Participation in a yoga intervention is associated with improved mental health among Latinx adolescents

Latinx youth with mental health disorders have worse outcomes when compared to their White (non-Hispanic) counterparts. Latinx youth also have less access to and lower utilization of mental health services. Emerging research supports the psychological and physical benefits of engaging in yoga and yoga may function as a complimentary treatment option for patients with mental health challenges. However, research assessing the efficacy of yoga and mindfulness is particularly sparse among Latinx youth, who may particularly benefit from mind body awareness activities given barriers to more traditional health approaches. The objective of this quasi-experimental study was to examine the effects of a 12-week Vinyasa flow-based yoga group intervention on anxiety, depression, empathy, and life satisfaction among adolescents receiving outpatient mental health treatment. Adolescents (n = 186; 12-17 years old) were recruited to an active intervention condition (Yoga); a subsequent group of participants (n = 91) were recruited in the same manner to an assessment-only comparison control condition (Comparison). The Yoga group participated in culturally and developmentally tailored group yoga classes for 12 weeks. Structural equation modelling was used to evaluate the main effect intervention response between participants in the two conditions. At the post-intervention assessment, after controlling for baseline levels of outcome variables (i.e., depression, anxiety, empathy, and life satisfaction), on average participants in the yoga condition reported: less depression symptoms (B = -1.54, p = 0.008), less anxiety symptoms (B = -0.75, p = 0.048), greater empathy (B = 1.32, p = 0.025) and greater life satisfaction (B = 0.30, p = 0.013) as compared to the Comparison condition. Yoga interventions can be an acceptable and feasible modality for promoting well-being and reducing mental health problems among Latinx youth.

The Mediating Effect of Maternal Wellbeing on the Association between Neighborhood Perception and Child Wellbeing: A Longitudinal Investigation

OBJECTIVES

Negative perceptions of one's neighborhood are linked to poor mental and physical health. However, it is unclear how caregiver's neighborhood perception affects health outcomes in children. This study assessed the mediating effect of maternal wellbeing on the association between neighborhood perception and child wellbeing at different time points and overall.

METHOD

A structural equation model (SEM) was used to evaluate whether maternal wellbeing mediates the influence of neighborhood perception on child wellbeing at different ages. The Fragile Families and Child Wellbeing Study data from years 3, 5, and 9 was analyzed. The delta method evaluated the mediation effect of maternal wellbeing, controlling for mothers' age. Direct and indirect effects of neighborhood perception at year 3 on child wellbeing at year 9 via maternal wellbeing at year 5 were analyzed via a longitudinal mediation with a two time points lag.

RESULTS

Maternal wellbeing partially mediated the effect of neighborhood perception on child wellbeing at different ages. Longitudinal mediation analyses revealed that better neighborhood perception at year 3 improved maternal wellbeing at year 5 and child wellbeing at year 9; maternal wellbeing at year 5 partially mediated the effect of neighborhood perception at year 3 on child wellbeing at year 5.

CONCLUSIONS FOR PRACTICE

Our findings suggest that it may be beneficial for mental health practitioners to discuss relationships between neighborhood environment and wellbeing with caregivers, with a focus on reframing negative self-perceptions. Future research should evaluate longitudinal relationships between changes in neighborhood infrastructure and corresponding wellbeing in caregivers and children.

Feasibility, acceptability and preliminary impact of mindfulness-based yoga among Hispanic/Latinx adolescents

BACKGROUND

The Hispanic/Latinx population constitutes the fastest growing ethnic/racial minority group in the United States (U.S.). Compared to their non-Hispanic/Latinx White counterparts, Hispanic/Latinx youth experience more depression and anxiety, and have more unmet mental health needs (88% vs 76%). Emerging research supports the psychological and physical benefits of mind-body awareness training to enhance well-being and mental health, but almost no studies have recruited ethnic/racial minority samples.

PURPOSE

The current study examined the feasibility, acceptability and preliminary impact of a mindfulness-based yoga program among Hispanic/Latinx public high school students.

PROCEDURES

Participants (N = 187) were recruited from a local public high school in a large multi-ethnic urban school district in the Southeast U.S. and participated in 6 weekly hour-long sessions of mindfulness-based yoga. Participants completed assessments at pretest and one month after program completion.

MAIN FINDINGS

The sample was predominantly Hispanic/Latinx (95%) and female (64%), on average 15.2 years old (SD = 1.3), and 51% were born outside the U.S. Participants reported on average a 14.2% reduction in depressive symptoms (pretest mean = 5.51, posttest mean = 4.73, p = .032, Cohen's d = 0.2), a 14.9% reduction in anxiety symptoms (pretest mean = 9.90, posttest mean = 8.42, p = .005, Cohen's d = 0.2), and a 21.9% reduction in stress (pretest mean = 9.66, posttest mean = 7.54, p < .001, Cohen's d = 0.5).

