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Moss L, Wu K, Tucker A, Durbin-Matrone R, Roude GD, Francois S, Richardson L, Theall KP. A Qualitative Exploration of the Built Environment as a Key Mechanism of Safety and Social Cohesion for Youth in High-Violence Communities. J Urban Health 2024:10.1007/s11524-024-00861-z. [PMID: 38609700 DOI: 10.1007/s11524-024-00861-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/14/2024]
Abstract
The characteristics of a neighborhood's built environment may influence health-promoting behaviors, interactions between neighbors, and perceptions of safety. Although some research has reported on how youth in high-violence communities navigate danger, less work has investigated how these youth perceive the built environment, their desires for these spaces, and how these desires relate to their conceptions of safety and perceptions of other residents. To fill this gap, this study used focus group data from 51 youth ages 13-24 living in New Orleans, Louisiana. Four themes were developed using reflexive thematic analysis: community violence is distressing and disruptive, youth use and want to enjoy their neighborhood, systemic failure contributes to negative outcomes, and resources and cooperation create safety. This analysis indicates that young people desire to interact with the built environment despite the threat of community violence. They further identified built environment assets that facilitate socialization and recreation, such as local parks, and social assets in the form of cooperation and neighbor-led civic engagement initiatives. In addition, the youth participants demonstrated awareness of structural inequities that influence neighborhood health and violence-related outcomes. This study contributes to efforts to understand how youth with high levels of community violence exposure understand and interact with the built and social environments.
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Affiliation(s)
- Lolita Moss
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Kimberly Wu
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Amber Tucker
- Violence Prevention Institute, Tulane University, New Orleans, LA, USA
| | - Reanna Durbin-Matrone
- Partners for Advancing Health Equity, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | | | | | - Katherine P Theall
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Haley CO, Singleton CR, King LE, Dyer L, Theall KP, Wallace M. Association of Food Desert Residency and Preterm Birth in the United States. Int J Environ Res Public Health 2024; 21:412. [PMID: 38673324 PMCID: PMC11049944 DOI: 10.3390/ijerph21040412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Food deserts are a major public health concern. Inadequate access to healthy food has been associated with poor nutrition and the development of dietary related chronic conditions. OBJECTIVE To determine the association between geographic access to nutritious food and preterm birth and whether gestational hypertension mediates this relationship. METHODS Food access data was retrieved from the U.S. Department of Agriculture Food Access Research Atlas (2019) and used to quantify the percentage of Census tracts within each county that were food deserts: low-income tracts with limited access to grocery stores, supermarkets, or other sources of healthy, nutritious foods. These data were merged with US birth records from 2018 to 2019 by using the maternal county of residence (n = 7,533,319). We fit crude and adjusted logistic regression models with generalized estimating equations to determine the association between living in a food desert and the odds of preterm birth. We conducted a secondary within-group analysis by stratifying the fully adjusted model by race for non-Hispanic White and non-Hispanic Black birthing people. RESULTS In the fully adjusted model, we found a dose-response relationship. As the prevalence of tract-level food deserts within counties increased, so did the likelihood of preterm birth (mid-range: odds ratio (OR) = 1.04, 95% confidence interval (C.I.) 1.01-1.07; high: OR = 1.07, 95% C.I. 1.03-1.11). Similar results were seen in the White-Black stratified models. However, a disparity remained as Black birthing people had the highest odds for preterm birth. Lastly, gestational hypertension appears to mediate the relationship between nutritious food access and preterm birth (natural indirect effect (NIE) = 1.01, 95% CI = 1.00, 1.01). CONCLUSION It is salient, particularly for Black birthing people who experience high rates of adverse birth outcomes, that the role of food desert residency be explored within maternal and child health disparities.
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Affiliation(s)
- Chanell O. Haley
- Department of Behavioral, Social and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (C.R.S.); (L.E.K.); (L.D.); (K.P.T.); (M.W.)
- Mary Amelia Center for Women’s Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Chelsea R. Singleton
- Department of Behavioral, Social and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (C.R.S.); (L.E.K.); (L.D.); (K.P.T.); (M.W.)
| | - Lily E. King
- Department of Behavioral, Social and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (C.R.S.); (L.E.K.); (L.D.); (K.P.T.); (M.W.)
| | - Lauren Dyer
- Department of Behavioral, Social and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (C.R.S.); (L.E.K.); (L.D.); (K.P.T.); (M.W.)
| | - Katherine P. Theall
- Department of Behavioral, Social and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (C.R.S.); (L.E.K.); (L.D.); (K.P.T.); (M.W.)
- Mary Amelia Center for Women’s Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - Maeve Wallace
- Department of Behavioral, Social and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (C.R.S.); (L.E.K.); (L.D.); (K.P.T.); (M.W.)
- Mary Amelia Center for Women’s Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
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Fleckman JM, Ford J, Eisenberg S, Taylor CA, Kondo M, Morrison CN, Branas CC, Drury SS, Theall KP. From neighborhood to household: connections between neighborhood vacant and abandoned property and family violence. Res Sq 2024:rs.3.rs-4022003. [PMID: 38559063 PMCID: PMC10980094 DOI: 10.21203/rs.3.rs-4022003/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Rates of family violence, including intimate partner violence (IPV) and child maltreatment, remain high in the U.S. and contribute to substantial health and economic costs. How neighborhood environment may influence family violence remains poorly understood. We examine the association between neighborhood vacant and abandoned properties and family violence, and the role collective efficacy may play in that relationship. Data were used from a longitudinal cohort of 218 maternal-child dyads in a southern U.S. city known for elevated rates of violence. Women were matched on their propensity score, for living in a neighborhood with elevated vacant and cited properties. Analyses accounting for clustering in neighborhood and matched groups were conducted to examine the association between neighborhood vacant and abandoned property and family violence, and the potential mediating relationship of collective efficacy. The likelihood of experiencing child maltreatment at 12-months of age was more than twice as high for children living in neighborhoods with a high vacant and cited property rates compared to women living in neighborhoods with fewer vacant and cited properties (OR=2.11, 95% CI=1.03, 4.31). Women living in neighborhoods characterized by high levels of vacant and cited properties were also more than twice as likely to report IPV (OR=2.52, 95% CI=1.21, 5.25). Associations remained mostly stable after controlling for key covariates. Collective efficacy did not act as a mediator in the relationship between vacant and cited properties and family violence. Reducing neighborhood vacant and cited properties may be an important target for interventions focused on reducing family violence.
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Affiliation(s)
| | | | | | | | - Michelle Kondo
- Northern Research Station USDA Forest Service: USDA Forest Service Northern Research Station
| | | | | | - Stacy S Drury
- Boston Childrens Hospital: Boston Children's Hospital
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Wu K, Doe E, Roude GD, Wallace J, Francois S, Richardson L, Theall KP. Social capital and changes of psychologic distress during early stage of COVID-19 in New orleans. Sci Rep 2024; 14:5773. [PMID: 38459081 PMCID: PMC10924086 DOI: 10.1038/s41598-024-56249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
Here we report on the relationship between measures of social capital, and their association with changes in self-reported measures of psychological distress during the early period of the COVID-19 pandemic. We analyze data from an existing cluster randomized control trial (the Healthy Neighborhoods Project) with 244 participants from New Orleans, Louisiana. Changes in self-reported scores between baseline (January 2019-March 2020) and participant's second survey (March 20, 2020, and onwards) are calculated. Logistic regression is employed to examine the association between social capital indicators and measures of psychological distress adjusting for key covariates and controlling for residential clustering effects. Participants reporting higher than average scores for social capital indicators are significantly less likely to report increases in psychosocial distress between pre and during the early stage of the COVID-19 pandemic. Those who report higher than average sense of community were approximately 1.2 times less likely than those who report lower than average sense of community scores to experience increases in psychological distress before and during the global pandemic (OR 0.79; 95% CI 0.70,0.88, p ≤ 0.001), even after controlling for key covariates. Findings highlight the potentially important role that community social capital and related factors may play in the health of underrepresented populations during times of major stress. Specifically, the results suggest an important role of cognitive social capital and perceptions of community membership, belonging, and influence in buffering changes of mental health distress experienced during the initial period of the COVID-19 pandemic among a sample of residents.
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Affiliation(s)
- Kimberly Wu
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
| | - Erica Doe
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | | | - Jasmine Wallace
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | | | | | - Katherine P Theall
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
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McKinley CE, Saltzman LY, Theall KP. The Weaving Healthy Families program: Promoting parenting practices, family resilience, and communal mastery. Fam Process 2024; 63:97-112. [PMID: 36710265 PMCID: PMC10382600 DOI: 10.1111/famp.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 06/18/2023]
Abstract
Parenting quality, family resilience, and community resilience and support have been found to be primary protective factors for the disproportionate burden of anxiety, posttraumatic stress disorder (PTSD), substance use disorder (SUD), depression, and suicide that US Indigenous youth and adults tend to experience. The purpose of this research study was to examine pilot results for outcomes related to relational factors for Indigenous family members who participated in the Weaving Healthy Families (WHF) program (translated to Chukka Auchaffi' Natana, in the Choctaw tribal language), a culturally grounded and empirically informed program geared toward promoting wellness, family resilience, parenting practices, and community resilience while also preventing SUD and violence. This nonrandomized pre-experimental pilot intervention followed a longitudinal design, which included pre-test, a post-test, and a 6-, 9-, and 12-month post-intervention follow-up surveys. Repeated-measures regressions were utilized with generalized estimating equations (GEE) to examine changes in parenting, family resilience, and communal mastery before and after the intervention for 24 adults and adolescents (12-17) across eight tribal families. Results indicate that the overall quality of parenting improved, as measured by improved parental monitoring and reductions in inconsistent discipline and corporal punishment. We identified sex differences in positive parenting, poor monitoring, and corporal punishment, with greater decreases in these measures among males over time. Family resilience and communal mastery improved for adolescent and adult participants after the WHF program. Our results indicate promising improvements across relational, familial, and community ecological, which provide clear clinical implications.
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Affiliation(s)
| | - Leia Y. Saltzman
- Tulane University School of Social Work, New Orleans, Louisiana, USA
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Haley CO, King LE, Dyer L, Evans MG, Theall KP, Wallace M. Maternity Care Deserts in Louisiana and Breastfeeding Initiation. Womens Health Issues 2024:S1049-3867(23)00211-6. [PMID: 38216366 DOI: 10.1016/j.whi.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/10/2023] [Accepted: 11/21/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Breastfeeding provides physical, psychological, and immunological benefits to both the mother and infant, but breastfeeding rates are suboptimal. The purpose of this study was to examine whether residing in a maternity care desert (a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with lower breastfeeding rates among birthing people in Louisiana from 2019 to 2020. METHODS Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all live births provided by the Louisiana Office of Vital Records (n = 112,151), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory geospatial analysis to examine the association between place of residence and breastfeeding initiation and racial disparities in initiation. We conducted a secondary within-group analysis by fitting the fully adjusted model stratified by race/ethnicity for non-Hispanic white and non-Hispanic Black birthing people. RESULTS We found that residing in a parish with limited (odds ratio [OR] = 0.87; 95% confidence interval [CI] [0.77, 0.99]) to no access (OR = 0.88; 95% CI [0.80, 0.97]) was significantly associated with lower breastfeeding initiation rates. The within-group analysis determined that both non-Hispanic Black and non-Hispanic white birthing people residing in a parish with limited or no maternity care access had lower breastfeeding initiation rates. CONCLUSION Reducing rural and racial inequities in breastfeeding may require structural changes and investments in infrastructure to deliver pregnancy care.
