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Davlyatov G, Choi S, Borkowski NM, Hearld KR, Aswani M. Federally Qualified Health Centers' Screening for social risk factors and Health Outcomes. J Ambul Care Manage 2024:00004479-990000000-00041. [PMID: 38744311 DOI: 10.1097/jac.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Federally Qualified Health Centers (FQHCs) are ideally positioned to identify and address health-related social needs, but little is understood about the relationship between social risk factor (SRF) screening and health outcomes. We studied 1352 FQHCs from the 2019 Uniform Data System. Ordinary least squares regression was used to estimate the relationship between SRF screening and the percentage of patients with adequately controlled diabetes and hypertension. Results show 71% of the FQHCs in the sample collected SRFs. FQHCs' screened for SRFs had higher percentages of patients with adequately controlled diabetes (69.5% vs 67.0%, P < .001) and hypertension (63.8% vs 59.4%, P < .001) relative to FQHCs not collecting SRFs.
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Affiliation(s)
- Ganisher Davlyatov
- Author Affiliations: Department of Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Dr Davlyatov); Department of Management, College of Business and Economics, California State University Los Angeles, Los Angeles, California (Dr Choi); and Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama (Drs Borkowski, Hearld, and Aswani)
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Paulino-Ramírez R, Hearld KR, Butane SA, Tapia L, Budhwani H, Naar S, Rodriguez-Lauzurique M. Serological Confirmed Syphilis Among Transgender Women in Dominican Republic. Transgend Health 2022; 7:237-241. [PMID: 35785048 PMCID: PMC9245724 DOI: 10.1089/trgh.2020.0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose Transgender women (TW) in the Dominican Republic (DR) are at high risk for syphillis infection. Although treatable, infection rates remain at epidemic proportions. Methods In 2016, we conducted a national survey, with serological sampling of TW in the DR (n=255). Results In our sample, syphillis seropositivity was 47.45%. There was a statistically significant association between age (t=-2.93, df, p<0.01), arrest history (χ 2=8.15, p<0.01), exposure to violence (χ 2=3.73, p<0.05), and syphilis seropositivity. Multivariate analyses show TW arrested in the past 6 months have higher odds of seropositivity (odds ratio=2.05, confidence interval: 1.04-4.06, p<0.05). Conclusions There is a need for education and public health campaigns focused on TW specifically.
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Affiliation(s)
- Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Kristine R Hearld
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Seyram A Butane
- Center for Translational Behavioral Science (CTBScience), Florida State University College of Medicine (FSU), Tallahassee, Florida, USA
| | - Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Henna Budhwani
- School of Public Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Sylvie Naar
- Center for Translational Behavioral Science (CTBScience), Florida State University College of Medicine (FSU), Tallahassee, Florida, USA
| | - Mayra Rodriguez-Lauzurique
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic.,Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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Budhwani H, Hearld KR, Hasbun J, Waters J. HIV knowledge among cisgender female sex workers of Haitian descent working at the border of Haiti and Dominican Republic. Front Reprod Health 2021; 3. [PMID: 34957464 PMCID: PMC8697639 DOI: 10.3389/frph.2021.700861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In this brief report, we aim to assess levels of HIV mis-information among cisgender Haitian female sex workers engaged in sex work at the Haiti and Dominican Republic border. We conducted bivariate analyses on the 2014 Border Study on Sex Workers comparing responses from female sex workers on the Haiti side of the border to those from their peers on the Dominican Republic side (N = 212). Prevention of HIV acquisition by correct and consistent condom use with each sex act was correctly endorsed by 90.5% of female sex workers in Haiti but only 57.0% of their peers in Dominican Republic (χ2 = 32.28, p < 0.001); 84.1% of respondents in Haiti correctly identified that HIV can be transmitted through a single unprotected sexual act, compared to 52.3% in Dominican Republic (χ2 = 25.2, p < 0.001). Significantly higher percentages of female sex workers in Dominican Republic correctly responded that HIV can be transmitted in pregnancy, compared to respondents in Haiti (96.5 vs. 71.4%; χ2 = 21.42, p < 0.001). Higher percentages of respondents in Dominican Republic correctly answered that HIV can be transmitted through needle sharing, relative to respondents in Haiti (100.0 vs. 89.7%; χ2 = 9.45, p < 0.01). Respondents in Dominican Republic more accurately rejected the possibility of transmission through food or through mosquito bites, compared to respondents in Haiti (95.4 vs. 81.8%, χ2 = 8.51, p < 0.01; 97.7 vs. 86.5%, χ2 = 7.81, p < 0.01, respectively). Findings indicate that if HIV knowledge is examined aggregating responses to individual questions, then elements of misinformation may remain unaddressed. For example, we found significant differences in correct answers ranging from 16.7 to 100.0%.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kristine R Hearld
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Julia Hasbun
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
| | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
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Budhwani H, Hearld KR, Butame SA, Naar S, Tapia L, Paulino-Ramírez R. Transgender Women in Dominican Republic: HIV, Stigma, Substances, and Sex Work. AIDS Patient Care STDS 2021; 35:488-494. [PMID: 34762515 PMCID: PMC8817706 DOI: 10.1089/apc.2021.0127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Exposure to stigma, violence, sex work, and substance use are associated with increased HIV risk, but relationships between these factors have not been fully elucidated among transgender women whose data are often aggregated with men who have sex with men and other sexual and gender minorities. Considering this gap, we aimed to identify a serologically confirmed HIV estimate for transgender women and examine the relationships between stigma, sex work, substance use, and HIV among a national sample of transgender women in Dominican Republic. We analyzed biomarkers and self-report data from the third wave of Dominican Republic's Encuesta de Vigilancia