Browsing by Author "Bordnick, Patrick S."
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Item An Innovative Intervention for Obsessive Compulsive Disorder: A Web-Based Self-Help Program for OCD(2014-05) McIngvale-Cegelski, Elizabeth; Bordnick, Patrick S.; Hart, John M.; Torres, Luis R.; Kao, Dennis T.Obsessive Compulsive Disorder (OCD) is a mental illness characterized by unwanted intrusive thoughts followed by repetitive rituals. 50.6% of adult cases of OCD are considered severe according to the National Institute of Mental Health. Interventions based on evidence based modalities for OCD in the United States are difficult to access and are extremely costly. The OCD Challenge (OCDC) is an interactive Internet based self-help program for OCD. This website allows participants to engage in an evidence-based intervention (CBT, specifically exposure with response prevention) for their OCD. The OCD Challenge is an online intervention that guides participants through the website, prompting them to climb their personal “OCD Mountain” with step-by-step direction along the way. The OCDC is a novel approach that will afford many individuals with OCD the opportunity to receive an evidence-based intervention that may not otherwise be available. This research study describes the development of the online interactive program and the demographics of participants who are accessing the program. Future studies should examine the feasibility of the website on OCD, disability, depression, anxiety and stress symptom reduction.Item BBW Seeks FWB: an Exploration of Risk among Women-Seeking-Women via Craigslist(2014-05) Ford, Amanda F.; Torres, Luis R.; Bordnick, Patrick S.; McPhail, Beverly; Sampson, McClain M.In the face of a national discourse aimed at bridging gaps in healthcare and related services, the importance of illuminating areas of disparity for under-researched, marginalized populations is key to making significant strides in healthcare reform. A disproportionate focus on male risk, especially in terms of men who have sex with men (MSM), has overshadowed the need for Women-Seeking-Women (WSW) specific (Women-Seeking-Women) investigation and the development of strategies that target this specific population. Within the context of research about sexually transmitted infections (STIs), the prevalence rates of STIs for mixed-orientation women – women who have sex with both men and women – are estimated to be higher at 45-74% than the 29-45% rate of heterosexual women, yet estimates represent a wide range based on the intricacies of the population and the paucity of population-specific research (Mojola & Everett, 2012). Initially, the development of a conceptual framework that addresses the unique needs of WSW is invaluable to increasing dialogue about under-researched populations and to the eventual development of modalities of care that are tailor-made for WSW. The subsequent formation and pilot testing of a survey aimed at exploring risk within WSW via online modalities is a vital link between uncovering the distinction between labels, behavior and the ensuing provision of preventive practices. Ultimately, the expansion of research to a population hidden within the current dialogue of STI education about is invaluable and will be a catalyst for future research, impacting the understanding of individual identity, behavioral motivations, health outcomes, and the normalization of hidden populations within the greater context of society.Item Comparative Effectiveness of Smoking Cessation Medications among Schizophrenic Smokers(2014-08) Wu, I-Hsuan; Abughosh, Susan M.; Chen, Hua; Essien, Ekere James; Bordnick, Patrick S.; Peters, Ronald J.; Johnson, Michael L.BACKGROUND: Schizophrenic patients have higher smoking rates when compared to people in the general population. Additionally, they tend to have much lower smoking cessation rates and higher nicotine dependence level. A variety of pharmaceutical cessation aids are available, which include nicotine replacement therapy (NRT), Bupropion SR, and Varenicline. OBJECTIVES: To compare different pharmacotherapies in smoking cessation and to examine which medication could lead to a higher smoking abstinence rate for both short (12 weeks + 4 weeks) and long term (one year) among schizophrenic patients (1st objective). Further, to assess which cessation medication exposure would have lower risks in developing risk factors of cardiovascular diseases (2nd objective) and suicide behaviors/attempts (3rd objective). METHODS: A population-based retrospective cohort study was conducted using the General Electric (GE) electronic medical record database (1995 – 2011). The cohort consisted of patients with a diagnosis of schizophrenia or schizoaffective disorder (ICD-9 code 295.00-295.99) and who had newly initiated use of any smoking cessation medication. This cohort was then followed for 12 weeks (up to 16 weeks) and 1 year to observe their smoking status at short and long term after cessation treatment. Multivariate logistic regression models were used to determine which cessation medication was more effective in quitting. For our second objective, we excluded our cohort who (1) were not prescribed atypical antipsychotics and (2) already had diagnosis of diabetes, hyperlipidemia or hypertension prior to index date. Follow up period was from 12 weeks onwards index date up to one year. The relative risk of developing cardiovascular risks was assessed using Cox proportional hazards regression