This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of nondominant racial populations in multiple ways. First, institutional racism developed policies and procedures that have reduced access to housing, neighborhood and educational quality, employment opportunities, and other desirable resources in society. Second, cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and fostering health-damaging psychological responses, such as stereotype threat and internalized racism. Finally, a large and growing body of evidence indicates that experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioral patterns that increase health risks.

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Racism and Health I: Pathways and Scientific Evidence

A systematic and conceptual review of posttraumatic stress in childhood cancer survivors and their parents

This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.

Television exposure in children after a terrorist incident.

Background: Previous studies consistently found remarkable prevalence rates of posttraumatic stresssymptoms (PTSS) and posttraumatic stress disorders (PTSD) in pediatric patients and their parents.Findings suggest a signiﬁcant association between child and parent PTSS. The present study examined,in a sample of pediatric patients with different conditions, incidence rates and determinants of PTSSand PTSD in the patients, and their mothers and fathers. Also, associations of maternal, paternal andchild PTSS and PTSD were analyzed. Method: Two hundred and nine children (aged 6.5–14.5 years)were interviewed 5–6 weeks after an accident or a new diagnosis of cancer or diabetes mellitus type 1 bymeans of the Child PTSD Reaction Index. Their mothers (n ¼ 180) and fathers (n ¼ 175) were as-sessed with the Posttraumatic Diagnostic Scale. Results: Children reported PTSS levels in the mildrange. Sixteen percent of the fathers and 23.9% of the mothers met full DSM-IV diagnostic criteria forcurrent PTSD. Type of trauma impacted differently on parents and children. In children, accident-related injury was associated with higher PTSS scores. Conversely, in parents, diagnosis of cancer intheir child was associated with more symptoms. Functional status of the child was also found to be animportant predictor of PTSS in children and parents. PTSS scores of mothers and fathers were signi-ﬁcantly correlated with each other. However, child PTSS were not signiﬁcantly related to PTSS ofmothers and fathers. This was true for total scores as well as for DSM-IV symptom clusters. Conclu-sions: There is a need for careful evaluation of PTSS and PTSD in pediatric patients with accidentalinjuries or sudden onset of severe chronic diseases and in their respective parents. Importantly, chil-dren, their mothers, and their fathers should be assessed separately, because a signiﬁcant associationbetween child and parental PTSS may not exist. Keywords: Chronic illness, injury, pediatrics, parent–child relationships, posttraumatic stress disorder, trauma. Abbreviations: PTSS: Posttraumatic stresssymptoms; PTSD: Posttraumatic stress disorder; RI: Child PTSD Reaction Index; PDS: PosttraumaticDiagnostic Scale.Threats to a child’s health or life such as an accidentor the diagnosis of a severe chronic disease cancause traumatic reactions both in the child and inhis or her parents. Studies of pediatric patients andtheir parents consistently found remarkable preval-ence rates of posttraumatic stress symptoms (PTSS)and posttraumatic stress disorders (PTSD). Groupsstudied included children with a variety of acute andchronic physical conditions and their parents (DiGallo, Barton, & Parry-Jones, 1997; Kazak et al.,1997; Pelcovitz et al., 1998; Landolt, Boehler,Schwager, Schallberger, & Nuessli, 1998; Landoltet al., 2002; Stallard, Velleman, & Baldwin, 1998;Stuber, Christakis, Houskamp, & Kazak, 1996). Insum, the epidemiologic data are consistent with thetrauma literature regarding responses to moderate-magnitude traumatic exposure. Prevalence ratesdiffered depending on the measures and samplesused. Interestingly, parents tend to show higherrates of PTSS and PTSD than their children.Mediating factors in the development of PTSS andPTSD in children have been widely studied. Mostauthors acknowledge that, while every child will ex-periencepsychologicaldistressifthestressorissevereenough, the development of PTSS and PTSD ismultifactorial. Among othervariables, female sexhasoften been found to be a signiﬁcant risk factor (Yule,1999). Clinical observations and empirical researchhave also suggested that the children’s and parentsPTSS and PTSD are associated. Several studies havedocumentedconcordantresponsesinparents(mostlymothers) and children that were exposed to the sametrauma (Barakat et al., 1997; De Vries et al., 1999;Greenetal.,1991;Laoretal.,1996;McFarlane,1987;Pelcovitz et al., 1998; Smith, Perrin, Yule, & Rabe-Hesketh,2001).However,otherresearchersfoundnorelationship between parental and child PTSS(Koplewicz et al., 2002; McDermott & Cvitanovich,2000; Parker, Watts, & Allsopp, 1995; Stuber et al.,1996). Some of the reasons contributing to theseinconsistent ﬁndings may be methodological. Sam-ples were not homogeneous with regard to age of thechild, the types of trauma the child was exposed to,and the time elapsed since occurrence of the trauma.Moreover, differences in assessment methods mayalso be important. Notably, all studies that failed toﬁnd associations between parental and child PTSShaveusedchildrenasindependentinformantsoftheirown symptoms. Most studies that found signiﬁcantassociationsbetweenparentalandchildPTSS,onthe

