Publications by authors named "Cindy A Crusto"

25 Publications

  • Page 1 of 1

Racial Discrimination, Mental Health, and Parenting Among African American Mothers of Preschool-Aged Children.

J Am Acad Child Adolesc Psychiatry 2021 Jun 18. Epub 2021 Jun 18.

Center for Research on People of Color, Columbia University School of Nursing, New York.

Objective: Indirect exposure to racism experienced by a caregiver (ie, vicarious racism) is associated with poor outcomes for children, but mechanisms of vicarious racism transmission are poorly understood. The purpose of this study was to examine the relationship between experiences of racial discrimination and parenting among African American mothers and to identify psychological mediators and moderators of this relationship.

Method: African American mothers (N = 250) with young children (mean age = 3.7 years old) reported on perceived racial discrimination (Race-Related Events Scale), parenting (Parenting Stress Index, Parenting Styles and Dimensions Questionnaire), coping (Coping Strategies Index), and mental health (Stress Overload Scale, Beck Depression Inventory). Multivariable linear regression was used to examine associations between perceived racial discrimination and parenting and to test coping as a moderator of these relationships. Ordinary least-squares regression-based path analysis with bootstrapping was used to examine mediation by stress overload and depressive symptoms.

Results: At least one experience of racial discrimination was reported by 57% of women. Experiences of racial discrimination were associated with increased parenting stress (β = 0.69, p = .02), and this relationship was mediated by stress overload (95% CI [0.35, 1.09]) and depressive symptoms (95% CI [0.27, 1.18]). Racial discrimination was not associated with parenting styles, and coping strategies largely did not moderate the relationships examined.

Conclusion: Racial discrimination has harmful intergenerational effects on African American children and families. Systemic-level interventions are needed, including adoption of policies to promote racial justice and eliminate structural racism in the United States. Future research on coping strategies specific to racism-related stress is needed to inform approaches to intervention.
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http://dx.doi.org/10.1016/j.jaac.2021.05.023DOI Listing
June 2021

The Influence of Discrimination and Coping Style on Blood Pressure Among Black/African American Women in the InterGEN Study.

Health Equity 2020 29;4(1):272-279. Epub 2020 Jun 29.

School of Nursing, Columbia University, New York, New York, USA.

Although research has explored the effects of racism on mental health, few studies have investigated the effects of racism on physical health. In this study, we examined the influence of racial discrimination and race-related stress and coping on blood pressure within a cohort of Black/African American women. This was a secondary data analysis of 226 Black/African American women from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study. Experiences of racial discrimination and coping, measured by the Experiences of Discrimination scale and the Race-Related Events Scale, were analyzed in relation to systolic blood pressure (SBP) and diastolic blood pressure (DBP). Multiple linear regression was used to explore the interaction effect of coping and discrimination on blood pressure for both scales. Age and elevated body mass index were associated with increased SBP and DBP, and low income was associated with increased DBP. Among individuals who reported no personal experience of discrimination, more active coping strategies were associated with higher DBP. There was no evidence of a relationship between type of coping strategies used and blood pressure among individuals who did report experiences of discrimination. Differences in coping strategy in response to racism were not found to have a significant moderating effect on DBP in Black/African American women.
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http://dx.doi.org/10.1089/heq.2019.0122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8175254PMC
June 2020

The Association Between Neighborhood Social Vulnerability and Cardiovascular Health Risk Among Black/African American Women in the InterGEN Study.

Nurs Res 2021 Jun 1. Epub 2021 Jun 1.

University of Minnesota, Minneapolis, MN Columbia University School of Nursing, New York, NY Yale School of Nursing, Orange, CT Yale School of Medicine, New Haven, CT University of Pretoria, South Africa Columbia University School of Nursing, New York, NY.

Background: Black/African American women in the United States are more likely to live in neighborhoods with higher social vulnerability than other racial/ethnic groups, even when adjusting for personal income. Social vulnerability, defined as the degree to which the social conditions of a community affect its ability to prevent loss and suffering in the event of disaster, has been used in research as an objective measure of neighborhood social vulnerability. Black/African American women also have the highest rates of hypertension and obesity in the U.S.

Objectives: The purpose of this study was to examine the relationship between neighborhood social vulnerability and cardiovascular risk (hypertension and obesity) among Black/African American women.

