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Anderson AT, Mack WJ, Horiuchi SS, Paulukonis S, Zhou M, Snyder AB, Doctor JN, Kipke M, Coates T, Freed G. National Quality Indicators in Pediatric Sickle Cell Anemia. Pediatrics 2024; 153:e2022060804. [PMID: 38444343 PMCID: PMC10982541 DOI: 10.1542/peds.2022-060804] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE To assess nationally endorsed claims-based quality measures in pediatric sickle cell anemia (SCA). METHODS Using data from the Sickle Cell Data Collection programs in California and Georgia from 2010 to 2019, we evaluated 2 quality measures in individuals with hemoglobin S/S or S/β-zero thalassemia: (1) the proportion of patients aged 3 months to 5 years who were dispensed antibiotic prophylaxis for at least 300 days within each measurement year and (2) the proportion of patients aged 2 to 15 years who received at least 1 transcranial Doppler ultrasound (TCD) within each measurement year. We then evaluated differences by year and tested whether performance on quality measures differed according to demographic and clinical factors. RESULTS Only 22.2% of those in California and 15.5% in Georgia met or exceeded the quality measure for antibiotic prophylaxis, with increased odds associated with rural residence in Georgia (odds ratio 1.61; 95% confidence interval 1.21-2.14) compared with urban residence and a trend toward increased odds associated with a pediatric hematologist prescriber (odds ratio 1.28; 95% confidence interval 0.97, 1.69) compared with a general pediatrician. Approximately one-half of the sample received an annual assessment of stroke risk using TCD (47.4% in California and 52.7% in Georgia), with increased odds each additional year in both states and among younger children. CONCLUSIONS The rates of receipt of recommended antibiotic prophylaxis and annual TCD were low in this sample of children with SCA. These evidence-based quality measures can be tracked over time to help identify policies and practices that maximize survival in SCA.
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Affiliation(s)
- Ashaunta T. Anderson
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Wendy J. Mack
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | | | - Mei Zhou
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Angela B. Snyder
- Georgia Health Policy Center, Georgia State University, Atlanta, Georgia
| | - Jason N. Doctor
- Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, Los Angeles, California
| | - Michele Kipke
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Thomas Coates
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California
- Children’s Hospital Los Angeles, Los Angeles, California
| | - Gary Freed
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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Gorsky KG, Butala S, House M, Moon C, Calvetti S, Khando T, Kipke M, Lakshmanan A. Uncertainty and the NICU Experience: A Qualitative Evaluation of Family and Provider Perspectives. Children (Basel) 2023; 10:1745. [PMID: 38002836 PMCID: PMC10670907 DOI: 10.3390/children10111745] [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] [Received: 08/31/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023]
Abstract
There is limited information regarding caregiver and provider perspectives on uncertainty across the continuum of the neonatal intensive care unit (NICU) experience. Open-ended semi-structured interviews were conducted with providers and English- and Spanish-speaking caregivers of infants with a history of admission to a quaternary safety-net NICU. Major themes were generated using inductive-deductive thematic analysis. Seventy-six individuals participated in the study: 47 caregivers and 29 providers. The median gestational age of the infants was 29 weeks and 85% were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm. Most providers were neonatologists (37%) and nurses (27%) and more than half had over ten years of experience. A conceptual model of caregiver uncertainty was developed and key domains included drivers of uncertainty and its impact, and factors influencing coping and adaptation. Our analysis found a positive association between caregiver information gathering, clinical continuity, support systems, maternal mental health supports, and witnessing a child's progress and the development of adjustment to chronic uncertainty. These results suggest key areas for intervention that can promote parental adaptation to the uncertainty inherent in the NICU experience.
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Affiliation(s)
- Katharine Griffin Gorsky
- Division of Neonatology, San Francisco School of Medicine, University of California, San Francisco, CA 94158, USA;
| | - Saloni Butala
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- School of Medicine, WesternU College of Osteopathic Medicine of the Pacific, Pomona, CA 91766, USA
| | - Madison House
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- School of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Chelsea Moon
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- School of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Sam Calvetti
- Community Health Outcome Intervention Research, Children’s Hospital, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Tenzin Khando
- Life Course Intervention Research Network, University of California, Los Angeles, CA 94158, USA;
| | - Michele Kipke
- School of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA; (S.B.); (M.H.)
- Department of Health Systems Science, Bernard J. Tyson School of Medicine, Pasadena, CA 91101, USA
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3
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Javanbakht M, Khan L, Mustanski B, Shoptaw S, Baum MK, Mehta SH, Kirk GD, Lai S, Moore R, Milloy MJ, Kipke M, Hayashi K, DeBeck K, Siminski S, White LM, Gorbach P. Substance use and other factors associated with COVID-19 vaccine uptake among people at risk for or living with HIV: Findings from the C3PNO consortium. Prev Med Rep 2023; 35:102300. [PMID: 37455759 PMCID: PMC10289823 DOI: 10.1016/j.pmedr.2023.102300] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
Objective We describe the prevalence of COVID-19 vaccine uptake, substance use, and other factors associated with vaccine hesitancy among participants from nine North American cohort studies following a diverse group of individuals at risk for or living with HIV. Methods Between May 2021 and January 2022, participants completed a survey related to COVID-19 vaccination. Participants included those with and without substance use. Those responding as 'no' or 'undecided' to the question "Do you plan on getting the COVID-19 vaccine?" were categorized as vaccine hesitant. Differences between groups were evaluated using chi-square methods and multivariable log-binomial models were used to calculate prevalence ratios (PR) of COVID-19 vaccine hesitancy with separate models for each substance. Results Among 1,696 participants, COVID-19 vaccination was deferred or declined by 16%. Vaccine hesitant participants were younger, with a greater proportion unstably housed (14.8% vs. 10.0%; p = 0.02), and not living with HIV (48.% vs. 36.6%; p <.01). Vaccine hesitant participants were also more likely to report cannabis (50.0% vs. 42.4%; p = 0.03), methamphetamine (14.0% vs. 8.2%; p <.01), or fentanyl use (5.5% vs. 2.8%; p = 0.03). Based on multivariable analyses methamphetamine or fentanyl use remained associated with COVID-19 vaccine hesitancy (Adjusted PR = 1.4; 95% CI 1.1-1.9 and Adjusted PR = 1.6; 95% CI 1.0-2.6, respectively). Conclusion As new COVID-19 vaccines and booster schedules become necessary, people who use drugs (PWUD) may remain vaccine hesitant. Strategies to engage hesitant populations such as PWUD will need to be tailored to include special types of outreach such as integration with substance use programs such as safe injection sites or recovery programs.