y Comportamiento con Vinculación Serológica, employing logistic and negative binomial regression to estimate models (n = 307). HIV rate was 35.8%. Nearly 75% of respondents engaged in sex work. Over 20% reported experiencing violence; 61.6% reported being stigmatized. Participation in sex work was associated with higher levels of stigma [incidence rate ratio (IRR): 1.70, p < 0.05]. Respondents who experienced violence had over three times higher odds of living with HIV relative to respondents who had not been victimized [odds ratio (OR): 3.15, p < 0.05]. Marijuana users were less likely to experience stigma compared with cocaine users (IRR: 1.72, p < 0.05), and a higher risk of alcohol dependency was associated with higher odds of experiencing violence (OR: 1.17, p < 0.001). Findings illustrate the importance of disaggregating data collected from transgender women compared with other sexual and gender minorities to ascertain subpopulation-specific estimates and indicate an urgent need to implement structural interventions and policies to protect transgender women's health and their human rights.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham (UAB), School of Public Health, Department of Health Care Organization and Policy, Birmingham, Alabama, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham (UAB), School of Public Health, Department of Health Care Organization and Policy, Birmingham, Alabama, USA
| | - Seyram A Butame
- Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, Florida, USA
| | - Sylvie Naar
- Florida State University College of Medicine (FSU), Center for Translational Behavioral Science (CTBScience), Tallahassee, Florida, USA
| | - Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramírez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE), Santo Domingo, Dominican Republic
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Kennedy KC, Hearld KR, May B, Hall AG, Feldman SS, McKnight K, Kraus A, Feng W, Opoku-Agyeman W. Inpatient Telehealth and Coronavirus Disease 2019 Outcomes: Experiences in Alabama. Telemed Rep 2021; 2:148-155. [PMID: 35720748 PMCID: PMC8812284 DOI: 10.1089/tmr.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 06/15/2023]
Abstract
Background: During the early months of the coronavirus disease 2019 (COVID-19) pandemic, hospitals were concerned about preserving personal protective equipment. UAB Hospital Medicine designed a strategy to outfit acute care patient rooms on a COVID-19 unit with telemedicine technology to allow for remote clinician rounding. Objective: To describe one hospital's experience with inpatient telehealth and compare outcomes between patients with and without inpatient telehealth visits. Design and Methods: Retrospective chart review of patients admitted to UAB Hospital Medicine with COVID-19 between March 16, 2020 and April 24, 2020. Logistic and negative binomial regression models were used to examine the relationship between telehealth visits and the likelihood of a subsequent transfer to the intensive care unit (ICU), ventilation, and number of ICU days. Clinician interviews provided additional insight into the telehealth implementation. Findings: One-quarter of the patients received a telehealth visit. Half were admitted to the ICU, and one-third received ventilation. Regression models did not identify statistically significant differences in transfer to the ICU, number of ICU days, and ventilation between patients with and without telehealth visits. Older age and increased respiratory rate were associated with higher odds of ICU admission. Patients with a cough were associated with lower odds of ventilation and fewer ICU days. Discussion: Implementation challenges included difficulties associated with assisting patients with operating the tablets. However, clinicians noted that there was a great benefit to patients being able to see an unmasked physician. Furthermore, the telehealth program proved to be a viable strategy for connecting patients in isolation with their families. Findings can inform the future development of inpatient telemedicine strategies.
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Affiliation(s)
- Kierstin Cates Kennedy
- UAB Hospital | Hospital Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristine R. Hearld
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brian May
- UAB Hospital | Hospital Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Allyson G. Hall
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sue S. Feldman
- Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kyndal McKnight
- UAB Hospital | Hospital Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigayle Kraus
- School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Wendy Feng
- School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences, University of North Carolina at Wilmington, Wilmington, North Carolina, USA
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Hearld KR, Wu D, Budhwani H. HIV Testing Among Muslim Women in the United States: Results of a National Sample Study. Health Equity 2021; 5:17-22. [PMID: 33564736 PMCID: PMC7868576 DOI: 10.1089/heq.2020.0041] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: More than one million Americans are living with human immunodeficiency virus (HIV), and less than half of Americans have ever accepted an HIV test. There are no national HIV testing estimates for Muslim Americans, an underserved and often stigmatized population. Considering the lack of HIV testing estimates for this population, we conducted an exploratory study on HIV testing and potential associates in American Muslim women from across the United States. Methods: We applied logistic regression models to examine the Muslim Women's Health Project data, collected in 2015 (N=218). Results: Health care engagement and intimate partner violence were significantly associated with having been tested for HIV. Respondents using contraceptives received an influenza vaccination, and received an abnormal pap test had more than two times higher odds of having been tested for HIV (odds ratio [OR]=2.56, OR=2.43, OR=2.93, respectively; p<0.05 all). Having been sexually abused was associated with more than two times higher odds of having been tested for HIV (OR=2.49; p<0.05). Conclusion: Respondents reported higher rates of HIV testing as compared with the general public, signaling HIV knowledge, engagement in preventative health care, and possibly HIV risk. Scholars and practitioners should not assume that Muslim patients are at low risk for HIV and do not engage in HIV-risk behaviors. Thus, assumptions about Muslims women's willingness to accept HIV testing should be further examined to elucidate HIV risk among this population.
