Previous epidemiological studies have found lower mood, anxiety, and substance use disorder prevalence in Black Americans, in general, compared with White Americans. We estimated the prevalence and persistence of psychiatric disorders in African Americans, Caribbean Blacks, and non-Hispanic Whites.
We drew data from wave 1 (2001–2002) of the National Epidemiological Survey of Alcohol and Related Conditions, a nationally representative sample of US adults, which included 7529 African Americans, 469 Caribbean Blacks, and 24 502 non-Hispanic Whites.
Blacks had equal or lower prevalence than Whites of lifetime (adjusted odds ratio [AOR] = 0.6 for African Americans; 0.3 for Caribbean Blacks) and 12-month (AOR = 0.7 for African Americans; 0.4 for Caribbean Blacks) Axis I psychiatric disorders, but higher prevalence of several personality disorders. Among Blacks, Caribbean Blacks had higher prevalence of 12-month psychotic disorders and lower lifetime prevalence of major depressive disorder, alcohol dependence, and drug abuse than African Americans. There were no differences in persistence of disorders between Caribbean Blacks and African Americans.
This study yielded new data on prevalence of mental disorders in these groups, which has important implications for clinical work with US Blacks.
We examined Philip Morris USA’s exploration of corporate social responsibility practices and principles and its outcome.
We analyzed archival internal tobacco industry documents, generated in 2000 to 2002, related to discussions of corporate social responsibility among a Corporate Responsibility Taskforce and senior management at Philip Morris.
In exploring corporate social responsibility, Philip Morris executives sought to identify the company’s social value—its positive contribution to society. Struggling to find an answer, they considered dramatically changing the way the company marketed its products, apologizing for past actions, and committing the company to providing benefits for future generations. These ideas were eventually abandoned. Despite an initial call to distinguish between social and economic value, Philip Morris ultimately equated social value with providing shareholder returns.
When even tobacco executives struggle to define their company’s social value, it signals an opening to advocate for endgame scenarios that would encourage supply-side changes appropriate to the scale of the tobacco disease epidemic and consistent with authentic social value.
We assessed factors related to smoke-free policies among a cross-sectional, nationally representative, random-digit-dial sample (landline and cell phone) of US multiunit housing residents (n = 418). Overall, 29% reported living in smoke-free buildings, while 79% reported voluntary smoke-free home rules. Among those with smoke-free home rules, 44% reported secondhand smoke incursions in their unit. Among all respondents, 56% supported smoke-free building policy implementation. These findings suggest that smoke-free building policies are needed to protect multiunit housing residents from secondhand smoke in their homes.
We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older.
We analyzed data from the 2003–2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions.
LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men.
Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.
Though most behavioral traits are moderately to highly heritable, the genes that influence them are elusive: many published genetic associations fail to replicate. With physical traits like eye color and skin pigmentation, in contrast, several genes with large effects have been discovered and replicated. We draw on R.A. Fisher’s geometric model of adaptation to explain why traits of interest to behavioral scientists may have a genetic architecture featuring hundreds or thousands of alleles with tiny individual effects, rather than a few with large effects, and why such an architecture makes it difficult to find robust associations between traits and genes. In the absence of strong directional selection on a trait, alleles with large effect sizes will probably remain rare, and such a lack of strong directional selection is likely to characterize most traits currently of interest in social science. We evaluate these predictions via a genome-wide association study (GWAS) that carefully measured over 100 physical and behavioral traits with a sample size typical of candidate gene studies. While we replicated several known genetic associations with physical traits, we found only two associations with behavioral traits that met the nominal genome-wide significance threshold. We use the theory and findings to discuss (1) the challenges for social science genomics, particularly the likelihood that genes are connected to behavioral variation by lengthy, nonlinear, interactive causal chains; (2) the prospects for dealing with these challenges; and (3) the inherent tradeoff between two ways of meeting these challenges: increasing sample size and improving phenotype measurement.
Recent research suggests that the social environment can moderate the expression of genetic influences on health and that genetic influences can shape an individual’s sensitivity to the social environment. Evidence supports four major mechanisms: genes can influence an individual’s response to stress in the environment, genes may enhance an individual’s sensitivity to both favorable and adverse environments, inherited characteristics may better fit with some environments than with others, and inherited capabilities may only become manifest in challenging or responsive environments. Further progress depends on better recognition of patterns of interaction between genes and the environment, improved methods of assessing the environment and its impact on genetic mechanisms, the use of appropriately designed laboratory studies, identification of heritable differences in an individual before environmental moderation occurs, and clarification of the timing of the impact of social and genetic moderation.