Methods: We conducted a secondary analysis of data from the InterGEN Study that enrolled Black/African American women in the Northeast United States. Participants' addresses were geocoded to ascertain neighborhood vulnerability using the Centers for Disease Control and Prevention's Social Vulnerability Index at the Census tract level. We used multivariable regression models to examine associations between objective measures of neighborhood quality and indicators of structural racism and systolic and diastolic blood pressure (BP) and obesity (body mass index >24.9), and to test psychological stress, coping, and depression as potential moderators of these relationships.

Results: Seventy-four percent of participating Black/African American women lived in neighborhoods in the top quartile for social vulnerability nationally. Women living in the top 10% of most socially vulnerable neighborhoods in our sample had more than a threefold greater likelihood of hypertension when compared to those living in less vulnerable neighborhoods. Objective neighborhood measures of structural racism (% poverty, % unemployment, % residents >25 years old without a high school diploma, and % residents without access to a vehicle) were significantly associated with elevated diastolic BP and obesity in adjusted models. Psychological stress had a significant moderating effect on the associations between neighborhood vulnerability and cardiovascular risk.

Discussion: We identified important associations between structural racism, the neighborhood environment, and cardiovascular health among Black/African American women. These findings add to a critical body of evidence documenting the role of structural racism in perpetuating health inequities and highlight the need for a multifaceted approach to policy, research, and interventions to address racial health inequities.
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http://dx.doi.org/10.1097/NNR.0000000000000523DOI Listing
June 2021

Associations between social determinants of health, perceived discrimination, and body mass index on symptoms of depression among young African American mothers.

Arch Psychiatr Nurs 2021 02 25;35(1):94-101. Epub 2020 Nov 25.

Columbia University School of Nursing and Center for Research on People of Color, 560 W 168th Street, Room 605, New York, New York 10032, United States of America. Electronic address:

Purpose: The association between symptoms of depression and risks for cardiovascular disease (CVD) remains equivocal for African American (AA) mothers. We examined the association between social determinants of health (perceived discrimination), and cardiovascular risk (BMI) on symptoms of depression in a sample of young AA mothers.

Methods: Secondary data from 219 adult AA mothers between the ages of 21 and 46 with an average BMI of 29.8 and yearly family income of $14,999 were analyzed using a latent growth model that evaluated four time points to assess changes in symptoms of depression.

Results: Initial BMI was significantly associated with initial symptoms of depression (b = 0.12, p = .019). Perceived discrimination (unfair treatment) was associated with higher initial symptoms of depression (b = 1.14, p = .017).

Conclusion: The findings suggest that elevated BMI and perceived discrimination are associated with higher reported symptoms of depression among young, socioeconomically disadvantaged AA mothers. These results advance the scientific understanding of young AA mothers' risk for symptoms of depression and CVD by elucidating the impact of perceived discrimination and social experiences on mental health. Further studies of SDoH and CVD risk factors and perceived racism and depression are needed to shed light on the long-term mental health impact on AA mothers and their children.
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http://dx.doi.org/10.1016/j.apnu.2020.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7890049PMC
February 2021

Examining Mother-Reported Poor Sleep and Blood Pressure in Black/African American Mother-Child Dyads.

J Cardiovasc Nurs 2021 Mar-Apr 01;36(2):116-123

Background: Poor sleep is a confirmed risk factor for hypertension (HTN), and Black/African American (AA) women have among the highest rates of HTN in the United States.

Objective: We examined the relationship between sleep and blood pressure (BP) among Black/AA mother-child dyads using data from the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure study.

Methods: Data for this study were derived from 250 Black/AA mother-child dyads from low-income neighborhoods, collected via 4 home visits over 2 years. Mothers reported poor sleep, including reports of sleeping worse than usual and nighttime awakenings. Recordings of BP were obtained for mother and child. Mother BP was scored as normal (<120/<80 mm Hg), elevated (120-129/<80 mm Hg), stage 1 HTN (130-139/80-89 mm Hg), or stage 2 HTN (systolic ≥140 or diastolic ≥90 mm Hg). Generalized linear models examined the relationships between mother-reported poor sleep variables and both mother and child BP. Adjusted models examining mother BP controlled for the mother's age, education, marital status, smoking, body mass index, and depression symptoms.

