The treatment of mental illness has evolved from familial care and religious intervention to institutionalization and, more recently, community‐based models. Early asylums offered custodial care, later replaced by state hospitals emphasizing medical authority. The mid‐twentieth century saw deinstitutionalization, driven by pharmaceutical advances and legal reforms, yet a fully realized community care system never materialized. Instead, fragmented services emerged, often involving welfare and criminal justice systems. A shift toward consumer‐driven, recovery‐oriented care has since gained momentum, emphasizing autonomy, rights, and the potential for recovery. This historical trajectory underscores the complex interplay between social change, medical authority, and evolving treatment paradigms.

Research has shown that while female caregivers report worse health-related struggles, male caregivers are disproportionately more likely to report interferences with daily tasks due to health-related struggles. Because of this discrepancy, we conducted secondary analyses using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) to explore health-related interferences among a sample representative of adults across 40 US states. We performed four Poisson regression models to assess whether: (1) risk of caregivers reporting interferences differed by sex, (2) male caregivers had higher risk of interferences compared to non-caregiving males, (3) interferences among caregivers overall differed by race/ethnicity, and (4) interferences among only male caregivers differed by race/ethnicity. While controlling for relevant covariates, we found male caregivers had 19

In recent years, researchers and policymakers have called attention to the importance of child and adolescent trauma for understanding adult health status. The primary aim of this study is to describe the adverse childhood events reported in a sample of runaway and homeless youths and examine their impact on these youths’ current health status. We utilize survey data collected from a community sample of runaway and homeless youths gathered in metro Atlanta. Using the Adverse Childhood Experiences Scale (ACEs scale), we examined the relationship between ACEs and several health status measures using OLS and logistic regression. We found that runaway and homeless youths endorsed experiencing many ACEs, especially sexual minority youths, youths who had prior involvement with child-serving social service systems, and youths who were homeless for more than a year. Black/African American youths were slightly less likely to report many adverse childhood experiences. Runaway and homeless youths who reported more ACEs had increased odds of experiencing significant current mental health and/or substance abuse problems. Our study suggests ACEs are an important factor shaping these youths’ health and underscores the potential value of trauma-informed care for youths experiencing homelessness.

Abstract Nursing homes continue to experience persistent challenges in retaining nursing home staff. Understanding the life course context of nursing home staff has the potential to shed needed light on this persistent issue. The life course perspective emphasizes understanding the dynamic interplay of personal, social, organizational, and historical factors and how this dynamism influence lives. Using cross-sectional survey data from 678 nursing home staff working in 23 nursing homes, we use ordinal logit regression to estimate a predictive model consisting of demographic, job quality and life course factors predicting employment intentions. Life course-relevant findings include: intergroup differences in employment intentions by life course markers and identities with career stage, benefits status, and breadwinner status demonstrating significant impact on intent to stay. Further, we find evidence that cumulative disadvantage, emotional burnout and other care roles have additional significant impacts on intent to stay. This study has practical implications for nursing home leadership and policy makers. Nursing home leaders need to amend their conventional strategies of retaining the LTC workforce by creating tailored supports for workers while simultaneously addressing job quality deficits. Access to mental health services, increased leave for caregiving and respite, improved access to high-quality health insurance and benefits that assist this workforce to deal with contingency factors and career mobility (e.g. small grants, tuition remission) have the potential to alleviate some of the instability in this often-vulnerable workforce.

Virtual exchange programs represent a relatively novel approach designed to foster a more global perspective and promote discipline-specific learning; however, this approach has not been widely adopted in sociology. This article reports findings on student experiences and learning in a virtual exchange program involving two large introductory sociology classes in Hong Kong and Atlanta. A postsurvey invited students to reflect qualitatively on their experiences, and six major themes emerged from the data: (1) global application of sociological knowledge, (2) social and cultural relativism, (3) breaking the shell and gaining intellectual and social flexibility, (4) social networking opportunities, (5) challenges and adjustments, and (6) keeping contact beyond school. Based on our experience and the students' feedback, we conclude that virtual exchange is an effective pedagogical approach for internationalizing sociology curricula, enhancing intercultural competency, and deepening students' understanding of core sociological concepts.

