Factors Associated with Insured Children's Use of Physician Visits, Dentist Visits, Hospital Care, and Prescribed Medications in the United States: An Application of Behavioral Model of Health-Services Use

This study is the first to examine factors in the utilization of physician services, dentist services, hospital care, and prescribed medications focusing exclusively on insured children in the United States. Data describing 48,660 insured children were extracted from the 2021 National Survey of Children's Health. Children in the present sample were covered by private health insurance, public health insurance, or other health insurance. Logistic regression results showed self-reported health to be negatively associated with physician visits, hospital-care use, and prescription use, but teeth condition to be positively associated with dentist visits. Physician visits were associated negatively with age, Hispanic ethnicity, Asian ethnicity, family income at or below 200% of the federal poverty level, and other health insurance, but positively with parental education and metropolitan residency. Dentist visits were associated positively with girls, age, and parental education, but negatively with Asian ethnicity and public health insurance. Use of hospital care was associated negatively with age and Asian ethnicity, but positively with parental education and public health insurance. Use of prescriptions was associated positively with age, Black ethnicity, parental education, and public health insurance, but negatively with Hispanic ethnicity, Asian ethnicity, and family income at or below 200% of the federal poverty level. Implications included the expansion of public health insurance, promotion of awareness of medicine discount programs, and understanding of racial/ethnic minorities' cultural beliefs in health and treatment.

Factors Contributing to the Health of 0- to 5-Year-Old Low-Birth-Weight Children in the United States: Application of the Multiple Disadvantage Model

This secondary data analysis of 1731 low-birth-weight children and their parents in the United States investigated children's health and its associations with social disorganization, social structural factors, social relationships, health/mental health, and access to health insurance/services. The study drew on data from the 2021 National Survey of Children's Health. Logistic regression yielded results showing low-birth-weight children's excellent/very good/good health to be associated positively with parents' education and health. In turn, child health was associated negatively with being Black, having a family income at or below the 100% federal poverty level, difficulty parenting the child, child chronic health condition(s), parent mental health, and substance use in the family. The implications of the present findings in terms of interventions promoting maternal and child health as well as participation in government assistance programs for low-income families are discussed.

Factors in Immigrant Children's Use of Physician and Dentist Visits, Hospital Care, and Prescribed Medication in the United States

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence.

A Causal Analysis of Young Adults' Binge Drinking Reduction and Cessation

BACKGROUND

This study, using the multiple disadvantage model (MDM), sought to identify factors (disadvantaging social disorganization, social structural, social integration, health/mental health, co-occurring substance use, and substance treatment access factors) in young adults' binge drinking reduction and cessation in the United States.

METHODS

We extracted data on 942 young adult binge drinkers (25-34 years, 47.8% female) from the National Longitudinal Study of Adolescent to Adult Health (Add Health), carrying out a temporal-ordered causal analysis, meaning the evaluation of select variables' impacts on an outcome at a subsequent time.

RESULTS

MDM found a relatively high reduction likelihood for non-Hispanic African Americans and respondents with relatively more education. MDM found a relatively low reduction likelihood accompanying an alcohol-related arrest, higher income, and greater number of close friends. Change to nondrinking was found more likely for non-Hispanic African Americans, other non-Hispanic participants having minority ethnicity, older respondents, those with more occupational skills, and healthier respondents. Such change became less likely with an alcohol-related arrest, higher income, relatively more education, greater number of close friends, close friends' disapproval of drinking, and co-occurring drug use.

CONCLUSIONS

Interventions incorporating a motivational-interviewing style can effectively promote health awareness, assessment of co-occurring disorders, friendships with nondrinkers, and attainment of occupational skills.

Testing the Multiple Disadvantage Model of Health with Ethnic Asian Children: A Secondary Data Analysis

This study of ethnic Asian children in the United States asked whether their health exhibited relationship with any of six factors: social disorganization, social structural factors, social relationships, the health of their parents, their access to medical insurance, acculturation. The sample of 1350 ethnic Asian children was extracted from the 2018 National Survey of Children's Health. Logistic regression results showed that these children's excellent/very good/good health was associated positively with safe neighborhoods, family incomes, family cohesiveness, family support, and receipt of Temporary Assistance for Needy Families (TANF). In turn, health was associated negatively with single-mother households. Implications of the present results in terms of interventions promoting family support, TANF participation, safe neighborhoods, and professionals' cultural competency are discussed.

Older Adults' Preventive Behaviors During COVID-19 Outbreak: Application of Multiple Disadvantage Model

This study explored older adults' preventive behaviors during the pandemic. A sample of 2982 community-dwelling older adults was extracted from the United States National Health and Aging Trends Study. Results showed that number of preventive behaviors was decreased with rundown neighborhood and age; but increased with Blacks, Hispanics, other ethnic minorities, income, female, number of persons in household, social cohesion, social network, family/peer support, severity of COVID-19 symptoms, and anxiety during COVID-19 outbreak. The study results imply that joint effort of government and ethnic minority advocacy groups in public health education should focus on preventive measures as well as racial disparities in health, and that rejuvenating rundown neighborhoods, promoting neighboring, providing stimulus checks and unemployment insurance, and maintaining connection with family and friends will promote preventive behaviors.

Ethnicity and Self-reported Depression Among Hispanic Immigrants in the U.S

Viewed to be healthier than ethnic Hispanics born in the United States, Hispanic immigrants represent numerous subgroups with clearly heterogeneous geographic, cultural, structural, and social origins. This study asked how the factors length of U.S. residency, social status, lifestyle, and health care might explain self-reported depression within 5 large, discrete subgroups comprising immigrants from, in turn, Mexico, Puerto Rico, Cuba, the Dominican Republic, and other nations in Central and South America. The study also examined ethnicity's potential role moderating self-reported depression's associations. With pooled data from National Health Interview Surveys 1999-2015, it evaluated each ethnic group separately. Self-reported depression was associated generally with lengthening residence in the U.S., with being female, with poverty, with unemployment, with lack of education, and with lifestyle and health-care factors. These associations were not uniform across ethnic groups, however. Where self-reported depression is concerned, descriptive results suggest the proverbial health advantage may largely accrue specifically to Hispanic immigrants of Cuban and of Central/South American origin.