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Affiliation(s)
- Kristine R. Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Danielle Wu
- Department of Nutrition, College of Human Ecology, Cornell University, Ithica, New York, USA
| | - Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Budhwani H, Hearld KR, Hasbún J, Franklin SG, Vashi BG, Cataldo NA, Conserve DF, Waters J. Assessing Human Immunodeficiency Virus (HIV) Prevention Through Knowledge and Condom Use Among Female Sex Workers at the Border of Haiti and Dominican Republic. AIDS Patient Care STDS 2020; 34:477-483. [PMID: 33147085 DOI: 10.1089/apc.2020.0148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Geographic border studies are relatively scare, but have the potential to inform bilateral health policies that affect the well-being of female sex workers (FSWs) who work at these borders as well as those individuals who solicit their services, both groups being at high risk for human immunodeficiency virus (HIV). We applied bivariate and multivariate techniques to examine FSWs' HIV knowledge and condom use across three partner types, at the Haiti Dominican Republic border, using data from the Study on Sex Workers (n = 241, 2014). Condom use was significantly lower among FSWs on the Haitian side of the border compared to the Dominican side, yet levels of HIV knowledge were similar; specifically, 81% of respondents on the Dominican side reported using condoms every time they had sex with a client, compared to 38% of peers in Haiti (p < 0.001). After introducing controls, FSWs in Haiti continued to have lower odds of using condoms with clients (p < 0.001), noncommercial partners (p < 0.001), and regular partners (p < 0.05) compared to peers in the Dominican Republic. This unique border study highlights disparities in FSWs' condom use regardless of HIV knowledge. The lack of consistent condom use by FSWs in Haiti has the potential to exacerbate the HIV epidemic at the border and impact both nations' HIV incidence rates.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kristine R. Hearld
- Department of Health Services Administration, School of Health Professions, and School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Julia Hasbún
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
| | - Sarah G. Franklin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bijal G. Vashi
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nicholas A. Cataldo
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Donaldson F. Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
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Hearld KR, Budhwani H, Martínez-Órdenes M, Altaf A, Hasbun J, Waters J. Female Sex Workers' Experiences of Violence and Substance Use on the Haitian, Dominican Republic Border. Ann Glob Health 2020; 86:105. [PMID: 32874936 PMCID: PMC7442172 DOI: 10.5334/aogh.2889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Female sex workers (FSW) are socially and economically marginalized, and this vulnerability can be exacerbated when they hold the intersectional identity of also being an immigrant, such as in the case of Haitian FSWs in the Dominican Republic. Objective Considering that half of migratory young women and girls relocating across the Latin American and Caribbean region do so without their families, increasing the likelihood of experiencing abuses, our primary objective was to test the hypothesis that Haitian FSWs in the Dominican Republic have higher odds of being physically abused by sexual partners compared to Haitian FSWs in Haiti. Methods We conducted bivariate analyses and multivariate analyses on 2014 Hispaniola Sex Workers Study (N = 232). Findings Approximately 80% of Haitian FSWs in the Dominican Republic reported experiencing violence by a regular partner (80.3%), compared with 60.0% of Haitian FSWs in Haiti (χ2 = 11.34, p < 0.001). Controlling for socio-demographics, substance use, childhood abuse, and sexual behaviors, Haitian FSWs in Haiti maintained lower odds of experiencing violence by a regular partner (OR:0.37, p < 0.01) and higher odds of experiencing violence from a coworker (OR:6.38, p < 0.001) compared to FSWs in the Dominican Republic. Using sex to avoid arrest is associated with higher odds of experiencing violence by a client and violence by a coworker (OR:2.18, p < 0.05; OR:3.74, p < 0.001; respectively). Accepting payment in the form of drugs/alcohol is associated with higher odds of experiencing physical violence by a regular partner but lower odds of experiencing violence by a client (OR:3.99, p < 0.05; OR:0.43, p < 0.05; respectively). Conclusions Assuming health is a human right, then practitioners and scholars must actively collaborate to fortify vulnerable populations against injurious structural and sociocultural forces examining the intersectionality and compound effects of multiple stigmatized identities, in this study being an FSW and an immigrant, that moderate the potential positive effects of public health interventions.
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Affiliation(s)
| | | | | | | | | | - John Waters
- Caribbean Vulnerable Communities Coalition, JM
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Hearld KR, Hearld LR, Budhwani H, McCaughey D, Celaya LY, Hall AG. The future state of patient engagement? Personal health information use, attitudes towards health, and health behavior. Health Serv Manage Res 2019; 32:199-208. [PMID: 31238748 DOI: 10.1177/0951484819845840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The past decade has given rise to interest in the effects of health care information on personal well-being. However, investigations to-date typically centered on mass communication programs in health rather than on individuals’ psychosocial characteristics, agency, and behaviors associated with their engagement with this information. Considering this gap, we examined whether the availability of personal health information is associated with health prevention behaviors in the United States. Using multivariable path analysis and data from the 2017 Health Information National Trends Survey, we investigate whether the use of personal health information is associated with positive, preventative health behaviors (healthy eating, tobacco smoking, and exercise), and if this relationship is mediated by patient confidence in their ability to care for themselves and by their self-perceived health status. Findings indicate that the use of health information, at low levels, is important for improving patient attitudes regarding their health status and confidence in caring for themselves. Perceived health-status and patient confidence, in turn, are associated with preventative health behaviors. Notably, too much information does not necessarily result in positive health behaviors among patients. Organizations may wish to critically assess how much information they make readily available to the populations they serve.
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Affiliation(s)
- Kristine R Hearld
- 1 Department of Health Services Administration, University of Alabama at Birmingham
| | - Larry R Hearld
- 1 Department of Health Services Administration, University of Alabama at Birmingham
| | - Henna Budhwani
- 2 Department of Health Care Organization and Policy, University of Alabama at Birmingham
| | - Deirdre McCaughey
- 2 Department of Health Care Organization and Policy, University of Alabama at Birmingham
| | | | - Allyson G Hall
- 1 Department of Health Services Administration, University of Alabama at Birmingham
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Abstract
In this study, we examined vaccination behaviors-single dose human papillomavirus (HPV) vaccination, triple dose HPV vaccination, and influenza vaccination-among Muslim women residing in the United States. Using logistic regression models, we analyzed self-reported survey. We found that respondents had lower rates of HPV vaccination and higher rates of influenza vaccination, relative to the general American population. The respondents in our sample who reported contraceptive use had higher odds of vaccination. In this study the authors provide a springboard for the enhancement of patient-centered care through better understanding of health behaviors and cultural preferences of underrepresented communities in research.