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Affiliation(s)
- Chanell O Haley
- Department of Behavioral, Social, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Mary Amelia Center for Women's Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | - Lily E King
- Department of Behavioral, Social, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Lauren Dyer
- Department of Behavioral, Social, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Mary Amelia Center for Women's Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Melissa G Evans
- Department of Behavioral, Social, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Mary Amelia Center for Women's Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katherine P Theall
- Department of Behavioral, Social, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Mary Amelia Center for Women's Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Maeve Wallace
- Department of Behavioral, Social, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; Mary Amelia Center for Women's Health Equity Research, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
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7
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Craig LS, Sarpong DF, Peacock EM, Roberts S, Theall KP, Williams L, Al-Dahir S, Davis TC, Arnold CL, Williams A, Fields T, Wilson M, Krousel-Wood M. Using Community Feedback to Inform Strategies for Inclusive Participation in Research: Lessons Learned From the Louisiana Community Engagement Alliance (LA-CEAL). Am J Public Health 2024; 114:S29-S32. [PMID: 37944099 PMCID: PMC10785181 DOI: 10.2105/ajph.2023.307457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Leslie S Craig
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Daniel F Sarpong
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Erin M Peacock
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Shearon Roberts
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Katherine P Theall
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - LaKeisha Williams
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Sara Al-Dahir
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Terry C Davis
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Connie L Arnold
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Allie Williams
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Tynesia Fields
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Michelle Wilson
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
| | - Marie Krousel-Wood
- Leslie S. Craig, Erin M. Peacock, Michelle Wilson, and Marie Krousel-Wood are with Tulane University, School of Medicine, Department of Medicine, Center for Health Outcomes, Implementation and Community-Engaged Science, New Orleans, LA. Daniel F. Sarpong, LaKeisha Williams, Sara Al-Dahir, and Tynesia Fields are with Xavier University of Louisiana, College of Pharmacy, New Orleans. Shearon Roberts is with Xavier University of Louisiana, Department of Mass Communication, New Orleans. Katherine P. Theall and Allie Williams are with Tulane University, School of Public Health and Tropical Medicine, New Orleans. Terry C. Davis and Connie L. Arnold are with Louisiana State University Health Sciences Center‒Shreveport, Shreveport, LA
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Hassani M, De Haro C, Flores L, Emish M, Kim S, Kelani Z, Ugarte DA, Hightow-Weidman L, Castel A, Li X, Theall KP, Young S. Exploring mobility data for enhancing HIV care engagement in Black/African American and Hispanic/Latinx individuals: a longitudinal observational study protocol. BMJ Open 2023; 13:e079900. [PMID: 38101845 PMCID: PMC10729277 DOI: 10.1136/bmjopen-2023-079900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Increasing engagement in HIV care among people living with HIV, especially those from Black/African American and Hispanic/Latinx communities, is an urgent need. Mobility data that measure individuals' movements over time in combination with sociostructural data (eg, crime, census) can potentially identify barriers and facilitators to HIV care engagement and can enhance public health surveillance and inform interventions. METHODS AND ANALYSIS The proposed work is a longitudinal observational cohort study aiming to enrol 400 Black/African American and Hispanic/Latinx individuals living with HIV in areas of the USA with high prevalence rates of HIV. Each participant will be asked to share at least 14 consecutive days of mobility data per month through the study app for 1 year and complete surveys at five time points (baseline, 3, 6, 9 and 12 months). The study app will collect Global Positioning System (GPS) data. These GPS data will be merged with other data sets containing information related to HIV care facilities, other healthcare, business and service locations, and sociostructural data. Machine learning and deep learning models will be used for data analysis to identify contextual predictors of HIV care engagement. The study includes interviews with stakeholders to evaluate the implementation and ethical concerns of using mobility data to increase engagement in HIV care. We seek to study the relationship between mobility patterns and HIV care engagement. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Institutional Review Board of the University of California, Irvine (#20205923). Collected data will be deidentified and securely stored. Dissemination of findings will be done through presentations, posters and research papers while collaborating with other research teams.
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Affiliation(s)
- Maryam Hassani
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Cristina De Haro
- University of California Irvine, Paul Merage School of Business, Irvine, California, USA
| | - Lidia Flores
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Mohamed Emish
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Seungjun Kim
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Zeyad Kelani
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
| | - Dominic Arjuna Ugarte
- Department of Emergency Medicine, University of California Irvine, Orange, California, USA
| | | | - Amanda Castel
- Department of Epidemiology, The George Washington University, Washington, District of Columbia, USA
- The George Washington University, Milken Institute of Public Health, Washington, District of Columbia, USA
| | - Xiaoming Li
- University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Sean Young
- University of California Irvine, Donald Bren School of Information and Computer Sciences, Irvine, California, USA
- Department of Emergency Medicine, University of California Irvine, Orange, California, USA
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Goldin Evans M, Gee RE, Phillippi S, Sothern M, Theall KP, Wightkin J. Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review. Health Promot Pract 2023:15248399231211531. [PMID: 37978809 DOI: 10.1177/15248399231211531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.
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Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | | | - Stephen Phillippi
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Melinda Sothern
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Tulane University, New Orleans, LA, USA
| | - Joan Wightkin
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Skeen SJ, Tokarz S, Gasik RE, Solano CM, Smith EA, Sagoe MB, Hudson LV, Steele K, Theall KP, Clum GA. A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47151. [PMID: 37874637 PMCID: PMC10630874 DOI: 10.2196/47151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In 2020, Greater New Orleans, Louisiana, was home to 7048 people living with HIV-1083 per 100,000 residents, 2.85 times the US national rate. With Louisiana routinely ranked last in indexes of health equity, violent crime rates in Orleans Parish quintupling national averages, and in-care New Orleans people living with HIV surviving twice the US average of adverse childhood experiences, accessible, trauma-focused, evidence-based interventions (EBIs) for violence-affected people living with HIV are urgently needed. OBJECTIVE To meet this need, we adapted Living in the Face of Trauma, a well-established EBI tailored for people living with HIV, into NOLA GEM, a just-in-time adaptive mobile health (mHealth) intervention. This study aimed to culturally tailor and refine the NOLA GEM app and assess its acceptability; feasibility; and preliminary efficacy on care engagement, medication adherence, viral suppression, and mental well-being among in-care people living with HIV in Greater New Orleans. METHODS The development of NOLA GEM entailed identifying real-time tailoring variables via a geographic ecological momentary assessment (GEMA) study (n=49; aim 1) and place-based and user-centered tailoring, responsive to the unique cultural contexts of HIV survivorship in New Orleans, via formative interviews (n=12; aim 2). The iOS- and Android-enabled NOLA GEM app leverages twice-daily GEMA prompts to offer just-in-time, in-app recommendations for effective coping skills practice and app-delivered Living in the Face of Trauma session content. For aim 3, the pilot trial will enroll an analytic sample of 60 New Orleans people living with HIV individually randomized to parallel NOLA GEM (intervention) or GEMA-alone (control) arms at a 1:1 allocation for a 21-day period. Acceptability and feasibility will be assessed via enrollment, attrition, active daily use through paradata metrics, and prevalidated usability measures. At the postassessment time point, primary end points will be assessed via a range of well-validated, domain-specific scales. Care engagement and viral suppression will be assessed via past missed appointments and self-reported viral load at 30 and 90 days, respectively, and through well-demonstrated adherence self-efficacy measures. RESULTS Aims 1 and 2 have been achieved, NOLA GEM is in Beta, and all aim-3 methods have been reviewed and approved by the institutional review board of Tulane University. Recruitment was launched in July 2023, with a target date for follow-up assessment completion in December 2023. CONCLUSIONS By leveraging user-centered development and embracing principles that elevate the lived expertise of New Orleans people living with HIV, mHealth-adapted EBIs can reflect community wisdom on posttraumatic resilience. Sustainable adoption of the NOLA GEM app and a promising early efficacy profile will support the feasibility of a future fully powered clinical trial and potential translation to new underserved settings in service of holistic survivorship and well-being of people living with HIV. TRIAL REGISTRATION ClinicalTrials.gov NCT05784714; https://clinicaltrials.gov/ct2/show/NCT05784714. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47151.
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Affiliation(s)
- Simone J Skeen
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Center for Community-Engaged Artificial Intelligence, Tulane University, New Orleans, LA, United States
- Department of Psychology, Hunter College, City University of New York, New York, NY, United States
| | - Stephanie Tokarz
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Rayna E Gasik
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Chelsea McGettigan Solano
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Ethan A Smith
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Momi Binaifer Sagoe
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Lauryn V Hudson
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Kara Steele
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Gretchen A Clum
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Ghio M, Simpson JT, Ali A, Fleckman JM, Theall KP, Constans JI, Tatum D, McGrew PR, Duchesne J, Taghavi S. Association Between Markers of Structural Racism and Mass Shooting Events in Major US Cities. JAMA Surg 2023; 158:1032-1039. [PMID: 37466952 PMCID: PMC10357360 DOI: 10.1001/jamasurg.2023.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/22/2023] [Indexed: 07/20/2023]
Abstract
Importance The root cause of mass shooting events (MSEs) and the populations most affected by them are poorly understood. Objective To examine the association between structural racism and mass shootings in major metropolitan cities in the United States. Design, Setting, and Participants This cross-sectional study of MSEs in the 51 largest metropolitan statistical areas (MSAs) in the United States analyzes population-based data from 2015 to 2019 and the Gun Violence Archive. The data analysis was performed from February 2021 to January 2022. Exposure Shooting event where 4 or more people not including the shooter were injured or killed. Main Outcome and Measures MSE incidence and markers of structural racism from demographic data, Gini income coefficient, Black-White segregation index, and violent crime rate. Results There were 865 MSEs across all 51 MSAs from 2015 to 2019 with a total of 3968 injuries and 828 fatalities. Higher segregation index (ρ = 0.46, P = .003) was associated with MSE incidence (adjusted per 100 000 population) using Spearman ρ analysis. Percentage of the MSA population comprising Black individuals (ρ = 0.76, P < .001), children in a single-parent household (ρ = 0.44, P < .001), and violent crime rate (ρ = 0.34, P = .03) were other variables associated with MSEs. On linear regression, structural racism, as measured by percentage of the MSA population comprising Black individuals, was associated with MSEs (β = 0.10; 95% CI, 0.05 to 0.14; P < .001). Segregation index (β = 0.02, 95% CI, -0.03 to 0.06; P = .53), children in a single-parent household (β = -0.04, 95% CI, -0.11 to 0.04; P = .28), and Gini income coefficient (β = -1.02; 95% CI, -11.97 to 9.93; P = .93) were not associated with MSEs on linear regression. Conclusions and Relevance This study found that major US cities with higher populations of Black individuals are more likely to be affected by MSEs, suggesting that structural racism may have a role in their incidence. Public health initiatives aiming to prevent MSEs should target factors associated with structural racism to address gun violence.
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Affiliation(s)
- Michael Ghio
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - John Tyler Simpson
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ayman Ali
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Julia M. Fleckman
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katherine P. Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Joseph I. Constans
- Tulane University School of Science & Engineering, New Orleans, Louisiana
| | - Danielle Tatum
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Patrick R. McGrew
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Juan Duchesne
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
- University Medical Center, New Orleans, Louisiana
| | - Sharven Taghavi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
- University Medical Center, New Orleans, Louisiana
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Craig LS, Sarpong DF, Peacock EM, Theall KP, Williams L, Al-Dahir S, Davis TC, Arnold CL, Williams A, Fields T, Wilson M, Krousel-Wood M. Clinical trial participation among underserved communities: Insights from the Louisiana Community Engagement Alliance. Am J Med Sci 2023; 366:254-262. [PMID: 37517691 PMCID: PMC10962264 DOI: 10.1016/j.amjms.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Diverse, equitable and inclusive participation in clinical research is needed to ensure evidence-based clinical practice and lessen disparities in health outcomes. Yet, clinical trial participation remains critically low in minoritized communities, particularly among Blacks. The Louisiana Community Engagement Alliance against COVID-19 Disparities (LA-CEAL) was launched in response to the disproportionate impact of COVID-19 on Black Louisianans to understand community barriers and preferences and increase inclusive participation in research. This study aims to understand perceptions regarding COVID-19 trial participation among underrepresented Louisianans. METHODS A rapid assessment integrating cross-sectional, surveys among federally qualified health center (FQHC) patients and community residents, and focus group discussions (FGDs) from community representatives was conducted in 2020-2021. Factors and perceptions underlying trial participation were identified using logistic regression models and thematic analyses, respectively. RESULTS Quantitative findings (FQHC: N=908, mean age=46.6 years, 66.4% Black; community: N=504, mean age=54.2 years, 93.7% Black) indicated that 0.9% and 3.6%, respectively, ever participated in a COVID-19 trial. Doctors/Healthcare providers were most trusted (FQHC=55.1%; community=59.3%) sources of information about trials. Advancing age was associated with increased odds of being very willing to participate (ORFQHC=1.03, 95% CI 1.02-1.05; ORCommunity=1.02, 95% CI 1.00-1.04). Qualitative data (6 FGDs, 29 attendees) revealed limited awareness, experimentation/exploitation-based fears, and minimal racial/ethnic representation among trialists as barriers to participation. CONCLUSION COVID-19 trial participation rates were low in our sample. Altruism was a key facilitator to participation; fear, mistrust, and low awareness were predominant barriers. Community-centered approaches, engaging informed providers and trusted community members, may facilitate inclusive trial participation.
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Affiliation(s)
- Leslie S Craig
- Tulane University, School of Medicine, New Orleans, LA, USA
| | - Daniel F Sarpong
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA; Yale School of Medicine, General Internal Medicine, Office of Health Equity Research
| | - Erin M Peacock
- Tulane University, School of Medicine, New Orleans, LA, USA
| | - Katherine P Theall
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - LaKeisha Williams
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | - Sara Al-Dahir
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | - Terry C Davis
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Connie L Arnold
- Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Allie Williams
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Tynesia Fields
- Xavier University of Louisiana, College of Pharmacy, New Orleans, LA, USA
| | | | - Marie Krousel-Wood
- Tulane University, School of Medicine, New Orleans, LA, USA; Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
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Stojanovski K, King EJ, O'Connell S, Gallagher KS, Theall KP, Geronimus AT. Spiraling Risk: Visualizing the multilevel factors that socially pattern HIV risk among gay, bisexual & other men who have sex with men using Complex Systems Theory. Curr HIV/AIDS Rep 2023; 20:206-217. [PMID: 37486568 PMCID: PMC10403445 DOI: 10.1007/s11904-023-00664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE OF REVIEW Global disparities in HIV infection, particularly among gay, bisexual, and other men who have sex with men (GBMSM), indicate the importance of exploring the multi-level processes that shape HIV's spread. We used Complex Systems Theory and the PRISMA guidelines to conduct a systematic review of 63 global reviews to understand how HIV is socially patterned among GBMSM. The purpose was to conduct a thematic analysis of the reviews to (1) synthesize the multi-level risk factors of HIV risk, (2) categorize risk across the socioecological model, and (3) develop a conceptual model that visualizes the interrelated factors that shape GBMSMS's HIV "risk." RECENT FINDINGS We included 49 studies of high and moderate quality studies. Results indicated that GBMSM's HIV risk stems from the individual, interpersonal, and structural levels of the socioecological model. We identified a few themes that shape GBMSM's risk of HIV infection related to biomedical prevention methods; sexual and sex-seeking behaviors; behavioral prevention methods; individual-level characteristics and syndemic infections; lived experiences and interpersonal relationships; country-level income; country-level HIV prevalence; and structural stigma. The multi-level factors, in tandem, serve to perpetuate GBMSM's risk of HIV infection globally. The amalgamation of our thematic analyses from our systematic reviews of reviews suggests that the risk of HIV infection operates in an emergent, dynamic, and complex nature across multiple levels of the socioecological model. Applying complex systems theory indicates how multilevel factors create a dynamic and reinforcing system of HIV risk among GBMSM.
