Older adults, like any other age group, have a diverse set of health beliefs, health seeking patterns, and health practices, all of which have the potential to influence health behavior and ultimately health outcomes. The purpose of this study was to further the understanding of health behavior among elderly African American women, with 'health behavior' encompassing the combination of health related beliefs, patterns of health seeking behavior, and health practices in relation to both acute health problems and acute episodes of chronic conditions. The investigation was intended to answer two questions: 1. What are the health-related behaviors of older African American women? 2. Are age, education, living arrangement, and marital status related to their perceived health status? This study was both exploratory and descriptive, using content analysis as the method for examining responses related to health behavior among 45 elderly African American women, aged 67 and older living in Allegheny County. The data were originally collected for a supplemental grant to a controlled randomized prospective study entitled Geriatric Health Care and Assessment (RO1 AG08276), funded by the National Institute on Aging in 1992. Key Concepts of the Noel Chrisman model (1977) for a health seeking process, along with selected questions from the supplemental study's semi-structured questionnaire, provide the organizing framework for this exploration. These concepts include: symptom definition, illness- shifts in role behavior, lay consultation and referral, treatment actions and adherence. Given the importance of perceived health status, this variable was evaluated for relationships with selected demographic characteristics: age, education, income, living arrangement and marital status and other health behavior measures included in the study. In addition, I examined perceptions of care and race and gender preferences since these were themes emerging as a result of the questions asked in the study.

Abstract The literature has reported that some older veterans are still distressed by memories of traumatic experiences decades after wartime military service. Recent research has suggested that posttraumatic stress symptoms may appear or reappear during late life in survivors of past trauma and that stress associated with age-related changes may intensify this phenomenon. This dissertation research examined the relationship between past combat exposure and posttraumatic stress symptomatology in community-dwelling veterans of World War II and the Korean War. The risk factor of perceived stress and the protective factor of perceived social support were examined for their potential to exacerbate or mitigate this relationship. The study also investigated the effect of past combat exposure and the role of the moderating variables on health-related quality of life. A secondary aim of the research was to assess the direct effect of perceived stress and perceived social support on the outcome variables. The results indicated that past combat exposure was positively associated with experiencing posttraumatic stress symptoms in World War II and Korean War veterans. Perceived stress was found to significantly exacerbate this relationship. Direct effect relationships were found between perceived stress and both posttraumatic stress symptomatology and health-related quality of life. The mean number of posttraumatic stress symptoms experienced by participants at the symptomatic level was five. The most frequent symptom experienced was sleep disturbance, the second was becoming upset at reminders of the traumatic experience. Increased levels of posttraumatic stress symptoms were found in veterans who were not married, living in an urban area, and diagnosed with depression.

The aim of this research is to understand the factors that enhance and improve outcomes for children in early childhood intervention programs (ECI). This will be done by measuring the impact of the integration of services for children, especially children at developmental risk and/or with developmental delays/disabilities. This research will use existing early intervention data from two different early education programs in Pennsylvania, one which is identified as Fully Integrated EC Program and the other as Consultative Ad-hoc- EC Coordinated Program. The hypothesis being tested is that fully integrated program initiatives will show significantly better child and family outcomes than the more traditional consultative-ad-hoc community-based early childhood programs. The data will be analyzed using both descriptive statistics and multivariate analyses. The results have implication at the agency and practice levels as well as at the policy and funding levels. This study will also contribute to advance understanding and knowledge of best practices in early childhood intervention and education programs.

Extensive literature links interparental relationship quality, particularly coparent conflict, with child behavior problems. Evidence suggests associations between and among interparental discord related to child-rearing disagreements, parenting difficulties, maternal depressive symptoms and child functioning. Experts assert that children function best when their biological parents have a stable marital relationship, and that interparental conflict can jeopardize the stability of the marriage, potential for marriage and the continuation of father involvement However, the preponderance of such research has investigated White, middle-class married or divorced families. Little is known about interparental relationship quality, family moderating factors and behavior problems of young children in African American, low-income, single- mother-headed families. Exploration of this problem is important because early childhood behavioral problems can persist and can contribute to childrens academic underachievement and societal maladjustment. Grounded in the ecological and risk and resilience theoretical perspectives, this quantitative, cross-sectional survey design study investigated associations among interparental relations, maternal depressive symptoms, maternal parenting, and pre-school child behavior problems in African American, low-income, single-mother-headed families. With the cooperation of the Allegheny County Assistance Office, a randomly selected group of 100 mothers and their 3- or 4-year old children, participated in this study. This study used the Time 1 data from an NIMH-funded longitudinal study with Dr. Aurora Jackson as principal investigator. Hierarchical regression analyses were used. Contrary to research with White families, greater mother-reported interparental relationship problems were not associated with more child behavior problems. As hypothesized, fewer maternal depressive symptoms and more optimal maternal parenting were associated with fewer child behavior problems. Controlling for frequency of father contact did not affect relationships in the model. A post hoc finding showed that greater father contact was associated with fewer internalizing behavior problems. Neither fewer maternal depressive symptoms nor more optimal maternal parenting buffered the association between poor interparental relations and child behavior problems. These findings suggest further investigation particularly considering the extensive financial investments and programs funded by the African American Healthy Marriage Initiative. These programs intend to encourage marriage and strengthen poor families, yet have scant research about Black nonmarital, coparent relationships from which to inform these efforts.

