Urban Indians Research Articles

The Relationship Between Leadership Characteristics and Services Provided Among IHS Urban Indian Health Programs.

The Urban Indian Health Program was created by the Indian Health Service to establish a culturally appropriate health care delivery model for Native Americans who relocate to urban areas. The 31 community-based Indian Health Programs under the Office of Urban Indian Health Program vary in culture, socioeconomic, and patient mix. Strategic decision-making by these community-based Indian Health Programs depends upon various factors, including leaders' characteristics, organizational characteristics, and service area market factors.

Dietary Calcium Intake and Association with Serum Calcium in Healthy Urban North Indian Adults: The Calcium-Chandigarh Urban Bone Epidemiological Study

Abstract Introduction: Data on dietary calcium intake (DCI) from healthy North Indian adults are limited. Hence, the present study aims to assess DCI in healthy community-dwelling adults residing in an affluent North Indian city and correlate with serum biochemical parameters. Methods: Healthy men and women were recruited from the community by door-to-door surveys. Serum total calcium, phosphate, 25-hydroxyvitamin D, and iPTH were estimated. DCI was assessed by recalling the diet consumed in the previous 7 days. Results: A total of 291 participants were included (mean age = 39.4 ± 12.9 years). The mean (± standard deviation) and median (inter-quartile range) DCI were 392.6 ± 169.1 mg/day and 391 (274-518) mg/day, respectively. DCI was higher in men compared with women. Only 21.3% of participants had DCI more than RDA (600 mg/day). Serum calcium was found to be significantly higher across each quartile of DCI. On multiple linear regression analysis, DCI emerged as an independent positive predictor of serum total calcium. Conclusion: DCI is low in urban Indians. Promotion of consumption of dairy products and fortification of commonly consumed foods with calcium is needed.

Expert Opinion on the Role of Sacubitril/Valsartan in the Management of Hypertension in India.

Hypertension, a key modifiable risk factor for cardiovascular diseases (CVD), significantly contributes to premature death and morbidity worldwide. Despite stabilization in age-adjusted global prevalence, the absolute number of hypertensive individuals doubled from 2000 to 2010, largely due to increases in low- and middle-income countries. In 2021, only 21% of hypertensive individuals globally had effective blood pressure (BP) control. In India, hypertension is the leading risk factor for death and disability, with prevalence rates of 24% in men and 21% in women, as reported by the 2019-2020 National Family Health Survey (NFHS-5). Alarmingly, just 25% of rural and 38% of urban hypertensive Indians are undergoing treatment, with only 10% and 20% achieving BP control, respectively. This highlights the hypertension paradox, where clinical inertia and hesitancy in intensifying BP-lowering therapy persist despite the availability of antihypertensive drugs. This expert opinion paper aims to provide a comprehensive evaluation of sacubitril/valsartan in hypertension management, leveraging insights from its approved use in heart failure and examining its benefits and challenges across diverse hypertensive populations. The formulation of this expert opinion involved employing evidence-based methodologies and utilizing all available data. The document underwent scrutiny by expert cardiologists, whose clinical experiences and examination of the evidence and guidelines informed the formation of the expert opinion. This expert opinion paper provides a thorough and informed evaluation of sacubitril/valsartan, highlighting its potential to address unmet needs in BP control, particularly in challenging cases such as resistant hypertension and chronic kidney disease.

