All Articles

Sarah Araji¹, Ashley Griffin², Laura Dixon^3,4, Shauna-Kay Spencer¹, Charlotte Peavie¹, Kedra Wallace^1,5*

 

¹Department of Obstetrics & Gynecology, University of Mississippi Medical Center, Jackson, MS, 39216, USA

²Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, 39216 USA

³Department of Psychology, University of Mississippi, Oxford, MS 38677 USA

⁴Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, 39216 USA

⁵Department of Neurobiology & Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, 39216 USA

Anxiety during pregnancy is associated with adverse outcomes in mothers and infants. Unfortunately, as anxiety is often synonymously mentioned with depression, the studies focusing solely on anxiety during pregnancy are not as robust as those in the field of depression are. In this work, we provide an overview of what is currently known about general anxiety during pregnancy, pregnancy-related anxiety and the potential impacts anxiety could have on post-partum care. An overview of potential risk factors, post-partum maternal outcomes, infant outcome along with pharmacological and non-pharmacological treatments are covered with a specific focus on high-risk pregnancies. Although anxiety during pregnancy is normative; anxiety can become problematic and negatively impact upon behavior, resulting in potential harm to the mother, as well as her developing fetus or child (ren) at home. The clinical diagnosis for anxiety and conditions associated with anxiety often require lengths of time that are not applicable for the pregnant patient, which has led to diagnosis and terms such as pregnancy-related anxiety. Importantly, increasing awareness about the increased potential risk to mothers who may be affected by anxiety during pregnancy or the post-partum period has the potential to improve maternal mental health screening and access to care.

Divya K. Madhusudhan¹, Kore N. Glied¹, Eugene Nguyen¹, Jennifer Rose¹, Dena M. Bravata^1,2*

 

¹Crossover Health, San Clemente, CA

²Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA

Introduction: Anxiety disorders which include generalized anxiety disorder, panic disorder (PD), post-traumatic stress disorder, and obsessive-compulsive disorder are common psychiatric condition associated with significant social, occupational, physical, and economic costs. Interventions that target the respiratory dysregulation associated with anxiety disorders have demonstrated considerable therapeutic benefit. However, no such intervention has been evaluated in among PD patients receiving care in an employer-sponsored health center.

Objective: To evaluate the use of a novel, capnometry-assisted breathing therapy on clinical outcomes, engagement, and satisfaction for patients with PD receiving care in an employer-sponsored health center.

Methods: Prospective analysis of participants using the program between 1/1/2018 and 06/30/2020.

Results: Twenty-two participants enrolled. Their average weekly usage remained high throughout the 4-week treatment protocol of 17 minutes twice a day for 28 days (11.6 sessions (SD 3.1) in week one and 10.4 sessions (SD 4.0) in week four). Their average Panic Disorder Severity Scale score decreased from 13.3 (SD ± 3.6) to 5.6 (SD ± 1.8), indicating that panic severity decreased from “moderately ill” to “slightly ill.” Use of the program was associated with clinically and statistically significant improvements in respiratory markers: average respiratory rate decreased from 14.9 (SD 3.6) to 11.9 (SD 4.7) breaths per minute (p<0.001) and end-tidal pCO2 increased from 37.2 mmHg (SD 4.2) to 39.1 mmHg (SD 3.6) (p<0.001). Engagement was associated with decline in utilizations of behavioral health services at employer-sponsored primary care center clinic after the intervention.

Conclusion: The clinical improvements observed in this pilot suggest that capnometry-assisted breathing therapy is a valuable tool for patients suffering from panic-associated symptoms.

Tiffany Field^1,2*, Shantay Mines², Samantha Poling², Miguel Diego¹, Debra Bendell², Connie Veazey²

¹University of Miami/Miller School of Medicine, USA

²Fielding Graduate University, USA

The effects of age (young versus old) and living status (alone versus with others) during the COVID-19 lockdown were assessed via a Survey Monkey questionnaire on 260 individuals (18-82 years). Both age and living status and their interaction effects were explored via ANOVAs on scales for health, media use, mood states including anxiety and depression, posttraumatic stress symptoms, fatigue and sleep disturbances. ANOVAs were conducted via a median split on age as well as on a group comparison of young (20-40 years) versus old (60-80 years) individuals. The results of these two types of data analyses were consistent on most variables, suggesting that the young versus the old experienced more stress, anxiety, depression, and PTSD symptoms as well as greater fatigue and sleep disturbances. And, they reported fewer health activities. Significant effects were also noted for the alone versus living with others’ groups including less engagement in exercise and work at home by the alone individuals as well as more stress, depression, fatigue, and PTSD symptoms. A significant age by living condition interaction effect suggested that the young living alone had the highest depression scores. The experiences that were common to the young, the living alone, and the young living alone were being lonely, depressed and fatigued. These results highlight the importance of prevention/intervention for the young, the alone and the young alone during lockdowns like COVID-19.

