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Mosen DM, Banegas MP, Keast EM, Dickerson JF. Examining the Association of Social Needs with Future Health Care Utilization in an Older Adult Population: Which Needs Are Most Important? Popul Health Manag 2023; 26:413-419. [PMID: 37943589 PMCID: PMC10698796 DOI: 10.1089/pop.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
Abstract Social needs, such as social isolation and food insecurity, are important individual-level social determinants of health, especially for adults ages 65 years and older. These needs may be associated with future health care utilization, but this research area has not been studied extensively. The objective of this study was to examine the independent association of 5 individual social needs with future (1) emergency department (ED) visits and (2) hospital admissions. This observational study included 9649 Kaiser Permanente Northwest (KPNW) Medicare members who completed the Medicare Total Health Assessment (MTHA) quality improvement survey between August 17, 2020 and January 31, 2022. The 5 social needs assessed by the MTHA, defined as binary measures (yes/no), included (1) financial strain, (2) food insecurity, (3) housing instability, (4) social isolation, and (5) transportation needs. ED utilization (yes/no) and hospitalization (yes/no), the current study outcome measures, were measured in the 12 months after MTHA assessment. In multivariable analyses, 3 of the 5 social needs were significantly associated with higher ED utilization: financial strain (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.11-1.76, P < 0.05), housing instability (OR = 1.43, 95% CI = 1.02-1.99, P < 0.05), and social isolation (OR = 1.19, 95% CI = 1.05-1.34, P < 0.05), and 1, financial strain, was significantly associated with hospital admissions (OR = 1.66, 95% CI = 1.23-2.23, P < 0.05). The study results identified which social needs are most strongly associated with future ED utilization and hospital admissions. Further research is needed to better understand whether addressing social needs is associated with improved patient-level health outcomes over time.
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Affiliation(s)
- David M. Mosen
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Matthew P. Banegas
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
- Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA
| | - Erin M. Keast
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - John F. Dickerson
- Kaiser Permanente Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
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2
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Taylor SN, Munson D. Health Care of People Experiencing Homelessness: Part I. NEJM EVIDENCE 2023; 2:EVIDra2300123. [PMID: 38320148 DOI: 10.1056/evidra2300123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Homelessness and Health CarePeople who experience homelessness have high rates of medical illness. They struggle with conditions associated with living in crowded shelters, trauma, and exposure to extreme weather. Here, Taylor and Munson review the care of this vulnerable population.
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Affiliation(s)
| | - David Munson
- Massachusetts General Hospital, Boston
- Boston Health Care for the Homeless Program, Boston
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3
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Chamberlin G, Lopes MD, Iyer S, Psaros C, Bassett IV, Medeiros S, O'Connor C, Ard KL. "That was our afterparty": a qualitative study of mobile, venue-based PrEP for MSM. BMC Health Serv Res 2023; 23:504. [PMID: 37198608 DOI: 10.1186/s12913-023-09475-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND HIV preexposure prophylaxis (PrEP) uptake among men who have sex with men (MSM), a group disproportionately impacted by HIV, is not commensurate with need. Settings which reduce or remove barriers to accessing care are promising venues to support PrEP uptake. PrEP provision at mobile clinics represents a novel strategy to increase PrEP access; however, the acceptability and feasibility of this approach have not been well studied. METHODS Our objective was to understand patient and staff experiences of a mobile clinic van offering PrEP and sexual health services in Boston, Massachusetts, USA. We interviewed mobile unit users and conducted focus groups with mobile unit staff and users. Data were organized using Dedoose software, and content analysis was used to identify themes of access, community, and stigma. RESULTS Nineteen individuals (16 patients and 3 staff members) participated in interviews (N = 13) or focus groups (N = 6). All patients identified as MSM, 63% were Hispanic or Latino, and 21% of patient interviews were conducted in Spanish. Logistical and psychological convenience facilitated service use, while the community-oriented environment improved satisfaction with care. Overall, participants supported expansion of mobile unit services and recommended changes to improve access to longitudinal care. However, some barriers to PrEP persisted, including low HIV risk perception and stigma about sexual behavior. CONCLUSIONS Mobile units can promote sexual health and PrEP uptake, particularly for populations facing social and logistical barriers to care in traditional settings.
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Affiliation(s)
- Grace Chamberlin
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Surabhi Iyer
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Kevin L Ard
- Harvard Medical School, Boston, MA, USA.
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
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4
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Saha R, Miller AP, Parriott A, Horvath H, Kahn JG, Malekinejad M. Viral blood-borne infections testing and linkage to care cascade among persons who experience homelessness in the United States: a systematic review and meta-analysis. BMC Public Health 2022; 22:1421. [PMID: 35883158 PMCID: PMC9327172 DOI: 10.1186/s12889-022-13786-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 07/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Persons who experience homelessness remain at increased risk for three viral blood-borne infections: human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). We assessed the yield of testing and linkage to care programs targeting this population for these infections in the United States (US). METHODS We searched PubMed, Embase, Web of Science, and Cochrane Central for peer-reviewed articles through August 27, 2020. Additionally, we searched the grey literature. Two individuals independently reviewed all relevant studies to check for eligibility and extracted data for each step in the care cascade. We used random-effects model to generate weighted pooled proportions to assess yield at each step. Cumulative proportions were calculated as products of adjacent-step pooled proportions. We quantitatively synthesized data from the studies that focused on non-drug injecting individuals. RESULTS We identified 24 studies published between 1996-2019 conducted in 19 US states. Seventeen studies screened for HIV, 12 for HCV, and two screened for HBV. For HIV, 72% of approached were recruited, 64% had valid results, 4% tested positive, 2% were given results, and 1% were referred and attended follow-up. Of positives, 25% were referred to treatment and started care. For HCV, 69% of approached were recruited, 63% had valid results, 16% tested positive, 14% were given results, and 3% attended follow-up. Of positives, 30% were referred for treatment and 19% started care. The yield at each care cascade step differs widely by recruitment strategy (for example, for HIV: 71.6% recruited of reached under service-based with zero yield under healthcare facility-based and outreach). CONCLUSIONS A very large proportion of this population reached for HIV and HCV care were lost in the follow-up steps and never received treatment. Future programs should examine drop-out reasons and intervene to reduce health disparities in this population.
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Affiliation(s)
- Ria Saha
- Senior Public Health Intelligence Analyst, Medway Council, London, UK
| | - Amanda P Miller
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
| | - Andrea Parriott
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, USA
- California Department of Public Health, Sacramento, CA, USA
| | - Hacsi Horvath
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - James G Kahn
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Mohsen Malekinejad
- University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, 3333 California St., Ste. 265, Box 0936, San Francisco, CA, 94118, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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5
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Valencia J, Lazarus JV, Ceballos FC, Troya J, Cuevas G, Resino S, Torres-Macho J, Ryan P. Differences in the hepatitis C virus cascade of care and time to initiation of therapy among vulnerable subpopulations using a mobile unit as point-of-care. Liver Int 2022; 42:309-319. [PMID: 34767680 DOI: 10.1111/liv.15095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/31/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS People who inject drugs (PWID) and other marginalized populations with high hepatitis C virus (HCV) infection rates represent a unique challenge for treatment initiation due to health, administrative and social barriers. We analysed the HCV cascade of care (CoC) in some vulnerable subpopulations in Madrid, Spain, when using a mobile point-of-care (PoC). METHODS From 2019 to 2021, a mobile unit was used to screen active HCV using a linkage-to-care and two-step PoC-based strategy. Viremic participants were grouped into four subgroups: PWID, homeless individuals and people with a mental health disorder (MHD) and alcohol use disorder (AUD). Logistic regression, and Cox and Aalen's additive models were used to analyse associated factors and differences between groups. RESULTS A prospectively recruited cohort of 214 HCV-infected individuals (73 PWID, 141 homeless, 57 with a MHD and 91 with AUD) participated in the study. The overall HCV CoC analysis found that 178 (83.1%) attended a hospital, 164 (76.6%) initiated direct-acting antiviral therapy and 141 (65.8%) completed therapy, of which 99 (95.2%) achieved sustained virological response (SVR). PWID were significantly less likely to initiate treatment, whereas individuals with AUD waited longer before starting the treatment. Both people with AUD and PWID were significantly less likely to complete HCV treatment. CONCLUSIONS Overall, SVR was achieved in the majority of the participants treated. However, PWID need better linkage to care and treatment, whereas PWID and AUD need more support for treatment completion.