model after controlling for other covariates. Similarly, for our third objective, relative risk of suicide behaviors/attempts risks was assessed using Cox proportional hazards regression model with one year follow up from index date. RESULTS: The sample comprised of a total of 3,976 schizophrenic smokers who had used at least one type of cessation medication. Abstinence rate was about 18.02% at week 12 and 17.20% at year 1. Among those who quit at 12th week, about 75.22% of the quitting effect sustained at 1 year. We did not find any differences between cessation medications after 12 weeks and 1 year of cessation treatment. Other predictors we found that were associated with quitting included being older, white, whose residential area was in the west part of U.S., and without smoking counseling. Patients who reported not smoking at week 12 and who did not receive cessation medications during week 16 to year 1 were more likely to be abstinent from smoking at year 1. After excluding those who had diabetes, hyperlipidemia, or hypertension prior to cessation medications, we had 580 schizophrenic smokers. Among those, nearly half (n=276, 47.59%) developed one or more criteria of the metabolic syndromes within just one year after the treatment. We found that smokers who were prescribed NRT were less likely to develop metabolic syndromes as compared to those who were prescribed Varenicline. Rates of suicide ideations/behaviors were 2.65% within one year after the exposure. We did not find any differences in leading suicide between the medications. The only predictor we found to be associated with suicide was comorbidity index. CONCLUSIONS/IMPORTANCE: This was the first retrospective study that examined comparative effectiveness of smoking cessation medications among schizophrenic smokers. Predictors identified in this study should be considered when designing smoking cessation interventions. This minority population may need more tailored approaches to achieve a successful cessation outcome. Further, physicians are advised to carefully weigh the risks against the benefits before prescribing cessation medications since risks for metabolic syndromes and suicide were found to be very high. Healthcare providers should monitor patients’ lab data regularly and pay close attention to all the possible signs of suicide thoughts among this high risk population, especially those who are on pharmacological cessation intervention attempting to quit smoking.Item Depression in the Barrio: Risk and Protective Factors for Depression among Mexican American Drug Users(2014-05) Villarreal, Yolanda R.; Torres, Luis R.; Bordnick, Patrick S.; Sampson, McClain M.Understanding the relationship between depression and drug use is essential given that drug users with depression are more likely to engage in high risk drug use behaviors. The current study aimed to explore the risk or protective relationship of the cultural values of familismo, personalismo, fatalismo, and machismo and depression among Mexican American heroin injecting men. Furthermore, this research aimed to explore the relationship between chronic neighborhood stress, acute stress, and depression among the aforementioned population. This work aimed to identify strengths clinicians may utilize when working with this population while simultaneously identify risks ripe for clinical intervention. Data for the current analysis comes from a study of Mexican-American injection heroin users. A cross-sectional research design and field intensive outreach methodology was utilized to recruit 227 Mexican-American men. Participants who met the criteria for depression (CESD) were categorized into depressed and non-depressed groups. Selected covariates associated with the dependent variable were examined using logistic regression. Findings suggest that respondents with high familismo and fatalismo scores were less likely to score high for depressive symptomatology. Additionally, findings revealed that chronic stress was a risk factor for depressive symptomatology while acute stress was protective. The results begin to elucidate the protective and risk nature of culture and community for depression among a group of Mexican American heroin injectors residing in the Barrio.Item Drug Use in Aging Mexican American Men: The Role of Culture and Social Capital(2012-08) Flores, David V.; Torres, Luis R.; Bordnick, Patrick S.; Torres-Vigil, IsabelIn the first decade of the twenty-first century, rates for substance abuse treatment among older adults increased significantly. In the next decade the number of individuals 50 and older in need of drug abuse treatment will double to almost 6 million. Injection drug use (IDU) among older adults continues to be a significant health issue in the U.S., and a disproportionate amount of IDU use is among minority communities. IDU is associated with numerous health and social consequences such as incarceration, homelessness, depression, HIV, Hepatitis C, and suicide ideation. Of particular concern is the predicted increase in alcohol and drug use among older Hispanics, expected to result from an upsurge in the Hispanic population. These factors, compounded by the growth of Hispanics in the U.S., are of significant public health concern. Factors such as Social Capital and Cultural Values have been found to influence drug use and treatment, such as efforts to prevent transition to IDU, the onset of IDU, efforts to achieve cessation, and specifically for heroin use. Understanding