Authors:Edison J. Trickett Pages: 197 - 204 Abstract: Abstract The intellectual legacy of Seymour Sarason continues to serve as a critical resource for the field of community psychology. The present paper draws on one of Sarason’s favorite aphorisms and two of his seminal writings to suggest the relevance of ideas articulated 35–40 years ago for the current time. Each in their own way highlights the importance of unearthing and interrogating core assumptions underlying our research and our efforts to make a positive difference. The aphorism reminds us that the rhetoric of change is far easier to articulate than to enact and all too often ignores or disguises issues of power among actors. The “misdirection” of Psychology reflected his assertion that the asocial, acultural, and ahistorical nature of American Psychology reflected American culture more generally and ill prepared it to understand and engage in social change, particularly with respect to educational reform. The “anarchist insight” articulated his belief in interrogating the implications of the increasingly interdependent relationship of science and the state for the autonomy of scientists and scientific inquiry. The evidence-based practice movement is offered as an example of the current day relevance of the aphorism and core insights of these two papers. The paper concludes with a plea to rekindle the discussion and continued examination of Sarason’s paradigmatic insights for the intellectual and social development of the field. PubDate: 2015-12-01 DOI: 10.1007/s10464-015-9744-9 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Marybeth Shinn; Judith Samuels; Sean N. Fischer; Amanda Thompkins; Patrick J. Fowler Pages: 205 - 216 Abstract: Abstract A randomized trial compared effects of a Family Critical Time Intervention (FCTI) to usual care for children in 200 newly homeless families in which mothers had diagnosable mental illness or substance problems. Adapted from an evidence-based practice to prevent chronic homelessness for adults with mental illnesses, FCTI combines housing and structured, time-limited case management to connect families leaving shelter with community services. Families were followed at five time points over 24 months. Data on 311 children—99 ages 1.5–5 years, 113 ages 6–10 years, and 99 ages 11–16 years—included mother-, teacher-, and child-reports of mental health, school experiences, and psychosocial well-being. Analyses used hierarchical linear modeling to investigate intervention effects and changes in child functioning over time. Referral to FCTI reduced internalizing and externalizing problems in preschool-aged children and externalizing for adolescents 11–16. The intervention led to declines in self-reported school troubles for children 6–10 and 11–16. Both experimental and control children in all age groups showed reductions in symptoms over time. Although experimental results were scattered, they suggest that FCTI has the potential to improve mental health and school outcomes for children experiencing homelessness. PubDate: 2015-12-01 DOI: 10.1007/s10464-015-9742-y Issue No:Vol. 56, No. 3-4 (2015)
Authors:Sabrina Oesterle; J. David Hawkins; Margaret R. Kuklinski; Abigail A. Fagan; Christopher Fleming; Isaac C. Rhew; Eric C. Brown; Robert D. Abbott; Richard F. Catalano Pages: 217 - 228 Abstract: This study tested sustained effects of the Communities That Care (CTC) prevention system on health-risking behaviors 9 years after baseline in a community-randomized trial involving 24 towns in seven states. Earlier analyses found sustained effects on abstinence from drug use and delinquency through Grade 12 in a panel of fifth graders. At age 19, 91 % (n = 3986) of the living panel completed the survey. Data were analyzed using generalized linear mixed models. The prevalence of lifetime and current substance use and delinquency were the primary outcomes. Secondary outcomes included substance use disorders, major depression, suicidality, educational attainment, and sexual risk behaviors. CTC had a significant overall effect across lifetime measures of the primary outcomes for males, but not for females or the full sample, although lifetime abstinence from delinquency in the full sample was significantly higher in CTC communities (ARR = 1.16). Males in CTC communities also continued to show greater lifetime abstinence from cigarette smoking (ARR = 1.22). CTC did not have a sustained effect on current substance use and delinquency nor did it improve the secondary outcomes at age 19 for either gender. Communities using CTC may need to extend their prevention planning to include the high school years to sustain effects on drug use and delinquency beyond high school for both genders. Trial Registration ClinicalTrials.gov identifier: NCT01088542. PubDate: 2015-09-16 DOI: 10.1007/s10464-015-9749-4 Issue No:Vol. 56, No. 3-4 (2015)