Preventive health-care behavior: a serial multiple mediation analysis

Purpose Preventive health-care behavior (PHB) adoption as a primordial prevention to stay healthy and avoid lifestyle disease risk is a global trend. This paper aims to use the PHB model and stimulus-organism-response theory to empirically examine the role of individual and technological factors in influencing primordial PHB. Design/methodology/approach A sequential mixed-method was adopted to identify the primordial PHB adoption and propose a conceptual framework. The identified determinants and the hypothesized relationships were empirically tested using a convenience sample of 406 urban Indians. Partial least square structural equation modeling is used for data analysis. Findings The derived conceptual framework was empirically tested to assess the role of health literacy (HL), health value (HV) and digital health information seeking (DHIS) on primordial PHB. Findings confirmed the significant influence of DHIS on HL, HL on HV and PHB and HV on PHB. The direct effects of DHIS on PHB and HV were insignificant. HL solely mediated the indirect effect of DHIS on PHB, while the mediation of HV was insignificant. HL and HV fully mediated the relationship between DHIS and PHB. Research limitations/implications The impact of DHIS on PHB adoption and the serial multiple mediating roles of HL and HV are significant in understanding primordial PHB adoption for both academic theory and practice. However, the cross-sectional study on urban Indians needs further validation across geographies. Originality/value To the best of the authors’ knowledge, this pioneering study is among the first to propose and validate a comprehensive model of primordial PHB adoption.

To evaluate dietary protein intake as per recommended dietary allowance (RDA 2020) and correlate it with the malnutrition universal screening tool score (must) in urban Indians aged 40-60 years.

To evaluate dietary protein intake as per recommended dietary allowance (RDA 2020) and correlate it with the malnutrition universal screening tool score (must) in urban Indians aged 40-60 years.

The taste of homemade: trusting ‘healthy’ food on app-based delivery services in Hyderabad, India

ABSTRACT Public and biomedical discourses blame changing spatio-temporal rhythms, traffic, pollution, and stressful work timings for the rise in metabolic illnesses in privileged urban Indian, white-collar households. In these households, homemade food is seen as ‘safe' and ‘healthy,' while outside food is considered ‘dangerous' and linked to increasing metabolic ill-health. Despite this, app-based food ordering has surged in the last nine years, disrupting this binary. This paper uses ethnographic and qualitative data from fieldwork in Hyderabad, India, to explore how IT-employed households with type 2 diabetes determine which foods are good to trust online. They do this through ‘embodied knowing,' a visceral sensibility to gauge the quality of food and the intentions of its maker. Trusted foods are made by figures ‘like your mother,' who embody this knowing. Apps capitalise on classed, gendered and relational forms of trust by evoking motherly figures to market ‘homely' and ‘home-style' food as ‘safe' and ‘healthy.' In doing so, they disrupt taken-for-granted understandings of the outside-home boundary, making mothers virtually visible in the marketplace and allowing ‘outside’ foods to be accepted through the embodied knowing of the food and its maker.

Comparison of homocysteine, vitamin B12 and folic acid between rural and urban ageing Indians and its association with mild cognitive impairment and cardiovascular risk factors: a cross-sectional analysis.

The relationship between blood levels of homocysteine (HCY), vitamin B12, folic acid and cognitive impairment is inconclusive. Since HCY is an independent risk factor for cardiovascular diseases, understanding its association with Framingham risk score (FRS) may provide insight into the shared underlying mechanism between cardiovascular disease and cognitive impairment. Cross-sectional analyses utilized baseline data from two ongoing longitudinal studies: the Tata Longitudinal Study of Ageing (n = 923), an urban cohort, and Srinivaspura Ageing, NeuroSenescence and COGnition (n = 4239), a rural cohort. The study compared the HCY, vitamin B12 and folic acid levels across cohorts and normal versus mild cognitive impairment (MCI) participants. The association between HCY and cognitive status was established using regression models. Three models were analysed: model 1-unadjusted; model 2-adjusted for age, gender, smoking, alcohol consumption, diet, hypertension, cardiac illness, diabetes; and model 3-adjusted for variables in model 2 plus vitamin B12 and folic acid. Correlation was calculated between HCY and FRS. The urban cohort exhibited a significantly higher level of HCY [median (IQR) (17.70 (10.2) versus 14.70 (9.7); P < 0.001)], vitamin B12 (251 (231) versus 219 (138); P < 0.001) and folic acid (8.21 (8) versus 5.48 (4); P < 0.001) levels compared to rural cohort. HCY, vitamin B12 and folic acid levels did not differ significantly between normal and MCI participants in the urban cohort. In the rural cohort, among the age-gender matched MCI-normal, participants with normal cognition had higher levels of vitamin B12 (≥60 years) [227 (152) versus 217 (175); P = 0.03] and folic acid (<60 years) [5.91 (4) versus 5.40 (4); P = 0.04] compared to MCI. There was no association between HCY and cognitive status in both the cohorts, but there was a significant positive relationship between vitamin B12 deficiency and Clinical Dementia Rating-Sum of the Boxes (CDR-SOB), as well as folic acid deficiency and CDR-SOB in rural and urban cohorts, respectively, within a specific age group. A significant correlation was observed between FRS and HCY in the rural cohort (r = 0.17, P < 0.001), but not in the urban cohort. This study revealed significant differences in HCY, vitamin B12 and folic acid levels between the cohorts. In the rural cohort, participants with MCI had lower vitamin B12 and folic acid levels in a certain age group. Association between HCY and cognitive status was insignificant in both the cohorts. A small significant correlation between FRS and HCY was seen in the rural cohort.