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Affiliation(s)
- Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lamia Khan
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Steve Shoptaw
- Department of Family Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marianna K. Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Shruti H. Mehta
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Gregory D. Kirk
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shenghan Lai
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Richard Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - M-J Milloy
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Michele Kipke
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Kora DeBeck
- School of Public Policy, Simon Fraser University, Vancouver, Canada
| | | | - Lisa M White
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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4
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Stocks JB, Calvetti S, Rosso MT, Slay L, Kipke M, Puentes M, Hightow-Weidman LB. Evaluating the Feasibility and Acceptability of a Digital Pre-Exposure Prophylaxis Navigation and Activation Intervention for Racially and Ethnically Diverse Sexual and Gender Minority Youth (PrEPresent): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e50866. [PMID: 37773616 PMCID: PMC10576232 DOI: 10.2196/50866] [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: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND To end the HIV epidemic by 2030, we must double down on efforts to tailor prevention interventions to both young men who have sex with men and transgender and nonbinary youth. There is an urgent need for interventions that specifically focus on pre-exposure prophylaxis (PrEP) uptake in sexual and gender minority youth (SGMY) populations. There are several factors that impact the ability of SGMY to successfully engage in the HIV prevention continuum, including uptake of PrEP. Patient activation, having the knowledge, skills, and self-efficacy to manage one's health, is an important indicator of willingness and ability to manage one's own health and care autonomously. Patient navigation also plays an important role in helping SGMY access PrEP and PrEP care, as navigators help guide patients through the health care system, set up medical appointments, and get financial, legal, and social support. OBJECTIVE This study aims to evaluate the feasibility and acceptability of a digital PrEP navigation and activation intervention among a racially and ethnically diverse sample of SGMY living in the Los Angeles area. METHODS In phase 1, we will conduct formative research to inform the development of PrEPresent using qualitative data from key informant interviews involving PrEP care providers and navigators and working groups with SGMY. In phase 2, we will complete 2 rounds of usability testing of PrEPresent with 8-10 SGMY assessing both the intervention content and mobile health delivery platform to ensure features are usable and content is understood. In phase 3, we will conduct a pilot randomized controlled trial to evaluate the feasibility and acceptability of PrEPresent. We will randomize, 1:1, a racially and ethnically diverse sample of 150 SGMY aged 16-26 years living in the Los Angeles area and follow participants for 6 months. RESULTS Phase 1 (formative work) was completed in April 2021. Usability testing was completed in December 2021. As of June 2023, 148 participants have been enrolled into the PrEPresent pilot randomized controlled trial (phase 3). Enrollment is expected to be completed in July 2023, with final results anticipated in December 2023. CONCLUSIONS The PrEPresent intervention aims to bridge the gaps in PrEP eligibility and PrEP uptake among racially and ethnically diverse SGMY. By facilitating the delivery of PrEP navigation and focusing on improving patient activation, the PrEPresent intervention has the potential to positively impact the PrEP uptake cascade in the HIV care continuum as well as serve as a model for the tailoring of PrEP interventions based on behavior-based qualifications for PrEP instead of generalized gender-based eligibility. TRIAL REGISTRATION ClinicalTrials.gov NCT05281393; https://clinicaltrials.gov/ct2/show/NCT05281393. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50866.
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Affiliation(s)
- Jacob B Stocks
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Sam Calvetti
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Matthew T Rosso
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
| | - Lindsay Slay
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Michele Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Manuel Puentes
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lisa B Hightow-Weidman
- Institute on Digital Health and Innovation, College of Nursing, Florida State University, Tallahassee, FL, United States
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5
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Moallef S, Genberg BL, Hayashi K, Mehta SH, Kirk GD, Choi J, DeBeck K, Kipke M, Moore RD, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Milloy MJ. Day-to-day impact of COVID-19 and other factors associated with risk of nonfatal overdose among people who use unregulated drugs in five cities in the United States and Canada. Drug Alcohol Depend 2022; 241:109633. [PMID: 36171158 PMCID: PMC9476331 DOI: 10.1016/j.drugalcdep.2022.109633] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The COVID-19 pandemic has compounded the longstanding drug poisoning crisis in Canada and the United States (US). Research is needed to understand the contributions of COVID-19 and subsequent infection control measures. We sought to estimate the prevalence of and factors associated with nonfatal overdose among participants in nine prospective cohorts of people who use unregulated drugs (PWUD) in Canada and the US. METHODS Data were derived from nine cohorts of PWUD in urban centres in Canada (Vancouver, BC) and the US (Baltimore, MD; Miami, FL; Chicago, IL; Los Angeles, CA) between May, 2020 and April, 2021. Multivariable logistic regression was used to identify factors associated with nonfatal overdose among participants who used unregulated drugs in the past month. RESULTS Among 885 participants (including 253 females), 41 (4.6 %) experienced a non-fatal overdose in the past month, and 453 (51.2 %) reported being highly impacted day-to-day by the pandemic. In multivariable analyses, people who experienced a non-fatal overdose were more likely to be female (Adjusted Odds Ratio [AOR]=2.18;95 % Confidence Interval [CI]=1.10-4.30); unstably housed/homeless (AOR=2.16;95 % CI=1.11-4.26); engaged in medications for opioid use disorder (AOR=2.45;95 % CI=1.19-4.97); and highly impacted day-to-day (AOR=2.42;95 % CI=1.22-5.10). CONCLUSION Our findings may reflect characteristics of participants who experienced a compounding of vulnerabilities during the pandemic and thus are vulnerable to overdose, including women, those unstably housed/homeless, and those who perceived their daily lives were highly impacted by the pandemic. Multi-level interventions are needed to remediate the vulnerabilities and address the main driver of poisoning crisis.