CONCLUSION

These findings provide support for the effectiveness of a mindfulness-based yoga program for Hispanic/Latinx adolescents, a medically underrepresented group experiencing significant mental health disparities.

1166 Investigating Social Workers’ Sleep Health Knowledge: Opportunities to Promote Sleep Health Among Underserved Populations

Introduction

Social workers are often front-line psychosocial providers working with underserved populations, many of whom struggle with sleep. They are uniquely positioned to promote sleep health among individuals experiencing health inequities. However, U.S. accredited social work programs do not require sleep health training. We used both quantitative and qualitative methodologies to investigate social work students’: a) sleep health knowledge; b) self-reported sleep quality; c) prior sleep health education; and d) client discussions about sleep, in order to inform the development of a sleep health training for social work students.

Methods

Twenty-five social work students were recruited via a listserv email sent at a Florida university. Participants were asked to complete the Sleep Beliefs Scale (SBS) and the Pittsburgh Sleep Quality Index (PSQI) and then to participate in a one-hour long focus group (3 groups with 6-11 students/group) conducted by experienced qualitative researchers.

Results

Mean age was 27.0±11.5 yrs, 92.0% were female, and 48.0% were non-Hispanic white, 28.0% African American, 16.0% Hispanic, 8.0% other. Only 28.0% indicated that they had ever discussed sleep with clients. Knowledge of healthy sleep behaviors (assessed via the SBS) was moderate on a 0-20 scale (13.88, S.D.= 2.7). Participants had an average PSQI score of 8.8 (SD.=4.0), reported sleeping an average of 6.0 hours (SD=1.6), and mean sleep efficiency of 87.0% (SD=12.0). Themes from focus group data highlight students’ lack of exposure to sleep health training and a dearth of sleep discussions in clinical practice.

Conclusion

Though social work students acknowledged the importance of sleep health promotion, they reported feeling ill-equipped to promote healthy sleep practices due to lack of sleep education. Sleep health training could allow social workers to confidently promote healthy sleep practices among their clients, recognize when appropriate to refer clients for evaluation for sleep disorders, and improve social workers’ own sleep health. An online educational program was subsequently created by study investigators to meet these aims.

Support

American Academy of Sleep Medicine Foundation

A sleep hygiene and yoga intervention conducted in affordable housing communities: Pilot study results and lessons for a future trial

BACKGROUND

and purpose: Inadequate sleep is highly prevalent among socioeconomically disadvantaged and racial/ethnic minority communities and is often related to maladaptive sleep behaviors and stress. There is scant research investigating the delivery of these interventions in underserved communities. The purpose of this study was to develop and test the feasibility and acceptability of a sleep education and yoga intervention for socioeconomically disadvantaged and racial/ethnic diverse adults.

MATERIALS AND METHODS

We present quantitative and qualitative data from a single-arm sleep education and yoga pilot study (n = 17) conducted in two affordable housing communities, and the multi-modal process we employed to refine the intervention for a future trial.

RESULTS

Participants were age 43.6 years on average (±19.3 years) and 88.2% were female. Nearly 56% identified as non-Hispanic Black and 19% as Hispanic/Latino. Results showed significant pre/post-intervention improvements in sleep duration (5.4 ± 1.2 h/night vs 6.9 ± 1.7 h/night; p < 0.01), sleep-related impairment (-8.15; p < 0.01), sleep disturbance (-5.95; p < 0.01), and sleep hygiene behaviors (-5.50; p < 0.01).

CONCLUSION

This study indicates intervention acceptability and improvements in sleep and sleep hygiene. Future randomized controlled trials are needed to assess efficacy.

Adapting sleep hygiene for community interventions: a qualitative investigation of sleep hygiene behaviors among racially/ethnically diverse, low-income adults

BACKGROUND

Despite the high prevalence of inadequate sleep in racially/ethnically diverse, low-income adults, there is scant research targeting sleep health interventions among underserved populations. Sleep hygiene (SH) recommendations may help promote sleep health for the general population; however, they likely require tailoring to optimize uptake and effectiveness in the "real world" given socio-contextual factors. As an initial step to developing contextually appropriate and effective community-based SH interventions, we conducted qualitative research to understand SH behaviors, beliefs, and barriers in a low-income, ethnically diverse sample of adults.

