SPH Community Health Sciences Papers
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Item Reproductive Health Surveillance in the US-Mexico Border Region: Beyond the Border (and Into the Future)(Centers for Disease Control and Prevention, 2008-9-15) Kotelchuck, MiltonItem Causal Beliefs about Obesity and Associated Health Behaviors: Results from a Population-Based Survey(BioMed Central, 2010-3-3) Wang, Catharine; Coups, Elliot J.BACKGROUND. Several genetic variants are associated with obesity risk. Promoting the notion of genes as a cause for obesity may increase genetically deterministic beliefs and decrease motivation to engage in healthy lifestyle behaviors. Little is known about whether causal beliefs about obesity are associated with lifestyle behaviors. Study objectives were as follows: 1) to document the prevalence of various causal beliefs about obesity (i.e., genes versus lifestyle behaviors), and 2) to determine the association between obesity causal beliefs and self-reported dietary and physical activity behaviors. METHODS. The study data were drawn from the 2007 Health Information National Trends Survey (HINTS). A total of 3,534 individuals were included in the present study. RESULTS. Overall, 72% of respondents endorsed the belief that lifestyle behaviors have 'a lot' to do with causing obesity, whereas 19% indicated that inheritance has 'a lot' to do with causing obesity. Multinomial logistic regression analyses indicated that the belief that obesity is inherited was associated with lower reported levels of physical activity (OR = 0.87, 95% CI: 0.77-0.99) and fruit and vegetable consumption (OR = 0.87, 95% CI: 0.76-0.99). In contrast, the belief that obesity is caused by lifestyle behaviors was associated with greater reported levels of physical activity (OR = 1.29, 95% CI: 1.03-1.62), but was not associated with fruit and vegetable intake (OR = 1.07, 95% CI: 0.90-1.28). CONCLUSIONS. Causal beliefs about obesity are associated with some lifestyle behaviors. Additional research is needed to determine whether promoting awareness of the genetic determinants of obesity will decrease the extent to which individuals will engage in the lifestyle behaviors essential to healthy weight management.Item Preconception Care Between Pregnancies: The Content of Internatal Care(Springer US, 2006-7-1) Lu, Michael C.; Kotelchuck, Milton; Culhane, Jennifer F.; Hobel, Calvin J.; Klerman, Lorraine V.; Thorp, John M.For more than two decades, prenatal care has been a cornerstone of our nation's strategy for improving pregnancy outcomes. In recent years, however, a growing recognition of the limits of prenatal care and the importance of maternal health before pregnancy has drawn increasing attention to preconception and internatal care. Internatal care refers to a package of healthcare and ancillary services provided to a woman and her family from the birth of one child to the birth of her next child. For healthy mothers, internatal care offers an opportunity for wellness promotion between pregnancies. For high-risk mothers, internatal care provides strategies for risk reduction before their next pregnancy. In this paper we begin to define the contents of internatal care. The core components of internatal care consist of risk assessment, health promotion, clinical and psychosocial interventions. We identified several priority areas, such as FINDS (family violence, infections, nutrition, depression, and stress) for risk assessment or BBEEFF (breastfeeding, back-to-sleep, exercise, exposures, family planning and folate) for health promotion. Women with chronic health conditions such as hypertension, diabetes, or weight problems should receive on-going care per clinical guidelines for their evaluation, treatment, and follow-up during the internatal period. For women with prior adverse outcomes such as preterm delivery, we propose an internatal care model based on known etiologic pathways, with the goal of preventing recurrence by addressing these biobehavioral pathways prior to the next pregnancy. We suggest enhancing service integration for women and families, including possibly care coordination and home visitation for selected high-risk women. The primary aim of this paper is to start a dialogue on the content of internatal care.Item Adaptation of a Smoking Cessation and Prevention Website for Urban American Indian/Alaska Native Youth(Springer-Verlag, 2010-1-16) Taualii, Maile; Bush, Nigel; Bowen, Deborah J.; Forquera, RalphTobacco use among American Indian youth is a disproportionately significant problem. We adapted and modified an existing web-based and youth-focused tobacco control program to make it appropriate for young urban American Indian/Alaska Natives (AI/ANs). The results of the focus group indicate that AI/AN youth were very receptive to the use of a web-based Zine-style intervention tool. They wanted the look and feel of the website to be more oriented toward their cultural images. Future research should examine if successful programs for reducing non-ceremonial tobacco use among