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- ItemExploring Couple and Family Therapist Involvement in Social Justice Praxis(2023) Golojuch, Laura; Mittal, Mona; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)As the nation becomes more diverse, multicultural competence and social justice are being increasingly recognized as essential components to effective therapy practice (Hays, 2020; Ratts et al., 2016; Vera & Speight, 2003). While some scholars in the field of Couple and Family Therapy (CFT) have urged the importance of infusing social justice into training and clinical practice for years (see Hardy, 2001; Knudson-Martin et al., 2019; McDowell et al., 2019; McGoldrick, 2007), this topic is understudied and underprioritized by the field at large. Recent CFT scholars also acknowledge the importance of advocacy as an accompaniment to therapy (J. M. Goodman et al., 2018, Jordan & Seponski, 2018a, 2018b). Counseling and social work fields have prioritized social justice advocacy and codified it into mission statements and ethical codes (Ratts et al., 2016; Ratts & Greenleaf, 2018; Toporek & Daniels, 2018). Although CFTs are trained systemically, and may be enacting micro-level advocacy intervention in the therapy room, they do not always view themselves as advocates or enact macro-level advocacy interventions (J. M. Goodman et al., 2018; Holyoak et al., 2020; Jordan & Seponski, 2018b). This study utilized a sequential transformative mixed methods design to assess multicultural competence, social justice commitment and self-efficacy, and advocacy competence in a nationally representative sample of CFTs (n = 101) using survey methods. A subsample of 22 participants were interviewed to further explore their practices as multiculturally competent and socially just clinicians. Three complementary frameworks were utilized to ground the study: The Multicultural and Social Justice Counseling Competencies (MSJCC), critical consciousness, and Public Health Critical Race praxis. Overall, multicultural competence, social justice commitment, and social justice self-efficacy scores were high in this sample, while advocacy competence scores were lower. Results showed that identifying as Black or African American and completing additional training in multicultural competence and social justice were associated with multicultural competence. Results also showed that working in an agency setting vs. other settings was associated with lower levels of multicultural competence. Results showed that identifying as female compared to male, having a higher level of oppression, a higher level of civic engagement, and more additional training in multicultural competence were all associated with social justice commitment. Results showed that being older, completing more additional training, and having a higher level of oppression were all associated with higher levels of social justice self-efficacy. Finally, results showed that identifying as non-binary compared to male, completing more hours of additional training, and experiencing higher levels of oppression were all associated with advocacy competence. Additionally, receiving more post-graduate hours of training in multicultural competence, social justice, and advocacy competence was associated with higher multicultural competence, social justice, and advocacy competence. Qualitative findings revealed ways in which CFTs developed and embodied socially just clinical practice and explored recommendations for training.
- ItemEXAMINING THE ASSOCIATION BETWEEN INTERPREGNANCY INTERVAL AND MATERNAL HEALTH IN THE POSTPARTUM PERIOD(2023) Barber, Gabriela A; Thoma, Marie E; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Interpregnancy interval (IPI) is defined as the period of time between a previous birth and a subsequent conception, usually measured in months. While recommendations issued by the World Health Organization and the American College of Obstetricians and Gynecologists provide guidance for ideal birth spacing, many births occur after non-optimal IPIs – either too short (<18 months) or too long (60+ months). These recommendations were motivated by the body of research on a host of adverse infant and maternal health outcomes associated with non-optimal IPIs. To date, the literature has focused heavily on the association between IPI and adverse infant health outcomes, with limited attention in comparison being given to IPI and maternal health. Within the research on IPI and maternal health, there is a narrow focus on physical health outcomes related to pregnancy/delivery complications, with few studies looking at health outcomes in the postpartum and beyond. In order to fill this gap, this research investigated the association between IPI and several postpartum maternal health outcomes/indicators, including 1) postpartum depression (PPD), 2) attendance at a postpartum checkup, and 3) postpartum contraceptive use (any and type). One of the perennial difficulties in studying IPI is parsing out whether IPI has an independent association with a health outcome