METHODS

We recruited 24 racially/ethnically diverse adults from an affordable housing community who self-reported sleeping ≤6 hours on average. Participants were invited to either an individual interview (n = 5) or a focus group (n = 3). A deductive, thematic-analysis approach was employed. Data collection and interpretation were informed by the Socio-Contextual Model of Behavior Change.

RESULTS

There was evidence of high acceptability of SH and interest in improving sleep health. Barriers to implementing SH were multifaceted, including individual (knowledge, motivation, habits, medical issues, stress, trauma), interpersonal (caregiving), organizational (job strain), and environmental (noise) factors.

CONCLUSIONS

Future strategies for adapting behavioral SH interventions should target knowledge, skill development, and behavioral change domains, such as motivation, social support, and self-efficacy. In addition, adapting SH beyond the clinical context for a high-need community population requires attention to multilevel sociocontextual factors that contribute to sleep health, particularly chronic stress, prior trauma, and adverse sleeping environments. Development of novel trauma-informed SH interventions may promote effective and safe implementation.

Evening intake of alcohol, caffeine, and nicotine: night-to-night associations with sleep duration and continuity among African Americans in the Jackson Heart Sleep Study

STUDY OBJECTIVES

We examined the night-to-night associations of evening use of alcohol, caffeine, and nicotine with actigraphically estimated sleep duration, sleep efficiency, and wake after sleep onset (WASO) among a large cohort of African American adults.

METHODS

Participants in the Jackson Heart Sleep Study underwent wrist actigraphy for an average of 6.7 nights and completed concurrent daily sleep diary assessments to record any consumption of alcohol, caffeine, and nicotine within 4 hours of bedtime. Linear mixed-effect models were fit and adjusted for age, sex, educational attainment, body mass index, depression, anxiety, stress, and having work/school the next day.

RESULTS

Eligible participants (n = 785) were an average of 63.7 years (SD: 10.6), and were predominantly female (67.9%). There were 5164 days of concurrent actigraphy and sleep diary data. Evening alcohol use was associated with that night's lower sleep efficiency (-0.98% [95% CI: -1.67% to -0.29%], p = 0.005), but not with WASO or sleep duration. Evening nicotine use was associated with that night's lower sleep efficiency [1.74% (95% CI: -2.79 to -0.68), p = 0.001] and 6.09 minutes higher WASO ([95% CI: 0.82 to 11.35], p = 0.02), but was not associated with sleep duration. Evening caffeine use was not associated with any of the sleep parameters.

CONCLUSION

Nicotine and alcohol use within 4 hours of bedtime were associated with increased sleep fragmentation in the associated night, even after controlling for multiple potential confounders. These findings support the importance of sleep health recommendations that promote the restriction of evening alcohol and nicotine use to improve sleep continuity.

Treatment of Sleep Disturbance May Reduce the Risk of Future Probable Alzheimer's Disease

OBJECTIVE

This study explored two research questions: (a) Does sleep medication neutralize or provide a protective effect against the hazard of Alzheimer's disease (AD)? (b) Do apolipoprotein (APOE) e4 carriers reporting a sleep disturbance experience an increased risk of AD?

METHOD

This study is a secondary analysis of the National Alzheimer's Coordinating Center's Uniform Data Set ( n = 6,782) using Cox proportional hazards regression.

RESULTS

Sleep disturbance was significantly associated with eventual AD development. Among the subset of participants taking general sleep medications, no relationship between sleep disturbance and eventual AD was observed. Among individuals not taking sleep medications, the increased hazard between the two variables remained. Among APOE e4 carriers, sleep disturbance and AD were significant, except among those taking zolpidem.

DISCUSSION

Our findings support the emerging link between sleep disturbance and AD. Our findings also suggest a continued need to elucidate the mechanisms that offer protective factors against AD development.

Mild cognitive impairment: associations with sleep disturbance, apolipoprotein e4, and sleep medications

OBJECTIVE

Mild cognitive impairment (MCI) is associated with increased memory problems although the ability to complete daily life activities remains relatively intact. This study examined: (1) if sleep disturbance increased the hazard of MCI; (2) if APOE e4 carriers with sleep disturbance experience an increased risk of MCI; and, (3) if prescription sleep medications provide a protective effect against MCI. We hypothesized that sleep disturbance increases the hazard of MCI, this relationship is stronger among APOE e4 carriers reporting a sleep disturbance. Furthermore, we hypothesized that sleep medications decrease the hazard of MCI.

METHODS

To determine whether sleep medication mediates the risk of developing MCI for individuals with sleep disturbance and/or APOE e4, we analyzed the National Alzheimer's Coordinating Center Uniform Data Set. We selected participants with normal cognition at baseline (n = 6798), and conduced survival analyses.

