We examined the relationship between discrimination and substance use disorders among a diverse sample of Latinos. We also investigated whether the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity.
Our analyses focused on 6294 Latinos who participated in the National Epidemiologic Survey on Alcohol and Related Conditions from 2004 to 2005. We used multinomial logistic regression to examine the association between discrimination and substance use disorders.
Discrimination was significantly associated with increased odds of alcohol and drug use disorders among Latinos. However, the relationship between discrimination and substance use disorders varied by gender, nativity, and ethnicity. Discrimination was associated with increased odds of alcohol and drug use disorders for certain groups, such as women, US-born Latinos, and Mexicans, but this relationship did not follow the same pattern for other subgroups.
It is important to determine which subgroups among Latinos may be particularly vulnerable to the negative effects of discrimination to address their needs.
The goal of the HealthMap Vaccine Finder is to provide a free, comprehensive, online service where users can search for locations that offer immunizations. In this article, we describe the data and systems underlying the HealthMap Vaccine Finder (HVF) and summarize the project’s first year of operations.
We collected data on vaccination services from a variety of providers for 2012–2013. Data are used to populate an online, public, searchable map.
In its first year, HVF collected information from 1256 providers representing 46 381 locations. The public Web site received 625 124 visits during the 2012–2013 influenza vaccination season.
HVF is a unique tool that connects the public to vaccine providers in their communities. During the 2012–2013 influenza season, HVF experienced significant usage and was able to respond to user feedback with new features.
Functioning program infrastructure is necessary for achieving public health outcomes. It is what supports program capacity, implementation, and sustainability. The public health program infrastructure model presented in this article is grounded in data from a broader evaluation of 18 state tobacco control programs and previous work. The newly developed Component Model of Infrastructure (CMI) addresses the limitations of a previous model and contains 5 core components (multilevel leadership, managed resources, engaged data, responsive plans and planning, networked partnerships) and 3 supporting components (strategic understanding, operations, contextual influences). The CMI is a practical, implementation-focused model applicable across public health programs, enabling linkages to capacity, sustainability, and outcome measurement.
We examined whether It’s Your Game…Keep It Real (IYG) reduced dating violence among ethnic-minority middle school youths, a population at high risk for dating violence.
We analyzed data from 766 predominantly ethnic-minority students from 10 middle schools in southeast Texas in 2004 for a group randomized trial of IYG. We estimated logistic regression models, and the primary outcome was emotional and physical dating violence perpetration and victimization by ninth grade.
Control students had significantly higher odds of physical dating violence victimization (adjusted odds ratio [AOR] = 1.52; 95% confidence interval [CI] = 1.20, 1.92), emotional dating violence victimization (AOR = 1.74; 95% CI = 1.36, 2.24), and emotional dating violence perpetration (AOR = 1.58; 95% CI = 1.11, 2.26) than did intervention students. The odds of physical dating violence perpetration were not significantly different between the 2 groups. Program effects varied by gender and race/ethnicity.
IYG significantly reduced 3 of 4 dating violence outcomes among ethnic-minority middle school youths. Although further study is warranted to determine if IYG should be widely disseminated to prevent dating violence, it is one of only a handful of school-based programs that are effective in reducing adolescent dating violence behavior.
We estimated sodium intake, which is associated with elevated blood pressure, a major risk factor for cardiovascular disease, and assessed its association with related variables among New York City adults.
In 2010 we conducted a cross-sectional, population-based survey of 1656 adults, the Heart Follow-Up Study, that collected self-reported health information, measured blood pressure, and obtained sodium, potassium, and creatinine values from 24-hour urine collections.
Mean daily sodium intake was 3239 milligrams per day; 81% of participants exceeded their recommended limit. Sodium intake was higher in non-Hispanic Blacks (3477 mg/d) and Hispanics (3395 mg/d) than in non-Hispanic Whites (3066 mg/d; both P < .05). Higher sodium intake was associated with higher blood pressure in adjusted models, and this association varied by race/ ethnicity.
Higher sodium intake among non-Hispanic Blacks and Hispanics than among Whites was not previously documented in population surveys relying on self-report. These results demonstrate the feasibility of 24-hour urine collection for the purposes of research, surveillance, and program evaluation.
Most state Medicaid programs reimburse nondental primary care providers (PCPs) for providing preventive oral health services to young children. We examined the association between who (PCP, dentist, or both) provides these services to Medicaid enrollees before age 3 years and oral health at age 5 years.