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Affiliation(s)
- Soroush Moallef
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada
| | - Becky L Genberg
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Shruti H Mehta
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gregory D Kirk
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - JinCheol Choi
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada; School of Public Policy, Simon Fraser University, Burnaby, BC, Canada
| | - Michele Kipke
- Division of Research on Children, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Richard D Moore
- Division of Infectious Diseases, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marianna K Baum
- Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Heath, University of California Los Angeles, Los Angeles, CA, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Heath, University of California Los Angeles, Los Angeles, CA, USA
| | | | - M-J Milloy
- British Columbia Centre on Substance Use, St. Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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6
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Pytell JD, Shen NM, Keruly JC, Lesko CR, Lau B, Fojo AT, Baum MK, Gorbach PM, Javanbakht M, Kipke M, Kirk GD, Mustanski B, Shoptaw S, Siminski S, Moore RD, Chander G. The relationship of alcohol and other drug use during the COVID-19 pandemic among people with or at risk of HIV; A cross-sectional survey of people enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109382. [PMID: 35331580 PMCID: PMC8891146 DOI: 10.1016/j.drugalcdep.2022.109382] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/15/2022] [Accepted: 02/26/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Alcohol use during the COVID-19 pandemic increased. People living with HIV or at risk for HIV acquisition often have psycho-social and structural barriers or co-occurring substance use making them vulnerable to the adverse effects of alcohol. We describe factors associated with alcohol use during the COVID-19 pandemic in this group. METHODS From May 2020 to February 2021, 1984 people enrolled in 6 existing cohort studies completed surveys about alcohol and other drug use during the COVID-19 pandemic. We describe the past-month prevalence of no alcohol use, low-risk use, and hazardous use. We use multinomial regression to describe factors associated with low-risk or hazardous alcohol use relative to no alcohol use. RESULTS Forty-five percent of participants reported no alcohol use, 33% low-risk use, and 22% hazardous use in the past 30 days. Cannabis and stimulant use were associated with a higher prevalence of low-risk use relative to no use. Tobacco, stimulant, cannabis use and recent overdose were associated with a higher prevalence of hazardous use relative to no use. Substance use treatment and living with HIV were associated with a lower prevalence of low-risk or hazardous use relative to no use. CONCLUSIONS Stimulant use was strongly associated with a higher prevalence of hazardous alcohol use while engagement in substance use treatment or living with HIV was associated with a lower prevalence. Ascertaining hazardous alcohol and other drug use, particularly stimulants, in clinical care could identify people at higher risk for adverse outcome and harm reduction counseling.
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Affiliation(s)
- Jarratt D Pytell
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA.
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Gregory D Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Susanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Geetanjali Chander
- Department of Medicine, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA
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7
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Lesko CR, Keruly JC, Moore RD, Shen NM, Pytell JD, Lau B, Fojo AT, Mehta SH, Kipke M, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Chander G. COVID-19 and the HIV continuum in people living with HIV enrolled in Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) cohorts. Drug Alcohol Depend 2022; 241:109355. [PMID: 35331581 PMCID: PMC8837482 DOI: 10.1016/j.drugalcdep.2022.109355] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. METHODS From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. RESULTS Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. CONCLUSIONS Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA.
| | - Jeanne C Keruly
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Richard D Moore
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Nicola M Shen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Jarratt D Pytell
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Anthony T Fojo
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
| | - Shruti H Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA
| | - Michele Kipke
- University of Southern California, Children's Hospital Los Angeles, CHL 4650 W. Sunset Blvd., Los Angeles, CA 90027, USA
| | - Marianna K Baum
- Department of Dietetics and Nutrition, Roger Stempel College of Public Health, Florida International University, 11200 SW 8 Street, AHC-5, 326, Miami, FL 33199, USA
| | - Steven Shoptaw
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Boulevard, Los Angeles, CA 90024, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing and Department of Medical Social Sciences, Northwestern University, 625 N. Michigan Ave, Chicago, IL 60611, USA
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Box 951772, CHS 41-295, Los Angeles, CA 90095-1772, USA
| | - Suzanne Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY 14226, USA
| | - Geetanjali Chander
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 1830 E. Monument St., Baltimore, MD 21287, USA
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8
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Feder KA, Choi J, Schluth CG, Hayashi K, DeBeck K, Milloy MJ, Kirk GD, Mehta SH, Kipke M, Moore RD, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Genberg BL. Factors associated with self-reported avoidance of harm reduction services during the COVID-19 pandemic by people who use drugs in five cities in the United States and Canada. Drug Alcohol Depend 2022; 241:109544. [PMID: 35779987 PMCID: PMC9225925 DOI: 10.1016/j.drugalcdep.2022.109544] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study examines individual-level factors associated with avoiding two important health services for people who use drugs-medications for treatment of opioid use disorder and syringe service programs-during the first year of the COVID-19 pandemic. METHODS Data come from two subsamples of people who use drugs who were active participants in one of nine cohort studies in Vancouver, British Columbia; Baltimore, Maryland; Los Angeles, California; Chicago, Illinois; and Miami, Florida. Participants were interviewed remotely about COVID-19-associated disruptions to healthcare. We estimated the association of demographic, social, and health factors with each outcome using logistic regression among 702 participants (medication analysis) and 304 participants (syringe service analysis.) Analyses were repeated, stratified by city of residence, to examine geographic variation in risk. RESULTS There were large differences between cities in the prevalence of avoiding picking up medications for opioid use disorder, with almost no avoidance in Vancouver (3%) and nearly universal avoidance in Los Angeles, Chicago, and Miami (>90%). After accounting for between-city differences, no individual factors were associated with avoiding picking up medications. The only factor significantly associated with avoiding syringe service programs was higher levels of self-reported worry about COVID-19. CONCLUSION During the first year of the COVID-19 pandemic, geographic differences in service and policy contexts likely influenced avoidance of health and harm reduction services by people who use drugs in the United States and Canada more than individual differences between people.