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Affiliation(s)
- K Stojanovski
- Department of Social, Behavioral and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, USA.
| | - E J King
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
| | - S O'Connell
- Department of Epidemiology, Tulane School of Public Health & Tropical Medicine, New Orleans, USA
| | - K S Gallagher
- Department of Health Policy and Management, Tulane School of Public Health & Tropical Medicine, New Orleans, USA
| | - K P Theall
- Department of Social, Behavioral and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, USA
- Department of Epidemiology, Tulane School of Public Health & Tropical Medicine, New Orleans, USA
| | - A T Geronimus
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
- Institute for Social Research, University of Michigan, Ann Arbor, USA
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Craig LS, Cunningham-Myrie CA, Theall KP, Gustat J, Hernandez JH, Hotchkiss DR. Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways. Front Med (Lausanne) 2023; 10:1094280. [PMID: 37332764 PMCID: PMC10272613 DOI: 10.3389/fmed.2023.1094280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Multimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity-HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use. Materials and methods Latent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 (N = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity-HRQoL relationship. Results LCA revealed four profiles, including a Relatively Healthy class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Compared to the Relatively Healthy class, Vascular-Inflammatory class membership was associated with lower physical functioning (β = -5.5; p < 0.001); membership in Vascular-Inflammatory (β = -1.7; p < 0.05), and Respiratory (β = -2.5; p < 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for Vascular-Inflammatory (p < 0.05) and Respiratory (p < 0.05) classes. Conclusion Specific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services.
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Affiliation(s)
- Leslie S. Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States
| | | | - Katherine P. Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Julie H. Hernandez
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - David R. Hotchkiss
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Cornfield J, Odinga H, Kermani J, Theall KP, Chaparro MP. Enablers and Barriers of Community Garden Use in New Orleans, Louisiana: An Environmental Assessment and Qualitative Analysis. Am J Health Promot 2023; 37:356-365. [PMID: 36202219 DOI: 10.1177/08901171221131710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To explore factors associated with community garden use. APPROACH Environmental assessment of community gardens and semi-structured interviews. SETTING New Orleans, Louisiana. PARTICIPANTS 10 community gardens (environmental assessment), 20 community members (including garden users and non-users) and garden administrators (qualitative interviews). METHOD Gardens were assessed based on (1) accessibility, (2) information, (3) design, (4) cleanliness, (5) walkability, (6) parking, and (7) noise. Semi-structured interviews took place over Zoom; transcribed interviews were analyzed using thematic analysis. RESULTS Gardens assessed in the environmental assessment ranked high in design and cleanliness but low on accessibility and information availability. Salient themes from the qualitative interviews include skill-building, access to fresh foods, and increased social engagement as enablers of community garden participation, with availability of information and time as both potential enablers of, or barriers to, participation. Community members perceived that gardens could increase fresh food access, while administrators believed that it is not possible for community gardens to produce enough food to create community-wide impact, highlighting instead the importance of the social aspects of the garden as beneficial for health. CONCLUSION Community gardens should improve garden physical accessibility and information availability to incentivize use. Community gardens are valued as means for skill-building and social engagement. Future research should prioritize investigating the association between the social aspects of participating in community gardens and health outcomes.
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Affiliation(s)
- Julie Cornfield
- School of Public Health and Tropical Medicine, Bachelor of Science in Public Health (BSPH) Program, New Orleans, LA, USA
| | - Harmonii Odinga
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, 25812Tulane University, New Orleans, LA, USA
| | - Jaleh Kermani
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, 25812Tulane University, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, 25812Tulane University, New Orleans, LA, USA
- Department of Epidemiology, School of Public Health and Tropical Medicine, 25812Tulane University, New Orleans, LA, USA
| | - M Pia Chaparro
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, 25812Tulane University, New Orleans, LA, USA
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McKinley CE, Saltzman LY, Theall KP. Centering Historical Oppression in Prevention Research with Indigenous Peoples: Differentiating Substance Use, Mental Health, Family, and Community Outcomes. J Soc Serv Res 2023; 49:133-146. [PMID: 37808249 PMCID: PMC10554570 DOI: 10.1080/01488376.2023.2178596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
The purpose of this pilot study was to understand how historical oppression relates to changes in outcomes for people who participate in the culturally grounded Weaving Healthy Families (WHF) program (i.e., alcohol and drug use, symptoms of anxiety, parenting practices, and communal mastery [CM]). This nonexperimental and longitudinal design used repeated measures regression analysis and generalized estimating equations (GEE) to examine postintervention changes according to reported levels of historical oppression among 24 participants in eight families. How do postintervention changes differ for WHF participants reporting lower and higher levels of historical oppression? Results indicated that participants reporting lower historic oppression reported greater postintervention improvements as indicated by declines in alcohol use, anxiety, and poor parental monitoring. All participants reported increases in CM, regardless of the level of historical oppression. Given historical oppression drives psychosocial conditions, such as substance abuse, mental health, and family challenges, settler colonial oppression must be addressed within social service interventions. Social service providers must work redress historical oppression rather than replicate them. The WHF program holds promise to center structural determinants in social service programs. Future inquiries assessing longitudinal changes in perceptions of historical oppression change and how they are associated with psychosocial outcomes are needed.
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Affiliation(s)
| | - Leia Y. Saltzman
- School of Social Work, Tulane University, New Orleans, Louisiana, USA
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Gill A, Felker-Kantor E, Cunningham-Myrie C, Greene LG, Lyew-Ayee P, Atkinson U, Abel W, Anderson SG, Theall KP. Neighborhoods and adolescent polysubstance use in Jamaica. PeerJ 2023; 11:e14297. [PMID: 36815978 PMCID: PMC9933737 DOI: 10.7717/peerj.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 10/03/2022] [Indexed: 02/15/2023] Open
Abstract
Background The purpose of this study was to identify latent classes of polysubstance use among adolescents in Jamaica and the role of neighborhood factors in the association with polysubstance use class membership. Methods This secondary analysis utilized a national cross-sectional household drug use survey conducted across 357 households in Jamaica (April 2016-July 2016) among a total of 4,625 individuals. A total of 750 adolescents (11-17 years) were included in this analysis. Latent class analysis (LCA) was conducted to identify polysubstance use patterns as well as latent neighborhood constructs. Neighborhood factors included social disorganization, concentrated disadvantage, community resources, community violence, and police station concentration. Multinomial regression analysis was implemented to evaluate the association between polysubstance use class membership and latent classes of neighborhood factors. Result The prevalence of lifetime polysubstance use was 27.56%. Four classes of polysubstance use were identified by comparing a series of five class models. The Bootstrap Likelihood Ratio Test (BLRT) indicated a good fit for the four-class model (<0.001). The prevalence of alcohol latent classes was: (1) heavy alcohol users and experimental smokers (Class I) (15.20%), (2) most hazardous polysubstance users (Class II) (5.33%), (3) heavy smokers and moderate alcohol users (Class III) (7.07%), and (4) experimental alcohol users (Class IV) (72.44%). Three classes of neighborhoods were identified by comparing a series of four-class models. The prevalence of the neighborhood classes was: (1) low social disorganization and disadvantage (Class I) (58.93%), (2) high social disorganization and moderate disadvantage (Class II) (10.93%), and (3) high social disorganization related to perceived drug use and disadvantage (Class III) (30.13%). The BLRT indicated a good fit for the three-class model (p = < 0.004). Multinomial regression analysis indicated that adolescents living in neighborhoods with high disorder and moderate disadvantage (Class II) were 2.43 times (odds ratio (OR)) = 2.43, confidence interval (CI)) = 1.30-4.56) more likely to be heavy alcohol users and experimental smokers (Class I) compared to experimental alcohol users, adjusting for sex, age, ethnicity, religion, and income. Class II of neighborhood classes presented with the highest levels of community violence (100%), perceived disorder crime (64.6%), police station concentration (6.7%), and community resources (low resources is 87.6%), while the concentrated disadvantage was moderate (14.8%). Conclusions Alcohol polysubstance use latent classes were identified among youth in this context. Neighborhoods with high disorder and moderate disadvantage (Class II) were associated with a higher likelihood of polysubstance use. The role of neighborhood conditions in shaping adolescent polysubstance use should be considered in policy, prevention, and treatment interventions.
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Affiliation(s)
- Amrita Gill
- Department of Social, Behavioural and Population Sciences, Tulane University, New Orleans, LA, United States of America
| | - Erica Felker-Kantor
- Department of Social, Behavioural and Population Sciences, Tulane University, New Orleans, LA, United States of America
| | - Colette Cunningham-Myrie
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Lisa-Gaye Greene
- Mona Geoinformatics Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Parris Lyew-Ayee
- Mona Geoinformatics Institute, University of the West Indies, Mona, Kingston, Jamaica
| | - Uki Atkinson
- Ministry of Health and Wellness, National Council on Drug Abuse, Kingston, Jamaica
| | - Wendel Abel
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - Simon G. Anderson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom,The George Alleyne Chronic Disease Research Centre, Caribbean Institute of Health Research, University of the West Indies, Cave Hill, Barbados
| | - Katherine P. Theall
- Department of Social, Behavioural and Population Sciences, Tulane University, New Orleans, LA, United States of America,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
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18
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Jahn JL, Wallace M, Theall KP, Hardeman RR. Neighborhood Proactive Policing and Racial Inequities in Preterm Birth in New Orleans, 2018‒2019. Am J Public Health 2023; 113:S21-S28. [PMID: 36696607 PMCID: PMC9877384 DOI: 10.2105/ajph.2022.307079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/26/2023]
Abstract
Objectives. To measure neighborhood exposure to proactive policing as a manifestation of structural racism and its association with preterm birth. Methods. We linked all birth records in New Orleans, Louisiana (n = 9102), with annual census tract rates of proactive police stops using data from the New Orleans Police Department (2018-2019). We fit multilevel Poisson models predicting preterm birth across quintiles of stop rates, controlling for several individual- and tract-level covariates. Results. Nearly 20% of Black versus 8% of White birthing people lived in neighborhoods with the highest rates of proactive police stops. Fully adjusted models among Black birthing people suggest the prevalence of preterm birth in the neighborhoods with the highest proactive policing rates was 1.41 times that of neighborhoods with the lowest rates (95% confidence interval = 1.04, 1.93), but associations among White birthing people were not statistically significant. Conclusions. Taken together with previous research, high rates of proactive policing likely contribute to Black‒White inequities in reproductive health. Public Health Implications. Proactive policing is widely implemented to deter violence, but alternative strategies without police should be considered to prevent potential adverse health consequences. (Am J Public Health. 2023;113(S1):S21-S28. https://doi.org/10.2105/AJPH.2022.307079).