Haiyan XING¹*, Wei YU^2#

¹Department of Nursing, School of Medicine, Shaoxing University, Zhejiang Province, China

²Institute of Epidemiology, Shaoxing Keqiao District Center for Disease Control and Prevention, Zhejiang Province, China

The purpose of this study is to examine the change of Health-related quality of life (HRQOL) and rearing behavior among migrant children as well as their correlations in the city of Shaoxing, China. By cluster sampling, 149 migrant children had completed the questionnaires in 2014 and 2015. Spearman’s correlation was performed to clarify the relationship between change of HRQOL and rearing behavior in migrant children. Multiple linear stepwise regression analytical methods were used to identify the variables that were associated with change of HRQOL. The results showed that total score, physical health, psychosocial health, emotional functional and social functional of HRQOL among migrant children had increased and overprotection of parents was declined. There were negative correlation between change of quality of life (total score) and change of parents rejection or mother overprotection. There were also negative correlation between change of psychosocial health and change of parents rejection and overprotection. The change of quality of life was mostly reflected by change of mother rejection. These data show that HRQOL and negative rearing behavior among migrant children had improved. The change of quality of life was most affected by the negative rearing behavior of parents, especially mothers.

Stefanie R. Pilkay¹*, Terri Combs-Orme², Frances Tylavsky³, Nicole Bush⁴, Alicia K. Smith⁵

¹Falk College, School of Social Work, Syracuse University, Syracuse, New York

²College of Social Work, University of Tennessee, Knoxville, Tennessee

³Department of Preventive Medicine, University of Tennesse Health and Science Center, e, Memphis, Tennessee

⁴Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, California

⁵Department of Gynecology and Obstetrics, Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia

Summary: The prenatal environment can influence gene expression involved in the development, possibly contributing to generational patterns of psychological health. Moreover, sex-specific developmental differences in-utero may result in gene expression differences associated with the prenatal environment. However, it is not clear if maternal overall psychological symptoms will associate with newborn’s gene expression, or if such patterns are consistent between sexes. This study explored the relationships between maternal psychological health (PsyH) and newborn’s gene expression patterns. We assessed PsyH with the Brief Symptom Inventory and newborn gene expression in umbilical cord blood. We conducted combined and sex-stratified analyses of genes expressed in umbilical cord blood.

Findings: PsyH associated with differential expression of 157 genes in males. The 157 differentially expressed genes are more likely to function in metabolic processes. There were no significant differences in gene expression in females.

Application: The sex-specific nature of these findings suggests males may be more vulnerable than females to mothers’ psychological functioning during pregnancy. It is possible that the male-specific results are due in part to female newborns developing under different neuroendocrine conditions. Future research examining prenatal exposures should consider sex differences.

Ruchita Agrawal^1,2*

¹Seven Counties Services, Louisville KY, USA (Formerly, Centerstone)

²Department of Psychiatry, University of Louisville, Louisville KY, USA

Benzodiazepines have been commonly prescribed for the treatment of anxiety and insomnia in the last few decades. There has been a rising concern regarding safety of benzodiazepines due to overdose related deaths, addictions, and cognitive side effects. COVID- 19 pandemic is expected to cause a mental health crisis. Several studies have shown an increase in anxiety and insomnia. This could mean that prescriptions of benzodiazepine could increase due to increase in anxiety and insomnia. We caution health care providers to use best practices and treat patients with psychotherapy as the first line of treatment and not pharmacotherapy. Prescription Drug Monitoring programs (PDMPs) were started due to this concern of overdose deaths, diversion related to opioids and benzodiazepines. PDMPs are mandatory in most states in the United States of America now.We recommend all health care providers to look at their benzodiazepine prescribing practice, monitor PDMP data and make policies to implement changes in order to avoid the next crisis of benzodiazepines after opioids.

