Theses and Dissertations - School of Social Work

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    Psychosocial Needs of US Active Duty Military Service Members and Spouses with Cancer: a Qualitative Study
    (University of Alabama Libraries, 2021) Godfrey, Kelli; Albright, David L.; Csikai, Ellen L.; University of Alabama Tuscaloosa
    Current United States active duty military (AD) service members and spouses are at an increased risk of developing various types of cancer at a higher rate reported than their military predecessors (Defense Health Research Programs, 2017; Zhu et al., 2009; Steinmaus, Lu, Todd, & Smith, 2004). Active duty service members and spouses also face challenges not faced by their civilian counterparts because of the military lifestyle and “mission first” culture. These challenges can include being geographically separated from families, friends, and other support systems, along with deployments, frequent moves, and the lack of consistent support systems. Therefore, when AD service members and spouses are diagnosed with cancer psychosocial needs may not be met. The research and literature surrounding the psychosocial needs of AD military service members and spouses with cancer are limited as the current research focuses mainly on non-military affiliated groups or veterans. The purpose of this qualitative research was to understand the psychosocial needs of US AD service members and spouses diagnosed with cancer. Data from semi-structured interviews provided insight that facilitated understanding these psychosocial needs. Participants discussed support systems, relationships, psychological and emotional responses, and ways the military environment both supported and lacked support during their cancer journey. Participants further noted that some of the barriers included not knowing what support systems were available and availability depended upon geographic location and how “close” the community was; not having to pay any out-of-pocket costs; and that chains of command inconsistently supported their service members and families. The results of this study have implications for social workers who work within the military structure as well as civilian providers. Ensuring that AD service members and spouses know the available resources, both through the military and in the civilian community, is one area that can improve the psychosocial outcomes of AD service members and spouses with cancer. The results also show the importance in understanding the stressors that cause additional mental and physical barriers, unique to the military environment, during treatment and into survivorship. Participants were eager to have their voices heard and wanted to ensure that fellow AD service members and spouses with cancer have improved experiences with health care systems and support.
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    "It Was a Curse, It Was a Generational Cycle": Understanding the Lived Experience of Sibling Abuse and Survovors of Intimate Partner Violence.
    (University of Alabama Libraries, 2021) Ikenberg, Carin; Carlson, Catherine E; University of Alabama Tuscaloosa
    The purpose of this qualitative, hermeneutic phenomenological study with interpretive phenomenological analysis, was to explore my participants' experiences of sibling abuse in childhood and intimate partner violence in adulthood, as well as explore connections between the types of abuse and abusers. This study is novel in examining the long-term impact of sibling abuse in the context of intimate partner violence victimization outcomes. By examining participants' descriptions of their experiences, several nuances came to light about the experience of sibling abuse, and how it impacted participants' vulnerability to violence in adulthood. The most notable finding was the lack of parental support for both types of victimization. In childhood, the parental failure to protect impacted participants in three ways. One, because the sibling abuse was tolerated by their parents, they learned that it was "OK" to be abused. Two, participants came to expect and accept abuse in future relationships based on their childhood experiences. And three, because their parents failed to protect them in childhood, they could not be counted on to help them in adulthood; therefore, participants felt "stuck" in their relationships with intimate partner violence. Current family violence theories may explain the long-term outcome of sibling abuse, but my study, and the current state of the literature around long-term outcomes, may best explain victimization outcomes when the victim of sibling abuse also experiences parental failure to protect. Additionally, because sibling abuse often occurs in homes where there are other types of violence present, more research needs to be done to identify the most significant contributors to a victimization outcome, as well as protective factors in the home that prevent revictimization.