urban AI/AN youth can keep young irregular smokers from becoming adult smokers.Item Outcome of Crisis Intervention for Borderline Personality Disorder and Post Traumatic Stress Disorder: A Model for Modification of the Mechanism of Disorder in Complex Post Traumatic Syndromes(BioMed Central, 2010-4-27) Laddis, AndreasBACKGROUND. This study investigates the outcome of crisis intervention for chronic post traumatic disorders with a model based on the theory that such crises manifest trauma in the present. The sufferer's behavior is in response to the current perception of dependency and entrapment in a mistrusted relationship. The mechanism of disorder is the sufferer's activity, which aims to either prove or disprove the perception of entrapment, but, instead, elicits more semblances of it in a circular manner. Patients have reasons to keep such activity private from therapy and are barely aware of it as the source of their symptoms. METHODS. The hypothesis is that the experimental intervention will reduce symptoms broadly within 8 to 24 h from initiation of treatment, compared to treatment as usual. The experimental intervention sidesteps other symptoms to engage patients in testing the trustworthiness of the troubled relationship with closure, thus ending the circularity of their own ways. The study compares 32 experimental subjects with 26 controls at similar crisis stabilization units. RESULTS. The results of the Brief Psychiatric Rating Scale (BPRS) supported the hypothesis (both in total score and for four of five subscales), as did results with Client Observation, a pilot instrument designed specifically for the circular behavior targeted by the experimental intervention. Results were mostly non-significant from two instruments of patient self-observation, which provided retrospective pretreatment scores. CONCLUSIONS. The discussion envisions further steps to ascertain that this broad reduction of symptoms ensues from the singular correction that distinguishes the experimental intervention. TRIAL REGISTRATION. Protocol Registration System NCT00269139. The PRS URL is https://register.clinicaltrials.govItem Association between Neighborhood Safety and Overweight Status among Urban Adolescents(BioMed Central, 2009-8-11) Duncan, Dustin T.; Johnson, Renee M.; Molnar, Beth E.; Azrael, DeborahBACKGROUND. Neighborhood safety may be an important social environmental determinant of overweight. We examined the relationship between perceived neighborhood safety and overweight status, and assessed the validity of reported neighborhood safety among a representative community sample of urban adolescents (who were racially and ethnically diverse). METHODS. Data come from the 2006 Boston Youth Survey, a cross-sectional study in which public high school students in Boston, MA completed a pencil-and-paper survey. The study used a two-stage, stratified sampling design whereby schools and then 9th–12th grade classrooms within schools were selected (the analytic sample included 1,140 students). Students reported their perceptions of neighborhood safety and several associated dimensions. With self-reported height and weight data, we computed body mass index (BMI, kg/m2) for the adolescents based on CDC growth charts. Chi-square statistics and corresponding p-values were computed to compare perceived neighborhood safety by the several associated dimensions. Prevalence ratios (PRs) and 95% confidence intervals (CI) were calculated to examine the association between perceived neighborhood safety and the prevalence of overweight status controlling for relevant covariates and school site. RESULTS. More than one-third (35.6%) of students said they always felt safe in their neighborhood, 43.9% said they sometimes felt safe, 11.6% rarely felt safe, and 8.9% never felt safe. Those students who reported that they rarely or never feel safe in their neighborhoods were more likely than those who said they always or sometimes feel safe to believe that gang violence was a serious problem in their neighborhood or school (68.0% vs. 44.1%, p < 0.001), and to have seen someone in their neighborhood assaulted with a weapon (other than a firearm) in the past 12 months (17.8% vs. 11.3%, p = 0.025). In the fully adjusted model (including grade and school) stratified by race/ethnicity, we found a statistically significant association between feeling unsafe in one's own neighborhood and overweight status among those in the Other race/ethnicity group [(PR = 1.56, (95% CI: 1.02, 2.40)]. CONCLUSION. Data suggest that perception of neighborhood safety may be associated with overweight status among urban adolescents in certain racial/ethnic groups. Policies and programs to address neighborhood safety may also be preventive for adolescent overweight.Item The GirlStars Program: Challenges to Recruitment and Retention in a Physical Activity and Health Education Program for Adolescent Girls Living in Public Housing(Centers for Disease Control and Prevention, 2010-2-15) Strunin, Lee; Douyon, Maisha; Chavez, Maria; Bunte, Doris; Horsburgh, C. RobertBACKGROUND. Although