Papers by Cheryl Zlotnick
Sigma's 30th International Nursing Research Congress, Jul 26, 2019
Overview: Rates of overweight and obesity in adults and children has reached epidemic proportions... more Overview: Rates of overweight and obesity in adults and children has reached epidemic proportions globally. In 2016, 1.9 billion adults (18+) were overweight, and of these, 650 million adults suffered from obesity. Among children, 41 million preschool children were overweight and over 340 million children and adolescents, aged 5-19 were overweight or obese. Childhood obesity is not only a strong predictor for adulthood obesity, but also increases the risk of developing premature onset of illnesses and serious non-communicable diseases. In addition, life quality is poorer in overweight and obesity in children and may affect the child`s social life. Due to the ominous trends of increasingly overweight and obese children and adolescents, and the correspondingly problematic morbidity of associated diseases, the World Health Organization (WHO) has declared childhood obesity an epidemic requiring world attention. The proportion of overweight and obese adults and children is inequitably distributed in different population groups, and varies according to social characteristics such as socioeconomic status, ethnicity and geographic area. Many research studies found that among low socioeconomic status and ethnic minorities, overweight and obesity rates are higher, both in children and adults. In addition to genetics, other explanations for this inequity includes social and environmental factors such as eating patterns, food choice and parent`s attitudes to lifestyle and eating habits. Children born to overweight or obese parents, who have problematic eating habits, and who adopt a sedentary lifestyle are at an increased risk for being overweight and obese as children and later as adults. Results: ongoing project Conclusion: ongoing project
Journal of nursing & care, Oct 31, 2016
Journal of Clinical Nursing, Mar 18, 2022
Aims and objectivesThis study examines the relationship between social status and postpartum depr... more Aims and objectivesThis study examines the relationship between social status and postpartum depression by migrant generation and determines whether social support moderates the relationship between migrant generations and postpartum depression.BackgroundPostpartum depression (PPD) afflicts more than 1 in 10 childbearing women worldwide; and this mental health problem may be higher among vulnerable populations of women such as migrants, an increasingly prevalent group in many countries. Social support and migrant generation (1st generation—mother and her parents born outside the host country; 2nd generation—mother born in the host country but not her parents; 2.5 generation—mother and one parent born in the host country) may contribute to the conflicting findings on migrant mothers and postpartum depression.DesignThis study used a cross‐sectional design.MethodsSample recruitment of migrant and non‐migrant first‐time mothers (n=515) was implemented through an online platform. A STROBE checklist guided the reporting of this study.ResultsPPD was lower among mothers with social support. While social support was negatively associated with PPD for all mothers, PPD was not associated with migrant generation nor was a moderation effect found.ConclusionsSocial support is negatively associated with PPD for all mothers, but levels of PPD for migrant mothers may be linked to country‐specific healthcare resources and immigration policies. Immigrant policies influence migrant mothers’ healthcare access; thus, immigration policies may influence PPD among first‐time migrant mothers and the manner in which nurses can provide formal support. This study finds that social support, including the formal social support provided by nurses, decreases the likelihood of PPD. Demands on nurses’ technical and assessment skills are high, but nurses also need to remember that their skills of providing social support are equally important, and for first‐time mothers, may contribute to decreasing PPD.
Frontiers in Psychology, Jul 11, 2022
Journal of The Society for Social Work and Research, Jun 1, 2021
Objective: This integrative study reviewed quantitative community-based participatory research (C... more Objective: This integrative study reviewed quantitative community-based participatory research (CBPR) studies on adult migrant populations and examined CBPR partnerships with community representatives. Method: The search identified relevant studies via MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and PsychInfo databases. Results: From the original 476 studies identified, a final sample of 26 studies focusing on migrants’ health and health care was selected. CBPR community representatives were comprised of members of the public or staff recruited from a variety of sites (e.g., churches, hospitals). The ethnicity of community representatives matched the respondents of the target population in all studies, but few studies (n = 3) reported the migrant status (e.g., refugees) of the study sample. Conclusions: Although immigration status is among the societal characteristics that can lead to discrimination (i.e., intersectionality), this integrative review found that the majority of CBPR studies targeting migrants either did not specify the type of migrant group included or combined disparate migrant groups (e.g., migrants with and without documentation). Terms such as migrants, refugees, and immigrants were used interchangeably. Careful attention must be paid to the selection of community representatives to better represent the population of interest.