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Affiliation(s)
- Kristine R Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Milner AN, Hearld KR, Abreau N, Budhwani H, Mayra Rodriguez-Lauzurique R, Paulino-Ramirez R. Sex work, social support, and stigma: Experiences of transgender women in the Dominican Republic. INT J TRANSGENDERISM 2019; 20:403-412. [PMID: 32999625 DOI: 10.1080/15532739.2019.1596862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Transgender populations, and especially those in resource-limited settings, are at an elevated risk of experiencing stigma and discrimination. Aims: This study sought to examine the relationship between parental, familial, and other social support, experiences of stigma and discrimination, quality of life, and sex work in a national sample of transgender women in the Dominican Republic (n = 291). Methods: Descriptive analyses for the outcome variable, sex work, as well as for measures associated with socio-demographics, social support, stigma, quality of life, and experiences of abuse and violence were performed. Bivariate analysis examined differences between respondents involved in sex work and those not involved in sex work. Results: We found that participation in sex work was associated with low social support and quality of life and increased experiences of stigma, discrimination, and abuse. Specifically, Dominican transgender women involved in sex work received less social support than their non-sex working peers; they experienced heightened arguments and problems with non-parental family members, professors or bosses, classmates, and close friends, as well of loss of friendships. Involvement in sex work was also associated with higher levels of stigma and discrimination, lower quality of life, and experiences of sexual abuse, torture, and experiences of attempted murder on one's life. Discussion: Transgender women participating in sex work require more rather than less social support from family members and loved ones, especially in areas where workplace discrimination policies that affect transgender individuals are nebulous, such as the Dominican Republic.
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Affiliation(s)
| | | | - Nicole Abreau
- Universidad Iberoamericana-UNIBE, Santo Domingo, Dominican Republic
| | - Henna Budhwani
- University of Alabama at Birmingham, Birmingham, AL, USA
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Hearld KR, Milner AN, Budhwani H, Abreau N, Rodriguez-Lauzurique RM, Charow R, Paulino-Ramirez R. Alcohol Use, High Risk Behaviors, and Experiences of Discrimination Among Transgender Women in the Dominican Republic. Subst Use Misuse 2019; 54:1725-1733. [PMID: 31046549 DOI: 10.1080/10826084.2019.1608253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study examines associations between alcohol use, high risk sexual behaviors, and experiences of stigma among transgender women across the Dominican Republic. Data from the 2015 Transgender Health Needs Study were analyzed using bivariate analyses (N = 291). Results: High rates of stigma, verbal abuse, alcohol use, and sex work are found and are associated with each other. Almost 45% of regular alcohol users are engaging in sex work (43.6%), compared with 31.1% of the non-regular alcohol users (χ2=4.82, p < .05). Having sex under the influence of alcohol is statistically associated with high risk behaviors, such as engaging in sex work, sometimes or never using a condom when receiving anal sex, and higher numbers of sexual partners. Furthermore, transgender women who have had sex under the influence of alcohol report statistically significantly higher levels of verbal abuse, discrimination, and levels of perceived transgender stigma. Conclusions/Importance: Findings suggest that although anti-discrimination laws exist, policies may not protect transgender women from experiencing stigma and discrimination at work, potentially forcing them to seek alternative careers and engage in behaviors that expose them to greater personal risk and harm. This intersection of factors may indicate a notable public health gap in transgender health in the Dominican Republic.
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Affiliation(s)
| | | | - Henna Budhwani
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Nicole Abreau
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Rosa Mayra Rodriguez-Lauzurique
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
| | - Rebecca Charow
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Robert Paulino-Ramirez
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
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Budhwani H, Hearld KR, Milner AN, Charow R, McGlaughlin EM, Rodriguez-Lauzurique M, Rosario S, Paulino-Ramirez R. Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic. Suicide Life Threat Behav 2018; 48:788-796. [PMID: 28950402 DOI: 10.1111/sltb.12400] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 06/29/2017] [Indexed: 12/01/2022]
Abstract
Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p < .001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p < .01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p < .05 and OR = 2.894, p < .05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, University Boulevard, Birmingham, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham, University Boulevard, Birmingham, USA
| | | | - Rebecca Charow
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | | | - Mayra Rodriguez-Lauzurique
- Centro de Orientacion e Investigación Integral (COIN), Santo Domingo, and Institute for Tropical Medicine & Global Health, Universidad Iberoamericana, Santo Domingo, Dominican Republic
| | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramirez
- Institute for Tropical Medicine & Global Health, Universidad Iberoamericana, Santo Domingo, and Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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Budhwani H, Borgstede S, Palomares AL, Johnson RB, Hearld KR. Behaviors and Risks for Cardiovascular Disease Among Muslim Women in the United States. Health Equity 2018; 2:264-271. [PMID: 30310874 PMCID: PMC6179134 DOI: 10.1089/heq.2018.0050] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study examines statistical associates of cardiovascular disease risk factors, as defined by the American Heart Association's Life's Simple Seven, among Muslim women who reside in the United States. Methods: Data collected nationally through the 2015 Muslim Women's Health project were analyzed (N=373). Logistic regression models estimated associations between sample characteristics and diet, exercise, alcohol consumption, blood pressure, cholesterol, and weight. Results: Over half of respondents reported exercising regularly (64%) and maintaining a healthy diet (85%); 20% consumed alcohol. About 5% reported having high cholesterol, 4% had high blood pressure, and 42% reported being overweight. Perceived and experienced stigma were associated with alcohol use (odds ratio [OR]=1.085, p<0.001) and being overweight (OR=0.938, p<0.001). Married respondents had 42% lower odds of exercising and 83% lower odds of drinking alcohol. Compared to foreign-born respondents, U.S.-born respondents had 2.9 higher odds of drinking alcohol and 2.7 higher odds of having high cholesterol (OR=2.931, p<0.001; OR=2.732, p<0.01, respectively). Significant effects were also found when examining the statistical impact of of age, Islamic sect, and education on cardiovascular disease risk factors. Conclusion: With increasing focus on precision medicine, personalized healthcare, and patient-centered medical homes (all interventions designed to promote disease prevention and assist in managing chronic health conditions) better understanding the health of understudied populations is imperative to the success of these interventions. Our findings suggest countervailing forces may affect the health of American Muslim women; therefore, additional studies with this hard-to-reach population are warranted and will be informative to improving overall population health in the United States, an overarching priority for both public health practitioners and medical providers.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Seth Borgstede
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Aarin L Palomares
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roman B Johnson
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristine R Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama
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Hearld KR, Hearld LR, Landry AY, Budhwani H. Evidence that patient-centered medical homes are effective in reducing emergency department admissions for patients with depression. Health Serv Manage Res 2018; 32:26-35. [PMID: 30149725 DOI: 10.1177/0951484818794340] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The patient-centered medical home (PCMH) has increasingly been touted as one means of integrating behavioral health and primary care and more holistically caring for patients with chronic disease. With its whole person orientation, the PCMH presents an opportunity to reduce emergency department visits for patients with depression by focusing on the patient and his/her health care needs, facilitating communication among providers and patients, and improving patients' access to care providers across settings. This study examines the relationship between PCMH capacity - defined as the ability to offer a service identified as a component part of the PCMH - and the number of emergency department visits for patients with depression. Health plan claims data, self-report data from physician practices on their PCMH characteristics, and the Area Resource File were analyzed. Results show that overall PCMH capacity is associated with fewer emergency department visits for patients with depression, and interpersonal aspects of the PCMH in particular, were associated with fewer emergency department visits while technical capabilities were not. Interpersonal activities that facilitate care coordination, patient engagement, and connect patients with community resources might be more effective in keeping patients out of the emergency department for unnecessary reasons as compared to technical activities focused on reporting and information management.