This study examined the relationships between life stressors (acute stress, chronic stress, and parental stress) and maternal depression as they relate to parenting self-efficacy among economically disadvantaged Korean women. The present investigation was based on the premise that parenting behavior develops as the result of multiple factors, including stressors, which combine to produce a final effect. The family stress model was expanded to include an examination of socio-environmental stresses as factors that might impair parenting through negative effects on maternal psychological functioning. In addition, parental stress was added as a stressor contributing to parenting quality. The study also investigated the effects of maternal depression on parenting efficacy as a predictor and mediator. The study aimed to assess: (a) the relationship between mothers' stressors (acute, chronic, and parental stress) and parenting self-efficacy while controlling for income, mother's education, mother's job status and total support; (b) the relationships between mothers' stressors and maternal depression; (c) the relationship between maternal depression and parenting self-efficacy; and (d) a mediating effect of maternal depression on the relationship between mothers' stressors and parenting self-efficacy. The study design was cross-sectional, and employed a convenience sampling method. The study participants were Korean mothers of children ages 3-5 in 12 daycare centers in Seoul, Korea. A total of 429 individuals participated in this study and data on 408 cases were analyzed. The results showed that socio-environmental stress and parental stress could result in depression and a low level of parenting self-efficacy among Korean mothers. Although income was an important variable, chronic stress and parental stress were found to be even more influential variables on maternal depression and parenting self-efficacy. This study found that the lower the income, the more vulnerable the mother was to stress, and it also showed that chronic stressors had more influence on maternal depression for low-income mothers than for middle-class mothers. This study showed that the mental health of low-income mothers mediated the relationship between chronic stress and parenting. To maximize effective parenting under high-stress conditions, mothers need to first protect their own psychological well-being against environmental contexts. For the welfare of the children, attention must be shown to the mental health of mothers and their welfare. Policy development and management for these issues are desperately needed in Korea.

Based on the traditions of role theory (Biddle and Thomas, 1979; Longres, 2000; Mead, 1934; Sarbin and Allen, 1954) and self-efficacy theory (Bandura, 1997), this study examined non-custodial fathers and their involvement with their child. Using a convenience sample (n = 72) recruited from men enrolled in the Erie Family Center for Child Development Fatherhood Initiatives Programs, survey participants completed a questionnaire designed to assess their level of self-efficacy, the co-parenting relationship with the custodial mother of their child, and their parenting satisfaction, each posited to be determinants of their paternal involvement. Path analysis was used to assess the effects of these relationships on paternal involvement. Moreover, this study tested the hypothesis that paternal involvement would co-vary with child custody status and marital status. Study results suggest parent satisfaction had the largest direct effect on paternal involvement while co-parenting relationships had the smallest effect on paternal involvement. Controlling for the effects of child custody status and marital status were not statistically significant. The magnitude of parent satisfaction and the minor effect of co-parenting relationship on paternal involvement may have been moderated by the non-custodial fathers participation in fatherhood programs. Implications for social work practice and social welfare policy are discussed.

This longitudinal repeated measures study was designed to evaluate and compare the ffectiveness of volunteer support versus traditional case management for those with HIV in improving level of independent functioning. A non-random sample of one hundred and fifty-three clients (eighty-two in professional, seventy-one in the volunteer program) participated in the study. Evaluative tools utilized included a Checklist of Needs and Level of Independent Functioning Scale (LIF). It was predicted that volunteer case managers would be more effective than professionals in improving the independent functioning of clients with HIV and mental health/drug and alcohol problems. It was also predicted that volunteers would be more effective than professionals in assisting clients with obtaining a greater percentage of outside needs (needs provided by other agencies and defined as more critical in increasing independence). Multivariate analyses of data collected were used to test for relationships between two case management interventions (independent variables), time spent with clients (mediator) and two outcome (dependent) variables, level of independent functioning and percentage of outside needs met . Results supported the prediction that clients of volunteers improved their level of independent functioning and had more outside needs met than clients in the professional group. Path analyses revealed that increased time spent by volunteers (total time, number of contacts) partially mediated improvement in level of independent functioning. Face to face time, the most intense form of time, appeared to fully mediate the relationship between independent and dependent variables. However, the time variables did not mediate the relationship between type of intervention and outside needs met. Recommendations were made for agencies to consider utilizing volunteers in a professional capacity. Also, the evaluative tools developed for this study may be useful to demonstrate outcomes to support lobbying efforts for increased funding. Future research could focus on further refining the LIF scale.

