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In the context of multiple adversities, women are demonstrating resilience in rebuilding their futures, through participation in microfinance programs. In addition to the economic benefits of microfinance, there is evidence to suggest that it is an effective vehicle for improving health. The parent study is a community-based trial to evaluate the effectiveness of a livestock microfinance intervention, Pigs for Peace (PFP), on health and economic outcomes with households in 10 villages in eastern Democratic Republic of Congo. The analysis for this manuscript includes only baseline data from female participants enrolled in the ongoing parent study. Multiple regression analysis was used to examine if livestock/animal asset value moderates the relationship between conflict-related traumatic events and current mental health symptoms. The majority of women are 25 years or older, married, have on average 4 children in the home and have never attended school. Nearly 50% of women report having at least one livestock/animal asset at baseline. Over the past 10 years, women report on average more than 4 (M = 4.31, SD 3·64) traumatic events (range 0-18). Women reported symptoms consistent with PTSD with a mean score of ·2.30 (SD = 0·66 range 0-4) and depression with a mean score of 1.86 (SD = 0·49, range 0-3.47). The livestock/animal asset value by conflict-related traumatic events interaction was significant for both the PTSD (p = 0·021) and depression (p = 0·002) symptom models. The study provides evidence of the moderating affect of livestock/animal assets on mental health symptoms for women who have experienced conflict. The findings supports evidence about the importance of livestock/animal assets to economics in rural households but expands on previous research by demonstrating the psychosocial effects of these assets on women's health. clinicaltrials.gov NCT02008708.

Objectives. To evaluate the effectiveness of the Safety and Health Involvement For Truckers (SHIFT) intervention with a randomized controlled design. Methods. The multicomponent intervention was a weight-loss competition supported with body weight and behavioral self-monitoring, computer-based training, and motivational interviewing. We evaluated intervention effectiveness with a cluster-randomized design involving 22 terminals from 5 companies in the United States in 2012 to 2014. Companies were required to provide interstate transportation services and operate at least 2 larger terminals. We randomly assigned terminals to intervention or usual practice control conditions. We assessed participating drivers (n = 452) at baseline and 6 months. Results. In an intent-to-treat analysis, the postintervention difference between groups in mean body mass index change was 1.00 kilograms per meters squared (P < .001; intervention = −0.73; control = +0.27). Behavioral changes included statistically significant improvements in fruit and vegetable consumption and physical activity. Conclusions. Results establish the effectiveness of a multicomponent and remotely administered intervention for producing significant weight loss among commercial truck drivers.

Research on the role of social support in recovery from severe mental illness is limited and even more limited is research on the potential effects of participating in various activities. This study explores these relationships by analyzing baseline data from a 153-participant subsample in the Study of Transitions and Recovery Strategies. Higher scores on the recovery assessment scale were related to both social support/network size and engagement in more activities. The particular nature of the activities (more/less social, more/less physically active, inside/outside the home) was not important, rather, activities of any type were related to recovery. Furthermore, engagement in activities was more important as levels of social support declined. The results suggest that both social support and activities may promote recovery, and that for persons with poor social support, engagement in a variety of individualized activities may be particularly beneficial.

Background Consumer-driven homecare models support aging and disabled individuals to live independently through the services of homecare workers. Although these models have benefits, including autonomy and control over services, little evidence exists about challenges homecare workers may face when providing services, including workplace violence and the negative outcomes associated with workplace violence. This study investigates the prevalence of workplace violence among homecare workers and examines the relationship between these experiences and homecare worker stress, burnout, depression, and sleep. Methods We recruited female homecare workers in Oregon, the first US state to implement a consumer driven homecare model, to complete an on-line or telephone survey with peer interviewers. The survey asked about demographics and included measures to assess workplace violence, fear, stress, burnout, depression and sleep problems. Results Homecare workers (n = 1,214) reported past-year incidents of verbal aggression (50.3% of respondents), workplace aggression (26.9%), workplace violence (23.6%), sexual harassment (25.7%), and sexual aggression (12.8%). Exposure was associated with greater stress (p < .001), depression (p < .001), sleep problems (p < .001), and burnout (p < .001). Confidence in addressing workplace aggression buffered homecare workers against negative work and health outcomes. Conclusions To ensure homecare worker safety and positive health outcomes in the provision of services, it is critical to develop and implement preventive safety training programs with policies and procedures that support homecare workers who experience harassment and violence.

Context: Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity-oriented health care (EOHC) is widely assumed to lead to improvements in patients' health outcomes, little empirical evidence supports this claim. To remedy this, we tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship. Methods: Our analysis uses longitudinal data from 395 patients recruited from 4 primary health care clinics serving people living in marginalizing conditions. The participants completed 4 structured interviews composed of self-report measures and survey questions over a 2-year period. Using path analysis techniques, we tested a hypothesized model of the process through which patients' perceptions of EOHC led to improvements in self-reported health outcomes (quality of life, chronic pain disability, and posttraumatic stress [PTSD] and depressive symptoms), including particular covariates of health outcomes (age, gender, financial strain, experiences of discrimination). Findings: Over a 24-month period, higher levels of EOHC predicted greater patient comfort and confidence in the health care patients received, leading to increased confidence to prevent and manage their health problems, which, in turn, improved health outcomes (depressive symptoms, PTSD symptoms, chronic pain, and quality of life). In addition, financial strain and experiences of discrimination had significant negative effects on all health outcomes. Conclusions: This study is among the first to demonstrate empirically that providing more EOHC predicts better patient health outcomes over time. At a policy level, this research supports investments in equity-focused organizational and provider-level processes in primary health care as a means of improving patients' health, particularly for those living in marginalizing conditions. Whether these results are robust in different patient groups and across a broader range of health care contexts requires further study.