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Affiliation(s)
- Kristine R Hearld
- 1 Department of Health Services Administration For Budhwani, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Larry R Hearld
- 1 Department of Health Services Administration For Budhwani, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Y Landry
- 1 Department of Health Services Administration For Budhwani, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Henna Budhwani
- 2 Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
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Hearld KR, Budhwani H. Maternal Health Care Use by Pregnant Women Living with HIV: Factors Associated with Prenatal, Delivery, and Postnatal Care in Haiti. J Health Care Poor Underserved 2018; 28:1452-1461. [PMID: 29176107 DOI: 10.1353/hpu.2017.0126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study compares maternal health care utilization of women living with HIV with that of their HIV-negative peers in Haiti. Data from the 2012-2013 Haiti Demographic and Health Survey were analyzed. Three percent of mothers were HIV-positive. These mothers had over two times greater odds than HIV-negative mothers of accessing prenatal care in the first trimester and to deliver in a medical institution, and 1.9 greater odds of having a medical personnel at delivery. Haiti has made progress in increasing maternal health care utilization, specifically in an effort to reduce mother-to-child-transmission of HIV. Haiti's ability to bring institutions together, implement practical policies, and actively engage the most vulnerable pregnant women, those with HIV and those residing in remote areas, may offer valuable insight to similar resource-poor nations seeking to reduce rates of mother-to-child transmission.
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Helova A, Hearld KR, Budhwani H. Associates of Neonatal, Infant and Child Mortality in the Islamic Republic of Pakistan: A Multilevel Analysis Using the 2012-2013 Demographic and Health Surveys. Matern Child Health J 2018; 21:367-375. [PMID: 27449785 DOI: 10.1007/s10995-016-2121-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives Pakistan is one of five nations contributing to half of the world's child mortality and holds under-five mortality rates which are nearly double global targets. Reasons for this shortfall include civil conflicts, political uncertainty, low education, poverty, rural-urban disparities, and limited health care access. The aim of this study was to explore associations between individual characteristics, community factors, and child mortality in Pakistan. Methods Data were derived from the 2012 to 2013 Pakistan Demographic and Health Survey, and included 7399 live births and 380 child deaths. Multivariate, multilevel logistic regression was used to model risk of neonatal, infant and under-five child deaths. Results Seventy-one percent of child deaths occurred during the neonatal period. Significant factors (p < 0.05) associated with lower odds of child mortality included adhering to recommended minimum of 24 months interpregnancy interval and higher household wealth. These were significant for neonatal (OR 0.448; 0.871), infancy (OR 0.465; 0.881), and under-five deaths (OR 0.465; 0.879). Employed mothers had higher odds of neonatal (OR 1.479), infant (OR 1.506), and child mortality (OR 1.459). Likewise, women living in consanguineous marriages had higher odds of infant (OR 1.454) and under-five deaths (OR 1.381). Children in Balochistan, Punjab, and Sindh, regions disproportionately poor, rural with low levels of education, were at highest risk of dying. Conclusions for Practice Findings may assist in designing targeted interventions, developing appropriate public health messaging, and implementing policies designed to lower child mortality. Focusing on lowering rates of maternal poverty, increasing opportunities for education, and improving access to health care could assist in reducing child mortality in Pakistan.
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Affiliation(s)
- Anna Helova
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA
| | - Kristine R Hearld
- Department of Health Services Administration, 563 School of Health Professions, University of Alabama at Birmingham, 1705 University Boulevard, Birmingham, AL, 35233, USA
| | - Henna Budhwani
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA.
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Abstract
Background American Muslim women are an understudied population; thus, significant knowledge gaps exist related to their most basic health behaviors and indicators. Considering this, we examined American Muslim women’s contraception utilization patterns. Methods Self-reported data collected in late 2015 were analyzed. Women who identified as Muslim, were at least 18 years old, sexually active, and current residents of the United States (n = 224) met the inclusion criteria. Convenience sampling was employed. Multivariate logistic regression models estimated associations between demographics, marital status, ethnicity, nativity, health insurance, religious practice, and contraception use. Results Identifying as Muslim, in general, was significantly associated with greater odds of using contraception in general and condoms compared to American Muslim women who identify as Sunni. Identifying as Shia was associated with greater odds of using oral contraceptive pills relative to Sunni respondents. South Asian ethnicity was associated with higher odds of using oral contraceptive pills compared to those of Middle Eastern or North African ethnicity. Conclusions Findings suggest American Muslim women’s contraception utilization patterns share certain similarities with both American women in general and disadvantaged racial and ethnic minority groups in the United States, implying that factors that influence American Muslim women’s use of contraceptives are possibly countervailing and likely multifaceted. More research is needed to accurately identify associates of contraceptive use in this population. This work serves as a starting point for researchers and practitioners seeking to better understand reproductive health decision in this understudied population.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham (UAB), 310D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, UK.
| | - Jami Anderson
- Health Services Administration, University of Alabama at Birmingham, Birmingham, UK
| | - Kristine R Hearld
- Health Services Administration, University of Alabama at Birmingham, Birmingham, UK
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Abstract
Hospitals have long played important roles in the provision of health promotion services (HPS) in local communities, defined as activities that enable people to increase control over and improve their health, including programs such as disease prevention and wellness. Nearly 2 decades ago, researchers cross-sectionally documented the provision of HPS by hospitals, but little research has been done to update this work or document how HPS have changed over time. This study assessed changes in the provision of HPS among US hospitals between 1996 and 2014. Relationships were assessed using random effects Poisson regression models. The overall number of HPS reported by hospitals was relatively modest (approximately half of all possible services, on average). The number of services increased modestly over time, although the rate of increase became less positive over time. The findings highlight a number of opportunities to improve hospital provision of HPS.