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Affiliation(s)
- Jorge Valencia
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,Harm Reduction Unit 'SMASD', Addictions and Mental Health Department, Madrid, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Francisco C Ceballos
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Jesús Troya
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Guillermo Cuevas
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Salvador Resino
- Viral Infection and Immunity Unit, National Centre for Microbiology, Health Institute Carlos III, Madrid, Spain
| | - Juan Torres-Macho
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain
| | - Pablo Ryan
- Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain.,School of Medicine, Complutense University of Madrid, Madrid, Spain.,Gregorio Marañón Health Research Institute, Madrid, Spain
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Khalili M, Powell J, Park HH, Bush D, Naugle J, Ricco M, Magee C, Braimoh G, Zevin B, Fokuo JK, Masson CL. Shelter-Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness. Hepatol Commun 2021; 6:50-64. [PMID: 34628726 PMCID: PMC8710795 DOI: 10.1002/hep4.1791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 12/26/2022] Open
Abstract
Hepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low‐barrier linkage to HCV therapy among individuals accessing homeless shelters. HCV rapid testing was performed at four large shelters in San Francisco (SF) and Minneapolis (MN). Sociodemographic status, HCV risk, barriers to testing, and interest in therapy were captured. Participants received information about HCV. Those testing positive underwent formal HCV education and onsite therapy. Multivariable modeling assessed predictors of receipt of HCV therapy and sustained virologic response (SVR). A total of 766 clients were tested. Median age was 53.7 years, 68.2% were male participants, 46.3% were Black, 27.5% were White, 13.2% were Hispanic, and 57.7% had high school education or less; 162 (21.1%) were HCV antibody positive, 107 (66.0%) had detectable HCV RNA (82.1% with active drug use, 53.8% history of psychiatric illness), 66 (61.7%) received HCV therapy, and 81.8% achieved SVR. On multivariate analysis, shelter location (MN vs. SF, odds ratio [OR], 0.3; P = 0.01) and having a health care provider (OR, 4.1; P = 0.02) were associated with receipt of therapy. On intention to treat analysis, the only predictor of SVR when adjusted for age, sex, and race was HCV medication adherence (OR, 14.5; P = 0.01). Conclusion: Leveraging existing homeless shelter infrastructure was successful in enhancing HCV testing and treatment uptake. Despite high rates of active substance use, psychiatric illness, and suboptimal adherence, over 80% achieved HCV cure. This highlights the critical importance of integrated models in HCV elimination efforts in people experiencing homelessness that can be applied to other shelter settings.
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Affiliation(s)
- Mandana Khalili
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,University of California San Francisco Liver Center, San Francisco, CA, USA
| | | | - Helen H Park
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dylan Bush
- Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Jessica Naugle
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, USA
| | | | - Catherine Magee
- Division of Gastroenterology and Hepatology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | | | - Barry Zevin
- San Francisco Department of Public Health, Street Medicine and Shelter Health, San Francisco, CA, USA
| | - J Konadu Fokuo
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Carmen L Masson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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7
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A H, L M, Am J, M M, Gp A, S V. Community-Based Assessment and Treatment of Hepatitis C Virus-Related Liver Disease, Injecting Drug and Alcohol Use Amongst People Who Are Homeless: A Systematic Review and Meta-Analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103342. [PMID: 34210551 DOI: 10.1016/j.drugpo.2021.103342] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/19/2021] [Accepted: 06/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS We performed a systematic review and meta-analysis addressing community-based assessment and treatment of hepatitis C virus (HCV)-related liver disease, injecting drug use (IDU) and alcohol use amongst people who are homeless (PWAH). METHODS Using systematic review methodology, databases were searched (MEDLINE/ EMBASE/CINAHL) for studies combining PWAH, HCV-related liver disease and community assessment until December 2019. Studies with a sample size ≥ 30, with PWAH constituting at least 30% of the cohort were included and a quality assessment performed. Pooled estimates of key indicators were analysed using meta-analysis. RESULTS We identified 39 studies (n = 13,918), 37 categorised as poor quality (Newcastle-Ottawa Scale). Prevalence of homelessness ranged between 30%-100% (37 studies). Eight studies provided all of the following: HCV screening, alcohol/substance use/liver fibrosis assessment and HCV treatment. No study provided interventions for alcohol use, with two providing opioid substitution treatment. Alcohol use prevalence (24 studies) was 4%-97%, being 59% (95% CI 20%-92%) in four studies that included only PWAH. Recent IDU prevalence (16 studies) was 7%-73%, being 21% (95% CI 17%-26%) in four studies that included only PWAH. HCV seroprevalence (25 studies) was 2.5% - 58%; in 13 studies that included only PWAH, this was 20% (95% CI 12%-30%). Prevalence of F4 fibrosis (nine studies) was 6%-28%, being 7% and 16% in two studies that included only PWAH. Direct acting antiviral-based intention-to-treat sustained virological response (SVR) rates (five studies) were 82%-92%, being 92% in the one study that included only PWAH. In the only two randomised controlled trials (RCT) identified, community-based interventions (mental health/peer mentor) significantly increased linkage to care (p = 0.04), HCV treatment (p = 0.005) and SVR rates (p = 0.018). CONCLUSION The burden from alcohol/IDU and HCV, and consequently liver disease in PWAH needs addressing. RCT trials assessing community-based interventions to improve liver health in PWAH are needed.
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Affiliation(s)
- Hashim A
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Macken L
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Jones Am
- Sussex Partnership Foundation Trust, Hove, United Kingdom
| | - McGeer M
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Aithal Gp
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom; Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Verma S
- Department of Gastroenterology and Hepatology, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom; Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, United Kingdom.
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Ash MJ, Berkley-Patton J, Christensen K, Haardörfer R, Livingston MD, Miller T, Woods-Jaeger B. Predictors of medical mistrust among urban youth of color during the COVID-19 pandemic. Transl Behav Med 2021; 11:1626-1634. [PMID: 34080637 PMCID: PMC8195192 DOI: 10.1093/tbm/ibab061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic has disproportionately impacted communities of color and highlighted longstanding racial health inequities. Communities of color also report higher rates of medical mistrust driven by histories of medical mistreatment and continued experiences of discrimination and systemic racism. Medical mistrust may exacerbate COVID-19 disparities. This study utilizes the Behavior Model for Vulnerable Populations to investigate predictors of medical mistrust during the COVID-19 pandemic among urban youth of color. Minority youth (N = 105) were recruited from community organizations in Kansas City, Missouri to complete an online survey between May and June 2020. Multiple linear regressions were performed to estimate the effect of personal characteristics, family and community resources, and COVID-19 need-based factors on medical mistrust. Results indicated that loneliness, financial insecurity (e.g., job loss, loss of income) due to the COVID-19 pandemic, and eligibility for free or reduced lunch predicted medical mistrust. Insurance status, neighborhood median household income, social support, and perceived COVID-19 risk were not significantly associated with medical mistrust. Future research and policies are necessary to address systemic factors that perpetuate medical mistrust among youth of color.
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Affiliation(s)
- Marcia J Ash
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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9
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Hajek A, Bertram F, Heinrich F, van Rüth V, Ondruschka B, Kretzler B, Schüler C, Püschel K, König HH. Determinants of health care use among homeless individuals: evidence from the Hamburg survey of homeless individuals. BMC Health Serv Res 2021; 21:317. [PMID: 33827570 PMCID: PMC8026095 DOI: 10.1186/s12913-021-06314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To identify the determinants of health care use among homeless individuals. METHODS Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates. RESULTS Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]). CONCLUSIONS Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedikt Kretzler
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Schüler
- Deutsches Rotes Kreuz Kreisverband Hamburg Altona und Mitte e.V, Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Ly TDA, Castaneda S, Hoang VT, Dao TL, Gautret P. Vaccine-preventable diseases other than tuberculosis, and homelessness: A scoping review of the published literature, 1980 to 2020. Vaccine 2021; 39:1205-1224. [PMID: 33509694 DOI: 10.1016/j.vaccine.2021.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Homelessness may result in the breakdown of regular health services, including routine vaccination programmes. A scoping review was conducted to describe vaccine-preventable diseases (VPD) other than tuberculosis in people experiencing homelessness (PEH). METHODS We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We searched peer-reviewed literature published in English, French, Spanish or Portuguese reporting the outbreak of VPD or VPD prevalence in both infant and adult homeless populations published between 1980 and 2020, using PubMed/Medline, SciELO, Google Scholar, and Web of Science databases. Relevant information from the studies was charted in Microsoft Excel and results were summarised using a descriptive analytical method. RESULTS Eighty-one articles were included. A high prevalence of past hepatitis B virus (HBV) and hepatitis A virus (HAV) infections were observed through serosurveys, mostly in high income countries or high-middle income countries (USA, Canada, France, Iran or Brazil). Ten outbreaks of HAV infection were also reported, with lethality rates ranging from 0 to 4.8%. The studies identified numerous risk factors positively associated with HBV infection, including older age, homosexual or bisexual practice, injected drug use (IDU), and, with HAV infection including IDU, having sexual partner(s) with a history of unspecified hepatitis, insertive anal penetration, or originating from a country with a high prevalence of anti-HAV antibody. Eleven outbreaks of pneumococcal infection affecting PEH were reported in Canada and USA, with lethality rates from 0 to 15.6%. Six diphtheria outbreaks were reported. Vaccination status was rarely documented in these studies. CONCLUSIONS The literature suggests that homeless populations generally experience a high VPD burden suggesting the need for a national vaccination programme and planning for delivering vaccines in this population.
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Affiliation(s)
- Tran Duc Anh Ly
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| | | | - Van Thuan Hoang
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Thi Loi Dao
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France; Pneumology Department, Thai Binh University of Medicine and Pharmacy, Viet Nam
| | - Philippe Gautret
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France; IHU-Méditerranée Infection, Marseille, France.