Community Mental Health Journal - COMMUNITY MENT HEALTH J, 1999
A growing number of children in the UnitedStates are being placed into foster care. Past studiesi... more A growing number of children in the UnitedStates are being placed into foster care. Past studiesindicate that effective case manager interventions havehelped foster families with a variety of different problems. This study enrolled a randomlyselected sample of 130 children under age four who hadbeen newly placed into foster care. The purpose of thisstudy was to identify the services needed by foster care families and determine which servicesrequire the most case manager effort. Consistent withother research, many foster care children in this studyexhibited developmental, medical and psychosocial concerns. Nevertheless, we found that it wasservices aimed at the foster care parents, rather thanthe foster care children, that required the mostlabor-intensive case management services.
Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2004
Children living in poverty not only have disproportionately more health problems, but also have d... more Children living in poverty not only have disproportionately more health problems, but also have disproportionately lower health care service utilization. Change, whether in health care delivery system or in family living situation, may interfere with or jeopardize insurance status and thereby influence access to health care services. We hypothesized that children who have maintained Medicaid insurance compared to those who have not will be more likely to have preventive care visits and less likely to have emergency room visits. We further hypothesized that transient situations such as homeless episodes, foster care placement, and living in more than one location in the same 1-year period will contribute to loss in Medicaid coverage. This retrospective cohort study was conducted at an urban children's hospital outpatient clinic at which 210 family respondents were recruited over a 1-year period. An in-person interview containing several standardized instruments was administered to the caregiver. In addition, children's medical records were retrospectively abstracted from point of study entry to first contact. Findings indicated that children who lost Medicaid coverage, compared to others, had significantly fewer preventive care health visits. There were no differences in emergency room visits. Transient situations did not appear to influence preventive or emergency room care. In addition, the change into a managed-care delivery system also increased loss of coverage. Loss of coverage may be a barrier to preventive care services. To ensure optimal preventive care services, the onus is on the providers and plans to facilitate continued insurance coverage.
Journal of Urban Health, 2007
Increasingly, geographic information systems employing spatial data are being used to identify co... more Increasingly, geographic information systems employing spatial data are being used to identify communities with poorer health care status. Since health care indicators are strongly linked to income, could these data, usually based on adult indicators, be used for pediatric health care need? We hypothesized that individuallevel indicators such as quality of life scales (QOL) would be better than communitylevel indicators at identifying families with poorer health care practices. Surveys and medical record reviews were used for a sample of 174 caregivers of young children. Lower level of income was associated with poorer scores on several QOL domains, and on the primary health practices (i.e., non-urgent emergency room use and lack of age-appropriate immunization status). One community-level indicator, the medically underserved area (MUA), was almost as good as the best individual-level indicators at predicting primary health care practices. The community-level indicator of MUA appears to meet its initial intent, providing information on the location of very lowincome individuals with high health care need even among a sample of Medicaidinsured children with an identified health care provider.
Journal of Transcultural Nursing, 2013
Two tools were created to help international students to better understand culture by becoming mo... more Two tools were created to help international students to better understand culture by becoming more astute observers of nonverbal behaviors, particularly behaviors depicting emotions among Norwegian students. The two tools were a trilingual list of words illustrating emotions and an exercise with images to practice verbalizing their observations of emotional expression. Students compared the subdued behaviors of Norwegians to the Israelis' very vivid behaviors. The intense emotional expression of Israelis influenced their interpretations. By making comparisons and through the experiences with Israelis, they learned more about culture and their own emotional expression. Creative strategies can contribute to students understanding and reflection of patients in a different culture. Encouraging students to grasp the nuances of emotional expression is part of understanding a different culture. Students, like faculty, learn that self-exploration is an evolving process that requires checking out one's assumptions and interpretations.
Journal of the American Academy of Nurse Practitioners, 2005
Journal of Substance Abuse Treatment, 1996
Although there is an increasing number of outpatient drug programs, there remains little consensu... more Although there is an increasing number of outpatient drug programs, there remains little consensus on which service components are most effective for pregnant and parenting women seeking treatment. In this investigation, we studied 48 women who remained in treatment for 5 consecutive months to: (1) examine differences between clients who maintained 30 to 90 days of abstinence and those who did not, and (2) test the association between services and abstinence. Although we found no demographic differences between abstinent and nonabstinent women, we did find that significantly more abstinent women received family therapy services compared to nonabstinent women as they remained in treatment. Furthermore, we found that clients who were abstinent tended to receive more services overall than those who were not. Providers need to consider their population when deciding on which service components will be included," and family therapy is one service component that shouM be available to pregnant and parenting women.