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Affiliation(s)
- Kenneth A. Feder
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States,Correspondence to: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21211, USA
| | - JinCheol Choi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Catherine G. Schluth
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Vancouver, Canada
| | - Michael-John Milloy
- British Columbia Centre on Substance Use, Vancouver, Canada,Division of Social Medicine, Department of Medicine, University of British Columbia, Columbia
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States,Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Shruti H. Mehta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
| | - Michele Kipke
- Keck School of Medicine, University of Southern California, United States
| | - Richard D. Moore
- Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Marianna K. Baum
- Stemple School of Public Health, Florida International University, United States
| | - Steven Shoptaw
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, USA
| | - Pamina M. Gorbach
- Department of Epidemiology, UCLA Fielding School of Public Health, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, United States
| | - Marjan Javanbakht
- Department of Epidemiology, Fielding School of Public Health, University of California, USA
| | | | - Becky L. Genberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States
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9
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King L, Hayashi K, Genberg B, Choi J, DeBeck K, Kirk G, Mehta SH, Kipke M, Moore RD, Baum MK, Shoptaw S, Gorbach PM, Mustanski B, Javanbakht M, Siminski S, Milloy MJ. Prevalence and correlates of stocking up on drugs during the COVID-19 pandemic: Data from the C3PNO Consortium. Drug Alcohol Depend 2022; 241:109654. [PMID: 36266158 PMCID: PMC9535877 DOI: 10.1016/j.drugalcdep.2022.109654] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data from the COVID-19 pandemic describes increases in drug use and related harms, especially fatal overdose. However, evidence is needed to better understand the pathways from pandemic-related factors to substance use behaviours. Thus, we investigated stockpiling drugs among people who use drugs (PWUD) in five cities in the United States and Canada. METHODS We used data from two waves of interviews among participants in nine prospective cohorts to estimate the prevalence and correlates of stockpiling drugs in the previous month. Longitudinal correlates were identified using bivariate and multivariate generalized linear mixed-effects modeling analyses. RESULTS From May 2020 to February 2021, we recruited 1873 individuals who completed 2242 interviews, of whom 217 (11.6%) reported stockpiling drugs in the last month at baseline. In the multivariate model, stockpiling drugs was significantly and positively associated with reporting being greatly impacted by COVID-19 (Adjusted Odds Ratio [AOR]= 1.21, 95% CI: 1.09-1.45), and at least daily use of methamphetamine (AOR = 4.67, 95% CI: 2.75-7.94) in the past month. CONCLUSIONS We observed that approximately one-in-ten participants reported stocking up on drugs during the COVID-19 pandemic. This behaviour was associated with important drug-related risk factors including high-intensity methamphetamine use. While these correlations need further inquiry, it is possible that addressing the impact of COVID-19 on vulnerable PWUD could help limit drug stockpiling, which may lower rates of high-intensity stimulant use.
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Affiliation(s)
- L. King
- British Columbia Centre for Substance Use, 400–1045 Howe Street, Vancouver, BC V6Z2A9, Canada,University of British Columbia, Faculty of Medicine, 317 - 2194 Health Sciences Mall, Vancouver V6T 1Z3, BC, Canada
| | - K. Hayashi
- British Columbia Centre for Substance Use, 400–1045 Howe Street, Vancouver, BC V6Z2A9, Canada
| | - B. Genberg
- The John Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD, United States
| | - J. Choi
- British Columbia Centre for Substance Use, 400–1045 Howe Street, Vancouver, BC V6Z2A9, Canada
| | - K. DeBeck
- British Columbia Centre for Substance Use, 400–1045 Howe Street, Vancouver, BC V6Z2A9, Canada,Simon Fraser University School of Public Policy, 8888 University Dr, Burnaby, BC, Canada, V5A 1S6
| | - G. Kirk
- The John Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD, United States
| | - SH Mehta
- The John Hopkins University, Department of Epidemiology, 615N Wolfe Dr, Baltimore, MD, United States
| | - M. Kipke
- University of Southern California Keck School of Medicine, 1975 Zonal Ave, Los Angeles, CA, United States
| | - RD Moore
- The John Hopkins University School of Medicine, 733N Broadway, Baltimore, MD, United States
| | - MK Baum
- Florida International University, Department of Dietetics and Nutrition, 1250 SW 108th Ave, Miami, FL, United States
| | - S. Shoptaw
- University of California Los Angeles, Department of Family Medicine, 100 Medical Plaza Driveway, Los Angeles, CA, United States
| | - PM Gorbach
- University of California Los Angeles, Department of Epidemiology, 10833 Le Conte Ave, Los Angeles, CA, United States
| | - B. Mustanski
- Northwestern University, Department of Medical Social Sciences, 625N Michigan Ave, Chicago, IL, United States
| | - M. Javanbakht
- University of California Los Angeles, Department of Epidemiology, 10833 Le Conte Ave, Los Angeles, CA, United States
| | - S. Siminski
- Frontier Science Foundation, 4033 Maple Road, Amherst, NY, United States
| | - M-J Milloy
- British Columbia Centre for Substance Use, 400-1045 Howe Street, Vancouver, BC V6Z2A9, Canada; University of British Columbia, Department of Medicine, 2775 Laurel Street, Vancouver, BC, Canada V5Z 1M9.
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10
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Hill BJ, Motley DN, Rosentel K, VandeVusse A, Fuller C, Bowers SM, Williams M, Kipke M, Kuhns L, Pashka N, Reisner S, DeMonte JB, Goolsby RW, Rupp BM, Slye N, Strader LC, Schneider JA, Razzano L, Garofalo R. Employment as HIV Prevention: An Employment Support Intervention for Adolescent Men Who Have Sex With Men and Adolescent Transgender Women of Color. J Acquir Immune Defic Syndr 2022; 91:31-38. [PMID: 35551157 PMCID: PMC9377485 DOI: 10.1097/qai.0000000000003020] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to adapt and pilot-test an employment support, primary HIV intervention tailored to the needs of adolescent men who have sex with men and adolescent transgender women of color. SETTING The intervention was implemented in 2 settings: controlled environment (Phase 1) and real-world community-based (Phase 2) setting in Chicago, IL. METHODS Eighty-seven adolescent men who have sex with men and adolescent transgender women of color ages 16-24 participated in Work2Prevent , a 4-session employment and HIV prevention intervention, designed to increase job-readiness and reduce HIV risk. Intervention sessions consisted of group activities: educational games, roleplaying/modeling behavior, and self-regulation exercises. Participants were assessed at baseline, postintervention, and 8-month (Phase 1) or 3-month follow-up (Phase 2). RESULTS Participants evaluated Work2Prevent as feasible and acceptable, rating intervention quality, usefulness, and satisfaction highly. Overall, 59.6% (Phase 1) and 85.0% (Phase 2) participants attended 2 or more sessions. At 8 months, Phase 1 participants reported a mean increase of 11.4 hours worked per week. Phase 2 participants reported a mean increase of 5.2 hours worked per week and an increase in job-seeking self-efficacy. Phase 2 participants also reported a decrease in transactional sex work. CONCLUSION Work2Prevent is one of the first structural primary HIV interventions to specifically focus on adolescent employment readiness. Findings suggest Work2Prevent is feasible and acceptable, improved adolescent employment outcomes, and reduced HIV risk associated with transactional sex work. Our study underscores the need for alternative pathways, such as addressing socioeconomic determinants, to prevent adolescent HIV infection.