Financial hardship screening among Native American patients with cancer: a qualitative analysis

BackgroundCancer-related financial hardship is an increasingly recognized concern for patients, families, and caregivers. Many Native American (NA) patients are at increased risk for cancer-related financial hardship due to high prevalence of low income, medical comorbidity, and lack of private health insurance. However, financial hardship screening (FHS) implementation for NA patients with cancer has not been reported. The objective of this study is to explore facilitators and barriers to FHS implementation for NA patients.MethodsWe conducted key informant interviews with NA patients with cancer and with clinical staff at an academic cancer center. Included patients had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service, Tribal health program, or Urban Indian health program. Interviews included questions regarding current financial hardship, experiences in discussing financial hardship with the cancer care and primary care teams, and acceptability of completing a financial hardship screening tool at the cancer center. Clinical staff included physicians, advanced practice providers, and social workers. Interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software.ResultsWe interviewed seven patients and four clinical staff. Themes from the interviews included: 1) existing resources and support services; 2) challenges, gaps in services, and barriers to care; 3) nuances of NA cancer care; and 4) opportunities for improved care and resources. Patients identified financial challenges to receiving cancer care including transportation, lodging, food insecurity, and utility expenses. Patients were willing to complete a FHS tool, but indicated this tool should be short and not intrusive of the patient’s financial information. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. Having designated staff familiar with I/T/U systems was helpful, but perspectives differed regarding who should administer FHS.ConclusionsWe identified facilitators and barriers to implementing FHS for NA patients with cancer at both the patient and clinician levels. Findings suggest clear organizational structures and processes are needed for financial hardship to be addressed effectively.

Strong cultural connectedness buffers urban American Indian children from the negative effects of stress on mental health.

We explored whether urban American Indian (AI) caregivers who maintained a strong sense of cultural connectedness buffered their children from the negative effects of stress on mental health. A community sample of 161 urban AI children (91 girls) ages 8-15 years (M = 11.20 years) and their primary caregivers participated between 2016 and 2017. Caregiver cultural connectedness moderated associations among child stressful life events and increased anger (R2 = .13) and post-traumatic stress disorder (PTSD) symptoms (R2 = .15). For caregivers with greater cultural connectedness, associations were attenuated and not significant. Higher hair cortisol was related to increased depressive (R2 = .11), anxiety (R2 = .10), and PTSD (R2 = .15) symptoms and was not moderated by cultural connectedness.

