Objective: To examine cross-sectional and longitudinal associations between (a) activity-limiting fall worry (ALW) and (b) self-reported health-related restrictions and social engagement among older adults. Method: The National Health and Aging Trends Study Waves 5 (T1) and 6 (T2) provided data ( n = 6,279). Binary and multinomial logistic regression models were used to examine association of T2 social engagement restrictions with T2 fall worry and association of T1–T2 changes in social engagement restrictions with T1–T2 changes in fall worry. Results: ALW was significantly associated with both informal and formal social engagement restriction at T2. Onset of ALW and continued ALW between T1 and T2 were also significantly associated with newly reported restrictions in both informal and formal social engagement at T2 even controlling for falls incidents and changes in health status and other covariates. Discussion: The findings underscore the importance of reducing fall worry and preventing social disengagement in late life.
Purpose: Given the growing number of people with disabilities in Estonia, an initial rehabilitation needs assessment instrument that included the World Health Organization Disability Assessment Schedule (WHODAS 2.0) was developed and tested to determine its feasibility in assessing social rehabilitation needs. Method: WHODAS 2.0 items were complemented with questions about the nature of disability-related problems with regard to personal, social and environmental aspects of functioning. Four rehabilitation specialists assessed 101 persons' needs in face-to-face interviews. Data were analyzed using descriptive statistics and thematic analysis. Results: The comprehensive initial assessment instrument tested was sufficiently informative to assess functioning and identify social rehabilitation and other social needs. Participants had difficulty in understanding some WHODAS 2.0 items, and coding and scoring respondents' answers using WHODAS 2.0 frames of reference proved challenging for interviewers. Conclusion: The WHODAS 2.0 is mainly related to health conditions. Complementing it with questions about the nature and severity of the difficulties social rehabilitation service applicants experienced added essential information for planning interventions.Implications for RehabilitationA well conceived, holistic initial assessment that addresses biological, psychological, sociocultural and environmental factors can provide substantial information for targeting services to meet a person's rehabilitation needs.The WHODAS 2.0 is a useful framework for conducting initial assessments, but since it focuses on health needs, supplementing it with additional items about personal, social and environmental factors may be necessary to address services needs from social, vocational and other rehabilitation perspectives.Rehabilitation specialists must be well prepared to use the WHODAS 2.0 and conduct the overall assessment, including providing clear instructions and support to applicants applying for services.
ABSTRACT Background: US suicide rates among older women have substantially increased over the past decade. We examined potential differences in sociodemographic and risk/precipitating factors among older female suicide decedents who died by drug overdose versus firearms, hanging/suffocation, and other means, and postmortem toxicology results by suicide means. Methods: Data are from the 2005 to 2015 US National Violent Death Reporting System ( N = 12,401 female decedents aged 50 years and over). We used three logistic regression models, with overdose versus firearms, overdose versus hanging/suffocation, and overdose versus “other” means as the dependent variables, to examine associations between suicide means and sociodemographic and risk/precipitating factors. χ 2 tests were used to examine positive toxicology of prescription and illicit drugs by suicide means. Results: Compared to firearm users, overdose users were younger and had higher odds of having had previous suicide attempts/intent disclosures, mental disorders (e.g. depression/dysthymia: AOR = 1.18, 95% CI = 1.05–1.34), and substance abuse other than alcohol, but lower odds of having had relationship problems and any crisis. Compared to hanging/suffocation, overdose declined (AOR = 0.95, 95% CI = 0.93–0.97) during the study period and was less prevalent among Hispanic and Asian women and those with job/finance/housing problems. Toxicology reports showed that 47%, 43%, and 45% of overdose users were antidepressant, opiate, and benzodiazepine positive, respectively. Firearm users had the lowest rates of positive toxicology results for these drugs. Conclusions: Suicide prevention should include limiting access to large quantities of prescription medications and firearms for those at risk of suicide. More effective mental health/substance abuse treatment and chronic illness management support are also needed.