Results: In adjusted models, nighttime awakenings were associated with stage 2 HTN (b = 2.70, 95% confidence interval [CI], 0.54-4.86, P < .05). Compared with children whose mother who had normal BP, children whose mother had elevated BP had higher diastolic BP (b = 0.37; 95% CI, 0.19-0.54; P < .001). Mother elevated BP was associated with both child systolic BP (b = 2.49; 95% CI, 0.44-4.53; P < .05) and diastolic BP (b = 2.07; 95% CI, 0.39-3.76; P < .05). Mother stage 1 HTN was associated with both child systolic BP (b = 2.16; 95% CI, 0.29-4.03; P < .05) and diastolic BP (b = 3.91; 95% CI, 2.40-5.42; P < .001). We detected a significant interaction between mother stage 2 HTN and mother nighttime awakenings in predicting higher child diastolic BP (b = 8.16; 95% CI, 0.65-15.68; P < .05).

Conclusions: We found evidence for an association between mothers' nighttime awakenings and very high BP. Our study also illuminated a strong relationship between high mother BP and high child BP. Finally, our study found preliminary support for the potentially mediating role of mothers' nighttime awakenings in predicting the relationship between mother stage 2 HTN and child BP.
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http://dx.doi.org/10.1097/JCN.0000000000000749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878358PMC
October 2020

Association of Obesity with DNA Methylation Age Acceleration in African American Mothers from the InterGEN Study.

Int J Mol Sci 2019 Aug 31;20(17). Epub 2019 Aug 31.

Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA.

African American women are affected by earlier onset of age-associated health deteriorations and obesity disproportionally, but little is known about the mechanism linking body mass index (BMI) and biological aging among this population. DNA methylation age acceleration (DNAm AA), measuring the difference between DNA methylation age and chronological age, is a novel biomarker of the biological aging process, and predicts aging-related disease outcomes. The present study estimated cross-tissue DNA methylation age acceleration using saliva samples from 232 African American mothers. Cross-sectional regression analyses were performed to assess the association of BMI with DNAm AA. The average chronological age and DNA methylation age were 31.67 years, and 28.79 years, respectively. After adjusting for smoking, hypertension diagnosis history, and socioeconomic factors (education, marital status, household income), a 1 kg/m increase in BMI is associated with 0.14 years increment of DNAm AA (95% CI: (0.08, 0.21)). The conclusion: in African American women, high BMI is independently associated with saliva-based DNA methylation age acceleration, after adjusting for smoking, hypertension, and socioeconomic status. This finding supports that high BMI accelerates biological aging, and plays a key role in age-related disease outcomes among African American women.
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http://dx.doi.org/10.3390/ijms20174273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747309PMC
August 2019

Risk and Protective Factors for Alcohol, Marijuana, and Cocaine Use Among Child Welfare-Involved Youth.

Child Youth Serv Rev 2018 Dec 26;95:88-94. Epub 2018 Sep 26.

Human Development and Family Studies, Pennsylvania State University.

Youth involved in child welfare services (CWS) are at elevated risk for substance use. CWS involvement may provide an opportunity for intervention to prevent subsequent use; however, little is known about mitigating substance use risk in this population. Using data from the second National Survey of Child and Adolescent Well-Being (NSCAW II), the present study examined individual, psychological, and contextual risk factors (e.g., prior substance use, depression, posttraumatic stress, maltreatment experiences) and protective factors (e.g., caregiver monitoring, peer relationships) following CWS involvement (Wave 1) in relation to alcohol, marijuana, and cocaine use 36 months later (Wave 3). The nationally-representative sample of CWS-involved youth was restricted to individuals who were aged 11 years or older at Wave 1 and had at least a partial interview at Wave 3 ( = 763). Three logistic regression models showed that Wave 1 substance use increased the likelihood of marijuana and cocaine use at Wave 3 [marijuana = 1.41 (1.19-1.68); cocaine = 1.26 (1.07-1.50)] but not binge alcohol use [ = 1.44 (0.95-2.19)]. Other risk and protective factors had limited predictive value for Wave 3 substance use. The present findings suggest that initiating substance use prior to or at the time of CWS involvement is a critical risk factor for later substance use. Substance use screening and referral to treatment is imperative for CWS-involved youth.
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http://dx.doi.org/10.1016/j.childyouth.2018.09.037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588184PMC
December 2018

Perceived Racial Discrimination and DNA Methylation Among African American Women in the InterGEN Study.