Cultural Perceptions of Health in Asian Indian Adults

ObjectiveTo gain an understanding of the cultural perceptions of health among Asian Indian adults in an urban setting. DesignQualitative semistructured interviews. SettingMidwest urban community ParticipantsAsian Indian adults (n = 20) aged ≥25 years, who self-identified as 100% Asian Indian descent. Phenomenon of InterestIndividual interviews were conducted by a trained interviewer to assess cultural perceptions of health. AnalysisTranscript analysis was performed by 2 independent coders using verbatim transcripts. Content analysis was used to identify themes using a grounded theory approach. ResultsThe salient themes that emerged were a cultural definition of health, acculturation, mental health, and health information. Participants believed good health was associated with the ability to perform daily activities, regular exercise, and eating well. There was a lack of awareness of Asian Indian-specific body mass index categories and that overweight and obesity were an important risk factor for chronic diseases. Conclusion and ImplicationsThese data provide a context for health promotion efforts and underscore a gap in awareness of risk factors risk for chronic diseases among the Asian Indian community. Culturally specific interventions targeted at the Asian Indian population, considering their worldview and perceptions of health, will help address this important public health concern.

Optimizing Network Costs for NFV Solutions in Urban and Rural Indian Cellular Networks

Optimizing Network Costs for NFV Solutions in Urban and Rural Indian Cellular Networks

Effect of early menopause on cognition and brain morphology in an Urban Indian Cohort.

Evidence for the effect of early menopause on cognition among older women is not consistent and is scant among the Indian population. We aimed to examine the effect of early menopause (≤45 years) on cognitive performance and brain morphology among older dementia-free females of the TLSA cohort using a multiple linear regression analysis. In a sample of 528 women, 144 (27%) had early menopause. The linear regression analysis showed that women with early menopause performed poorly in cognition and had lesser total gray matter volume [β=-11973.94, p=0.033], left middle frontal [β=-353.14, p=0.033], and left superior frontal [β=-460.97, p<0.026] volume. Dementia-free women with early menopause had poorer cognition, lower total gray matter, and frontal lobe. More research is needed to explore the link between earlier menopause and cognitive decline and develop ways to address it. Evidence on the effect of early menopause on brain morphology is inconsistent and scant in low and middle-income countries, such as India. In a cohort of dementia-free individuals in urban Bangalore, we observed that participants with early menopause had significantly lower cognitive performance and lower total gray matter and frontal lobe volume. We recommend increasing awareness of this fact among the medical community and the general public. There is an urgent need to explore the underlying biological mechanism and to discover effective interventions to mitigate the effect.

Developing Causality and Severity Assessment Frameworks for Food Safety Signals Using Social Media Reviews: A Technical Report Based on Data From an Urban Indian Suburb.

Social media reviews are a valuable data source, reflecting consumer experiences and interactions with businesses. This study leverages such data to develop a passive surveillance framework for food safety in urban India. By employing a Bidirectional Encoder Representations from Transformers (BERT)-powered Aspect-Based Sentiment Analysis tool, branded as Eat At Right Place (ERP), the study analyses over 100,000 reviews from 93 restaurants to identify and assess food safety signals. The Causality Assessment Index (CAI) and Severity Assessment Score (SAS) are introduced to systematically evaluate potential risks. The CAI uses pattern recognition and temporal relationships to establish causality while the SAS quantifies severity based on sub-aspects such as cleanliness, food handling, and unintended health outcomes. Results indicate that 40% of the restaurants had a CAI above 1, highlighting significant food safety concerns. The framework successfully prioritizes corrective actions by grading the severity of issues, demonstrating its potential for real-time food safety management. This study underscores the importance of integrating innovative data-driven approaches into public health monitoring systems and suggests future improvements in natural language processing algorithms and data source expansion. The findings pave the way for enhanced food safety surveillance and timely regulatory interventions.

Comparison of invasive blood pressure monitoring vs. non-invasive blood pressure monitoring in critically ill children receiving vasoactive agents-a prospective observational study.