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11
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Clermont D, Gilmer T, Burgos JL, Berliant E, Ojeda VD. HIV and Sexual Health Services Available to Sexual and Gender Minority Youth Seeking Care at Outpatient Public Mental Health Programs in Two California Counties. Health Equity 2020; 4:375-381. [PMID: 32923842 PMCID: PMC7484894 DOI: 10.1089/heq.2020.0014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: Sexual and gender minority youth (SGMY, ages 16-24 years) face disparities in sexually transmitted infections (STIs) and HIV, in part, due to exposure to settings and behaviors that may harm youth's physical and mental health. This study examines the scope of sexual health and HIV services available to youth living with serious mental illness (SMI), including SGMY, seeking care at publicly funded outpatient mental health programs. Methods: Between 2018 and 2019, we surveyed 183 managers of mental health programs serving youth living with SMI of ages 16-24 years, including SGMY, in San Diego and Los Angeles counties. Participants reported on programs' target populations, sexual health/HIV service provision, and the use of peer providers. Descriptive statistics and Pearson chi-square tests were used to describe sexual health/HIV services and identify programmatic characteristics associated with providing these services. Results: Overall, 46% of all programs surveyed provided sexual health/HIV services. Of these, 62% provided HIV education, 81% provided sexual/reproductive health education, and 69% provided sexual/reproductive health education tailored for lesbian, gay, bisexual, queer, intersex (LGBQI) youth. Peers often provided these services. Chi-squared tests showed that programs employing peer specialists (p=0.009) and targeting LGBQI youth (p=0.045) were significantly more likely to provide sexual health/HIV services. Conclusion: The use of peer providers may reduce stigma around sexual/HIV service utilization and promote SGMY's trust. Publicly funded outpatient mental health programs serving youth and especially those actively engaging SGMY may consider also offering onsite HIV, STI, and sexual health services, creating a one-stop-shop approach.
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Affiliation(s)
- Donald Clermont
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Todd Gilmer
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Jose Luis Burgos
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Emily Berliant
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA
| | - Victoria D Ojeda
- Department of Family Medicine and Public Health and University of California, San Diego School of Medicine, La Jolla, California, USA.,Department of Medicine, University of California, San Diego School of Medicine, La Jolla, California, USA
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Ross J, Field C, Kaye S, Bowman J. Prevalence and correlates of low self-reported physical health status among prisoners in New South Wales, Australia. Int J Prison Health 2019; 15:192-206. [PMID: 31172857 DOI: 10.1108/ijph-06-2018-0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to examine the prevalence and predictors of low self-reported physical health status among NSW prison inmates. DESIGN/METHODOLOGY/APPROACH Cross-sectional random sample of 1,098 adult male and female prisoners, interviewed as part of the 2015 Justice Health and Forensic Mental Health Network Patient Health Survey. FINDINGS Almost a quarter of participants had "low self-reported physical health status". Independent predictors of "low health status" were having been in out of home care before the age of 16 years, being illiterate, smoking 20 or more cigarettes a day, not eating more than one serve of fruit a day, not being physically active in the 12 months before incarceration, higher body mass index score and low self-reported mental health status. Many of these predictors are modifiable risk factors for chronic disease, which could be targeted during incarceration. ORIGINALITY/VALUE This paper demonstrates the utility of a using a single item measure of self-reported physical health status among Australian prisoners, and helps to characterise those prisoners in greatest need of intervention for issues relating to their health.
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Affiliation(s)
- Joanne Ross
- Research Unit, Justice Health and Forensic Mental Health Network, Malabar, Australia
- National Drug and Alcohol Research Centre, University of New South Wales , Sydney, Australia
| | - Courtney Field
- Research Unit, Justice Health and Forensic Mental Health Network, Matraville, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales , Sydney, Australia
- Research Unit, Justice Health and Forensic Mental Health Network, Matraville, Australia
| | - Julia Bowman
- Research Unit, Justice Health and Forensic Mental Health Network, Matraville, Australia
- Faculty of Health, University of Technology Sydney , Sydney, Australia
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Harris T, Winetrobe H, Rhoades H, Castro CA, Wenzel S. Moving Beyond Housing: Service Implications for Veterans Entering Permanent Supportive Housing. CLINICAL SOCIAL WORK JOURNAL 2018; 46:130-144. [PMID: 30416223 PMCID: PMC6219637 DOI: 10.1007/s10615-018-0648-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg-Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N=126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including "equal access to services," "enhancing economic stability," "providing safe and affordable housing with trauma-informed services," and "training service social workers to deliver well-informed linkages and services" are discussed.
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Affiliation(s)
- Taylor Harris
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Hailey Winetrobe
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Harmony Rhoades
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Carl Andrew Castro
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
| | - Suzanne Wenzel
- School of Social Work, University of Southern California, 1149 S. Hill St. Suite 360, Los Angeles, CA 90015
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Carvalho PMRDS, Matos MAD, Martins RMB, Pinheiro RS, Caetano KAA, Souza MMD, Carneiro MADS, Teles SA. Prevalence, risk factors and hepatitis B immunization: helping fill the gap on hepatitis B epidemiology among homeless people, Goiânia, Central Brazil. CAD SAUDE PUBLICA 2017; 33:e00109216. [PMID: 28792993 DOI: 10.1590/0102-311x00109216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/22/2016] [Indexed: 12/26/2022] Open
Abstract
Data are limited in Brazil on hepatitis B infection among homeless individuals, a marginalized population with high risk of sexually transmissible infections (STI), including hepatitis B. The aim of this study was to investigate hepatitis B epidemiology in homeless persons lodged in a public shelter in Goiânia, Central Brazil. From August 2014 to June 2015, 353 individuals were interviewed and tested for markers of HBV infection. Overall HBV prevalence was 21.8% (95%CI: 17,82-26,41), and 19,5% (95%CI: 15,75-24,0) showed a serological profile of previous HBV vaccination. Older individuals (> 50 years), blacks, and homosexuals or bisexuals showed increased exposure to HBV. The low frequency of individuals immunized against HBV, high social vulnerability, and risk behaviors emphasize the need for health services administrators to provide more opportunities for HBV vaccination in this target population.
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Pinsker EA, Hennrikus DJ, Erickson DJ, Call KT, Forster JL, Okuyemi KS. Cessation-related weight concern among homeless male and female smokers. Prev Med Rep 2017; 7:77-85. [PMID: 28593127 PMCID: PMC5458131 DOI: 10.1016/j.pmedr.2017.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/14/2017] [Accepted: 05/15/2017] [Indexed: 11/05/2022] Open
Abstract
Concern about post-cessation weight gain is a barrier to making attempts to quit smoking; however, its effect on smoking cessation is unclear. In this study we examine cessation-related weight concern among the homeless, which hasn't been studied. Homeless males (n = 320) and females (n = 110) participating in a smoking cessation RCT in the Twin Cities, Minnesota from 2009 to 2011 completed surveys on cessation-related weight concern, smoking status, and components from the Behavioral Model for Vulnerable Populations. Generalized estimating equations were used to examine baseline predictors of cessation-related weight concern at baseline, the end of treatment, and 26-weeks follow-up. Logistic regression models were used to examine the relationship between cessation-related weight concern and smoking status at the end of treatment and follow-up. Females had higher cessation-related weight concern than males. Among males, older age, Black race, higher BMI, depression, and having health insurance were associated with higher cessation-related weight concern. Among females, nicotine dependence, greater cigarette consumption, indicating quitting is more important, older age of smoking initiation, and less support to quit from family were associated with higher cessation-related weight concern. In multivariate analyses, cessation-related weight concern decreased over time among females. Cessation-related weight concern wasn't associated with smoking cessation. Although several types of characteristics predicted cessation-related weight concern among males, only smoking characteristics predicted cessation-related weight concern among females. Given the small proportion of quitters in this study (8% of males and 5% of females), further research on the impact of cessation-related weight concern on smoking cessation among the homeless is warranted. Concern about post-quitting weight gain is higher among homeless females than males. In multivariate analyses, weight concern decreased over time among homeless females. Several types of variables predicted weight concern among homeless males. Only smoking characteristics predicted weight concern among homeless females. Weight concern was not associated with smoking cessation among the homeless.
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Affiliation(s)
- Erika Ashley Pinsker
- Minneapolis VA Health Care System, Center for Chronic Disease Outcomes Research, One Veterans Drive Minneapolis, MN 55417, USA.,University of Minnesota, Department of Medicine, 401 East River Parkway Suite 131, Minneapolis, MN 55455, USA
| | - Deborah Jane Hennrikus
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St., Minneapolis, MN 55455, USA
| | - Darin J Erickson
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St., Minneapolis, MN 55455, USA
| | - Kathleen Thiede Call
- University of Minnesota, Division of Health Policy & Management, 516 Delaware St. SE Suite 15-223, Minneapolis, MN 55455, USA
| | - Jean Lois Forster
- University of Minnesota, Division of Epidemiology and Community Health, 1300 S 2nd St., Minneapolis, MN 55455, USA
| | - Kolawole Stephen Okuyemi
- University of Minnesota, Program in Health Disparities Research, 717 Delaware St. SE Suite 166, Minneapolis, MN 55414, USA
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Lu L, Zeng J, Zeng Z. What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socio-economic and health status. Int J Equity Health 2017; 16:30. [PMID: 28148264 PMCID: PMC5289053 DOI: 10.1186/s12939-017-0523-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 01/13/2017] [Indexed: 12/03/2022] Open
Abstract
Background Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Methods Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Results Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test’s P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725). Conclusions This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China’s healthcare system reform.