What was the research about?Acute pain, like severe back pain, headache, or joint and muscle pain, is a common health problem that can limit function and well-being.Medicines called opioids can help ease acute pain.But long-term opioid use can lead to addiction or overdose.Clinical practice guidelines identify prescribing practices that clinicians, like doctors or nurses, should avoid when using opioids to treat acute pain.Unsafe practices may include prescribing high levels of opioids or long-acting opioids at a patient's first visit. How can people use the results?Clinics can use the results when considering how to help clinicians prescribe opioids safely.To learn more about this project, visit www.pcori.org/Kraemer426.

ObjectivesAs understanding of the pathogenesis and treatment strategies for osteoarthritis (OA) evolves, it is important to understand how patient factors are also changing. Our goal was to examine demographics and known risk factors of patients with OA over time.DesignOpen-cohort retrospective study using electronic health records.SettingLarge US integrated health system with 7 hospitals, 2.6 million outpatient clinic visits and 97 300 hospital admissions annually in a mostly rural geographic region.ParticipantsAdult patients with at least two encounters and a diagnosis of OA or OA-relevant surgery between 2001 and 2018. Because of geographic region, over 96% of participants were white/Caucasian.InterventionsNone.Primary and secondary outcome measuresDescriptive statistics were used to examine age, sex, body mass index (BMI), Charlson Comorbidity Index, major comorbidities and OA-relevant prescribing over time.ResultsWe identified 290 897 patients with OA. Prevalence of OA increased significantly from 6.7% to 33.5% and incidence increased 37% (from 3772 to 5142 new cases per 100 000 patients per year) (p<0.0001). Percentage of females declined from 65.3% to 60.8%, and percentage of patients with OA in the youngest age bracket (18–45 years) increased significantly (6.2% to 22.7%, p<0.0001). The percentage of patients with OA with BMI ≥30 remained above 50% over the time period. Patients had low comorbidity overall, but anxiety, depression and gastro-oesophageal reflux disease showed the largest increases in prevalence. Opioid use (tramadol and non-tramadol) showed peaks followed by declines, while most other medications increased slightly in use or remained steady.ConclusionsWe observe increasing OA prevalence and a greater proportion of younger patients over time. With better understanding of how characteristics of patients with OA are changing over time, we can develop better approaches for managing disease burden in the future.

Background:Concurrent therapeutic prescribing of prescription stimulants with opioid analgesics is increasing in the United States. Stimulant medication use is associated with increased risk for long-term opioid therapy (LTOT), and LTOT is associated with increased risk for opioid use disorder (OUD). Aims:To determine if stimulant prescriptions among those with LTOT (≥90 days) are associated with greater risk for opioid use disorder (OUD). Methods:This retrospective cohort study from 2010 to 2018 used a United States, nationally distributed Optum© analytics Integrated Claims-Clinical dataset. Patients ≥18 years of age, and free of prevalent OUD in the two years prior to index were eligible. All patients had a new ≥90-day opioid prescription. The index date was day 91. We compared risk for new OUD diagnoses in patients with and without a prescription stimulant overlapping LTOT. Entropy balancing and weighting controlled for confounding factors. Results:Patients (n = 5,712), were 57.7 (SD±14.9) years of age on average, majority female (59.8%) and 73.3% White race. Among patients with LTOT, 2.8% had overlapping stimulant prescriptions. Before controlling for confounding, dual stimulant-opioid prescriptions, compared to opioid only, were associated with OUD risk (HR = 1.75; 95%CI:1.17-2.61). After controlling for confounding, this association was no longer present (HR = 0.89; 95%CI:0.47-1.71). Results did not differ in sensitivity analyses limiting the cohort to those <56 years of age. Conclusions:Dual stimulant use among patients with LTOT does not increase risk for OUD. Stimulants prescribed for ADHD and other conditions may not worsen opioid outcomes for some patients with LTOT.