Biol Res Nurs 2018 03 19;20(2):145-152. Epub 2017 Dec 19.

1 Yale School of Nursing, Orange, CT, USA.

Introduction: Experiences of racial discrimination have been associated with poor health outcomes. Little is known, however, about how perceived racial discrimination influences DNA methylation (DNAm) among African Americans (AAs). We examined the association of experiences of discrimination with DNAm among AA women in the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study.

Methods: The InterGEN study examines the effects of genetic and psychological factors on blood pressure among AA women and their children. Measures include the Major Life Discrimination (MLD) and the Race-Related Events (RES) scales. In the present analysis, we examined discrimination and DNAm at baseline in the InterGEN study. The 850K EPIC Illumina BeadChip was used for evaluating DNAm in this epigenome-wide association study (EWAS).

Results: One hundred and fifty-two women contributed data for the RES-EWAS analysis and 147 for the MLD-EWAS analysis. Most were 30-39 years old, nonsmokers, had some college education, and had incomes
Conclusion: We observed significant epigenetic associations between disease-associated genes (e.g., schizophrenia, bipolar disorder, and asthma) and perceived discrimination as measured by the MLD Scale. Future health disparities research should include epigenetics in high-risk populations to elucidate functional consequences induced by the psychosocial environment.
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http://dx.doi.org/10.1177/1099800417748759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741522PMC
March 2018

Video Game Intervention for Sexual Risk Reduction in Minority Adolescents: Randomized Controlled Trial.

J Med Internet Res 2017 09 18;19(9):e314. Epub 2017 Sep 18.

play2PREVENT Lab, Yale School of Medicine, Yale University, New Haven, CT, United States.

Background: Human immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed.

Objective: We hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents.

Methods: Participants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age.

Results: A total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56).

Conclusions: An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months.

Trial Registration: Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0).
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http://dx.doi.org/10.2196/jmir.8148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5625130PMC
September 2017

Reflections on a Community Psychology Setting and the Future of the Field.

Am J Community Psychol 2016 12 24;58(3-4):348-353. Epub 2016 Nov 24.

The Consultation Center, Division of Prevention and Community Research, Yale University School of Medicine, New Haven, CT, USA.

The 50th anniversary of the Swampscott Conference offers an opportunity to reflect on a community psychology setting, The Consultation Center at Yale, that was formed in response to the 1963 Community Mental Health Act and the 1965 Swampscott Conference. The Center has flourished as a community psychology setting for practice, research, and training for 39 of the 50 years since Swampscott. Its creation and existence over this period offers an opportunity for reflection on the types of settings needed to sustain the field into the future.
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http://dx.doi.org/10.1002/ajcp.12108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497455PMC
December 2016

A Systematic Review of DNA Methylation and Preterm Birth in African American Women.

Biol Res Nurs 2017 May 19;19(3):308-317. Epub 2016 Sep 19.

1 Yale School of Nursing, Orange, CT, USA.

Background: The causes of many cases of preterm birth (PTB) remain enigmatic. Increased understanding of how epigenetic factors are associated with health outcomes has resulted in studies examining DNA methylation (DNAm) as a contributing factor to PTB. However, few studies on PTB and DNAm have included African American women, the group with the highest rate of PTB.

Methods: The objective of this review was to systematically analyze the existing studies on DNAm and PTB among African American women.

Results: Studies ( N = 10) were limited by small sample size, cross-sectional study designs, inconsistent methodologies for epigenomic analysis, and evaluation of different tissue types across studies. African Americans comprised less than half of the sample in 50% of the studies reviewed. Despite these limitations, there is evidence for an association between DNAm patterns and PTB.

Conclusions: Future research on DNAm patterns and PTB should use longitudinal study designs, repeated DNAm testing, and a clinically relevant definition of PTB and should include large samples of high-risk African American women to better understand the mechanisms for PTB in this population.
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http://dx.doi.org/10.1177/1099800416669049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357599PMC
May 2017

The Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure Study (InterGEN): Design and Methods for Recruitment and Psychological Measures.