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Affiliation(s)
- Liming Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou, 510120, China.
| | - Jingchun Zeng
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
| | - Zhi Zeng
- Hunan Provincial Maternal and Child Health Care Hospital, #53 Xiangchun Road, Changsha, 410008, China
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Noska AJ, Belperio PS, Loomis TP, O’Toole TP, Backus LI. Engagement in the Hepatitis C Care Cascade Among Homeless Veterans, 2015. Public Health Rep 2017; 132:136-139. [PMID: 28135425 PMCID: PMC5349485 DOI: 10.1177/0033354916689610] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Veterans Health Administration (VHA) is the largest provider of hepatitis C virus (HCV) care nationally and provides health care to >200 000 homeless veterans each year. We used the VHA's Corporate Data Warehouse and HCV Clinical Case Registry to evaluate engagement in the HCV care cascade among homeless and nonhomeless veterans in VHA care in 2015. We estimated that, among 242 740 homeless veterans in care and 5 424 712 nonhomeless veterans in care, 144 964 (13.4%) and 188 156 (3.5%), respectively, had chronic HCV infection. Compared with nonhomeless veterans, homeless veterans were more likely to be diagnosed with chronic HCV infection and linked to HCV care but less likely to have received antiviral therapy despite comparable sustained virologic response rates. Homelessness should not necessarily preclude HCV treatment eligibility with available all-oral antiviral regimens.
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Affiliation(s)
- Amanda J. Noska
- Department of Internal Medicine, Providence VA Medical Center, Providence, RI, USA
| | - Pamela S. Belperio
- Patient Care Services/Population Health Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Timothy P. Loomis
- Patient Care Services/Population Health Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thomas P. O’Toole
- Department of Internal Medicine, Providence VA Medical Center, Providence, RI, USA
| | - Lisa I. Backus
- Patient Care Services/Population Health Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Ferreira PM, Guimarães RA, Souza CM, Guimarães LCDC, Barros CVDL, Caetano KAA, Rezza G, Spadoni L, Brunini SM. Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study. BMC Public Health 2017; 17:90. [PMID: 28100196 PMCID: PMC5241983 DOI: 10.1186/s12889-016-3952-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 12/15/2016] [Indexed: 12/22/2022] Open
Abstract
Background Homeless men are highly vulnerable to acquisition of the hepatitis C virus (HCV) compared to the general population. In Brazil, a country of continental dimensions, the extent of HCV infection in this population remains unknown. The objective of this study is to investigate the epidemiological profile of exposure to HCV in homeless men in Central Brazil. Methods A Cross-sectional study was conducted in 481 men aged over 18 years attending therapeutic communities specialized in the recovery and reintegration of homeless people. Participants were tested for anti-HCV markers using rapid tests. Poisson regression analysis was used to verify the risk factors associated with exposure to HCV. Results The prevalence of HCV exposure was 2.5% (95.0% CI: 1.4 to 4.3%) and was associated with age, absence of family life, injection drug use, number of sexual partners, and history of sexually transmitted infections (STI). Participants reported multiple risk behaviors, such as alcohol (78.9%), cocaine (37.1%) and/or crack use (53.1%), and inconsistent condom use (82.6%). Injection drug use was reported by 8.7% of participants. Conclusions The prevalence of HCV infection among homeless men was relatively high. Several risk behaviors were commonly reported, which shows the high vulnerability of this population. These findings emphasize the need for the development of specific strategies to reduce the risk of HCV among homeless men.
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Affiliation(s)
| | | | | | | | | | | | | | - Lila Spadoni
- Faculty of Psicology, UniEvangélica, Anápolis, Goiás, Brazil
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Haley DF, Linton S, Luo R, Hunter-Jones J, Adimora AA, Wingood GM, Bonney L, Ross Z, Cooper HL. Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care. J Health Care Poor Underserved 2017; 28:315-328. [PMID: 28239005 PMCID: PMC5501981 DOI: 10.1353/hpu.2017.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. METHODS We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. RESULTS Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). CONCLUSION These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.
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Chirikov VV, Shaya FT, Mullins CD, dosReis S, Onukwugha E, Howell CD. Determinants of quality of care and treatment initiation in Medicare disabled patients with chronic hepatitis C. Expert Rev Gastroenterol Hepatol 2016; 9:1447-62. [PMID: 26524244 DOI: 10.1586/17474124.2015.1095087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Aligning with a national priority to bridge health disparities in disadvantaged populations, we explored contextual determinants of pretreatment quality of care and treatment receipt of Medicare disabled patients with hepatitis C virus (HCV) infection. METHODS We used Medicare claims (2006-2009) linked to the Area Health Resource Files. Ordinal partial proportional odds and weighted modified Poisson regressions were used to model the determinants of quality care receipt and interferon-based treatment, respectively. RESULTS We identified 1936 Medicare disabled HCV patients, of whom 10.4% were treated with peg-interferon. Despite the high comorbidity burden among HCV disabled patients, greater engagement in care correlated with greater likelihood of quality care and treatment receipt. CONCLUSION Our study highlights the need for process and linkage to care in Medicare disabled HCV patients, but future research relevant to novel interferon-free agents is needed to assess patterns of quality of care and treatment receipt in this vulnerable population.
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Affiliation(s)
- Viktor V Chirikov
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Fadia T Shaya
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA.,b 2 University of Maryland School of Medicine, Baltimore, MD, USA
| | - C Daniel Mullins
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Susan dosReis
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Ebere Onukwugha
- a 1 Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, Saratoga Offices 12th Floor, Baltimore, MD 21201, USA
| | - Charles D Howell
- c 3 Department of Medicine, Howard University College of Medicine, 2041 Georgia Ave. Suite 5C02, Washington, DC 20060, USA
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Sogarwal R, Madge V, Bishi P, Woleng A, Garg R. Predisposing, enabling, and need factors associated with utilization of HCV testing services among PWID in two settings in India. HEPATOLOGY, MEDICINE AND POLICY 2016; 1:1. [PMID: 30288303 PMCID: PMC5918529 DOI: 10.1186/s41124-016-0010-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022]
Abstract
Background The Hepatitis C virus (HCV) is very common among people who inject drugs (PWID), yet PWID in India have suboptimal access to HCV testing and treatment. This study sought to identify HCV risk factors among male PWID who utilized a free needle and syringe exchange program and to examine the predisposing, enabling, and need factors associated with utilization of HCV testing services by those PWID reporting that they had been tested. Methods A cross-sectional study was conducted in Imphal, Manipur and Amritsar, Punjab. These two settings have high HCV prevalence and large numbers of PWID. A team of 18 field investigators obtained data through face-to-face interviews using a structured multiple-choice questionnaire. The questionnaire was administered to 1241 of 2644 male PWID aged 15 years and above enrolled in the needle and syringe program of India's AIDS Control Program, with study participants selected through consecutive sampling. Statistical analyses included descriptive statistics and multivariate regression. Results Twenty-four percent of PWID in our study sample reported having been tested for HCV. Unlike PWID in Imphal, more than half of PWID in Amritsar reported unprotected sex and use of alcohol or non-injecting drugs as being among their HCV risk factors (67.1 and 77.8 %, respectively). However, opioid substitution therapy non-adherence was reported more often in Imphal than in Amritsar. Education, marital status, place of residence and duration of injecting drug use were found to significantly enable access to HCV testing while alcohol use, frequent mobility and unprotected sex were found to significantly inhibit access to HCV testing for PWID after controlling for other explanatory variables. Conclusions Predisposing and enabling determinants provide an area for developing effective interventions to improve HCV testing practices among PWID. HCV prevention programs that address safe injecting and sexual practices, OST adherence and frequent mobility customized for PWID by age are strongly recommended.
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Affiliation(s)
- Ruchi Sogarwal
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Varada Madge
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Pratyush Bishi
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Apam Woleng
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Rishi Garg
- MAMTA Health Institute for Mother and Child, New Delhi, India
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Petrovich JC, Pollio DE, North CS. Predictors of VA and Non-VA Health Care Service Use by Homeless Veterans Residing in a Low-Demand Emergency Shelter. Fed Pract 2016; 33:42-48. [PMID: 30766166 PMCID: PMC6369027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
When given a choice between VA and non-VA outpatient services, significantly more veterans chose to use VA medical and psychiatric services, but outpatient substance abuse-related services were used equally.