Purpose The US military depends on women to meet recruiting goals, but women participate at lower rates than men. Theorists suggest that military and family policies affect women’s lower participation. Research has confirmed the impact of policy changes on women’s military service during specific time periods. The purpose of this paper is to examine how and when military policies affecting women developed over the course of history, exploring two related hypotheses: first, when women’s military participation is vital, policies affecting their military and family roles punctuate in tandem, and second, cultural values impact policy solutions to reconcile women’s roles. Design/methodology/approach Punctuated equilibrium and a women’s military participation theory informed the hypotheses. US Census and Defense Department data were used to identify periods of service when women’s military participation was vital. Historical policies were mapped and analyzed to identify policy patterns and themes affecting women’s military participation 1895–2015. Findings Evidence supports both hypotheses. When women are needed during wartimes, policies simultaneously encourage their service and regulate their family roles. However, policies evolved from separating servicewomen’s roles prior to the 1970s (e.g. prohibiting motherhood), to supporting their families (e.g. maternity leave) – a shift precipitated by sweeping changes in broader society and the military’s change from the draft to an All-Volunteer Force. Originality/value Findings elucidate the link between military and family policies affecting US women’s military participation and retention. Results may inform policy advocacy aimed at optimizing the US Department of Defense’s diversity efforts.
All chapters conclude with Summary and Notes. Preface. Research Navigator. 1. Politics, Rationalism, and Social Welfare. Politics and Social Welfare Policy. Illustration 1-1: Special Tips for the Legislative Process. The Policymaking Process. The American Public and Social Welfare. Illustration 1-2: We Can Take Care of Our Own...or Can We? 2. Government and Social Welfare. Historical Perspectives on Social Welfare. Illustration 2-1: The Revolution No One Noticed. The Expansion of Social Welfare. Finances in the Welfare State. Illustration 2-2: Intelligence Report: Our Low Taxes. The Legacy of Reaganomics. Helping the Truly Needy. The Presidential Years of Bill Clinton. 3. Defining Poverty: Where to Begin? What Is Poverty? Poor and Homeless: Not Invisible Anymore. Illustration 3-1: Homeless in Paradise. Illustration 3-2: Pam Jackson's New Apartment. A Fundamental Shift. 4. Preventing Poverty: The Social Insurance Programs. Preventing Poverty through Compulsory Savings. Illustration 4-1: Social Security--Who Qualifies, and How Much Do Beneficiaries Receive? Illustration 4-2: Will You Reap What You Sow? Unemployment Compensation. Workers' Compensation. 5. Helping the Poor: Aged, Blind, and Disabled. Public Assistance for the Deserving Poor. Illustration 5-1: Example of What Happens When You Are Disabled. Rehabilitative Services for Individuals with Disabilities. The Era of Civil Rights for People with Disabilities. Illustration 5-2: What Is Reasonable Accommodation for People with Disabilities? Disability Policy for Children. Building a Better Policy on Disability. Illustration 5-3: Guidance from the EEOC in Implementing the Americans with Disabilities Act in Cases of Psychiatric Impairment. General Assistance: The State and Community Response to Welfare. Federalism and Social Welfare. 6. Ending Welfare as We Knew It: Temporary Assistance for Needy Families. From Mothers' Aid to AFDC. Trying to Make Parents Pay. Welfare and Work. Illustration 6-1: What Mothers and Fathers Think about Child Support Enforcement. Why the Fuss about AFDC? Illustration 6-2: Why Mother Slapped Me. Illustration 6-3: The Unreported Work of Mothers Receiving Public Assistance. An End to Welfare as We Knew It. 7. Fighting Hunger: Nutrition Policy and Programs in the United States. Malnutrition Amid Plenty. Setting Nutritional Policy. Tightening Food Stamps' Belt: The Welfare Reform of 1996. Food Stamp Program Operations. Nutrition Programs for Younger, Older, and Disabled Veterans. Illustration 7-1: A Client's View of the Food Stamp Program. Nutritional Politics. Illustration 7-2: The Thrifty Food Plan--How Much Is It Worth? 8. Improving Health Care: Treating the Nation's Ills. Good Health or Medical Attention? Health Care Policy Today. What Ails Medicine? Illustration 8-1: A Proposed Consumer Bill of Rights and Responsibilities. The Politics of Health Care for All. Health Care--Some Ethical Dilemmas. 9. Changing Paradigms in the Poverty Wars: Victories, Defeats, and Stalemates. The Curative Strategy in the 1960s War on Poverty. Illustration 9-1: Community Development: A Foundation Perspective. LBJ and the Economic Opportunity Act. Politics Overtake the War on Poverty. Why Hasn't Head Start Cured Poverty? Fueling Employment: Make-Work versus the Real Thing. Illustration 9-2: Report Card on Empowerment Zones. Building Communities through Service. 10. Providing Social Services: Help for Children, the Elderly, and People with Mental Illness. Social Services in the United States. Social Services for People with ADM Problems. The Rights of Mental Health Service Consumers. Illustration 10-1: Needle-Exchange Programs in the U.S.A.: Time to Act Now. Child Welfare Policy. Illustration 10-2: What to Do about Helping People with Severe Mental Illness. Illustration 10-3: Little Mary Ellen. Social Services for Older Americans. 11. Challenging Social Welfare: Racism and Sexism. Gender Inequities. Illustration 11-1: Women in Federal and State Offices. Illustration 11-2: A Call for Lustiness: Just Say No to the Sex Police. Gay Rights. Blacks, Hispanics, and Social Welfare. Illustration 11-3: A Dialogue on Race. Native Americans and Social Welfare. Immigration and Social Welfare. 12. Implementing and Evaluating Social Welfare Policy: What Happens after a Law Is Passed. The Politics of Implementation. Evaluating Social Policy. Illustration 12-1: Rational Evaluation: What Questions to Ask. Illustration 12-2: Is Theory-Based Evaluation Better? Illustration 12-3: What to Do if Your Agency's Program Receives a Negative Evaluation.