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    Resilience From a Marginalized Perspective: Towards a Culturally Responsive Construct
    (University of Alabama Libraries, 2021) Prowell, Ashley N.; Williams, Javonda; University of Alabama Tuscaloosa
    Resilience can be defined as positive adaptation despite adversity or one’s ability to bounce back in the face of significant threats to development. While the general consensus on what it means to be resilient has expanded over time, our conceptualizations of the concept continue to be largely understood from a mainstream, homogeneous perspective. Underlying assumptions regarding this perspective are that: a) resilience holds the same meaning for all individuals and groups; and b) marginalized youth possess a sort of “ordinary magic” that they can and should utilize in persevering through historical and contextual constraints. The idea that promoting a perspective of resilience based on the typical behavior of the majority has the potential to do more harm than good for marginalized and disadvantaged groups, such as African Americans, is what drives the current dissertation. The current dissertation addresses this issue by answering the following questions: 1) What is the lived experience of African American youth’s resilience within the context of childhood adversity due to race and social class (specifically, low-income/poverty)? and 2) How do African Americans frame their lived experience with resilience within the context of childhood adversity due to race and social class (specifically, low-income/poverty)? This dissertation draws upon Post-structuralism, Ecological Systems Theory, and Intersectionality Theory, as it utilizes a phenomenological design with interpretive repertoires as a feature to center 9, African American individuals from low-income childhood backgrounds and their lived experience with adversity and positive adaptation. Findings identify eight themes of childhood adversity, six themes regarding external factors of positive adaptation, and six themes regarding internal factors of positive adaptation within family, community, and individual dimensions. Findings also conclude seven interpretive repertoires in which participants used to frame their lived experience with resilience, underscoring institutional and structural inequalities as a key factor in making their experience unique. Much of social work and its efforts are targeted towards the marginalized, vulnerable, and disadvantaged. Therefore, it is fitting that a contextually- and culturally-driven stance on the concept of resilience would aid social workers and their practices in being more open and inclusive of the experiences of those they aim to serve. As the concept of resilience is ubiquitous to the field of social work and its practices, it is important to understand marginalized perspectives on what it means to overcome adversity and be resilient.
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    A Longitudinal Analysis of Disparities of Depression and Anxiety Among U.S. Older Adults with Chronic Conditions within Different Age Groups
    (University of Alabama Libraries, 2021) Hao, Zhichao; Ruggiano, Nicole; University of Alabama Tuscaloosa
    Suffering chronic conditions greatly contribute to mental health problems like depression and anxiety among older adults. Although an array of literature has focused on this field of study, little research has examined how depression and anxiety change over time or differs from each age group from a developmental and comprehensive view. Purpose This study aims to understand the disparities of depression and anxiety of older adults with chronic conditions among different age groups. A longitudinal study will provide a holistic understanding of risk and protective factors associated with depression and anxiety to tailor and provide supportive services for older adults according to their changing needs. Methods This study applied the latest rounds (round 5 to round 9) of the National Health and Aging Trends Study (NHATS). In total, 3,541 older adults who were sample persons, had at least one chronic condition, and participated in all 5 rounds were included. The Transactional Theory of Stress and Coping (TTSC) model was utilized to select predictors. Descriptive analysis was conducted for all predictors, and generalized estimating equation (GEE) was applied to explore and identify the risk and protective factors. Results Age, race and ethnicity, self-rated health, number of chronic conditions, cognitive capacity, frequency of negative feelings, self-realization, self-efficacy and resilience, activity participation, and technology use were significantly associated with depression and anxiety. Besides, demographic factors like gender, marital status, and income were significantly associated with anxiety. Furthermore, depression may decrease over time but only happens in a relatively short time, and the extent of decline also slows down gradually. However, anxiety did not change over time. Conclusions The findings highlight the need to provide support and link resources to caregivers and call for efficient chronic condition management to provide early screening, assessment, and diagnosis. Recommendations from healthcare providers, proper education of healthy lifestyle and the dissemination of related information, and prompting older adults to engage in more physical activities can also make a difference in helping older adults gain better physical and mental health to prevent them from suffering depression and anxiety. Detailed implications are discussed.