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Affiliation(s)
- Jaquelyn L Jahn
- Jaquelyn L. Jahn is with The Ubuntu Center on Racism, Global Movements, and Population Health Equity at Drexel University Dornsife School of Public Health, Philadelphia, PA. Maeve Wallace and Katherine P. Theall are with the Department of Social, Behavioral, and Population Science and the Mary Amelia Center for Women's Health Equity Research at the Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Rachel R. Hardeman is with the Division of Health Policy and Management, the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health, as well as the Minnesota Population Center, Minneapolis
| | - Maeve Wallace
- Jaquelyn L. Jahn is with The Ubuntu Center on Racism, Global Movements, and Population Health Equity at Drexel University Dornsife School of Public Health, Philadelphia, PA. Maeve Wallace and Katherine P. Theall are with the Department of Social, Behavioral, and Population Science and the Mary Amelia Center for Women's Health Equity Research at the Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Rachel R. Hardeman is with the Division of Health Policy and Management, the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health, as well as the Minnesota Population Center, Minneapolis
| | - Katherine P Theall
- Jaquelyn L. Jahn is with The Ubuntu Center on Racism, Global Movements, and Population Health Equity at Drexel University Dornsife School of Public Health, Philadelphia, PA. Maeve Wallace and Katherine P. Theall are with the Department of Social, Behavioral, and Population Science and the Mary Amelia Center for Women's Health Equity Research at the Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Rachel R. Hardeman is with the Division of Health Policy and Management, the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health, as well as the Minnesota Population Center, Minneapolis
| | - Rachel R Hardeman
- Jaquelyn L. Jahn is with The Ubuntu Center on Racism, Global Movements, and Population Health Equity at Drexel University Dornsife School of Public Health, Philadelphia, PA. Maeve Wallace and Katherine P. Theall are with the Department of Social, Behavioral, and Population Science and the Mary Amelia Center for Women's Health Equity Research at the Tulane University School of Public Health and Tropical Medicine, New Orleans, LA. Rachel R. Hardeman is with the Division of Health Policy and Management, the Center for Antiracism Research for Health Equity at the University of Minnesota School of Public Health, as well as the Minnesota Population Center, Minneapolis
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19
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Cunningham-Myrie C, Theall KP, Younger-Coleman N, Wiggan J, McFarlane S, Francis D, Bennett N, Tulloch-Reid M, Ferguson TS, Davidson T, Govia I, Guthrie-Dixon N, Aiken W, Grant A, Webster-Kerr K, Wilks R. Who moves in vulnerable Caribbean neighborhoods? Positive deviance for physical activity: Findings from the Jamaica health and Lifestyle Survey 2017 (JHLS III). Prev Med Rep 2022; 30:101998. [PMID: 36189127 PMCID: PMC9519374 DOI: 10.1016/j.pmedr.2022.101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/26/2022] Open
Abstract
Decreased physical activity (PA) has been associated with residents living in neighborhoods perceived as being disordered or having high crime levels. What is unknown are the characteristics of individuals who engage in moderate to vigorous levels of PA (MVPA) despite living in these vulnerable neighborhoods, or who may be referred to as positive deviants (PD). We examined the factors associated with PD for PA among Jamaicans. Between 2016 and 2017 the Jamaica Health and Lifestyle Survey, a cross-sectional nationally representative survey (n = 2807), was conducted on individuals aged 15 years and older. Regression analyses were performed to identify associations with PD, defined using engagement in MVPA among persons living in vulnerable neighborhoods (N = 1710). Being female (odds ratio [OR]a = 0.64 (0.48, 0.86); p = 0.003), obese while living in an urban area (ORa = 0.39; 95 % CI = 0.26, 0.59; p < 0.0001), unemployed (ORa = 0.53; 95 % CI = 0.39, 0.73; p < 0.0001), or a student (ORa = 0.62; 95 % CI = 0.39, 0.98); p = 0.041) was associated with a significantly lower likelihood of PD, while having a personal medical history of at least one chronic disease significantly increased likelihood (ORa = 1.43; 95 % CI = 1.08, 1.90; p = 0.014). Taking a PD approach may be one angle to consider in trying to determine what is working and for whom, so that this may be harnessed in policy, prevention and intervention programming to increase PA.
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Affiliation(s)
- C Cunningham-Myrie
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | - K P Theall
- Departments of Social, Behavioral, and Population Sciences and Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - N Younger-Coleman
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - J Wiggan
- Ministry of Health & Wellness, Jamaica
| | - S McFarlane
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - D Francis
- School of Health and Human Performance, Georgia College and State University, Milledgeville, GA, USA
| | - N Bennett
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - M Tulloch-Reid
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - T S Ferguson
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | | | - I Govia
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - N Guthrie-Dixon
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - W Aiken
- Department of Surgery, Radiology, Anaesthesia & Intensive Care, University of the West Indies, Mona, Kingston, Jamaica
| | - A Grant
- Ministry of Health & Wellness, Jamaica
| | | | - R Wilks
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
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20
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Harville EW, Wallace ME, Theall KP. Eviction as a social determinant of pregnancy health: County-level eviction rates and adverse birth outcomes in the United States. Health Soc Care Community 2022; 30:e5579-e5587. [PMID: 36065610 DOI: 10.1111/hsc.13983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/10/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Access to housing is an important manifestation of structural racism and discrimination, and birth outcomes show wide health disparities, but few studies have examined eviction and birth outcomes. This multilevel study merged data from the Eviction Lab on 2015 eviction judgements and records with the National Center for Health Statistics natality dataset. The analytic sample included 2,950,965 births across 5924 counties in 45 states. Outcomes of interest were low birthweight (<2500 g; LBW) and preterm birth (<37 weeks gestation; PTB). We fit generalised estimating equations to account for clustering within county and a logistic distribution to estimate the odds ratio of LBW or PTB associated with the county-level eviction rate, with control for individual- and county-level characteristics. Results were calculated separately for non-Hispanic white, non-Hispanic black and Hispanic mothers. After adjustment for covariates, living in the counties in the highest quartile of eviction was associated with a 12-13% increased odds of LBW. The magnitude of association with PTB was not as large. Non-Hispanic black women were more likely to live in counties in the highest quartile of eviction rate (43%, vs. 23% for white women and 23% for Hispanic women) or filing rate (44%, vs. 23% for white and 18% for Hispanic). The association between eviction rate and LBW/PTB was strongest for black women, while there was essentially no association among Hispanic women. Housing instability may be a key social determinant of poor birth outcomes and should be considered in state and local maternal and child health policy and programming.
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Affiliation(s)
- Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maeve E Wallace
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Katherine P Theall
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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21
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Madkour AS, Felker-Kantor E, Welsh DA, Molina PE, Theall KP, Ferguson T. Lifetime Alcohol Use Trajectories and Health Status Among Persons Living with HIV (PLWH). J Stud Alcohol Drugs 2022; 83:695-703. [PMID: 36136440 PMCID: PMC9523753 DOI: 10.15288/jsad.21-00303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/20/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE We characterized lifetime drinking trajectories among persons living with HIV (PLWH) and examined how trajectories are related to health. METHOD Adults (ages 20-71) were recruited between 2015 and 2017 for a cohort study examining the impact of alcohol use on geriatric comorbidities in PLWH in New Orleans. The New Orleans Alcohol Use in HIV (NOAH) Study (n = 356; 68.8% male) included in-person interviews, anthropometric measurements, and biospecimen collection. Average monthly drinks per decade of life was derived from participants' reported average quantity and frequency of alcoholic beverages for each decade. Health indicators included CD4 count, viral load, health-related quality of life, frailty, comorbidities, body mass index, heavy drinking, anxiety, depression, and posttraumatic stress disorder. Participants also reported lifetime experiences with homelessness and incarceration. Latent curve modeling was applied in MPlus to derive lifetime drinking trajectories. Latent trajectory parameters were modeled as predictors of physical, mental, and social health, controlling for demographics. RESULTS Alcohol consumption increased significantly between the teen years and midlife (31-40), declining thereafter through ages 50-60. Significant interindividual differences were observed in all trajectory parameters. Persons with higher starting points of alcohol consumption showed worse mental health (depression and anxiety) and social experiences (homelessness and incarceration history) at study baseline. A steeper increase in volume of alcohol consumption after ages 10-20 was associated with worse health-related quality of life, greater frailty and comorbidities, and greater odds of current heavy drinking. CONCLUSIONS Understanding lifetime alcohol consumption patterns is important in addressing physical and mental health among adult PLWH.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Erica Felker-Kantor
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - David A. Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Patricia E. Molina
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Physiology, School of Medicine, Louisiana State University, New Orleans, Louisiana
| | - Katherine P. Theall
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Tekeda Ferguson
- Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, New Orleans, Louisiana
- Department of Epidemiology, School of Public Health, Louisiana State University, New Orleans, Louisiana
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22
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Goldin Evans M, Wallace M, Theall KP, Mahoney AM, Richardson L, Daniel CM. State-Level Recommendations to Reduce Inequities in Sexually Transmitted Infections. Womens Health Issues 2022; 32:427-430. [PMID: 35961852 DOI: 10.1016/j.whi.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/05/2022] [Accepted: 07/15/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Melissa Goldin Evans
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
| | - Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Department of Social, Behavioral, and Population Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | | | - Lisa Richardson
- Institute of Women and Ethnic Studies, New Orleans, Louisiana
| | - Clare M Daniel
- Newcomb Institute, Tulane University, New Orleans, Louisiana
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23
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Howell MP, Jones CW, Herman CA, Mayne CV, Fernandez C, Theall KP, Esteves KC, Drury SS. Impact of prenatal tobacco smoking on infant telomere length trajectory and ADHD symptoms at 18 months: a longitudinal cohort study. BMC Med 2022; 20:153. [PMID: 35477473 PMCID: PMC9047258 DOI: 10.1186/s12916-022-02340-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/14/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Prenatal maternal tobacco smoking is a predictor of child attention-deficit/hyperactivity disorder (ADHD) and is associated with offspring telomere length (TL). In this study, we examine the relationship between maternal prenatal smoking, infant TL, and maternal report of early childhood symptoms of ADHD. METHODS One-hundred and eighty-one mother-infant dyads were followed prospectively for the infant's first 18 months of life. Prenatal smoking was assessed from maternal report and medical records. TL was measured from infant buccal swab DNA obtained across the first 18 months of life. ADHD symptoms were obtained from maternal report on the Child Behavior Check List. Multiple regression models tested the relation between prenatal smoking and both ADHD symptoms and infant TL. Additional analyses tested whether the change in infant TL influenced the relation between prenatal smoking and ADHD symptoms. RESULTS Sixteen percent of mothers reported prenatal smoking. Infant TL at 4, 12, and 18 months of age were correlated. Consistent with previous cross-sectional studies linking shorter offspring TL to maternal prenatal smoking, maternal prenatal smoking predicted greater telomere shortening from four to 18 months of infant age (β = - 5.797, 95% CI [-10.207, -1.386]; p = 0.010). Maternal depression was positively associated with both prenatal smoking (odds ratio (OR): 4.614, 95% CI [1.733, 12.282]; p = 0.002) and child ADHD symptoms (β = 4.713, 95% CI [2.073, 7.354]; p = 0.0006). To prevent confounding, analyses examined the relation between TL, ADHD symptoms, and prenatal smoking only in non-depressed mothers. In non-depressed mothers, infant TL attrition across the first 18 months moderated the relation between smoking and child ADHD. CONCLUSIONS The findings extend previous studies linking prenatal smoking to shorter infant TL by providing data demonstrating the effect on TL trajectory. The relation between prenatal smoking and early infant ADHD symptoms was moderated by the change in TL. The findings provide novel initial evidence suggesting that TL dynamics are one mechanistic pathway influencing the relation between maternal prenatal smoking and ADHD.
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Affiliation(s)
- Meghan P Howell
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA
| | - Christopher W Jones
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cade A Herman
- Tufts University School of Medicine, Boston, MA, USA
| | - Celia V Mayne
- Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA
| | - Camilo Fernandez
- Department of Orthopedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA.,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Katherine P Theall
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA
| | - Kyle C Esteves
- Clinical Neuroscience Research Center, Tulane University School of Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA
| | - Stacy S Drury
- Department of Pediatrics, Tulane University School of Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA. .,Department of Psychiatry and Behavioral Science, Tulane University School of Medicine, 1430 Tulane Avenue, #8526, New Orleans, Louisiana, 70112, USA.
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24
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Theall KP, Morrison CN, Jacoby SF, Tucker A, Wallace ME, Kondo MC, Branas CC, Gustat J. Neighborhood Blighted Property Removal and 311 Calls for Non-Emergency Services: A Test of a Marker of Social Control. Geogr Anal 2022; 54:261-273. [PMID: 35873902 PMCID: PMC9292234 DOI: 10.1111/gean.12286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/12/2021] [Accepted: 02/25/2021] [Indexed: 06/15/2023]
Abstract
Many studies have demonstrated that collective efficacy is associated with positive health outcomes, lower crime, and violence in urban communities, and residents' emotional connection to their community. Remediation of blighted properties has been theoretically linked to increases in collective efficacy. The purpose of this study was to examine the impact of blighted property remediation on city non-emergency 311 calls for public incivilities and deterioration, as potential markers of collective efficacy. We used a quasi-experimental design to test whether 311 calls for service changed around remediated vacant lots in New Orleans, Louisiana, United States, many of which were left vacant after Hurricane Katrina in 2005. In six city neighborhoods eligible for blighted property remediation as part of a city program, 203 treated vacant lots were matched 1:3 without replacement to control lots that were eligible for but did not receive treatment. This yielded a total of 812 vacant lots partitioned within 48 months, or 38,976 lot-months. Controls were in the same New Orleans neighborhoods as their matched treatment lots but were at least 250 feet away to minimize contamination. Overall difference-in-differences models detected postintervention declines in calls related to dumping and garbage, and slight but mostly non-significant changes in calls between intervention and control lots in all but calls for dumping and vehicles. Blighted property remediation may have an impact on dumping and garbage, which is important. Despite being geographically specific, low-cost and longitudinal, the nature of 311 calls and structural and historic factors at play in both the concentration of vacant properties in communities and residents' willingness to call must be considered. Further analyses of changes in 311 data and additional qualitative inquiry are warranted to more fully determine the utility of these data.
