Modeling changes in adolescent health risk behaviors approaching and just after the time of emancipation from foster care

BACKGROUND

Emancipated foster youth frequently engage in behaviors that contribute to poor health. Whether health risk behaviors increase following emancipation or are established while in foster care remains unclear.

OBJECTIVE

This secondary data analysis examined substance use and attitudes toward sexual risk behaviors to understand continuity in risk behaviors among foster youth before emancipation and following emancipation.

PARTICIPANTS AND SETTING

Youth ages 16-20 (N = 151) who had been in foster care for at least 12 months and were expected to emancipate were recruited. The urban county where the study was conducted allowed youth to remain in foster care until 21 years of age.

METHODS

Participants completed surveys assessing substance use and attitudes toward sexual risk behaviors at baseline, 6 and 12 months. Multilevel models estimated trajectories of health behaviors and attitudes, with emancipation timing as the primary predictor. Individual and child welfare characteristics were included as covariates.

RESULTS

Substance use did not change with emancipation (B_s = 0.01, p = 0.81) and positive attitudes about risky sexual behavior significantly decreased as youth approached emancipation (B_s = 1.67, p < 0.01). Placement instability and adversity were not associated with either outcome (ps > 0.08). Females reported more positive attitudes about higher-risk sexual behavior than males (B = 3.09, p < 0.01) and less substance use (B = -1.15, p = 0.03).

CONCLUSIONS

Substance use and attitudes about sexual risk behaviors are established before emancipation; interventions prior to emancipation are necessary to improve health outcomes.

Threshold, budget and deadline: beyond the discourse of climate scarcity and control

Since its inception, the Intergovernmental Panel on Climate Change (IPCC) has always been at the centre of the global climate debate. Its authoritative reports provide cultural resources for public understanding on the challenge of climate change. While the IPCC maintains its perception as a policy-neutral adviser, the IPCC in practice acts as a powerful discursive agent that guides policy debates in a certain direction by enacting influential scientific concepts. These concepts include three prominent metaphors-temperature threshold, carbon budget and climate deadline-that have been widely circulated across science, policy and advocacy. Three metaphors differ on ways in which the risk of climate change is expressed in terms of space and time. But they all constitute the discourse of climate scarcity-the cognitive view of that we have (too) little space and time to stay below a physical limit for avoiding dangerous climate change. This discursive construction of physical scarcity on climate change has significant political and psychological implications. Politically, the scarcity discourse has the risk of increasing a post-political tendency towards managerial control of the global climate ('scarcity of politics'). Psychologically, however, scarcity has a greater risk of generating a 'scarcity mindset' that inhibits our cognitive capacity to imagine human life beyond managing physical scarcity. Under a narrow mindset of scarcity, the future is closed down to the 'point of no return' that, if crossed, is destined to be the end. To go beyond the scarcity discourse, a new discourse of emancipation has to be fostered. Climate change can be reframed not as a common single destination but as a predicament for actively reimagining human life. Such a narrative can expand our imaginative capacity and animate political action while embracing social losses.

Elective egg freezing and women's emancipation

All studies show that the primary reason for women to consider elective egg freezing (EEF) is the lack of a partner. The first question then is where this shortage comes from and how it can be remedied. The main cause of the 'lack of partner' issue for highly educated women (the group most involved in elective egg freezing) is the reversed gender gap in education. It is concluded that EEF may increase individual reproductive autonomy but does not increase reproductive freedom for the group of highly educated women. Regardless of how many women freeze their eggs, a large number of educated women will eventually have to choose between going it alone as a single mother or looking for another life goal. Finally, some possible policy measures are proposed to reduce the gender gap and thus remove the real cause of the problem.

Truth in numbers? Emancipation, race, and federal census statistics in the debates over Black mental health in the United States, 1840-1900

To the keen observer of American political and medical history, a disturbing set of debates surrounded the sanity of free Black residents of the United States of America after the publication of the controversial 1840 census returns on race and insanity. This article analyzes how the census became a battlefield where physicians and other commentators fought over-and thus shaped-various political meanings of Black insanity before and after the American Civil War, up until the 1890s, as the South underwent a massive political and social transformation, from slavery to emancipation. It also highlights the arguments raised by authors such as James McCune Smith and Ramón de la Sagra who attempted to disprove the returns shortly after their publication, and whose arguments contributed to efforts to combat scientific racism.