Authors:A. W. Batchelder; J. S. Gonzalez; A. Palma; E. Schoenbaum; D. W. Lounsbury Pages: 229 - 240 Abstract: Abstract Syndemic risk is an ecological construct, defined by co-occurring interdependent socio-environmental, interpersonal and intrapersonal determinants. We posited syndemic risk to be a function of violence, substance use, perceived financial hardship, emotional distress and self-worth among women with and at-risk for HIV in an impoverished urban community. In order to better understand these interrelationships, we developed and validated a system dynamics (SD) model based upon peer-reviewed literature; secondary data analyses of a cohort dataset including women living with and at-risk of HIV in Bronx, NY (N = 620); and input from a Bronx-based community advisory board. Simulated model output revealed divergent levels and patterns of syndemic risk over time across different sample profiles. Outputs generated new insights about how to effectively explore multicomponent multi-level programs in order to strategically develop more effective services for this population. Specifically, the model indicated that effective multi-level interventions might bolster women’s resilience by increasing self-worth, which may result in decreased perceived financial hardship and risk of violence. Overall, our stakeholder-informed model depicts how self-worth may be a major driver of vulnerability and a meaningful addition to syndemic theory affecting this population. PubDate: 2015-09-14 DOI: 10.1007/s10464-015-9750-y Issue No:Vol. 56, No. 3-4 (2015)
Authors:Allen W. Barton; Steven M. Kogan; Junhan Cho; Geoffrey L. Brown Pages: 241 - 251 Abstract: Abstract This study was designed to examine the associations of biological father and social father involvement during childhood with African American young men’s development and engagement in risk behaviors. With a sample of 505 young men living in the rural South of the United States, a dual mediation model was tested in which retrospective reports of involvement from biological fathers and social fathers were linked to young men’s substance misuse and multiple sexual partnerships through men’s relational schemas and future expectations. Results from structural equation modeling indicated that levels of involvement from biological fathers and social fathers predicted young men’s relational schemas; only biological fathers’ involvement predicted future expectations. In turn, future expectations predicted levels of substance misuse, and negative relational schemas predicted multiple sexual partnerships. Biological fathers’ involvement evinced significant indirect associations with young men’s substance misuse and multiple sexual partnerships through both schemas and expectations; social fathers’ involvement exhibited an indirect association with multiple sexual partnerships through relational schemas. Findings highlight the unique influences of biological fathers and social fathers on multiple domains of African American young men’s psychosocial development that subsequently render young men more or less likely to engage in risk behaviors. PubDate: 2015-09-11 DOI: 10.1007/s10464-015-9748-5 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Adam Voight; Thomas Hanson; Meagan O’Malley; Latifah Adekanye Pages: 252 - 267 Abstract: Abstract This study used student and teacher survey data from over 400 middle schools in California to examine within-school racial disparities in students’ experiences of school climate. It further examined the relationship between a school’s racial climate gaps and achievement gaps and other school structures and norms that may help explain why some schools have larger or smaller racial disparities in student reports of climate than others. Multilevel regression results problematized the concept of a “school climate” by showing that, in an average middle school, Black and Hispanic students have less favorable experiences of safety, connectedness, relationships with adults, and opportunities for participation compared to White students. The results also show that certain racial school climate gaps vary in magnitude across middle schools, and in middle schools where these gaps are larger, the racial achievement gap is also larger. Finally, the socioeconomic status of students, student–teacher ratio, and geographic location help explain some cross-school variation in racial climate gaps. These findings have implications for how school climate in conceptualized, measured, and improved. PubDate: 2015-09-16 DOI: 10.1007/s10464-015-9751-x Issue No:Vol. 56, No. 3-4 (2015)