When Child Welfare Caseworkers Intervene, Do Women Surviving IPV Obtain Recommended Services?

This study looked at 991 women surviving intimate partner violence (IPV), exploring several factors in their receipt of IPV services through the child welfare system. A secondary data analysis, the research used longitudinal data from the National Survey of Child and Adolescent Well-Being II, was conducted to evaluate the relationship between receiving IPV services and child welfare intervention and between such receipt and demographic characteristics. Women in the sample had been substantiated for maltreatment and had lifetime experience of IPV; 15% of these women had received IPV services. Generalized estimation equation results showed likelihood of receiving services increased when the case plan specified needed IPV services. Biological/adoptive mothers retaining custody of children were relatively unlikely to receive IPV services, as were lower income women. Receipt of services was relatively unlikely at the third-wave interview compared with the first-wave interview, but no difference in likelihood of receiving services was found between first- and second-wave interviews. In addition, likelihood of receiving services was not associated here with the number of recent IPV episodes, IPV maltreatment, mother's perceived engagement with caseworker, and mother's race/ethnicity, employment, and education. Some implications for practice are discussed.

His resynchronization therapy produces more physiological ventricular repolarisation compared with biventricular pacing

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

BACKGROUND

Biventricular pacing (BVP) is known to shorten activation time in patients with heart failure and left bundle branch block (LBBB) but its effects on repolarisation are not well studied. His bundle pacing (HBP) can correct LBBB to deliver cardiac resynchronization therapy (HBP-CRT), producing more physiological ventricular activation time and pattern than BVP. It is not known whether this translates to more physiological repolarisation, and if so whether the effect is mediated through its effects on activation.

PURPOSE

We measured the effects of HBP-CRT and BVP on left ventricular repolarisation using non-invasive epicardial mapping (ECGI).

METHODS

Patients were recruited in two groups. 1) Patients scheduled for clinically indicated BVP procedures for heart failure with LBBB, 2) Individuals with narrow QRS, normal ventricular function and intact conduction systems. Using non-invasive electrocardiographic imaging, we identified patients with LBBB in whom HBP shortened ECGI-derived left ventricular (LV) activation time by >10ms. We compared the effects of HBP and BVP on ECGI-derived dispersion of LV repolarisation times and activation-recovery intervals (a surrogate for action potential duration).

RESULTS

21 patients in whom HBP shortened LV activation time by >10ms and an equal number of individuals with narrow intrinsic QRS were recruited. LV repolarisation dispersion was reduced by HBP-CRT (-42.0 ms, 95% confidence interval (CI): -52.3 to -31.7 ms, p <0.001) but not by BVP (11.9 ms, 95% CI: -6.24 to 30.1 ms, p = 0.182). The mean within-patient change in LV repolarisation dispersion from BVP to HBP-CRT was -56.5 ms (95% CI: -70.5 to -42.5 ms, p < 0.001). LV repolarisation dispersion with HBP-CRT was not different from individuals with narrow intrinsic QRS (2.75 ms, 95% CI: -16.2 to 21.7 ms, p = 0.981). The magnitude of reduction in LV repolarisation dispersion with HBP-CRT from intrinsic LBBB appeared similar to the magnitude of LV activation time shortening (-54.9 ms, 95% CI: -68.2 to -41.6 ms, p < 0.001). However, LV activation-recovery interval dispersion was also reduced by HBP-CRT (-44.3 ms, 95% CI: -69.2 to -19.3 ms, p < 0.001). Repolarisation mapping demonstrated normalisation of repolarisation pattern by HBP-CRT.

CONCLUSIONS

HBP-CRT can normalise repolarisation dispersion, producing more physiological repolarisation compared with BVP, which does not resolve the repolarisation abnormality of LBBB. HBP-CRT improves repolarisation through both activation resynchronization and modulation of action-potential duration. If these acute results translate to longer term outcomes, HBP-CRT may reduce the risk of ventricular arrhythmias in heart failure with LBBB to a greater extent than BVP. Abstract Figure. Epicardial Repolarisation Maps

Data spanning three decades illustrate racial disparities in likelihood of obesity

Obesity rates have risen significantly in recent decades, with underprivileged Americans associated with higher rates of the condition. Risks associated with obesity, furthermore, appear unequally distributed across different racial/ethnic groups, according to the literature. The present study examined racial disparities in obesity as a function of socioeconomic factors, using a sample of American adults from a 32-year longitudinal study. We accounted for the time factor as we evaluated obesity's associations with selected socioeconomic factors; we also examined race/ethnicity's moderating role in obesity-socioeconomic status associations over time. We used data from the National Longitudinal Survey of Youth (NLSY) to obtain a final sample of 118,749 person-waves for analysis. A subsample of person-waves numbering 65,702 represented data from White respondents; one numbering 31,618 represented data from Black respondents; and one numbering 21,429 represented data from Hispanic respondents. Needing to consider repeated measures of the same variables over time, we chose generalized estimated equations (GEE) for use in the data analysis. Speaking generally, the obtained results suggested that for the two smaller subsamples, minority race/ethnicity could have introduced disadvantages that helped explain links between obesity and race/ethnicity. Results also showed that White-Black disparities in obesity have widened slightly in the past three decades, while White-Hispanic disparities have stabilized during the same time period.