"Starting from a higher place": linking Habermas to teaching and learning clinical reasoning in the emergency medicine context

Teaching clinical reasoning in emergency medicine requires educators to foster diagnostic accuracy and judicious decision-making amidst chaotic ambient factors including clinician fatigue, high cognitive load, and diverse patient expectations. The current study applies the early work of Jurgen Habermas and his knowledge-constitutive interests as a lens to explore an educational approach where physician-educators were asked to make their expert reasoning visible to emergency medicine trainees, to more deliberately make visible and accessible the context-specific thinking that emergency physicians routinely use. An action research methodology was used. The 'making thinking visible' teaching approach was introduced to five emergency medicine educators working in large public hospital emergency departments. Participants were asked to trial this teaching method and document its impact on student learning over two reporting cycles. Based on written reports of trialing the teaching approach, participants identified a need to change from: (1) introducing thinking structures to cultivating enquiry; and, (2) providing explanations based on cognitive thinking routines towards encouraging the learner to see the relevance of the clinical context. Educators described how they developed a more diagnostic and reflexive approach to learners, recognized the need to cultivate independent thinking, and valued the opportunity to reflect on their usual teaching. Teaching clinical reasoning using the 'making thinking visible' approach prompted educators to decrease the emphasis on providing technical information to assisting learners to understand the purposes and meanings behind clinical reasoning in emergency medicine. The knowledge-constitutive interests work of Jurgen Habermas was found to provide a robust framework supporting this emancipatory teaching approach.

The Impact of Health Care Education on Utilization Among Adolescents Preparing for Emancipation From Foster Care

PURPOSE

As teens in foster care prepare for emancipation, health care navigation is often overlooked, as caseworkers address other social needs. This study examined the impact of health care education materials designed for foster youth, called ICare2CHECK. It was hypothesized that ICare2CHECK would increase nonurgent ambulatory health care use and decrease emergency/urgent care use.

METHODS

Adolescents (N = 151; aged 16-22 years) were enrolled in ICare2CHECK and received health education materials at their baseline study visit. Surveys were repeated every 3 months to assess health care utilization. After 12 months of enrollment, health care data for all eligible youth and matched comparison youth (N = 151) over the previous 24 months were extracted from the electronic health record (N = 302). Electronic health record data were coded as counts of completed nonurgent ambulatory care encounters (i.e., primary and preventative care and specialty care), completed urgent or emergency encounters (i.e., urgent and emergency department visits and hospitalizations), completed foster care clinic visits, and total completed visits.

RESULTS

Health care use significantly decreased over time for both enrolled and comparison youth. Females, youth engaging in health risk behaviors, and those with a mental health or chronic condition diagnosis used significantly more health care. Receipt of educational materials was associated with a smaller decline in health care use and nonurgent ambulatory care use, controlling for covariates. Self-reported use of educational materials was associated with increased utilization in the enrolled condition.

CONCLUSIONS

Results suggest that ICare2CHECK is associated with increased engagement in health care generally and nonurgent ambulatory care specifically (e.g., outpatient primary and specialty care).

Problematizing official narratives of HIV and AIDS education in Scotland and Zimbabwe

When human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are framed within an intersectional approach, they have the potential to transform understandings of social justice within the curriculum and education policy and practice in general. Yet, this transformative potential is often hampered by official narratives that fail to position HIV and AIDS as an integral component of overlapping systems of oppression, domination and discrimination. This article explores how official HIV and AIDS narratives tend to promote systemic injustice and inequality within education policy and practice in both Scotland and Zimbabwe, despite their good intents. We frame our argument within a transformative education discourse which seeks to create participatory and emancipatory HIV-related messages at school, tertiary and community levels. Using a narrative enquiry design, a Foucauldian theoretical lens was used to analyse the narratives derived from key informant responses, supplemented by analysis of key documents that deal with HIV and AIDS in both Scotland and Zimbabwe. Four broad narratives emerged: the 'Gay' Narrative; the Migration Narrative; the Conspiracy Narrative; and the Religious Narrative. We discuss how each of these narratives entrench stigma across both developed and developing world contexts, and propose how a more intersectional interpretation would contribute to a deeper and less stigmatizing understanding of HIV, thus offering more useful insights into related policy and educational practices. This article will thus contribute to the growing body of intersectional HIV and AIDS knowledge that is relevant for schools, teacher education, public health and community settings, not only in the countries studied, but the world over.

