The author discusses 3 variables that assess different aspects of social relationships—social support, social integration, and negative interaction. The author argues that all 3 are associated with health outcomes, that these variables each influence health through different mechanisms, and that associations between these variables and health are not spurious findings attributable to our personalities. This argument suggests a broader view of how to intervene in social networks to improve health. This includes facilitating both social integration and social support by creating and nurturing both close (strong) and peripheral (weak) ties within natural social networks and reducing opportunities for negative social interaction. Finally, the author emphasizes the necessity to understand more about who benefits most and least from socialconnectedness interventions.

/pdf/social-relationships-and-health-3l9d7bp4y3.pdf

Social relationships and health.

Statistical Analysis with Missing Data

Risky families are characterized by conflict and aggression and by relationships that are cold, unsupportive, and neglectful. These family characteristics create vulnerabilities and/or interact with genetically based vulnerabilities in offspring that produce disruptions in psychosocial functioning (specifically emotion processing and social competence), disruptions in stress-responsive biological regulatory systems, including sympathetic-adrenomedullary and hypothalamic-pituitary-adrenocortical functioning, and poor health behaviors, especially substance abuse. This integrated biobehavioral profile leads to consequent accumulating risk for mental health disorders, major chronic diseases, and early mortality. We conclude that childhood family environments represent vital links for understanding mental and physical health across the life span.

/pdf/risky-families-family-social-environments-and-the-mental-and-2ydtsobufc.pdf

Risky Families: Family Social Environments and the Mental and Physical Health of Offspring

www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Mini Mental State

BACKGROUND: Women with endometriosis may also have associated disorders related to autoimmune dysregulation or pain. This study examined whether the prevalence of autoimmune, chronic pain and fatigue and atopic disorders is higher in women with endometriosis than in the general female population. METHODS AND RESULTS: A cross-sectional survey was conducted in 1998 by the Endometriosis Association of 3680 USA members with surgically diagnosed endometriosis. Almost all responders had pain (99%), and many reported infertility (41%). Compared with published rates in the general USA female population, women with endometriosis had higher rates of hypothyroidism (9.6 versus 1.5%, P < 0.0001), fibromyalgia (5.9 versus 3.4%, P < 0.0001), chronic fatigue syndrome (4.6 versus 0.03%, P < 0.0001), rheumatoid arthritis (1.8 versus 1.2%, P 0.001), systemic lupus

High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis

Importance Racial disparities in use of analgesia in emergency departments have been previously documented. Further work to understand the causes of these disparities must be undertaken, which can then help inform the development of interventions to reduce and eradicate racial disparities in health care provision. Objective To evaluate racial differences in analgesia administration, and particularly opioid administration, among children diagnosed as having appendicitis. Design, Setting, and Participants Repeated cross-sectional study of patients aged 21 years or younger evaluated in the emergency department who had an International Classification of Diseases, Ninth Revision diagnosis of appendicitis, using the National Hospital Ambulatory Medical Care Survey from 2003 to 2010. We calculated the frequency of both opioid and nonopioid analgesia administration using complex survey weighting. We then performed multivariable logistic regression to examine racial differences in overall administration of analgesia, and specifically opioid analgesia, after adjusting for important demographic and visit covariates, including ethnicity and pain score. Main Outcomes and Measures Receipt of analgesia administration (any and opioid) by race. Results An estimated 0.94 (95% CI, 0.78-1.10) million children were diagnosed as having appendicitis. Of those, 56.8% (95% CI, 49.8%-63.9%) received analgesia of any type; 41.3% (95% CI, 33.7%-48.9%) received opioid analgesia (20.7% [95% CI, 5.3%-36.0%] of black patients vs 43.1% [95% CI, 34.6%-51.4%] of white patients). When stratified by pain score and adjusted for ethnicity, black patients with moderate pain were less likely to receive any analgesia than white patients (adjusted odds ratio = 0.1 [95% CI, 0.02-0.8]). Among those with severe pain, black patients were less likely to receive opioids than white patients (adjusted odds ratio = 0.2 [95% CI, 0.06-0.9]). In a multivariable model, there were no significant differences in the overall rate of analgesia administration by race. However, black patients received opioid analgesia significantly less frequently than white patients (12.2% [95% CI, 0.1%-35.2%] vs 33.9% [95% CI, 0.6%-74.9%], respectively; adjusted odds ratio = 0.2 [95% CI, 0.06-0.8]). Conclusions and Relevance Appendicitis pain is undertreated in pediatrics, and racial disparities with respect to analgesia administration exist. Black children are less likely to receive any pain medication for moderate pain and less likely to receive opioids for severe pain, suggesting a different threshold for treatment.

/pdf/racial-disparities-in-pain-management-of-children-with-3v1cf7i66o.pdf

Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

This research tested how the effect of parental emotional and instrumental support on substance (tobacco, alcohol, and marijuana) use in adolescents is mediated. Data were from a sample of 1,702 adolescents surveyed between the 7th and 9th grades. Parental support was inversely related to substance use, and stress-buffering interactions were found at all assessment points. Structural modeling analyses indicated the effect of support was mediated through more behavioral coping and academic competence and less tolerance for deviance and behavioral undercontrol; these mediators were related to negative life events and deviant peer affiliations. Multiple-group analyses suggested buffering effects occurred because high support reduced the effect of risk factors and increased the effect of protective factors. Implications for the theory of social support effects and resilience mechanisms are discussed.

https://psycnet.apa.org/journals/psp/71/5/937.pdf

How are social support effects mediated? A test with parental support and adolescent substance use.

The relation of seven coping dimensions to substance (tobacco, alcohol, marijuana) use was tested with a sample of 1,668 participants assessed at mean age 12.5 years and two yearly follow-ups. An associative latent-growth model showed one index of engagement (behavioral coping) to be inversely related to initial level of adolescent use and growth over time in peer use. Three indices of disengagement (anger coping, helpless coping, and hangout coping) were positively related to initial levels of peer use and adolescent use and to growth in adolescent use. Life stress was positively related to initial levels for peer use and adolescent use and to growth in adolescent use. Moderation tests indicated that effects of coping were significantly greater at higher level of stress; behavioral coping buffered the effects of disengagement. Effects of life stress were greater for girls than for boys. Results are discussed with reference to mechanisms of coping-substance use relationships.

Coping dimensions, life stress, and adolescent substance use: a latent growth analysis.

This study investigated the convergence of temperament dimensions with constructs from C. R. Cloninger's (1987a) theory using data from a sample of 949 adolescents (M age = 13.6 years). Substantial convergence was found, and both types of constructs were related in predicted ways to self-regulation variables and adolescent substance use. Structural modeling procedures tested a mediational model for substance use; results showed mediation through self-control, academic competence, negative life events, and deviant peer affiliations. Interactions indicated that substance use could be predicted from a balance of systems for good control and poor control. Poor self-control was present for dimensions implicated in both externalizing and internalizing disorders. Results are discussed with reference to self-regulation models of substance use and the comorbidity of substance abuse and mental disorder.

Sean D. Cleary

Papers

High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis

Racial Disparities in Pain Management of Children With Appendicitis in Emergency Departments

How are social support effects mediated? A test with parental support and adolescent substance use.

Coping dimensions, life stress, and adolescent substance use: a latent growth analysis.

Temperament and novelty seeking in adolescent substance use: Convergence of dimensions of temperament with constructs from Cloninger's theory.