Collaborative Alliance of Parent and Child Welfare Caseworker

This secondary analysis of data describing 3,035 parents, drawn from the National Survey of Child and Adolescent Well-Being II, identified factors fostering the collaborative alliance of parents and caseworkers within the child welfare system. We used generalized least squares random effects modeling for panel data. We sought associations between caseworker engagement as perceived by parent and parent's interpersonal capacities, intrapersonal dynamics, problem severity, and racial/ethnic background, and between that perception and caseworker turnover. Parents in our sample had been substantiated for maltreatment of their children. Results showed that parent's perceived caseworker engagement was associated positively with seven factors: parent's social support, parent's mental health, kinship care, out-of-home placement, parent's African American ethnicity, parent's Hispanic ethnicity, parent/caseworker shared ethnicity, and family income. Perceived engagement was associated negatively with caseworker turnover (i.e., number of caseworkers assigned, by turns, to parent's case). Implications for practicing social work within the child welfare system are discussed.

Providing Health Care to Maltreated Children Receiving Child Welfare Services

This study sought associations between maltreated children's receipt of needed health care and five other variables or sets of variables: medical need, social structural factors, access to care, demographic factors, and child welfare intervention. Data for this study came from longitudinal records derived for a sample of 1,465 children (extracted from all records in a national data set) for whom maltreatment had been substantiated. Children in the sample had, following substantiation, either remained in the home or been placed in kinship care or other out-of-home setting. Generalized estimating equations were applied to the data. The results supported a negative association between the sample's receipt of needed health care and three factors: general physical health, age, and remaining in the home after substantiation. Data analysis also supported a positive association between receiving needed care and Medicaid receipt, family income of between 100 percent and 200 percent of federal poverty level, family income above 200 percent of federal poverty level, needed health care services included in child welfare case plan, and wave 2 interview. The study's implications for social work practice include the necessity of accurately identifying children's health problems, of addressing health needs in the case plan, and of coordinating meaningfully with health professionals.

Telling Medical Professionals About Victimization by Intimate Partner: Analysis of Women Surviving Intimate Partner Violence

This study investigated factors in women’s disclosure of intimate partner violence (IPV) to medical professionals. Its sample of 3,226 women surviving IPV was extracted from the National Intimate Partner and Sexual Violence Survey public-use dataset, dated 2010. The dichotomous outcome variable was told medical professional about IPV. Explanatory variables were physical violence experienced in the past year, need for medical services for IPV, injury, fear, poor physical health, number of health problems, poor mental health, African American, Latina, other ethnic minority, education, family income, inability to afford seeing doctor, age, and being married. Logistic regression results showed likelihood of IPV disclosure increased with 31 or more physical IPV episodes in preceding year, needed medical services for IPV, IPV-related injury, 2 or more health problems, fear of partner, poor mental health, inability to afford seeing doctor, and age 55 and over. Disclosure likelihood was decreased by other ethnic minority and absence of high school graduation. Our findings support standardized protocols identifying recent IPV, IPV injury, and multiple health problems, along with corresponding response training for medical professionals. Our findings also support making victim advocates and behavioral health specialists available in medical facilities to address patients’ fears and mental health.

What the Group Threat Hypothesis Notes About States' Medicaid Spending

This secondary data analysis examined the relationship between state Medicaid spending in 2000-2014 and the perspective of the group threat hypothesis. The hypothesis posits that as any racial minority group grows in size, the increase is perceived by the racial majority group to threaten its dominant status. The employed data described states' Medicaid spending, racial makeup, and poverty and unemployment rates and came from reports compiled by several federal agencies. It was processed first in 2 discrete date-based groups. Results with 2000-2009 data showed states' per capita Medicaid spending to be associated negatively with their racial makeup. Specifically, states with proportionally larger Hispanic populations appeared to spend less on Medicaid versus states with fewer Hispanic residents, as did states with proportionally larger other non-African American minority populations (versus states with fewer such residents). Our findings with 2010-2014 data indicated no association between Hispanic population and states' per capita Medicaid spending. Combining data from both periods, we observed no significant association between state Medicaid spending and each of the following: proportion of African Americans in state population, poverty rate, and unemployment rate. In general, state Medicaid spending increased gradually throughout the years studied. Policy implications are discussed.

Health of Women Surviving Intimate Partner Violence: Impact of Injury and Fear

This study examined associations between experiencing physical violence and stalking perpetrated by an intimate partner, and the number of health problems women reported. The sample of 2,626 women who survived intimate partner violence (IPV) was extracted from the National Intimate Partner and Sexual Violence Survey 2010. Results showed associations between greater number of health problems and the following seven factors: injury, fear, poor mental health, advanced age, less education, lower income, and marriage; no association was found between number of health problems and number of incidents of physical violence, stalking, or both (in preceding year). The results imply that IPV has long-term adverse impacts on women's physical health.

Factors Associated with Adherence to Preventive Breast Cancer Screenings among Middle-aged African American Women

Medical and other health professionals recommend biyearly screening for breast cancer for women 40-74 years of age. However, the breast cancer screening rate of African American women aged 45 and up is lower than that of other ethnicities. The present study intended to identify factors impacting African American women's participation in breast cancer screening. This study is a longitudinal secondary data analysis of 3,911 African American participants of the Study of Women's Health Across the Nation. By using Systems Model of Clinical Preventive Care, multinomial logistic regression was applied to explore the likelihood of having breast cancer screenings (breast exam and/or mammogram) associating with predisposing factors, enabling factors, referencing factors, and situational factors. Participants with older age, with higher education, having a healthcare provider for female health, in far distance, and with a cancer(s) were significantly more likely to adhere to the recommendations of breast cancer screenings. However, participants who did not have time to visit doctors, did not trust the physicians, and who smoked regularly were significantly less likely to adhere to the recommendations of breast cancer screenings. Implications for policy and practice are discussed.

A Longitudinal Analysis of Factors Associated with Therapeutic Alliances

This study examined the impact, on therapeutic alliances, made by client motivation to change, insight, mistrust, and other factors; as well as therapist's clinical experience. This secondary data analysis used a sample of 212 client respondents extracted from the Treatment of Depression Collaborative Research Program's data set. Results of generalized least squares random-effects modeling showed a significant impact exerted by client social-adjustment difficulties, insight, alcohol use, and gender; and client-therapist matching gender. Also, four elements of therapeutic alliances-regard, empathic understanding, unconditionality, and congruence-had four unique patterns of significant factors. To foster therapeutic alliances, therapists need to help clients develop awareness of and insight into the clients' social-adjustment difficulties; therapists should also be particularly sensitive to expectations of clients of the opposite sex. Implications for future research are suggested.