Shervin Assari^1,2*, Golnoush Akhlaghipour³, Mohammed Saqib⁴, Shanika Boyce⁵, Mohsen Bazargan¹

¹Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

²Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

³Department of Neurology, UCLA, Los Angeles, CA, USA

⁴Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA

⁵Department of Pediatrics, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

Background: Considerable research has suggested that race and age are two major determinants of brain development, including but not limited to development of the prefrontal cortex (PFC). Minorities’ Diminished Returns (MDRs), however, suggests that race (as a proxy of racism) may interact with various determinants of human and brain development. Minimal knowledge, however, exists on whether age and race also interact on shaping PFC response to threat among American children.

Purpose: Using data from a task-based functional brain imaging study and considering race as a sociological rather than a biological construct, we investigated combined effects of race and age on prefrontal cortical (PFC) response to threat. We explored racial heterogeneities in the association between age and PFC response to threat by comparing Black and White children.

Methods: This study used the task-based functional Magnetic Resonance Imaging (fMRI) data from the Adolescents Brain Cognitive Development (ABCD) study, a national, landmark, multi-center brain imaging investigation of 9-10 years old children in the US. The primary outcomes were mean beta weights of n-back runs measuring PFC response to threating versus neutral face contrast in the following regions of interest (ROIs): left hemisphere-lateral orbito-frontal, left hemisphere -superior-frontal, right hemisphere -caudal middle frontal, and right hemisphere -superior frontal cortex. The independent variable was age. Covariates were sex, ethnicity, family socioeconomic status, and neighborhood socioeconomic status. Race was the focal moderator. To analyze the data, we used linear regression models without and with interactions and SES as covariates.

Results: We included 5,066 9-10 years old children. Age and race did not show direct effects on PFC response to threatening relative to neutral faces. While ethnicity, sex, and socioeconomic status were controlled, age and race showed a systematic interaction on PFC response to threatening relative to neutral faces.

Conclusions: For American children, race and age do not have direct effects but multiplicative effects on PFC response to threat. The results may be reflective of social inequalities in how Black and White children are socialized and developed. The results are important given the role of the PFC in regulating the limbic system response to threat. Coordinated work of the limbic system and PFC is a core element of children’s behavioral and emotional development. Future research is needed on how social stratification and racism shape emotion processing and regulation of American children in response to threat.

Per Eisele*

Associate professor, Department of Psychology, Mid Sweden University, Sweden

Background: The mental health continuum was created for the purpose of measuring mental health with several different wellbeing items.

Aims: The aim of the present study was to investigate the mental health continuum together with a new struggle continuum scale. With languishing and flourishing at the ends of a vertical scale and surrendering and struggling at the ends of a horizontal scale a quadratic model is suggested. Four factors can be distinguished at the corners of the square, depressed, anxious, content and joyful.

Methods: The sample (N=294) consisted of 174 women with a mean age of 40.48 and 124 men with a mean age of 37.27 year. The mental health continuum scale was used together with a new scale measuring struggling, the tendency to give up easily or keep on fighting.

Results: The model was tested on a normal population and was confirmed. Result of chi-square, correlation and t-test analyses show that the two scales could detect depressed, anxious, content and joyful participants.

Conclusions: The result has implications for the choice between mindfulness and activity-based interventions. Discussion about the result are provided.

Dena M. Bravata^1,2*, Divya K. Madhusudhan², Michael Boroff², Kevin O. Cokley³

¹Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA

²Crossover Health, San Clemente, CA

³University of Texas at Austin, Austin, TX

K Gilrain*, P Fizur, R Allen, E Campbell, P Watson, S Jordan, E Kupersmith, A Rostain

Division of Behavioral Medicine, Cooper University Hospital, USA

Background: Promoting resilience in healthcare workers is a well-studied area that has taken on new significance in the context of the COVID-19 pandemic. Extant literature suggests a need to expand resiliency efforts, with a recommended focus on multimodal approaches.

Purpose: The present account describes the unique challenges faced by one urban, northeastern academic medical center during the COVID-19 crisis in promoting resiliency in their healthcare workers at all levels, with the related aim of examining feasibility and acceptability of doing so.

Methods: A review of existing procedures targeting wellness and resiliency at this hospital was completed. A literature review was conducted with regard to promoting resiliency and preventing burnout, with emphasis placed on case studies from other institutions during the pandemic. Post-intervention surveys were conducted to assess feasibility and acceptability.

Results: A multi-component approach was created based on a review of the literature and all available information. The current report focuses on the first five weeks of that effort, the results of which suggest sufficient feasibility and high acceptability among those surveyed. Common themes raised in support sessions are also identified and discussed.