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Affiliation(s)
- Katherine P. Theall
- School of Public Health and Tropical MedicineTulane UniversityNew OrleansLAUSA
| | - Christopher N. Morrison
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Sara F. Jacoby
- Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPAUSA
| | - Amber Tucker
- School of Public Health and Tropical MedicineTulane UniversityNew OrleansLAUSA
| | - Maeve E. Wallace
- School of Public Health and Tropical MedicineTulane UniversityNew OrleansLAUSA
| | | | - Charles C. Branas
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Jeanette Gustat
- School of Public Health and Tropical MedicineTulane UniversityNew OrleansLAUSA
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25
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Dyer L, Chambers BD, Crear-Perry J, Theall KP, Wallace M. The Index of Concentration at the Extremes (ICE) and Pregnancy-Associated Mortality in Louisiana, 2016-2017. Matern Child Health J 2022; 26:814-822. [PMID: 34148221 PMCID: PMC8684557 DOI: 10.1007/s10995-021-03189-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Social and contextual factors underlying the continually disproportionate and burdensome risk of adverse health outcomes experienced by Black women in the US are underexplored in the literature. The aim of this study was to use an index based on area-level population distributions of race and income to predict risk of death during pregnancy and up to 1 year postpartum among women in Louisiana. METHODS Using vital records data provided by the Louisiana Department of Health 2016-2017 (n = 125,537), a modified Poisson model was fit with generalized estimating equations to examine the risk of pregnancy-associated death associated with census tract-level values of the Index of Concentration at the Extremes (ICE)-grouped by tertile-while adjusting for both individual and tract-level confounders. RESULTS Analyses resulted in an estimated 1.73 (95% CI 1.02-2.93) times increased risk for pregnancy-associated death for those in areas which were characterized by concentrated deprivation (high proportions of Black and low-income residents) relative to those in areas of concentrated privilege (high proportions of white and high-income residents), independent of other factors. CONCLUSIONS FOR PRACTICE In addition to continuing to consider the deeply entrenched racism and economic inequality that shape the experience of pregnancy-associated death, we must also consider their synergistic effect on access to resources, maternal population health, and health inequities.
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Affiliation(s)
- Lauren Dyer
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA.
| | - Brittany D Chambers
- School of Medicine, Epidemiology and Biostatistics, University of San Francisco, 550 16th St., San Francisco, CA, 94158, USA
| | - Joia Crear-Perry
- National Birth Equity Collaborative, 4747 Earhart Blvd, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
| | - Maeve Wallace
- Department of Social, Behavioral, and Population Sciences, Mary Amelia Women's Center, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., New Orleans, LA, 70112, USA
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26
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Kondo MC, Felker-Kantor E, Wu K, Gustat J, Morrison CN, Richardson L, Branas CC, Theall KP. Stress and Distress during the COVID-19 Pandemic: The Role of Neighborhood Context. IJERPH 2022; 19:ijerph19052779. [PMID: 35270488 PMCID: PMC8910081 DOI: 10.3390/ijerph19052779] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023]
Abstract
Neighborhoods play a central role in health and mental health, particularly during disasters and crises such as the COVID-19 pandemic. We examined changes in psychological distress following the pandemic, and the potential role of neighborhood conditions among 244 residents of New Orleans, Louisiana. Using modified linear regression models, we assessed associations between neighborhood characteristics and change in psychological distress from before to during the pandemic, testing effect modification by sex and social support. While higher density of offsite alcohol outlets (β = 0.89; 95% CI: 0.52, 1.23), assault rate (β = 0.14; 95% CI: 0.03, 0.24), and walkable streets (β = 0.05; 95% CI: 0.02, 0.07) in neighborhoods were associated with an increase in distress, access to neighborhood parks (β = −0.03; 95% CI: −0.05, −0.01), collective efficacy (β = −0.23; 95% CI: −0.35, −0.09), and homicide rate (β = −1.2; 95% CI: −1.8, −0.6) were associated with reduced distress related to the pandemic. These relationships were modified by sex and social support. Findings revealed the important but complicated relationship between psychological distress and neighborhood characteristics. While a deeper understanding of the neighborhoods’ role in distress is needed, interventions that target neighborhood environments to ameliorate or prevent the residents’ distress may be important not only during crisis situations.
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Affiliation(s)
- Michelle C. Kondo
- Northern Research Station, USDA Forest Service, 100 N. 20th St, Suite 205, Philadelphia, PA 19103, USA
- Correspondence:
| | - Erica Felker-Kantor
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (E.F.-K.); (K.W.)
| | - Kimberly Wu
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (E.F.-K.); (K.W.)
| | - Jeanette Gustat
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (J.G.); (K.P.T.)
| | - Christopher N. Morrison
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (C.N.M.); (C.C.B.)
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Lisa Richardson
- Institute of Women and Ethnic Studies, Research and Technology Foundation, Inc., 2021 Lakeshore Drive, Suite 220, New Orleans, LA 70112, USA;
| | - Charles C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA; (C.N.M.); (C.C.B.)
| | - Katherine P. Theall
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; (J.G.); (K.P.T.)
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Abstract
The disproportionate rates of police surveillance and encounters in many communities in the US may be contributing to inequities in health and violence. Frequent policing in communities, which may often also be aggressive policing, has been associated with diminished health and well-being. This study adds to the growing body of research on this issue by examining the relationships between neighborhood police stop-and-frisk encounters and both health outcomes and violence rates in New Orleans, Louisiana, in an ecological, cross-sectional study using local police report, Centers for Disease Control and Prevention, and census data. The average rate of police stop-and-frisk encounters was more than three times higher for Black adults compared with their White counterparts. Even after we accounted for concentrated disadvantage (a high percentage of residents of lower socioeconomic status) and residential racial and income segregation, neighborhoods with higher rates of encounters had significantly higher prevalence rates of smoking, physical inactivity, and poor physical health, and they experienced significantly more violent crime (18.35 more per 1,000) and domestic violence (49.91 more per 1,000) events than neighborhoods with lower levels of police encounters. There is a need for strengthened policy focused on the relationship between frequent policing and health and violence outcomes.
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Duncan DT, Callander D, Bowleg L, Park SH, Brinkley-Rubinstein L, Theall KP, Hickson DA. Intersectional analysis of life stress, incarceration and sexual health risk practices among cisgender Black gay, bisexual and other men who have sex with men in the Deep South of the US: the MARI Study. Sex Health 2021; 17:38-44. [PMID: 31972125 DOI: 10.1071/sh19062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022]
Abstract
Objectives The purpose of the present study was to examine associations between life stress and incarceration history in relation to sexual health risk practices among a sample of cisgender Black gay, bisexual and other men who have sex with men (MSM) in the Deep South. METHODS Using data from a sample of 355 cisgender Black MSM in Mississippi and Georgia, multivariable logistic regression analyses were conducted to examine associations between life stress and sexual risk practices. In addition, we assessed whether stress may interact with experiences of incarceration to influence sexual health risk practices. RESULTS After controlling for sociodemographic characteristics, stress was associated with some sexual risk practices (e.g. alcohol and drug use during sex and group sex). Further, when an interaction with incarceration was assessed, among participants who had been incarcerated, high compared with low levels of stress were associated with alcohol use during sex (adjusted odds ratio (aOR) 4.59, 95% confidence interval (CI) 2.11-9.99, P < 0.001), drug use during sex (aOR 3.92, 95% CI 1.79-8.60, P < 0.001), condomless sex with casual partners (aOR 2.83, 95% CI 1.31-6.12, P < 0.001), having six or more casual partners (aOR 2.77, 95% CI 1.09-7.06, P = 0.02) and participating in group sex (aOR 5.67, 95% CI 2.07-15.51, P < 0.001). Stress and incarceration produced a dose-response effect for each association; similar associations with stress were not observed among men who had not been incarcerated. CONCLUSIONS Among people with experiences of incarceration, there are several possible ways our findings could be applied practically, including through safer sex and stress management interventions designed specifically for Black MSM following their release.
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Affiliation(s)
- Dustin T Duncan
- Department of Population Health, NYU School of Medicine, New York, NY 10016, USA; and Present address: Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA; and Corresponding author.
| | - Denton Callander
- Department of Population Health, NYU School of Medicine, New York, NY 10016, USA
| | - Lisa Bowleg
- Department of Psychology, Columbian College of Arts and Sciences, George Washington University, Washington, DC 20052, USA
| | - Su Hyun Park
- Department of Population Health, NYU School of Medicine, New York, NY 10016, USA
| | | | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University of School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA
| | - DeMarc A Hickson
- Center for Research, Evaluation and Environmental and Policy Change, My Brother's Keeper Inc., Jackson, MS 39211, USA; and Us Helping Us, People Into Living, Washington, DC 20010, USA
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Evans MG, Fleckman J, Williams TT, Tokarz SM, Theall KP. Delivering Health Information to Parents via a Theory-Informed SMS-Based Intervention: Development and Results from a Pilot Study. Matern Child Health J 2021; 26:49-57. [PMID: 34625869 DOI: 10.1007/s10995-021-03233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Short message service (SMS), or text-based, health interventions offer a promising opportunity to deliver health education and have been shown to improve diet and exercise. However, few are theory-based or target low-income parents. This pilot study, informed by the Theory of Planned Behavior (TPB), primarily sought to determine if health education delivered via SMS was feasible and acceptable to low-income parents of young children. METHODS Using a one-group, pre- to post-test study design to assess a 12-week SMS-based health education program, parents enrolled in a health-related program at an early childhood development center for low-income families were sent three text messages per week that corresponded to a weekly diet or physical activity-related theme. Surveys assessed pre-post changes in TPB constructs and collected program feedback. RESULTS Among the 119 eligible parents invited to participate, 109 were sent all text messages for the duration of the study. Participants were mostly Black (98.9%), 25-39 years old (83.9%), female (93.8%), and in single-parent households (63.8%). More than half (n = 59) completed the pre-survey, answered a bi-directional program text, or completed the post-survey. Twelve participants completed both the pre- and post-survey and at least one bi-directional text. Post-survey results revealed that most participants liked the program design and enjoyed their experience with the program. CONCLUSIONS SMS-based interventions can simplify delivery of health information to low-income parents of young children. Although engagement was low, retention was high, and feedback was largely positive.
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Affiliation(s)
- Melissa Goldin Evans
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA.
| | - Julia Fleckman
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| | - Tylar T Williams
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA. .,Institute of Women & Ethnic Studies, New Orleans, LA, USA.
| | - Stephanie M Tokarz
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
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Zhou M, Thompson TD, Lin HY, Chen VW, Karlitz JJ, Fontham ETH, Theall KP, Zhang L, Hsieh MC, Pollack LA, Wu XC. Impact of Relative Dose Intensity of FOLFOX Adjuvant Chemotherapy on Risk of Death Among Stage III Colon Cancer Patients. Clin Colorectal Cancer 2021; 21:e62-e75. [PMID: 34756680 PMCID: PMC8971135 DOI: 10.1016/j.clcc.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/25/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The National Comprehensive Cancer Network (NCCN) guidelines have recommended tailored chemotherapy for stage III high-risk (T4 and/or N2) and low-risk (T1-T3 and N1) colon cancer since 2018. Studies have investigated the effect of relative dose intensity (RDI) of FOLFOX on stage III colon cancer survival, however, none has performed a stratified analysis by risk profiles. This study aims to identify the FOLFOX optimal RDI for high-risk and low-risk stage III colon cancer patients. METHODS Data on 407 eligible patients, diagnosed with stage III colon cancer in 2011 who received FOLFOX, were collected by 8 population-based cancer registries. Multivariable Cox model and Fine-Gray competing risks model were employed to explore Optimal RDI defined as the lowest RDI administered without significant differences in either overall or cause-specific death. RESULTS Among the 168 high-risk patients, the optimal RDI cut-off was 70% (HR = 1.59 with 95% CI: 0.69-3.66 in overall mortality; HR = 1.24 with 95% CI: 0.42-3.64 in cause-specific mortality when RDI < 70% vs. RDI ≥ 70%). Among the 239 low-risk patients, none of the evaluated cut-offs were associated with significant differences in risk of death between comparison groups. The lowest assessed RDI was 45%, HR = 0.80; 95% CI: 0.24 to 2.73 for overall mortality and HR = 0.53; 95% CI: 0.06 to 4.95 for cause-specific mortality, when RDI <45% versus RDI ≥45%. CONCLUSIONS There is no significant harm on the risk of death when reducing RDI by <30% for high-risk patients. For the low-risk patients, we found that RDI as low as 45% did not significantly affect the risk of death.
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Affiliation(s)
- Meijiao Zhou
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hui-Yi Lin
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Vivien W Chen
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Jordan J Karlitz
- Division of Gastroenterology, School of Medicine, Tulane University; Gastroenterologist Southeast Louisiana Veteran Health Care System, New Orleans, LA
| | - Elizabeth T H Fontham
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Lu Zhang
- Department of Public Health Sciences, Clemson University, Clemson, SC
| | - Mei-Chin Hsieh
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Lori A Pollack
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xiao-Cheng Wu
- Epidemiology Program, School of Public Health and Louisiana Tumor Registry, Louisiana State University Health Sciences Center, New Orleans, LA.