We linked North Carolina Medicaid claims (1999–2006) to oral health surveillance data (2005–2006). Regression models estimated oral health status (number of decayed, missing, and filled primary teeth) and untreated disease (proportion of untreated decayed teeth), with adjustment for relevant characteristics and by using inverse-probability-of-treatment weights to address confounding.
We analyzed data for 5235 children with 2 or more oral health visits from a PCP, dentist, or both. Children with multiple PCP or dentist visits had a similar number of overall mean decayed, missing, and filled primary teeth in kindergarten, whereas children with only PCP visits had a higher proportion of untreated decayed teeth.
The setting and provider type did not influence the effectiveness of preventive oral health services on children’s overall oral health. However, children having only PCP visits may encounter barriers to obtaining dental treatment.
One of the biggest threats to the health of trans*females is HIV, particularly for those who are part of racial/minority groups. Yet health disparities for racial/ethnic minority trans*female youth remain understudied.
We examined baseline data from 282 trans*female youth ages 16–24 years old in the San Francisco Bay Area. We conducted Chi-squared tests for distributional differences between racial/ethnic minority and white participants in socio-demographic factors, HIV-related risk behaviors and syndemic factors.
A total of 4.8% of trans*female youth were HIV positive. Racial/ethnic minority and white trans*female youth differed significantly in their gender identities and sexual orientations. Racial/minority youth also had significantly lower educational attainment, were less likely to live with their parents of origin as a child, and were significantly more likely to engage in recent condomless anal intercourse compared to whites.
Important disparities in HIV-related sexual risk behavior, education, and residential stability exist between racial/ethnic minority and white trans*female youth. Efforts to assess the impact of multiple minority stress for racial/minority trans*female youth are imminently needed. Additionally, macro-level disparities must be addressed in prevention efforts for trans*female youth, especially for those from racial/ethnic minority groups, in order to prevent incident cases of HIV and reduce disparities.
Racial disparities in breast cancer mortality persist, and young Black women have higher disease incidence compared with White women. We compared trends in breast cancer mortality for young Black and White women with mortality trends for other common diseases from 1979 to 2010. In contrast to other cancers, ischemic heart disease, and stroke, the breast cancer mortality disparity has widened over the past 30 years, suggesting that unique aspects of disease biology, prevention, and treatment may explain persistent racial differences for young women.
We explored the interrelationships among diabetes, hypertension, and missing teeth among underserved racial/ethnic minority elders.
Self-reported sociodemographic characteristics and information about health and health care were provided by community-dwelling ElderSmile participants, aged 50 years and older, who took part in community-based oral health education and completed a screening questionnaire at senior centers in Manhattan, New York, from 2010 to 2012.
Multivariable models (both binary and ordinal logistic regression) were consistent, in that both older age and Medicaid coverage were important covariates when self-reported diabetes and self-reported hypertension were included, along with an interaction term between self-reported diabetes and self-reported hypertension.
An oral public health approach conceptualized as the intersection of 3 domains — dentistry, medicine, and public health — might prove useful in place-based assessment and delivery of services to underserved older adults. Further, an ordinal logit model that considers levels of missing teeth might allow for more informative and interpretable results than a binary logit model.
We evaluated a community-based, translational stress management program to improve health-related quality of life in Spanish-speaking Latinas with breast cancer.
We adapted a cognitive–behavioral stress management program integrating evidence-based and community best practices to address the needs of Latinas with breast cancer. Spanish-speaking Latinas with breast cancer were randomly assigned to an intervention or usual-care control group. Trained peers delivered the 8-week intervention between February 2011 and February 2014. Primary outcomes were breast cancer–specific quality of life and distress, and general symptoms of distress.
Of 151 participants, 95% were retained at 6 months (between May 2011 and May 2014). Improvements in quality of life from baseline to 6 months were greater for the intervention than the control group on physical well-being, emotional well-being, breast cancer concerns, and overall quality of life. Decreases from baseline to 6 months were greater for the intervention group on depression and somatization.
Results suggest that translation of evidence-based programs can reduce psychosocial health disparities in Latinas with breast cancer. Integration of this program into community-based organizations enhances its dissemination potential.
How do young people’s attitudes about whether condoms reduce pleasure shape condom practices—and, in turn, exposure to STIs and unintended pregnancy? Using a nationally representative sample of 2,328 heterosexually-active, unmarried 15–24 year-olds, we documented multivariate associations with condom non-use at last sexual episode. For both young men and women, pleasure-related attitudes were more strongly associated with lack of condom use than all socio-demographic or sexual history factors. Research and interventions should consistently assess and address young people’s attitudes about how condoms affect pleasure.
condoms; young adults; STI prevention; pregnancy prevention; sexual health; affirmative sexual health; sex-positive approaches
We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide.
Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis.
Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC.
LTC may be an important point of engagement in suicide prevention.
To describe the characteristics and evidence of comprehensive adolescent health (CAH) programs encompassing sexual and reproductive and other health services, educational and social support.
Systematic review of peer-reviewed and grey literature on CAH programs (1998-2013). Only programs with experimental, quasi-experimental or pre-post evaluations were included. Two independent reviewers screened 36,119 records and extracted articles using predefined criteria. Data was synthesised into descriptive characteristics; quality was assessed by evidence level (rigorous, strong, modest).
Data was extracted on 46 programs (181 studies) of which 19 programs were defined as comprehensive; 9 were excluded due to insufficient evaluations. Ten CAH programs met all inclusion criteria. Most were US based; others were implemented in Egypt, Ethiopia and Mexico. Few programs (N=3) displayed rigorous evidence, 5 had strong and 2 had modest evidence. All programs with rigorous/strong evidence directly or indirectly influenced adolescent sexual and reproductive health. Common elements of these programs included: long-term commitment to adolescents, interpersonal connections, community mobilization, and skill-building elements.
The long term impact of many CAH programs cannot be proven due to insufficient evaluations. Evaluation approaches that take into account the complex operating conditions of many programs are needed to better understand mechanisms behind program effects.
We examined whether the timely initiation of antiretroviral therapy (ART) differed by race and comorbidity among older (≥ 50 years) people living with HIV/AIDS (PLWHA).
We conducted frequency and descriptive statistics analysis to characterize our sample, which we drew from 2005–2007 Medicaid claims data from 14 states. We employed univariate and multivariable Cox regression analyses to evaluate the relationship between race, comorbidity, and timely ART initiation (≤ 90 days post-HIV/AIDS diagnosis).
Approximately half of the participants did not commence ART promptly. After we adjusted for covariates, we found that older PLWHA who reported a comorbidity were 40% (95% confidence interval = 0.26, 0.61) as likely to commence ART promptly. We found no racial differences in the timely initiation of ART among older PLWHA.
Comorbidities affect timely ART initiation in older PLWHA. Older PLWHA may benefit from integrating and coordinating HIV care with care for other comorbidities and the development of ART treatment guidelines specific to older PLWHA. Consistent Medicaid coverage helps ensure consistent access to HIV treatment and care and may eliminate racial disparities in timely ART initiation among older PLWHA.
In October 2013, multiple United States (US) federal health departments and agencies posted on Twitter, “We’re sorry, but we will not be tweeting or responding to @replies during the shutdown. We’ll be back as soon as possible!” These “last tweets” and the millions of responses they generated revealed social media’s role as a forum for sharing and discussing information rapidly.
Social media are now among the few dominant communication channels used today. We used social media to characterize the public discourse and sentiment about the shutdown.
The 2013 shutdown represented an opportunity to explore the role social media might play in events that could affect health.
We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City.
Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n=1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange).
There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre-and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR]=3.46, 95% confidence interval [CI]=2.41, 4.96 and AOR=4.02, 95% CI=1.67, 9.69, respectively) and Hispanics vs Whites (AOR=1.76, 95% CI=1.49, 2.09 and AOR=1.49, 95% CI=1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence.
New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection.
We assessed 2 pathways through which dietary antioxidants may counter adverse effects of exposure to particulate matter less than 2.5 micrometers in diameter (PM2.5) on blood pressure (BP): main (compensatory) and modifying (protective) models.
We used 2002 to 2003 data from the Detroit Healthy Environments Partnership community survey conducted with a multiethnic sample of adults (n = 347) in low- to moderate-income, predominantly Hispanic and non-Hispanic Black neighborhoods in Detroit, Michigan. We used generalized estimating equations to test the effects of ambient exposure to PM2.5 and dietary antioxidant intake on BP, with adjustment for multiple confounders.
Dietary antioxidant intake was inversely associated with systolic BP (b = −0.5; P < .05) and pulse pressure (b = −0.6; P < .05) in neighborhoods closest to major sources of air pollutants. Adverse effects of PM2.5 remained significant after accounting for antioxidant intakes. Exploratory analyses suggested potential modifying effects of antioxidant intake on associations between ambient PM2.5 exposure and BP.
