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Lin JS, Dubin JM, Aguiar J, Greenberg DR, Bennett NE, Brannigan RE, Halpern JA. Prevalence of sexual dysfunction and pursuit of sexual medicine evaluation among male physicians-a survey. Int J Impot Res 2024:10.1038/s41443-024-00827-4. [PMID: 38245626 DOI: 10.1038/s41443-024-00827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/22/2024]
Abstract
We sought to characterize the prevalence of sexual dysfunction and barriers to treatment among male physicians. Between June and December 2022, male physicians were invited to complete a questionnaire regarding sexual function. Surveys were disseminated electronically via social media and professional medical societies using Qualtrics (Provo, UT). In totla, 235 responses were included in the final analysis. The mean age of respondents was 36.3 ± 7.4 years (range 23-72). 27 (11.5%) reported having seen a doctor for sexual health. Of these 27, 40.7% saw a physician for erectile dysfunction, 29.6% for low libido, 22.2% for premature ejaculation, 7.4% for delayed ejaculation, and 33.3% for other concerns. An additional 29 (12.3%) considered establishing care for sexual issues but didn't, mostly due to being too busy. 46 (19.6%) respondents reported having taken medication to improve erectile function. Therefore, in a cohort of young male physicians, 23.8% had seen or considered seeing a doctor for sexual health concerns, and nearly 1 in 5 had taken medication for erectile dysfunction. Male physicians appear to be at higher risk for sexual dysfunction than the general population and face significant and unique barriers in access to care for sexual dysfunction.
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Affiliation(s)
- Jasmine S Lin
- Department of Urology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Justin M Dubin
- Department of Urology, Memorial Healthcare, Aventura, FL, USA
| | - Jonathan Aguiar
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel R Greenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nelson E Bennett
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert E Brannigan
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joshua A Halpern
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Nguyen TH, De Leo G, Barefield A. Factors Associated with Controlled Glycemic Levels in Type 2 Diabetes Patients: Study from a Large Medical Center and Its Satellite Clinics in Southeast Region in the USA. Healthcare (Basel) 2023; 12:26. [PMID: 38200932 PMCID: PMC10779028 DOI: 10.3390/healthcare12010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Diabetes, including type 1, type 2, and gestational, is a significant public health issue responsible for various clinical, economic, and societal issues. Most of the consequences, if uncontrolled, can result in serious health problems, such as heart disease, vision loss, and kidney disease. Approximately 37.3 million Americans have diabetes, including 37.1 million adults 18 years or older, with 90-95% type 2 diabetes (T2D). The purpose of this study is (1) to explore the profile of patients with T2D and (2) to identify the associated factors of diabetic status. Examined factors included sociodemographic characteristics, social factors, and comorbidities. The study analyzed a primary dataset from a retrospective chart review of adult patients with T2D who were seen at a large medical center and its satellite clinics in the southeast region of the United States in 2019. Sex, dyslipidemia, and the number of concordant comorbidities were found to be significant associated factors of diabetic status. In the era of intertwined patient-centered approach and public health, the study's findings can guide treatment plans and interventions targeting individuals and communities.
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Affiliation(s)
- Tran Ha Nguyen
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA 30912, USA;
| | - Gianluca De Leo
- Department of Health Management, Economics and Policy, Augusta University, Augusta, GA 30912, USA;
| | - Amanda Barefield
- Department of Undergraduate Health Professions, Augusta University, Augusta, GA 30912, USA;
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Berkovitz A, Migler RD, Qureshi A, Rosemore C, Torbenson MS, Vaughan R, Marcotte E, Simon SM. Clinical and demographic predictors of survival for fibrolamellar carcinoma patients-A patient community, registry-based study. Hepatol Commun 2022; 6:3539-3549. [PMID: 36245434 PMCID: PMC9701473 DOI: 10.1002/hep4.2105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 01/21/2023] Open
Abstract
Fibrolamellar hepatocellular carcinoma (FLC) is a rare primary liver cancer that affects primarily adolescents and young adults. It is associated with a poor overall prognosis. There is a need to better define risk factors, but small sample size has limited such studies. An FLC patient registry now provides data sufficient for statistically robust inferences. We leveraged a unique patient community-based FLC registry to analyze the prognostic impact of demographic and clinical characteristics evident at diagnosis. Variables were analyzed using Cox proportional hazards regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). In multivariable models of 149 patients (88 females and 61 males), female gender was associated with statistically significant improved survival with HR of 0.52 (95% CI 0.29-0.93). Factors evident at diagnosis that are associated with worse survival included the presence of 10 or more tumors within the liver (HR 7.1; 95% CI 2.4-21.04), and metastases at diagnosis (HR 2.17; 95% CI 1.19-3.94). Positive lymph nodes at diagnosis, despite being found significantly associated with worse survival in a univariate analysis, did not remain significant when adjusted for covariates in a multivariable analysis. We found no statistically significant effect of age at diagnosis nor tumor size at diagnosis on survival. Female gender may confer a favorable prognosis in FLC. Established high-risk prognostic factors that we confirmed in this Registry included the diagnostic presence of numerous intrahepatic tumors, and metastases. This is the first study derived from a FLC patient community-based registry, and highlights how registries of rare tumors can empower patients to meaningfully advance clinical and scientific discoveries.
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Affiliation(s)
- Amichai Berkovitz
- Laboratory of Cellular BiophysicsThe Rockefeller UniversityNew YorkNew YorkUSA
| | | | - Adam Qureshi
- Hospital BiostatisticsThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Carly Rosemore
- Laboratory of Cellular BiophysicsThe Rockefeller UniversityNew YorkNew YorkUSA,Department of PediatricsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | | | - Roger Vaughan
- Hospital BiostatisticsThe Rockefeller UniversityNew YorkNew YorkUSA
| | - Erin Marcotte
- Department of PediatricsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Sanford M. Simon
- Laboratory of Cellular BiophysicsThe Rockefeller UniversityNew YorkNew YorkUSA,The Fibrolamellar RegistryNew YorkNew YorkUSA
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Bermejo-Martins E, Luis EO, Fernández-Berrocal P, Martínez M, Sarrionandia A. The role of emotional intelligence and self-care in the stress perception during COVID-19 outbreak: An intercultural moderated mediation analysis. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021; 177:110679. [PMID: 36540668 PMCID: PMC9756564 DOI: 10.1016/j.paid.2021.110679] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
Background The relationship between emotional intelligence (EI) and stress has been widely studied, as well as the beneficial role of self-care to maintain health and wellbeing. However, the joint contribution of EI and self-care in predicting stress has not been examined during COVID-19 lockdown. This study aimed to examine the mediating role of self-care in the relationship between EI and stress and the potential moderator role of gender. Methods A sample of 1082 participants from four Hispanic countries completed measures related to socio-demographic, trait emotional intelligence (Trait Meta-Mood Scale), self-care activities (Self-care Activities Screening Scale) and stress (Perceived Stress Scale). Results Mediation analyses revealed that self-care increased the explained variance of the prediction of stress by EI dimensions after controlling gender and age. However, gender only moderated the relationship between self-care and stress in the mediation model corresponding to emotional attention. Conclusions Data supported a general model for the interaction of EI and self-care as contributing factors of stress. Further research is needed to replicate it in more culturally distant samples and to fully explore the potential role of gender differences. Future intervention programs should include a balanced combination of EI and self-care to increase their benefits on people's health.
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Affiliation(s)
- Elena Bermejo-Martins
- School of Nursing, University of Navarra, Spain
- Navarra Institute for Health Research IdiSNA, Spain
| | - Elkin O Luis
- School of Education and Psychology, University of Navarra, Spain
- Navarra Institute for Health Research IdiSNA, Spain
| | | | - Martín Martínez
- School of Education and Psychology, University of Navarra, Spain
- Navarra Institute for Health Research IdiSNA, Spain
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Nguyen T, Barefield A, Nguyen GT. Social Determinants of Health Associated with the Use of Screenings for Hypertension, Hypercholesterolemia, and Hyperglycemia among American Adults. Med Sci (Basel) 2021; 9:medsci9010019. [PMID: 33806794 PMCID: PMC8005927 DOI: 10.3390/medsci9010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
National and international health guidelines have recommended measurements of blood pressure, blood cholesterol, and blood glucose as the first step in detecting hypertension, hypercholesterolemia, and hyperglycemia, respectively. These chronic conditions are modifiable risk factors for chronic diseases such as obesity, diabetes, and cardiovascular disease. Social determinants of health (SDoHs) have contributed to persistent chronic condition disparities in the United States. This study identified SDoHs associated with the use of screening services for hypertension, hypercholesterolemia, and hyperglycemia by analyzing data from the 2019 United States National Health Interview Survey. Examined SDoHs consisted of demographic characteristics, socioeconomic status, and health care utilization. Age, gender, education, annual income, health coverage, and usual care source were positively associated with the odds of receiving secondary preventive services. There was a marginal significance among race/ethnicity and employment status in association with the odds of receiving secondary preventive services. This study's findings inform health educators and providers, public health professionals, and policymakers to fund, plan, and coordinate services and interventions accordingly to improve the population's quality of life and lengthen lifespan by promptly diagnosing and treating these diseases.