Nurs Res 2016 Jul-Aug;65(4):331-8

Cindy A. Crusto, PhD, is Associate Professor, Yale School of Medicine, New Haven, Connecticut, and Department of Psychology, University of Pretoria, South Africa. Veronica Barcelona de Mendoza, PhD, MSN, RN, APHN-BC, is Post-Doctoral Associate, Yale School of Nursing, Orange, Connecticut. Christian M. Connell, PhD, is Associate Professor, Yale School of Medicine, New Haven, Connecticut. Yan V. Sun, PhD, is Assistant Professor of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia. Jacquelyn Y. Taylor, PhD, PNP-BC, RN, FAHA, FAAN, is Associate Professor, Yale School of Nursing, Orange, Connecticut.

Background: Although studies show that genomics and environmental stressors affect blood pressure, few studies have examined their combined effects, especially in African Americans.

Objective: We present the recruitment methods and psychological measures of the Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study, which seeks to investigate the individual and combined effects of genetic (G) and environmental (E) (psychological) stressors on blood pressure in African American mother-child dyads. Genetic methods are presented elsewhere, but here we present the recruitment methods, psychological measures, and analysis plan for these environmental stressors.

Methods: This longitudinal study will enroll 250 mother-child dyads (N = 500). Study participation is restricted to women who (a) are ≤21 years of age, (b) self-identify as African American or Black, (c) speak English, (d) do not have an identified mental illness or cognitive impairment, and (e) have a biological child between 3 and 5 years old. The primary environmental stressors assessed are parenting stress, perceived racism and discrimination, and maternal mental health. Covariates include age, cigarette smoking (for mothers), and gender (for children). The study outcome variables are systolic and diastolic blood pressure.

Analysis: The main analytic outcome is genetic-by-environment interaction analyses (G × E); however, main effects (G) and (E) will be individually assessed first. Genetic (G) and interaction analyses (G × E) are described in a companion paper and will include laboratory procedures. Statistical modeling of environmental stressors on blood pressure will be done using descriptive statistics and generalized estimating equation models.

Implications: The methodology presented here includes the study rationale, community engagement and recruitment protocol, psychological variable measurement, and analysis plan for assessing the association of environmental stressors and blood pressure. This study may provide the foundation for other studies and development of interventions to reduce the risk for hypertension and to propose targeted health promotion programs for this high-risk population.
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http://dx.doi.org/10.1097/NNR.0000000000000163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930011PMC
May 2017

If We Build It, Will They Come? A Qualitative Study of Key Stakeholder Opinions on the Implementation of a Videogame Intervention for Risk Reduction in Adolescents.

Games Health J 2016 Aug 23;5(4):279-85. Epub 2016 Jun 23.

1 play2PREVENT Laboratory, Yale School of Medicine , New Haven, Connecticut.

Objective: Serious games are emerging as important tools that offer an innovative approach to teach adolescents behavioral skills to avoid risky situations. PlayForward: Elm City Stories, an interactive videogame targeting risk reduction, is currently undergoing evaluation. Collecting stakeholder data on its acceptability and real-life implementation strategies is critical for successful dissemination.

Materials And Methods: We collected interview data from four stakeholder groups regarding incorporating PlayForward into settings with adolescents. Transcripts were coded, creating a comprehensive code structure for each stakeholder group.

Results: We conducted 40 semi-structured interviews that included 14 adolescents (aged 12-15 years; 10 boys), eight parents/guardians (all women), 12 after-school/school coordinators (nine women), and 14 community partners (13 women). We identified four themes that reflected stakeholders' perceptions about how the videogame might be implemented in real-world settings. (1) Stakeholder groups expressed that the topics of sex, alcohol, and drugs were not being taught in an educational setting. (2) Stakeholder groups saw a videogame as a viable option to teach about sex, alcohol, and drugs. (3) Stakeholder groups thought that the videogame would fit well into other settings, such as after-school programs or community organizations. (4) Some stakeholder groups highlighted additional tools that could help with implementation, such as manuals, homework assignments, and group discussion questions.

Conclusion: Stakeholder groups supported the game as a delivery vehicle for targeted content, indicating high acceptability but highlighting additional tools that would aid in implementation.
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http://dx.doi.org/10.1089/g4h.2015.0092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991582PMC
August 2016

The Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) Study: Design and Methods for Complex DNA Analysis.