Racial/ethnic differences in HIV testing: An application of the health services utilization model

This study applying the health services utilization model examined the importance of predisposing, enabling, and need variables to the social mechanisms explaining lifetime HIV testing across racial/ethnic groups. Data for the study were derived from the National Health Interview Survey (collected 2013–2014), our final sample numbering 18,574 adults. Four subsamples reflected race/ethnicity: 13,347 Whites, 2267 Blacks, 2074 Hispanics, and 886 Asians. Logistic regression established respondent odds of ever having received HIV testing. Further statistical testing evaluated race/ethnicity’s potential moderating role in HIV testing. The findings generally support a role for Aday’s predisposing, enabling, and need factors in explaining HIV testing. Across the four subsamples, female gender, older age, and sexual minority status consistently increased lifetime HIV testing. However, we found racial/ethnic differences in HIV testing’s associations with these factors and others. Our study made a beginning in the effort to specify mechanisms leading to HIV testing—and reliable diagnosis—among four racial/ethnic groups. Understanding these mechanisms might multiply opportunities to raise testing rates for all, in turn reducing racial/ethnic disparities in HIV treatment.

Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization

BACKGROUND

Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use.

OBJECTIVES

This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations.

METHODS

We used nationally representative data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents.

RESULTS

Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions.

CONCLUSIONS

We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen-and it is often minority Americans who lack access and trust. If minority Americans' health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.

[The protective effect of optimized target delineation in intensity modulated radiation therapy on swallowing function in patients with different TNM staging of nasopharyngeal carcinoma]

Objective:To investigate the protective effect of optimized target delineation in intensity modulated radiation therapy(IMRT) on swallowing function in patients with different TNM staging of nasopharyngeal carcinoma.Method:Fifty patients with nasopharyngeal carcinoma were enrolled in this study. They were randomly divided into 25 cases of experimental group and 25 cases of control group by random number table and received IMRT treatment. Patients in control group only received routine delineation of target areas, the patients in experimental group were given the delineation of the relevant parts of the swallowing on the basis of the control group.And then, the degree of dysphagia, xerostomia, weight loss, and quality of life were assessed in the two groups of patients during and after IMRT.Result:There was no significant change in the degree of dysphagia in stage Ⅱ patients during radiotherapy, but the degree of dysphagia in stage Ⅲ and Ⅳ patients increased with the increase of radiotherapy time. After the end of radiotherapy, there was no significant change in the degree of dysphagia in the control group of patients. Compared with the 0th week after the end of radiotherapy, the stage Ⅱ patients in experimental group showed significant improvement in week 12(P<0.05), while the stage Ⅲ and Ⅳ patients showed significant improvement in week 24 after radiotherapy(P<0.05). The degree of xerostomia of two groups of patients continued to increase with varying degrees during and after IMRT(P<0.05 or P<0.01). The weight of the two groups of patients during radiotherapy continued to decrease with the increase of radiotherapy time,and gradually recovered after the end of radiotherapy.And in the experimental group, the weight loss was significantly lower in week 12 and week 24 than in the control group (P<0.05). During radiotherapy, the quality of life scores of the two groups became lower and lower with the increase of radiotherapy time compared with the 0th week of radiotherapy. After the end of radiotherapy, the quality of life began to gradually improve, and in week 24 after the end of radiotherapy, the quality of life of the experimental group of patients was significantly higher than that of the control group (P<0.05).Conclusion:During radiotherapy of patients with nasopharyngeal carcinoma, the structural organs associated with swallowing function are given individualized target delineation can reduce the occurring of dysphagia due to radiotherapy and improve the quality of life of patients after radiotherapy.

Mortality reductions from marginal increases in public spending on health

There is limited empirical evidence of the nature of any relationship between health spending and health outcomes in Australia. We address this by estimating the elasticity of health outcomes with respect to public healthcare spending using an instrumental variable (IV) approach to account for endogeneity of healthcare spending to health outcomes. Results suggest that, based on the conditional mean, a 1% increase in public health spending was associated with a 2.2% (p < 0.05) reduction in the number of standardised Years of Life Lost (YLL). Sensitivity analyses and robustness checks supported this conclusion. Further exploration using IV quantile regression indicated that marginal returns on public health spending were significantly greater for areas with poorer health outcomes compared to areas with better health outcomes. On average, marginal increases in public health spending reduce YLL, but areas with poorer health outcomes have the greatest potential to benefit from the same marginal increase in public health spending compared to areas with better health outcomes. Understanding the relationship between health spending and outcomes and how this differs according to baseline health outcomes can help meet dual policy objectives to improve the productivity of the healthcare system and reduce inequity.

Willingness for deceased organ donation under different legislative systems in Hong Kong: population-based cross-sectional survey

INTRODUCTION

Under the current opt-in system, the deceased organ donation rate remains low in Hong Kong. An opt-out system and an opt-in system combined with organ allocation priority (ie, priority to donors as transplant recipients) have been proposed to encourage willingness among the general population towards deceased organ donation. This study aimed to compare willingness, and its determinants, across these three legislative systems.

METHODS

A random telephone survey of Hong Kong permanent residents aged ≥18 years was conducted between August and October 2016 using an anonymous questionnaire. Willingness towards deceased organ donation was compared between the legislative systems with McNemar's test. Determinants of willingness were tested by logistic regression.