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Affiliation(s)
- Larry R Hearld
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham , Birmingham, Alabama
| | - Kristine R Hearld
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham , Birmingham, Alabama
| | - William Opoku-Agyeman
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham , Birmingham, Alabama
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Budhwani H, Hearld KR, Hasbun J, Charow R, Rosario S, Tillotson L, McGlaughlin E, Waters J. Transgender female sex workers' HIV knowledge, experienced stigma, and condom use in the Dominican Republic. PLoS One 2017; 12:e0186457. [PMID: 29095843 PMCID: PMC5667872 DOI: 10.1371/journal.pone.0186457] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Not only do transgender female sex workers have some of the highest rates of sexually transmitted infections (STI), human immunodeficiency virus (HIV), and experienced stigma, they also have higher likelihood of early sexual debut and some of the lowest levels of educational attainment compared to other stigmatized populations. Some of the most common interventions designed to reduce transmission of HIV and STIs seek to educate high-risk groups on sexual health and encourage condom use across all partner types; however, reaching stigmatized populations, particularly those in resource-limited settings, is particularly challenging. Considering the importance of condom use in stopping the spread of HIV, the aim of this study was two-fold; first to characterize this hard-to-reach population of transgender female sex workers in the Dominican Republic, and second, to assess associations between their HIV knowledge, experienced stigma, and condom use across three partner types. METHODS We analyzed self-reported data from the Questionnaire for Transgender Sex Workers (N = 78). Respondents were interviewed at their workplaces. Univariate and bivariate analyses were employed. Fisher Chi-square tests assessed differences in HIV knowledge and experienced stigma by condom use across partner types. RESULTS HIV knowledge was alarmingly low, condom use varied across partner type, and the respondents in our sample had high levels of experienced stigma. Average age of first sexual experience was 13.12 years with a youngest age reported of 7. Dominican Republic statutory rape laws indicate 18 years is the age of consent; thus, many of these transgender women's first sexual encounters would be considered forcible (rape) and constitute a prosecutable crime. On average, respondents reported 8.45 sexual partners in the prior month, with a maximum of 49 partners. Approximately two thirds of respondents used a condom the last time they had sex with a regular partner. This was considerably lower than condom use reported with coercive partners (92.96%) and clients (91.78%). Bivariate analyses revealed two trends: experienced stigma was associated with lower rates of condom use, and lower HIV knowledge was associated with lower rates of condom use. The former provides additional evidence that experienced stigma may become internalized, affecting individual-level behaviors-lowering self-confidence and resilience-making it more difficult to negotiate condom use due to lack of self-efficacy and desire to show trust in one's partner. The latter supports public health research that suggests gaps in HIV knowledge persist and are pronounced in highly stigmatized populations. DISCUSSION The vulnerabilities experienced by transgender persons, particularly in environments that vehemently adhere to conservative ideologies related to sex and gender, are significant and harm this population. These vulnerabilities could potentially be addressed through critically examining of impact of policies that indirectly promote or allow victimization of transgender citizens and subsequently diminish the effectiveness of public health and educational interventions. By taking action through the revocation of such laws, the Dominican Republic has the opportunity to improve overall population health, to protect some of its most stigmatized citizens, and to become the flag bearer of enhanced human rights in the Caribbean and Latin America.
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Affiliation(s)
- Henna Budhwani
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Kristine R. Hearld
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Julia Hasbun
- Centro de Orientación e Investigación Integral (COIN), Calle Arzobispo Meriño, Santo Domingo, Dominican Republic
| | - Rebecca Charow
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
| | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Calle Arzobispo Meriño, Santo Domingo, Dominican Republic
| | - Louise Tillotson
- Centro de Orientación e Investigación Integral (COIN), Calle Arzobispo Meriño, Santo Domingo, Dominican Republic
| | | | - John Waters
- Caribbean Vulnerable Communities Coalition (CVC), Kingston, Jamaica
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Budhwani H, Hearld KR, Milner AN, McGlaughlin E, Charow R, Rodriguez-Lauzurique RM, Rosario S, Paulino-Ramirez R. Transgender Women's Drug Use in the Dominican Republic. Transgend Health 2017; 2:188-194. [PMID: 29142909 PMCID: PMC5684664 DOI: 10.1089/trgh.2017.0032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 11/13/2022] Open
Abstract
Purpose: Studies on drug use in transgender populations, particularly those in resource-limited settings, are scarce. Considering that drug use can be a coping mechanism to deal with stigma and traumatic experiences, we examined associations between stigma, trauma, and drug use in a national sample of transgender women from the Dominican Republic. Methods: Bivariate analyses examined differences between drug users and abstainers (n=287). Multivariate analyses reported odds ratios (OR) with general drug, marijuana, and cocaine use as outcomes (n=243). Results: A quarter of respondents (24.5%) experienced sexual abuse, 12.1% were tortured, and 20.1% experienced a murder attempt. More than a quarter reported using illegal drugs (26.1%). Drug users had lower socioeconomic status; 30.0% of drug users had a primary level of education or less (18.2% of abstainers) and 17.6% of drug users had higher income, defined as greater than 10,001 pesos (∼$210 United States Dollars, USD) per month (28.1% of abstainers). More than half of drug users experienced some form of trauma (51.4%) compared to 43.5% of abstainers, and 28.4% of drug users, compared to 17.1% of abstainers, experienced a murder attempt on her life. Independent sample t-tests found significant differences between drug users and abstainers. Transgender women who experienced sexual abuse had three times high odds of using cocaine. Drug users were more likely to have experienced sexual abuse and attempted suicide (p<0.05 for both). Respondents who attempted suicide had higher odds of using drugs generally and using marijuana specifically, compared to respondents who had not attempted suicide (OR=2.665 and 3.168, respectively). Higher scores on the stigma scale were associated with higher odds of any drug use and cocaine use (OR=1.132 and 1.325, respectively). Conclusions: Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are not consistently enforced. Eliminating stigma and stigmatizing policies may reduce rates of drug use as a coping mechanism.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - Elaine McGlaughlin