Using 2020 National Survey on Drug Use and Health data (N = 27,170, age 18+), we examined associations of psychological distress with: (1) cannabis use frequency among all adults, and (2) cannabis use disorder (CUD) among cannabis users. Of all adults, 18.2% reported past-year cannabis use, 12.9% reported mild-moderate psychological distress, and 12.9% reported serious psychological distress. Greater proportions of cannabis users, especially those under age 35, reported psychological distress. Of cannabis users, 28.1% met DSM-5 CUD criteria. Multinomial logistic regression results showed that serious, compared to no, psychological distress was significantly associated with cannabis use at all frequency levels. Both mild-moderate and serious levels of distress were associated with similar elevated CUD risk (RRR = 1.57, 95% CI = 1.15-2.15 for mild-moderate distress; RRR = 1.58, 95% CI = 1.19-2.09 for serious distress) and 2-4 times higher risks of having moderate or severe, compared to mild, CUD and higher odds of having alcohol use disorder. The prevalence of CUD and other substance use/use disorder among cannabis users is concerning as are the significant associations of psychological distress with greater cannabis use frequency, CUD, and other substance use/use disorder. Younger adults especially may benefit from increased behavioral health services given their high prevalence of psychological distress, cannabis use, and CUD.
Despite the increasing rates of mental and substance use disorders (MSUDs) among older adults, little research has been done to investigate the influence of adverse childhood experiences (ACEs) on older adults’ MSUDs. Using the life course perspective, we examined the relationship between ten types of ACEs and six lifetime MSUDs among those age 50+ and gender differences in the relationship. Data came from the 2012–2013 United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) (N=14,738 for the 50+ age group). We employed multivariable logistic regression analyses to test main effects of ACEs and gender-ACEs interaction effects on lifetime major depressive disorder (MDD) and anxiety, post-traumatic stress, alcohol use, drug use, and nicotine use disorders. Of the sample, 53.2% of women and 50.0% of men reported at least one ACE. For both genders, parental/other adults’ substance use problems were the most prevalent (22.6%), followed by physical abuse and emotional neglect. Child abuse and neglect and parental/other adults’ substance use problems had small but consistently significant effects on all three mental disorders and all three substance use disorders (e.g., OR=1.28, 95% CI=1.12–1.46 for parental/other adults’ substance misuse on MDD). While the total number of ACEs had gender-neutral, cumulative effects on MSUDs, the effects of physical abuse, sexual abuse, and emotional neglect, as well as parental separation/divorce, were stronger among men. This study underscores the long-lasting negative impacts of ACEs and the need to further investigate why ACEs seem to have greater effects on older men than women.
Purpose: This study examines the impact of perpetrators' drug and alcohol use during and after sexual assault. Methods: The study relies on data provided by a representative sample of women in Texas who responded to a random digit dial survey and reported that they were sexually assaulted at some time in their lives. Questions about sexual assault victimization were drawn largely from the National Violence Against Women Survey. A series of binary logistic regressions was conducted to determine the impact of perpetrator's alcohol and drug use on violence during and after the assault. Results: Perpetrators' alcohol or drug use at the time of the sexual assault resulted in a greater likelihood of concurrent violence, including, hitting, slapping, kicking, use of a weapon, threats to harm or kill, and physical injury during the assault, and victims who experienced an alcohol– or drug-related sexual assault lost more time from work, school, home duties, and recreation. These impacts occurred regardless of the relationship of the perpetrator to the victim, location of the sexual assault, or ethnicity of the victim. Conclusions: This information can assist educators, advocates, and policy makers in directing efforts to limit alcohol and drug use and preventing situations where sexual violence is likely to emerge.
