Browsing by Author "Odgers, Candice L"
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Item Open Access Concurrent and Subsequent Associations Between Daily Digital Technology Use and High-Risk Adolescents' Mental Health Symptoms.(Child Dev, 2017-05-03) George, Madeleine J; Russell, Michael A; Piontak, Joy R; Odgers, Candice LAdolescents are spending an unprecedented amount of time using digital technologies (especially mobile technologies), and there are concerns that adolescents' constant connectivity is associated with poor mental health, particularly among at-risk adolescents. Participants included 151 adolescents at risk for mental health problems (Mage = 13.1) who completed a baseline assessment, 30-day ecological momentary assessment, and 18 month follow-up assessment. Results from multilevel regression models showed that daily reports of both time spent using digital technologies and the number of text messages sent were associated with increased same-day attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) symptoms. Adolescents' reported digital technology usage and text messaging across the ecological momentary assessment (EMA) period was also associated with poorer self-regulation and increases in conduct problem symptoms between the baseline and follow-up assessments.Item Open Access Does Virtual Communication with Parents Help Students Recover from Daily Stressors?: Daily and Experimental Tests with First Year College Students(2017) George, Madeleine JosephineEmerging adulthood, specifically the transition to college, is often marked by changing social networks, increased responsibility, and separation from the parental home environment. Educators, researchers, and those dedicated to the healthy development of young people are invested in understating how and why social support is important for students’ adjustment, wellbeing, and their ability to cope with the daily stressors that accompany this notable transition. In particular, parents are believed to be a key source of both perceived (stable) and enacted (immediate) support. Strong parental relationships predict students’ overall achievement and adjustment in the first year of college. Less is known about how parental relationships may impact students’ daily wellbeing and whether parents can provide helpful enacted support through daily communication. With the rapid ubiquitous rise in mobile technologies, students and their parents are now communicating more frequently during this transition; however, very little is known about whether daily virtual parental communication can help students cope with daily stressors. This study contributes to the existing literature by 1) describing students’ daily in-person and virtual communication with parents during the beginning of college, 2) examining whether students' daily virtual parental communication is associated with their same-day wellbeing, 3) testing whether daily virtual communication (i.e., enacted support) buffers daily responses to stressors, 4) examining the specificity of parental support (versus other sources of support), and 5) exploring whether the strength of students’ parental relationships (i.e., perceived support) is associated with students’ ‘reactivity’ to daily stressors. This dissertation consists of three studies that used daily assessments (i.e., ecological momentary assessments: EMA) and experimental manipulation to understand the momentary interplay between exposure to stressors, parent-child virtual communication, and students’ wellbeing during the transition to college.
Study 1, a 7-day EMA study of 136 first and second year college students, found that texting with a parent moderated the same-day associations between daily stressors and affect. Although daily parental virtual communication was not directly associated with same-day affect, on days when students reported a stressor and texted with a parent, they had lower negative and higher positive affect compared to stressor days when they did not text with a parent. Extending research by Gross (2009), Study 2 used an experimental paradigm in which 101 first year college students completed a virtual social exclusion stressor task (i.e., Cyberball) and then were assigned to text a parent, text a stranger, or play a solitary computer game. Students who ‘reached out’ via text message to parents or strangers demonstrated faster recovery in self-esteem following the experimentally induced stressor compared to students assigned to the no contact control. Study 3 followed the same 101 first year students with a 10-day EMA study. On days when students reported a stressor and called/texted with their parents (versus days without virtual parental contact), they reported lower negative affect and slept longer that night, as monitored objectively with a wearable wristband. Analyses testing for specificity across the three studies found that only virtual communication with parents or romantic partners, but not other texting patterns (number of texts or contacts) or partners (texting with acquaintances, siblings, roommates, or friends), moderated the daily associations between stressors and wellbeing. In addition, students with higher reported maternal relationship quality were less ‘reactive’ to stressors, such that in both experimental and naturalistic settings students with lower (versus higher) maternal relationship quality had steeper increases in negative affect when they experienced a stressor. Overall, the three studies found converging evidence that daily virtual communications with parents may aid students in dealing with daily stressors, especially for reducing negative affect. Possible explanations, ideas for future research, and implications are discussed.