Minimal research has been conducted on the simultaneous influence of multiple metalinguistic, linguistic, and processing skills that may impact literacy development in children who are in the process of learning to read and write. In this study, we assessed the phonemic awareness, morphological awareness, orthographic awareness, receptive vocabulary, and rapid naming abilities of second and third grade students ( N  = 56) and determined how these abilities predicted the children’s reading and spelling skills. Regression analyses revealed that morphological awareness was the sole unique contributor to spelling and, together with orthographic awareness, uniquely contributed to word recognition. Morphological awareness also was significantly related to reading comprehension. The results add to a growing literature base providing evidence that early literacy development is influenced by morphological awareness, an ability that has received considerably less educational attention. Additionally, the findings point to the importance of tapping into multiple sources of metalinguistic knowledge when providing instruction in reading and spelling.

The relationship between work-to-family conflict and family-to-work conflict was tested using a longitudinal research design with 234 dual-earner couples caring for both children and aging parents. Two waves of mailed survey data were collected. The mediating effects of role-related satisfaction were hypothesized to link these two forms of work-family conflict. The analytical steps for determining mediating effects followed suggestions by Baron and Kenny (1986). The results failed to show significant mediating effects of role-related satisfaction between the two forms of conflict over time for both husbands and wives, contrary to suggestions by Frone, Yardley, and Markel (1997). Instead, positive, direct relationships between the two types of work-family conflict were found. Limitations and implications are discussed. [PUBLICATION ABSTRACT]

BackgroundHumanitarian emergencies increase the risk of gender-based violence (GBV). We estimated the prevalence of GBV victimisation and perpetration among women and men in urban settings across Somalia, which has faced decades of war and natural disasters that have resulted in massive population displacements.MethodsA population-based survey was conducted in 14 urban areas across Somalia between December 2014 and November 2015.ResultsA total of 2376 women and 2257 men participated in the survey. One in five men (22.2%, 95% CI 20.5 to 23.9) and one in seven (15.5%; 95% CI 14.1 to 17.0) women reported physical or sexual violence victimisation during childhood. Among women, 35.6% (95% CI 33.4 to 37.9) reported adult lifetime experiences of physical or sexual intimate partner violence (IPV) and 16.5% (95% CI 15.1 to 18.1) reported adult lifetime experience of physical or sexual non-partner violence (NPV). Almost one-third of men (31.2%; 95% CI 29.4 to 33.1) reported victimisation as an adult, the majority of which was physical violence. Twenty-two per cent (21.7%; 95% CI 19.5 to 24.1) of men reported lifetime sexual or physical IPV perpetration and 8.1% (95% CI 7.1 to 9.3) reported lifetime sexual or physical NPV perpetration. Minority clan membership, displacement, exposure to parental violence and violence during childhood were common correlates of IPV and NPV victimisation and perpetration among women and men. Victimisation and perpetration were also strongly associated with recent depression and experiences of miscarriage or stillbirth.ConclusionGBV is prevalent and spans all regions of Somalia. Programmes that support nurturing environments for children and provide health and psychosocial support for women and men are critical to prevent and respond to GBV.

This study examined early care and education (ECE) providers' routine and pandemic-related use of digital technology for nutrition training and explored their attitudes and perceptions toward digital technology using the Technology Acceptance Model as a guiding framework to inform future training delivery. We employed a convergent mixed-methods design consisting of a national survey and semi-structured qualitative interviews with licensed ECE providers. Inclusion criteria were licensed/registered ECE providers, English-speaking, age ≥18, and currently caring for children for pay. Exclusion criteria included unlicensed providers and inactive programs. Survey data was analyzed using chi-square tests to examine differences by variable type and logistic regressions to examine predictors of digital technology use. Qualitative analysis underwent thematic analysis using a blended deductive/inductive approach guided by the Braun and Clarke multi-step method. Integrated analyses were conducted and shown through a joint display to contextualize the findings. Most ECE providers (97.9%) had access to high-speed internet, and 95.1% used electronic devices for work-related purposes. Approximately 83.2% had received nutrition training since the COVID-19 pandemic began, with 53.2% accessing training via virtual platforms. ECE providers enrolled in the Child and Adult Care Food Program were more likely to receive nutrition training digitally than those not enrolled (OR = 24.0, p < .001). As ECE providers' age increases, the odds of receiving training digitally decreased (OR = 0.52, p = .043). Providers reported that digital training improved accessibility and flexibility. However, the study also identified challenges such as reduced social connectedness, technical difficulties, and limited knowledge or awareness of digital nutrition training programming. Findings suggest that digital technology enhances access to nutrition training for ECE providers, yet barriers remain. Future efforts should focus on expanding digital training programming, improving technological support, and balancing digital and in-person training to optimize hands-on learning and social connectedness.

OBJECTIVE:The objectives of the study were to describe a sample of truck drivers, identify clusters of drivers with similar patterns in behaviors affecting energy balance (sleep, diet, and exercise), and test for cluster differences in health safety, and psychosocial factors. METHODS:Participants’ (n = 452, body mass index M = 37.2, 86.4% male) self-reported behaviors were dichotomized prior to hierarchical cluster analysis, which identified groups with similar behavior covariation. Cluster differences were tested with generalized estimating equations. RESULTS:Five behavioral clusters were identified that differed significantly in age, smoking status, diabetes prevalence, lost work days, stress, and social support, but not in body mass index. Cluster 2, characterized by the best sleep quality, had significantly lower lost workdays and stress than other clusters. CONCLUSIONS:Weight management interventions for drivers should explicitly address sleep, and may be maximally effective after establishing socially supportive work environments that reduce stress exposures.