Conclusions: The challenges raised by COVID-19 are significant, with a high probability of impact on the wellbeing of health care workers. Targeting resiliency now may be a key factor in preventing pathological responses later. The current approach appears feasible and acceptable with regard to targeting key resiliency areas. Future studies should focus on the longer term outcomes of these efforts.

Donald F. Graves¹*, Gayle S. Morse^1,4, Kathleen Kerr², David O. Carpenter^3,4

¹Psychology Department, Russell Sage College, Troy, NY, USA

²Department of Family and Community Medicine, University of Toronto, Toronto, Canada

³School of Public Health, University at Albany, Albany, NY, USA

⁴Institute for Health & the Environment, University at Albany, Albany, NY, USA

Gulf War Illess (GWI) is a serious health concern for 30% of veterans who were deployed during the first Gulf War. Symptoms include reduced physical, psychological, and neuropsychological wellness and function. Research indicates that these symptoms can be linked to environmental toxins that veterans were exposed to during their time in theater. Some data suggest that continued internal exposure may be maintaining the illness, thus a detoxification procedure could be of assistance to those experiencing GWI. Reviewed here is a novel detoxification procedure applied as a treatment for GWI and the positive outcomes associated with this procedure. Presented here is a brief logic for the detoxification method, a simple summary of the method, and the encouraging outcomes of the method. Awareness of this and similar detoxification methods’ impacts on GWI symptoms should highlight the need for more research on this and related topics.

Tudor M. Baetu*

Department of Philosophy and Arts, University of Quebec at Trois-Rivieres, Canada

The philosophical thesis of pain eliminativism can be understood in several ways. As a claim about the inadequacy and replacement of folk explanatory pain constructs and concepts, it is congruent with scientific findings. Eliminativism is controversial in as much as it demands a more or less radical recharacterization of the phenomenon of pain in order to ensure compatibility with physicalism and an identity model of reductive explanation. In this respect, eliminativism is at odds with experimental and explanatory paradigms at work in biomedical research. The latter is concerned with reproducible phenomena, controlled experiments generating evidence for causation and causal-mechanistic explanations. Since nothing here supports conclusive inferences about the identity or non-identity of pain, or aspects of it, with biological activity, it is not clear what, if anything at all needs to be eliminated.

Shervin Assari¹*, Sharon Cobb², Mohammed Saqib³, Mohsen Bazargan^1,4

¹Departments of Family Medicine, Charles R Drew University of Medicine and Science

²School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA, United States

³University of Michigan School of Public Health, Ann Arbor, MI, United States

⁴Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States

Background: A large body of empirical evidence on Minorities’ Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities.

Aim: The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days.

Methods: This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data.

Results: Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome.

Conclusion: In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Morgan James Grant*, Hala El-Agha, Thuy-Tien Ho, Shobal D. Johnson

Texas Woman’s University, Texas, United States

Thirteen Reasons Why (13RY) is a Netflix series that tells the story of a high school girl named Hannah Baker, who died from suicide due to a series of painful events of betrayal, sexual assault, bullying from classmates, and lack of support from friends, family, and school staff. She prepared and left behind a box with a suicide note and 13 audiotapes to give insight into her suicide. In Thirteen Reasons Why: The impact of suicide portrayal on adolescents’ mental health, Rosa et al. investigated “the influence of media portrayals of suicide on adolescent’s mood" by providing a descriptive, qualitative perspective of mental health, suicidality, and the prevalence of suicidal behavior or ideation, along with emotional processes most affected by the sensationalism and normalization of suicide. This commentary discusses the impact of suicide portrayal on adolescents and highlights the backlash that occurred in response to how 13RY depicted suicide by expanding on the study’s limitations, highlighting controversial issues, and making recommendations for future research by revealing the omission of certain key facts.

Jeffrey S. Nevid*, Alexander J. Gordon, Andrew S. Miele, Luke H. Keating

St. John’s University, New York

Efforts to understand personality features of people who use psychoactive substances have a long history, dating back to early psychoanalytic conceptualizations. Advancements in the field have focused on applying multidimensional personality inventories to better understand personality differences between substance users and non-users, and between different substance use types, with respect to both psychopathological traits and broad dimensional factors. A brief review of this evidence highlights personality features of persons with alcohol and other substance use problems and between users of different types of substances, especially alcohol and opioid substance use disorder patients. A better understanding of personality profiles of substance use disorder groups may be useful in tailoring treatment approaches based on profile characteristics.