Authors:Justin E. Heinze; Daniel J. Kruger; Thomas M. Reischl; Suzanne Cupal; Marc A. Zimmerman Pages: 268 - 279 Abstract: Abstract We examined the relationship between the cumulative presence of major disease (cancer, stroke, diabetes, heart disease, and hypertension), social support, and self-reported general and emotional well-being in a community representative sample of predominantly White and African American respondents (N = 1349). Across all ages, greater presence of disease predicted poorer reported general health, and predicted lower emotional well-being for respondents 40 and above. In contrast, social support predicted better-reported general and emotional well-being. We predicted that different types of social support (blood relatives, children, friends, community members) would be relatively more important for health in different age groups based on a lifespan or life stage model. This hypothesis was supported; across all ages, social support was related to better reported general and emotional health, but sources of support differed by age. Broadly, those in younger age groups tended to list familial members as their strongest sources of support, whereas older group members listed their friends and community members. As a whole, social support mediated the effect of disease on reported well-being, however, moderated mediation by type of support was not significant. The results are consistent with a lifespan approach to changing social ties throughout the life course. PubDate: 2015-10-13 DOI: 10.1007/s10464-015-9758-3 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Catherine P. Bradshaw; Adam J. Milam; C. Debra M. Furr-Holden; Sarah Lindstrom Johnson Pages: 280 - 292 Abstract: Abstract School safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents’ risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools. PubDate: 2015-12-01 DOI: 10.1007/s10464-015-9743-x Issue No:Vol. 56, No. 3-4 (2015)
Authors:Daisy R. Jackson; Elise Cappella; Jennifer Watling Neal Pages: 293 - 306 Abstract: Abstract In a cross-sectional sample of African-American 2nd–4th grade students (N = 681), we examine the moderating effects of classroom overt and relational aggression norms on peers’ social acceptance of classmates who exhibit overt and relational aggression in urban schools. Extending theory and research on classroom norms, we integrate social network data to adjust aggression norms based on children’s direct and indirect connections in the classroom. Results of multilevel models indicate that network-based classroom aggression norms moderated relations between children’s aggressive behavior and their social preference. Specifically, children benefited socially when their form of aggressive behavior fit with what was normative in the classroom social context. The moderating effect of classroom aggression norms was stronger for the association between overt aggression and social preference than relational aggression and social preference. Relationally aggressive youth were socially preferred by peers regardless of the classroom norm, although this positive association was magnified in classrooms with higher levels of relational aggression. Future research focused on aggression norms within classroom social networks are discussed and implications for school prevention efforts are considered. PubDate: 2015-09-28 DOI: 10.1007/s10464-015-9757-4 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Kate Schwartz; Elise Cappella; Edward Seidman Pages: 307 - 320 Abstract: Abstract The transition to middle/junior high school is associated with declines in students’ academic performance, especially among low-income, urban youth. Developmental psychologists posit such declines are due to a poor fit between the needs of early adolescents—industry, identity, and autonomy—and the environment of their new schools. Extracurricular participation during these years may act as a buffer for youth, providing a setting for development outside the classroom. The current study examines participation within and across activity settings among low-income, urban youth in New York City over this transition. Using the Adolescent Pathways Project data, this study explores how such participation relates to course performance. We find that a large percentage of youth are minimally or uninvolved in extracurricular activities during these years; that participation varies within youth across time; and that the association between participation and course performance varies by activity setting. Youth who participate frequently in community or athletic settings or have high participation in two or more settings are found to have higher GPAs in the year in which they participate and youth who participate frequently in the religious setting are found to have lower GPAs. High participation in more than two settings may be detrimental. PubDate: 2015-09-21 DOI: 10.1007/s10464-015-9752-9 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Casta Guillaume; Robert Jagers; Deborah Rivas-Drake Pages: 321 - 331 Abstract: Abstract The present study investigated how school climate, school connectedness and academic efficacy beliefs inform emergent civic engagement behaviors among middle school youth of color. These associations were examined both concurrently and longitudinally using a developmentally appropriate measure of civic engagement. Data were drawn from two subsamples of a larger study of social/emotional development in middle school (cross-sectional sample n = 324; longitudinal sample n = 232), M = 12 years old, 46 % female, 53 % male. Forty-two percent (42.2 %) of the sample self-identified