We examined effects of New York and California’s statewide smoke-free restaurant and bar polices on alcohol-related car crash fatalities. We used an interrupted time-series design from 1982 to 2008, with 312 monthly observations, to examine the effect of each state’s lawonsingle-vehicle-nighttime crashes and crashes involving a driver with a blood alcohol concentration of 0.08 grams per deciliter or greater.
Implementation of New York and California’s statewide smoke-free policies was not associated with alcohol-related car crash fatalities. Additionally, analyses showed no effect of New York’s smoke-free policy on alcohol-related car crash fatalities in communities along the Pennsylvania-New York border.
Statewide smoke-free restaurant and bar laws do not appear to affect rates of alcohol-related car crashes.
We examined the historical and regulatory framework of research with human participants in the United States, and described some possible unintended consequences of this framework in the context of paying young injection drug users for their time participating in behavioral and medical research. We drew upon our own experiences while conducting a long-running epidemiological study of hepatitis C virus infection.
We found that existing ethical and regulatory framings of research participation may lead to injustices from the perspectives of research participants.
We propose considering research participation as a specialized form of work and the use of community advisory boards to facilitate discussion about appropriate compensation for research participation among economically marginalized populations.
Examine long-term prescription drug misuse outcomes from three RCTs of brief universal preventive interventions conducted during middle school.
Study 1 tested the Iowa Strengthening Families Program (ISFP); 22 schools participated, with pretesting at grade 6 (1993) and outcomes measured at age 25. Study 2 evaluated a revised ISFP, renamed Strengthening Families Program: For Parents and Youth 10–14—SFP 10–14, plus the school-based Life Skills Training (SFP 10–14 + LST); 24 schools participated, with pretesting at grade 7 (1998) and outcomes at ages 21–25. Study 3 examined SFP 10–14 plus one of three school-based interventions selected from a menu (SFP 10–14 + School Program); 28 schools participated, with pretesting at grade 6 (2002) and outcomes at 12th grade. Self-reported outcomes were Prescription Opioid Misuse (POM) and Lifetime Prescription Drug Misuse Overall (PDMO).
Study 1: ISFP showed significant effects on POM and PDMO, Relative Reduction Rates (RRRs) of 65%, and comparable benefits for higher- and lower-risk subgroups. Study 2: SFP 10–14 + LST showed significant or marginally-significant effects on POM/PDMO across all ages; higher-risk participants showed stronger effects (RRRs 43–79%). Study 3: significant results were found for POM/PDMO (RRRs 20–21%); higher-risk and lower-risk participants showed comparable outcomes.
Brief universal interventions have potential for public health impact by reducing prescription drug misuse among adolescents and young adults.
Universal preventive intervention; prescription drug misuse; public health benefits
Evaluating programs targeting physical activity may help to reduce disparate rates of obesity among African Americans. We report formative process evaluation methods and implementation dose, fidelity, and reach in the Positive Action for Today’s Health trial.
We applied evaluation methods based on an ecological framework in 2 community-based police-patrolled walking programs targeting access and safety in underserved African American communities. One program also targeted social connectedness and motivation to walk using a social marketing approach. Process data were systematically collected from baseline to 12 months.
Adequate implementation dose was achieved, with fidelity achieved but less stable in both programs. Monthly walkers increased to 424 in the walking-plus-social marketing program, indicating expanding program reach, in contrast to no increase in the walking-only program. Increased reach was correlated with peer-led Pride Strides (r = .92; P < .001), a key social marketing component, and program social interaction was the primary reason for which walkers reported participating.
Formative process evaluation demonstrated that the walking programs were effectively implemented and that social marketing increased walking and perceived social connectedness in African American communities.
We examined whether nonresponse to the survey question on self-identified sexual orientation was associated with race and ethnicity, utilizing Washington State Behavioral Risk Factor Surveillance System data. The results of adjusted multinomial logistic regression indicated that the nonresponse rates of Asian Americans, Hispanics, and African Americans are higher than those of non-Hispanic Whites. Innovative ways of measuring sexual orientation to reduce racially and ethnically driven bias need to be developed and integrated into public health surveys.
We investigated whether elevated risks of health disparities exist in Hispanic lesbians and bisexual women aged 18 years and older compared with non-Hispanic White lesbians and bisexual women and Hispanic heterosexual women.