Incidence and associations of parental and child posttraumatic stress symptoms in pediatric patients

Background Government, industry and charitable organisations have an increasing focus on programs intended to support community resilience to disasters. But has consensus been reached as to what defines 'community resilience' and what its core characteristics are? Methods We undertook a systematic literature review of definitions of community resilience related to disasters. We conducted an inductive thematic analysis of the definitions and descriptions that we identified, in order to determine the proposed characteristics of community resilience prior to, during and after a disaster. Results We identified 80 relevant papers. There was no evidence of a common, agreed definition of community resilience. In spite of this, evidence was found of nine core elements of community resilience that were common among the definitions. The core elements were: local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook. Within these core elements, we identified 19 sub-elements linked to community resilience. Conclusion Our findings show that community resilience remains an amorphous concept that is understood and applied differently by different research groups. Yet in spite of the differences in conception and application, there are well-understood elements that are widely proposed as important for a resilient community. A focus on these individual elements may be more productive than attempting to define and study community resilience as a distinct concept.

What Do We Mean by ‘Community Resilience’? A Systematic Literature Review of How It Is Defined in the Literature

American Behavioral Scientist

Contagion in Stress: An Infectious Disease Model for Posttraumatic Stress in Children

This article describes an application of the Communities Advancing Resilience Toolkit (CART) Assessment Survey which has been recognized as an important community tool to assist communities in their resilience-building efforts. Developed to assist communities in assessing their resilience to disasters and other adversities, the CART survey can be used to obtain baseline information about a community, to identify relative community strengths and challenges, and to re-examine a community after a disaster or post intervention. This article, which describes an application of the survey in a community of 5 poverty neighborhoods, illustrates the use of the instrument, explicates aspects of community resilience, and provides possible explanations for the results. The paper also demonstrates how a community agency that serves many of the functions of a broker organization can enhance community resilience. Survey results suggest various dimensions of community resilience (as represented by core CART community resilience items and CART domains) and potential predictors. Correlates included homeownership, engagement with local entities/activities, prior experience with a personal emergency or crisis while living in the neighborhood, and involvement with a community organization that focuses on building safe and caring communities through personal relationships. In addition to influencing residents' perceptions of their community, it is likely that the community organization, which served as a sponsor for this application, contributes directly to community resilience through programs and initiatives that enhance social capital and resource acquisition and mobilization.

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Assessing community resilience: A CART survey application in an impoverished urban community.

This second of two articles describes the application of disaster mental health interventions within the context of the childs social ecology consisting of the Micro-, Meso-, Exo-, and Macrosystems. Microsystem interventions involving parents, siblings, and close friends include family preparedness planning andpractice, psychoeducation, role modeling, emotional support, and redirection. Mesosystem interventions provided by schools and faith-based organizations include safety and support, assessment, referral, and counseling. Exosystem interventions include those provided through community-based mental health programs, healthcare organizations, the workplace, the media, local volunteer disaster organizations, and other local organizations. Efforts to build community resilience to disasters are likely to have influence through the Exosystem. The Macrosystem - including the laws, history, cultural and subcultural characteristics, and economic and social conditions that underlie the other systems - affects the child indirectly through public policies and disaster programs and services that become available in the child's Exosystem in the aftermath of a disaster The social ecology paradigm, described more fully in a companion article (Noffsinger Pfefferbaum, Pfefferbaum, Sherrieb, & Norris,2012), emphasizes relationships among systems and can guide the development and delivery of services embedded in naturally-occurring structures in the child's environment.

Rose L. Pfefferbaum

Papers

American Behavioral Scientist

Contagion in Stress: An Infectious Disease Model for Posttraumatic Stress in Children

Assessing community resilience: A CART survey application in an impoverished urban community.

The burden of disaster: part II. applying interventions across the child's social ecology.

Community resilience and wellness for the children exposed to Hurricane Katrina.