Interventions to improve access to antioxidant-rich foods in polluted urban areas may be protective of cardiovascular health. However, efforts to reduce PM2.5 exposure remain critical for cardiovascular health promotion.
This study presented structural characteristics of a multiplex HIV transmission risk network of drug-using male sex workers (MSWs) and associates. The network comprised social, sexual, and drug-using relationships as well as affiliations with social venues.
Using a sample of 387 drug-using MSWs and their male and female associates, we estimated an exponential random graph model to examine the venue-mediated relationships between individuals, the structural characteristics of relationships not linked to social venues, and homophily.
Individuals affiliated with the same social venues, bars, or street intersections were more likely to have one-directional ties (weak ties) with others. Sex workers, as compared to other associates, were less likely to have reciprocated ties (strong ties) to other sex workers with the same venues. Individuals tended to have reciprocated ties not linked to venues. Partner choice tended to be based on homophily.
Social venues may provide a milieu for forming weak ties in HIV transmission risk networks centered on MSWs, which may foster the efficient diffusion of prevention messages as diverse information is obtained and information redundancy is avoided.
social network analysis; multiplex HIV transmission risk network; drug-using male sex workers; most-at-risk MSM; HIV risk behavior; exponential random graph models
We used National Health and Nutrition Examination Survey data to examine insurance status, source of routine care, cigarette and alcohol use, and self-rated health among lesbian, bisexual, and heterosexual women who have sex with women (WSW), compared to heterosexual women who do not have sex with women. We found higher risks of being uninsured among lesbian and bisexual women, worse self-rated health among bisexual women, higher alcohol use among bisexual and heterosexual WSW, and higher smoking across all subgroups.
We examined disparities in risk determinants and risk behaviors for sexually transmitted infections (STIs) between gay-identified, bisexual-identified, and heterosexual-identified young men who have sex with men (YMSM) and heterosexual-identified young men who have sex with women (YMSW) using a school-based sample of US sexually active adolescent males.
We analyzed a pooled data set of Youth Risk Behavior Surveys from 2005 and 2007 that included information on sexual orientation identity, sexual behaviors, and multiple STI risk factors.
Bisexual-identified adolescents were more likely to report multiple STI risk behaviors (number of sex partners, concurrent sex partners, and age of sexual debut) compared with heterosexual YMSW as well as heterosexual YMSM and gay-identified respondents. Gay, bisexual, and heterosexual YMSM were significantly more likely to report forced sex compared with heterosexual YMSW.
Our results provide evidence that sexual health disparities emerge early in the life course and vary by both sexual orientation identity and sexual behaviors. In particular, they show that bisexual-identified adolescent males exhibit a unique risk profile that warrants targeted sexual health interventions.
I tested a social marketing intervention delivered in health department waiting rooms via digital signage technology for increasing radon program participation among priority groups.
I conducted a tri-county, community-based study over a 3-year period (2010–2013) in a high-radon state by using a quasi-experimental design. We collected survey data for eligible participants at the time of radon test kit purchase.
Radon program participation increased at the intervention site (t38 = 3.74; P = .001; 95% confidence interval [CI] = 4.8, 16.0) with an increase in renters (χ21,228 = 4.3; P = .039), Special Supplementary Nutrition Program for Women, Infants, and Children families (χ21,166 = 3.13; P = .077) and first-time testers (χ21,228 = 10.93; P = .001). Approximately one third (30.3%; n = 30) attributed participation in the radon program to viewing the intervention message. The intervention crossover was also successful with increased monthly kit sales (t37 = 2.69; P = .01; 95% CI = 1.20, 8.47) and increased households participating (t23 = 4.76; P < .001; 95% CI = 3.10, 7.88).
A social marketing message was an effective population-based intervention for increasing radon program participation. The results prompted policy changes for Montana radon programming and adoption of digital signage technology by 2 health departments.
The Affordable Care Act (ACA) mandates that both Medicaid and insurance plans cover life-saving preventive services recommended by the US Preventive Services Task Force, including colorectal cancer (CRC) screening and choice between colonoscopy, flexible sigmoidoscopy, and fecal occult blood testing (FOBT).
People who choose FOBT or sigmoidoscopy as their initial test could face high, unexpected, out-of-pocket costs because the mandate does not cover needed follow-up colonoscopies after positive tests. Some people will have no coverage for any CRC screening because of lack of state participation in the ACA or because they do not qualify (e.g., immigrant workers).
Existing disparities in CRC screening and mortality will worsen if policies are not corrected to fully cover both initial and follow-up testing.