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    The preservation of spousal and partner relationships among nursing home residents
    (University of Alabama Libraries, 2021) Shaw, Shanae Logan; Csikai, Ellen L.; University of Alabama Tuscaloosa
    The decision to seek placement in a nursing home can be difficult for both the residents and their families. This may be especially true for spouses or partners of the potential nursing home residents. Disruption of the attachment relationship following placement is likely influence the psychosocial well-being of nursing home residents. Although the responsibility of nursing home staff is to ensure psychosocial well-being, including awareness of the influence that separation can have on a spousal or partner relationship, little is known about services offered for the maintenance of spousal and partner relationships. This mixed-method study explored the availability of services and activities that emphasize the preservation of spousal and partner relationships among nursing home residents. A survey instrument designed specifically for this study was administered with a sample of licensed social workers currently practicing in nursing homes in the states of Alabama, Georgia, Mississippi, and Tennessee. This study also explored the impact of the Coronavirus pandemic on relationships between nursing home residents and their spouses or partners. Survey results revealed that approximately 49% of respondents reported having a written policy to preserve these relationships; however, only 22% reported having a program to carry out the facility’s written policy. Data from semi-structured interviews provided an opportunity for further exploration. Providing privacy, facilitating outings, and encouraging participation in facility activities were often discussed by these social workers. Additionally, participants shared barriers experienced in implementation, including privacy and cognitive capacity. Both survey respondents and interview participants shared their perspectives on the impact of the COVID-19 pandemic and the resulting restrictions. Participants noted the negative effects of these restrictions on residents’ spousal and partner relationships, as well as mitigating practices including the use of plexiglass or window visits, video calls, and encouraging residents to remain engaged with family members. This results of this study have several implications for social work practice. Both current practices, as well as suggestions for additional services to preserve these important relationships, are highlighted. Nursing home social workers can utilize the results in the design and implementation of additional services to preserve relationships between residents and their spouses/partners.
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    Exploring associations between substance use and adolescent delinquency: an ecological perspective
    (University of Alabama Libraries, 2020-12) Li, Qingyi; Smith, Brenda D.; University of Alabama Tuscaloosa
    Adolescent delinquency and substance use are significant concerns which influence youth development and overall well-being in the United States. The present dissertation focuses on adolescent substance use and delinquent behaviors. Particularly, this study investigates relationships between three forms of adolescent substance use and delinquent behaviors. In addition, the study investigates whether factors from different layers of the adolescent eco-system moderate relationships between substance use and adolescent delinquency. Although many recent studies have investigated the relationship between substance abuse and adolescent delinquency, few studies have investigated moderating effects from an eco-systems perspective. To contribute to existing knowledge, the present study investigates three potential moderating effects representing different layers of the ecological system to advance understanding of more complicated and multifaceted relationships between substance use and adolescent delinquency. The sample of the present study was extracted from a cross-sectional public-use dataset, the National Survey on Drug Use and Health (NSDUH), 2017. The survey involved a nationally representative sample of adolescents (N=13,722). Hypotheses were generated based in theory and past empirical findings. The study findings partly supported most of the research hypotheses. Three forms of substance use were positively associated with both violent and theft delinquent behaviors. In addition, several factors were found to moderate the relationship between adolescent substance use and involvement with delinquent behaviors. Most importantly, positive drug prevention communication significantly moderated relationships between substance use and delinquency. Adolescent substance users who had ever received any positive drug prevention communication via mass media were less likely than those who had not received such messages to engage in both violent and theft behaviors. The findings are highly relevant to social work practice, research, and policy related to substance use and adolescent delinquency. Whereas many interventions to reduce adolescent delinquency or to mitigate negative effects of substance use focus on the individual and the family, the study results illustrate that larger social systems, including systems delivering mass communication, such as social media may also have potential to mitigate negative effects of adolescent substance use. Moreover, the findings suggest a number of future directions for further investigations of the role of family relationships and positive drug prevention communication in reducing substance use and delinquent behaviors among US adolescents.
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    A grounded theory study of the perceptions of caseworkers and foster parents regarding the health care of children in foster care
    (University of Alabama Libraries, 2020-08) Boltz, Laura Dozier; Smith, Brenda D.; University of Alabama Tuscaloosa
    Children in foster care have more health problems and more health care service needs than similar children in the general population. In addition, children in foster care often have a lack of continuity in care. This study aims to identify the perspectives of foster parents and social workers as they relate to the health care of children in foster care. Using a grounded theory method, interviews were conducted of eight foster parents and four social workers regarding who they perceive to be responsible for the health of children in foster care. The interviews were recorded and transcribed. The transcriptions were then coded using NVivo. The two main themes that emerged were communication and expectations. These themes were used to create the emerging theory of the interwoven set of conditions that occurs for foster parents and social workers to determine who is responsible for the health of children in foster care.