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Affiliation(s)
- James C Petrovich
- is a research without compensation appointee at the VA North Texas Health Care System in Dallas. is a distinguished professor and chair of the Department of Social Work at the University of Alabama at Birmingham. Dr. Petrovich is also assistant professor at the Department of Social Work at Texas Christian University in Fort Worth. is the Nancy and Ray L. Hunt Chair in Crisis Psychiatry and professor at the University of Texas Southwestern Medical Center Department of Psychiatry in Dallas
| | - David E Pollio
- is a research without compensation appointee at the VA North Texas Health Care System in Dallas. is a distinguished professor and chair of the Department of Social Work at the University of Alabama at Birmingham. Dr. Petrovich is also assistant professor at the Department of Social Work at Texas Christian University in Fort Worth. is the Nancy and Ray L. Hunt Chair in Crisis Psychiatry and professor at the University of Texas Southwestern Medical Center Department of Psychiatry in Dallas
| | - Carol S North
- is a research without compensation appointee at the VA North Texas Health Care System in Dallas. is a distinguished professor and chair of the Department of Social Work at the University of Alabama at Birmingham. Dr. Petrovich is also assistant professor at the Department of Social Work at Texas Christian University in Fort Worth. is the Nancy and Ray L. Hunt Chair in Crisis Psychiatry and professor at the University of Texas Southwestern Medical Center Department of Psychiatry in Dallas
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Li J, Maxwell AE, Glenn BA, Herrmann AK, Chang LC, Crespi CM, Bastani R. Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency. INTERNATIONAL JOURNAL OF SOCIAL SCIENCE RESEARCH 2016; 4:83-97. [PMID: 29057278 PMCID: PMC5647155 DOI: 10.5296/ijssr.v4i1.8678] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N = 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect = 0.166, SE = 0.07, p<.05; direct effect = 0.296, SE = 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.
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Affiliation(s)
- Jiang Li
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-8954
| | - Annette E Maxwell
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-794-9282
| | - Beth A Glenn
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-9715
| | - Alison K Herrmann
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-8483
| | - L Cindy Chang
- Jonsson Comprehensive Cancer Center and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-204-9038
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-9364
| | - Roshan Bastani
- Department of Health Policy and Management, Fielding School of Public Health, Jonsson Comprehensive Cancer Center, and UCLA Kaiser Permanente Center for Health Equity, University of California Los Angeles, 650 Charles E. Young Drive South, Room A2-125 CHS, Los Angeles, CA 90095, USA, Tel: 1-310-206-9266
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Kim HK, Lee M. Factors associated with health services utilization between the years 2010 and 2012 in Korea: using Andersen's Behavioral model. Osong Public Health Res Perspect 2016; 7:18-25. [PMID: 26981338 PMCID: PMC4776261 DOI: 10.1016/j.phrp.2015.11.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/23/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to examine the factors associated with health services utilization using Andersen's behavioral model. METHODS We collected Korea Health Panel data between the years 2010 and 2012 from the consortium of the National Health Insurance Service and the Korea Institute for Health and Social Affairs, and analyzed the data to determine the outpatients and inpatients of health services utilization. RESULTS Health services utilization was more significantly explained by predisposing and need factors than enabling factors. The outpatients were examined more specifically; sex, age, and marital status as predisposing factors, and chronic illness as a need factor were the variables that had significant effects on health-services-utilization experience. The inpatients were examined more specifically: sex, age, and marital status in predisposing factors; education level, economic activities, and insurance type in enabling factors; and chronic illness and disability status in need factors were the significant variables having greater effects on health-services-utilization experience. CONCLUSION This study suggests the practical implications for providing health services for outpatients and inpatients. Moreover, verifying the general characteristics of outpatients and inpatients by focusing on their health services utilization provides the baseline data for establishing health service policies and programs with regard to the recently increasing interest in health services.
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Affiliation(s)
- Han-Kyoul Kim
- BK21PLUS Program in Embodiment: Health–Society Interaction, Department of Public Health Sciences, Korea University Graduate School, Seoul, Korea
| | - Munjae Lee
- School of Health Policy and Management, College of Health Science, Korea University, Seoul, Korea
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Abstract
This article uses the behavioral model for vulnerable populations to evaluate the use of substance abuse treatment services among a sample of 926 substance abusers with one or more vulnerable health designations. A two-stage hierarchical logistic regression was completed to determine the influence of vulnerable and traditional need factors on the probability of receiving substance abuse treatment. Among traditional covariates, increased odds of receiving substance abuse treatment are associated with being either non-Hispanic White, Hispanic, having an income > US$5,000, and having a regular source of care. Among vulnerable covariates, injection drug use (odds ratio [OR] = 2.19, confidence interval [CI] = [1.46, 3.27]) and the receipt of public benefits (OR = 1.98, CI = [135, 2.92]) remain independent risk factors for the receipt of substance abuse treatment. Many who experience substance abuse disorders can also experience a multitude of other vulnerable health classifications, suggesting the need for a comprehensive, multidisciplinary approach to the treatment of substance use disorders.
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Frimpong JA, Guerrero EG, Kong Y, Tsai G. Correlates of HIV testing and receipt of test results in addiction health services in Los Angeles County. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:31. [PMID: 26245281 PMCID: PMC4527120 DOI: 10.1186/s13011-015-0026-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/17/2015] [Indexed: 11/13/2022]
Abstract
Background HIV testing and receipt of HIV test results among individuals with substance use disorders is less than optimal. We examined rates and correlates of HIV testing and receipt of test results in one of the largest public addiction health services systems in the United States. Methods The study included 139,516 adult clients in treatment between 2006 and 2011. We used logistic regression models to examine associations between predisposing, enabling, and need factors and two dependent variables, HIV testing rates and receipt of test results. Associations were considered statistically significance at p < .01. Results We found that 64 % of clients reported being tested for HIV, of whom 85 % reported receiving their test results. Likelihood of being tested was positively associated with being female, a minority, homeless, employed, having prior treatment episodes, comorbidities, injection drug use, or a history of mental illness. It was negatively associated with alcohol or marijuana as primary drug. Receipt of test results was more likely among clients on medication (methadone or buprenorphine) or whose method of drug use was smoking, inhalation, or injecting; it was less likely among older clients and those with more outpatient psychiatric visits. Conclusions Findings from this study may inform strategies and targeting of population groups to improve HIV testing practices and ultimately increase awareness of infection status among clients of addiction health services.
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Affiliation(s)
- Jemima A Frimpong
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA.
| | - Erick G Guerrero
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Yinfei Kong
- School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA, 90089, USA.
| | - Gary Tsai
- Los Angeles County Department of Public Health, Substance Abuse Prevention and Control, 1000 South Fremont Avenue, Building A-9 East, Alhambra, CA, 91803, USA.
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Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial. Nurs Res 2015; 64:177-89. [PMID: 25932697 DOI: 10.1097/nnr.0000000000000083] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. OBJECTIVES The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. METHODS A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. RESULTS Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. DISCUSSION Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.
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Chirikov VV, Shaya FT, Howell CD. Contextual analysis of determinants of late diagnosis of hepatitis C virus infection in medicare patients. Hepatology 2015; 62:68-78. [PMID: 25754171 DOI: 10.1002/hep.27775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 03/04/2015] [Indexed: 12/13/2022]
Abstract
UNLABELLED Patient- and county-level characteristics associated with advanced liver disease (ALD) at hepatitis C virus (HCV) diagnosis were examined in three Medicare cohorts: (1) elderly born before 1945; (2) disabled born 1945-1965; and (3) disabled born after 1965. We used Medicare claims (2006-2009) linked to the Area Health Resource Files. ALD was measured over the period of 6 months before to 3 months after diagnosis. Using weighted multivariate modified Poisson regression to address generalizability of findings to all Medicare patients, we modeled the association between contextual characteristics and presence of ALD at HCV diagnosis. We identified 1,746, 3,351, and 592 patients with ALD prevalence of 28.0%, 23.0%, and 15.0% for birth cohorts 1, 2, and 3. Prevalence of drug abuse increased among younger birth cohorts (4.2%, 22.6%, and 35.6%, respectively). Human immunodeficiency virus coinfection (prevalence ratio [PR] = 0.63; 95% confidence interval [CI]: 0.50-0.80; P = 0.001), dual Medicare/Medicaid eligibility (PR = 0.89; 95% CI: 0.80-0.98; P = 0.017), residence in counties with higher median household income (PR = 0.82; 95% CI: 0.71-0.95; P = 0.008), higher density of primary care providers (PR = 0.84; 95% CI: 0.73-0.98; P = 0.022), and more rural health clinics (PR = 0.90; 0.81-1.01; P = 0.081) were associated with lower ALD risk. End-stage renal disease (PR = 1.41; 95% CI: 1.21-1.63; P = 0.001), alcohol abuse (PR = 2.57; 95% CI: 2.33-2.84; P = 0.001), hepatitis B virus (PR = 1.32; 95% CI: 1.09-1.59; P = 0.004), and Midwest residence (PR = 1.22; 95% CI: 1.05-1.41; P = 0.010) were associated with higher ALD risk. Living in rural counties with high screening capacity was protective in the elderly, but associated with higher ALD risk among the disabled born 1945-1965. CONCLUSIONS ALD prevalence patterns were complex and were modified by race, elderly/disability status, and the extent of health care access and screening capacity in the county of residence. These study results help inform treatment strategies for HCV in the context of coordinated models of care.
