with ethical considerations.

Individual Differences in Patterns of Community Violence Exposure and Internalizing and Externalizing Behaviors.

Youth community violence has been linked with depressive and anxious symptoms, and aggressive behavior; however, little research has examined different combinations of emotional and behavioral adjustment among community-violence-exposed youth, or individual characteristics that may account for different patterns of emotional and behavioral adjustment in community-violence-exposed youth. This research used person-centered methods to examine how gender, temperament characteristics, and prior exposure to community violence were linked with classes of community violence exposure and internalizing and externalizing adjustment among a sample of urban African American youth. Participants were 464 African American adolescents (46.7% female; mean age = 14.83, SD = .43) who reported their community violence exposure in Grade 9 and for whom reports of depressive and anxious symptoms, and aggressive behavior were available. Latent class analysis identified four classes of adolescents distinguished by their exposure to community violence exposure and internalizing and externalizing behavior. The two classes with high community violence exposure were characterized by internalizing symptoms or aggressive behavior; the two classes with low community violence exposure had low internalizing symptoms with moderate aggression or had all moderate symptoms. These community violence adjustment classes were distinguished by gender, history of community violence exposure, behavioral inhibition, and fight-flight-freeze systems. Findings highlight heterogeneity in internalizing and externalizing responses of community-violence-exposed youth and suggest factors that explain community violence exposure, repeat exposure, and responses to community violence exposure.

Comparing alternative methods of measuring cumulative risk based on multiple risk indicators: Are there differential effects on children's externalizing problems?

This study examined several alternative methods to measure cumulative risk (CR) based on multiple risk indicators. Several methods for measuring CR are presented and their conceptual and methodological assumptions are assessed. More specifically, at the individual risk level, we examined the implications of various measurement approaches (i.e., dichotomous, proportion- and z-scores). At the composite level, we measured CR as an observed score, and compared this approach with two variable-centered approaches (consisting of reflective and formative indicators) and two person-centered approaches (consisting of latent class analysis and latent profile analysis). A decision tree was proposed to aid researchers in comparing and choosing the alternative methods. Using a sample of 169 low-income families (children approximately 5 years old, 51% girls; 74% African American, and their primary caregiver), we specified models to represent each of the alternative methods. Across models, the multiple risk composite was based on a set of 12 individual risk indicators including low maternal education, hunger, meal and money unpredictability, maternal psychopathology, maternal substance use, harsh parenting, family stress, and family violence. For each model, we estimated the effect size of the composite CR variable on children’s externalizing problems. Results indicated that the variable-centered CR composites had larger effects than the observed summary score CR indices and the person-centered methods.

Group-based, person-centered diabetes self-management education: healthcare professionals\u2019 implementation of new approaches

BackgroundHealthcare professionals’ person-centered communication skills are pivotal for delivering successful diabetes education. Many healthcare professionals favor person-centeredness as a concept, but implementation in practice remains challenging. Today, programs have often a fixed curriculum dominated by biomedical issues. Most person-centered methods are developed targeting individual consultations, although group-based programs are a widespread and efficient method of support. Person-centeredness in group-based programs requires a change in practice towards addressing biopsychosocial issues and facilitating group processes. The objective of this study was to explore how healthcare professionals implement new approaches to facilitate group-based, person-centered diabetes education targeting people with type 2 diabetes.MethodsThe study was guided by action research and divided into three studies: investigation, development, and pilot using a variety of qualitative methods. In the first study; observations across five settings were conducted. Forty-nine group participants and 13 professionals took part; the focus was to investigate approaches that supported or hindered person-centeredness in groups. Observations were supplemented by interviews (n = 12) and two focus groups (n = 16) with group participants, as well as interviews (n = 5) with professionals. In the second study; 14 professionals collaborated in two workshops to develop new approaches. In the third study, new approaches were pilot-tested using observations in three settings. Twenty-five group participants and five professionals took part. The analysis of the pilot test led to the final workshop where six professionals took part.ResultsImplementation was characterized by three categories. Some professionals chose not to implement the methods because they conflicted with their practice relying on the biomedical model. Other incorporated some approaches but was unable to structure the process, leaving participants uncertain about the aim. Finally, one setting succeeded with implementation, tailoring content and processes to group participants’ needs.ConclusionThe use of action research created context-sensitive approaches and increased professionals’ readiness to implement. More attention should be paid to systematic training of professionals. Training should be structured stepwise incorporating techniques directed towards existing skills including ample time to train and reiterate skills.