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    Poetry and youth adjudicated for illegal sexual behaviors: a mixed methods study
    (University of Alabama Libraries, 2020-12) Ellis, Taylor; Nelson-Gardell, Debra; University of Alabama Tuscaloosa
    The purpose of this longitudinal, embedded quasi-experimental mixed methods study was to explore the affect, self-identity, and behavioral patterns of youth adjudicated into a secure facility for their illegal sexual behaviors. Through a partnership with a secure facility and a community organization, the study examined intake and exit measure scores from the Millon Adolescent Clinical Inventory (MACI) and Psychopathy Checklist: Youth Version (PCL: YV) for 137 youth adjudicated for their illegal sexual behaviors in order to compare differences between those who participated in a creative writing class and those who did not. Furthermore, for those who participated in the creative writing class, their published poetry served as qualitative data analyzed for emotional expression. Finally, the two sets of data were “mixed” to determine whether there was a correlation between the types of emotions expressed and scores on outcomes of the two measures. The findings established that there were not great differences in outcome scores on the MACI and PCL: YV between those who participated in the creative writing class and those who did not. This was not surprising given that the creative writing class is an adjunct to the central therapeutic interventions available within the secure facility. However, those who did participate in a creative writing class had greater decreases in self-reported oppositional behaviors, while those who did not had greater decreases in suicidal tendencies and depressive affect. Next, regarding the poetry, a larger number of negative emotions were interpreted than positive emotions, but a full range of emotions was expressed through topics of grief, love, abuse, self-exploration, and various other topics. Finally, when assessing the correlation between the number of Positive or Negative Emotions interpreted and exit scores on the MACI and PCL: YV, there were significant correlations for the subscales on the MACI but not the sum score of the PCL: YV. The results of this study may encourage the inclusion of the arts in secure facilities and research contexts.
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    Unheard stories from middle eastern immigrant women ipv survivors: a qualitative study
    (University of Alabama Libraries, 2020-10) Ozturk, Burcu; Nelson-Gardell, Debra DNG; University of Alabama Tuscaloosa
    Intimate Partner Violence (IPV) affects all society, but immigrant communities can be distinctively more vulnerable. Although there have been numerous studies conducted on particular aspects of IPV among immigrants in the United States, there is limited research about intimate partner violence among Middle Eastern immigrants and refugees. This study aimed to advance knowledge and greater understanding of lived experiences of Middle Eastern women immigrant survivors and their coping strategies. A phenomenological design was utilized to explore ten Middle Eastern immigrant women IPV survivors lived experiences and their coping strategies. Participants were recruited in the U.S. and data was collected through semi-structured interviews. Interviews were transcribed verbatim, and NVivo12 software was utilized for analysis of the data. For the data analysis, phenomenological data analysis steps were followed. Regarding the research findings, the study provided a deeper understanding of lived experiences of Middle Eastern immigrant women survivors and their coping strategies after experiencing interpersonal violence. The study explored Middle Eastern immigrant women IPV survivors’ lived experiences and their coping strategies, as well as their challenges and strengths as immigrants, and highlighted that their abuse experiences were varied. The participants had different experiences with formal resources, such as the police and counseling services. In summary, the results suggest there is considerable need for future research to extend the study of this population, as well as an urgent need to increase accessible resources to empower immigrant IPV survivors in the United States.