or behavior or is exerting its effects through pregnancy intention, therefore, for each aim, pregnancy intention was tested as a moderator. For each aim, unique cut-offs for IPI were determined after examination of the association between more detailed IPI categories and the outcome of interest. Categories were collapsed into broader IPI classifications when the associations were similar in order to maximize precision of the estimates and in order to allow us to characterize the most clinically relevant exposure for specific health outcomes. In fully adjusted models, individuals who had IPIs less than 18 months were significantly more likely to experience elevated PPD symptoms (aOR: 1.19, 95% CI: 1.02 – 1.39, p=0.024) when compared to individuals with long IPIs, and individuals who had IPIs less than 12 months were significantly less likely to attend their postpartum checkup (aOR: 0.78, 95% CI: 0.66 – 0.93, p=0.006) when compared to those with long IPIs. Pregnancy intention was not found to significantly moderate either of these associations. For the third aim, pregnancy intention was found to moderate the association between IPI and any use of postpartum contraception. Stratified analyses show that it is among unintended pregnancies that there is an association between short IPI and increased use of any contraception in the postpartum. Among unintended pregnancies, those with IPIs less than 6 months (aOR: 2.31, 95% CI: 1.37 – 3.90, p=0.002) and those with IPIs of 6-11 months (aOR: 2.15, 95% CI: 1.48 – 3.10, p=0.001) were more likely to be using any contraception in the postpartum than those with long IPIs, and the magnitude of this association exceeded that of other IPI intervals and pregnancy intention categories. Among those who were using contraception in the postpartum, individuals with IPIs less than 6 months were more likely to be using highly-effective methods (aOR: 1.59, 95% CI: 1.22 – 2.10, p=0.001) than least-effective methods of contraception. Pregnancy intention did not significantly moderate the association between IPI and type of contraception. Future research should continue to explore the association between IPI and a broader range of maternal health outcomes and work to identify the mechanisms through which IPI may be impacting these outcomes. Recent changes in reproductive policies in the U.S. may also soon change the proportion of individuals who experience short IPIs, therefore making it even more important to understand how this shift may impact a broad range of maternal health behaviors and outcomes. This research highlights how an increase in births occurring after a short IPI would likely increase rates of PPD and increase demand for certain family planning services.
- Item¡Hay que hablar sobre esto! [We need to talk about this]: Exploring the Relationship Between Contraceptive and Consent Knowledge, Sexual Self-efficacy and Psychological Distress Among Latino Adolescents(2023) Kerlow, Marina Angelica; Lewin, Amy; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Latino adolescents are a growing population in the US (U.S. Census Bureau, 2020), and they experience disproportionately high rates of unintended teen pregnancy, STIs and HIV (Guilamo-Ramos et al., 2012; Martin et al., 2021). Also, adolescents struggle with high rates of mental health issues (Bitsko et al., 2022; Merikangas et al., 2010). Some studies support that psychological distress plays a role in teens’ sexual behavior and sexual self-efficacy (Lehrer et al., 2006; Seth et al., 2009; Seth et al., 2011). Yet, few studies have looked at the association between aspects of sexual health and psychological distress within Latino teens. This study conducted secondary data analysis using baseline data from a randomized controlled trial to test the effectiveness of El Camino, a comprehensive sexual health education curriculum developed by Child Trends. Participants consisted of 474 Latino adolescents (44.8% male and 53.1% female) and they completed electronic self-report surveys (mean age 16.55 years). 84.2% of the sample was foreign born and 15.8% was US born. Results indicated that there was a significant correlation between sexual self-efficacy and knowledge about contraception and sexual consent (r = .31, p < 0.001). There was a small significant correlation between sexual self-efficacy and psychological distress (r = .12, p < 0.001). Psychological distress did not moderate the relationship between knowledge and sexual self-efficacy. Interestingly, the interaction term between knowledge and gender was statistically significant (β = -0.44, SE = 0.09, p= <.001), indicating that the relationship between knowledge and sexual self-efficacy is stronger for males than for females. The findings support that Latino youth may benefit from interventions that strengthen their knowledge and sexual self-efficacy, despite differences in nativity status and levels of psychological distress. Future studies should consider potentially important cultural, societal, and relational factors that may further explain these results.