RESULTS

The proportion of those willing to consider deceased organ donation under the current opt-in system would significantly increase after combining it with allocation priority (64.5% vs 73.4%; P=0.018). "Fairness or reciprocity" was the major reported reason underlying the increase. In contrast, willingness would decrease after introducing the opt-out system (60.1%), although not significantly (P=0.336). The reduction might be attributable to a "belief of being forced to donate". Under the allocation priority system, reduced willingness to donate was associated with advanced age, lower educational attainment, and lower monthly household income. Under the opt-out system, reduced willingness was associated with being married, having a lower household income, and distrust of local government.

CONCLUSIONS

An opt-in system with allocation priority could induce willingness to donate, whereas an opt-out system may reduce willingness. The findings have implications for policy-making and promotion of organ donation.

Rural-to-Urban Migration, Strain, and Juvenile Delinquency: A Study of Eighth-Grade Students in Guangzhou, China

This examination of minor and serious delinquency among eighth graders in a large southern Chinese city, Guangzhou, also compared groups of these students, observing differences between the delinquency of migrants and that of urban natives. Data used were originally collected for the study "Stuck in the City: Migration and Delinquency Among Migrant Adolescents in Guangzhou." The present study asked whether and how various sources of strain and social control factors explained students' delinquency, questioning how meaningfully migration status moderated several of the observed delinquency relationships. Of students in the sample, 741 reported being natives of Guangzhou, and 497 reported migrating to Guangzhou from a rural area. The study conceptualized internal migration as a strain factor leading to delinquency, but the analyses did not suggest direct association between internal migration and delinquency. Results generally supported Agnew's theory, and, what's more, they tended to confirm that migration status moderated juvenile delinquency.

Skin Deep: Enhanced Variable May Help Explain Racial Disparities in Type 2 Diabetes and Prediabetes

INTRODUCTION

The study refined definitions of type 2 diabetes and prediabetes (Pre-/T2D) via its four-category outcome variable. Respondents were identified as Pre-/T2D on the basis of (a) doctor's diagnosis only (i.e., managed Pre-/T2D); (b) biomarker only (i.e., undiagnosed Pre-/T2D); or (c) both diagnosis and biomarker (i.e., unmanaged Pre-/T2D). The reference was Pre-/T2D not indicated. We linked the outcome to social structural and social support factors, health care-related factors, mental disorder, and lifestyle variables, for each racial/ethnic group.

METHODS

We used the 2011-2012 and 2013-2014 National Health and Nutrition Examination Surveys to measure the four-category outcome and examine race/ethnicity's role in explaining the outcome.

RESULTS

We found Pre-/T2D to be associated with age, BMI, physical activity, income, education, receiving health services, and other factors. A moderating role for race/ethnicity was also confirmed.

CONCLUSION

The racial disparities observed in our three main categories generally resulted from high levels of undiagnosed Pre-/T2D and high levels of diagnosed but unmanaged Pre-T2D. Race/ethnicity's moderating role generally indicated that, through the factors BMI, age, and receiving health services, minority status (with its attendant disadvantages) could facilitate undiagnosed Pre-/T2D as well as Pre-/T2D indicated concurrently by diagnosis and biomarker.

Social Risk and Protective Factors in Adolescents' Reduction and Cessation of Alcohol Use

BACKGROUND

Adolescents' alcohol use is related to many health problems, injuries, and violent acts, some with fatal consequences. A gap exists in the literature discussing risk/protective factors in change from non-heavy drinking to non-drinking, and also for change from heavy drinking to non-heavy drinking or non-drinking.

OBJECTIVE

This secondary study examined some risk and protective factors involved when adolescent non-heavy drinkers and adolescent heavy drinkers curb or terminate their drinking.

METHOD

The temporal-ordered analysis evaluated 570 nonheavy drinkers and 374 heavy drinkers (all adolescents), a sample extracted from Wave 1 and Wave 2 of the National Longitudinal Study of Adolescent to Adult Health, or Add Health.

RESULTS

We observed positive associations between likelihood of change from heavy/non-heavy drinking to nondrinking and 5 characteristics: neighborhood attachment, maternal receipt of public assistance, African American ethnicity, maternal involvement, physical maltreatment, depressive feelings, and substance-abuse treatment. We observed negative associations between this outcome and peer drinking, delinquent behaviors, drug use, and emotional maltreatment. Positive associations were found between likelihood of change from heavy drinking to non-heavy drinking and both maternal involvement and depressive feelings, while a negative association was found between this outcome and delinquent behaviors.

CONCLUSIONS

Reduction/cessation interventions should, at the individual level, focus on ending adolescent drinkers' associations with alcohol-using and delinquent peers. Interventions require supportive roles for parents, schools, and communities.

Racial/Ethnic Differences in Emotional Health: A Longitudinal Study of Immigrants' Adolescent Children

First, discrimination was conceptualized as a major source of stress for immigrants' adolescent children. Next, such children's emotional health (indicated by measures of self-esteem and depression) was examined for possible associations with discrimination, psychosocial supports, and social structure; additionally, race/ethnicity's possible moderating role in such associations was evaluated. Data from the first 2 waves of the Children of Immigrants Longitudinal Study (1991-2006) were employed, focusing on 3 groups: Asians, Hispanics, and Whites. Linear regression analyses were used to weigh how discrimination, psychosocial supports, and social structure measured at Wave 1 and Wave 2 related to self-esteem and depression measured at Wave 2. Asians exhibited the highest level of depression and were most likely to perceive discrimination; Asians' self-esteem was also low, compared to other groups'. Discrimination and psychosocial supports appeared to operate differentially in explaining the 3 groups' emotional health.