The primary aim of this study was to compare non-invasive blood pressure (NIBP) measurement using the automated oscillometric method with invasive blood pressure (IBP) measurement using peripheral arterial line insertion in critically ill children receiving vasoactive agents. Single-centre, prospective cohort study. Tertiary care 15 bedded Pediatric ICU in Urban Indian city. All critically ill children between the ages of 1 month to 16 years with shock on vasoactive medications and with IBP monitoring. Forty children with 1,072 paired BP measurements were incorporated in the final analysis. Among all normotensive children (Total number of paired measurements = 623) receiving vasoactive agents, Bland-Altman analysis revealed an acceptable agreement between Invasive mean blood pressure (MBP) and non-invasive MBP with a bias of -2.10 mmHg (SD 11.35). The 95% limits of agreement were from -24.34 to 20.14 mmHg. In children with hypotension (Total number of paired measurements = 449), Bland-Altman analysis showed disagreement between Invasive MBP and non-invasive MBP i.e., a bias of -8.44 mmHg (SD 9.62). The 95% limits of agreement were from -27.29 to 10.41 mmHg. A limited agreement exists between invasive blood pressure (IBP) and non-invasive blood pressure (NIBP) measurements in critically ill children requiring vasoactive agents. This discrepancy can lead to either an underestimation or an overestimation of blood pressure. While NIBP can serve as a screening tool for hemodynamically stable children, those who are hemodynamically unstable and necessitate the initiation of vasoactive agents should undergo IBP monitoring.

Molecular and genomic testing in Native American patients with metastatic lung and colorectal cancers: A retrospective chart review.

e23136 Background: The Native American (NA) population has the poorest cancer survival of all racial groups in the U.S. A long history of research misconduct has caused many tribal communities to hold unfavorable views toward genomic data collection. Routine molecular and genomic testing is standard of care for most metastatic lung and colorectal cancers but the frequency of such testing in NA patients is unknown. Many NA patients have limited financial resources and must rely on coverage for health care from an Indian Health Service, Tribal Health Service, or Urban Indian Health (ITU) program. However, ITU programs do not operate their own cancer treatment services and must refer their patients elsewhere for such care. Methods: A Native American Navigation program (NANP) was established at the Stephenson Cancer Center (SCC) in Oklahoma to promote cancer health equity and provide high-quality cancer care by facilitating access to care for ITU patients from across the state. The NANP interfaces with ITU programs to obtain approvals for care as well as to coordinate clinical and supportive services, such as transportation or food assistance. We conducted a retrospective chart review of patients referred from an ITU program to the SCC NANP in Oklahoma from 1/2014 to 6/2023. Among patients with metastatic colorectal cancer (CRC), we investigated the frequency of testing for KRAS, NRAS, BRAF as well as MSS/MSI. In patients with metastatic non-small cell lung cancer (NSCLC), we identified the frequency of EGFR, ALK, ROS1, and PD-L1 testing. Results: A total of 305 NA patients were referred to SCC for colorectal and lung cancers. Of these, 68 patients had metastatic disease and qualified for molecular and genomic testing per National Comprehensive Cancer Network guidelines. The mean age of our cohort was 63 with a male-to-female ratio of 1.6:1. Most (85.3%) patients eligible for testing had testing for at least one biomarker. In patients with metastatic CRC, 100% received MSS/MSI as well as KRAS testing and the frequency of NRAS and BRAF testing was 69.6% and 84.8% respectively. In patients with metastatic NSCLC, the frequency of EGFR, ALK, and ROS1 testing was 95.8%, 87.5%, and 79.1%, with PD-L1 testing frequency being 83.3%. Conclusions: The overall frequency of molecular and genomic testing in these navigated NA patients (85.3%) was comparable to the range reported in the general population (66-90%). By facilitating access to cancer care, programs such as the NANP may help NA patients receive appropriate testing to guide treatment. Larger studies are needed to further assess the role of navigation programs in reducing cancer disparities by facilitating access to appropriate molecular and genomic testing for NA patients with metastatic cancers.