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    Attitudes and opinions toward stress-related support services among police in a southern state: a qualitative study
    (University of Alabama Libraries, 2020) Barber, Brad W.; Albright, David L.; University of Alabama Tuscaloosa
    Police work is considered one of the most stressful occupations in the world and the high levels of stress associated with police work place officers at high risk for developing mental and physical health problems. Police officers also pose a threat to themselves, their families, and the general public when work-related stress is unresolved; high levels of stress among police can manifest into self-destructive, violent, and deviant behavior. Although stress management interventions have been available to police since the 1940s, the health and behavioral problems associated with unresolved stress have not shown any signs of improvement. The purpose of this study was to explore and identify (1) how police officers appraise stress-related support services, (2) suggestions they have regarding ways to improve these services, and (3) recommendations for new support services that would help to reduce and better manage work related stress. A pragmatic qualitative research approach was used to guide this study. Individual semi-structured interviews were conducted with a purposeful sample of 20 patrol officers with at least two years of police experience. Findings showed that overall attitudes toward support services were positive, but two external factors were identified as major barriers to using services. Distrust toward confidentiality protections with intervention workers resulted in a perceived threat of being deemed unfit for duty by supervisors for using a support service. Similarly, a fear of appearing weak to other officers keeps officers from seeking needed services. However, participants recommended several feasible implications for lowering these barriers and to increasing officers’ willingness to using support services if needed. Most participants endorsed mandatory counseling after a critical incident because a standardized policy would reduce the fear of looking weak and the threat of being deemed unfit for duty. Suggestions for increasing trust in confidentiality protections included allowing police to meet counselors at private and discrete locations, giving officers the option of choosing their own counselor rather than assigning them one, and requiring external intervention workers to conduct “ride alongs” to build rapport with officers and better understand the unique stress associated with police work.
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    The role of mood in the self-care activities of individuals with type 2 diabetes
    (University of Alabama Libraries, 2019) Brazeal, Billie Michelle; Hopson, Laura; University of Alabama Tuscaloosa
    Controlling type 2 diabetes mellitus requires the individual to perform specific self-care behaviors. The current study investigated the impact of anxiety and depression on these behaviors. In addition, the study investigated the role of sociodemographic variables, sleep and pain in the performance of specific self-care behaviors. Using data collected from primary care clinics providing integrated care to individuals with type 2 diabetics, the Chi-Square Test of Independence was conducted to investigate relationships. This was followed by a series of logistic regressions to identify variables that could predict changes in self-care. Depression and anxiety was measured by scores on the PHQ-9 and GAD-7. Levels of self-care were measured by information collected from patients completing the Summary of Diabetes Self-Care Activities. Findings from this study suggest that self-care behaviors can be influenced by numerous factors: anxiety, age, ethnicity, gender, marital status, and sleep difficulty. Both a correlation and predictive relationship between anxiety and general diet scores were found, but anxiety did not have a statistically significant impact on any other individual self-care behavior. The current study makes a meaningful contribution to the literature by examining the influence of anxiety, depression, sociodemographic factors, sleep and pain on improvements in self-care behaviors.
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    The effects of perceived cultural fit on active duty military wives
    (University of Alabama Libraries, 2019) Granda Anderson, Kimberly Carole; Pryce, Josephine; University of Alabama Tuscaloosa
    Based on cultural consonance theory, the overall aim of this study was to explore the effect of cultural consonance, or cultural fit, within military culture on the psychological well-being of military wives. This study is a secondary data analysis of 8,748 respondents from the Department of Defense 2008 Survey of Active Duty Spouses (ADSS). The sample included all eligible civilian female spouses of active duty male service members. Linear regression showed a significant relationship between the main effect predictor of cultural consonance, operationalized by the Affective Commitment Scale (ACS), and two outcome variables of psychological well-being, the Perceived Stress Scale (PSS-4) and the Kessler 6 (K6) scale of psychological distress. ANCOVAs showed that demographic control variables combined with the ACS boosted the amount of variance explained. The ACS retained its significance when adjusted for the effect of demographics, demonstrating that none accounted for an alternative explanation of the outcomes. Binary logistic regressions showed the most striking results. When individual control variables were combined with low cultural consonance scores, a minority of wives had up to thirteen times the odds of having negative psychological well-being outcomes. Frequency of major life events, lowest rank, lowest income, and lowest educational levels were among the factors producing the largest effects when combined with low cultural consonance. Race/ethnicity and family status (children) had no significance. Findings from this study may be used to add cultural consonance as a factor to be considered regarding military cultural competence education, organizational commitment and support of well-being in military wives.