- United Nations Family Planning Association (UNFPA), Tegucigalpa, Honduras
| | - Rebecca Charow
- Institute for Tropical Medicine and Global Health, Universidad Iberoamericana, Santo Domingo, República Dominicana
| | | | - Santo Rosario
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
| | - Robert Paulino-Ramirez
- Institute for Tropical Medicine and Global Health, Universidad Iberoamericana, Santo Domingo, República Dominicana
- Centro de Orientación e Investigación Integral (COIN), Santo Domingo, Dominican Republic
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Budhwani H, Hearld KR. Muslim Women's Experiences with Stigma, Abuse, and Depression: Results of a Sample Study Conducted in the United States. J Womens Health (Larchmt) 2017; 26:435-441. [PMID: 28263695 DOI: 10.1089/jwh.2016.5886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to explore associations between internalized stigma, exposure to physical abuse, experiences with sexual abuse, and depression in Muslim women residing in the United States. MATERIALS AND METHODS We analyzed self-reported data collected online in late 2015. Women who self-identified as Muslim, were at least 18 years old, and were residents of the United States met the inclusion criteria (n = 373). Logistic regression models were used to estimate associations between socioeconomic status, nativity, and the abovementioned indicators. RESULTS Internalized stigma measured through heightened vigilance was associated with depression. Each increase in the abbreviated heightened vigilance scale (higher scores indicate lower vigilance) was associated with 7.6% lower odds of meeting the Center for Epidemiologic Studies Depression Scale 10 (CES-D 10) cutoff for depression (OR = 0.924, 95% CI = 0.888-0.962, p < 0.001). Among individual factors, education, household income, experience with physical abuse, and exposure to sexual abuse were associated with depression. Respondents who reported experiencing physical abuse had almost two times higher odds of meeting the cutoff for depression relative to respondents who had not experienced physical abuse (OR = 1.994, 95% CI = 1.180-3.372, p < 0.01). Likewise, respondents who reported exposure to sexual abuse had over two times higher odds of depression compared with respondents who had not been exposed to sexual abuse (OR = 2.288, 95% CI = 1.156-4.528, p < 0.05). CONCLUSIONS These findings were from a group of well educated wealthy respondents; however, experience with negative exposures and rates of depression were high. Further research replicating these findings and evaluating evidence-based interventions designed to improve screening for mental illnesses and retention in care with this hard-to-reach population could produce valuable outcomes, particularly for clinicians and public health practitioners committed to improving population health.
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Affiliation(s)
- Henna Budhwani
- 1 Department of Health Care Organization and Policy, University of Alabama at Birmingham , Birmingham, Alabama
| | - Kristine R Hearld
- 2 Department of Health Services Administration, University of Alabama at Birmingham , Birmingham, Alabama
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Hearld KR, Hearld LR, Hall AG. Engaging patients as partners in research: Factors associated with awareness, interest, and engagement as research partners. SAGE Open Med 2017; 5:2050312116686709. [PMID: 28228949 PMCID: PMC5308537 DOI: 10.1177/2050312116686709] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 07/07/2016] [Accepted: 12/06/2016] [Indexed: 11/16/2022] Open
Abstract
Objectives: There is growing interest in engaging patients in healthcare research, which raises important questions about the factors that may promote such engagement. The purpose of this study was to examine the association between patient characteristics and three aspects of patient engagement in the medical research process: awareness, interest, and actual participation. Methods: Cross-sectional, bivariate analyses were employed using the 2014 Health Information National Trends Survey. Results: Analyses suggest modest levels of interest among respondents engaging as patient partners in the research process (37.7% of respondents), low level of awareness of what patient engagement in research was (15.3% of respondents), and a very low level of actual participation (2.7% of respondents). Respondents of higher socioeconomic status and with more positive patient attitudes regarding their health and healthcare were more likely to be interested in research. In comparison, relatively few patient characteristics were significantly associated with patient awareness and actual participation in research. Conclusion: Although it is promising that people are interested in being engaged in research, the results suggest that there is work to be done to raise awareness of these engagement opportunities. Likewise, the gap between awareness and participation highlights opportunities to identify why patients may be reluctant to participate even when they are aware of research opportunities.
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Affiliation(s)
- Kristine R Hearld
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Larry R Hearld
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Allyson G Hall
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
The patient-centered medical home (PCMH) has increasingly received attention as a model of care to potentially remedy the cost and quality problems that confront the US health care system, including and especially ambulatory care-related issues. This study examined the association between physician practices' PCMH capacity and 3 indicators of ambulatory care utilization: (1) emergency department utilization, (2) ambulatory care sensitive hospitalization rate, and (3) 30-day all-cause readmission rate. Results show that overall PCMH capacity is associated with lower rates, and technical aspects of the PCMH in particular were associated with lower utilization rates while interpersonal capabilities were not.