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Affiliation(s)
- Tran Nguyen
- College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
- Correspondence: ; Tel.: +1-706-721-2940
| | - Amanda Barefield
- College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
| | - Gia-Thien Nguyen
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
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Lobelo F, Supapannachart KJ, Zhou T, Frediani JK. Exercise and Diet Counseling Trends From 2002 to 2015: A Serial Cross-Sectional Study of U.S. Adults With Cardiovascular Disease Risk. Am J Prev Med 2021; 60:e59-e67. [PMID: 33342670 DOI: 10.1016/j.amepre.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Exercise and dietary behavioral counseling are effective clinical practices recommended by the U.S. Preventive Services Task Force to reduce cardiovascular disease risk among high-risk individuals. METHODS Medical Expenditure Panel Survey data from 2002 to 2015 were analyzed in 2018. Prevalence ratios of exercise, dietary, and both types of counseling among individuals with overweight or obesity with additional cardiovascular disease risk factors were calculated and adjusted for demographic covariates (N=116,048). Adjusted prevalence ratios were calculated for sociodemographic and health factors associated with counseling receipt using 2014-2015 data. RESULTS From 2002 to 2015, adjusted prevalence ratios ranged from 43% to 63%. Compared with 2002, receipt of both types of counseling was 6% higher in 2015 (49%, 95% CI=48%, 51%). In 2015, compared with privately insured people, those without insurance (prevalence ratio=0.91, 95% CI=0.84, 0.99) or on Medicare (prevalence ratio=0.77, 95% CI=0.73, 0.82) were less likely to receive counseling. Individuals with 3 (prevalence ratio=1.46, 95% CI=1.39, 1.54), 4 (prevalence ratio=1.74, 95% CI=1.63, 1.85), or 5 (prevalence ratio=1.89, 95% CI=1.67, 2.15) cardiovascular disease risk factors received counseling more frequently than those with 2 cardiovascular disease risk factors. Female participants (prevalence ratio=1.07, 95% CI=1.03, 1.11) and racial minorities (Hispanics: prevalence ratio=1.31, 95% CI=1.24, 1.38; Blacks: prevalence ratio=1.11, 95% CI=1.05, 1.18; Asians: prevalence ratio=1.12, 95% CI=1.01, 1.24) reported higher rates of counseling. CONCLUSIONS Despite modest improvements since 2002, up to 37% of individuals at high cardiovascular disease risk were not receiving exercise counseling, and 43% were not receiving dietary counseling in 2015. Continued implementation and scale up of effective programs to increase behavioral lifestyle counseling among high-risk populations are needed more than ever to mitigate the U.S. cardiometabolic disease burden.
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Affiliation(s)
- Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia.
| | | | - Tianyi Zhou
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jennifer K Frediani
- Exercise is Medicine Global Research and Collaboration Center, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Jensen KM, Campagna EJ, Juarez-Colunga E, Runyan DK, Prochazka AV. Predictors of Receipt of Clinical Preventive Services in Adolescents and Adults with Down Syndrome Accessing Medicaid. Disabil Health J 2020; 14:101016. [PMID: 33229308 DOI: 10.1016/j.dhjo.2020.101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 10/12/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Persons with Down syndrome (DS) require preventive care that addresses their age-/gender- and syndrome-specific needs. Yet, adolescents and adults with DS do not receive these preventive care services as recommended. OBJECTIVE/HYPOTHESIS To identify factors that predict receipt of age-/gender- and syndrome-specific preventive healthcare among adolescents and adults with DS. We hypothesized that more healthcare encounters and greater medical complexity would increase receipt of preventive care due to more opportunities to complete these activities. METHODS Using Medicaid claims (2006-2010) for California, Colorado, Michigan, and Pennsylvania, we conducted a retrospective cohort study of adolescents and adults with DS (≥12 years old). We modeled receipt of both ≥1 wellness examination and ≥1 thyroid function test (TFT) in 2009-2010 as a function of receipt of those same healthcare activities in 2006-08, adjusting for demographics, key comorbidities, and medical complexity using multivariable logistic regression. RESULTS In this cohort of 3487 adolescents and adults with DS accessing Medicaid, 17% received both ≥1 wellness examination and ≥1 TFT in 2006-2008, 15% in 2009-2010, and only 7% during both time periods. Despite medical complexity and frequent healthcare interactions, the best predictor of future receipt of these activities was past receipt. State of residence variably impacted receipt of these preventive activities. CONCLUSIONS Although past receipt of wellness examination and TFT was the best predictor of future receipt of these activities, overall rates were quite low in this cohort of adolescents and adults with DS. Further work is needed to improve preventive healthcare delivery to this vulnerable population.
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Affiliation(s)
- Kristin M Jensen
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Mail Stop F443, 13199 E. Montview Blvd, 80025, Aurora, CO, USA; University of Colorado School of Medicine, Department of Pediatrics, Division of General Academic Pediatrics, 13123 East 16th Avenue, Box B023, 80045, Aurora, CO, USA; University of Colorado School of Medicine, Department of Internal Medicine, Division of General Internal Medicine, 12631 E. 17th Ave., Mailstop B180, 80045, Aurora, CO, USA.
| | - Elizabeth J Campagna
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Mail Stop F443, 13199 E. Montview Blvd, 80025, Aurora, CO, USA.
| | - Elizabeth Juarez-Colunga
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, Mail Stop F443, 13199 E. Montview Blvd, 80025, Aurora, CO, USA; Colorado School of Public Health, Department of Biostatistics and Informatics, 13001 E 17th Place, Mailstop B119, 80045, Aurora, CO, USA.
| | - Desmond K Runyan
- Kempe Center for the Prevention of Child Abuse and Maltreatment, The Gary Pavilion at Children's Hospital Colorado, Anschutz Medical Campus, 13123 E, 16th Ave., Suite B390, 80045, Aurora, CO, USA.
| | - Allan V Prochazka
- University of Colorado School of Medicine, Department of Internal Medicine, Division of General Internal Medicine, 12631 E. 17th Ave., Mailstop B180, 80045, Aurora, CO, USA.
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Rich NE, Murphy CC, Yopp AC, Tiro J, Marrero JA, Singal AG. Sex disparities in presentation and prognosis of 1110 patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2020; 52:701-709. [PMID: 32598091 PMCID: PMC7655123 DOI: 10.1111/apt.15917] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/02/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although sex disparities in hepatocellular carcinoma (HCC) incidence have been well described, there are limited data examining sex disparities in HCC prognosis. AIM To characterise sex differences in HCC presentation and prognosis. METHODS We performed a retrospective study of consecutive patients (n = 1110, 23.5% women) diagnosed with HCC between 2008 and 2017 at two US health systems. We used Cox proportional hazard and multivariable logistic regression models to identify factors associated with overall survival, early tumour detection and response to HCC treatment (per the modified Response Evaluation Criteria in Solid Tumors [mRECIST] criteria). RESULTS Women were older at HCC diagnosis (mean 62.5 vs 59.2 years, P < 0.001) and had a higher proportion of early-stage tumours (53.1% vs 43.7% Barcelona Clinic Liver Cancer [BCLC] stage 0/A, P = 0.04), but similar liver function compared to men (49.2% vs 47.1% Child Pugh A, P = 0.27). In univariable analysis, women had significantly better overall survival than men (median 17.1 vs 12.0 months, P = 0.02). When stratified by age, younger (<65 years) women had better overall survival than men (18.3 vs 11.2 months, P = 0.02); however, older (≥65 years) women and men had similar overall survival (15.5 vs 15.7 months, P = 0.45). In multivariable analysis, female sex was independently associated with lower mortality after adjusting for age, race/ethnicity, alpha-fetoprotein, BCLC stage, Albumin-Bilirubin grade and Child Pugh score (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.68-0.98). In secondary analyses, female sex was independently associated with early tumour detection (odds ratio [OR] 1.46, 95% CI 1.05-2.02) and response to first HCC treatment (OR 1.72, 95% CI 1.18-2.53) after adjusting for the same covariates. CONCLUSION In a large cohort of patients with HCC, women had significantly better prognosis than men.