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Wallace ME, Vilda D, Theall KP, Stoecker C. Firearm Relinquishment Laws Associated With Substantial Reduction In Homicide Of Pregnant And Postpartum Women. Health Aff (Millwood) 2021; 40:1654-1662. [PMID: 34550804 DOI: 10.1377/hlthaff.2021.01129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Homicide is a leading cause of death among women who are pregnant and up to one year postpartum in the United States. Most incidents are perpetrated by an intimate partner with a firearm. Some states have implemented laws that prohibit firearm possession by perpetrators of domestic violence and, in some instances, include explicit statutory language mandating relinquishment of firearms once a person has become prohibited from possessing them. We examined the impact of these policies on state-level rates of homicide among pregnant and postpartum women during the period 2011-19. We found that state laws prohibiting possession of firearms and requiring relinquishment of firearms by people convicted of domestic violence-related misdemeanors were associated with substantial reductions in homicide of pregnant and postpartum women. State policy makers should consider further strengthening domestic violence-related firearm regulations and their enforcement to prevent homicide of pregnant and postpartum women.
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Affiliation(s)
- Maeve E Wallace
- Maeve E. Wallace is an assistant professor in the Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine, in New Orleans, Louisiana
| | - Dovile Vilda
- Dovile Vilda is a research assistant professor in the Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
| | - Katherine P Theall
- Katherine P. Theall is a professor in the Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health and Tropical Medicine
| | - Charles Stoecker
- Charles Stoecker is an associate professor in the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
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Dunaway LEF, Bazzano AN, Gray SA, Theall KP. Health, Neighborhoods, and School Readiness from the Parent Perspective: A Qualitative Study of Contextual and Socio-Emotional Factors. Int J Environ Res Public Health 2021; 18:ijerph18179350. [PMID: 34501939 PMCID: PMC8430681 DOI: 10.3390/ijerph18179350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/03/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
The objective of this qualitative study was to address existing gaps in the literature by gathering parent perspectives on both health and school readiness in regard to neighborhood context, specifically parents’ perceived level of neighborhood safety and support, on physical health and the behavioral and cognitive domains of school readiness. Focus groups were conducted with a total of 28 parents or caregivers whose children attended Early Head Start/Head Start Centers or who received Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services in New Orleans, Louisiana during fall 2015. Parents discussed concepts of school readiness, neighborhood, the intersection between the two, and parental stress; however, few expressed a clear connection between their concerns about safety, their own stress, and their child’s readiness for school. Disparities in both health and school readiness exist between both racial and socioeconomic groups in the United States, and this study offers a unique and enhanced understanding of the impact of non-academic factors on the well-being and development of young children.
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Affiliation(s)
- Lauren E. Futrell Dunaway
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (L.E.F.D.); (A.N.B.)
| | - Alessandra N. Bazzano
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (L.E.F.D.); (A.N.B.)
| | - Sarah A.O. Gray
- Psychology Department, School of Science and Engineering, Tulane University, New Orleans, LA 70118, USA;
| | - Katherine P. Theall
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA; (L.E.F.D.); (A.N.B.)
- Correspondence:
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Vilda D, Wallace ME, Daniel C, Evans MG, Stoecker C, Theall KP. State Abortion Policies and Maternal Death in the United States, 2015‒2018. Am J Public Health 2021; 111:1696-1704. [PMID: 34410825 PMCID: PMC8589072 DOI: 10.2105/ajph.2021.306396] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To examine associations between state-level variation in abortion-restricting policies in 2015 and total maternal mortality (TMM), maternal mortality (MM), and late maternal mortality (LMM) from 2015 to 2018 in the United States. Methods. We derived an abortion policy composite index for each state based on 8 state-level abortion-restricting policies. We fit ecological state-level generalized linear Poisson regression models with robust standard errors to estimate 4-year TMM, MM, and LMM rate ratios and 95% confidence intervals (CIs) associated with a 1-unit increase in the abortion index, adjusting for state-level covariates. Results. States with the higher score of abortion policy composite index had a 7% increase in TMM (adjusted rate ratio [ARR] = 1.07; 95% CI = 1.02, 1.12) compared with states with lower abortion policy composite index, after we adjusted for state-level covariates. Among individual abortion policies, states with a licensed physician requirement had a 51% higher TMM (ARR = 1.51; 95% CI = 1.15, 1.99) and a 35% higher MM (ARR = 1.35; 95% CI = 1.09, 1.67), and states with restrictions on Medicaid coverage of abortion care had a 29% higher TMM (ARR = 1.29; 95% CI = 1.03, 1.61). Conclusions. Restricting access to abortion care at the state level may increase the risk for TMM.
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Affiliation(s)
- Dovile Vilda
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Maeve E Wallace
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Clare Daniel
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Melissa Goldin Evans
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Charles Stoecker
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
| | - Katherine P Theall
- Dovile Vilda, Maeve E. Wallace, Melissa Goldin Evans, and Katherine P. Theall are with Mary Amelia Center for Women's Health Equity Research; Department of Social, Behavioral, and Population Sciences; Tulane University School of Public Health and Tropical Medicine; New Orleans, LA. Clare Daniel is with Newcomb Institute, Tulane University, New Orleans. Charles Stoecker is with the Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine
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Abstract
PURPOSE We examine pilot results for the culturally adapted Weaving Healthy Families (WHF) program to promote resilience and wellness while preventing substance abuse and violence among Native American (NA) families. METHODS Results were drawn from paired sample t tests and analyses of variance (ANOVA) with a convenience sample of 24 adults and adolescents from eight NA families (pretest, posttest, and, where available, 6-month postintervention). RESULTS Along with substance abuse reduction and prevention, t test results indicated reductions in (a) adult depressive symptoms and improvements in adult conflict resolution and health behaviors; (b) adolescent wellness; and (c) adult and adolescent resilience, communal mastery, social support, and sugar-sweetened beverage consumption. ANOVA tests revealed reductions in adult psychological and physical violence and improvements in adult and adolescent family resilience, family environment, and emotional regulation. CONCLUSIONS Results reveal promising preliminary results for the WHF program to promote resilience and thriving while reducing risk for substance abuse and violence in NA families.
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Affiliation(s)
| | - Katherine P. Theall
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Craig LS, Cunningham-Myrie CA, Hotchkiss DR, Hernandez JH, Gustat J, Theall KP. Social determinants of multimorbidity in Jamaica: application of latent class analysis in a cross-sectional study. BMC Public Health 2021; 21:1197. [PMID: 34162349 PMCID: PMC8220124 DOI: 10.1186/s12889-021-11225-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable disease (NCD) multimorbidity is associated with impaired functioning, lower quality of life and higher mortality. Susceptibility to accumulation of multiple NCDs is rooted in social, economic and cultural contexts, with important differences in the burden, patterns, and determinants of multimorbidity across settings. Despite high prevalence of individual NCDs within the Caribbean region, exploration of the social epidemiology of multimorbidity remains sparse. This study aimed to examine the social determinants of NCD multimorbidity in Jamaica, to better inform prevention and intervention strategies. Methods Latent class analysis (LCA) was used to examine social determinants of identified multimorbidity patterns in a sample of 2551 respondents aged 15–74 years, from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008. Multimorbidity measurement was based on self-reported presence/absence of 11 chronic conditions. Selection of social determinants of health (SDH) was informed by the World Health Organization’s Commission on SDH framework. Multinomial logistic regression models were used to estimate the association between individual-level SDH and class membership. Results Approximately one-quarter of the sample (24.05%) were multimorbid. LCA revealed four distinct profiles: a Relatively Healthy class (52.70%), with a single or no morbidity; and three additional classes, characterized by varying degrees and patterns of multimorbidity, labelled Metabolic (30.88%), Vascular-Inflammatory (12.21%), and Respiratory (4.20%). Upon controlling for all SDH (Model 3), advancing age and recent healthcare visits remained significant predictors of all three multimorbidity patterns (p < 0.001). Private insurance coverage (relative risk ratio, RRR = 0.63; p < 0.01) and higher educational attainment (RRR = 0.73; p < 0.05) were associated with lower relative risk of belonging to the Metabolic class while being female was a significant independent predictor of Vascular-Inflammatory class membership (RRR = 2.54; p < 0.001). Material circumstances, namely housing conditions and features of the physical and neighbourhood environment, were not significant predictors of any multimorbidity class. Conclusion This study provides a nuanced understanding of the social patterning of multimorbidity in Jamaica, identifying biological, health system, and structural determinants as key factors associated with specific multimorbidity profiles. Future research using longitudinal designs would aid understanding of disease trajectories and clarify the role of SDH in mitigating risk of accumulation of diseases.
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Affiliation(s)
- Leslie S Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, USA.
| | | | - David R Hotchkiss
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Julie H Hernandez
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
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Cunningham-Myrie C, Theall KP, Younger-Coleman N, Greene LG, Lyew-Ayee P, Wilks R. Associations of neighborhood physical and crime environments with obesity-related outcomes in Jamaica. PLoS One 2021; 16:e0249619. [PMID: 33819299 PMCID: PMC8021199 DOI: 10.1371/journal.pone.0249619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/22/2021] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To examine whether proximity and density of public open spaces, public parks, street connectivity, and serious and violent crimes were associated with Body Mass Index (BMI) and Waist Circumference (WC) within and across levels of urbanicity, sex and socioeconomic status (SES) in Jamaica, a small island developing state (SIDS). METHODS Secondary analysis was conducted using data from the Jamaica Health and Lifestyle Survey 2008 (JHLS II). All respondents were geocoded to area of residence in Enumeration Districts (EDs). Intraclass correlation coefficients (ICCs) were derived and multilevel mixed effects regression models applied to 2529 participants nested within 101 EDs from all 14 parishes in Jamaica. RESULTS There was significant clustering across neighborhoods for mean BMI (ICC = 4.16%) and mean WC (ICC = 4.42%). In fully adjusted models statistically significant associations included: increased mean BMI among men, with increased intersection density/ km2 (β = 0.02; 95% CI = 1.96 x10-3, 0.04, p = 0.032); increased mean WC among urban residents with increased crimes/km2/yr (β = 0.09; 95% CI = 0.03, 0.16, p<0.01) and among persons in the middle class, with further distance away from public parks (β = 0.30; 95% CI = 0.08, 0.53, p<0.01). CONCLUSIONS Neighborhood physical and crime environments were associated with obesity-related outcomes in Jamaica. Policymakers in SIDS such as Jamaica should also note the important differences by urbanicity, sex and SES in prevention efforts designed to stem the growing obesity epidemic.
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Affiliation(s)
| | - Katherine P. Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States of America
| | - Novie Younger-Coleman
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - Lisa-Gaye Greene
- Mona GeoInformatics Institute, University of the West Indies, Mona, Jamaica
| | - Parris Lyew-Ayee
- Mona GeoInformatics Institute, University of the West Indies, Mona, Jamaica
| | - Rainford Wilks
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
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Vilda D, Hardeman R, Dyer L, Theall KP, Wallace M. Structural racism, racial inequities and urban-rural differences in infant mortality in the US. J Epidemiol Community Health 2021; 75:788-793. [PMID: 33504545 PMCID: PMC8273079 DOI: 10.1136/jech-2020-214260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/15/2020] [Accepted: 01/06/2021] [Indexed: 11/13/2022]
Abstract
Background While evidence shows considerable geographic variations in county-level racial inequities in infant mortality, the role of structural racism across urban–rural lines remains unexplored. The objective of this study was to examine the associations between county-level structural racism (racial inequity in educational attainment, median household income and jail incarceration) and infant mortality and heterogeneity between urban and rural areas. Methods Using linked live birth/infant death data provided by the National Center for Health Statistics, we calculated overall and race-specific 2013–2017 5-year infant mortality rates (IMRs) per 1000 live births in every county. Racially stratified and area-stratified negative binomial regression models estimated IMR ratios and 95% CIs associated with structural racism indicators, adjusting for county-level confounders. Adjusted linear regression models estimated associations between structural racism indicators and the absolute and relative racial inequity in IMR. Results In urban counties, structural racism indicators were associated with 7%–8% higher black IMR, and an overall structural racism score was associated with 9% greater black IMR; however, these findings became insignificant when adjusting for the region. In white population, structural racism indicators and the overall structural racism score were associated with a 6% decrease in urban white IMR. Both absolute and relative racial inequity in IMR were exacerbated in urban counties with greater levels of structural racism. Conclusions Our findings highlight the complex relationship between structural racism and population health across urban–rural lines and suggest its contribution to the maintenance of health inequities in urban settings.