Biol Res Nurs 2016 10 26;18(5):521-30. Epub 2016 Apr 26.

School of Medicine, Emory University, Atlanta, GA, USA.

The Intergenerational Impact of Genetic and Psychological Factors on Blood Pressure (InterGEN) study aims to delineate the independent and interaction effects of genomic (genetic and epigenetic) and psychological-environmental (maternally perceived racial discrimination, mental health, and parenting behavior) factors on blood pressure (BP) among African American mother-child dyads over time. The purpose of this article is to describe the two-step genetic and epigenetic approach that will be executed to explore Gene × Environment interactions on BP using a longitudinal cohort design. Procedure for the single collection of DNA at Time 1 includes the use of the Oragene 500-format saliva sample collection tube, which provides enough DNA for both the Illumina Multi-Ethnic Genotyping and 850K EPIC methylation analyses. BP readings, height, weight, percentage of body fat, and percentage of body water will be measured on all participants every 6 months for 2 years for a total of 4 time points. Genomic data analyses to be completed include multivariate modeling, assessment of population admixture and structure, and extended analyses including Bonferroni correction, false discovery rate methods, Monte Carlo approach, EIGENSTRAT methods, and so on, to determine relationships among both main and interaction effects of genetic, epigenetic, and psychological environmental factors on BP.
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http://dx.doi.org/10.1177/1099800416645399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025343PMC
October 2016

Building Capacity for Trauma-Informed Care in the Child Welfare System: Initial Results of a Statewide Implementation.

Child Maltreat 2016 05 28;21(2):113-24. Epub 2016 Feb 28.

Division of Prevention & Community Research and The Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.

Exposure to childhood trauma is a major public health concern and is especially prevalent among children in the child welfare system (CWS). State and tribal CWSs are increasingly focusing efforts on identifying and serving children exposed to trauma through the creation of trauma-informed systems. This evaluation of a statewide initiative in Connecticut describes the strategies used to create a trauma-informed CWS, including workforce development, trauma screening, policy change, and improved access to evidence-based trauma-focused treatments during the initial 2-year implementation period. Changes in system readiness and capacity to deliver trauma-informed care were evaluated using stratified random samples of child welfare staff who completed a comprehensive assessment prior to (N = 223) and 2 years following implementation (N = 231). Results indicated significant improvements in trauma-informed knowledge, practice, and collaboration across nearly all child welfare domains assessed, suggesting system-wide improvements in readiness and capacity to provide trauma-informed care. Variability across domains was observed, and frontline staff reported greater improvements than supervisors/managers in some domains. Lessons learned and recommendations for implementation and evaluation of trauma-informed care in child welfare and other child-serving systems are discussed.
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http://dx.doi.org/10.1177/1077559516635273DOI Listing
May 2016

Children exposed to the arrest of a family member: Associations with mental health.

J Child Fam Stud 2014 Feb;23(2):214-244

Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT.

The arrest of a parent or other family member can be detrimental to children's health. To study the impact of exposure to the arrest of a family member on children's mental health and how said association may change across developmental periods, we examined baseline data for children (birth through 11 years) entering family-based systems of care (SOC). Children exposed to the arrest of a family member had experienced significantly more 5.38 ( = 2.59) different types of potentially traumatic events (PTE) than children not exposed to arrest 2.84 ( = 2.56). Multiple regression model results showed that arrest exposure was significantly associated with greater behavioral and emotional challenges after controlling for children's age, gender, race/ethnicity, household income, caregiver's education, parenting factors, and other PTE exposure. Further analyses revealed differences in internalizing and externalizing behaviors associated with arrest exposure across developmental levels. This study highlights some of the mental health challenges for children exposed to the arrest of a family member, while adding to our knowledge of how such an event affects children across different developmental periods. More trauma-informed, developmentally appropriate systems need to be in place at all levels to assist children and families experiencing arrest.
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http://dx.doi.org/10.1007/s10826-013-9717-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4016966PMC
February 2014

Health, emergency department use, and early identification of young children exposed to trauma.

J Emerg Med 2014 May 22;46(5):719-24. Epub 2014 Feb 22.

Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.

Background: Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency departments (EDs) are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters).