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Budhwani H, Hearld KR, Barrow G, Peterson SN, Walton-Levermore K. A comparison of younger and older men who have sex with men using data from Jamaica AIDS Support for Life: characteristics associated with HIV status. Int J STD AIDS 2015; 27:769-75. [PMID: 26138898 DOI: 10.1177/0956462415594752] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/14/2015] [Indexed: 11/15/2022]
Abstract
Jamaica is home to over 10% of the Caribbean's HIV-positive population. Men who have sex with men (MSM) have a higher prevalence of HIV compared to the general public. Thus, the purpose of this study is to assess characteristics associated with HIV, such as condom use and number of sexual partners, comparing young, those aged 18-24, to older, aged 25 and older, MSM in Jamaica. We hypothesised, and found support for the notion, that younger MSM would have a lower rate of some risky behaviours associated with HIV seropositivity. Service data for 160 self-selected MSM aged 18-62, from Kingston, Jamaica were analysed. The majority identified as homosexual (compared to bisexual), over half of respondents completed a tertiary level of education (e.g. any post-high school training), and 59.1% were employed. Almost all participants reported agreeing to use a condom when requested (93.6%). Prevalence of HIV was 17.8%, much lower than the 32% found in national studies, and is likely an underestimation reflecting patterns of this self-selected sample. Additionally, over one-third reported experiencing sexual abuse. Statistically significant relationships were found between age group and tertiary education, employment status, condom use with a regular partner, and sexual abuse. Younger MSM were more likely to have been sexually abused and were more likely to always wear a condom with their regular partner. A limitation of this study was the extent of missing data, restricting generalisability. However, by acknowledging the heterogeneity of the Jamaican MSM population, and subsequently evaluating behaviours across age groups, nuances emerge which highlight behavioural diversity. Findings may inform public health practitioners in developing targeted interventions.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
| | - Kristine R Hearld
- University of Alabama at Birmingham, School of Health Professions, Birmingham, AL, USA
| | - Geoffrey Barrow
- University of West Indies, Department of Medicine, Kingston, Jamaica
| | - Suzanne N Peterson
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL, USA
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Abstract
PURPOSE Longitudinally (2008-2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community. DESIGN/METHODOLOGY/APPROACH Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH. FINDINGS Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH. IMPLICATIONS Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH's ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities. ORIGINALITY/VALUE To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices' PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.
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Sheppard KD, Brown CJ, Hearld KR, Roth DL, Sawyer P, Locher JL, Allman RM, Ritchie CS. Symptom burden predicts nursing home admissions among older adults. J Pain Symptom Manage 2013; 46:591-7. [PMID: 23218806 PMCID: PMC3748255 DOI: 10.1016/j.jpainsymman.2012.10.228] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 10/11/2012] [Accepted: 10/17/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Symptom burden has been associated with functional decline in community-dwelling older adults and may be responsive to interventions. Known predictors of nursing home (NH) admission are often nonmodifiable. OBJECTIVES To determine if symptom burden independently predicted NH admission among community-dwelling older adults over an eight and a half-year follow-up period. METHODS A random sample of community-dwelling Medicare beneficiaries in Alabama, stratified by race, gender, and rural/urban residence had baseline in-home assessments of sociodemographic measurements, Charlson comorbidity count, and symptoms. Symptom burden was derived from a count of 10 patient-reported symptoms. Nursing home admissions were determined from telephone interviews conducted every six months over the eight and a half years of study. Cox proportional hazard modeling was used to examine the significance of symptom burden as a predictor for NH admission after adjusting for other variables. RESULTS The mean ± SD age of the sample (N = 999) was 75.3 ± 6.7 years, and the sample was 51% rural, 50% African American, and 50% male. Thirty-eight percent (n = 380) had symptom burden scores ≥2. Seventy-five participants (7.5%) had confirmed dates for NH admission during the eight and a half years of follow-up. Using Cox proportional hazard modeling, symptom burden remained an independent predictor of time to NH placement (hazard ratio = 1.11; P = 0.02), even after adjustment for comorbidity count, race, sex, and age. CONCLUSION Symptom burden is an independent risk factor for NH admission. Aggressive management of symptoms in older adults may reduce or delay NH admission.
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Affiliation(s)
- Kendra D Sheppard
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Salanitro AH, Hovater M, Hearld KR, Roth DL, Sawyer P, Locher JL, Bodner E, Brown CJ, Allman RM, Ritchie CS. Symptom burden predicts hospitalization independent of comorbidity in community-dwelling older adults. J Am Geriatr Soc 2012; 60:1632-7. [PMID: 22985139 DOI: 10.1111/j.1532-5415.2012.04121.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults. DESIGN Prospective, observational study with a baseline in-home assessment of symptom burden. SETTING Central Alabama. PARTICIPANTS Nine hundred eighty community-dwelling adults aged 65 and older (mean 75.3 ± 6.7) recruited from a random sample of Medicare beneficiaries stratified according to sex, race, and urban/rural residence. MEASUREMENTS Symptom burden score (range 0-10). One point was given for each symptom reported: shortness of breath, tiredness or fatigue, problems with balance or dizziness, leg weakness, poor appetite, pain, stiffness, constipation, anxiety, and loss of interest in activities. Dependent variables were hospitalizations and ED visits, assessed every 6 months during the 8.5-year follow-up period. Using Cox proportional hazards models, time from the baseline in-home assessment to the first hospitalization and first hospitalization or ED visit was determined. RESULTS During the 8.5-year follow-up period, 545 (55.6%) participants were hospitalized or had an ED visit. Participants with greater symptom burden had higher risk of hospitalization (hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.05-1.14) and hospitalization or ED visit (HR = 1.10, 95% CI = 1.06-1.14) than those with lower scores. Participants living in rural areas had significantly lower risk of hospitalization (HR = 0.83, 95% CI = 0.69-0.99) and hospitalization or ED visit (HR = 0.80, 95% CI = 0.70-0.95) than individuals in urban areas, independent of symptom burden and comorbidity. CONCLUSION Greater symptom burden was associated with higher risk of hospitalization and ED visits in community-dwelling older adults. Healthcare providers treating older adults should consider symptom burden to be an additional risk factor for subsequent hospital utilization.
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Affiliation(s)
- Amanda H Salanitro
- Geriatric Research, Education and Clinical Center Veterans Affairs Tennessee Valley Healthcare, Nashville, Tennessee 37212, USA.
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