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Affiliation(s)
- Viktor V Chirikov
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Fadia T Shaya
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD.,University of Maryland School of Medicine, Baltimore, MD
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Fernández-Calderón D, Fernández F, Ruiz-Curado S, Verdejo-García A, Lozano ÓM. Profiles of substance use disorders in patients of therapeutic communities: link to social, medical and psychiatric characteristics. Drug Alcohol Depend 2015; 149:31-9. [PMID: 25682479 DOI: 10.1016/j.drugalcdep.2015.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 01/07/2015] [Accepted: 01/07/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Therapeutic community (TC) clients frequently display a pattern of multiple substance use disorders (SUDs) which is associated with poorer treatment outcomes. This study aimed to characterize multiple SUD profiles in patients enrolled in TCs, and examine the association of these profiles with social, medical and psychiatric outcomes. METHODS Observational study. We acquired substance use diagnoses and sociodemographic, medical and psychiatric comorbidity data for 4102 patients who had been admitted to six public TCs in Andalusia (Spain) from 2004 to 2012. Latent class analysis was applied to participants' substance use diagnoses, and the resulting classes were associated with social (i.e., education, employment, criminality), medical (i.e., infectious diseases) and psychiatric comorbidity. RESULTS We found four differentiated profiles of substance use diagnoses among TC patients: cocaine/opiates (Class 1: 37% of participants); cocaine/opiates/benzodiazepines (Class 2: 25.3%); alcohol (Class 3: 24.7%); and cocaine/cannabis/alcohol (Class 4: 12.9%). Classes 1 and 2 were associated with poorer social and medical characteristics. Class 2 was also associated with greater prevalence of impulsive spectrum mental disorders. Class 3 was associated with greater prevalence of mood and anxiety disorders and cognitive dysfunction, and Class 4 was associated with higher prevalence of psychotic illness. CONCLUSIONS Patients admitted to TCs have heterogeneous substance use diagnostic profiles. Profiles involving multiple use of heroin, cocaine, alcohol and benzodiazepines are associated with poorer social and medical function and impulse control disorders. Profiles involving alcohol use and cannabis/cocaine use are associated with cognitive dysfunction and psychotic illness respectively.
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Affiliation(s)
- David Fernández-Calderón
- Therapeutic Community of Cartaya, Agency of Social Services and Dependence of Ansalusia, Huelva, Spain
| | - Fermín Fernández
- Research and Information System Department, Agency of Social Services and Dependence of Ansalusia, Sevilla, Spain; Clinical, Experimental and Social Psychology Department, University of Huelva, Huelva, Spain
| | - Sofía Ruiz-Curado
- Education and Social Psychology Department, University of Pablo de Olavide, Sevilla, Spain
| | - Antonio Verdejo-García
- Red de Trastornos Adictivos, University of Granada, Spain; School of Psychological Sciences, Monash University, Australia
| | - Óscar M Lozano
- Clinical, Experimental and Social Psychology Department, University of Huelva, Huelva, Spain; Red de Trastornos Adictivos, University of Granada, Spain.
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Hahn EA, Burns JL, Jacobs EA, Ganschow PS, Garcia SF, Rutsohn JP, Baker DW. Health Literacy and Patient-Reported Outcomes: A Cross-Sectional Study of Underserved English- and Spanish-Speaking Patients With Type 2 Diabetes. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:4-15. [PMID: 26513026 DOI: 10.1080/10810730.2015.1061071] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. English- and Spanish-speaking adults with Type 2 diabetes used a bilingual multimedia touchscreen to complete questionnaires. The behavioral model for vulnerable populations guided multivariable regression and mediation testing. Dependent variables were diabetes self-care, health status, and satisfaction with communication. Independent variables included sociodemographic and clinical characteristics, health literacy, health beliefs, and self-efficacy. Spanish speakers had lower health literacy and poorer physical, mental, and overall health compared to English speakers. Higher health literacy was associated with less social support for diet, fewer diet and medication barriers, younger age, higher diabetes knowledge, and talking with health care professionals to get diabetes information. In contrast to expectations, health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this group's lower health literacy. Increasing health-related self-efficacy might be an important clinical strategy for improving outcomes in underserved patients with Type 2 diabetes.
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Affiliation(s)
- Elizabeth A Hahn
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- b Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - James L Burns
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elizabeth A Jacobs
- c Department of Medicine and Health Innovation Program , University of Wisconsin School of Medicine and Public Health , Madison , Wisconsin , USA
| | - Pamela S Ganschow
- d Department of Medicine , Stroger Hospital, and Rush University Medical Center , Chicago , Illinois , USA
| | - Sofia F Garcia
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
- b Center for Patient-Centered Outcomes , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Joshua P Rutsohn
- a Department of Medical Social Sciences , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - David W Baker
- e Healthcare Quality Evaluation , The Joint Commission , Oakbrook Terrace , Illinois , USA
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Tyler D, Nyamathi A, Stein JA, Koniak-Griffin D, Hodge F, Gelberg L. Increasing hepatitis C knowledge among homeless adults: results of a community-based, interdisciplinary intervention. J Behav Health Serv Res 2014; 41:37-49. [PMID: 23616250 DOI: 10.1007/s11414-013-9333-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Homeless adults have high rates of hepatitis C virus infection (HCV) and low levels of HCV knowledge. This study reports results of an interdisciplinary, community-based intervention using stakeholder cooperation, case management, risk factor identification, and modification of dysfunctional psychosocial factors to increase HCV knowledge among homeless adults (N = 747). Data are from a randomized quasi-experimental study, with the major goal of evaluating the effectiveness of a Nurse Case Managed Intervention compared to a Standard Intervention, encouraging completion of a three-series hepatitis A/hepatitis B vaccination program. Increased HCV knowledge was measured with an 18-item questionnaire discerning risk factors for HCV and common misconceptions about individuals with HCV. A significant increase in HCV knowledge resulted regardless of intervention format. Receiving the Nurse Case Managed Intervention predicted greatest gain in HCV knowledge (p < 0.000). Successfully engaging key stakeholders, outreach workers, community organizations, and homeless people themselves proved most efficacious in increasing HCV knowledge.
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Chong MT, Yamaki J, Harwood M, d'Assalenaux R, Rosenberg E, Aruoma O, Bishayee A. Assessing health conditions and medication use among the homeless community in Long Beach, California. J Res Pharm Pract 2014; 3:56-61. [PMID: 25114938 PMCID: PMC4124681 DOI: 10.4103/2279-042x.137073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all-cause mortality compared to the general population. This study sought to evaluate medication use, regular physician visits, and identify health conditions among the homeless population of Long Beach, California. Methods: Two “brown bag” medication review events were held at homeless shelters in the Long Beach area. Demographic information, medication use, and comorbid disease states were obtained through surveys. Findings: Three-fourths of the cohort (95 participants) consisted of males, and the average age of participants was 48 years. Psychiatric disorders and cardiovascular disease were the most common disease states reported at 32% and 46%, respectively and so were medications used in treating these chronic diseases. Medication adherence was found to be a significant problem in this population, where more than 30% of patients were nonadherent to medications for chronic diseases. Furthermore, foot problems, hearing and vision difficulties constitute the most commonly overlooked health problems within the homeless population. Conclusion: Based on this and other similar finding, we must accept that the homeless represent a vulnerable population, and that because of this fact, more programs should be focused at improving availability and access to health care among the homeless. Regarding the high number of reported health problems in the study, more studies are needed and more studies should incorporate screening for foot, hearing, and vision issues, both to increase awareness and to provide an opportunity for devising possible solutions to these highly preventable conditions.
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Affiliation(s)
- Mok Thoong Chong
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Jason Yamaki
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA ; Department of Pharmacy Practice, Chapman University, Orange, Irvine, CA 92618, USA
| | - Megan Harwood
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Richard d'Assalenaux
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Ettie Rosenberg
- Department of Clinical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Okezie Aruoma
- Department of Pharmaceutical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
| | - Anupam Bishayee
- Department of Pharmaceutical Sciences, American University of Health Sciences, Signal Hill, CA 90755, USA
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Carmo RA, Melo APS, Dezanet LNC, de Oliveira HN, Cournos F, Guimarães MDC. Correlates of hepatitis B among patients with mental illness in Brazil. Gen Hosp Psychiatry 2014; 36:398-405. [PMID: 24725973 DOI: 10.1016/j.genhosppsych.2014.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 03/02/2014] [Accepted: 03/04/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess correlates of hepatitis B among adults with mental illness under care in Brazil. METHOD Cross-sectional national multicenter study of 2206 patients with mental illnesses randomly selected from 26 public mental health services. Sociodemographic and behavioral data were obtained from face-to-face interviews and psychiatric diagnoses from medical charts. Serology testing was conducted, and prevalence rate ratios were estimated by log-binomial regression. RESULTS The weighted prevalence rates of current hepatitis B virus (HBV) infection (HBsAg+) and previous HBV exposure (anti-HBc+) were 2.0% [95% confidence interval (CI): 1.5%-2.7%] and 17.1% (95% CI: 16.0%-19.0%), respectively. Correlates of HBsAg+ included male gender, younger age (18-29 years), unstable place of residence, intellectual disability, main psychiatric diagnosis of dementia, presence of other medical comorbitidy, use of alcohol/drugs during sex, more than one sexual partner and use of cocaine. Correlates of anti-HBc+ included male gender, older age (≥30 years), black skin color, lower education, unstable place of residence, currently hospitalized, intellectual disability, history of any sexually transmitted disease or syphilis, poor HIV knowledge, history of imprisonment and sexual violence. CONCLUSIONS Hepatitis B is an important comorbidity among psychiatric patients in Brazil. Screening for HBV, effective prevention and intervention strategies, including universal HBV immunization, should be routine practices in these mental health services.