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Affiliation(s)
- Nicole E. Rich
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX
| | - Caitlin C. Murphy
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX
| | - Adam C. Yopp
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Surgery, UT Southwestern Medical Center, Dallas TX
| | - Jasmin Tiro
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX
| | - Jorge A. Marrero
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX,Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas TX,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas TX
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Bertoncello C, Cocchio S, Fonzo M, Bennici SE, Russo F, Putoto G. The potential of mobile health clinics in chronic disease prevention and health promotion in universal healthcare systems. An on-field experiment. Int J Equity Health 2020; 19:59. [PMID: 32357888 PMCID: PMC7195790 DOI: 10.1186/s12939-020-01174-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health clinics (MHCs) are recognized to facilitate access to healthcare services, especially in disadvantaged populations. Notwithstanding that in Europe a wide-ranging background in mobile screening units for cancer is shared, evidences about MHCs targeting also at other non-communicable diseases (NCDs) in universal health coverage systems are scarce. The aim of this study was to describe the population attracted with a MHC initiative and to assess the potential of this tool in prevention and control of NCDs. METHODS Our MHC was set up in a railway wagon. Standard body measurements, finger-stick glucose, total cholesterol and blood pressure were recorded. Participants were asked about smoking, physical activity, diet, compliance to national cancer screening programmes and ongoing pharmacological treatment. One-to-one counselling was then provided. RESULTS Participants (n = 839) showed a higher prevalence of overweight/obesity, insufficient intake of vegetables, sedentary lifestyle, and a lower compliance to cancer screening compared with reference population. Our initiative attracted groups at higher risk, such as foreigners, men and people aged from 50 to 69. The proportion of newly diagnosed or uncontrolled disease exceeded 40% of participants for both hypertension and hypercholesterolemia (7% for diabetes). Adherence rate to counselling was 99.4%. CONCLUSIONS The MHC was effective in attracting hard-to-reach groups and individuals who may have otherwise gone undiagnosed. MHCs can play a complementary role also in universal coverage health systems, raising self-awareness of unreached population and making access to primary health care easier.
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Affiliation(s)
- Chiara Bertoncello
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy
| | - Silvia Cocchio
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy
| | - Marco Fonzo
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy.
| | - Silvia Eugenia Bennici
- Hygiene and Public Health Unit, DCTVSP Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Via Loredan 18, 35131, Padova (PD), Italy
| | - Francesca Russo
- Organizational Unit Prevention and Public Health, Venice, Veneto Region, Italy
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Zhang T, Liu J, Liu C. Changes in Perceived Accessibility to Healthcare from the Elderly between 2005 and 2014 in China: An Oaxaca-Blinder Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3824. [PMID: 31658753 PMCID: PMC6843178 DOI: 10.3390/ijerph16203824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/05/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022]
Abstract
Elderly people are characterized with high needs for healthcare, accompanied by high barriers in access to healthcare. This study aimed to identify temporal changes in access to healthcare and determinants of such changes from the elderly in China, over the period between 2005 and 2014. Two waves (2005 and 2014) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), measuring changes in perceived accessibility to healthcare when needed by the elderly (≥65 years). The effects of the explanatory variables (need, predisposing and enabling factors) on the changes were divided into two components using the Oaxaca-Blinder decomposition method: (1) the endowment portion as a result of distribution differences of the explanatory variables and (2) the coefficient portion as a result of differential responses of the dependent variable to the explanatory variables. Perceived accessibility to healthcare from the elderly increased from 89.6% in 2005 to 96.7% in 2014. The coefficient portion (82%) contributed more to the change than the endowment portion (63%) after adjustments for a negative interaction effect (-45%) between the two. Lower perceived accessibility was associated with older age, lower income, lower affordability of daily expenses and lower insurance coverage. But the coefficient effects suggested that their impacts on perceived accessibility to healthcare declined over time. By contrast, the impacts of gender and out-of-pocket payment ratio for medical care on perceived accessibility to healthcare increased over time. Perceived accessibility to healthcare from the elderly improved between 2005 and 2014. Gender gaps are closing. But the increased effect of out-of-pocket medical payments on perceived accessibility to healthcare deserves further investigation and policy interventions.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
| | - Jing Liu
- Department of Health Information Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 43003, China.
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
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New Human Immunodeficiency Virus Diagnoses Among Men Who Have Sex With Men Attending Sexually Transmitted Disease Clinics, STD Surveillance Network, January 2010 to June 2013. Sex Transm Dis 2019; 45:577-582. [PMID: 29465646 DOI: 10.1097/olq.0000000000000802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To estimate new human immunodeficiency virus (HIV) diagnosis rates among HIV negative men who have sex with men (MSM) who are repeatedly tested for HIV in sexually transmitted disease (STD) clinics and assess the impact of demographic and disease-specific characteristics that are associated with higher HIV diagnosis rates. STUDY DESIGN Retrospective analysis using 2010 to 2013 data from the STD Surveillance Network (SSuN), a sentinel surveillance system comprised of health departments in 12 cities conducting sentinel surveillance in 40 STD clinics. We analyzed data from all MSM repeatedly (≥2 times) tested for HIV, with an initial negative HIV test required for staggered cohort entry. Follow-up time was accrued from the date of the first negative HIV test to the most recent negative test or the first positive HIV test. The STD diagnoses during the follow-up period were reviewed. We estimated HIV diagnoses rates (number of HIV diagnoses/total number of person-years [PY] at risk) by demographic and clinical characteristics with 95% confidence intervals (CI) using an inverse variance weighted random effects model, adjusting for heterogeneity between SSuN jurisdictions. RESULTS Overall, 640 HIV diagnoses occurred among 14,824 individuals and 20,951.6 PY of observation, for an adjusted incidence of HIV diagnosis of 3.0 per 100 PY (95% CI, 2.6-3.4). Rates varied across race/ethnicity groups with the highest rate among Blacks (4.7/100 PY; 95% CI, 4.1-5.3) followed by Hispanics, whites, and persons of other races/ethnicities. Men who have sex with men having a diagnosis of primary or secondary (P&S) syphilis on or after the first negative HIV test had a higher new HIV diagnosis rate (7.2/100 PY; 95% CI, 5.8-9.0) compared with MSM who did not have a P&S syphilis diagnosis (2.8/100 PY; 95% CI, 2.6-3.1). Men who have sex with men who tested positive for rectal gonorrhea (6.3/100 PY; 95% CI, 5.7-6.9) or rectal chlamydia (5.6/100 PY; 95% CI, 4.6-6.6) had higher rates of new HIV diagnosis when compared to those with negative test results. CONCLUSIONS Men who have sex with men attending SSuN STD clinics have high rates of new HIV diagnoses, particularly those with a previous diagnosis of P&S syphilis, rectal chlamydia, and/or gonorrhea. Sexually transmitted disease clinics continue to be important clinical setting for diagnosing HIV among MSM populations.
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Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men. Behav Med 2019; 45:102-117. [PMID: 31343960 PMCID: PMC8620213 DOI: 10.1080/08964289.2019.1585327] [Citation(s) in RCA: 153] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The contribution of medical mistrust to healthcare utilization delays has gained increased public health attention. However, few studies examine these associations among African-American men, who delay preventive healthcare more often and report higher levels of medical mistrust than non-Hispanic White men. Additionally, studies rarely account for other factors reportedly working in tandem with medical mistrust to increase African-American men's preventive health screening delays (i.e., everyday racism and perceived racism in healthcare). We examined associations between medical mistrust, perceived racism in healthcare, everyday racism, and preventive health screening delays. Analyses were conducted using cross-sectional data from 610 African-American men aged 20 years and older recruited primarily from barbershops in four US regions (2003-2009). Independent variables were medical mistrust (MM), everyday racism (ER), and perceived racism in healthcare (PRH). Dependent variables were self-reported routine checkup, blood pressure screening, and cholesterol screening delays. Using multiple logistic regression and tests for mediation, we calculated odds ratios and 95% confidence intervals to assess associations between the independent and dependent variables. After final adjustment, African-American men with higher MM were significantly more likely to delay blood pressure screenings. Men with more frequent ER exposure were significantly more likely to delay routine checkups and blood pressure screenings. Higher levels of PRH were associated with a significant increased likelihood of delaying cholesterol screening. MM did not mediate associations between ER and screening delays. Increasing preventive health screening among African-American men requires addressing medical mistrust and racism in and outside healthcare institutions.
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Affiliation(s)
- Wizdom Powell
- University of Connecticut Health Center, Health Disparities Institute
| | - Jennifer Richmond
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Department of Health Behavior
| | | | - Irene Yen
- University of California Merced, Public Health Department
| | - Allison Joslyn
- University of Connecticut Health Center, Health Disparities Institute
| | - Giselle Corbie-Smith
- University of North Carolina at Chapel Hill, Departments of Social Medicine and Medicine
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Rotarou ES, Sakellariou D. Determinants of utilisation rates of preventive health services: evidence from Chile. BMC Public Health 2018; 18:839. [PMID: 29976166 PMCID: PMC6034328 DOI: 10.1186/s12889-018-5763-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preventive health services play a vital role in population health. However, access to such services is not always equitably distributed. In this article, we examine the barriers affecting utilisation rates of preventive health services, using Chile as a case study. METHODS We conducted a cross-sectional study analysing secondary data from 206,132 Chilean adults, taken from the 2015 National Socioeconomic Characterisation Survey of the Government of Chile. We carried out logistic regressions to explore the relationship between the dependent variable use of preventive services and various demographic and socioeconomic variables. RESULTS Categories more likely to use preventive services were women (OR=1.16; 95%CI: 1.11-1.21) and inactive people (OR=1.41; 95%CI: 1.33-1.48). By contrast, single individuals (OR= 0.85 ; 95%CI: 0.80-0.91) and those affiliated with the private healthcare provider (OR= 0.89; 95%CI: 0.81-0.96) had fewer odds of undertaking preventive exams. CONCLUSIONS The findings underline the necessity of better information campaigns on the availability and necessity of preventive health services, addressing health inequality in accessing health services, and tackling lifestyle-related health risks. This is particularly important in countries - such as Chile - characterised by high income inequality and low utilisation rates of preventive health services.