Study Objectives: Describe the prevalence of physical health symptoms, ED use, and health-related problems in young children (birth through 5 years) affected by trauma, and to predict whether or not children experiencing trauma are more likely to be affected by health-related problems.

Methods: Community-based, cross-sectional survey of 208 young children. Traumatic events were assessed by the Traumatic Events Screening Inventory - Parent Report Revised. Child health symptoms and health-related problems were measured using the Caregiver Information Questionnaire, developed by ORC Macro (Atlanta, GA).

Results: Seventy-two percent of children had experienced at least one type of traumatic event. Children exposed to trauma were also experiencing recent health-related events, including visits to the ED (32.2%) and the doctor (76.9%) for physical health symptoms, and recurring physical health problems (40.4%). Children previously exposed to high levels of trauma (four or more types of events) were 2.9 times more likely to report having had recently visited the ED for health purposes.

Conclusions: Preventing recurrent trauma or recognizing early trauma exposure is difficult, but essential if long-term negative consequences are to be mitigated or prevented. Within EDs, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury, and mortality.
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http://dx.doi.org/10.1016/j.jemermed.2013.11.086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004686PMC
May 2014

The role of parenting stress in young children's mental health functioning after exposure to family violence.

J Trauma Stress 2013 Oct 13;26(5):605-12. Epub 2013 Sep 13.

Department of Psychiatry, Yale School of Medicine, The Consultation Center, Yale University, New Haven, Connecticut, USA.

This study evaluates the associations of young children's exposure to family violence events, parenting stress, and children's mental health functioning. Caregivers provided data for 188 children ages 3 to 5 years attending Head Start programming. Caregivers reported 75% of children had experienced at least 1 type of trauma event, and 27% of children had experienced a family violence event. Child mental health functioning was significantly associated with family violence exposure after controlling for children's age, gender, household income, and other trauma exposure (β = .14, p = .033). Stress in the parenting role partially mediated the relationship between family violence exposure and young children's mental health functioning (β = .12, p = .015, 95% confidence interval [0.02, 0.21]). Interventions for young children exposed to family violence should address the needs of the child, as well as the caregiver while also building healthy parent-child relationships to facilitate positive outcomes in children faced with trauma.
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http://dx.doi.org/10.1002/jts.21842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081031PMC
October 2013

Exposure to traumatic events and the behavioral health of children enrolled in an early childhood system of care.

J Trauma Stress 2012 Dec;25(6):700-4

Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA.

Children may be exposed to numerous types of traumatic events that can negatively affect their development. The scope to which studies have examined an array of events among young children has been limited, thereby restricting our understanding of exposure and its relationship to behavioral functioning. The current cross-sectional study describes traumatic event exposure in detail and its relationship to behavioral health among an at-risk sample of young children (N = 184), under 6 years of age, upon enrollment into an early childhood, family-based, mental health system of care. Caregivers completed home-based semistructured interviews that covered children's exposure to 24 different types of traumatic events and behavioral and emotional functioning. Findings indicated that nearly 72% of young children experienced 1 or more types of traumatic events. Multiple regression model results showed that exposure was significantly associated with greater behavioral and emotional challenges with children's age, gender, race/ethnicity, household income, and caregiver's education in the model. These findings highlight the prevalence of traumatic exposures among an at-risk sample of young children in a system of care and suggest that this exposure is associated with behavioral and emotional challenges at a young age.
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http://dx.doi.org/10.1002/jts.21756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3526816PMC
December 2012

Exposure to traumatic events and health-related quality of life in preschool-aged children.

Qual Life Res 2013 Oct 7;22(8):2159-68. Epub 2012 Dec 7.

Department of Psychiatry, Yale School of Medicine, The Consultation Center, Yale University, New Haven, CT, 06511, USA,

Purpose: To examine the association of lifetime exposure to traumatic events with health-related quality of life (HRQOL) and psychosocial health in children aged 3 through 5 years.

Methods: This study is a community-based, cross-sectional survey of 170 children and their parents. Traumatic events were assessed by the Traumatic Events Screening Inventory-Parent Report Revised using criteria for potentially traumatic events in young childhood outlined by the Zero to Three working group. HRQOL of young children was measured using the 97-item Infant/Toddler Quality of Life Questionnaire, and psychosocial health was measured using the Child Behavior Checklist 1.5-5.