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Affiliation(s)
- Dovile Vilda
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Lauren Dyer
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Katherine P Theall
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maeve Wallace
- Mary Amelia Center for Women's Health Equity Research, Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Ferguson TF, Rosen E, Carr R, Brashear M, Simon L, Theall KP, Ronis MJ, Welsh DA, Molina PE. Associations of Liver Disease with Alcohol Use among People Living with HIV and the Role of Hepatitis C: The New Orleans Alcohol Use in HIV Study. Alcohol Alcohol 2020; 55:28-36. [PMID: 31812989 DOI: 10.1093/alcalc/agz089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 09/19/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
AIM This cross-sectional analysis of the New Orleans Alcohol Use in HIV (NOAH) study assesses whether current and lifetime alcohol use in people living with HIV (PLWH) are associated with greater liver disease and how hepatitis C-viral (HCV) co-infection (HIV/HCV+) modifies the association. METHODS Alcohol use was measured by Lifetime Drinking History (LDH), a 30-day Timeline Followback calendar, the Alcohol Use Disorder Identification Test, and phosphatidylethanol. Liver disease was estimated by alanine aminotransferase (ALT), aspartate aminotransferase (AST), AST platelet ratio-index (APRI), fibrosis-4 index (FIB-4) and nonalcoholic fatty liver disease-fibrosis score. Associations between alcohol consumption and liver disease were estimated with multivariable logistic regression. Models were adjusted for age, sex, body-mass index, hepatitis B and HIV viral load. RESULTS Participants (N = 353) were majority male (69%) and black (84%) with a mean age of 48.3 ± 10 years. LDH was significantly associated with advanced liver fibrosis (FIB-4 aOR = 22.22 [1.22-403.72]) only among HIV/HCV+ participants with an LDH of 100-600 kg. HIV/HCV+ participants had a higher prevalence of intermediate and advanced liver disease markers than HIV/HCV- (P < 0.0001). Advanced markers of liver disease were most strongly associated with hazardous drinking (≥40(women)/60(men) grams/day) (APRI aOR = 15.87 (3.22-78.12); FIB-4 aOR = 6.76 (1.81-7.16)) and PEth ≥400 ng/ml (APRI aOR = 17.52 (2.55-120.54); FIB-4 aOR = 17.75 (3.30-95.630). CONCLUSION Results indicate a greater association of current alcohol use with liver disease than lifetime alcohol use, which varied by HCV status. These findings stress the importance of reducing alcohol use in PLWH to decrease risk of liver disease and fibrosis.
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Affiliation(s)
- Tekeda F Ferguson
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Public Health, Department of Epidemiology, School of Public Health, 2020 Gravier Street, LEC - 3rd Floor, New Orleans, Louisiana 70112, LA, USA
| | - Erika Rosen
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Public Health, Department of Epidemiology, School of Public Health, 2020 Gravier Street, LEC - 3rd Floor, New Orleans, Louisiana 70112, LA, USA
| | - Rotonya Carr
- University of Pennsylvania, Perelman School of Medicine, Division of Gastroenterology, 421 Curie Boulevard, 907 Biomedical Research Building II/III, Philadelphia, Pennsylvania 19104, PA, USA
| | - Meghan Brashear
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - Liz Simon
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Physiology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
| | - Katherine P Theall
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Tulane University, School of Public Health and Tropical Medicine, Department of Global Community Health and Behavioral Sciences, 1440 Canal Street, Suite 2210, New Orleans, LA 70112, USA
| | - Martin J Ronis
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Pharmacology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA, and
| | - David A Welsh
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Pulmonology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
| | - Patricia E Molina
- Louisiana State University Health Sciences Center, Comprehensive Alcohol Research Center, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA.,Louisiana State University Health - New Orleans, School of Medicine, Physiology, 1901 Perdido Street, New Orleans, Louisiana 70112, LA, USA
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Broussard DL, Wallace ME, Richardson L, Theall KP. Building Governmental Public Health Capacity to Advance Health Equity: Conclusions Based on an Environmental Scan of a Local Public Health System. Health Equity 2020; 4:362-365. [PMID: 32908957 PMCID: PMC7473161 DOI: 10.1089/heq.2019.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 12/03/2022] Open
Abstract
Vast health inequities persist in cities across the United States. Although recommendations exist to guide governmental public health institutions seeking to advance population health equity, local contexts are likely to influence how these pursuits take shape. We review recommendations for pursuing equity that were developed from an environmental scan conducted in the city of New Orleans. The recommendations, which are based on perspectives provided by city and state public health leaders, leaders from other city governmental departments, and community-based health department partners, center around the enduring impact of systemic racism, working across sectors, and prioritizing community engagement.
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Affiliation(s)
- Danielle L Broussard
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Maeve E Wallace
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.,Mary Amelia Douglas-Whited Community Women's Health Education Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lisa Richardson
- Institute of Women and Ethnic Studies, New Orleans, Louisiana, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA.,Mary Amelia Douglas-Whited Community Women's Health Education Center, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Simon L, Ferguson TF, Vande Stouwe C, Brashear MM, Primeaux SD, Theall KP, Welsh DA, Molina PE. Prevalence of Insulin Resistance in Adults Living with HIV: Implications of Alcohol Use. AIDS Res Hum Retroviruses 2020; 36:742-752. [PMID: 32449647 DOI: 10.1089/aid.2020.0029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Unhealthy alcohol use is prevalent among persons living with HIV (PLWH). Aging and increased survival of PLWH on antiretroviral therapy (ART) are complicated by metabolic dysregulation and increased risk of insulin resistance (IR) and diabetes mellitus. The objective of this study was to determine the prevalence and association of IR with unhealthy alcohol use in adult in-care PLWH. A cross-sectional analysis of metabolic parameters and alcohol use characteristics was conducted in adult PLWH enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. IR was estimated using homeostatic model assessment (HOMA-IR), triglyceride index, and McAuley index and beta cell function (HOMA-β). Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT)-C, 30-day timeline followback (TLFB), lifetime drinking history, and phosphatidylethanol (PEth) measures. A total of 351 participants, with a mean age [±standard deviation (SD)] of 48.1 ± 10.4 years, were included (69.6% male). Of these, 57% had an AUDIT-C score of 4 or greater, indicating unhealthy alcohol use. Mean body mass index (BMI) was 27.2 ± 7.0 kg/m2, 36.4% met criteria for metabolic syndrome, and 14% were diagnosed with diabetes. After adjusting for education, race, BMI, smoking status, viral load, CD4 count, use of protease inhibitors, statins, or metformin; physical activity and diabetes diagnosis, HOMA-IR, and McAuley index were negatively associated with AUDIT-C, and HOMA-β cell function was negatively associated with AUDIT-C, PEth, and TLFB. Cross-sectional analysis of NOAH participants indicates that alcohol use is associated with decreased HOMA-β cell function, suggesting dysregulation of endocrine pancreatic function.
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Affiliation(s)
- Liz Simon
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Tekeda F. Ferguson
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- Department of Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Curtis Vande Stouwe
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Meghan M. Brashear
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Stefany D. Primeaux
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Katherine P. Theall
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - David A. Welsh
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- Pulmonary/Critical Care and Allergy/Immunology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Patricia E. Molina
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, Louisiana, USA
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
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Cunningham-Myrie CA, Younger NO, Theall KP, Greene LG, Lyew-Ayee P, Wilks R. Understanding neighbourhood retail food environmental mechanisms influencing BMI in the Caribbean: a multilevel analysis from the Jamaica Health and Lifestyle Survey: a cross-sectional study. BMJ Open 2020; 10:e033839. [PMID: 32830113 PMCID: PMC7445353 DOI: 10.1136/bmjopen-2019-033839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To derive estimates of the associations between measures of the retail food environments and mean body mass index (BMI) in Jamaica, a middle-income country with increasing prevalence of obesity. DESIGN Cross-sectional study. SETTING Data from the Jamaica Health and Lifestyle Survey 2008 (JHLS II), a nationally representative population-based survey that recruited persons at their homes over a 4-month period from all 14 parishes and 113 neighbourhoods defined as enumeration districts. PARTICIPANTS A subsample of 2529 participants aged 18-74 years from the JHLS II who completed interviewer-administered surveys, provided anthropometric measurements and whose addresses were geocoded. PRIMARY OUTCOME MEASURE Mean BMI, calculated as weight divided by height squared (kg/m2). RESULTS There was significant clustering across neighbourhoods for mean BMI (intraclass correlation coefficients=4.16%). Fully adjusted models revealed higher mean BMI among women, with further distance away from supermarkets (β=0.12; 95% CI 8.20×10-3, 0.24; p=0.036) and the absence of supermarkets within a 1 km buffer zone (β=1.36; 95% CI 0.20 to 2.52; p=0.022). A 10 km increase in the distance from a supermarket was associated with a 1.7 kg/m2 higher mean BMI (95% CI 0.03 to 0.32; p=0.020) in the middle class. No associations were detected with fast-food outlets or interaction by urbanicity. CONCLUSIONS Higher mean BMI in Jamaicans may be partially explained by the presence of supermarkets and markets and differ by sex and social class. National efforts to curtail obesity in middle-income countries should consider interventions focused at the neighbourhood level that target the location and density of supermarkets and markets and consider sex and social class-specific factors that may be influencing the associations.
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Affiliation(s)
| | - Novie O Younger
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - Katherine P Theall
- Global Community Health and Behavioral Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Lisa-Gaye Greene
- Mona GeoInformatics Institute, University of the West Indies, Mona, Jamaica
| | - Parris Lyew-Ayee
- Mona GeoInformatics Institute, University of the West Indies, Mona, Jamaica
| | - Rainford Wilks
- Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
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Chaparro MP, Bilfield A, Theall KP. Exposure to Neighborhood Crime Is Associated with Lower Levels of Physical Activity and Higher Obesity Risk among Adolescent Girls, but Not Boys. Child Obes 2020; 15:87-92. [PMID: 30508407 DOI: 10.1089/chi.2018.0165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Neighborhood safety has been linked to physical activity and obesity among adolescents, but few studies have used objective measures of crime or examined associations by gender. The goal of this study was to investigate if exposure to objectively measured neighborhood crime was associated with physical activity and overweight/obesity among adolescents, and if this association varied by gender. METHODS Georeferenced data from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 were linked to census tract-level data on crime reports from the Federal Bureau of Investigation, focusing on a sample of adolescents 12-20 years of age (n = 15,261). Our outcome variables were engaging in moderate-to-vigorous physical activity in the previous week and overweight/obesity status, defined as ≥85th percentile in the CDC's age- and sex-specific BMI-for-age growth charts (based on measured weight and height). Our exposure variable was neighborhood-level violent crime risk, categorized as low vs. high. Gender-stratified three-level multilevel logistic regression models were fitted adjusting for individual, family, and neighborhood-level demographic and socioeconomic variables and adolescents' diet quality. RESULTS In fully adjusted models, girls exposed to high crime neighborhoods had 26% lower odds of engaging in moderate-to-vigorous physical activity during the previous week [odds ratio (OR) = 0.74, confidence interval (95% CI) = 0.59-0.92] and 27% higher odds of being overweight/obese (OR = 1.27, 95% CI = 1.02-1.58), compared with adolescent girls exposed to low crime neighborhoods. No significant associations were found between exposure to neighborhood crime and physical activity and overweight/obesity among boys. CONCLUSION Prevention efforts focused on encouraging adolescents to be physically active need to account for gender-specific barriers to exercise outdoors.
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Affiliation(s)
- M Pia Chaparro
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Alissa Bilfield
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
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Craig LS, Hotchkiss DR, Theall KP, Cunningham-Myrie C, Hernandez JH, Gustat J. Prevalence and patterns of multimorbidity in the Jamaican population: A comparative analysis of latent variable models. PLoS One 2020; 15:e0236034. [PMID: 32702046 PMCID: PMC7377400 DOI: 10.1371/journal.pone.0236034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/26/2020] [Indexed: 01/15/2023] Open
Abstract
Background Evidence suggests that the single-disease paradigm does not accurately reflect the individual experience, with increasing prevalence of chronic disease multimorbidity, and subtle yet important differences in types of co-occurring diseases. Knowledge of multimorbidity patterns can aid clarification of individual-level burden and needs, to inform prevention and treatment strategies. This study aimed to estimate the prevalence of multimorbidity in Jamaica, identify population subgroups with similar and distinct disease profiles, and examine consistency in patterns identified across statistical techniques. Methods Latent class analysis (LCA) was used to examine multimorbidity patterns in a sample of 2,551 respondents aged 15–74 years, based on data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 and self-reported presence/absence of 11 chronic conditions. Secondary analyses compared results with patterns identified using exploratory factor analysis (EFA). Results Nearly one-quarter of the sample (24.1%) were multimorbid (i.e. had ≥2 diseases), with significantly higher burden in females compared to males (31.6% vs. 16.1%; p<0.001). LCA revealed four distinct classes, including a predominant Relatively Healthy class, comprising 52.7% of the sample, with little to no morbidity. The remaining three classes were characterized by varying degrees and patterns of multimorbidity and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Four diseases determined using physical assessments (obesity, hypertension, diabetes, hypercholesterolemia) were primary contributors to multimorbidity patterns overall. EFA identified three patterns described as “Vascular” (hypertension, obesity, hypercholesterolemia, diabetes, stroke); “Respiratory” (asthma, COPD); and “Cardio-Mental-Articular” (cardiovascular disease, arthritis, mental disorders). Conclusion This first study of multimorbidity in the Caribbean has revealed a high burden of co-existing conditions in the Jamaican population, that is predominantly borne by females. Consistency across methods supports the validity of patterns identified. Future research into the causes and consequences of multimorbidity patterns can guide development of clinical and public health strategies that allow for targeted prevention and intervention.