- ItemTHE LONGER-TERM IMPACT OF PERCEIVED DISCRIMINATION ON COUPLE RELATIONSHIP FUNCTIONING: EXAMINING PSYCHOLOGICAL AND PHYSIOLOGICAL PATHWAYS AMONG MIDDLE-AGED AND OLDER-AGED ADULTS IN THE UNITED STATES(2023) Du, Jingshuai; Quinn, Sandra SQ; Mittal, Mona MM; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The current study aimed to investigate the longer-term impact of everyday discrimination and major lifetime discrimination at Time 1 (T1; 2008 and 2010) on couple relationship functioning at Time 3 (T3; 2016 and 2018) across 8 years. It also aimed to explore if psychological (measured by depressive symptoms) and physiological stress responses (measured by allostatic load) at Time 2 (T2; 2012 and 2014) mediated the longitudinal association between discrimination and couple relationship functioning among middle-aged and older-aged adults in the United States (U.S.). To answer the study aims, I conducted a longitudinal mediation path analysis (N = 2,344) in Mplus Version 8 using data from the Health and Retirement Study, an ongoing national survey of the health and aging experience of U.S. adults aged 51 and older residing in the community. The primary longitudinal mediation model with control variables demonstrated good model fit (χ2 = 21.78, p < 0.01, CFI = 0.99, RMSEA = 0.04, SRMR = 0.01). The analysis results suggested that depressive symptoms at T2 significantly mediated the longitudinal association between the two types of discrimination and the two types of couple relationships spanning 8 years while controlling for race, age, gender, education, number of reasons for everyday discrimination and T1 assessments of couple support and couple strain. However, allostatic load was not found to be a significant mediator between the two types of discrimination and the two aspects of couple relationship functioning (couple support and couple strain). The direct relationship between discrimination (everyday and major lifetime discrimination) and couple relationship functioning (couple strain and couple support) was not significant either. The results from the multi-group analysis suggested that several structural paths differed significantly across gender, age groups, and number of reasons for everyday discrimination, but none of the paths differed significantly based on race. Overall, the current study did not find evidence supporting the pathway from perceived discrimination to couple relationship functioning through allostatic load. It provided evidence supporting depressive symptoms as a mediating mechanism between perceived discrimination and couple relationship functioning. Future work should develop innovative methods for assessing and measuring allostatic load to test its possible mediation role between perceived discrimination and couple relationship functioning. Moreover, effective and culturally-responsive interventions and programs are needed to decrease all types of discrimination and depression in order to improve couple relationship functioning among middled-aged and older-aged adults in the U.S.
- ItemInfluence of Latinx Fathers' Behaviors, Cognitions, Affect, and Family Congruence on Youth Energy Balance-Related Health Outcomes(2022) Rodriguez, Matthew Rene; Roy, Kevin; Hurtado Choque, Ghaffar Ali; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)For decades, researchers have studied and theorized about the ways fathers interact with children and other members of the family. While this research provides important evidence, few father involvement studies have included Latinx fathers. Numerous father involvement conceptual frameworks have helped us understand the ways fathers interact with their families. Much of this research has focused on fathers' behaviors, but research suggests other domains need more investigation, such as fathers' cognitions and affect. Understanding these additional domains of father involvement can provide important evidence for understanding the ways fathers influence the health of children. Fathers influence the health of their children within different cultural and socio-political contexts. When considering Latinx father involvement within a social determinants of health approach, research has encouraged focusing on upstream factors that can contribute to the health of Latinx families. Addressing these upstream factors can shape the health and wellbeing of children. Currently, Latinx youth suffer disproportionately from obesity compared to all other racial and ethnic groups in the U.S. Through investigating Latinx father involvement, I fill an important gap by researching the extent to which Latinx fathers' affect, behaviors, and cognitions shape youth health outcomes. I also investigate theorized moderators that may influence the relationship between fathers' involvement and youth health outcomes. Using a cross sectional study design with a community-based sample of Latinx fathers and youth (ages 10-14) (n=193), I use latent moderation structural analyses to test the theorized causal mechanisms.