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    Older adults conception of a ‘good death’
    (University of Alabama Libraries, 2019) Maynard, Quentin Robert; Csikai, Ellen L.; University of Alabama Tuscaloosa
    Advances in medical care have led to an increasing number of older adults living with at least one chronic illness over a longer period of time. Correspondingly the disease trajectory and dying process may be prolonged, providing individuals with more time to plan for what they consider a ‘good death.’ A ‘good death’ is described through research primarily according to medical and biological aspects. While the psychosocial and spiritual elements are also part of a ‘good death,’ it is difficult to delineate the individual aspects important to individuals near the end of life. This study used descriptive qualitative research methods to describe older adults’ conceptions of a ‘good death,’ specifically the psychosocial and spiritual factors. Data were collected from 12 community-dwelling older adults in central Alabama, utilizing a semi-structured interview guide. Qualitative content analysis guided the data analysis procedures. Corr’s (1992) task-based approach to coping with dying framed the study and served to categorize participant statements. The findings suggested that a number of physical, psychological, social, and spiritual components contributed to the conception of a ‘good death,’ and that these were often interrelated. For example, the type of medical treatment desired at the end of life was influenced by the potential effect on members of the participants’ social network, such as necessity for the participants’ family members to care for them when they were no longer independent and had a poor quality of life. Participants’ motivations and values guided what these individuals believed could help them achieve a ‘good death.’ Conceptions were highly personal with the realization that preparation would allow them to control their situation, although unpredictable, near the end of life. Health social work practice may be strengthened by these findings as it confirms the holistic nature of helping older adults prepare in advance for the end of life. Efforts to maximize quality of life throughout serious illness and near the end of life are essential so that older adults may die a ‘good death.’
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    A longitudinal analysis of factors associated with adherence to preventive Pap test recommendations among middle-age Chinese American women
    (University of Alabama Libraries, 2019) Guo, Yuqi; Hopson, Laura M.; Noh, Hyunjin; University of Alabama Tuscaloosa
    Background: Pap tests can prevent cervical cancers by allowing for the early detection and removal of precancerous lesions. In the US, Chinese American women (66%) have a lower rate of obtaining Pap tests within the past three years than non-Hispanic white women (83%), Filipino women (83%), and Asian Indians (70%). Predictors of adherence to repeated Pap tests among Chinese American women are not well understood in the current literature. Purpose: The purpose of this longitudinal study is to analyze factors associated with adherence to preventive Pap tests among middle-aged Chinese American women. This longitudinal study will: (a) estimate annual uptake of Pap testing and examine changes over a seven-year period among middle-aged Chinese American women and (b) determine which factors are associated with middle-aged Chinese American women’s adherence to Pap testing for cervical cancer prevention in the U.S. health care system. Method: The Study of Women's Health across the Nation (SWAN) Series provides the data from Chinese females for this secondary analysis. In total, the present study analyzed data from 498 individuals (1,326 person-time-waves). By using the Systems Model of Clinical Preventive Care, Generalized Estimating Equation (GEE) was applied to explore associations between the likelihood of having a pap test and explanatory factors. Result: Of the 1,326 person-time-waves, 61% (n= 824) had a Pap test in seven waves. The likelihood of adhering to Pap test among Chinese American women was significantly and positively associated with having a physician for female health care (PFH), time spent by the PFH, having cancer(s), and having fibroids. However, patients who were too busy to visit healthcare providers and patients who did not have a primary health care provider were less likely to adhere to a Pap test. Discussion and Implications: The findings highlighted the importance of the availability of healthcare resources and education about Pap testing for Chinese American women to encourage them to have preventive Pap tests. It is important for health care providers and social workers to emphasize the benefits of using preventive Pap tests for Chinese American women. Implications for practice are discussed.
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    Social work education and social justice: an examination through the social justice education perspective
    (University of Alabama Libraries, 2018) Bell, Amber Dawn; Pryce, Josephine G.; Simon, Cassandra E.; University of Alabama Tuscaloosa
    The Council on Social Work Education (CSWE) develops and oversees curriculum standards of social work education programs which sets the tone for what is disseminated in these programs. As a specialized accrediting agency recognized by the Council for Higher Education Accreditation, CSWE is tasked with ensuring the education disseminated in social work education programs is of quality. Furthermore, CSWE must evaluate and assess social work education programs’ curricula to ensure the set criteria is met. CSWE uses its Educational Policies and Accreditation Standards (EPAS) to disseminate and evaluate social work education program’s curricula. Although, much is included in the curriculum of social work education, this study focuses on its approach to the construct of social justice. It is important to note that in 1979, social justice was officially recognized as a core value in social work practice by the National Association of Social Workers; however, it is unclear how this construct is addressed in social work education. This exploratory study attempts to add to this limited knowledge using accreditation manuals from CSWE at two distinct time periods to explore whether the historical and current approach of social work education toward social justice supports the Social Justice Education Perspective.