Dinesh K Arya*

Yarralumla, Australia

To manage COVID-19 pandemic, most nations have been proactive in introducing wide-ranging measures to prevent its spread, as well as to support the economy. During this pandemic, almost the entire population has been impacted by quarantine and social isolation-related restrictions. It is this aspect that makes this pandemic different from other recent disasters.

It is essential that appropriate mental health support is targeted to support people with suspected and confirmed COVID-19 infections, as well as for the health professionals caring for this cohort. During the pandemic it is also essential that access to appropriate mental health support for those experiencing mental disorders is increased, and that appropriate psychosocial support is available for those experiencing financial hardship resulting from quarantine and social isolation-related restrictions so that they can sustain themselves.

Jeremias L. Convocar*, Vicente D. Billones, Nelly L. Supiter

West Visayas State University, La Paz, Iloilo City, Philippines

Introduction: Previous studies provide insight into the association between incarceration and mental health of prison inmates, but fail to look into the influence Geopathic Stress (GS) and spirituality on perceived stress. This study aimed to determine the levels and relationships that exist among male inmates Perceived Stress, GS and Spirituality.

Method: The study design is a descriptive-correlational study that was conducted among 144 conveniently and purposively selected male inmates of certain city Rehabilitation Center in the Philippines, during the third quarter of fiscal Year 2019. The data gathering for the study utilized the adopted Perceived Stress Scale⁵³, the Religiosity/Spirituality Scale⁵⁴ and the researcher⁵⁵ GS instrument. Some of the items in the instruments were slightly modified with corresponding vernacular language translations in order to fit with prison inmates’ context. The percentage analysis, mean, standard deviation, Mann-Whitney U test, and Kruskall Wallis H test with probability level set at 0.05 alpha.

Results: Generally, the male inmates had fair level of perceived stress and moderate level of spirituality regardless of their age, educational attainment, length of incarceration and status of case. Those who stayed longer (over 3 years) in prison experience most stress than those who stayed shorter. GS induces ones’ level of stress. A negative association between inmates perceived stress and spirituality and a positive association between GS and perceived stress. GS has always been ignored because most of the people are unaware of its occurrence in certain areas and its harmful effects on human health.

Conclusions: Although prison life is generally stressful, if inmates get involved in any religious-spiritual activities like bible study and worship service, vocational trainings, sports, exercises and other stress reduction activities may increase feelings of physical and mental well-being. Perceived long stay in prison induced the boredom of imprisonment and desire for liberty and longing to be with their family all adds to the stress of incarceration. On the other hand, if the inmates unluckily stayed over by sleeping for a long period of time within geopathically stressed area, they will be most likely to experience chronic stress that might develop various health problems. Spirituality is an internal resource that helps male inmates to cope well with stress. When one is connected with his spirituality, there is such a huge reservoir of support and help that one’s worries in life seem inconsequential. The results of this study may challenge health professionals in the correctional system to look into and consider GS and spirituality in managing inmates' stress and mental health.

Najmeh Maharlouei^1,3, Sharon Cobb², Mohsen Bazargan^3,4, Shervin Assari³*

¹ Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran

² School of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, CA

³ Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

⁴ Department of Family Medicine, UCLA, Los Angeles, CA

Background: Education, employment, and marital status are among the main socioeconomic status (SES) indicators that are associated with subjective health and happiness. The effects of these SES indicators may, however, be different for various demographic groups.

Aims: To understand if SES indicators differently impact men and women, we tested gender differences in the effects of education, employment, and marital status on the subjective health and happiness of American adults.

Methods: This cross-sectional study used data of the General Social Survey (GSS), a series of nationally representative surveys between 1972 and 2018 in the US. Our analytical sample included 65,814 adults. The main independent variables were education attainment, marital status, and employment. Outcomes were self-rated health (SRH) and happiness measured using single items. Age and year of the study were covariates. Gender was the moderator.

Results: Overall, high education, being employed, and being married were associated with better SRH and happiness. We, however, found significant interactions between gender and educational attainment, marital status, and employment on the outcomes, which suggested that the effect of high education and marital status were stronger for women. In comparison, the effect of employment was stronger for men. Some inconsistencies in the results were observed for SRH compared to happiness.

Conclusions: In the United States, while education, employment, and marital status are critical social determinants of subjective health and happiness, these effects vary between women and men. Men’s outcomes seem to be more strongly shaped by employment, while women’s outcomes are more strongly shaped by education and marital status.

Dinesh K Arya*

ACT Health, 2 Bowes Street, Woden, ACT 2606, Australia

The challenge for mental health services is to ensure that available resources are able to meet the needs of mental health consumers. It is useful to develop a staff resourcing model that is based entirely on the identification of mental health needs of consumers. Such a model has the potential to ensure that available mental health staffing resources are not wasted and mental health consumers receive an appropriate level of mental health support.