A Social Ecology Analysis of Childbirth Among Females Emancipating From Foster Care

PURPOSE

No research has examined childbirth from a national perspective among females emancipating from foster care. The present study fills this gap by: (1) documenting the rates of initial and repeat births among females ages 17 and 19 in a national prospective study and (2) identifying risk and protective factors at age 17 that predict childbirth between ages 17 and 19.

METHODS

This study used data from the National Youth in Transition Database and Adoption and Foster Care Analysis and Reporting System to identify risk and protective factors associated with childbirth in a national sample of transition-age female youth (N = 3,474).

RESULTS

The cumulative rate of childbirth by age 19 was 21%, with higher rates reported between ages 17 and 19 (17%; n = 602) compared with age 17 or earlier (9%; n = 313). In logistic regression analysis, black race and Hispanic ethnicity, placement with relatives, runaway status, trial home visit placement, early emancipation from foster care, and lifetime incarceration histories were associated with increased likelihood of childbirth. In contrast, school enrollment and employment skills were associated with decreased likelihood of childbirth. The multivariate odds of childbirth between ages 17 and 19 increased 10-fold if youth already had a child by age 17.

CONCLUSIONS

Sexual health and pregnancy prevention programs should specifically target youths who already have children. Increased attention should be paid to adolescents placed with biological families and those with histories of criminal involvement.

Emancipating Sexuality: Breakthroughs into a Bulwark of Tradition

This article presents evidence for a rising emancipatory spirit, across generations and around the world, in a life domain in which religion hitherto blocked emancipatory gains: sexual freedoms. We propose an explanation of rising emancipative values that integrates several approaches into a single idea-the utility ladder of freedoms. Specifically, we suggest that objectively improving living conditions-from rising life expectancies to broader education-transform the nature of life from a source of threats into a source of opportunities. As life begins to hold more promise for increasing population segments, societies climb the utility ladder of freedoms: practicing and respecting universal freedoms becomes increasingly vital to take advantage of rising life opportunities. This trend has begun to spill over into a life domain in which religious norms have until recently been able to resist emancipatory gains: sexual freedoms. We present (1) crossnational, (2) longitudinal, (3) generational and (4) multilevel evidence on an unprecedentedly broad basis in support of this theory.

Problematization of perspectives on health promotion and empowerment in mental health nursing--within the research network "MeHNuRse" and the Horatio conference, 2012

Mental illness is increasing worldwide, while society's response seems to be a trend toward narrower and more specialized mental health care. This development is creating great demands on mental health nurses to include a health promotion perspective in care and support of persons with mental illness. A health promotion perspective emphasizes cooperation and communication with people who suffer from long-term mental illness, focusing on their independence and health. From a health perspective, every human being is an actor in his/her own life, with an inherent ability to make his/her own choices. However, persons who suffer from long-term mental illness are at risk of losing power and control over areas of their lives and their health. Mental health nurses are in a position to support these individuals in promoting health and in maintaining or regaining control over their lives. The emphasis of this paper is to problematize mental health nurses’ responsibility to provide health-promoting nursing care in relation to empowerment by means of emancipation, self-efficacy, and self-management. We argue that mental health nurses can work from a health-promoting perspective by using these concepts and that this challenges some of the traditional ideas of health promotion in mental health nursing. The theoretical background discussions in this paper have their origin in the research network “Mental Health Nursing Research in Scandinavia” (MeHNuRse) and from the professional discussions developed during a 2012 workshop that included mental health nurses and researchers at the European Horatio Festival in Stockholm.

Cumulative teen birth rates among girls in foster care at age 17: an analysis of linked birth and child protection records from California

This study used linked foster care and birth records to provide a longitudinal, population-level examination of the incidence of first and repeat births among girls who were in foster care at age 17. Girls in a foster care placement in California at the age of 17 between 2003 and 2007 were identified from statewide child protection records. These records were probabilistically matched to vital birth records spanning the period from 2001 to 2010. Linked data were used to estimate the cumulative percentage of girls who had given birth before age 20. Birth rates and unadjusted risk ratios were generated to characterize foster care experiences correlated with heightened teen birth rates. Between 2003 and 2007 in California, there were 20,222 girls in foster care at age 17. Overall, 11.4% had a first birth before age 18. The cumulative percentage who gave birth before age 20 was 28.1%. Among girls who had a first birth before age 18, 41.2% had a repeat teen birth. Significant variations by race/ethnicity and placement-related characteristics emerged. Expanded data and rigorous research are needed to evaluate prevention efforts and ensure parenting teens are provided with the needed services and supports.