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Affiliation(s)
- Brandon J. Hill
- Howard Brown Health, Center for Education, Research, & Advocacy, Chicago, IL
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, IL
| | - Darnell N. Motley
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Medicine, Chicago Center for HIV Elimination (CCHE), The University of Chicago, Chicago, IL
| | - Kris Rosentel
- Department of Sociology, Northwestern University, Evanston, IL
| | | | - Charlie Fuller
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Shannon M.E. Bowers
- Office for Research, Division of Biomedical Research, Northwestern University, Chicago, IL
| | - Meghan Williams
- Howard Brown Health, Center for Education, Research, & Advocacy, Chicago, IL
| | - Michele Kipke
- Division of Research on Children Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA
| | - Lisa Kuhns
- Division of Adolescent & Young Adult Medicine, Ann & Robert H Lurie Children's Hospital, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Justin B. DeMonte
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Rachel W. Goolsby
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Betty M. Rupp
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Nicole Slye
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - Lisa C. Strader
- Department of Biostatistics, Collaborative Studies Coordinating Center, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; and
| | - John A. Schneider
- Howard Brown Health, Center for Education, Research, & Advocacy, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Medicine, Chicago Center for HIV Elimination (CCHE), The University of Chicago, Chicago, IL
| | - Lisa Razzano
- Department of Research, Thresholds, Chicago, IL
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL
| | - Robert Garofalo
- Division of Adolescent & Young Adult Medicine, Ann & Robert H Lurie Children's Hospital, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
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11
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Lakshmanan A, Sunshine I, Escobar CM, Kipke M, Vanderbilt D, Friedlich PS, Mirzaian CB. Connecting to Early Intervention Services After Neonatal Intensive Care Unit Discharge in a Medicaid Sample. Acad Pediatr 2022; 22:253-262. [PMID: 34757023 PMCID: PMC8901461 DOI: 10.1016/j.acap.2021.10.006] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe caregiver perspectives regarding connecting to early intervention (EI) services after neonatal intensive care unit discharge in a Medicaid sample. METHODS Open-ended semistructured interviews and focus groups were conducted with English- or Spanish-speaking families enrolled in Medicaid in an urban high-risk infant follow-up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. RESULTS Thirty-two participants completed the study. The infant's median (interquartile range) birth weight was 1365 (969, 2800) grams; 50% were Hispanic; 31% reported living in a neighborhood with fourth quartile economic hardship. Eighty-one percent were classified as having chronic complex disease per the Pediatric Medical Complexity Algorithm and 63% had a diagnosis of developmental delay. A conceptual model was constructed and the analysis revealed major themes describing families' challenges and ideas to facilitate connection to EI. We identified subthemes related to the person in environment: health care environment/support and socio-economic resources, parent perspectives and built environment; provider level factors such as appointment scheduling, staff limitations, and parent suggestions to improve health care and service navigation, which included improved information sharing, the importance of patient advocates, video resources, early referrals to EI facilitated by the discharging hospital and system workarounds. CONCLUSIONS The results from this study may provide a granular roadmap for providers to help facilitate referrals to EI services. We identified several ideas such as using advocates and providing transitional resources, including online media, that might improve the connection to EI services.
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Affiliation(s)
- Ashwini Lakshmanan
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California (A Lakshmanam), Los Angeles, Calif; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (A Lakshmanam), Los Angeles, Calif.
| | - Isabel Sunshine
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Cindy M Escobar
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif; Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (M Kipke), Los Angeles, Calif
| | - Douglas Vanderbilt
- Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (D Vanderbilt), Los Angeles, Calif
| | - Philippe S Friedlich
- Division of Neonatal Medicine, Fetal and Neonatal Medicine Institute, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California (A Lakshmanam, I Sunshine, CM Escobar, and PS Friedlich), Los Angeles, Calif
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California (CB Mirzaian), Los Angeles, Calif
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12
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Derrick T, Mack W, Palinkas L, Kipke M, Javier JR. Evaluating an Evidence-Based Parenting Intervention Among Filipino Parents: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e21867. [PMID: 35175200 PMCID: PMC8895283 DOI: 10.2196/21867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Filipino Americans underuse mental health and preventive care services even though studies have indicated that Filipino youth experience high rates of suicidal ideation, substance abuse, and teen pregnancies, whereas adults experience immigration stress, discrimination, and depression. Evidence-based parenting interventions provided in early childhood have proven to be effective in preventing the onset and escalation of child mental health disorders. In a pilot randomized controlled trial, we found that participation in the Incredible Years Basic Parent Training Program (IY) improved parenting stress and positive parenting practices and decreased child internalizing and externalizing symptoms among Filipino families. A fully powered trial is needed to determine the efficacy of IY as a prevention program among Filipino families. OBJECTIVE The aims of this study are to describe the design and rationale of a randomized controlled trial evaluating the effects of the web-based IY program among parents recruited from multiple community-based settings and its impact on parenting practices, parenting stress, and child problem behavior among Filipino Americans and describe the impact of COVID-19 on our study protocols. METHODS This study uses a randomized controlled 2-arm individually randomized group treatment pretest-posttest design for 180 parent-child dyads. Individuals are eligible if they are ≥18 years, live in California, and have at least one Filipino child aged 8-12 years. Consenting participants are randomly allocated to receive either the 12-week IY parenting intervention (intervention arm) or American Academy of Pediatrics' Bright Future handouts and placed on a waitlist to receive IY posttrial (waitlist control arm). Primary outcomes include the Parent Practices Interview and the Parenting Stress Index. Secondary outcomes will be measured using the Child Behavior Checklist (completed by parent) and will include child internalizing and externalizing behaviors and total problems. Data are collected at baseline and 3- and 6-month follow-ups. RESULTS Changes made to the protocol owing to COVID-19 include administration of surveys remotely and implementation of the intervention on the web. The pandemic has provided an opportunity to evaluate the effectiveness of a web-based version of IY that may improve access and increase use of the intervention. Recruitment and data collection procedures are still ongoing and are expected to be completed by December 2022. CONCLUSIONS Our research will determine whether IY promotes positive parenting practices and prevents child internalizing and externalizing behaviors in healthy but high-risk populations such as Filipino families. It will also uplift cultural narratives and add to the evidence base for web-based parenting programs and their implementation in real-world settings. If found efficacious, IY has the potential to prevent behavioral health disparities in this understudied and high-risk Filipino population and can be scaled, adapted, and implemented in other at-risk racial and ethnic minority communities. TRIAL REGISTRATION ClinicalTrials.gov NCT04031170; https://clinicaltrials.gov/ct2/show/NCT04031170. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21867.