Results: One hundred and twenty-three (72 %) of children had experienced at least one type of trauma event. Children who had been exposed to 1-3 types of trauma and those exposed to 4 or more types of trauma had significantly worse HRQOL and psychosocial health than children not exposed to trauma. Significant effect sizes between children exposed to low levels or high levels of traumatic events and children not exposed to trauma ranged from small to large.

Conclusions: Exposure to traumatic events in early childhood is associated with less positive HRQOL and psychosocial health. Cumulative trauma exposure led to significant effects in outcome variables in this population. Interventions to decrease trauma exposure and to reduce significant stress in early childhood associated with exposure to trauma may be appropriate strategies for preventing negative health conditions throughout the life span.
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http://dx.doi.org/10.1007/s11136-012-0330-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616160PMC
October 2013

Traumatic Impact of Familial Arrest on Young Children.

J Trauma Treat 2012 Oct;1

Division of Community and Prevention Research, Yale University School of Medicine.

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http://dx.doi.org/10.4172/2167-1222.1000e108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4233657PMC
October 2012

Creating a safe space to learn: The significant role of graduate students in fostering educational engagement and aspirations among urban youth.

Community Psychol 2011 ;44(1):33-36

Yale University School of Medicine, Department of Psychiatry, Division of Prevention & Community Research.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123117PMC
January 2011

Posttraumatic stress among young urban children exposed to family violence and other potentially traumatic events.

J Trauma Stress 2010 Dec 30;23(6):716-24. Epub 2010 Nov 30.

Department of Psychiatry, Division of Prevention and Community Research, Yale University School of Medicine, New Haven, CT, USA.

This study examines the relationship between the number of types of traumatic events experienced by children 3 to 6 years old, parenting stress, and children's posttraumatic stress (PTS). Parents and caregivers provided data for 154 urban children admitted into community-based mental health or developmental services. By parent and caregiver report, children experienced an average of 4.9 different types of potentially traumatic events. Nearly one quarter of the children evidenced clinically significant PTS. Posttraumatic stress was positively and significantly related to family violence and other family-related trauma exposure, nonfamily violence and trauma exposure, and parenting stress. Additionally, parenting stress partially mediated the relationship between family violence and trauma exposure and PTS. This study highlights the need for early violence and trauma exposure screening in help-seeking populations so that appropriate interventions are initiated.
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http://dx.doi.org/10.1002/jts.20590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098710PMC
December 2010

Measuring changes in interagency collaboration: an examination of the Bridgeport Safe Start Initiative.

Eval Program Plann 2007 Aug 19;30(3):294-306. Epub 2007 Apr 19.

Division of Prevention and Community Research, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA.

This paper describes the evaluation of interagency collaboration in a network of child-serving providers as part of the evaluation of the Bridgeport Safe Start Initiative (BSSI). In line with the system of care approach, the objectives of BSSI included reducing fragmentation of efforts and delivering integrated services to families of young children exposed to or at risk of exposure to family violence. Interagency collaboration was examined via social network and focus group data collected at three time points starting at baseline. Network analysis findings suggest that over time the network structure became consistent with BSSI's vision of an ideal collaborative network structure. Focus group findings, however, present a more complex picture of the status of collaboration. This paper sheds light on approaches and challenges to measuring interagency collaboration in a service delivery system and communicating social network analysis findings to stakeholders in a way that is accessible and useful.
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http://dx.doi.org/10.1016/j.evalprogplan.2007.04.001DOI Listing
August 2007

Utilizing program evaluation as a strategy to promote community change: evaluation of a comprehensive, community-based, family violence initiative.

Am J Community Psychol 2006 Dec;38(3-4):191-200

The Division of Prevention and Community Research and The Consultation Center, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT 06511, USA.

This paper describes the authors' work in a community that received Federal funding for an integrated system of care to reduce the impact and incidence of exposure to violence for children less than six years of age. The paper includes a review of the conceptual framework that guided the work of the authors and provides a brief overview of the issue of family violence, the impact of this violence on young children, and the Federal response to this issue. In addition, a description of the Initiative and the community in which it was based is provided along with some aspects of the evaluation plan. Finally, the authors discuss how their work with this Initiative depicts an approach to facilitating change within communities.
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http://dx.doi.org/10.1007/s10464-006-9086-8DOI Listing
December 2006
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