We analyzed population-based data from the Washington State Behavioral Risk Factor Surveillance System (2003–2009) using adjusted logistic regressions.
Hispanic lesbians and bisexual women, compared with Hispanic heterosexual women, were at elevated risk for disparities in smoking, asthma, and disability. Hispanic bisexual women also showed higher odds of arthritis, acute drinking, poor general health, and frequent mental distress compared with Hispanic heterosexual women. In addition, Hispanic bisexual women were more likely to report frequent mental distress than were non-Hispanic White bisexual women. Hispanic lesbians were more likely to report asthma than were non-Hispanic White lesbians.
The elevated risk of health disparities in Hispanic lesbians and bisexual women are primarily associated with sexual orientation. Yet, the elevated prevalence of mental distress for Hispanic bisexual women and asthma for Hispanic lesbians appears to result from the cumulative risk of doubly disadvantaged statuses. Efforts are needed to address unique health concerns of diverse lesbians and bisexual women.
We used population-based data to comprehensively examine disability among lesbian, gay, and bisexual adults.
We estimated prevalence of disability and its covariates and compared by sexual orientation by utilizing data from the Washington State Behavioral Risk Factor Surveillance System (n=82531) collected in 2003, 2005, 2007, and 2009. We used multivariate logistic regression to examine the relationship between disability and sexual orientation, after we controlled for covariates of disability.
Findings indicated that the prevalence of disability is higher among lesbian, gay, and bisexual adults compared with their heterosexual counterparts; lesbian, gay, and bisexual adults with disabilities are significantly younger than heterosexual adults with disabilities. Higher disability prevalence among lesbians and among bisexual women and men remained significant after we controlled for covariates of disability.
Higher rates of disability among lesbian, gay, and bisexual adults are of major concern. Efforts are needed to prevent, delay, and reduce disabilities as well as to improve the quality of life for lesbian, gay, and bisexual adults with disabilities. Future prevention and intervention efforts need to address the unique concerns of these groups.
We evaluated the association between the county sprawl index, a measure of residential density and street accessibility, and physical activity and body mass index (BMI).
We conducted a multilevel cross-sectional analysis in a sample of Nurses’ Health Study participants living throughout the United States in 2000 to 2001 (n = 136 592).
In analyses adjusted for age, smoking status, race, and husband’s education, a 1-SD (25.7) increase in the county sprawl index (indicating a denser, more compact county) was associated with a 0.13 kilograms per meters squared (95% confidence interval [CI] = −0.18, −0.07) lower BMI and 0.41 (95% CI = 0.17, 0.65) more metabolic equivalent (MET) hours per week of total physical activity, 0.26 (95% CI = 0.19, 0.33) more MET hours per week of walking, and 0.47 (95% CI = 0.34, 0.59) more MET hours per week of walking, bicycling, jogging, and running. We detected potential effect modification for age, previous disease status, husband’s education level (a proxy for socioeconomic status), and race.
Our results suggest that living in a dense, compact county may be conducive to higher levels of physical activity and lower BMI in women.
Community health workers (CHWs) are increasingly being incorporated into health programs because they are assumed to effectively deliver health messages in a culturally relevant manner to disenfranchised communities. Nevertheless, the role of CHWs—who they are, what they do, and how they do it—is tremendously varied. This variability presents a number of challenges for conducting research to determine the effectiveness of CHW programs, and translating research into practice. We discuss some of these challenges and provide examples from our experience working with CHWs. We call for future research to identify of the “core elements” of effective CHW programs that improve the health and well-being of disenfranchised communities.
We evaluated changes in colorectal cancer (CRC) incidence and mortality by anatomic site since 1975 to assess the possible impact of CRC screening.
Using data from 9 Surveillance, Epidemiology, and End Results cancer registries, we estimated trends in CRC incidence from 1975–2007 and incidence-based mortality from 1985–2007. We evaluated trends separately for proximal and distal CRC, overall and by stage, tumor site, and race.
Between 1975–2007, 323,237 adults in the study area were diagnosed with CRC. For most tumor and population subgroups, incidence rates increased between 1975–1985 and subsequently declined markedly. Declines were most rapid between 1999–2007, and were greater for distal than proximal CRC. Declines in incidence were also greater for white adults than black adults, and greatest for regional-stage disease. There was little difference in trends across subsites within the proximal and distal colorectum. Declines in incidence-based mortality mirrored those for incidence.