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Affiliation(s)
| | - Wendy Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lawrence Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Michele Kipke
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Division of Research on Child, Youth, and Families, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Joyce Rivera Javier
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.,Division of General Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
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13
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Gateau K, Song A, Vanderbilt DL, Gong C, Friedlich P, Kipke M, Lakshmanan A. Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study. BMC Pregnancy Childbirth 2021; 21:48. [PMID: 33435907 PMCID: PMC7802207 DOI: 10.1186/s12884-020-03536-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/08/2020] [Accepted: 12/30/2020] [Indexed: 01/02/2023] Open
Abstract
Background Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother’s mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations. Design/ methods In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models. Results One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant’s Vineland Adaptive Behavior Scales, second edition of − 9.08 (− 15.6, − 2.6) (p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of − 8.1 (− 12, − 3.9)(p < 0.01) and − 7.7 (− 12, − 3) (p = 0.01) respectively. Conclusions More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03536-0.
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Affiliation(s)
- Kameelah Gateau
- Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA
| | - Ashley Song
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Department of Preventive Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Douglas L Vanderbilt
- Section of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cynthia Gong
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Philippe Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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14
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Hidalgo MA, Layland E, Kubicek K, Kipke M. Sexual Racism, Psychological Symptoms, and Mindfulness Among Ethnically/Racially Diverse Young Men Who Have Sex with Men: a Moderation Analysis. Mindfulness (N Y) 2020; 11:452-461. [PMID: 35082927 PMCID: PMC8789003 DOI: 10.1007/s12671-019-01278-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study examined the potential moderating role of trait mindfulness on the association between perceived sexual racism and psychological symptoms among a community-based sample of ethnic/racial minority young men who have sex with men (MSM) residing in greater Los Angeles. METHODS From a cross-sectional sample of 448 participants, aged 16-24 years, survey data were analyzed to examine rates of perceived sexual racism, mindfulness, psychological symptoms, and moderation by mindfulness through various analyses, including analysis of variance and logistic regression. RESULTS Results indicated that Latino young MSM reported the lowest scores of sexual racism, and sexual racism was associated with higher odds of psychological symptoms, suicidal ideation with a plan in the past year, and self-injury in the past 3 months. The protective potential of mindfulness was suggested by its main effects on psychological symptoms; however, it only buffered the effects of sexual racism on suicidal ideation with a plan and self-injury, with marginal buffering effects on depression. CONCLUSIONS Findings underscore the potential utility of assessing sexual racism among young MSM of color, as well as the potential benefit of mindfulness approaches to buffer the effects of sexual racism on symptoms of depression. Interpretation of these findings is briefly discussed.
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Affiliation(s)
- Marco A. Hidalgo
- Division of Adolescent and Young Adult Medicine, Children’s Hospital Los Angeles, 4650 Sunset Blvd., MS#2, Los Angeles, CA 90027, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric Layland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Katrina Kubicek
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michele Kipke
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Lakshmanan A, Song AY, Flores-Fenlon N, Parti U, Vanderbilt DL, Friedlich PS, Williams R, Kipke M. Association of WIC Participation and Growth and Developmental Outcomes in High-Risk Infants. Clin Pediatr (Phila) 2020; 59:53-61. [PMID: 31672064 PMCID: PMC8345225 DOI: 10.1177/0009922819884583] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The objective of this study was to describe the association of enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), and infant growth and neurodevelopmental outcomes. Z scores and Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) and Vineland Adaptive/Behavior Scale-II (VABS-II) scores represented primary outcomes. We conducted bivariate analyses and linear regression. Children who were enrolled in WIC or WIC/SNAP had weight z scores U (95% confidence interval [CI]) that were 1.32 (0.42-2.21) or 1.19 (0.16-2.23) units higher. Enrollment in WIC or WIC/SNAP was associated with a higher score (95% CI) of 11.7 U (1.2-22.2 U) or 11.5 (0.1-22.9) for Bayley-III cognitive score and 10.1 U (1.9-19.1 U) or 10.3 (0.9-19.7) for the VABS-II composite score. These findings support increased advocacy for participation in WIC or WIC/SNAP for families with high-risk infants.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States
| | - Ashley Y. Song
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Nicole Flores-Fenlon
- USC/LAC+USC Neonatal-Perinatal Medicine Fellowship Program, Division of Neonatology, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Urvashi Parti
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Douglas L. Vanderbilt
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States,Division of General Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Philippe S. Friedlich
- Fetal and Neonatal Medicine, Division of Neonatology, Department of Pediatrics, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Roberta Williams
- Division of Cardiology, Children’s Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michele Kipke
- Saban Research Institute, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Lakshmanan A, Kubicek K, Williams R, Robles M, Vanderbilt DL, Mirzaian CB, Friedlich PS, Kipke M. Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study. BMC Pediatr 2019; 19:223. [PMID: 31277630 PMCID: PMC6610911 DOI: 10.1186/s12887-019-1604-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 04/11/2019] [Accepted: 06/27/2019] [Indexed: 12/31/2022] Open
Abstract
Background We have limited information on families’ experiences during transition and after discharge from the neonatal intensive care unit. Methods Open-ended semi-structured interviews were conducted with English or Spanish- speaking families enrolled in Medicaid in an urban high-risk infant follow up clinic at a safety-net center, which serves preterm and high-risk term infants. We generated salient themes using inductive-deductive thematic analysis. Results Twenty-one participants completed the study. The infant’s median (IQR) birth weight was 1750 (1305, 2641) grams; 71% were Hispanic and 10% were Black non-Hispanic; 62% reported living in a neighborhood with 3-4th quartile economic hardship. All were classified as having chronic disease per the Pediatric Medical Complexity Algorithm and 67% had medical complexity. A conceptual model was constructed and the analysis revealed major themes describing families’ challenges and ideas to support transition centered on the parent-child role and parent self-efficacy. The challenges were: (1) comparison to normal babies, (2) caregiver mental health, (3) need for information. Ideas to support transition included, (1) support systems, (2) interventions using mobile health technology (3) improved communication to the primary care provider and (4) information regarding financial assistance programs. Specific subthemes differed in frequency counts between infants with and without medical complexity. Conclusions Families often compare their preterm or high-risk infant to their peers and mothers feel great anxiety and stress. However, families often found hope and resilience in peer support and cited that in addition to information needs, interventions using mobile health technology and transition and financial systems could better support families after discharge. Electronic supplementary material The online version of this article (10.1186/s12887-019-1604-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. .,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Katrina Kubicek
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Roberta Williams
- Division of Cardiology, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Marisela Robles
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, USA
| | - Douglas L Vanderbilt
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA.,Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christine B Mirzaian
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, Los Angeles, CA, 90027, USA
| | - Michele Kipke
- USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Flores-Fenlon N, Song AY, Yeh A, Gateau K, Vanderbilt DL, Kipke M, Friedlich P, Lakshmanan A. Smartphones and Text Messaging are Associated With Higher Parent Quality of Life Scores and Enrollment in Early Intervention After NICU Discharge. Clin Pediatr (Phila) 2019; 58:903-911. [PMID: 31088122 PMCID: PMC8362840 DOI: 10.1177/0009922819848080] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/16/2022]
Abstract
The purpose of this study was to evaluate the impact of access to communication technology on caregiver quality of life, neurodevelopmental, and medical outcomes (eg, rehospitalization, emergency room visits, or surgeries) in preterm infants, and enrollment in public assistance programs. In this cross-sectional study, we surveyed families of preterm infants in a high-risk infant-follow-up clinic. We estimated associations of access to various modes of communication technology with outcomes, adjusting for sociodemographic and infant characteristics using linear and unconditional logistic regression. Access to email, text messaging, and smartphones was associated with higher quality of life scores on the Multicultural Quality of Life Index, and email and smartphone access was significantly associated with increased enrollment in early intervention. Evaluating smartphone and email access on neonatal intensive care unit discharge is important when considering enrollment in community programs and caregiver quality of life.