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Affiliation(s)
- Elena S. Rotarou
- Department of Economics, University of Chile, Diagonal Paraguay 257, Office 1506, 8330015 Santiago, Chile
| | - Dikaios Sakellariou
- Cardiff University, School of Healthcare Sciences, Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB UK
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Alsan M, Wanamaker M. TUSKEGEE AND THE HEALTH OF BLACK MEN. THE QUARTERLY JOURNAL OF ECONOMICS 2018; 133:407-455. [PMID: 30505005 PMCID: PMC6258045 DOI: 10.1093/qje/qjx029] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
JEL Codes: I14, O15 For forty years, the Tuskegee Study of Untreated Syphilis in the Negro Male passively monitored hundreds of adult black males with syphilis despite the availability of effective treatment. The study's methods have become synonymous with exploitation and mistreatment by the medical profession. To identify the study's effects on the behavior and health of older black men, we use an interacted difference-in-difference-in-differences model, comparing older black men to other demographic groups, before and after the Tuskegee revelation, in varying proximity to the study's victims. We find that the disclosure of the study in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men. Our estimates imply life expectancy at age 45 for black men fell by up to 1.5 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men and 25% of the gap between black men and women.
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Yu SWY, Hill C, Ricks ML, Bennet J, Oriol NE. The scope and impact of mobile health clinics in the United States: a literature review. Int J Equity Health 2017; 16:178. [PMID: 28982362 PMCID: PMC5629787 DOI: 10.1186/s12939-017-0671-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/24/2017] [Indexed: 11/24/2022] Open
Abstract
As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation's overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population. This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics MobileHealthMap.org , the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there are limitations and challenges to this healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into our healthcare system.
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Affiliation(s)
- Stephanie W. Y. Yu
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Caterina Hill
- Department of Global Health and Social Medicine, Harvard Medical School, c/o The Family Van, 1542 Tremont St, Roxbury, MA 02120 USA
| | - Mariesa L. Ricks
- Harvard Business School, Soldiers Field, Boston, MA 02163 USA
- Harvard University T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Jennifer Bennet
- The Family Van: Harvard Medical School, 1542 Tremont St, Roxbury, MA 02120 USA
| | - Nancy E. Oriol
- Harvard Medical School, 260 Longwood Ave, Suite 244, Boston, MA 02115 USA
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
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Shimada YJ, Tsugawa Y, Iso H, Brown DFM, Hasegawa K. Association of bariatric surgery with risk of acute care use for hypertension-related disease in obese adults: population-based self-controlled case series study. BMC Med 2017; 15:161. [PMID: 28830535 PMCID: PMC5568280 DOI: 10.1186/s12916-017-0914-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/11/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypertension carries a large societal burden. Obesity is known as a risk factor for hypertension. However, little is known as to whether weight loss interventions reduce the risk of hypertension-related adverse events, such as acute care use (emergency department [ED] visit and/or unplanned hospitalization). We used bariatric surgery as an instrument for investigating the effect of large weight reduction on the risk of acute care use for hypertension-related disease in obese adults with hypertension. METHODS We performed a self-controlled case series study of obese patients with hypertension who underwent bariatric surgery using population-based ED and inpatient databases that recorded every bariatric surgery, ED visit, and hospitalization in three states (California, Florida, and Nebraska) from 2005 to 2011. The primary outcome was acute care use for hypertension-related disease. We used conditional logistic regression to compare each patient's risk of the outcome event during sequential 12-month periods, using pre-surgery months 13-24 as the reference period. RESULTS We identified 980 obese patients with hypertension who underwent bariatric surgery. The median age was 48 years (interquartile range, 40-56 years), 74% were female, and 55% were non-Hispanic white. During the reference period, 17.8% (95% confidence interval [CI], 15.4-20.2%) had a primary outcome event. The risk remained unchanged in the subsequent 12-month pre-surgery period (18.2% [95% CI, 15.7-20.6%]; adjusted odds ratio [aOR] 1.02 [95% CI, 0.83-1.27]; P = 0.83). In the first 12-month period after bariatric surgery, the risk significantly decreased (10.5% [8.6-12.4%]; aOR 0.58 [95% CI, 0.45-0.74]; P < 0.0001). Similarly, the risk remained significantly reduced in the 13-24 months after bariatric surgery (12.9% [95% CI, 10.8-15.0%]; aOR 0.71 [95% CI, 0.57-0.90]; P = 0.005). By contrast, there was no significant reduction in the risk among obese patients who underwent non-bariatric surgery (i.e., cholecystectomy, hysterectomy, spinal fusion, or mastectomy). CONCLUSIONS In this population-based study of obese adults with hypertension, we found that the risk of acute care use for hypertension-related disease decreased by 40% after bariatric surgery. The data provide the best evidence on the effectiveness of substantial weight loss on hypertension-related morbidities, underscoring the importance of discussing options for weight reduction when treating obese patients with hypertension.
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Affiliation(s)
- Yuichi J Shimada
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Gray/Bigelow 800, Boston, MA, 02114, USA.
| | - Yusuke Tsugawa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 1-1 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - David F M Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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Slagter SN, van Waateringe RP, van Beek AP, van der Klauw MM, Wolffenbuttel BHR, van Vliet-Ostaptchouk JV. Sex, BMI and age differences in metabolic syndrome: the Dutch Lifelines Cohort Study. Endocr Connect 2017; 6:278-288. [PMID: 28420718 PMCID: PMC5457493 DOI: 10.1530/ec-17-0011] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/18/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION To evaluate the prevalence of metabolic syndrome (MetS) and its individual components within sex-, body mass index (BMI)- and age combined clusters. In addition, we used the age-adjusted blood pressure thresholds to demonstrate the effect on the prevalence of MetS and elevated blood pressure. SUBJECTS AND METHODS Cross-sectional data from 74,531 Western European participants, aged 18-79 years, were used from the Dutch Lifelines Cohort Study. MetS was defined according to the revised NCEP-ATPIII. Age-adjusted blood pressure thresholds were defined as recommended by the eight reports of the Joint National Committee (≥140/90 mmHg for those aged <60 years, and ≥150/90 mmHg for those aged ≥60 years). RESULTS 19.2% men and 12.1% women had MetS. MetS prevalence increased with BMI and age. Independent of BMI, abdominal obesity dominated MetS prevalence especially in women, while elevated blood pressure was already highly prevalent among young men. Applying age-adjusted blood pressure thresholds resulted in a 0.2-11.9% prevalence drop in MetS and 6.0-36.3% prevalence drop in elevated blood pressure, within the combined sex, BMI and age clusters. CONCLUSIONS We observed a gender disparity with age and BMI for the prevalence of MetS and, especially, abdominal obesity and elevated blood pressure. The strict threshold level for elevated blood pressure in the revised NCEP-ATPIII, results in an overestimation of MetS prevalence.
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Affiliation(s)
- Sandra N Slagter
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert P van Waateringe
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - André P van Beek
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Melanie M van der Klauw
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce H R Wolffenbuttel
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jana V van Vliet-Ostaptchouk
- Department of EndocrinologyUniversity of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Parker LJ, Hunte H, Ohmit A, Thorpe RJ. Factors Associated With Black Men's Preference for Health Information. Health Promot Pract 2016; 18:119-126. [PMID: 27549607 DOI: 10.1177/1524839916664488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Black men are less likely to seek routine health care examinations or preventative care compared with their racial/ethnic and gender counterparts. Because of Black men's limited engagement with the health system, Black men's preference to receive health information is unclear. Guided by a revised version of the Andersen Healthcare Utilization Model, the aim of the study is to examine factors associated with Black men's preference for informal or formal health information. Findings from the study demonstrate that financial barriers to care (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.43-0.98) and higher income (OR = 2.44, 95% CI = 1.49-4.00) were most predictive of using a formal source for health information. Furthermore, age (OR = 1.02, 95% CI = 1.01-1.03) and having a college education (OR = 0.44, 95% CI = 0.26-0.76) were associated with using a formal place for health information. Interestingly, health care discrimination was not associated with preferred source or place for health information. Results from the study suggest that predisposing and enabling factors are most salient to the use of formal sources of health information among Black men.