Racial Disparities in Intimate Partner Violence Examined Through the Multiple Disadvantage Model

This research adopted the perspective of the multiple disadvantage model to explore racial disparities in intimate partner violence (IPV) against women and IPV's links to social structural factors, social relationships, substance use, and health/mental health and access to related services. The study used data from 6,588 women who completed the National Violence Against Women Survey; linear regression was conducted separately for four ethnic groups. Results consistently showed physical assaults to increase with posttraumatic stress disorder symptoms. For African Americans, increases in assaults were linked to injury, disclosing IPV to friends/family as well as medical professionals, Medicaid use, and drug use; decreases, in turn, were linked to past assault by ex-partners. For Latinas, increases in assaults were associated with eight factors: being married, number of ex-partners, depression, disclosing IPV to friends/family and disclosing to mental-health professionals, drug use, alcohol abstinence, and partner's frequent alcohol use. For European Americans, increases in assaults were linked to number of ex-partners, injury, low income, Medicaid use, disclosing IPV to friends/family as well as mental-health professionals, and alcohol abstinence; decreases were associated with age and with other health insurance coverages. For women of other ethnicity, increases were linked to number of ex-partners, disclosing IPV to mental-health professionals, Medicaid use, drug use, and woman's own as well as partner's alcohol abstinence; decreases in this ethnicity category were linked to past assault by ex-partners. Intervention and policy implications are discussed.

Racial Disparities in Intimate Partner Violence and in Seeking Help With Mental Health

Applying Aday and Andersen's health services utilization model, this examination of racial disparities in women's experience of intimate partner violence also looked at racial disparities in mental disorders and in use of mental health professionals' help. We conducted a secondary data analysis of 6,589 women completing the National Violence Against Women Survey. Per our linear regression results, minority women, versus White, tended proportionally to seek less help from mental health professionals. Help seeking by African American women was less likely if they were using illegal drugs; among Hispanic women, additional threats from partner curtailed help seeking from mental health professionals. "Other ethnic minority" women's help seeking decreased with their use of stimulants. Implications for intervention are discussed.

Change in Adolescents’ Alcohol-Use Patterns, From Non-Drinking to Non-Heavy Drinking or Heavy Drinking

This study examined risk and protective factors at work when adolescents change from a non-drinking alcohol-use pattern to either non-heavy drinking or heavy drinking. Using a sample of 1,725 non-drinkers extracted from the National Longitudinal Study of Adolescent to Adult Health, we conducted multinomial logistic regression and found that likelihood of change from non-drinking to non-heavy drinking was associated positively with safe neighborhood, female, peers’ drinking, emotional maltreatment, and delinquent behaviors. We found a negative association between such likelihood and being African American. We found that likelihood of change from non-drinking to heavy drinking was associated positively with peers’ drinking, depressive feelings, drug use, and repeating a grade(s) at school. We found a negative association between such likelihood and having a married mother, being African American or some other non-Hispanic minority ethnicity, and maternal supervision. Implications for intervention and future research are discussed.

Race, Employment Disadvantages, and Heavy Drinking: A Multilevel Model

We intended to determine (1) whether stress from employment disadvantages led to increased frequency of heavy drinking and (2) whether race had a role in the relationship between such disadvantages and heavy drinking. Study data came from the National Longitudinal Survey of Youth, a prospective study that has followed a representative sample of youth since 1979. Our study employed data from 11 particular years, during which the survey included items measuring respondents' heavy drinking. Our final sample numbered 10,171 respondents, which generated 75,394 person-waves for data analysis. Both of our hypotheses were supported by results from multilevel mixed-effects linear regression capturing the time-varying nature of three employment disadvantages and of the heavy-drinking outcome. Results show that more-frequent heavy drinking was associated with employment disadvantages, and that disadvantages' effects on drinking were stronger for Blacks and Hispanics than for Whites. That worsening employment disadvantages have worse effects on minority groups' heavy drinking (compared to Whites) probably contributes to the racial health disparities in our nation. Policies and programs addressing such disparities are especially important during economic downturns.

Marital status and work-related health limitation: a longitudinal study of young adult and middle-aged Americans

OBJECTIVES

The literature establishes clearly the health benefit of marriage. Much less clear from published data is whether work-related health (dis)advantages accruing to marital transitions persist over time or are limited to the short term. Informed by the marital resources and marital crisis perspectives, this study sought links between marital status measured via three approaches and work-related health limitation, exploring these relationships across genders.

METHODS

The study employed data from eight recent waves (1996-2010) of the National Longitudinal Survey of Youth. It applied generalized estimating equations to estimate the impacts, on work-related health limitation, of current marital status; of marital transition 2 years in the past; and of marital transition 8 years in the past.

RESULTS

Our gender-specific results indicated that lower likelihood of work-related health limitation was associated with a married status, a stable married status, and an entry into marriage.

CONCLUSIONS

Results are consistent overall with the marital resources perspective. The use of three different approaches to evaluate the relationship of marital status to work-related health limitation may explain the gender-specific results.

Depression and Substance Use: A Temporal-Ordered Model

BACKGROUND AND OBJECTIVES

This study sought empirical evidence for the self-medication hypothesis. It asked whether diagnosis of depression, together with the use of mental-health care, leads to substance use.

METHODS

Data came from the 5-wave, longitudinal Fragile Families and Child Wellbeing (FFCW) Study, an investigation of a cohort of nearly 5,000 births, which over sampled non-marital births. FFCW examined newborns' biological mothers and fathers, all of whom lived in the United States. The adults were initially interviewed between 1998 and 2000 (the period of the cohort's births); they were then re-interviewed for four times over 10 years. FFCW measured mental health-related variables, level of drug use, and social structural and demographic factors, all of which are also measured by the present study. Respondents in our study's two final subsamples had responded to every FFCW interview item we would use in constructing our final model's variables. Our subsample of mothers totaled 3,477 women, from whom 5,987 person-waves were derived. Our subsample of fathers totaled 2,096 men, yielding 3,543 person-waves.

RESULTS

We used STATA generalized estimating equations for panel data, and found some evidence to support the self-medication hypothesis. In addition, our results indicated that the relationship of substance use to the use of mental-health care was gender-specific. Conclusions/Importance: Empirical evidence from this study only partially supported the self-medication hypothesis; the co-occurrence of depression and substance abuse in our sample was also reflective of social structural and demographic variables and of prior substance use variables.