The impact of opiate addiction on public health has been severe with its links to disease, death, economics, and mental health problems. Many opiate addicts inject drugs several times each day which has been associated with many infectious diseases, including: Hepatitis B and C, tuberculosis, and HIV/AIDS (National Institutes on Drug Abuse, 2000). This study investigated the relationships of psychological dysfunction, drug treatment engagement, HIV risk reduction attitudes, and HIV risk behaviors among methadone maintained clients. It was guided by the AIDS Risk Reduction Model (ARRM), a heuristic device that helps to explain/predict behavior change of individuals in relationship to sexual and injection drug use transmission of HIV/AIDS. A quantitative cross-sectional research design was utilized to examine the relationship between psychological dysfunction and HIV risk behavior among methadone maintained clients and how drug treatment engagement and HIV risk reduction attitudes affect this relationship. A total of 200 participants who were at least 18 years old and were enrolled in methadone maintenance treatment were included in this investigation. This study found that 60% of the participants had experienced moderate to high levels of psychological dysfunction. Psychological dysfunction was categorized into past depression, anxiety, and hostility symptoms. Multiple regression analyses showed that overall psychological dysfunction and drug treatment engagement predicts HIV risk behavior among methadone maintained individuals (F=13.06; p<.000). However, when the standardized regression coefficients of the individual independent variables were examined, only drug treatment engagement was found to significantly contribute to the prediction of HIV risk behavior ($=-.22; p< .01), indicating that those who reported higher levels of treatment engagement had lower levels of HIV risk behavior. The mediating role of drug treatment engagement on the relationship between psychological dysfunction and HIV risk behavior was supported. Although, it was not supported for HIV risk reduction attitudes, analysis showed that HIV risk reduction attitudes were moderately and significantly correlated with HIV risk behavior. The findings of this study provide social work and public health practitioners who work in the field of drug and alcohol treatment and HIV prevention with vital information This study underscores the need for early identification and modification of psychological problems among methadone maintained individuals. Drug treatment provides a vital opportunity to address psychological problems and HIV risk behavior, there is an irrefutable need for the social work and public health professionals to further research and develop/refine interventions to prevent the spread of HIV disease among this population. Early screening and treatment of psychological problems may help increase drug treatment engagement rates which may reduce HIV risk behavior and ultimately save lives among methadone maintained clients.

This mixed-method study examined the influence of intimate partner violence (IPV) on the mental health help seeking experience of twenty-two women who received domestic violence services at a local Womens Domestic Violence Center and Shelter. The volunteer convenience sample completed the Conflict Tactic Scale 2 Short Form (CTS2S), Patient Health Questionnaire (PHQ)-9, Post-traumatic Stress Disorder Checklist-Civilian (PCL-C), and the Social Support from Others (SFO) scale along with a qualitative interview based on the Health Belief Model (HBM) assessing their experiences of mental health service acquisition outside of the shelter. Findings revealed high rates of psychological abuse (95%), physical assault and injury (82%), and sexual coercion (64%) by their intimate partner in past year. Reported PTSD was 62% and depression 55%. Identified themes related to the womens perceived need for mental health care, barriers to care, and benefits of care. Perceived need related to feelings of fear, anxiety, isolation, and concern for children. Barriers included difficulty trusting and forming a therapeutic alliance with mental health providers and finding appropriate mental health response to IPV. Perceived benefits of mental health treatment related to receiving validation and improved self-regard. Mixed-method analyses revealed a significant relationship for perceived need with both depression and PTSD. Higher perceived barriers significantly related to PTSD and depression. Lower perceived benefit significantly related to PTSD but not to depression. Social support negatively correlated with depression, PTSD and IPV. The majority of the women cited shelter staff and residents as primary providers of support. Implications include the need for increased understanding of IPV among mental health providers and increased flexibility of services for IPV victims. Further research is suggested on the mental health implications of psychological abuse and trauma associated with IPV and increasing effective provider and treatment strategies to engage IPV victims in mental health treatment.

The value of exploring the potential risks of retirement to individual well-being via a longitudinal analysis framed by theory is demonstrated in this study in a variety of ways. The measures for well-being are a sense of personal control and the experience of depression, and the sample used is of 260 individuals who were either working in 1995 (T1) and 1998 (T2), retired at both times, or who moved from work to retirement between T1 and T2. The analysis used was a mixed model repeated-measures ANOVA, and the theory which helped frame and interpret the analysis was social learning theory. Well-being, itself, is defined as the capacity to live life to its fullest often characterized as self-actualization which in all likelihood will be increasingly important to many of the exploding number of individuals who find that much of their life may actually follow retirement, which, in fact, is a relatively recent social institution. Among findings in this study which may be worth pursuing in the future via both qualitative and quantitative research are that 1) individuals working at both T1 and T2 demonstrated a significantly greater sense of personal control than those retired at both time periods; 2) that individuals who moved from work to retirement between T1 and T2 actually showed a modest increase in their sense of personal control, as opposed to the other work status groups; and 3) that individuals who moved from work to retirement actually showed a significant decrease in the experience of depression, again as opposed to the other two work status groups. Some objectives of future research suggested by these findings might be to 1) design studies focused on well-being which begin tracking individuals prior to retirement, with pre-retirement preparation programs offered by many private and public institutions, and continue to study those individuals for at least ten years, or even longer, as with the Harvard Study of Adult Development; 2) develop domain specific scales for a sense of personal control for both the work and retirement environments; and 3)focus attention on, and stimulate policy debate around, the costs and benefits to society of a relatively new social institution: retirement.