physical inactivity is a concern for all adolescents, physical activity levels are especially low among minority adolescents and minimal among girls from low-income families. After-school programs can reduce high-risk behaviors and strengthen schools, families, and communities. CONTEXT. We conducted an operational research project that provided free access to a program of regular, organized physical activity combined with health education sessions for adolescent girls in 2 public housing developments in Boston, Massachusetts. METHODS. From July 2002 through October 2005, at each of 2 public housing sites, the GirlStars program participants met each week for two 2-hour sessions, 1 dedicated to physical activity and 1 dedicated to health education. Sessions were led by the project coordinator and a resident assistant at each development. OUTCOME. Participants in the GirlStars program increased their health knowledge, self-confidence, and decision-making skills, but rates of participation were low. Factors that affected participation included safety concerns, lack of community support for the program, interpersonal conflicts, attrition in staff, and conflicts with other activities. INTERPRETATION. Programs in public housing developments that address these barriers to recruitment and retention may be more successful and reach more girls.Item Syphilis and Hepatitis B Co-Infection among HIV-Infected, Sex-Trafficked Women and Girls, Nepal(Centers for Disease Control and Prevention, 2011-12-29) Silverman, Jay G.; Decker, Michele R.; Gupta, Jhumka; Dharmadhikari, Ashwin; Seage, George R.; Raj, AnitaSex trafficking may play a major role in spread of HIV across South Asia. We investigated co-infection with HIV and other sexually transmitted diseases among 246 sex-trafficked women and girls from Nepal. Those who were HIV positive were more likely than those who were HIV negative to be infected with syphilis and/or hepatitis B.Item Alcohol and HIV Disease Progression: Weighing the Evidence(Current Science Inc., 2010-9-3) Hahn, Judith A.; Samet, Jeffrey H.Heavy alcohol use is commonplace among HIV-infected individuals; however, the extent that alcohol use adversely impacts HIV disease progression has not been fully elucidated. Fairly strong evidence suggests that heavy alcohol consumption results in behavioral and biological processes that likely increase HIV disease progression, and experimental evidence of the biological effect of heavy alcohol on simian immunodeficiency virus in macaques is quite suggestive. However, several observational studies of the effect of heavy alcohol consumption on HIV progression conducted in the 1990s found no association of heavy alcohol consumption with time to AIDS diagnosis, while some more recent studies showed associations of heavy alcohol consumption with declines of CD4 cell counts and nonsuppression of HIV viral load. We discuss several plausible biological and behavioral mechanisms by which alcohol may cause HIV disease progression, evidence from prospective observational human studies, and suggest future research to further illuminate this important issue.Item Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems(BioMed Central, 2006-2-27) Kim, Theresa W.; Kertesz, Stefan G.; Horton, Nicholas J.; Tibbetts, Nicole; Samet, Jeffrey H.BACKGROUND: Because individuals with HIV/AIDS often have complex medical and social needs, the impact of housing status on medical service utilization is difficult to isolate from the impact of conditions that may worsen during periods of homelessness such as depression and substance abuse. We examine whether episodes of homelessness are independently associated with suboptimal medical utilization even when accounting for concurrent addiction severity and depression. METHODS: We used data from a 30-month cohort of patients with HIV/AIDS and alcohol problems. Housing status, utilization (ambulatory visits, emergency department (ED) visits, and hospitalizations) and other features were assessed with standardized research interviews at 6-month intervals. Multivariable longitudinal regression models calculated incidence rate ratios (IRR) comparing utilization rates during 6-month intervals (homeless versus housed). Additional models assessed whether addiction severity and depressive symptoms could account for utilization differences. RESULTS: Of the 349 subjects, 139 (39%) reported homelessness at least once during the study period; among these subjects, the median number of nights homeless per 6-month interview period was 30. Homelessness was associated with higher ED utilization (IRR = 2.17; 95% CI = 1.72–2.74) and hospitalizations (IRR = 2.30; 1.70–3.12), despite no difference in ambulatory care utilization (IRR = 1.09; 0.89–1.33). These associations were attenuated but remained significant when adjusting for addiction severity and depressive symptoms. CONCLUSION: In patients with HIV/AIDS and alcohol problems, efforts to improve housing stability may help to mitigate intensive medical utilization patterns.