Early stages of the co-occurring, mental health and substance use disorder (MH-SUD) recovery process present various social and physical challenges to the recovering person, including habitual cigarette smoking. Presenting smoking cessation to a person with a co-occurring disorder could also depend on behavioral health professional’s perceptions of implementing supplemental services in early recovery. Behavioral health professionals also face the challenge of assessing people’s motivation to quit smoking. Data was collected through an online survey that shaped this quantitative, cross-sectional study focused on understanding perceptions of smoking cessation in early MH-SUD recovery. The study’s data highlighted that the participants (N = 61) perceive smoking cessation as an appropriate intervention while also reporting high levels of self-confidence when assessing motivation to quit to smoking. Identifying as a smoker and former smoker, highest level of education and gender did not have a significant impact on perceptions of smoking cessation in early MH-SUD recovery. The study created an overview on how behavioral health professionals understand and support smoking cessation that contributes additional knowledge to social work’s existing research on habitual cigarette smoking and co-occurring disorders.

Mexican Americans, the largest Hispanic subgroup in the United States, tend to underuse mental health services. Grounded in Andersen's behavioral model of health services use, the purpose of this nonexperimental study was to examine the likelihood of birth country, education, income, and insurance predicting which respondents would report seeking mental health services to treat depression. The Mini International Neuropsychiatric Interview was used to diagnose depression in 203 Mexican Americans whose data was archived from the primary study. This archived data was analyzed within this study. The results of the 2 x 2 chi-square tests of independence indicated a significant association between a person's birth country and the likelihood that a person will seek mental health treatment, with U.S.-born participants more likely to seek mental health treatment than foreign-born participants. There were no significant bivariate associations found between education, income, or insurance and seeking mental health treatment. The full model containing the 4 independent variables was statistically significant per the results of the binary logistic regression analysis. This finding indicates that the model reliably distinguished between respondents who reported seeking and not seeking mental health treatment. The results of the binary logistic regression analysis indicated education was the only independent variable that made a uniquely significant contribution to the model, with participants with 12 years or more of education more likely to seek mental health treatment. The implications for positive social change include the potential to provide communities and health care providers knowledge of the factors that influence whether Mexican Americans with depression access mental health.

Medical interpreter services will be essential for developing and implementing culturally relevant interventions and treatment for limited English proficiency (LEP) populations. This study sought to identify the possible risks or protective factors that may be associated with vicarious traumatization (VT) or vicarious posttraumatic growth among medical interpreters in behavioral health settings. A 2-step cluster analysis was conducted yielding 2 distinct groupings of medical interpreters (Subtype 1, n = 73; Subtype 2, n = 101). The most important predictor determining the 2 subtypes was whether the participant had a personal history of trauma. In addition, there were significant differences between the 2 subtypes among the following variables: Trauma and Attachment Belief Scale T-scores of VT; years as a medical interpreter; years as a behavioral health medical interpreter; level of education as it relates to interpreting; personal history of trauma; personal or family history similar to any of the trauma survivors served in the past year; specific mental health training; sought personal therapy related to exposure to traumatic material from work environment; current relationship status; race; and whether spoken, sign, or both spoken and sign language interpretation was provided. The results of this quantitative study further support the constructivist self-development theory where VT is the result of the accumulated effects of repeated exposure to trauma material in combination with the person of the provider. Understanding these risk and protective factors will continue to support the provision of effective treatment of LEP individuals in behavioral health settings and the ongoing professional development of behavioral health medical interpreters.

As a result of the passage of the Affordable Care Act, the behavioral healthcare field is experiencing an increased demand for services. This increase is based on the availability of healthcare coverage to an estimated 13.4 million previously uninsured individuals. To meet this demand for treatment, the workforce of behavioral health therapists must grow. The largest generation entering the workforce, the Millennial Generation - those born after 1980 - is believed to lack commitment to their employers, frequently vacating their positions for the next best offer. The purpose of this case study was to determine factors that both affect retention and contribute to employee turnover among Millennial behavioral health therapists, in the hope of identifying approaches for retaining them in not-for-profit organizations. This exploration used Rousseau's psychological contract theory as the theoretical lens. Secondary data from academic literature, public media, and published surveys were collected and analyzed using open coding to identify patterns and trends. Key variables influencing retention were parity in compensation, organizational culture, the opportunity to advance careers, and make a difference in the community. The implications for social change include informing policy makers and organizational leaders in behavioral healthcare about developing creative methods to increase retention. Recommendations include employer evaluation and improvement in their organizational culture and quality of relationships with their employees. The implementation of these recommendations could result in improved client outcomes, fiscal integrity, and organizational continuity.