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Affiliation(s)
- Ricardo Andrade Carmo
- Infectious Diseases Reference Center CTR-DIP Orestes Diniz, Municipal Health Division/Federal University of Minas Gerais, Belo Horizonte, Brazil; Research Group in Epidemiology and Health Service Evaluation, Belo Horizonte, Brazil.
| | - Ana Paula Souto Melo
- Research Group in Epidemiology and Health Service Evaluation, Belo Horizonte, Brazil; School of Medicine, Federal University of São João Del-Rei, Divinópolis, Brazil
| | - Lorenza Nogueira Campos Dezanet
- Research Group in Epidemiology and Health Service Evaluation, Belo Horizonte, Brazil; Eduardo de Menezes Hospital, State Health Department of Minas Gerais, Belo Horizonte, Brazil
| | - Helian Nunes de Oliveira
- Research Group in Epidemiology and Health Service Evaluation, Belo Horizonte, Brazil; Raul Soares Hospital, State Health Department of Minas Gerais, Belo Horizonte, Brazil
| | - Francine Cournos
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark Drew Crosland Guimarães
- Research Group in Epidemiology and Health Service Evaluation, Belo Horizonte, Brazil; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Rimawi BH, Mirdamadi M, John JF. Infections and Homelessness: Risks of Increased Infectious Diseases in Displaced Women. WORLD MEDICAL & HEALTH POLICY 2014. [DOI: 10.1002/wmh3.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Med Care 2014; 52:454-61. [PMID: 24714583 DOI: 10.1097/mlr.0000000000000112] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. OBJECTIVES We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. RESEARCH DESIGN We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. RESULTS HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. CONCLUSIONS Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.
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Haley DF, Lucas J, Golin CE, Wang J, Hughes JP, Emel L, El-Sadr W, Frew PM, Justman J, Adimora AA, Watson CC, Mannheimer S, Rompalo A, Soto-Torres L, Tims-Cook Z, Carter Y, Hodder SL. Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064). AIDS Patient Care STDS 2014; 28:206-17. [PMID: 24697160 DOI: 10.1089/apc.2013.0366] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Women at high-risk for HIV acquisition often face challenges that hinder their retention in HIV prevention trials. These same challenges may contribute to missed clinical care visits among HIV-infected women. This article, informed by the Gelberg-Andersen Behavioral Model for Vulnerable Populations, identifies factors associated with missed study visits and describes the multifaceted retention strategies used by study sites. HPTN 064 was a multisite, longitudinal HIV seroincidence study in 10 US communities. Eligible women were aged 18-44 years, resided in a census tract/zipcode with high poverty and HIV prevalence, and self-reported ≥1 personal or sex partner behavior related to HIV acquisition. Multivariate analyses of predisposing (e.g., substance use) and enabling (e.g., unmet health care needs) characteristics, and study attributes (i.e., recruitment venue, time of enrollment) identified factors associated with missed study visits. Retention strategies included: community engagement; interpersonal relationship building; reduction of external barriers; staff capacity building; and external tracing. Visit completion was 93% and 94% at 6 and 12 months. Unstable housing and later date of enrollment were associated with increased likelihood of missed study visits. Black race, recruitment from an outdoor venue, and financial responsibility for children were associated with greater likelihood of attendance. Multifaceted retention strategies may reduce missed study visits. Knowledge of factors associated with missed visits may help to focus efforts.
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Affiliation(s)
- Danielle F. Haley
- FHI 360, Durham, North Carolina
- Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia
| | | | - Carol E. Golin
- University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Jing Wang
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - James P. Hughes
- Fred Hutchinson Cancer Research Center, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Lynda Emel
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Wafaa El-Sadr
- ICAP-Columbia University, Mailman School of Public Health, New York, New York
| | - Paula M. Frew
- Behavioral Sciences and Health Education, Rollins School of Public Health, Atlanta, Georgia
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Justman
- ICAP-Columbia University, Mailman School of Public Health, New York, New York
| | - Adaora A. Adimora
- University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Sharon Mannheimer
- ICAP-Columbia University, Mailman School of Public Health, New York, New York
- Harlem Hospital Center, New York, New York
| | - Anne Rompalo
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | | | - Yvonne Carter
- University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina
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Salem BE, Nyamathi A, Brecht L, Phillips LR, Mentes J, Sarkisian C, Stein JA. Constructing and identifying predictors of frailty among homeless adults—a latent variable structural equations model approach. Arch Gerontol Geriatr 2014; 58:248-56. [PMID: 24505611 PMCID: PMC4005873 DOI: 10.1016/j.archger.2013.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Homeless urbanites are a heterogeneous population with unique health and social service needs. The study examined situational, behavioral, health-related and resource indicators in terms of their direct impact on frailty, hypothesized as a latent variable. Using structural equation modeling (SEM), a model was tested with 150 homeless men and women, ages 40–73, from three homeless day center drop-in sites on Skid Row and one residential drug treatment (RDT) facility that works with homeless parolees and probationers. In bivariate analyses with the latent construct frailty, months homeless (p < 0.01), female gender (p < 0.05), education (p < 0.05), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), health care utilization (p < 0.01), and falls (p < 0.001) were significantly associated with frailty. In the final path model, significant predictors of frailty included educational attainment (p < 0.01), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), and falls (p < 0.01). These findings will serve as a foundation for future nurse-led, community-based initiatives that focus on key predictors of frailty among the homeless and the development of interventions.
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Affiliation(s)
- Benissa E. Salem
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Adeline Nyamathi
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Lynn Brecht
- UCLA School of Nursing, Address: 700 Tiverton Avenue Los Angeles,
CA 90095
| | - Linda R Phillips
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Janet Mentes
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Catherine Sarkisian
- Geriatric Research Education Clinical Center (GRECC), Address:
11301 Wilshire Blvd. Los Angeles, CA 90073
| | - Judith A. Stein
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
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38
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Muirhead L. Cancer risk factors among adults with serious mental illness. Am J Prev Med 2014; 46:S98-103. [PMID: 24512937 DOI: 10.1016/j.amepre.2013.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
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Nguyen AB, Clark TT, Belgrave FZ. Gender roles and acculturation: relationships with cancer screening among Vietnamese American women. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2014; 20:87-97. [PMID: 24491129 PMCID: PMC5508564 DOI: 10.1037/a0033474] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The aim of this study was to examine the influence of demographic variables and the interplay between gender roles and acculturation on breast and cervical cancer screening outcomes among Vietnamese American women. Convenience sampling was used to recruit 100 Vietnamese women from the Richmond, VA, metropolitan area. Women were recruited to participate in a larger cancer screening intervention. All participants completed measures on demographic variables, gender roles, acculturation, and cancer screening variables. Findings indicated that traditional masculine gender roles were associated with increased self-efficacy for breast and cervical cancer screening. Higher levels of acculturation were associated with higher probability of having had a Papanicolaou test. In addition, acculturation moderated the relationship between traditional female gender roles and cancer screening variables. For highly acculturated women, higher levels of feminine gender roles predicted higher probability of having had a previous clinical breast exam and higher levels of self-efficacy for cervical cancer screening, while the opposite was true for lower acculturated women. The findings of this study indicate the important roles that sociodemographic variables, gender roles, and acculturation play in affecting health attitudes and behaviors among Vietnamese women. These findings also help to identify a potentially high-risk subgroup and existing gaps that need to be targeted by preventive interventions.
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Affiliation(s)
- Anh B Nguyen
- Cancer Prevention Fellowship Program, Division of Cancer Control & Population Sciences, National Cancer Institute
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40
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Salem BE, Nyamathi A, Phillips LR, Mentes J, Sarkisian C, Brecht L. Development of a frailty framework among vulnerable populations. ANS Adv Nurs Sci 2014; 37:70-81. [PMID: 24469090 PMCID: PMC4162317 DOI: 10.1097/ans.0000000000000013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Frailty is a public health issue that is experienced by homeless and other vulnerable populations; to date, a frailty framework has not been proposed to guide researchers who study hard-to-reach populations. The Frailty Framework among Vulnerable Populations has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, that is, situational, health-related, behavioral, resource, biological, and environmental factors that contribute to physical, psychological, and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions.