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Affiliation(s)
- Lauren J Parker
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Anita Ohmit
- 3 Indiana Minority Health Coalition, Indianapolis, IN, USA
| | - Roland J Thorpe
- 1 Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Powell W, Adams LB, Cole-Lewis Y, Agyemang A, Upton RD. Masculinity and Race-Related Factors as Barriers to Health Help-Seeking Among African American Men. Behav Med 2016; 42:150-63. [PMID: 27337619 PMCID: PMC4979354 DOI: 10.1080/08964289.2016.1165174] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Men's tendency to delay health help-seeking is largely attributed to masculinity, but findings scarcely focus on African American men who face additional race-related, help-seeking barriers. Building principally on reactance theory, we test a hypothesized model situating racial discrimination, masculinity norms salience (MNS), everyday racism (ERD), racial identity, sense of control (SOC), and depressive symptomatology as key barriers to African American men's health help-seeking. A total of 458 African American men were recruited primarily from US barbershops in the Western and Southern regions. The primary outcome was Barriers to Help-Seeking Scale (BHSS) scores. The hypothesized model was investigated with confirmatory factor and path analysis with tests for measurement invariance. Our model fit was excellent [Formula: see text] CFI = 0.99; TLI = 1.00; RMSEA = 0.00, and 90% CI [0.00, 0.07] and operated equivalently across different age, income, and education strata. Frequent ERD and higher MNS contributed to higher BHHS scores. The relationship between ERD exposure and BHHS scores was partially mediated by diminished SOC and greater depressive symptomatology. Interventions aimed at addressing African American men's health help-seeking should not only address masculinity norms but also threats to sense of control, and negative psychological sequelae induced by everyday racism.
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Bass SB, Muñiz J, Gordon TF, Maurer L, Patterson F. Understanding help-seeking intentions in male military cadets: An application of perceptual mapping. BMC Public Health 2016; 16:413. [PMID: 27184052 PMCID: PMC4869204 DOI: 10.1186/s12889-016-3092-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background Research suggests that men are less likely to seek help for depression, substance abuse, and stressful life events due to negative perceptions of asking for and receiving help. This may be exacerbated in male military cadets who exhibit higher levels of gender role conflict because of military culture. Methods This exploratory study examined the perceptions of 78 male military cadets toward help-seeking behaviors. Cadets completed the 31-item Barriers to Help Seeking Scale (BHSS) and a component factor analysis was used to generate five composite variables and compare to validated factors. Perceptual mapping and vector modeling, which produce 3-dimensional models of a group’s perceptions, were then used to model how they conceptualize help-seeking. Results Factor analysis showed slightly different groupings than the BHSS, perhaps attributed to different characteristics of respondents, who are situated in a military school compared to general university males. Perceptual maps show that cadets perceive trust of doctors closest to them and help-seeking farthest, supporting the concept that these males have rigid beliefs about having control and its relationship to health seeking. Differences were seen when comparing maps of White and non-White cadets. White cadets positioned themselves far away from all variables, while non-White cadets were closest to “emotional control”. Conclusion To move these cadets toward help-seeking, vector modeling suggests that interventions should focus on their general trust of doctors, accepting lack of control, and decreasing feelings of weakness when asking for help. For non-White cadets a focus on self-reliance may also need to be emphasized. Use of these unique methods resulted in articulation of specific barriers that if addressed early, may have lasting effects on help-seeking behavior as these young men become adults. Future studies are needed to develop and test specific interventions to promote help-seeking among military cadets.
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Affiliation(s)
- Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Room 951, Philadelphia, PA, 19122, USA.
| | - Javier Muñiz
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Room 951, Philadelphia, PA, 19122, USA
| | - Thomas F Gordon
- Department of Psychology, University of Massachusetts-Lowell, 113 Wilder St., Lowell, MA, 01854-3059, USA
| | - Laurie Maurer
- Department of Social and Behavioral Sciences, Temple University, College of Public Health, 1301 Cecil B. Moore Ave., Room 951, Philadelphia, PA, 19122, USA
| | - Freda Patterson
- Department of Behavioral Health and Nutrition, University of Delaware, 026 North College Ave., Carpenter Sports Building, Newark, DE, 19711, USA
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Health services use and prescription access among uninsured patients managing chronic diseases. J Community Health 2014; 39:572-83. [PMID: 24338075 DOI: 10.1007/s10900-013-9799-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Effective chronic condition management is dependent upon prescription medication access and compliance. Impacted access results in increased pain, worsening of the condition and association of additional health-related problems. Prescription medication costs constitute a significant burden for patients who are uninsured and managing chronic conditions. This burden links to the likelihood of medication non-compliance. The purpose of this research was to test the ability of the Andersen Behavioral Model of Health Services Use to examine health behaviors among adult uninsured patients managing physician-diagnosed chronic conditions. To enhance its chronic disease management model for uninsured patients diagnosed with chronic conditions requiring prescription regimens, a local community health center added a pharmaceutical access component to its health care delivery model. The Andersen Behavioral Model of Health Services Use was employed to gain insight on how the predictors of predisposing, enabling and need factors impact the change in clinical outcomes and the number of non-urgent triage telephone encounters, physician visits, and emergency department visits of each uninsured patient diagnosed with a chronic condition requiring prescription medication treatment and receiving care at this facility. Individual health behavior patterns are based on predisposition to care, factors that impede or enable the use of care and overall need for care. In this study, there was a statistically significant relationship between population characteristics and health behavior; between health behavior and outcomes; and between population characteristics and outcomes.
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Kang S, Chung W, Kim H, Lee S. What Factors Cause a Complete Examination of Infant Health Checkup? HEALTH POLICY AND MANAGEMENT 2014. [DOI: 10.4332/kjhpa.2014.24.3.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Saffari M, Karimi T, Koenig HG, Al-Zaben F. Psychometric evaluation of the Persian version of the Type 2 Diabetes and Health Promotion Scale (T2DHPS): a diabetes-specific measure of lifestyle. Scand J Caring Sci 2014; 29:603-12. [PMID: 25236973 DOI: 10.1111/scs.12181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/09/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND A healthy lifestyle is important for maintaining health and preventing complications in patients with type 2 diabetes, and yet, few instruments are available to measure this. AIM The aim of the present study was to examine the psychometrics of a recently developed tool that can be used to screen for a health-promoting lifestyle in patients with type 2 diabetes. METHODS Data were collected from outpatients attending diabetes clinics. The Type 2 Diabetes and Health Promotion Scale (T2DHPS), EQ-5D, medical records and a demographic questionnaire were administered to 368 participants. Forward-backward translation of the original English version was used to develop a Persian version. Internal consistency of the scale was assessed by Cronbach's alpha and item-to-total correlation. Acceptability was measured by assessing floor and ceiling effects for each item and subscale. The item scaling test was used to examine the convergent and discriminant validity of the measure. Pearson correlation was used to determine the predictive validity of the scale. An explanatory factor analysis and known-group method were used to establish construct validity. RESULTS Adjusted item-total correlations were higher than 0.20. Cronbach's alpha for the 28-item scale was 0.88 and for subscales ranged from 0.53 to 0.94. Correlations between the total score and subscale scores were significant (<0.01) and adequate (r's ≥ 0.53). There were significant relationships between the T2DHPS and both the EQ-5D and indicators of glycaemic control. Convergent and discriminant validity of the scale was established. Significant differences in lifestyle dimensions were present between different groups of patients, demonstrating known-group validity. A six-factor solution was obtained that explained 54.6% of the total variance. CONCLUSION The T2DHPS is a valid and reliable tool for investigating lifestyle behaviours in patients with type 2 diabetes. Further studies to establish the psychometric properties of the scale in other languages and cultures are suggested.
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Affiliation(s)
- Mohsen Saffari
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Health Education Department, School of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Tooba Karimi
- Health Education Department, School of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Harold G Koenig
- Duke University Medical Center, Durham, NC, USA.,Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faten Al-Zaben
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Oertelt-Prigione S, Gohlke BO, Dunkel M, Preissner R, Regitz-Zagrosek V. GenderMedDB: an interactive database of sex and gender-specific medical literature. Biol Sex Differ 2014; 5:7. [PMID: 24904731 PMCID: PMC4047004 DOI: 10.1186/2042-6410-5-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 05/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Searches for sex and gender-specific publications are complicated by the absence of a specific algorithm within search engines and by the lack of adequate archives to collect the retrieved results. We previously addressed this issue by initiating the first systematic archive of medical literature containing sex and/or gender-specific analyses. This initial collection has now been greatly enlarged and re-organized as a free user-friendly database with multiple functions: GenderMedDB (http://gendermeddb.charite.de). DESCRIPTION GenderMedDB retrieves the included publications from the PubMed database. Manuscripts containing sex and/or gender-specific analysis are continuously screened and the relevant findings organized systematically into disciplines and diseases. Publications are furthermore classified by research type, subject and participant numbers. More than 11,000 abstracts are currently included in the database, after screening more than 40,000 publications. The main functions of the database include searches by publication data or content analysis based on pre-defined classifications. In addition, registrants are enabled to upload relevant publications, access descriptive publication statistics and interact in an open user forum. CONCLUSIONS Overall, GenderMedDB offers the advantages of a discipline-specific search engine as well as the functions of a participative tool for the gender medicine community.