Recent declines in CRC incidence and mortality are greater for distal than proximal CRC. Differing trends across populations may reflect variation in screening prevalence; distinct trends by tumor characteristics likely reflect differences in screening efficacy.
We estimated e-cigarette (electronic nicotine delivery system) awareness, use, and harm perceptions among US adults.
We drew data from 2 surveys conducted in 2010: a national online study (n = 2649) and the Legacy Longitudinal Smoker Cohort (n = 3658). We used multivariable models to examine e-cigarette awareness, use, and harm perceptions.
In the online survey, 40.2% (95% confidence interval [CI] = 37.3, 43.1) had heard of e-cigarettes, with awareness highest among current smokers. Utilization was higher among current smokers (11.4%; 95% CI = 9.3, 14.0) than in the total population (3.4%; 95% CI = 2.6, 4.2), with 2.0% (95% CI = 1.0, 3.8) of former smokers and 0.8% (95% CI = 0.35, 1.7) of never-smokers ever using e-cigarettes. In both surveys, non-Hispanic Whites, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes.
Awareness of e-cigarettes is high, and use among current and former smokers is evident. We recommend product regulation and careful surveillance to monitor public health impact and emerging utilization patterns, and to ascertain why, how, and under what conditions e-cigarettes are being used.
Although previous research has shown that low socioeconomic status (SES) is associated with mental illness, it is unclear which aspects of SES are most important. We investigated this issue by examining associations between 5 aspects of SES and adolescent mental disorders.
Data came from a national survey of US adolescents (n = 6483). Associations among absolute SES (parental income and education), relative SES (relative deprivation, subjective social status), and community level income variation (Gini coefficient) with past-year mental disorders were examined.
Subjective social status (mean 0, variance 1) was most consistently associated with mental disorder. Odds ratios with mood, anxiety, substance, and behavior disorders after controlling for other SES indicators were all statistically significant and in the range of 0.7 to 0.8. Associations were strongest for White adolescents. Parent education was associated with low risk for anxiety disorder, relative deprivation with high risk for mood disorder, and the other 2 indicators were associated with none of the disorders considered.
Associations between SES and adolescent mental disorders are most directly the result of perceived social status, an aspect of SES that might be more amenable to interventions than objective aspects of SES.
Although cigarette smoking is decreasing in the U.S., hookah tobacco smoking (HTS) is an emerging trend associated with substantial toxicant exposures. The purpose of this study was to assess how a representative sample of U.S. tobacco control policies may apply to HTS.
We examined municipal, county, and state legal texts that apply to the largest 100 cities in the U.S. We developed a summary policy variable that distinguishes cities without clean air legislation preventing cigarette or HTS in freestanding bars; with anti-smoking legislation exempting HTS by name; with anti-smoking legislation providing for a different exemption under which HTS may fall; and with anti-smoking legislation and no clear exemption governing HTS. We used multinomial logistic regression to determine associations between community-level socio-demographic variables and our policy outcome variable.
Although 73 of the 100 largest cities in the U.S. have laws that disallow cigarette smoking in bars, HTS may be allowed due to exemptions in 69 of these 73 cities. While 4 of these cities have passed legislation specifically exempting HTS, 65 may permit HTS via generic tobacco retail establishment exemptions. Compared with cities without clean air legislation, the cities in which HTS may be exempted had denser populations.
Although three-fourths of the largest cities in the U.S. disallow cigarette smoking in bars, HTS may be permitted in nearly 90% of these cities via exemptions. Closing this gap in clean air regulation may significantly reduce exposure to HTS.
We investigated the relationship between secondhand smoke and periodontal disease in nonsmokers.
We undertook a cross-sectional analysis of the Atherosclerosis Risk in Communities study with 2739 lifetime nonsmokers aged 53–74 years, unexposed to other sources of tobacco, who received a complete periodontal examination at visit 4. Exposure was reported as average hours per week in close contact with a smoker in the preceding year. We defined severe periodontitis as 5 or more periodontal sites with probing pocket depth of 5 millimeters or more and clinical attachment levels of 3 millimeters or more in those sites. Other outcomes were extent of periodontal probing depths of 4 millimeters or more and extent of clinical attachment levels of 3 millimeters or more.
In a binary logistic regression model, adjusted odds of severe periodontitis for those exposed to secondhand smoke 1 to 25 hours per week increased 29% (95% confidence interval=1.0, 1.7); for those exposed to secondhand smoke 26 hours per week, the odds were twice as high (95% confidence interval=1.2, 3.4) as for those who were unexposed.
