Mobility safety, especially fall prevention, plays a significant role in successful aging for older adults. Fall preventive programs aim to reduce risks for mortality from fall-related injuries among older adults. However, the covariation between personal perceptions of falls and factors and confidence of self-management in falls (CSMoF) is still under-studied despite its importance to fall prevention. Using the International Classification of Functioning, Disability, and Health (ICF) model, this dissertation aimed to investigate the relative contribution of CSMoF in relation to fall risk self-perceptions while controlling for demographics and self-reported health and functioning. Participants were 691 older adults recruited from Area Agency on Aging at Arlington, Texas. They completed measures of physical functioning, CSMoF, fall risk perceptions and fear of falls. Regression analyses indicated that fear of falls was the most predictive factor of CSMoF among older persons. Physical function measures of age, chronic illnesses of metabolism, sensory impairment, and health status were also significant predictors of the CSMoF. The interaction of perception of falls and fall experience attenuated CSMoF, with physical functioning limitations. Fear of falls served as a mediator through which demographic predictors influence CSMoF. The joint effects of perception of falls and fear of falls likely explain CSMoF …

The objectives of the present dissertation were: (1) determine the relationships between time use in physical vs social leisure activities (PLA - SLA), and cognitive vs emotional leisure activities (CLA - ELA) by older adults age cohort (60-69, 70-79 and 80-plus yrs.); (2) ascertain the role of sex in moderating the relationship between time use in PLA-SLA and CLA-ELA by older adults age cohort; and (3) assess how employment status mediates the relationship between time use in PLA-SLA and CLA-ELA by older adults age cohort with moderation by sex. Secondary data was obtained from the 2019 American Time Use Survey database. Applying a cross-sectional design, data were analyzed using a linear regression model in SPSS version 27 and PROCESS Macro with Hayes Model 1 and 59. We identified the extent of the conditional indirect moderation effect of sex and the indirect employment status mediation effect moderated by sex in the relationship between PLA-SLA and CLA-ELA by older adult age cohorts. An index of moderated mediation was used to test the significance of each effect. The 80-plus yrs. cohort SLA time use was greater than in PLA across cohorts. Sex moderation showed a stronger effect in men by substantially decreasing their …

There remains a dearth of literature that explains with no ambiguity, the complex relationships that exist between adverse childhood experiences (ACEs) and resilience, as well as school engagement and school in individuals with a co-occurring diagnosis of autism spectrum disorder (ASD) and attention deficit hyperactive disorder (ADHD). This study seeks to fill this missing gap in the literature. These research questions were answered using a retrospective cross-sectional study design of national secondary data from the National Survey of Children's Health (NSCH). The findings revealed that the more ACEs an individual had, the less they were likely to engage and succeed in school. A similar finding was obtained for resilience as individuals with more ACEs showed less resilience. However, counterintuitively to the hypothesis of the project, having both ASD and ADHD does not necessarily make these outcomes worse compared to having a singular diagnosis of either ASD or ADHD. The significance of this study is that it informs rehabilitation counselors as well as educators on the need for early identification of individuals with ASD and ADHD with a background of ACEs and commence interventions early enough to ensure they are more resilient and obtain improved success in school-related activities as well …

In the US, rural Native American communities (RNACs) experience excess morbidity in mental health disorders and mortality from opioid use disorder (OUD). This study used mixed methods to evaluate and analyze the primary data from 76 healthcare providers (HPs) from 24 states across the US (physicians = 7%), to identify HP knowledge and training regarding available prevention, treatment, and recovery (PTR) programs in treating OUD, assessment and management skills, and networking and collaboration capacity among the RNACs they serve. The HP completed the Opioid Survey for Health Care Providers online. A majority of HPs reported a need for knowledge and training regarding OUD treatments (92%). Less than half of the HPs provide intensive outpatient treatment; 40% contracted out for medication assisted treatment/medications for opioid use disorder (MAT/MOUD) services. Recovery support was low at 33% for adults and 38% for youth. HPs reported use of Narcan to be effective in reversing overdose (87%). Qualitative responses supported survey findings and described barriers, including lack of resources, inadequate staffing, insufficient funding, lack of training and OUD knowledge, stigma, and lack of tribal involvement and support. The study findings indicate HPs' need for information and training about OUD and networking and collaboration of healthcare …