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Affiliation(s)
- Sabine Oertelt-Prigione
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3/4, Berlin 10117, Germany ; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Björn-Oliver Gohlke
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin 13125, Germany ; German Cancer Consortium (DKTK), Heidelberg 69120, Germany
| | - Mathias Dunkel
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin 13125, Germany
| | - Robert Preissner
- Structural Bioinformatics Group, Charité-Universitätsmedizin Berlin, Berlin 13125, Germany
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine, Charité-Universitätsmedizin Berlin, Hessische Str. 3/4, Berlin 10117, Germany ; German Center for Cardiovascular Research (DZHK), Berlin, Germany ; Center for Cardiovascular Research (CCR), Charité-Universitätsmedizin Berlin, Berlin 10115, Germany
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Avery AK, Del Toro M, Caron A. Increases in HIV screening in primary care clinics through an electronic reminder: an interrupted time series. BMJ Qual Saf 2013; 23:250-6. [PMID: 24143815 DOI: 10.1136/bmjqs-2012-001775] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE AIM Identify and eliminate barriers to HIV testing in primary care and to decrease the rates of patients never being tested, and limit unnecessary repeat testing. SETTING Primary care clinics within an urban publicly funded safety net hospital and community health system in Cleveland, Ohio. Reported HIV prevalence among male Cleveland residents is 1193.5/100 000. DESIGN A time series analysis using statistical process control was used. METHODS Primary care encounters of patients aged 13-64 years from selected sites were reviewed throughout the initiative for HIV testing prior to the visit and associated with the visit. RESULTS Run charts of the proportion of men and women never tested for HIV demonstrated marked improvement and special cause variation with six sequential quarters falling outside of the trend lines. Evaluation of encounters associated with a first HIV test confirmed testing occurring within primary care rather than elsewhere in the health system. CONCLUSIONS Implementing an electronic medical record-based reminder effectively increased HIV testing among primary care patients not previously tested, while education and practice feedback alone did not.
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Affiliation(s)
- Ann K Avery
- Division of Infectious Diseases, The MetroHealth System, , Cleveland, Ohio, USA
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Sociodemographic Determinants in Preventive Tests for Cardiovascular Diseases in a Representative Sample of the Adult Greek Population. High Blood Press Cardiovasc Prev 2013; 20:81-7. [DOI: 10.1007/s40292-013-0005-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/22/2012] [Indexed: 12/01/2022] Open
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Lanier Y, Sutton MY. Reframing the context of preventive health care services and prevention of HIV and other sexually transmitted infections for young men: new opportunities to reduce racial/ethnic sexual health disparities. Am J Public Health 2013; 103:262-9. [PMID: 23237172 PMCID: PMC3558761 DOI: 10.2105/ajph.2012.300921] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2012] [Indexed: 11/04/2022]
Abstract
Young Black males, aged 13 to 29 years, have the highest annual rates of HIV infections in the United States. Young Black men who have sex with men (MSM) are the only subgroup with significant increases in HIV incident infections in recent years. Black men, particularly MSM, are also disproportionately affected by other sexually transmitted infections (STIs). Therefore, we must strengthen HIV and STI prevention opportunities during routine, preventive health care visits and at other, nontraditional venues accessed by young men of color, with inclusive, nonjudgmental approaches. The Affordable Care Act and National HIV/AIDS Strategy present new opportunities to reframe and strengthen sexual health promotion and HIV and STI prevention efforts with young men of color.
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Affiliation(s)
- Yzette Lanier
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Doshi RK, Malebranche D, Bowleg L, Sangaramoorthy T. Health care and HIV testing experiences among Black men in the South: implications for "Seek, Test, Treat, and Retain" HIV prevention strategies. AIDS Patient Care STDS 2013; 27:123-33. [PMID: 23268586 DOI: 10.1089/apc.2012.0269] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Few studies have explored how overall general health care and HIV/STI testing experiences may influence receipt of "Seek, Test, Treat, and Retain" (STTR) HIV prevention approaches among Black men in the southern United States. Using in-depth qualitative interviews with 78 HIV-negative/unknown Black men in Georgia, we explored factors influencing their general health care and HIV/STI testing experiences. The Andersen behavioral model of health care utilization (Andersen model) offers a useful framework through which to examine the general health care experiences and HIV testing practices of Black men. It has four primary domains: Environment, Population characteristics, Health behavior, and Outcomes. Within the Andersen model framework, participants described four main themes that influenced HIV testing: access to insurance, patient-provider communication, quality of services, and personal belief systems. If STTR is to be successful among Black men, improving access and quality of general health care, integrating HIV testing into general health care, promoting health empowerment, and consumer satisfaction should be addressed.
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Affiliation(s)
- Rupali Kotwal Doshi
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David Malebranche
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lisa Bowleg
- Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, Pennsylvania
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Avery AK, Toro MD, Einstadter D. Decreasing Missed Opportunities for HIV Testing in Primary Care through Enhanced Utilization of the Electronic Medical Record. JOURNAL OF AIDS & CLINICAL RESEARCH 2012; Suppl 4:10.4172/2155-6113.S4-006. [PMID: 24363958 PMCID: PMC3868368 DOI: 10.4172/2155-6113.s4-006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We sought to decrease "missed opportunities" for HIV testing by implementing an electronic medical record based intervention designed to increase HIV testing among previously untested men and women ages 18-64 seeking primary medical care in an urban publicly-funded health care system. METHODS In July 2010, we implemented an electronic medical record based reminder to alert providers to the absence of an HIV test among all patients' ages 13-64 years old. We compared the rate of missed opportunities for HIV testing among primary care patients seen during the two and a half years before the intervention with that of patients seen during the two years after the intervention was begun. A "missed opportunity" was defined as the failure of a previously untested patient to obtain HIV testing despite having made one or more primary care office visits during a specified time period. RESULTS After the implementation of HIV testing reminders, first-time HIV testing increased significantly for both men and women 18-64 years old, resulting in a significant reduction in "missed opportunities." The intervention was equally effective across different racial and ethnic groups. An increase in new HIV diagnoses after the intervention was observed, consistent with an increase in the number of individuals in the population who received testing. CONCLUSIONS An electronic medical record-based reminder can significantly increase HIV testing among men and women ages 18-64 who are seeking primary care services.
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Affiliation(s)
- Ann K. Avery
- Case Western Reserve University, Cleveland, Ohio, USA
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Abstract
The aim is to describe the burden of chronic disease and related risk factors among low-income women of reproductive age. We analyzed population-based data from the 2005-2006 Pregnancy Risk Assessment Monitoring System (PRAMS) for 14,990 women with a live birth in 7 states. We examined the prevalence of selected chronic diseases and related risk factors (preexisting diabetes, gestational diabetes, chronic hypertension, pregnancy-induced hypertension, obesity, smoking or binge drinking prior to pregnancy, smoking or excessive weight gain during pregnancy, and postpartum depressive symptoms) by Federal Poverty Level (FPL) (≤100% FPL; 101-250% FPL; >250% FPL). Approximately one-third of women were low-income (≤100% FPL), one-third were near-low-income (101-250% FPL), and one-third were higher-income (>250% FPL). Compared to higher-income women, low-income women were significantly more likely to smoke before or during pregnancy (34.2% vs. 14.4%, and 24.8% vs. 5.4%, respectively), be obese (22.2% vs. 16.0%), experience postpartum depressive symptoms (23.3% vs. 7.9%), have 3 or more chronic diseases and/or related risk factors (28.1% vs. 14.4%) and be uninsured before pregnancy (48.9% vs. 4.8%). Low-income women of reproductive age experienced a higher prevalence of selected chronic diseases and related risk factors. Enhancing services for these women in publicly-funded family planning clinics may help reduce disparities in pregnancy and long-term health outcomes in the poor.
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Yeo JY, Jeong HS. Determinants of health screening and its effects on health behaviors. ACTA ACUST UNITED AC 2012. [DOI: 10.4332/kjhpa.2012.22.1.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hill C, Zurakowski D, Bennet J, Walker-White R, Osman JL, Quarles A, Oriol N. Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities. Am J Public Health 2012; 102:406-10. [PMID: 22390503 PMCID: PMC3487671 DOI: 10.2105/ajph.2011.300472] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2011] [Indexed: 12/22/2022]
Abstract
The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.
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Affiliation(s)
- Caterina Hill
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
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Xiong GL, Iosif AM, Bermudes RA, McCarron RM, Hales RE. Preventive medical services use among community mental health patients with severe mental illness:the influence of gender and insurance coverage. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21274355 DOI: 10.4088/pcc.09m00927gre] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Accepted: 01/28/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study examines predictors of reduced preventive health service use in patients with severe mental illness by examining psychiatric diagnoses and demographic factors. METHOD Of 387 patients approached in 4 community mental health clinics regarding their preventive health services use from January 2005 to May 2007, 234 (60.5%) were interviewed. Of those participants interviewed, 221 had a DSM-IV-TR diagnosis of (1) primary psychotic disorder (schizophrenia or schizoaffective disorder), (2) bipolar disorder, or (3) recurrent major depressive disorder. Psychiatric disorders and demographic factors that predicted high service utilization were analyzed using analysis of variance and χ² tests. RESULTS In the linear predictive model, use of preventive services was not statistically different among the 3 diagnostic groups. Participants with primary psychotic disorder used a similar number of preventive services compared to those with bipolar disorder and major depression. Women used more services than men (P < .01), and individuals with health insurance used more than uninsured participants (P < .001). CONCLUSION Male gender and not having medical insurance were predictive of lower preventive health service use in this sample of patients with severe mental illness. Further research is needed to replicate these findings and to improve use of preventive health services in people with severe mental illness.