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Affiliation(s)
- Nicole Flores-Fenlon
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Ashley Y. Song
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Amy Yeh
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Division of Neonatology, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kameelah Gateau
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Douglas L. Vanderbilt
- Division of General Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michele Kipke
- Division of Research on Children, Youth and Families, Children's Hospital Los Angeles, Los Angeles, CA, USA,Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Philippe Friedlich
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ashwini Lakshmanan
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA,USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hill BJ, Rosentel K, Bak T, Silverman M, Crosby R, Salazar L, Kipke M. Exploring Individual and Structural Factors Associated with Employment Among Young Transgender Women of Color Using a No-Cost Transgender Legal Resource Center. Transgend Health 2017; 2:29-34. [PMID: 28795154 PMCID: PMC5546788 DOI: 10.1089/trgh.2016.0034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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] [Indexed: 11/22/2022] Open
Abstract
Purpose: The purpose of this study was to explore individual and structural factors associated with employment among young transgender women (TW) of color. Methods: Sixty-five trans women of color were recruited from the Transgender Legal Defense and Education Fund to complete a 30-min interviewer-assisted survey assessing sociodemographics, housing, workplace discrimination, job-seeking self-efficacy, self-esteem, perceived public passability, and transactional sex work. Results: Logistic regression models revealed that stable housing (structural factor) and job-seeking self-efficacy (individual factor) were significantly associated with currently being employed. Conclusion: Our findings underscore the need for multilevel approaches to assist TW of color gain employment.
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Affiliation(s)
- Brandon J Hill
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, Illinois.,Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois.,The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana
| | - Kris Rosentel
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, Illinois.,School of Social Service Administration, University of Chicago, Chicago, Illinois
| | - Trevor Bak
- Department of Obstetrics and Gynecology, Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3), The University of Chicago, Chicago, Illinois
| | - Michael Silverman
- Transgender Legal Defense & Education Fund, Inc., New York, New York
| | - Richard Crosby
- The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana.,College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Laura Salazar
- School of Public Health, Georgia State University, Atlanta, Georgia
| | - Michele Kipke
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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19
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Lakshmanan A, Agni M, Lieu T, Fleegler E, Kipke M, Friedlich PS, McCormick MC, Belfort MB. The impact of preterm birth <37 weeks on parents and families: a cross-sectional study in the 2 years after discharge from the neonatal intensive care unit. Health Qual Life Outcomes 2017; 15:38. [PMID: 28209168 PMCID: PMC5312577 DOI: 10.1186/s12955-017-0602-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/24/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about the quality of life of parents and families of preterm infants after discharge from the neonatal intensive care unit (NICU). Our aims were (1) to describe the impact of preterm birth on parents and families and (2) and to identify potentially modifiable determinants of parent and family impact. METHODS We surveyed 196 parents of preterm infants <24 months corrected age in 3 specialty clinics (82% response rate). Primary outcomes were: (1) the Impact on Family Scale total score; and (2) the Infant Toddler Quality of Life parent emotion and (3) time limitations scores. Potentially modifiable factors were use of community-based services, financial burdens, and health-related social problems. We estimated associations of potentially modifiable factors with outcomes, adjusting for socio-demographic and infant characteristics using linear regression. RESULTS Median (inter-quartile range) infant gestational age was 28 (26-31) weeks. Higher Impact on Family scores (indicating worse effects on family functioning) were associated with taking ≥3 unpaid hours/week off from work, increased debt, financial worry, unsafe home environment and social isolation. Lower parent emotion scores (indicating greater impact on the parent) were also associated with social isolation and unpaid time off from work. Lower parent time limitations scores were associated with social isolation, unpaid time off from work, financial worry, and an unsafe home environment. In contrast, higher parent time limitations scores (indicating less impact) were associated with enrollment in early intervention and Medicaid. CONCLUSIONS Interventions to reduce social isolation, lessen financial burden, improve home safety, and increase enrollment in early intervention and Medicaid all have the potential to lessen the impact of preterm birth on parents and families.
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Affiliation(s)
- Ashwini Lakshmanan
- Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, CA, 90027, Los Angeles, USA.
- Newborn and Infant Critical Care Unit, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #31, CA, 90027, Los Angeles, USA.