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    Relationships between social sector spending, public healthcare spending, and mental health service use
    (University of Alabama Libraries, 2018) McKinney, Robert Earl; MacNeil, Gordon; Albright, David L.; University of Alabama Tuscaloosa
    Recent research suggests that increased governmental social sector spending, those monies allocated for such diverse things as transportation infrastructure, parks, police and fire protection, education, and income support, is positively related to improved health. This study, expanding upon the work of Elizabeth Bradley and Lauren Taylor, was intended to determine if there is a similar relationship between components of social sector spending and mental health indicators. The study uses mental health indicator data that are drawn from the National Survey on Drug Use and Health (SAMHSA) and spending data that are drawn from the US Census Bureau and the Centers for Medicare and Medicaid. My regression analyses suggest that, for two of the three identified mental health indicators, there is a relationship between social sector spending and mental health indicators. These findings of the descriptive study are considered in the context of Gelberg’s Behavioral Model for Vulnerable Populations. Although the data for the dependent variables (mental health indicators) are longitudinal for a 12-year period, they were reported in 2-year panels, thus limiting the study to six observations over 12 years. This has negative implications for the power of the study. Additionally, the data for the independent variable captured spending at the state level, with no analysis of particular programs or activities.
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    Immigration status, peer victimization, and negative emotions as they relate to bullying behavior among school-aged children
    (University of Alabama Libraries, 2018) Yang, Fan; Hopson, Laura M.; University of Alabama Tuscaloosa
    Bullying encompasses aggressive behaviors in a situation where an individual experiences negative actions from one or more individuals repeatedly and over time in the forms of emotional, verbal, physical, race-based, and cyber aggressiveness. Anti-bullying research and interventions ensure healthy school climate for students as well as promote individual development and academic success. The current dissertation study investigated bullying perpetration and its association with risk factors identified by general strain theory (GST): limited financial resource, parental rejection, peer victimization, chronic disease, and negative school experience. The mediating role of negative emotions identified by GST was also tested in this study. In addition, guided by minority stress theory, this study investigated whether a student’s immigration status affected the relationship between risk factors and bullying perpetration. Using the Health Behavior in School-Aged Children (HBSC) study 2009-2010 cycle, four groups of weighted least squared linear regression models were conducted to examine hypothesized relationships. Study results indicated that bullying was associated with negative emotions, peer victimization, immigration status, being Hispanic, negative school experience, the interaction between immigration status and peer victimization, and the interaction between immigration status and negative emotions. The mediating role of negative emotions was not supported by this study. The association between negative emotions, peer victimization, and bullying perpetration varied across different immigrant status groups. It was concluded that, generalizing from this nationally representative sample, bullying among immigrant children was clearly a rich and complex problem that merited further study. The implications for cultural-sensitive interventions in bullying behaviors, as well as the limitations of the study and directions for future research were presented.