This chapter reports on the evaluation of state and local level National Standards for Culturally and Linguistically Appropriate Services in Health Care (aka CLAS Standards), specifically those standards addressing the health needs of sexual minority individuals, with an emphasis on the inclusion of bisexual+ communities and the implications of bisexual+ (non)inclusion in CLAS standards. At the state and local levels, bisexual identity is rarely recognized as distinct from other sexual identities. This lack of representation raises an essential issue of how local communities, states, and the federal government struggle with sexual minority data classification and prioritizing health benchmarks for sexual minority populations and subpopulations. We also found that the CLAS cultural competency policy definition at the federal level lacks an appropriate degree of bi‐inclusivity. The findings from this study reveal that the five states in our sample implemented CLAS Standards in ways that demonstrated bi‐erasure. Specifically, states defined gender and sexual minorities through exclusionary categories that place emphasis on the “Other”. LGBTQ+ evaluators can rely on the Principles of LGBTQ+ Evaluation to create strategies that demonstrate how to effectively address the intersecting ramifications of bi‐erasure at the policy level.

Purpose: Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people face mental health disparities. These disparities are amplified in the Southern regions of the United States. This study assessed the role of outness, discrimination, and other demographic variables on possible serious mental illness (SMI) among LGBTQ+ Southerners. Methods: This study used data from the 2017 LGBT Institute Southern Survey, a cross-sectional convenience sample of 6502 LGBTQ+ adults living in 14 Southern states. Multivariable logistic regression was performed to examine differences between those with and without possible SMI. Results: Outness was associated with a lower likelihood of possible SMI (odds ratio [OR]: 0.696, 95% confidence interval [CI]: 0.574-0.844, p = 0.001), especially when controlling for discrimination in the past 12 months (OR: 0.693, 95% CI: 0.576-0.834, p ≤ 0.001) and lifetime discrimination (OR: 0.678, 95% CI: 0.554-0.829, p = 0.001). Lifetime discrimination was associated with a higher likelihood of possible SMI (OR: 1.413, 95% CI: 1.034-1.932, p = 0.033), as was discrimination experienced in the past 12 months (OR: 1.626, 95% CI: 1.408-1.877, p ≤ 0.001). Black/African American respondents had the lowest percentage of possible SMI (21.0%) compared with other races, despite having lower or comparable rates of outness. Conclusion: These results indicate a possible promotive effect of outness against possible SMI among LGBTQ+ Southerners, as well as possible promotive group-level factors among Black/African American LGBTQ+ Southerners. Policies and interventions that address discrimination against LGBTQ+ Southerners should be expanded, and future research should address how the relationships between outness, discrimination, and mental health outcomes may vary by subgroup.

This cluster randomized clinical trial compares clinician-facing interventions to prevent unsafe opioid prescribing in opioid-naive primary care patients with acute noncancer pain.

This chapter explores the roles professional care-workers play in the lives of Gay, Lesbian, and Bisexual (G/I/B) youth. It improves understanding of the roles professional care-workers play in the support networks of G/I/B youth. The chapter describes the range and nature of professional care-workers' interactions with youths and examines the extent that professionals are present in youths' networks. Professionals, especially gay-identified and/or gay-supportive ones, offer a special social safety net for youth who have difficulty constructing supportive networks of friends and families. Education-based programs, including Gay-Straight Alliances and teacher/student diversity training programs, and other youth outreach and health care programs also are helping to respond to young g/l/b people's needs, especially those who are not comfortable or capable of reaching out to openly gay agencies. Regardless of the source or location, this study affirms the importance and value of professional carework in empowering G/I/B youths to live in a homophobic society.

The climate and culture of treatment for clients with serious mental illness (SMI) are complex. In this study, we aim to cultivate a deeper understanding of the treatment environment using a network typological approach to measure the local treatment context and assess its implications on the perceived quality of clients’ relationships with their care providers. We use in-depth egocentric network data from clients with SMI in community mental health centers and state psychiatric hospitals from the Indiana Mental Health Services and HIV Risk Study ( N = 417). Clustering analysis identifies five unique and distinct network types: supportive, sparse, diverse, clinical, and treatment-focused. Weighted least squares regressions reveal clients in networks with high amounts of support predict a more trusting working alliance, whereas care-oriented networks predict a less trusting alliance. Our findings underscore the need to consider the local network context in studies of the quality of care provided to people with SMI.