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Affiliation(s)
- Glen L Xiong
- Department of Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA.
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Tong VT, Dietz PM, England LJ, Farr SL, Kim SY, D'Angelo D, Bombard JM. Age and racial/ethnic disparities in prepregnancy smoking among women who delivered live births. Prev Chronic Dis 2011; 8:A121. [PMID: 22005614 PMCID: PMC3221563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Prenatal smoking prevalence remains high in the United States. To reduce prenatal smoking prevalence, efforts should focus on delivering evidence-based cessation interventions to women who are most likely to smoke before pregnancy. Our objective was to identify groups with the highest prepregnancy smoking prevalence by age within 6 racial/ethnic groups. METHODS We analyzed data from 186,064 women with a recent live birth from 32 states and New York City from the 2004-2008 Pregnancy Risk Assessment Monitoring System (PRAMS), a population-based survey of postpartum women. We calculated self-reported smoking prevalence during the 3 months before pregnancy for 6 maternal racial/ethnic groups by maternal age (18-24 y or ≥25 y). For each racial/ethnic group, we modeled the probability of smoking by age, adjusting for education, Medicaid enrollment, parity, pregnancy intention, state of residence, and year of birth. RESULTS Younger women had higher prepregnancy smoking prevalence (33.2%) than older women (17.6%), overall and in all racial/ethnic groups. Smoking prevalences were higher among younger non-Hispanic whites (46.4%), younger Alaska Natives (55.6%), and younger American Indians (46.9%). After adjusting for confounders, younger non-Hispanic whites, Hispanics, Alaska Natives, and Asian/Pacific Islanders were 1.12 to 1.50 times as likely to smoke as their older counterparts. CONCLUSION Age-appropriate and culturally specific tobacco control interventions should be integrated into reproductive health settings to reach younger non-Hispanic white, Alaska Native, and American Indian women before they become pregnant.
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Affiliation(s)
- Van T. Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
| | - Patricia M. Dietz
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucinda J. England
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry L. Farr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shin Y. Kim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denise D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer M. Bombard
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Grzywacz JG, Stoller EP, Brewer-Lowry AN, Bell RA, Quandt SA, Arcury TA. Gender and health lifestyle: an in-depth exploration of self-care activities in later life. HEALTH EDUCATION & BEHAVIOR 2011; 39:332-40. [PMID: 21632439 DOI: 10.1177/1090198111405195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED OBJECTIVE. Evaluate similarities and differences in the self-care domain of health lifestyle among older, rural-dwelling women and men. METHOD Qualitative analysis of in-depth interview data from 62 community-dwelling older (M = 74.3 years) African and European American women and men. RESULTS Both older women and men rely heavily on over-the-counter medications and home remedies for self-care; professional health care is typically sought when self-care is not effective. However, relative to men, women were more knowledgeable about different approaches to self-care, especially home remedies; they used a wider range of self-care activities; and they placed greater priority on self-care over professional health care. DISCUSSION The structure of older women's and men's self-care domain of health lifestyle is similar. However, there are subtle differences in health lifestyle that are likely embedded in gendered role behavior and may contribute to women's greater health complaints.
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Hammond WP, Mohottige D, Chantala K, Hastings JF, Neighbors HW, Snowden L. Determinants of usual source of care disparities among African American and Caribbean Black men: findings from the National Survey of American Life. J Health Care Poor Underserved 2011; 22:157-75. [PMID: 21317513 PMCID: PMC3062470 DOI: 10.1353/hpu.2011.0016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The Aday-Andersen model was used as a framework for investigating the contribution of immigration status (i.e., nativity and acculturation), socioeconomic factors, health care access, health status, and health insurance to usual source of health care (USOC) in a nationally representative sample of African American (n=551) and Caribbean Black men (n=1,217). METHODS We used the 2001-2003 National Survey of American Life, a nationally representative household survey of non-institutionalized U.S. Blacks to conduct descriptive and logistic regression analyses. RESULTS Older age, more health conditions, neighborhood medical clinic access, and health insurance were associated with higher odds of reporting a USOC. Odds were lower for men with lower-middle incomes and poorer mental health status. Having health insurance was associated with higher odds of reporting a USOC for African American men but lower odds among Caribbean Black men. Odds were higher in the presence of more health conditions for African American men than for Caribbean Black men. CONCLUSIONS Health care reform policies aimed solely at increasing health insurance may not uniformly eliminate USOC disparities disfavoring U.S. and foreign-born non-Hispanic Black men.
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Affiliation(s)
- Wizdom Powell Hammond
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA.
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Mavriplis CA. Should we abandon the periodic health examination?: NO. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2011; 57:159-161. [PMID: 21642714 PMCID: PMC3038802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Cleo A Mavriplis
- Primrose Family Medicine Centre, 35 Primrose Ave, Ottawa, ON K1R 0A1; e-mail
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Hammond WP, Matthews D, Mohottige D, Agyemang A, Corbie-Smith G. Masculinity, medical mistrust, and preventive health services delays among community-dwelling African-American men. J Gen Intern Med 2010; 25:1300-8. [PMID: 20714819 PMCID: PMC2988156 DOI: 10.1007/s11606-010-1481-z] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2009] [Revised: 03/12/2010] [Accepted: 07/22/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND The contribution of masculinity to men's healthcare use has gained increased public health interest; however, few studies have examined this association among African-American men, who delay healthcare more often, define masculinity differently, and report higher levels of medical mistrust than non-Hispanic White men. OBJECTIVE To examine associations between traditional masculinity norms, medical mistrust, and preventive health services delays. DESIGN AND PARTICIPANTS A cross-sectional analysis using data from 610 African-American men age 20 and older recruited primarily from barbershops in the North, South, Midwest, and West regions of the U.S. (2003-2009). MEASUREMENTS Independent variables were endorsement of traditional masculinity norms around self-reliance, salience of traditional masculinity norms, and medical mistrust. Dependent variables were self-reported delays in three preventive health services: routine check-ups, blood pressure screenings, and cholesterol screenings. We controlled for socio-demography, healthcare access, and health status. RESULTS After final adjustment, men with a greater endorsement of traditional masculinity norms around self-reliance (OR: 0.77; 95% CI: 0.60-0.98) were significantly less likely to delay blood pressure screening. This relationship became non-significant when a longer BP screening delay interval was used. Higher levels of traditional masculinity identity salience were associated with a decreased likelihood of delaying cholesterol screening (OR: 0.62; 95% CI: 0.45-0.86). African-American men with higher medical mistrust were significantly more likely to delay routine check-ups (OR: 2.64; 95% CI: 1.34-5.20), blood pressure (OR: 3.03; 95% CI: 1.45-6.32), and cholesterol screenings (OR: 2.09; 95% CI: 1.03-4.23). CONCLUSIONS Contrary to previous research, higher traditional masculinity is associated with decreased delays in African-American men's blood pressure and cholesterol screening. Routine check-up delays are more attributable to medical mistrust. Building on African-American men's potential to frame preventive services utilization as a demonstration, as opposed to, denial of masculinity and implementing policies to reduce biases in healthcare delivery that increase mistrust, may be viable strategies to eliminate disparities in African-American male healthcare utilization.
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Affiliation(s)
- Wizdom Powell Hammond
- Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC 27599-7440, USA.
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Kuklina EV, Yoon PW, Keenan NL. Prevalence of coronary heart disease risk factors and screening for high cholesterol levels among young adults, United States, 1999-2006. Ann Fam Med 2010; 8:327-33. [PMID: 20644187 PMCID: PMC2906527 DOI: 10.1370/afm.1137] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Previous studies have reported low rates of screening for high cholesterol levels among young adults in the United States. Although recommendations for screening young adults without risk factors for coronary heart disease (CHD) differ, all guidelines recommend screening adults with CHD, CHD equivalents, or 1 or more CHD risk factors. This study examined national prevalence of CHD risk factors and compliance with the cholesterol screening guidelines among young adults. METHODS National estimates were obtained using results for 2,587 young adults (men aged 20 to 35 years; women aged 20 to 45 years) from the 1999-2006 National Health and Nutrition Examination Surveys. We defined high low-density lipoprotein cholesterol (LDL-C) as levels higher than the goal specific for each CHD risk category outlined in the National Cholesterol Education Program Adult Treatment Panel III guidelines. RESULTS About 59% of young adults had CHD or CHD equivalents, or 1 or more of the following CHD risk factors: family history of early CHD, smoking, hypertension, or obesity. In our study, the overall screening rate in this population was less than 50%. Moreover, no significant difference in screening rates between young adults with no risk factors and their counterparts with 1 or more risk factors was found even after adjustment for sociodemographic and health care factors. Approximately 65% of young adults with CHD or CHD equivalents, 26% of young adults with 2 or more risk factors, 12% of young adults with 1 risk factor, and 7% with no risk factor had a high level of LDL-C. CONCLUSIONS CHD risk factors are common in young adults but do not appear to alter screening rates. Improvement of risk assessment and management for cardiovascular disease among young adults is warranted.