A qualitative inquiry into the lived experiences of menstrual health and hygiene in the transgender and non-binary people in urban areas of India

Significance Most global research on menstrual health and hygiene (MHH) focuses on cisgender women and girls, with limited evidence on the experiences of transgender and non-binary (TNB) people. This study aimed to document the lived experiences of menstruation management among TNB people in urban India. Methods We conducted 13 semi-structured interviews with TNB adults aged 19–40 years in three major Indian cities in collaboration with community organizations. We asked participants to share their experiences of managing menstruation in multiple spaces of life, e.g. at home, school, workplace, and other public spaces. Interviews were audio recorded, transcribed, de-identified, and cleaned. After a deductive and inductive process of developing a code book, we coded transcripts and developed code summaries to identify emergent themes. Results We identified three major themes in MHH for TNB urban Indians: (i) gendering of menstruation, (ii) navigating physical aspects of menstruation, and (iii) challenges beyond bleeding. ‘Gendering of menstruation’ shaped overall experiences of MHH among participants. Gendered expectations upon menarche triggered gender dysphoria. Participants reported having little knowledge about menstruation prior to menarche, which led to a state of confusion and shame, and exacerbated their dysphoria from gendering of norms around menstruation. ‘Navigating physical aspects of menstruation’ was less challenging in familiar, private surroundings, however, accessing public spaces and bathrooms remained a major challenge and stressor. Though many participants reported undergoing hormonal replacement therapy (HRT) in part to suppress menstruation, they continued experiencing menstrual symptoms which triggered continued dysphoria. Participants reported facing ‘challenges beyond bleeding’ which included burden of multiple diseases, mis-gendered healthcare services, and lack of social support. Discussion Documenting the lived experiences of menstrual health and hygiene among TNB people supports the call to ‘de-gender’ menstruation. Magnifying the voices and lived experienced of TNB people can bolster the development of effective interventions to enhance their wellbeing.

Participatory action research to develop and implement multicomponent, multilevel strategies for implementing colorectal cancer screening interventions in American Indian communities in New Mexico

BackgroundDespite the effectiveness of colorectal cancer (CRC) screening, American Indians (AIs) have low screening rates in the US. Many AIs receive care at Indian Health Services, Tribal, and Urban Indian (I/T/U) healthcare facilities, where published evidence regarding the implementation of CRC screening interventions is lacking. To address this gap, the University of New Mexico Comprehensive Cancer Center and the Albuquerque Area Southwest Tribal Epidemiology Center collaborated with two tribally-operated healthcare facilities in New Mexico with the goal of improving CRC screening rates among New Mexico’s AI communities.MethodsGuided by the principles of Community Based Participatory Research, we engaged providers from the two tribal healthcare facilities and tribal community members through focus group (two focus groups with providers (n = 15) and four focus group and listening sessions with community members (n = 65)), to elicit perspectives on the feasibility and appropriateness of implementing The Guide to Community Preventive Services (The Community Guide) recommended evidence-based interventions (EBIs) and strategies for increasing CRC screening. Within each tribal healthcare facility, we engaged a Multisector Action Team (MAT) that participated in an implementation survey to document the extent to which their healthcare facilities were implementing EBIs and strategies, and an organizational readiness survey that queried whether their healthcare facilities could implement additional strategies to improve uptake of CRC screening.ResultsThe Community Guide recommended EBIs and strategies that received the most support as feasible and appropriate from community members included: one-on-one education from providers, reminders, small media, and interventions that reduced structural barriers. From the providers’ perspective, feasible and acceptable strategies included one-on-one education, patient and provider reminders, and provider assessment and feedback. Universally, providers mentioned the need for patient navigators who could provide culturally appropriate education about CRC and assist with transportation, and improved support for coordinating clinical follow-up after screening. The readiness survey highlighted overall readiness of the tribal facility, while the implementation survey highlighted that few strategies were being implemented.ConclusionsFindings from this study contribute to the limited literature around implementation research at tribal healthcare facilities and informed the selection of specific implementation strategies to promote the uptake of CRC screening in AI communities.