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Affiliation(s)
| | - Adeline Nyamathi
- Associate Dean for International Research and Scholarly Activities, University of California, Los Angeles School of Nursing
| | | | - Janet Mentes
- University of California, Los Angeles School of Nursing
| | - Catherine Sarkisian
- UCLA Division of Geriatrics, VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center (GRECC)
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41
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Salem BE, Nyamathi AM, Brecht ML, Phillips LR, Mentes JC, Sarkisian C, Leake B. Correlates of frailty among homeless adults. West J Nurs Res 2013; 35:1128-52. [PMID: 23676627 PMCID: PMC3759620 DOI: 10.1177/0193945913487608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Frailty, a relatively unexplored concept among vulnerable populations, may be a significant issue for homeless adults. This cross-sectional study assessed correlates of frailty among middle age and older homeless adults (N = 150, 40-73). A Pearson (r) bivariate correlation revealed a weak relationship between frailty and being female (r = .230, p < .01). Significant moderate negative correlations were found between frailty and resilience (r = -.395, p < .01), social support (r = -.377, p < .01), and nutrition (r = -.652, p < .01). Furthermore, Spearman's rho (r s) bivariate correlations revealed a moderate positive relationship between frailty and health care utilization (r(s) = .444, p < .01). A stepwise backward linear regression analysis was conducted and in the final model, age, gender, health care utilization, nutrition, and resilience were significantly related to frailty. Over the next two decades, there is an anticipated increase in the number of homeless adults which will necessitate a greater understanding of the needs of this hard-to-reach population.
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Wooten NR, Mohr BA, Lundgren LM, Adams RS, Merrick EL, Williams TV, Larson MJ. Gender differences in substance use treatment utilization in the year prior to deployment in Army service members. J Subst Abuse Treat 2013; 45:257-65. [PMID: 23726826 PMCID: PMC3755744 DOI: 10.1016/j.jsat.2013.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/24/2013] [Accepted: 04/04/2013] [Indexed: 01/15/2023]
Abstract
Although military men have heavier drinking patterns, military women experience equal or higher rates of dependence symptoms and similar rates of alcohol-related problems as men at lower levels of consumption. Thus, gender may be important for understanding substance use treatment (SUT) utilization before deployment. Military health system data were analyzed to examine gender differences in both substance use diagnosis (SUDX) and SUT in 152,447 Army service members returning from deployments in FY2010. Propensity score analysis of probability of SUDX indicated that women had lower odds (AOR: 0.91, 95% CI: 0.86-0.96) of military lifetime SUDX. After adjusting for lifetime SUDX using propensity score analysis, multivariate regression found women had substantially lower odds (AOR: 0.61; 95% CI: 0.54-0.70) of using SUT the year prior to deployment. Findings suggest gender disparities in military-provided SUT and a need to consider whether military substance use assessment protocols are sensitive to gender differences.
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Affiliation(s)
- Nikki R Wooten
- University of South Carolina, College of Social Work, Columbia, SC 29208, USA.
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Abstract
Globally, hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection leads to liver fibrosis and cirrhosis, which in turn causes resultant hepatocellular carcinoma (HCC). Frequently, HCC recurs very soon even after a potentially curative treatment such as surgical interference or locoregional ablative therapies. Chronic HBV/HCV infection is often responsible for this recurrence, through secondary carcinogenesis. Antiviral therapy after a curative treatment of HCC plays an important role in preventing or delaying recurrence and improves survival in patients with HBV/HCV infection-related HCC. This article reviews the worldwide epidemiology of HBV/HCV infection, the association of viral infection with HCC, the mechanism of hepatitis virus-related hepatocarcinogenesis, and the paramount importance of antiviral therapy in the management of HCC.
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Nyamathi A, Salem BE, Marlow E, Zhang S, Yadav K. Understanding correlates of hepatitis C virus infection among homeless recently paroled men. JOURNAL OF FORENSIC NURSING 2013; 9:161-170. [PMID: 24158154 PMCID: PMC3853137 DOI: 10.1097/jfn.0b013e31827a5908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This cross-sectional study assessed predictors of Hepatitis C virus (HCV) positivity with baseline data collected on recently released male parolees (N = 157) participating in a randomized trial focused on reduction of drug use, recidivism, and risk for hepatitis and HIV infections. In this sample, the prevalence of HCV was 25%. The logistic regression analysis revealed that being an injection drug user was significantly related to HCV infection. However, contrary to most of the current literature, being Black had significantly lower odds of contracting HCV than their White counterparts. Moreover, having lived on the streets, not being part of a close family in childhood, and being older were also associated with HCV infection. These findings highlight the need for skilled assessments that target the vulnerabilities of homeless adults, especially those who have been incarcerated. Understanding drug use patterns, childhood networks, and family relationships, may assist in the design of interventions to reduce risky drug use and address behaviors derived from disadvantaged childhood.
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Affiliation(s)
- Adeline Nyamathi
- University of California, Los Angeles, School of Nursing 700 Tiverton Avenue, Los Angeles, CA 90095-1702
| | - Benissa E. Salem
- University of California, Los Angeles, School of Nursing 10880 Wilshire Blvd, Suite 550, Los Angeles, CA 90024
| | - Elizabeth Marlow
- University of California, San Francisco, School of Nursing 2 Koret Way, San Francisco, CA 94143-0602
| | - Sheldon Zhang
- San Diego State University 5500 Campanile Drive, San Diego, CA 92182-4423
| | - Kartik Yadav
- University of California, Los Angeles, School of Nursing 10880 Wilshire Blvd., Suite 550 Los Angeles, CA 90024
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Heaton LJ, Mancl LA, Grembowski D, Armfield JM, Milgrom P. Unmet dental need in community-dwelling adults with mental illness: results from the 2007 Medical Expenditure Panel Survey. J Am Dent Assoc 2013; 144:e16-23. [PMID: 23449910 PMCID: PMC3613122 DOI: 10.14219/jada.archive.2013.0122] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mental illness (MI) affects approximately one in five U.S. adults, and it is associated with oral disease and poor dental treatment outcomes. Little is known about dental care utilization or unmet dental need in this population. METHODS The authors examined data regarding presence or absence of dental visits and unmet dental need in community-dwelling adults with MI from the 2007 Medical Expenditure Panel Survey. They tested differences between adults with and without MI by using multivariate logistic regression. RESULTS Eighteen percent of adults (N = 19,368) had MI, and of these, 6.8 percent had unmet dental need. Although people with MI were not significantly more likely to have had a dental visit (46.3 percent) than were those without MI (42.2 percent; odds ratio [OR], 1.09; 95 percent confidence interval [CI], 0.97-1.23), they were significantly more likely to report unmet need (11.0 versus 5.3 percent; OR, 2.00; 95 percent CI, 1.67-2.41). Those with mood or anxiety disorders were most likely to report having an unmet dental need (P < .001 for all values). CONCLUSIONS Although people with MI did not visit the dentist significantly more often than did adults without MI, their higher level of unmet need suggests that current use of dental services is not addressing their needs adequately. PRACTICAL IMPLICATIONS Dentists should be familiar with MI conditions as patients with MI may have greater unmet dental need.
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Affiliation(s)
- Lisa J Heaton
- Department of Oral Health Sciences, School of Dentistry, University of Washington, 1959 N.E. Pacific St., Box 357475, Seattle, Wash. 98195-7475, USA.
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Beijer U, Wolf A, Fazel S. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2012; 12:859-70. [PMID: 22914343 PMCID: PMC3494003 DOI: 10.1016/s1473-3099(12)70177-9] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND 100 million people worldwide are homeless; rates of mortality and morbidity are high in this population. The contribution of infectious diseases to these adverse outcomes is uncertain. Accurate estimates of prevalence data are important for public policy and planning and development of clinical services tailored to homeless people. We aimed to establish the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people. METHODS We searched PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature for studies of the prevalence of tuberculosis, hepatitis C virus, and HIV in homeless populations. We also searched bibliographic indices, scanned reference lists, and corresponded with authors. We explored potential sources of heterogeneity in the estimates by metaregression analysis and calculated prevalence ratios to compare prevalence estimates for homeless people with those for the general population. FINDINGS We identified 43 eligible surveys with a total population of 63,812 (59 736 homeless individuals when duplication due to overlapping samples was accounted for). Prevalences ranged from 0·2% to 7·7% for tuberculosis, 3·9% to 36·2% for hepatitis C virus infection, and 0·3% to 21·1% for HIV infection. We noted substantial heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus infection, and HIV infection (all Cochran's χ(2) significant at p<0·0001; I(2)=83%, 95% CI 76-89; 95%, 94-96; and 94%, 93-95; respectively). Prevalence ratios ranged from 34 to 452 for tuberculosis, 4 to 70 for hepatitis C virus infection, and 1 to 77 for HIV infection. Tuberculosis prevalence was higher in studies in which diagnosis was by chest radiography than in those which used other diagnostic methods and in countries with a higher general population prevalence than in those with a lower general prevalence. Prevalence of HIV infection was lower in newer studies than in older ones and was higher in the USA than in the rest of the world. INTERPRETATION Heterogeneity in prevalence estimates for tuberculosis, hepatitis C virus, and HIV suggests the need for local surveys to inform development of health services for homeless people. The role of targeted and population-based measures in the reduction of risks of infectious diseases, premature mortality, and other adverse outcomes needs further examination. Guidelines for screening and treatment of infectious diseases in homeless people might need to be reviewed. FUNDING The Wellcome Trust.
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Affiliation(s)
- Ulla Beijer
- Department of Women's and Children's Health, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Achim Wolf
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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