This study utilized data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) at two different time points, seven years apart, to examine the relationship between physical illness and depressive symptoms in elderly Mexican Americans. The two physical illnesses studied are coronary artery disease and type II diabetes due to their high prevalence among Mexican Americans. The relationship between physical illness and depressive symptoms is examined longitudinally and prospectively, in both directions. In addition, the relationship between depressive symptoms and three behavioral health risk factors: alcohol use, cigarette smoking, and physical inactivity, at baseline is examined. The roles of gender, acculturation, nativity, and locus of control are examined as moderators of the key relationships studied. Additionally, self-rated health at baseline is examined as a predictor of physical illness and mortality at follow-up. / text

<p> Breast cancer is the most prevalent cancer among women (apart from skin cancers). African American (AA) women have lower rates of breast cancer, but higher mortality from the disease. Tertiary prevention may play a role in improving survivorship. Lifestyle changes after diagnosis have been studied, with conflicting evidence on the direction of behavior change, as well as the successful maintenance of outcomes. In this secondary data analysis study, we utilized the Behavior Change data set of The Women's Circle of Health Study (WCHS), with 1599 cases of breast cancer diagnoses among women (both AA and European American (EA) in the New York City metropolitan area and northern New Jersey). Raw data from the `Behavior Change Section'--a survey subset from the WCHS--was converted into scores of `healthy/positive behavior change'. While both groups made positive behavior changes, a significantly greater percentage of AA made positive/healthy dietary (intake of fruits, vegetables, fats, meat) behavior changes compared to EA women (p&lt;0.001). More AA women made positive changes related to tobacco use (p&lt;0.001) and alcohol consumption (p=0.029). The current analysis did not assess an intervention, motivations for change, or health outcomes. Programs promoting decreased tobacco and alcohol consumption and healthy weight management may be an impetus for such change. Future research may focus efforts on AA, with additional attention to health care issues apart from lifestyle--including access to health care-- as this group has higher rates of breast cancer mortality. Characterizing the behaviors before and after diagnosis may be even more useful in determining the course of change for women with breast cancer.</p>

The enactment of the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008 sought to eliminate longstanding discriminatory insurance practices against behavioral health disorders by requiring health insurers of large group plans to apply no more restrictive financial requirements and treatment limitations to mental health and substance use disorder benefits relative to those applied to medical/surgical benefits. Since the parity act went into effect in 2010, the prevalence of mental health conditions has continued to rise while the proportion of those seeking mental health services has remained stagnant. As a result, an increasing trend in the percentage of Americans with a perceived unmet need for behavioral health services has been observed over the past decade. Many of those with an unmet need for services cite an inability to afford the cost of care, no insurance/underinsurance, and/or lack of available behavioral health clinicians as some of the primary reasons for not obtaining wanted care. This suggests a disconnect exists between the policy and practice of parity that warrants further investigation. Understanding the history of behavioral health coverage and parity in the United States and the current structure of America’s health insurance system provides context for why healthcare reform legislations, like the MHPAEA, are necessary. Furthermore, dissecting the provisions and limitations of the MHPAEA and the Affordable Care Act’s impact on behavioral health parity exposes barriers that perpetuate the disconnect between policy and practice. The various barriers that continue to limit access to behavioral health care despite the MHPAEA will be evaluated to better understand why they exist and how they facilitate a persistent unmet need. Mental health in America is a critical medical and public health concern as the prevalence of poor mental health has continued to grow, especially amidst the COVID-19 pandemic. The shortcomings of current legislation and the mental health care delivery system need to be addressed to develop future legislation that can be better equipped to deliver true parity in practice.

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Understanding local perceptions of disease causation could help public health officials improve strategies to prevent bloody diarrhoea. A cross-sectional survey was conducted in Dhaka, Bangladesh to elicit community beliefs about the causes of and prevention strategies for bloody diarrhoea. Between March and June 2003, we interviewed 541 randomly selected respondents. Overall, 507 (93%) respondents perceived that a vaccine could prevent bloody diarrhoea. If a vaccine provided lifetime protection, 445 (83%) respondents stated that they would opt to get the vaccine and would pay a median of $0·05 (range U.S.$0·01-0·15) for it, equivalent to <1% of their median weekly income. There was almost universal perception that an effective vaccine to prevent bloody diarrhoea was highly beneficial and acceptable. While respondents valued a vaccine for prevention of bloody diarrhoea, they were only willing to pay minimally for it. Therefore, achieving a high rate of Shigella vaccine coverage may require subsidy of vaccine purchase.