Racial disparities in age at time of homicide victimization: a test of the multiple disadvantage model

This study sought the factors associated with race/ethnicity disparities in the age at which homicide deaths tend to occur. We used the multiple disadvantage model to take race into account as we evaluated associations between age at time of homicide victimization and several social structural, mental health-related, and lifestyle factors. Data were derived from the 1993 National Mortality Followback Survey, a cross-sectional interview study of spouses, next of kin, other relatives, and close friends of individuals 15 years and older who died in the United States in 1993. Our results showed age at time of homicide mortality to be related to the three types of factors; race moderated some of these relationships. In general, being employed, married, and a homeowner appeared associated with reduced victimization while young. The relationship of victimization age and employment was not uniform across racial groups, nor was the relationship of victimization age and marital status uniform across groups. Among Blacks, using mental health services was associated with longer life. Homicide by firearm proved important for our Black and Hispanic subsamples, while among Whites, alcohol's involvement in homicide exerted significant effects. Our results suggest that programs and policies serving the various racial/ethnic groups can alleviate multiple disadvantages relevant in homicide victimization at an early age.

Domestic Violence and Treatment Seeking: A Longitudinal Study of Low-Income Women and Mental Health/Substance Abuse Care

A study with 591 low-income women examined domestic violence's role in treatment seeking for mental health or substance abuse problems. (The women resided in one of two California counties.) Following Aday's behavioral model of health services utilization, the secondary data analysis considered the women's need, enabling, and predisposing factors. Generalized estimating equations analyzed the women's longitudinal records of treatment seeking. Results showed that those in the sample who were likely to seek treatment had experienced three or more controlling behaviors and only one abusive behavior. Multivariate data analysis showed treatment-seeking women were likely to be white and older; responsible for few dependent children; not graduates of high school; employed; not participating in Medicaid; diagnosed; and perceiving a need for treatment. The implications of these results for services and policies are discussed.

Problem drinking's associations with social structure and mental health care: race/ethnicity differences

This research used a nationally representative sample of 12,756 respondents self-identified as White, Black, Hispanic, or Asian to examine problem drinking in relationship to social structure and mental healthcare factors. Associations between problem drinking and particular factors varied by racial/ethnic group. Results also indicated that Whites' problem-drinking rates were higher than those of Hispanics, Blacks, and Asians. Americans sometimes use alcohol to manage stress stemming from social disadvantage and inadequate material resources. Across racial/ethnic groups, drinking level was associated with the type and degree of such disadvantage. Additionally, the presence of a mental health problem was associated with problem drinking.

The role of immigration status in heavy drinking among Asian Americans

We examined the role of Asian Americans' immigration status in their heavy drinking, using a national sample of 3,574 Asian American adults during 2008 to 2011 when surveyed by the National Health Interview Survey. Our results, with relevant social structural factors controlled, show that U.S.-born Asian Americans exhibited the highest heavy-drinking levels, followed by long-time-resident Asian immigrants, then recent-resident Asian immigrants (our three main subsamples). The higher heavy-drinking levels characterizing U.S.-born Asians who were male and younger, as compared to immigrant Asians who were male and younger, helped explain differential heavy-drinking levels across subsamples. The study's limitations are noted.

A spatial analysis of student binge drinking, alcohol-outlet density, and social disadvantages

BACKGROUND AND OBJECTIVES

This paper examined whether and how student binge drinking at the individual level was influenced by population disadvantages, community instability, alcohol-outlet density, and protective factors generated by community and school.

METHODS

We used a dataset collected in 2002 by the Alabama Department of Mental Health, with additional materials generated by the 2000 Census and from the Alabama State Department of Education. School-catchments were employed as geographic units of analysis. The final sample comprised 78,138 public-school students in grades 6-12 who attended schools located in the 566 school-catchments.

RESULTS

We hypothesized the presence of spatial processes that, once identified, would enhance understanding of student binge drinking. Our results confirmed that student binge drinking in a focal area was affected by that area's structural factors and also by individual-level risk and protective factors. The results did not support the hypothesized impact of surrounding areas' characteristics on student binge drinking in the focal area.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The results of our study clearly indicate that both environment-based factors and individual-level risk and protective factors are important in explaining student binge drinking in Alabama.

Urban-rural differentials: a spatial analysis of Alabama students' recent alcohol use and marijuana use

BACKGROUND AND OBJECTIVES

This study of Alabama public school students sought urban-rural differences in social and spatial mechanisms connecting structural factors to recent use of alcohol and marijuana.

METHODS

Its dataset comprised a state-sponsored 2002 need-assessment survey of Alabama students; Alabama education department data; U. S. Census data; and alcohol-outlet locations listed by Alabama's Alcoholic Beverage Control Board. It measured structural-disadvantage factors (population disadvantages, community instability, alcohol-outlet density), social-organization factors (protective role of community, protective role of school), and recent-use factors. Using Geographic Information Systems (GIS), it generated maps of school catchment areas (SCAs)-the units of analysis for the study-that outline spatial patterns (across areas deemed urban or rural) of students' recent use of alcohol and marijuana.

RESULTS

In the final sample of 370 SCAs, significant urban-versus-rural differences were observed for certain structural factors and in how these factors were associated with substance use. These differences aside, spatial analysis weighing the SCAs' particular geographic characteristics suggested location's importance, showing that a school playing a strong protective role significantly reduced not just its own students' recent substance use, but that of students in neighboring SCAs as well.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

The findings show students' recent use of alcohol and marijuana are associated with characteristics of the environment. (Am J Addict 2013; 22:188-196).

Problem drinking by race and nativity: what is learned from social structural and mental health-related data of US-born and immigrant respondents?

BACKGROUND AND OBJECTIVES

 Although heavy drinking is considered a health risk, research demonstrates that some adults turn to alcohol in an effort to manage disabling stress or mental health problems. Race and nativity may be associated with such decisions to "self-medicate" with alcohol. This study identified and compared links between problem drinking and social structural and mental health-related factors for four race-nativity groups.