Introduction Comprehensive Medication Management (CMM) is a collaborative patient-centered approach to medication optimization. We recently implemented telephonic CMM as part of a multidisciplinary team within a team-based at-home care program. The objective of this study was to describe the type and frequency of medication therapy problems (MTPs) identified by pharmacists delivering CMM as part of this program, as well as the acceptance rates of the recommendations made to rectify them. Methods We conducted a retrospective chart review of all patients receiving CMM within the program between December 12, 2018 and December 31, 2019. We identified and classified MTPs based on the framework developed by the Pharmacy Quality Alliance. Descriptive statistics were used to determine the quantity of MTPs, as well as the acceptance rates of the recommendations. Results We identified 307 patients who received CMM. Of these patients, 58% were female (178/307) and 96% identified as White (296/307). Average age was 72 years old (SD 13). On average, pharmacists identified 4 MTPs/patient with a 35% acceptance rate (431/1228) for their recommendations. Of those accepted, pharmacists were able to resolve 185 (43%) of these MTPs on their own while providers resolved the remaining 246 (57%) MTPs. Acceptance of MTPs was more likely if patients were spoken to (38.4% vs 29.5%, relative risk [RR] = 1.30, 95% CI 1.10-1.54, P = .002). Conclusions Pharmacists were able to identify several MTPs when conducting telephonic CMM within a team-based at-home care program. These MTPs and their associated recommendations however, often failed to be resolved. Recommendations were more likely to be resolved if patients were spoken to, highlighting the importance of engaging the patient as part of CMM. Future studies should examine ways to improve intervention acceptance as well as the clinical and economic impact of changes made as a result of telephonic CMM and MTP identification.

BACKGROUND:Shigellosis, an acute diarrheal disease, is the third most common bacterial infection in the United States. Shigellosis most commonly affects children younger than 5 years; however, clusters and outbreaks of shigellosis have been reported among gay, bisexual, and other men who have sex with men (MSM). Evidence suggests that knowledge of shigellosis among MSM is low, indicating health promotion outreach is needed for this population.METHODS:To inform the development of shigellosis-related health communication materials and strategies, 6 focus groups were conducted in 2017, in Atlanta, GA among 24 self-identified gay and bisexual men. Participants were asked about their preferences and recommendations for health communication materials.RESULTS:Participants indicated they would prefer a range of physical and virtual materials placed in diverse locations where the community would see them. Respondents recommended health messages be simple, quick to read, and concise with limited word counts. Participants also advised the use of diverse images that were inclusive of couples of varying sexual orientations to reduce stigma. Participants advocated for the use of humor and provocative images to increase user engagement.CONCLUSIONS:The results emphasize the potential benefits of conducting formative research when designing health communication materials. Incorporating messaging preferences of MSM in the development of shigellosis-related health communication materials could enhance their relevance for the target population while also avoiding unintended consequences associated with stigmatizing MSM.

There is not one unifying definition of youth homelessness in the U.S. Rather, youth who are homeless are included in three separate definitions. Youth who sleep in motels are included in these definitions depending on whether they are in school, their age, and how long they are able to stay. Motel residents are not counted in the annual Point in Time counts in most cities and are excluded from literature on youth who are homeless, leaving a dearth of information on their experiences. In addition, little is known about the needs of motel youth and how they might differ from youth staying in other temporary accommodations, especially those recognized by HUD. This paper takes a first step to assess if youth who experience homelessness in motels vary in any major ways from youth who reported a different sleeping location on the previous night in a 2015 survey of Atlanta homeless youth. Findings show statistically significant relationships between one’s sleeping location and income, substance use, contact with homeless service providers, and age. The results imply that there might be important differences between youth who reside in motels and those who reside in other locations while homeless.

Research suggests that runaway and homeless youth (RHY) in the United States are vulnerable to sex and labor trafficking. In this paper, we report and analyze estimates of sex and labor trafficking collected as part of the Atlanta Youth Count 2018, a community-based field survey of RHY between the ages of 14 and 25 in the metro-Atlanta area. A total of 564 participants were recruited and completed a survey that included questions about their backgrounds as well as the Human Trafficking Screening Tool (HTST). We found that 39.9% experienced some form of trafficking while homeless. While 15.6% of the youth reported commercial sexual exploitation while homeless, coerced labor (29.3%) or fraud (25.2%) were even more common experiences. Women, transgender, and gender nonconforming youth, as well young people who had prior system involvement and those who had been homeless for more than a year were the most likely to report having been trafficked. The significance of these findings for research and policy on RHY and trafficking are discussed.

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.