Christopher Kam*, Christian R. Bellehumeur

Saint Paul University, Ottawa, Canada

Leah Carter*, Callie Hebert, Owen Carmichael, Robert L. Newton Jr

Pennington Biomedical Research Center, Baton Rouge, Louisiana

Rebecca Jackson¹*, J. Michelle Robertson^1,2

¹Brain Balance Achievement Centers, USA

²Department of Social and Behavioral Sciences, Friends University, Wichita, KS

Children with developmental or learning challenges often have co-occurring difficulties in emotional functioning. There is a longstanding need to identify effective nonpharmacologic treatments to address these emotional difficulties. However, few studies have examined training programs that are multimodal in nature and their effects specifically on mental well-being. The purpose of this study is to estimate the impact of an integrative multimodal training program (Brain Balance^®) on mental well-being in children and adolescents with developmental or learning challenges, as measured by parental surveys. A retrospective review was performed on 4 years of archived survey responses from parents of enrolled students (4-17 years; 70.8% male and 29.2% female) before and after program participation. Before program participation, all students tested below age-appropriate developmental levels. The Brain Balance program consisted of three 1-hour in-center sessions per week (45 minutes of sensorimotor stimulation and 15 minutes of academic activities), along with other multimodal activities targeting proprioception and balance, vestibular functioning, fine motor skills, rhythm and timing, auditory and visual processing, and retained primitive reflexes. Parental responses showed that, after 5-6 months of program participation, 75% of children showed up to 25% improvement, and 25% of children demonstrated 60-85.7% improvement, in the following areas: panic/anxiety attacks, worrying, depression-like symptoms, mood, obsessive thoughts or behaviors, social withdrawal, pessimism, emotional regulation, emotional self-awareness, and emotional expressiveness. These findings suggest the potential value of nonpharmacologic training programs in improving mental well-being in children and adolescents with developmental or learning challenges, especially programs that are comprehensive and multimodal.

Shervin Assari¹*, Hamid Chalian², Mohsen Bazargan^1,3

¹Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA

²Department of Radiology, Department of Radiology, Duke University Medical Center, Durham, USA

³Department of Family Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA

Background: Educational attainment and income are two socioeconomic status indicators with strong protective effects against cigarette smoking. Marginalization-related Diminished Returns, however, refer to less than expected protective effects of socioeconomic status indicators for the members of the racial and ethnic minority groups, particularly Blacks and Hispanics, compared to non-Hispanic Whites.

Aim: Borrowing data from a nationally representative study in the US, this study tested whether racial and ethnic differences exist in the effects of educational attainment and poverty status on cigarette smoking of American adults.

Methods: This cross-sectional study entered 28,329 adult participants of the Population Assessment of Tobacco and Health (PATH; 2013). Both educational attainment and poverty status were the independent variables. The dependent variable was current hookah smoking. Age, gender, and region were the covariates. Race and ethnicity were the effect modifiers (moderators).

Results: Overall, individuals with higher educational attainment were more likely to smoke a hookah. Individuals who lived out of poverty, however, had lower odds of current hookah smoking. Race and ethnicity both showed statistical interactions with both socioeconomic indicators suggesting that Blacks and Hispanics with high educational attainment and those who live out of poverty have disproportionately high odds of hookah smoking, compared to non-Hispanic Whites with high socioeconomic status.

Conclusion: In the United States, middle-class racial and ethnic minority people remain at higher risk of smoking hookah. As a result, we should expect a high tobacco burden in middle-class Black and Hispanic adults. We suggest that policymakers should not take an over-simplistic way and reduce the problem of race/ethnic inequalities in tobacco use to gaps in socioeconomic status between groups. Marginalization-related diminished returns generate tobacco disparities in higher socioeconomic status levels. Middle-class racial and ethnic minority people need extra support to stay healthy.

Carles Barcons Comellas^1,2*

¹Clinical Psychologist, Hospital Sagrat Cor, Serveis de Salut Mental Martorell, Spain

²PhD student. Department of Psychiatry and Forensic Medicine. Universitat Autònoma de Barcelona, Spain

Kelly L. Gilrain*, Alexa M. Hays, Victoria A. Grunberg, Anastasia Bullock, Philip Fizur, Steven E. Ross

Division of Behavioral Medicine, Cooper University Hospital, USA