as African American, 19.8 % as Multiracial or Mixed, 19.4 % as Latino, 11.6 % as Asian American or Pacific Islander, 11.6 % identified as Other, and 5.2 % as Native American. The study tested and found support for a latent mediation model in which more positive perceptions of school climate were positively related to school connectedness, and this in turn, was positively associated with civic engagement; school climate was also positively associated with academic-self-efficacy beliefs, but such beliefs did not mediate the climate-civic engagement association. Implications for future research and practice are discussed. PubDate: 2015-09-30 DOI: 10.1007/s10464-015-9759-2 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Sarah A. Stoddard; Jennifer Pierce Pages: 332 - 341 Abstract: Abstract Positive future expectations can facilitate optimal development and contribute to healthier outcomes for youth. Researchers suggest that internal resources and community-level factors may influence adolescent future expectations, yet little is known about the processes through which these benefits are conferred. The present study examined the relationship between contribution to community, neighborhood collective efficacy, purpose, hope and future expectations, and tested a mediation model that linked contribution to community and collective efficacy with future expectations through purpose and hope in a sample of 7th grade youth (N = 196; Mage = 12.39; 60 % female; 40 % African American; 71 % economically disadvantaged). Greater collective efficacy and contribution to community predicted higher levels of hope and purpose. Higher levels of hope and purpose predicted more positive future expectations. Contribution to community and neighborhood collective efficacy indirectly predicted future expectations via hope. Implications of the findings and suggestions for future research are discussed. PubDate: 2015-09-18 DOI: 10.1007/s10464-015-9754-7 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Emily M. Wright; Gillian M. Pinchevsky; Michael L. Benson; Dana L. Radatz Pages: 342 - 356 Abstract: Abstract This study examines the direct effects of neighborhood supportive mechanisms (e.g., collective efficacy, social cohesion, social networks) on depressive symptoms among females as well as their moderating effects on the impact of IPV on subsequent depressive symptoms. A multilevel, multivariate Rasch model was used with data from the Project on Human Development in Chicago Neighborhoods to assess the existence of IPV and later susceptibility of depressive symptoms among 2959 adult females in 80 neighborhoods. Results indicate that neighborhood collective efficacy, social cohesion, social interactions, and the number of friends and family in the neighborhood reduce the likelihood that females experience depressive symptoms. However, living in areas with high proportions of friends and relatives exacerbates the impact of IPV on females’ subsequent depressive symptoms. The findings indicate that neighborhood supportive mechanisms impact interpersonal outcomes in both direct and moderating ways, although direct effects were more pronounced for depression than moderating effects. Future research should continue to examine the positive and potentially mitigating influences of neighborhoods in order to better understand for whom and under which circumstances violent relationships and mental health are influenced by contextual factors. PubDate: 2015-09-21 DOI: 10.1007/s10464-015-9753-8 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Jack Tsai; Sriram Ramaswamy; Subhash C. Bhatia; Robert A. Rosenheck Pages: 357 - 367 Abstract: Abstract This study explored differences between homeless male veterans in metropolitan and micropolitan cities in Nebraska on sociodemographic, housing, clinical, and psychosocial characteristics as well as health service use. A convenience sample of 151 homeless male veterans (112 metropolitan, 39 micropolitan) were recruited from Veterans Affairs facilities and area shelters in Omaha, Lincoln, Grand Island, and Hastings in Nebraska. Research staff conducted structured interviews with homeless veterans. Results showed that compared to homeless veterans in metropolitans, those in micropolitans were more likely to be White, unmarried, living in transitional settings, and were far more transient but reported greater social support and housing satisfaction. Veterans in micropolitans also reported more medical problems, diagnoses of anxiety and personality disorders, and unexpectedly, were more likely to report using various health services and less travel time for services. Together, these findings suggest access to homeless and health services for veterans in micropolitan areas may be facilitated through Veterans Affairs facilities and community providers that work in close proximity to one another. Many homeless veterans in these areas are transient, making them a difficult population to study and serve. Innovative ways to provide outreach to homeless