Self-Care Practices and Health-Seeking Behaviors Among Older Adults in Urban Indian Slums: A Mixed Methods Study.

Background Effective self-care is crucial for maintaining health among older adults in resource-constrained communities. This study examined self-care practices, health-seeking behaviors, and associated factors among older adults in urban slums in India. Materials and methods A mixed methods study was conducted among 432 adults aged ≥65 years. Participants were selected through multistage random sampling from five slum areas. Self-care practices, health-seeking behaviors, demographic information, chronic conditions, self-efficacy, and health literacy were assessed through interviews. The qualitative data was explored through in-depth interviews with 30 participants. Results Inadequate health literacy (194, 45%) and low self-efficacy (162, 37.5%) were common. While 324 (75%) had an adequate diet and 378 (87.5%) took medications properly, only 86 (20%) monitored diabetes complications. Only 194 (45%) of the patients underwent recommended cancer screening, and 324 (75%) of the patients saw doctors ≥twice a year. Age, sex, education, income, comorbidities, self-efficacy, and health literacy had significant associations. Alongside facilitators such as social support, barriers such as limited healthcare access and suboptimal prevention orientation emerged. Conclusion Suboptimal prevention orientation and overreliance on secondary care instead of self-care among elderly people are problematic given the limited use of geriatric services. Grassroots health workers can improve health literacy and self-efficacy through home visits to enable self-care. Healthcare access inequities for vulnerable groups merit policy attention.

Difficulties in Emotion Regulation Scale-Short Form (DERS-SF): Psychometric Validation and Measurement Invariance Testing in a Sample of Urban Indian Adolescents

Background: Adolescents are particularly vulnerable to emotion dysregulation (ED), a transdiagnostic marker of psychological disorders with implications for academic achievement, identity development, social bonding, mental health, and the overall well-being and development of adolescents. A well-validated tool for the assessment of ED is imperative for credible advances in research on ED among Indian adolescents. Difficulties in Emotion Regulation Scale-Short Form (DERS-SF) is a promising tool to assess ED but requires proper psychometric validation among Indian adolescents. The current study validated the factor structure and examined psychometric aspects including gender invariance testing of the DERS-SF in Indian adolescents aged between 14 and 20 years. Methods: In a cross-sectional study, a community sample of n = 2079 adolescents completed the English version of the DERS-SF, the Strengths, and Difficulties Questionnaire, the Barratt Impulsiveness Scale, and the Adolescent Problem Behaviour Index. Results: The six-factor model of the DERS-SF exhibited an acceptable model fit in the current study sample. Invariance testing revealed that the DERS-SF is conceptually interpreted in a similar manner by male and female adolescents. Two-way MANOVA indicated gender and age variations on a few DERS-SF subscales. Reliability for DERS-SF was good, α = 0.86. Adequate construct validity was demonstrated by moderate to strong associations of the DERS-SF subscales with measures of internalizing and externalizing symptoms, adolescent problem behaviors, and impulsivity. Conclusions: DERS-SF retained the popular six-factor structure with acceptable psychometric properties and hence can be reliably used with Indian adolescents.

Question of Self in Namita Gokhale’s Paro: Dream of Passion

Namita Gokhale is a remarkable signature in Indian English fiction. She very brilliantly pinpoints the quest of identity of a woman in her very first novel Paro: Dream of Passion. The novel gives stress on concrete individual existence and consequently on subjectivity, individual freedom and choice. By writing Paro: Dream of Passion Namita Gokhale has initiated a new phase in Indian writing in English. Through two women characters –Paro and Priya-Namita Gokhale explores an exceptionally esoteric strata of society. Namita Gokhale’s Paro: Dream of Passion is the world of affluent business class and their idle rich counterparts, the working middle class and the world of legal professional, politician and service cadres. Obviously, the world of the novel is not representative of a cross-structure of Indian society, either in class, occupation, and cultural affiliation. But it is an interpretation of the life of highly Westernized urban Indian.