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Affiliation(s)
- Leslie S. Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - David R. Hotchkiss
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Katherine P. Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Colette Cunningham-Myrie
- Department of Community Health and Psychiatry, University of the West Indies, Mona, Jamaica
- * E-mail:
| | - Julie H. Hernandez
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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Ferguson TF, Beauchamp A, Rosen EM, Ray AN, Theall KP, Gilpin NW, Molina PE, Edwards S. Pilot Study of the Adaptation of an Alcohol, Tobacco, and Illicit Drug Use Intervention for Vulnerable Urban Young Adults. Front Public Health 2020; 8:314. [PMID: 32766200 PMCID: PMC7379478 DOI: 10.3389/fpubh.2020.00314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/09/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives: There is limited information about the applicability and effectiveness of tobacco and illicit drug use interventions in urban and racial/ethnic minority youth, a population with great need for prevention of alcohol and drug use. We pilot-tested the feasibility of a behavioral intervention to reduce alcohol, tobacco, and illicit drug use among urban young adults in New Orleans, Louisiana. Study Design: The 12-week intervention pilot project was developed to be implemented at a community-based social service organization that provides educational, juvenile justice-related case management, and mentoring services to youth with substance use and incarceration histories. Methods: One-hour intervention sessions included interactive discussions and lesson reviews guided by a health educator and peer facilitators. Recruitment was done by case managers. Thirty African American young adults aged 16-21 years participated between January 2016 and July 2017. Results: We were able to adapt the 14-session intervention to a 12-session, weekly curriculum that was well-received by the target population. Average rating for each session was 9.5 ± 0.3 (scale 0-10). Youth were willing to engage in the program, but retention was low. Rates of alcohol and drug use were significantly higher within our pilot population than national estimates. We found no significant decreases in self-reported alcohol, tobacco, or illicit drug use after participation in the intervention. Conclusion: Results emphasize the need to devote additional educational resources to intervention and retention factors for vulnerable youth. Individuals often experiment with drugs during adolescence; thus, this period represents a prime opportunity for education and intervention.
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Affiliation(s)
- Tekeda F. Ferguson
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Department Epidemiology, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA, United States
| | - Alaina Beauchamp
- Department Epidemiology, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA, United States
| | - Erika M. Rosen
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Department Epidemiology, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA, United States
| | - A. Nicole Ray
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Neuroscience Program, Tulane Brain Institute, Tulane University, New Orleans, LA, United States
| | - Katherine P. Theall
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Nicholas W. Gilpin
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Department of Physiology, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Patricia E. Molina
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Department of Physiology, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
| | - Scott Edwards
- Louisiana State University Health Sciences Center, Comprehensive Alcohol-HIV/AIDS Research Center, New Orleans, LA, United States
- Department of Physiology, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA, United States
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Glick JL, Lopez A, Pollock M, Theall KP. Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography. Int J Transgend Health 2020; 21:337-349. [PMID: 34993513 PMCID: PMC8726680 DOI: 10.1080/26895269.2020.1780661] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns. Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S. Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes. Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which "intersect like a star." Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping. Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.
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Affiliation(s)
- Jennifer L. Glick
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alex Lopez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Miranda Pollock
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana, USA
| | - Katherine P. Theall
- Global Community Health and Behavioral Sciences and LSUHSC Comprehensive Alcohol and HIV Research Center (CARC), Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Kajeepeta S, Theall KP, Kondo MC, Branas CC, Wallace ME, Jacoby SF, Morrison CN. The association between blighted property remediation and domestic crime by alcohol availability. Health Place 2020; 64:102364. [PMID: 32838890 PMCID: PMC7447840 DOI: 10.1016/j.healthplace.2020.102364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 01/10/2023]
Abstract
There is increasing evidence that place-based interventions reduce crime and interpersonal violence in urban settings. However, evidence concerning the impacts of these neighborhood interventions on domestic crime (crime between intimate partners, family, or household members) is inconclusive. We used data from a New Orleans, Louisiana, place-based blighted property remediation intervention to test the hypothesis that the intervention was associated with changes in domestic crime. Because there is evidence that alcohol availability is related to domestic crime, we also assessed whether this association was moderated by alcohol outlet density. We assessed overall associations using a difference-in-difference approach and assessed moderation using a triple-difference approach. The analytic sample consisted of 204 remediated lots and 612 non-remediated matched control lots over 84 months (2011-2017), for a total of 68,544 lot-months. In difference-in-differences analyses, the place-based intervention was associated with additional domestic crime incidence (β = 0.311, 95% CI: 0.016, 0.605; p = 0.039). In triple-difference analyses, on-premise bar density modified this association (β = -0.119, 95%CI: -0.147, -0.092; p < 0.001): in areas with higher bar density, increases in domestic crime were lower near remediated lots compared with control lots. Place-based interventions to reduce blighted properties may have contributed to fewer domestic crime incidents in areas with more bars.
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Affiliation(s)
- Sandhya Kajeepeta
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA.
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, LA, USA.
| | - Michelle C Kondo
- Philadelphia Field Station, Forest Service, United States Department of Agriculture, Philadelphia, PA, USA.
| | - Charles C Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Maeve E Wallace
- Department of Global Community Health and Behavioral Sciences, Tulane University, School of Public Health & Tropical Medicine, New Orleans, LA, USA.
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Christopher N Morrison
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA; Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC, Australia.
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Wallace M, Felker-Kantor E, Madkour A, Ferguson T, Welsh D, Molina P, Theall KP. Adverse Childhood Experiences, Smoking and Alcohol Use, and Allostatic Load Among People Living with HIV. AIDS Behav 2020; 24:1653-1662. [PMID: 31559525 DOI: 10.1007/s10461-019-02684-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Allostatic load is an indicator of multisystem physiologic dysregulation that may arise from prolonged or accumulated exposure to stress, including adverse childhood experiences (ACEs) and chronic stressors persisting into adulthood. People living with HIV (PLWH) may be particularly vulnerable given their high burdens of adversity across the life course. Using data from a cohort of middle aged PLWH, we examined associations between ACEs and two measures of allostatic load. In order to determine whether the negative impact of ACEs on allostatic load operates through increasing the adoption of adverse coping behaviors, we tested for mediation by smoking and alcohol use. PLWH who had experienced 4 or more ACEs had on average higher allostatic load in adulthood compared to those who experienced fewer. Neither smoking nor alcohol use mediated this relationship, however, suggesting alternative mechanisms may be at play.
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Affiliation(s)
- Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA.
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA
| | - Aubrey Madkour
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA
| | - Tekeda Ferguson
- Department of Epidemiology, Louisiana State University School of Public Health, 2020 Gravier St., 5th floor, New Orleans, LA, 70112, USA
| | - David Welsh
- Section of Pulmonary/Critical Care, Louisiana State University School of Medicine, 2020 Gravier St., 5th floor, New Orleans, LA, 70112, USA
| | - Patricia Molina
- Department of Physiology, Louisiana State University School of Medicine, 2020 Gravier St., 5th floor, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., suite 2200, New Orleans, LA, 70112, USA
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Burnette CE, Boel-Studt S, Renner LM, Figley CR, Theall KP, Miller Scarnato J, Billiot S. The Family Resilience Inventory: A Culturally Grounded Measure of Current and Family-of-Origin Protective Processes in Native American Families. Fam Process 2020; 59:695-708. [PMID: 30811593 PMCID: PMC6716378 DOI: 10.1111/famp.12423] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The purpose of this article is to introduce the Family Resilience Inventory (FRI) and present findings on initial efforts to validate this measure. The FRI is designed to assess family resilience in one's current family and in one's family of origin, enabling the assessment of family protective factors across these generations. The development of the FRI was the result of many years of ethnographic research with Southeastern Native American tribes; yet, we believe that this scale is applicable to families of various backgrounds. Items for the FRI were derived directly from thematic analysis of qualitative data with 436 participants, resulting in two 20-item scales. Due to missing data, eight cases were removed from the 127 participants across two tribes, resulting in an analytic sample size of 119. Conceptually, the FRI is comprised of two factors or scales measuring distinct dimensions of family resilience (i.e., resilience in one's current family and resilience in one's family of origin). The results of the confirmatory factor analysis supported the hypothesized two-factor structure (X2 (644) = 814.14, p = .03, X2 /df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Both the subscales and the total FRI scale (α = .92) demonstrated excellent reliability. The results also provided preliminary evidence of convergent and discriminant validity. This measure fills a gap in the absence of community-based, culturally grounded, and empirical measures of family resilience. The examination of family resilience, which may occur across generations, is an exciting new contribution of the FRI.
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Affiliation(s)
| | | | | | | | | | | | - Shanondora Billiot
- University of Illinois Champaign-Urbana School of Social Work, Champaign-Urbana, IL
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Ferguson TF, Theall KP, Brashear M, Maffei V, Beauchamp A, Siggins RW, Simon L, Mercante D, Nelson S, Welsh DA, Molina PE. Comprehensive Assessment of Alcohol Consumption in People Living with HIV (PLWH): The New Orleans Alcohol Use in HIV Study. Alcohol Clin Exp Res 2020; 44:1261-1272. [PMID: 32441814 DOI: 10.1111/acer.14336] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND High frequency of alcohol use among people living with HIV (PLWH) warrants careful assessment and screening to better understand its impact on HIV disease progression and development of comorbidities. Due to the limitations of the tools used to measure alcohol use, the links to health consequences are not fully understood. METHODS We completed a cross-sectional analysis to examine the prevalence of alcohol consumption using multiple alcohol assessment tools and their correlation and consistency in a cohort of PLWH (N = 365) enrolled in the New Orleans Alcohol Use in HIV (NOAH) Study. Alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT), timeline followback (TLFB) Calendar, lifetime drinking history, Alcohol and Drug Addiction Severity Index, and blood levels of phosphatidylethanol (PEth). Spearman's correlations were estimated for continuous measures of alcohol consumption; Wilcoxon rank-sum tests were used to compare means; and logistic regression was used to estimate odds of alcohol use by demographic characteristics. RESULTS Self-report of current alcohol use varied from 58.9 to 73.7% depending on the assessment. All the self-reported alcohol measures showed statistically significant correlations with the biological marker PEth. The highest correlation was with TLFB grams (r = 0.67, p < 0.001). Using TLFB, 73.7% of the cohort reported using alcohol in the last 30 days, and 61.6% had a positive PEth value. The prevalence of risky drinkers, meeting the TLFB > 3 (women) or >4 (men) drinks/day or>7 (women) or>14 (men) drinks/week, was 49.0%. Medium-risk drinking defined as an AUDIT score ≥ 8 was reported in 40.3%, and high-risk drinkers/probable AUD (AUDIT score ≥ 16) was met by 17.0% of the cohort. CONCLUSIONS Our results demonstrate the importance of comprehensive assessments for alcohol use, including self-report via multiple assessment tools administered by trained staff, as well as the addition of biomarkers for improved classification of subjects into different drinking categories.
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Affiliation(s)
- Tekeda F Ferguson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Katherine P Theall
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Meghan Brashear
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vincent Maffei
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Microbiology, Immunology, & Parasitology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans,, Louisiana
| | - Alaina Beauchamp
- Epidemiology, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Robert W Siggins
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Liz Simon
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Donald Mercante
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Steve Nelson
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David A Welsh
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Pulmonology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Patricia E Molina
- From the Comprehensive Alcohol-HIV/AIDS Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Madkour AS, Felker-Kantor E, Wallace M, Ferguson T, Welsh DA, Molina PE, Theall KP. Latent Alcohol Use Typologies and Health Status Among a Cohort of Adults Living with HIV. Alcohol Alcohol 2020; 54:584-592. [PMID: 31580404 DOI: 10.1093/alcalc/agz071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS To characterize latent typologies of alcohol use among persons living with human immunodeficiency virus (HIV) (PLWH) and test their relationship with physical and mental health status. METHODS Baseline data from 365 adult in-care PLWH enrolled in the New Orleans Alcohol Use in HIV study were analyzed. Indicators of current and former heavy drinking, intoxication, withdrawal and dependence symptoms, alcohol-related problems and past contact with alcohol use treatment were drawn from validated scales. Physical and mental health measures included SF-36 subscales, medication non-adherence and anxiety, depressive and post-traumatic stress disorder symptoms. Latent class analysis was conducted to characterize alcohol drinking typologies. Logistic and ordinary least-squares regression were employed to test associations between alcohol use and health status. RESULTS Four latent classes were identified: heavy drinkers (36%), former heavy drinkers (14%), heavy drinkers with problems (12%) and low-risk drinkers/abstainers (38%). Controlling for background characteristics, low-risk drinkers/abstainers showed significantly better health compared to heavy drinkers with problems across most domains. Although current and former heavy drinkers without alcohol-related problems were similar to heavy drinkers with problems in most health domains, they presented worse mental health and energy compared to low-risk drinkers/abstainers. CONCLUSIONS Heavy drinkers with alcohol-related problems evidenced the worst health status among PLWH, and should be considered for mental and physical health interventions. However, interventions to improve physical and mental health of PLWH should consider history of heavy alcohol use, as current alcohol use status alone may be insufficient for identifying groups at increased risk.
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Affiliation(s)
- Aubrey Spriggs Madkour
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Erica Felker-Kantor
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Maeve Wallace
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA
| | - Tekeda Ferguson
- Department of Epidemiology, School of Public Health, Louisiana State University, 2020 Gravier Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - David A Welsh
- Section of Pulmonary/Critical Care, School of Medicine, Louisiana State University, 1901 Perdido Street, 3rd Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Patricia E Molina
- Department of Physiology Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Katherine P Theall
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA.,Comprehensive Alcohol Research Center, School of Medicine, Louisiana State University, 1901 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
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