Item Open Access How Social Status Permeates Inequalities in Health: Three Studies on Experiences of Social Disadvantage(2020) Rivenbark, JoshuaThe social gradient of health is pervasive and unrelenting. Across nearly any layer of society – race, religion, economic standing, or others – the populations worst off in terms health are also the most socially disadvantaged. Over three studies, this dissertation examines some of the experiences that underlie the connection between social disadvantage and health, namely internalized perceptions of status, interpersonal interactions, and institutional actions. The first study examines the link between adolescents’ perceived social status and their mental health at a range of ages, identifying at what age mental health problems begin to track perceptions of status, as well as contextual factors that do (or do not) relate to perceptions of status. In the second study, data from a nationally representative survey in France are used to document rates of reporting discrimination within the healthcare setting by gender, immigrant status, race/ethnicity, and religion. Rates of foregoing medical care are also documented across the same groups, and the potential explanatory role of discrimination toward disparities in foregone care is then investigated. The third and final study looks at the role of institutional stigma, using state bans of Sharia law in the USA as an exemplary case of stigmatizing policies with minimal material consequences. National birth record data for the USA is used, and the variation in policy enactment over time and space is leveraged to examine birth outcomes for Muslim women who were pregnant at the time their state passed a ban. Findings reveal a decrease in the secondary sex ratio to targeted women, suggesting the stigmatizing policy acts as a population-level stressor with consequences for maternal health.
Item Open Access Integrated Behavioral-Physical Care Management in the Primary Care Setting(2015-04-30) Dakkak, MarkBackground: Care management programs for high-cost patients with complex medical and social needs are seen as an opportunity to improve quality of care, promote health, and reduce costs. However, mixed evidence of intervention effectiveness and a lack of supportive analytics tools limit the ability of programs to properly target patients with services that significantly impact health service use. The primary aim of this study is to evaluate a unified primary care and behavioral health intervention targeting high utilizer Medicaid enrollees by examining the program’s effect on subsequent health service utilization patterns. The secondary aim is to develop tools that improve the identification of patients for enrollment in high utilizer care management programs. Methods: This study employs a case-control study design that compares program participants to a carefully matched control group. Patients engaged in primary care were identified via high numbers of emergency department visits and referrals from physicians and the state Medicaid agency. Thirty-five Medicaid beneficiaries were enrolled between August 2013 and February 2014 and included in the final analysis. Priority was given to patients with comorbid mental health or substance abuse disorders, but a number of patients with significant chronic medical illness were also enrolled. Baseline rates of emergency department visits, hospital admissions, and primary care visits were calculated for the one-year pre-enrollment. Post-intervention rates were calculated as twice the number of encounters during a 6-month follow up period. Results: Enrollment of high utilizer Medicaid beneficiaries in integrated behavioral-physical care management did not result in a greater reduction of emergency department visits or hospital admissions compared to patients receiving standard primary care. Patients enrolled in the program showed an average decrease of 3.46 ED visits per year and an average increase of 0.17 hospital admissions per year. Similar high utilizer patients receiving standard primary care showed an average decrease of 4.43 ED visits per year and average decrease of 0.20 hospital admissions per year. However, program participants were significantly more engaged in primary care over the follow up period compared to the control group. Patients enrolled in the program had almost no change in primary care visit rate (increase of 0.14 visits per year), whereas control patients had an average decrease of 9.71 visits per year. Conclusion: This case-control study reveals the tough road ahead for programs attempting to show a return on investment—changes in outpatient healthcare use were not accompanied by a drop in more costly hospital healthcare use. A data application was developed to improve patient selection, which we hope reduces patient heterogeneity moving forward. More must be done to rigorously evaluate high utilizer care management programs on a larger study population.