veterans in micropolitan and more rural areas are needed. PubDate: 2015-09-09 DOI: 10.1007/s10464-015-9746-7 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Erin E. Toolis; Phillip L. Hammack Pages: 368 - 382 Abstract: Abstract The way that public space is structured has significant implications for identity, social interaction, and participation in society. For those experiencing homelessness, with no or limited private space, survival hinges on the accessibility and livability of public space. However, the increasing privatization of public space in the United States has contributed to the implementation of anti-homeless ordinances in cities, restricting sitting, standing, panhandling, and sleeping in public. This study analyzes data from interviews with housed and unhoused community members, text from a local policy document, and ethnographic observations to explore how boundaries between “insiders” and “outsiders” are drawn in public space and mediated through individual discourse. Our findings suggest that boundaries of exclusion are constructed through dominant narratives that portray the unhoused as a threat to safety and economic vitality, thus justifying the need for regulation and punishment through the criminalization of homelessness. Yet, informants also demonstrate resistance to this narrative by discussing how criminalization of homelessness perpetuates dehumanization, violence, and economic inequality. Policy implications for the regulation of public space are discussed. PubDate: 2015-09-24 DOI: 10.1007/s10464-015-9756-5 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Virgil D. Moorehead; Joseph P. Gone; Damia December Pages: 383 - 394 Abstract: Abstract This article reports insights from a 4-day Gathering of Native American Healers at the University of Michigan in October of 2010. This event convened 18 traditional healers, clinically trained service providers, and cross-cultural mental health researchers for a structured group dialogue to advance professional knowledge about the integration of Indigenous healing practices and conventional mental health treatments in community-based mental health services for Native Americans. Our thematic analysis of transcripts from five Roundtable sessions afforded several key insights and understandings pertaining to the integration of Indigenous healing and conventional mental health services. First, with reference to traditional healing, the importance of a rampant relationality, various personal qualities, Indigenous spirituality, and maintenance of traditional life and culture were accentuated by Roundtable participants. Second, for traditional healers to practice effectively, Roundtable participants posited that these individuals must maintain personal wellness, cultivate profound knowledge of healing practices, recognize the intrinsic healing potential within all human beings, and work for the community rather than themselves. In speaking to the possibilities and challenges of collaboration between Indigenous and conventional biomedical therapeutic approaches, Roundtable participants recommended the implementation of cultural programming, the observance of mutuality and respect, the importance of clear and honest communication, and the need for awareness of cultural differences as unique challenges that must be collaboratively overcome. PubDate: 2015-09-08 DOI: 10.1007/s10464-015-9747-6 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Corrina D. Salo; Dina Birman Pages: 395 - 407 Abstract: Abstract Acculturation to the culture of the host society as well as to one’s heritage culture have been shown to impact immigrants’ adjustment during the years following resettlement. While acculturation has been identified as an important factor in adjustment of Vietnamese immigrants (Birman and Tran in Am J Orthopsychiatr 78(1):109–120. doi:10.1037/0002-9432.78.1.109, 2008), no clear pattern of findings has emerged and too few studies have employed an ecological approach. The purpose of this paper is to contextualize the study of acculturation and adjustment by taking an ecological approach to exploring these relationships across several life domains, using a bilinear scale, and examining mediators of these relationships for adult Vietnamese refugees (N = 203) in the United States. We call this approach the Ecological Acculturation Framework (EAF). Results of a structural equation model (SEM) showed that job satisfaction fully mediated the relationship between American acculturation and psychological distress, demonstrating that this relationship was specific to an occupational domain. However, while Vietnamese acculturation predicted co-ethnic social support satisfaction, it did not predict reduced psychological distress. Implications for a life domains approach, including domain specificity, are discussed. PubDate: 2015-10-06 DOI: 10.1007/s10464-015-9760-9 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Sarah Cusworth Walker; Asia S. Bishop; Michael D. Pullmann; Grace Bauer Pages: 408 - 421 