the roles of Social Capital and Cultural Values among long-term drug injecting Mexican-Americans may elucidate mechanisms of cessation.Item FACTORS THAT IMPACT CONDOM USE SELF-EFFICACY IN POSTMENOPAUSAL WOMEN(2012-05) Rose, Alexis 1984-; Achenbaum, W. Andrew; Bordnick, Patrick S.; Gei, Alfredo; Epstein, Maxine W.; Pritzker, SuzanneBackground: In the 1980’s, researchers at the Centers for Disease Control and Prevention (CDC) assumed that Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) grew to epidemic proportions due to unsafe practices by sexually active gay men and intravenous drug users. Policymakers who did not wish to associate themselves with these two populations did not promote educational tactics for prevention among the general population. Times have changed since then, but there are still populations mistakenly assumed to be safe from Sexually Transmitted Diseases (STDs). Older Baby Boomer Women are in a different world than their mothers and grandmothers. This population also has different sexual histories, emphasizing the need for greater awareness of STDs. There is a need for preventive action to protect older women against STDs, particularly Human Papillomvirus (HPV). This virus causes over 97% of cervical cancer and is related to the causes of vulva, vagina, penis, and oropharynx cancers. Because their rates of STDs are increasing fast, this dissertation strives to examine and explore the factors that impact condom use self-efficacy and sexual activity among postmenopausal women. As a result of improvements in healthcare and a decrease in disability, postmenopausal women experience higher life expectancies and are now becoming victims of STDs. Many women place themselves at greater risk for STDs by not using protection during intercourse. Research Objective: To better understand the factors that impact current condom use self-efficacy among postmenopausal women, the researcher examined factors that also impacted younger populations. Furthermore, this study sought to understand if there are differences of these factors between sexually active and sexually inactive women. Methods: The conceptual framework of this study utilized many assumptions related to the Health Belief Model (HBM) (Rosenstock, 1974), the Theory of Reasoned Action (TRA) (Ajzen & Fishbein, 1980), the Theory of Planned Behavior (TPB) (Ajzen &Fishbein, 1980), and the AIDS Risk Reduction Model (ARRM) (Catania, 1990). This exploratory study design examined these factors among a purposive sample recruited at an outpatient OB/GYN clinic in a major hospital. Results: The major findings about condom use and STDs did not differ between sexually active and inactive women. Results are presented in terms of descriptive statistics due to the risk of type 1 errors. On a bivariate level high number of lifetime partners, being aware of HPV, perceiving limited partner barriers, and having positive views about self-perceived behavior control all significantly contributed to higher levels of condom use self-efficacy. The overall results, however, showed a mostly homogeneous group of women in terms of their awareness, attitudes, knowledge, and behaviors. The results of this dissertation emphasize that there is a strong need for more awareness of STD risks. The outcomes of this awareness could lead to more tolerance of condom use and knowledge of risk among this population.Item Latinas/os and the International Sex Trade: A Qualitative Study on the Perceptions of Customers, Victims, and Service Providers(2015-05) Torres, Melissa Irene; Torres, Luis R.; Bordnick, Patrick S.; Sampson, McClain M.; Kao, Dennis T.The U.S. is a leading destination country for foreign-born victims of human trafficking for the purpose of sexual and labor exploitation. The Trafficking Victims Protection Act (TVPA) of 2000 established the T-visa in order to annually certify 5,000 international victims, making them eligible for services afforded to refugees such as access to housing, medical, social, legal, and vocational services. However, the certification status and access to such services are contingent upon a victim agreeing to support investigations, testify against their trafficker, and assist with the prosecution process. Despite the estimated 17,500 international victims trafficked annually, roughly 2,300 total T-visas had been granted in the first 10 years of the TVPA. In 2005, the largest international sex trafficking case in U.S. history happened in Houston, TX. Latino traffickers forced over one hundred foreign-born Latinas into the sex trade in cantinas that cater to a Latino clientele. In U.S. cities with the highest rates of international sex trafficking, Latinas have the highest incidence and prevalence. Yet persistent gaps between estimated and actual numbers of victims identified reflect a flawed identification process. An explanation of the nuances involved in getting services to Latina victims of international sex trafficking demonstrates the different ways in which proper identification and assistance is necessary in helping to restore victims. This study explores the perceptions and experiences of international sex trafficking of Latinas as told by its various stakeholders in order to assess their impact on identifying and assisting victims. Narrative interviews were conducted with male customers who frequented cantinas where victims were rescued, law enforcement, legal, and social service providers who have identified Latina victims, and victims