RESULTS

Our main findings indicated that the hazard of MCI was significantly associated with sleep disturbance. The hazard remained among those who did not use sleep medication. Trazodone and zolpidem users did not have a significant hazard of MCI, but the significant hazard remained for those who did not use these medications. APOE e4 carriers had a significantly higher hazard of MCI. Among e4 carriers who used trazodone or zolpidem, there was not a statistically significant risk of MCI.

CONCLUSION

This study demonstrated the potential utilization of trazodone and zolpidem in the treatment of sleep disturbance while potentially mitigating the risk of MCI. While trazodone and zolpidem have been shown to positively impact sleep disturbance in individuals with normal cognition, further research should explore these findings given that these medications are potentially inappropriate for older adults.

Factor structure of a standards-based inventory of competencies in social work with groups

PURPOSES

This study extends previous findings on a measure of competencies based on Standards for Social Work Practice with Groups. The Inventory of Competencies in Social Work with Groups (ICSWG) measures confidence in performing the Standards. This study examines the latent structure of the Inventory, while illuminating the underlying structure of the Standards.

METHODS

A multinational sample of 586 persons completed the ICSWG. Exploratory factor analysis (EFA), reliability estimates, standard error of measurement estimates, and a range of validity tests were conducted.

RESULTS

The EFA yielded a six-factor solution consisting of core values, mutuality/connectivity, collaboration, and three phases of group development (planning, beginnings/middles, endings). The alphas were .98 for the scale and ranged from .85 to .95 for the subscales. Correlations between the subscales and validators supported evidence of construct validity.

DISCUSSION

The findings suggest key group work domains that should be taught and practiced in social work with groups.

Enhancing yoga participation: A qualitative investigation of barriers and facilitators to yoga among predominantly racial/ethnic minority, low-income adults

Yoga is underutilized among racial/ethnic minorities and low-income populations. To enhance participation among these demographic groups and to inform a future clinical trial, we conducted a qualitative formative investigation, informed by the Social Contextual Model of health behavior change, to identify barriers and facilitators to yoga that could impact study participation. We recruited twenty-four racially/ethnically diverse adults, with and without prior yoga experience, from a low-income, urban housing community to participate in either an individual interview or focus group. A thematic data analysis approach was employed. Barriers to yoga engagement included the perception that yoga lacks physicality and weight loss benefits, fear of injury, lack of ability/self-efficacy to perform the practices, preference for other physical activities, and scheduling difficulties. Facilitators of yoga engagement included a quality yoga instructor who provides individualized instruction, beginner level classes, and promotional messaging that highlights the potential benefits of yoga, such as stress reduction.

Alcohol and Drug Use Among Postoperative Bariatric Patients: A Systematic Review of the Emerging Research and Its Implications

BACKGROUND

Emerging research suggests that some bariatric surgery patients are at a heightened risk for developing substance use problems, especially alcohol use problems.

METHODS

An exhaustive literature review was conducted in January 2015 to investigate all articles published that included data on postoperative alcohol use, alcohol use disorders, and illicit drug use among bariatric surgery patients.

RESULTS

Twenty-three studies reported on alcohol and/or substance use among bariatric patients. Six studies longitudinally assessed alcohol use behaviors; 3 of these studies found an increase in alcohol use following surgery. Six studies were cross-sectional, and 2 studies assessed medical records. Five studies investigated the prevalence of admissions to substance abuse treatment, and 3 studies combined alcohol and drug use data in a single index. Six studies reported on illicit drug use and reported low-postoperative use. The studies' samples were primarily non-Hispanic white females in their upper 40s, and only 11 of the 23 studies utilized validated assessment instruments.

CONCLUSIONS

Studies employing longitudinal designs and large sample sizes indicate that bariatric patients who had the gastric bypass procedure are at an elevated risk for alcohol use problems postoperatively. Research also indicates that bariatric surgery patients might be overrepresented in substance abuse treatment facilities. Risk factors for problematic postoperative alcohol use include regular or problematic alcohol use presurgery, male gender, younger age, tobacco use, and symptoms of attention deficient and hyperactivity disorder. As a whole, however, studies indicate bariatric surgery patients demonstrate a low prevalence of problematic alcohol use, and studies about gastric bypass patients are not entirely conclusive. Prospective, longitudinal studies are needed, utilizing standardized and validated alcohol assessment instruments that follow postoperative bariatric patients well beyond 2 years, and account for types of bariatric procedure. Finally, study samples with greater racial/ethnic diversity and wider age ranges are needed.