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    Healthcare payer type and HIV health: a retrospective analysis
    (University of Alabama Libraries, 2018) Kay, Emma Sophia; Smith, Brenda D.; University of Alabama Tuscaloosa
    There are over half a million people living with HIV (PLWH) in the United States, all of whom require access to regular healthcare services in order to live with the disease. Borne out of the previously-fatal nature of HIV, the Ryan White HIV/AIDS Program (RWHAP) was created in 1990 in order to provide palliative services. Although the Affordable Care Act opened up additional health insurance options to PLWH, there remain questions about which healthcare payer type is associated with the best HIV health outcomes. To date, only a handful of studies have explored the association between healthcare payer type and HIV health, and few have examined this association using data collected after the Affordable Care Act was implemented. The principal purpose of this research was to identify the relationship between healthcare payer type and two key HIV health outcomes—specifically, viral suppression and two different measures of retention in care. The study sample consisted of 3,146 patients who attended at least one scheduled HIV primary care appointment at the University of Alabama at Birmingham’s 1917 Clinic within the 2015 calendar year. The 2016 calendar year served as the observation window. Multivariable logistic regression analyses were used to test associations between different single and multiple payer type combinations and HIV health outcomes. Results suggest that there is a meaningful and significant relationship between healthcare payer type and HIV health outcomes. In particular, receiving RWHAP supplementary services is associated with optimal health outcomes for PLWH, even when controlling for multiple sociodemographic characteristics. Furthermore, these findings suggest that healthcare payer type has a stronger association with retention in care than viral suppression. The results of this study provide timely insight into the criticality of health payer type in contributing to HIV health outcomes. They also have particular relevance for social work: Social workers have been integral to the provision of RWHAP wraparound services since the program’s inception, and their expertise in working with marginalized and/or vulnerable populations is as important now as ever.
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    Who’s in, who’s out: a descriptive analysis of demographic and contextual factors related to labor force participation among older adults
    (University of Alabama Libraries, 2018) White-Chapman, Nyshetia; MacNeil, Gordon; University of Alabama Tuscaloosa
    As the proportion of older adults in the United States grows, there are significant concerns surrounding economic well-being in retirement. The two major components of the U.S retirement income system, Social Security and employer-sponsored retirement plans, have undergone significant changes that erode financial security in retirement. Working longer has been proposed to help older adults overcome deficits in retirement income. However, even when motivated to work, many older adults face significant challenges in the labor market, particularly those who are unemployed or displaced. In the current study, secondary data from the Health and Retirement Study (HRS) is used to identify demographic and contextual factors associated with unemployment, displacement, and reemployment (among those who are displaced at Time 2) among older adults. Logistic regression is used to examine the influence of race/ethnicity, gender, education, relationship status, health status, income status, geographical location, eligibility for retirement/age, and sector of employment on unemployment, displacement, and reemployment. Results suggest being of an “other” race, being married, being in fair to poor health, and having household income below the poverty threshold increased the odds of employed while being previously employed in the service sector reduced the odds of unemployment. All else equal, being African American and living in the West increases the likelihood of displacement among older adults while being female, living in poverty, and being eligible for retirement (aged 62 and older) reduces an older adult’s chances of being displaced. Finally, all else equal, being African American, living in the Northeast, and being eligible for retirement (aged 62 and older) reduced the likelihood reemployment at Time 2. The major implications of these findings for research, policy, and practice are discussed.
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    Breast cancer risk factors in a sexual minority population: an examination of the 2014 and 2015 Behavioral Risk Factor Surveillance System
    (University of Alabama Libraries, 2017) Carter, Vicky L.; Simon, Cassandra E.; Pryce, Josephine G.; University of Alabama Tuscaloosa
    This study is a secondary data analysis of the 2014 and 2015 Behavioral Risk Factor Surveillance System (BRFSS). Using a sample of 3,082 respondents, in three racial categories- White, African American, and Hispanic, this study examined sexual orientation and breast cancer risk factors. The sample size included 1,544 randomly selected heterosexual and 1,534 self-identified lesbians. The overall aim of this study is to explore behavioral and non-behavioral/demographic breast cancer risk factor differences between heterosexual women and lesbians. Chi-square analysis revealed significant demographic differences between heterosexual women and lesbians in age, educational attainment, employment status, household income, and having health insurance. Race was not found to be significant. Analysis of behavioral factors also indicated higher rates of alcohol consumption and tobacco use, lower mammogram use, and lower fruit intake in the lesbian population compared to heterosexual women. Physical activity, obesity, and diet-vegetable intake were not significantly different between the two populations. Loglinear analysis indicated that the introduction of race when examining these significant demographic non-behavioral and behavioral findings, had little effect on previous chi-square analysis findings. Sexual orientation was found to be the main effect on the findings with the exception of educational attainment and health insurance. Findings from this study may be used to develop comprehensive, appropriate, culturally competent, interventions, in addition to advocating in areas of public policy to address the breast cancer risks of lesbians.