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
| | - Meghana Agni
- Drexel School of Medicine, Philadelphia, PA, USA
| | - Tracy Lieu
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Eric Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Michele Kipke
- Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Philippe S Friedlich
- Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, 4650 Sunset Boulevard, MS #31, CA, 90027, Los Angeles, USA
| | - Marie C McCormick
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Social and Behavioral Sciences, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mandy B Belfort
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
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20
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Lu Y, Pyatak EA, Peters AL, Wood JR, Kipke M, Cohen M, Sequeira PA. Patient perspectives on peer mentoring: type 1 diabetes management in adolescents and young adults. Diabetes Educ 2014; 41:59-68. [PMID: 25394732 DOI: 10.1177/0145721714559133] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to identify attitudes and topics relevant to peer mentoring as an adherence-promoting intervention for adolescents and young adults (YAs) with type 1 diabetes (T1D). METHODS Self-administered survey data were collected in 2 diabetes clinics from a convenience sample of adolescents as prospective mentees (ages 13-18) and YAs as prospective mentors (ages 19-25) with T1D. Survey topics included demographics, disease history, glycemic control, adherence, depression, barriers to disease management, social support, and interest in peer mentoring. Descriptive statistical analyses, thematic coding, and stepwise multivariate logistic regression were performed. RESULTS A majority of the 54 adolescents and 46 YAs expressed interest in a peer mentoring program. Having supportive friends and living in a large household positively predicted adolescent interest in having a peer mentor. Approximately one-third of all participants experienced social barriers to diabetes management. For adolescents, barriers included inflexible schedules, unfamiliar foods, and the embarrassment of checking blood glucose in front of others. Young adults reported barriers in tracking food consumption and remembering to check blood glucose. Various diabetes management skills were in high demand by adolescents, who especially desired to learn about managing T1D on their own and in college. Participants were open to multiple communication modes, including in-person meetings, phone, text messaging, and social media. CONCLUSIONS Many adolescents and young adults with T1D are interested in peer mentoring as a way to facilitate learning and sharing essential diabetes management skills and experiences.
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Affiliation(s)
- Yang Lu
- Department of Pediatrics, Harbor-UCLA Medical Center, and the Los Angeles Biomedical Research Institute, Torrance, California (Dr Lu)
| | - Elizabeth A Pyatak
- University of Southern California, Los Angeles, California (Dr Pyatak, Dr Peters, Dr Wood, Dr Kipke, Dr Sequeira)
| | - Anne L Peters
- University of Southern California, Los Angeles, California (Dr Pyatak, Dr Peters, Dr Wood, Dr Kipke, Dr Sequeira)
| | - Jamie R Wood
- University of Southern California, Los Angeles, California (Dr Pyatak, Dr Peters, Dr Wood, Dr Kipke, Dr Sequeira),Children's Hospital Los Angeles, Los Angeles, California (Dr Wood, Dr Kipke, Dr Cohen)
| | - Michele Kipke
- University of Southern California, Los Angeles, California (Dr Pyatak, Dr Peters, Dr Wood, Dr Kipke, Dr Sequeira),Children's Hospital Los Angeles, Los Angeles, California (Dr Wood, Dr Kipke, Dr Cohen)
| | - Marisa Cohen
- Children's Hospital Los Angeles, Los Angeles, California (Dr Wood, Dr Kipke, Dr Cohen)
| | - Paola A Sequeira
- University of Southern California, Los Angeles, California (Dr Pyatak, Dr Peters, Dr Wood, Dr Kipke, Dr Sequeira)
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21
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Herrick A, Stall R, Egan J, Schrager S, Kipke M. Pathways towards risk: syndemic conditions mediate the effect of adversity on HIV risk behaviors among young men who have sex with men (YMSM). J Urban Health 2014; 91:969-82. [PMID: 25146488 PMCID: PMC4199441 DOI: 10.1007/s11524-014-9896-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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] [Indexed: 11/27/2022]
Abstract
Research shows that young men who have sex with men (YMSM) engage in higher rates of health risk behaviors and experience higher rates of negative health outcomes than their peers. The purpose of this study is to determine if the effects of adversity on HIV risk are mediated by syndemics (co-occurring health problems). Participants were 470 ethnically diverse YMSM ages 18 to 24 recruited between 2005 and 2006 and surveyed every 6 months for 24 months. Regression analyses examined the impact of adversity on syndemics (emotional distress, substance use, and problematic alcohol use) and the effects of both adversity and syndemics on HIV risk behaviors over time. Gay-related discrimination and victimization-among other adversity variables-were significantly associated with syndemics and condomless sex (CS). Syndemics mediated the effects of adversity on CS in all models. Adverse events impact HIV risk taking among YMSM through syndemics. These findings suggest that prevention programs aimed at reducing adversity may reduce both the synergistic effect of multiple psychosocial health problems and HIV risk taking.
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Affiliation(s)
- Amy Herrick
- Graduate school of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA, USA,
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22
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Evans E, Friedlich P, Kipke M, Seri I. 288 HEALTH CARE DELIVERY AND HOSPITAL-BASED CLINICAL OUTCOMES FOR NEONATES WITH CONGENITAL DIAPHRAGMATIC HERNIA IN CALIFORNIA USING THE AMERICAN ACADEMY OF PEDIATRICS NEONATAL INTENSIVE CARE UNIT CLASSIFICATION. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0004.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Evans E, Friedlich P, Kipke M, Seri I. Health Care Delivery and Hospital-Based Clinical Outcomes for Neonates with Congenital Diaphragmatic Hernia in California Using the American Academy of Pediatrics Neonatal Intensive Care Unit Classification. J Investig Med 2006. [DOI: 10.1177/108155890605401s171] [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] [Indexed: 01/08/2023]
Affiliation(s)
- E. Evans
- USC Division of Neonatal Medicine
| | | | - M. Kipke
- Division of Research on Children, Youth, and Families, Department of Pediatrics, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, CA
| | - I. Seri
- USC Division of Neonatal Medicine
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Barber L, Friedlich P, Korst L, Kipke M, Seri I. 242 ACCURACY OF ADMINISTRATIVE DATA FOR TERM NEWBORNS WITH CONGENITAL MALFORMATIONS. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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25
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Anderson JE, Cheney R, Clatts M, Faruque S, Kipke M, Long A, Mills S, Toomey K, Wiebel W. HIV risk behavior, street outreach, and condom use in eight high-risk populations. AIDS Educ Prev 1996; 8:191-204. [PMID: 8806949] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In this paper we examine risk behavior, exposure to street outreach, and condom use in samples of injecting drug users (IDUs) and high-risk youth. We used systematic sampling methods to produce representative samples of injecting drug users IDUs (five sites) and high-risk youth (three sites). The populations surveyed engaged in high levels of sexual risk behavior: 20% to 46% reported two or more sex partners in the last month. The majority (62% to 97%) knew someone infected with HIV. Condom use rates approached national health promotion goals for nonsteady partners but not for steady or main partners. Having a condom at time of interview was the most consistent predictor of condom use at last intercourse. Many of the respondents have been in contact with street outreach programs and many acknowledged some personal risk for HIV infection. However, most of the injecting drug users and high-risk youth interviewed (and their sex partners) were still at risk through unprotected sex.
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Affiliation(s)
- J E Anderson
- Behavioral and Intervention Research Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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