METHODS

 Using data from the 2009 National Health Interview Survey, the final sample comprised 7,905 US-born Whites, 390 foreign-born Whites, 2,110 US-born Blacks, and 193 foreign-born Blacks. Investigated were the social structural variables of demographic factors (age, gender), socioeconomic status (employment, income, education), and social integration factors (family size, living with a partner). Mental health-related variables included chronic mental illness and access to and use of mental health services.

RESULTS

 Overall, both types of variables were found to be associated with large-quantity drinking and frequent binging, with the strength of association varying-for some factors-by race and/or nativity. Further, the findings indicated that, in the presence of chronic mental illness, both US- and foreign-born Black Americans engaged in relatively frequent binge-drinking when health-care variables were controlled.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

 These results underscore the need for mental health professionals to identify co-occurring mental illness and alcohol abuse among Black clients and, where it is found, to seek the root causes of the persistent stress that tends to accompany this co-occurrence.

The role of mental illness in alcohol abuse and prescription drug misuse: gender-specific analysis of college students

The present study examined whether and how collegians' misuse of prescription drugs and alcohol abuse are associated with mental illness and with a lack of mental health care. Nationally representative data were derived from 5,241 full-time American college students who completed the 2010 National Survey on Drug Use and Health. We observed the presence of alcohol abuse/dependence and the nonmedical use of prescription drugs to be associated with relatively serious mental illness and with lack of health care. In pursuing gender-specific results, we found that the association between alcohol abuse and mental illness was stronger among females than males.

Factors leading African Americans and black Caribbeans to use social work services for treating mental and substance use disorders

This secondary analysis of 5,000 African Americans and black Caribbeans explored how their use of social work services to address mental and substance use disorders was associated with the disorder involved as well as their perceived need for services, belief system, family resources, proximity to services, social-structural factors, and demographic characteristics. The sample was extracted from a national data set. Results of multinomial logistic regression showed that use of social work services was increased by dual diagnosis, substance use disorder alone, and mental disorder alone; by deteriorating mental health; by perceived stigma in treatment use; by welfare receipt and insurance coverage for mental health services; and by college graduation. Results also showed that use of services outside social work was promoted by dual diagnosis, substance use disorder alone, and mental disorder alone; by deteriorating mental health; by experience of racial discrimination; by insurance coverage for mental health services; by college education or graduation; and by female gender and increasing age. The findings' implications for social work intervention and education are discussed.

Intimate partner violence and welfare participation: a longitudinal causal analysis

This longitudinal study examined the temporal-ordered causal relationship between intimate partner violence (IPV), five mental disorders (depression, generalized anxiety disorder, social phobia, panic attack, posttraumatic stress disorder [PTSD]), alcohol abuse/dependence, drug abuse/dependence, treatment seeking (from physician, counselor, and self-help group), employment, child support, and welfare participation. It was a secondary data analysis of records of 571 women; the records were extracted from the study "Violence Against Women and the Role of Welfare Reform" (VAWRWR). Results from generalized estimating equations (GEE) showed that experiencing controlling behaviors reduced likelihood of welfare participation whereas experiencing physical abuse increased it. Significant impact on welfare participation was wielded by panic attack, drug abuse/dependence, and employment; treatment seeking and child support made no significant impact. The study found no significant mediating effect wielded by panic attack, drug abuse/dependence, employment, or child support on welfare participation's relationship to controlling behaviors or physically abusive behaviors experienced. Implications for intervention are discussed.

IR photodissociation spectroscopy of H7(+), H9(+), and their deuterated analogues

Cluster ions of H7(+)/D7(+) and H9(+)/D9(+) produced in a supersonic molecular beam with a pulsed discharge source are mass selected and studied with infrared laser photodissociation spectroscopy. Photodissociation occurs by the loss of H2 (D2) from each cluster, producing resonances in the 2000-4500 cm(-1) region. Vibrational patterns indicate that these ions consist of an H3(+) (D3(+)) core ion solvated by H2 (D2) molecules. There is no evidence for the shared proton structure seen previously for H5(+). The H3(+) ion core vibrational bands are weakened and broadened significantly, presumably by enhanced rates of intramolecular vibrational relaxation. Computational studies at the DFT/B3LYP or MP2 levels of theory (including scaling) are adequate to reproduce qualitative details of the vibrational spectra, but neither provides quantitative agreement with vibrational frequencies.

The role of social structural factors in treatment of mental health disorder

BACKGROUND

Mental disorder implies a biopsychosocial condition, so adequate mental health treatment involves not just medical and pharmacological care but also psychotherapy or counseling.

AIMS

The present study determined how social structural factors might explain accessing of primary care providers and specialty care providers in response to mental disorder, hypothesizing that the two broad types of care differ as to the likelihood of offering minimally adequate treatment.

METHOD

We analyzed data from the cross-sectional study called "2000-2001 Healthcare for Communities", employing five imputed data sets to handle missing data and defining minimally adequate treatment of mental disorder as "at least four counseling sessions at any provider and prescribed medication". Results While mental disorder can be treated in primary care or specialty facilities, our results show that minimally adequate treatment (as defined) is most likely to be obtained via specialty care.

CONCLUSION

For individuals with mental disorder, accessing only primary care creates social inequity, because care from specialty facilities is comparatively more adequate.

Racial differences in co-occurring substance use and serious psychological distress: the roles of marriage and religiosity

The study examined how marriage and religiosity can protect members of certain racial/ethnic groups against co-occurring substance use and serious psychological distress. Using the national dataset 2007 National Survey on Drug Use and Health, we analyzed data via multinomial logistic regression, observing several important results. Our findings generally support the deprivation-compensation thesis, in that religiosity elevates the mental health of racial/ethnic minority individuals more than that of Whites. We also found, however, that race/ethnicity moderates effects of education and poverty on the co-occurring behaviors, with Whites' mental health benefiting more from wealth and education than Blacks' or Hispanics' mental health did.