Abstract: Abstract Family involvement is recognized as a critical element of service planning for children’s mental health, welfare and education. For the juvenile justice system, however, parents’ roles in this system are complex due to youths’ legal rights, public safety, a process which can legally position parents as plaintiffs, and a historical legacy of blaming parents for youth indiscretions. Three recent national surveys of juvenile justice-involved parents reveal that the current paradigm elicits feelings of stress, shame and distrust among parents and is likely leading to worse outcomes for youth, families and communities. While research on the impact of family involvement in the justice system is starting to emerge, the field currently has no organizing framework to guide a research agenda, interpret outcomes or translate findings for practitioners. We propose a research framework for family involvement that is informed by a comprehensive review and content analysis of current, published arguments for family involvement in juvenile justice along with a synthesis of family involvement efforts in other child-serving systems. In this model, family involvement is presented as an ascending, ordinal concept beginning with (1) exclusion, and moving toward climates characterized by (2) information-giving, (3) information-eliciting and (4) full, decision-making partnerships. Specific examples of how courts and facilities might align with these levels are described. Further, the model makes predictions for how involvement will impact outcomes at multiple levels with applications for other child-serving systems. PubDate: 2015-09-25 DOI: 10.1007/s10464-015-9755-6 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Jennifer Watling Neal; Zachary P. Neal; Mariah Kornbluh; Kristen J. Mills; Jennifer A. Lawlor Pages: 422 - 435 Abstract: Abstract Despite widespread recognition of a research–practice gap in multiple service sectors, less is known about how pre-existing communication channels facilitate the flow of information between researchers and practitioners. In the current study, we applied an existing typology of brokerage developed by Gould and Fernandez (Sociol Methodol 19:89–126, 1989) to examine what types of brokerage facilitate information spread between researchers and educational practitioners. Specifically, we conducted semi-structured interviews with 19 school administrators and staff in two public school districts regarding their experiences searching for information about instructional, health, and social skills programs. Using deductive content analysis, we found evidence of all five types of brokerage identified by Gould and Fernandez (1989). However, only three types of brokerage—gatekeepers, representatives, and liaisons—were involved in the flow of information between school administrators and researchers. Moreover, information transfer often occurred in longer chains that involved multiple, distinct types of brokerage. We conclude with the broad implications of our findings for narrowing the research–practice gap by improving researchers’ dissemination efforts and practitioners’ search for information. PubDate: 2015-12-01 DOI: 10.1007/s10464-015-9745-8 Issue No:Vol. 56, No. 3-4 (2015)
Authors:Maria Y. Hernandez; Kurt C. Organista Pages: 79 - 88 Abstract: Abstract While depression is prevalent among immigrant Latinas, mental health literacy is low. Culturally tailored health narratives can improve mental health literacy and are now increasingly featured in Spanish language fotonovelas (i.e., booklets in a comic book format with posed photographs and dialogue bubbles). The purpose of this qualitative study is to explore why a depression literacy fotonovela proved effective with Latina immigrants at risk for depression in a quantitative randomized control study. This study is the qualitative companion of the previously published quantitative piece of a mixed methods study, the latter revealing posttest improvements in depression knowledge, self-efficacy to identify the need for treatment, and decreased stigma towards mental health care (Hernandez and Organista in Am J Community Psychol 2013. doi:10.1007/s10464-013-9587-1). Twenty-five immigrant Latinas participated in structured interviews, in the current qualitative study, 3 weeks after participating in the quantitative study. Results suggest depression literacy improved because participants evidenced high recall of the storyline and characters, which they also found appealing (e.g., liked peer and professional support offered to depressed main character). Further, identification with the main character was reflected in participants recalling similar circumstances impacting their mental health. Despite some improvement, stigma related to depression and its treatment remained for some women. Future research for the improvement of health literacy tools is discussed. PubDate: 2015-09-01 DOI: 10.1007/s10464-015-9729-8 Issue No:Vol. 56, No. 1-2 (2015)
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