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Affiliation(s)
- Elena V Kuklina
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Hammond WP, Matthews D, Corbie-Smith G. Psychosocial factors associated with routine health examination scheduling and receipt among African American men. J Natl Med Assoc 2010; 102:276-89. [PMID: 20437735 DOI: 10.1016/s0027-9684(15)30600-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION African American men often fail to obtain routine health examinations, which increases the probability of disease detection, yet little is known about psychosocial factors that motivate scheduling and receipt among this group. METHODS We used the Andersen model and theory of reasoned action as frameworks to evaluate the relative contribution of psychosocial factors to self-reported routine health examination scheduling and receipt in a cross-sectional sample of African American men (N = 386) recruited from barbershops (65.3%) and academic institutions/events (34.7%) in Michigan, Georgia, and North Carolina between 2003-2004 and 2007-2009. Participants completed measures assessing demographic factors, physical/mental health status, traditional male role norms, health-promoting male subjective norms, health value, and medical mistrust. Pearson's chi(2), analysis of variance, and multivariate logistic regression analyses were used to investigate associations between these study factors and routine health examination scheduling and receipt in the past year. RESULTS After final adjustment, the odds of scheduling a routine health examination were increased for men with a usual source of care (OR, 5.48; 95% CI, 3.06-9.78) and more health-promoting male subjective norms exposure (OR, 1.46; 95% CI, 1.02-2.04). Higher medical mistrust (OR, 0.26;; 95% CI, 0.09-0.76) and traditional male role norms (OR, 0.71; 95% CI, 0.52-0.98) reduced the odds of routine health examination receipt. The odds of routine health examination receipt were increased among men who were older (OR=1.05; 95% CI, 1.01-1.10), had a usual source of care (OR, 2.91; 95% CI, 1.54-5.51) and reported more male subjective norms exposure (OR, 1.51; 95% CI, 1.02-2.22). CONCLUSIONS Improving African American men's uptake of routine health examinations will require addressing medical mistrust, mitigating traditional masculine concerns about disclosing vulnerability, and leveraging male social networks.
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Affiliation(s)
- Wizdom Powell Hammond
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7440 USA.
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Mangano A. An analysis of the regional differences in health care utilization in Italy. Health Place 2010; 16:301-8. [DOI: 10.1016/j.healthplace.2009.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 10/15/2009] [Accepted: 10/19/2009] [Indexed: 10/20/2022]
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Pappa E, Kontodimopoulos N, Papadopoulos AA, Pallikarona G, Niakas D, Tountas Y. Factors affecting use of preventive tests for cardiovascular risk among Greeks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:2712-24. [PMID: 20054464 PMCID: PMC2790102 DOI: 10.3390/ijerph6102712] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Accepted: 10/19/2009] [Indexed: 12/02/2022]
Abstract
Data from a Greek national representative sample was used to investigate socio-demographic, self-perceived health, and health risk factors that determine the use of cardiovascular preventive tests (blood pressure, cholesterol and blood glucose). Chi-square and logistic regression analyses were used (p < 0.05). Older age, marriage, regular family doctor and chronic diseases increased the likelihood of receiving preventive tests, whereas low education and alcohol consumption reduced the likelihood of having these tests. The effect of obesity varied. Interventions which improve the knowledge of the poorly educated and empower the preventive role of the physicians may redress the inequalities and improve the effectiveness of preventive services utilization.
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Affiliation(s)
- Evelina Pappa
- Hellenic Open University, Faculty of Social Sciences, Bouboulinas 57, Patras, 26222, Greece; E-Mails:
(N.K.);
(A.A.P.);
(D.N.)
- Author to whom correspondence should be addressed; E-mail:
; Tel.: +30-2610-367441; Fax: +30-2610-367442
| | - Nick Kontodimopoulos
- Hellenic Open University, Faculty of Social Sciences, Bouboulinas 57, Patras, 26222, Greece; E-Mails:
(N.K.);
(A.A.P.);
(D.N.)
| | - Angelos A. Papadopoulos
- Hellenic Open University, Faculty of Social Sciences, Bouboulinas 57, Patras, 26222, Greece; E-Mails:
(N.K.);
(A.A.P.);
(D.N.)
- “ATTIKON” University Hospital, 1 Rimini Street, Athens, 12462, Greece
| | - Georgia Pallikarona
- Centre for Health Services Research, Department of Hygiene and Epidemiology, Medical School, Athens University, 25 Alexandroupoleos Street, Athens, 11527, Greece; E-Mail:
(Y.T.)
| | - Dimitris Niakas
- Hellenic Open University, Faculty of Social Sciences, Bouboulinas 57, Patras, 26222, Greece; E-Mails:
(N.K.);
(A.A.P.);
(D.N.)
| | - Yannis Tountas
- Hellenic Open University, Faculty of Social Sciences, Bouboulinas 57, Patras, 26222, Greece; E-Mails:
(N.K.);
(A.A.P.);
(D.N.)
- Centre for Health Services Research, Department of Hygiene and Epidemiology, Medical School, Athens University, 25 Alexandroupoleos Street, Athens, 11527, Greece; E-Mail:
(Y.T.)
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O'Donnell L, Bonaparte B, Joseph H, Agronick G, Leow DM, Myint-U A, Stueve A. Keep It Up: development of a community-based health screening and HIV prevention strategy for reaching young African American men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:299-313. [PMID: 19670966 DOI: 10.1521/aeap.2009.21.4.299] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article addresses the challenge of developing HIV prevention interventions that not only prove to be efficacious but also are designed from the outset to overcome obstacles to reaching priority populations. We describe how community input has informed development of Keep It Up (KIU), a community health screening and behavioral prevention program for young Black men. KIU embeds HIV prevention in a broader health promotion campaign, with the goal of reducing stigma and reaching a population that bears a disproportionate burden of HIV/AIDS and other health problems-hypertension, high cholesterol, diabetes, asthma, and obesity. Information from community partners, expert advisers, and focus groups was collected at key junctures and incorporated into four core components: social marketing, a computerized behavioral learning module, biological testing for HIV and other conditions, and a personalized health profile and risk reduction plan. A pilot with 116 participants provided evidence that the KIU model of integrating HIV prevention with other health screening is acceptable and has the potential to reach Black men at risk for HIV as well as other chronic health conditions.
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Affiliation(s)
- Lydia O'Donnell
- Health and Human Development Programs, Education Development Center, Inc., Newton, MA 02459, USA.
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Hughes RG, Clancy CM. Improving the quality of nursing care using the medical expenditure panel survey data. J Nurs Care Qual 2007; 22:93-6. [PMID: 17353742 DOI: 10.1097/01.ncq.0000263095.98686.d1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ronda G Hughes
- Agency for Healthcare Research and Quality, Rockville, MD 20850, USA.
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Determinants of a healthy lifestyle and use of preventive screening in Canada. BMC Public Health 2006; 6:275. [PMID: 17090313 PMCID: PMC1636639 DOI: 10.1186/1471-2458-6-275] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Accepted: 11/07/2006] [Indexed: 12/02/2022] Open
Abstract
Background This study explores the associations between individual characteristics such as income and education with health behaviours and utilization of preventive screening. Methods Data from the Canadian National Population Health Survey (NPHS) 1998–9 were used. Independent variables were income, education, age, sex, marital status, body mass index, urban/rural residence and access to a regular physician. Dependent variables included smoking, excessive alcohol use, physical activity, blood pressure checks, mammography in past year and Pap smear in past 3 years. Logistic regression models were developed for each dependent variable. Results 13,756 persons 20 years of age and older completed the health portion of the NPHS. In general, higher levels of income were associated with healthier behaviours, as were higher levels of education, although there were exceptions to both. The results for age and gender also varied depending on the outcome. The presence of a regular medical doctor was associated with increased rates of all preventive screening and reduced rates of smoking. Conclusion These results expand upon previous data suggesting that socioeconomic disparities in healthy behaviours and health promotion continue to exist despite equal access to medical screening within the Canadian healthcare context. Knowledge, resources and the presence of a regular medical doctor are important factors associated with identified differences.
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Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res 2006; 6:146. [PMID: 17081303 PMCID: PMC1635556 DOI: 10.1186/1472-6963-6-146] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 11/02/2006] [Indexed: 11/10/2022] Open
Abstract
Background Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Methods Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Results Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. Conclusion This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.
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