Journal of Nursing Care Quality, 1993
Journal of Community Psychology, 1999
Based on a 15-month prospective study, the following variables demonstrated an association with r... more Based on a 15-month prospective study, the following variables demonstrated an association with residential stability in a countywide probability sample of 397 homeless adults: female gender, a history of less than 1-year homelessness, absence of a health problem that limited work ability, entitlement-benefit income, and use of subsidized housing. Multivariate analyses show that two forms of public support-entitlement income and subsidized housing-were the most important variables associated with exits from homelessness into stable housing. Homeless adults with substance use disorders were more likely than other homeless adults to obtain unstable, but not stable housing. Homeless adults with mental disorders were no less likely than other homeless adults to report stable housing. Stable housing is necessary to break the cycle of homelessness, and economic resources such as entitlement income and subsidized housing are associated with stable housing for homeless adults.
Journal of Community Health Nursing, 1991
Public Health agencies are faced with the task of self-evaluation. For years, they have evaluated... more Public Health agencies are faced with the task of self-evaluation. For years, they have evaluated themselves solely through utilization as demonstrated by the numbers of patients that they have served. A new thrust is to change the methods of evaluation by devising and implementing a quality assurance (QA) system. Traditional QA systems focus on acutely ill patients and are based on the medical model. In contrast, public health focuses on well or chronically ill patients with services that involve mostly palliative treatment, disease prevention, and/or health promotion. The criteria used by hospitals do not apply. Thus, public health agencies are forced to review their standards and develop criteria applicable to public health. This re-examination of public health can stimulate new ways of viewing old programs and therefore, elicit information that has never been gathered before.
Journal of Community Health Nursing, 1987
Heart & Lung: The Journal of Acute and Critical Care, 1996
To describe the recovery process 1 year after percutaneous transluminal coronary angioplasty (PTC... more To describe the recovery process 1 year after percutaneous transluminal coronary angioplasty (PTCA) and measure factors that influence functional status. Prospective, one-group observational study. Mid-Atlantic, university-affiliated, tertiary care medical center. One hundred thirty-five adults who underwent first-time PTCA. The age range was 29 to 78 years (mean 57). Functional status. Data collection was initiated before PTCA by personal interview and self-administered questionnaire conducted in the hospital and 12 months after PTCA by mailed questionnaire. Data on clinical, demographic, occupational, and psychosocial factors were collected to determine the predictors of functional status 12 months after PTCA. One-tailed paired t tests were conducted to measure whether there was improvement (positive change) in functional status from before PTCA to 12 months after PTCA. Multivariate and logistic-regression analyses were also conducted. Although there were significant improvements in functional status outcomes in the categories of activities of daily living, mental health, and social interaction 12 months after PTCA, patients continued to report important functional status disabilities in the categories of activities of daily living (14%), social activity (14%), mental health (25%), quality of interaction (10%), and work performance (17%). The variable most predictive of functional status was the patient's baseline score on that particular functional status subscale. These findings are consistent with other studies on functional status. They suggest that rehabilitation programs should assess pre-PTCA functional status to identify those individuals at risk for poor outcome after PTCA and design interventions to restore physical and functional status after PTCA.
Health & Social Care in the Community, 2009
For almost two decades, the US Health Care for the Homeless (HCH) Program has funded clinics acro... more For almost two decades, the US Health Care for the Homeless (HCH) Program has funded clinics across the country for homeless populations. Between October and December 2003, for the first time ever, a nationally representative sample of the almost 200 HCH clinics with a response rate of approximately 71% (the HCH User Visit Survey) was created to examine the health status of its users (n = 1017). This study employed the HCH User Visit Survey's cross-sectional data set to evaluate health indicators of individuals using HCH Services with the US population, and compare individuals who reported they routinely used HCH clinics ('usual' HCH users) to those who did not ('non-usual' users). HCH users had poorer health status than the US population (44.0% versus 12.3%, respectively). Usual HCH users had similar healthcare status compared to non-usual users, but were more likely to be uninsured, non-English speakers, and walking or taking public transportation to their medical appointments. Usual versus non-usual HCH users were also more apt to have slept in cars, buses or on the streets in the week prior to the survey (14.8% versus 4.3%, respectively). This study shows that the HCH clinics are serving homeless individuals who have a variety of complex health and psychosocial needs, and its most frequent users are those who experience the most barriers accessing care.
Health & Social Care in the Community, 2012
Many children living in homeless situations in the U.S. have temporary stays in foster care, and ... more Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition.
Community Mental Health Journal, 2007
Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), we found that am... more Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), we found that among homeless mothers (n = 588), those living without their children were more likely to: be older than 35 years, unmarried, have been incarcerated, have been homeless for at least 1 year, and to have used psychiatric medication. Many homeless mothers had histories of childhood trauma, but it was the accumulation of adulthood traumas that was associated with not living with oneÕs children. Without mental health treatment, younger homeless mothers living with their children today may become the homeless mothers living without their children in the future.
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Papers by Cheryl Zlotnick