themselves. The dissertation is a three-manuscript dissertation and the three papers explore the disconnect all stakeholders feel about the role of men in Latino sex networks; the Experiences of Social Service Providers in Victim Identification and Service Provision for Latinas Trafficked for Sex in Houston and Los Angeles; and Latina Victims’ Experience of Sex Trafficking in Houston’s Latino Sex Networks. A more comprehensive process of victim identification is necessary in the fight against human trafficking.Item Meta-analysis of turnover intention among child welfare workers(2013-05) Kim, Hyosu 1975-; Kao, Dennis T.; Bordnick, Patrick S.; Torres, Luis R.High rates of turnover among public child welfare (CW) workers has a detrimental influence on social workers, clients and their families, agencies, and states. Although the severity and prevalence of the problem are well understood, it was only recently that research on turnover among CW workers became more popular. Our understanding of the phenomenon, however, is still lacking and requires quantitative research synthesis. To address this research gap, the purpose of this study is to conduct a meta-analysis of the existing literature on turnover intention among child welfare workers. Among 144 potentially qualifying studies, twenty two studies were included in this meta-analytic study. Utilizing Hunter and Schmidt (2004)'s method, this study quantitatively combined and analyzed 36 predictors from the included studies. Overall, predictors related to CW worker attitudes and perceptions (e.g., organizational commitment and job satisfaction) had the highest influence on turnover intention among CW workers. On the other hand, demographic predictors, such as age, race, and gender, showed small or negligible effects on turnover intention. Among work-related predictors, stress-related predictors and sub-factors of burnout had medium to high influence on turnover intention while predictors related to decision-making showed medium effect sizes. Among predictors in work environment category, various types of support predictors had varying influence on turnover intention while such variables as perceptions of fairness and policy had relatively high effect sizes of around .4. Several commonly-studied factors with proven validity, such as organizational commitment, stress, job satisfaction, professional commitment, and organizational climate, emerged as some of the strongest predictors. Other variables, such as perceptions of fairness, safety concern, and policy, were also shown to be strong predictors, but have received relatively less attention. While caseload is commonly thought of as one of major drivers of turnover, this study showed that caseload had little effect on turnover intention of CW workers. This study highlights several key areas of further research. First, job performance and economy-related factors are rarely utilized in studies of turnover intention among CW workers and therefore, deserve greater attention. Second, studies with private CW workers were relatively small compared to studies with public CW workers. Third, there has been a conceptual confusion of turnover intention measures, which future research can help to further clarify. The theoretical and practical implications highlighted by this study are also discussed.Item Virtual Patient Simulation Training for Clinical Social Work Diagnostic Assessment and Skills Evaluation(2015-08) Washburn, Micki; Bordnick, Patrick S.; Parrish, Danielle E.; Torres, Luis R.Despite successful completion of advanced clinical training and professional licensure, many clinicians lack adequately developed clinical assessment skills, resulting in misdiagnosis of mental health issues. Skill deficits may result from systemic factors associated with current clinical training programs including the widespread use of passive/observational learning and limited experiential learning opportunities, inadequate practice with live clients in field placements, and unstandardized assessment measures. This study evaluates standardized virtual patient simulation to determine the impact of these simulations on students’ self-efficacy, diagnostic accuracy and clinical interviewing skills. This project also compares students’ performance on Objective Clinical Structured Examinations (OSCEs) using both standard actor patients and virtual patients.Item Virtual patient simulations for brief assessment of mental health disorders in integrated care settings(Social Work in Mental Health, 5/1/2017) Washburn, Micki; Parrish, Danielle E.; Bordnick, Patrick S.This mixed methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrated care setting. A two by three factorial design was employed to evaluate three different simulated training conditions with a sample of 22 Masters level behavioral health students. Results support engagement in virtual patient simulation training to increase studentsÍ self-efficacy in brief clinical assessment, and support the use of virtual patient simulations to improve diagnostic accuracy. Results further indicate that virtual patient simulations have sufficient levels of usability and acceptability as a tool for developing brief clinical interviewing skills, and that participants found this method of instruction to be a valuable adjunct to traditional classroom or field based training. Future directions and next steps for the integration of technology enhanced simulations in clinical social services education are explored.