Exposure to secondhand smoke and severe periodontitis among nonsmokers had a dose-dependent relationship.
Racial/ethnic and socioeconomic disparities regarding untreated oral disease exist for older adults, and poor oral health diminishes quality of life. The ElderSmile program integrated screening for diabetes and hypertension into its community-based oral health activities at senior centers in northern Manhattan. Findings were that minority seniors were willing to be screened for primary care sensitive conditions by dental professionals, and a high level of unrecognized disease was found (7.8% and 24.6% of ElderSmile participants had positive screening results for previously undiagnosed diabetes and hypertension, respectively). Dental professionals may screen for primary care sensitive conditions and refer patients to health care providers for definitive diagnosis and treatment. The ElderSmile program is a replicable model for community-based oral and general health screening.
We examined migration-related changes in smoking behavior in the transnational Mexican-origin population.
We combined epidemiological surveys from Mexico (Mexican National Comorbidity Survey) and the United States (Collaborative Psychiatric Epidemiology Surveys). We compared 4 groups with increasing US contact with respect to smoking initiation, persistence, and daily cigarette consumption: Mexicans with no migrant in their family, Mexicans with a migrant in their family or previous migration experience, migrants, and US-born Mexican-Americans.
Compared with Mexicans with a migrant in their family or previous migration experience, migrants were less likely to initiate smoking (odds ratio [OR] =0.56; 95% confidence interval [CI] =0.38, 0.83) and less likely to be persistent smokers (OR = 0.41; 95% CI = 0.26, 0.63). Among daily smokers, the US-born smoked more cigarettes per day than Mexicans with a migrant in their family or previous migration experience for men (7.8 vs 6.5) and women (8.6 vs 4.3).
Evidence suggests that smoking is suppressed among migrants relative to the broader transnational Mexican-origin population. The pattern of low daily cigarette consumption among US-born Mexican Americans, noted in previous research, represents an increase relative to smokers in Mexico.
HIV prevalence is higher in jails than in the community, yet many jails do not conduct HIV testing. Jails in Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia have implemented innovative rapid HIV testing programs. We have summarized the results of these programs, including the numbers of persons tested, rapid and confirmatory HIV test results, and numbers of persons newly diagnosed with HIV. We have described facilitators and challenges of implementation. These programs confirmed that rapid HIV testing in jails was feasible and identified undiagnosed HIV infection. Challenges included limited space to provide confidential rapid HIV testing and rapid turnover of detainees. Implementation required collaboration between local governments, health agencies, and correctional institutions. These programs serve as models for expanding rapid HIV testing in jails.
We examined rates of and risk factors for repeat syphilis infection among men who have sex with men (MSM) in California.
We analyzed 2002 to 2006 California syphilis surveillance system data.
During the study period, a mean of 5.9% (range: 4.9%–7.1% per year) of MSM had a repeat primary or secondary (PS) syphilis infection within 2 years of an initial infection. There was no significant increase in the annual proportion of MSM with a repeat syphilis infection (P=.42). In a multivariable model, factors associated with repeat syphilis infection were HIV infection (odds ratio [OR] = 1.65; 95% confidence interval [CI] = 1.14, 2.37), Black race (OR = 1.84; 95% CI = 1.12, 3.04), and 10 or more recent sex partners (OR = 1.99; 95% CI = 1.12, 3.50).
Approximately 6% of MSM in California have a repeat PS syphilis infection within 2 years of an initial infection. HIV infection, Black race, and having multiple sex partners are associated with increased odds of repeat infection. Syphilis elimination efforts should include messages about the risk for repeat infection and the importance of follow-up testing. Public health attention to individuals repeatedly infected with syphilis may help reduce local disease burdens.
In 1906 Arthur Newsholme linked artificial feeding and fatal diarrhea in infants aged one year and younger on the basis of two independent sources of information: mortality registration and a three-year (1903–1905) census of infants from Brighton, United Kingdom. Artificial feeding was more common in the infants who had died (89.3%) than in those in the survey (22.3%). However, boldly assuming the two data sources were nested, Newsholme computed the risks of fatal diarrhea: these were 48 times greater for infants fed fresh cow’s milk and 94 times greater for those fed condensed milk than for infants who were exclusively breast-fed. This mode of computing risks and risk ratios before the invention of the cohort study design was more innovative than was the usual investigation techniques of his contemporary epidemiologists. Newsholme’s conclusions were consistent with the current knowledge that breastfeeding protects against fatal diarrhea.