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Yang CY, Smith TJ, Knowlton AR. Cancer Patient Perspectives on the Meaning of Healing and the Clinician as a Healer. Am J Hosp Palliat Care 2024; 41:658-663. [PMID: 37487577 DOI: 10.1177/10499091231191697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The experience of living with cancer is marked by suffering and loss, which creates a need for healing. Understanding what healing means to patients and how clinicians can play a role in the healing process is essential to holistic cancer care. OBJECTIVE The aim of this study was to explore the perspectives of cancer patients on the meaning and experiences of healing and the qualities of a clinician and the clinician-patient relationship that are healing. METHODS A qualitative study was conducted using semi-structured interviews with 14 cancer patients. Participants were asked about their illness experience, definition of healing, qualities of a healer, and relationships with clinicians that were healing. Interview transcripts were coded, and qualitative analysis was conducted to identify major themes. RESULTS Participants defined the nature of healing as comprising aspects of physical, mental, emotional, and spiritual well-being. Participants described healing as alleviating pain and symptoms; promoting mental strength, emotional comfort, and spiritual connection; restoring and adapting to losses; and improving quality of life. The qualities of a clinician that contributed to a healing relationship included listening, empathy and compassion, understanding patients' values and goals, and caring for the patient as a whole person. CONCLUSION Participants viewed healing as physical, psychosocial, and spiritual in nature and an important part of their cancer experience with an emphasis on quality of life. Clinicians played an important role beyond treating the cancer by helping in the healing process through their humanistic qualities and holistic approach to patient care.
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Affiliation(s)
- Cindy Y Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Thomas J Smith
- Departments of Oncology and Internal Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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2
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Mitchell MM, Tseng TY, Rubin LH, Cruz-Oliver D, Catanzarite Z, Clair CA, Moore DJ, Knowlton AR. Social support network factors associated with verbal fluency among vulnerable persons living with HIV. AIDS Care 2024; 36:358-367. [PMID: 37345842 PMCID: PMC10739652 DOI: 10.1080/09540121.2023.2216925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/16/2023] [Indexed: 06/23/2023]
Abstract
Vulnerable persons living with HIV (PLWH) are at high risk of cognitive impairment and challenges accessing quality social support in later life. Impaired verbal fluency (VF), a cognitive domain linked to HIV, could impede social support associated with health and well-being for already vulnerable PLWH. We examined the structure of social support, using latent class analysis, and the associations among quantity, specific forms and quality of social support and VF among PLWH. Participants enrolled in the BEACON study (n = 383) completed the Controlled Oral Word Association test (COWAT) and a social support network inventory. Latent class analysis with count variables was used to determine the number of classes of PLWH based on their social network characteristics. The majority of PLWH were male (61.4%) and African American (85.9%). Two distinct latent classes, with a major distinction in the number of network members who were female, knew participants' HIV status and HIV medication usage. Fewer support network members (β = -.13, p < 0.01), greater negative interactions (β = -.16, p < 0.01), and less positive interactions with network members (β = .15, p < 0.05) were significantly associated with lower COWAT scores. Comprehensive screening of high-risk PLWH and early intervention with those with cognitive impairment are important for addressing social support needs.
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Affiliation(s)
- Mary M. Mitchell
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Tuo-Yen Tseng
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Leah H. Rubin
- Departments of Neurology and Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA
| | - Dulce Cruz-Oliver
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Zachary Catanzarite
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Catherine A. Clair
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - David J. Moore
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Amy R. Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Pirotta E, Tyack PL, Durban JW, Fearnbach H, Hamilton PK, Harris CM, Knowlton AR, Kraus SD, Miller CA, Moore MJ, Pettis HM, Photopoulou T, Rolland RM, Schick RS, Thomas L. Decreasing body size is associated with reduced calving probability in critically endangered North Atlantic right whales. R Soc Open Sci 2024; 11:240050. [PMID: 38420631 PMCID: PMC10898963 DOI: 10.1098/rsos.240050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
Body size is key to many life-history processes, including reproduction. Across species, climate change and other stressors have caused reductions in the body size to which animals can grow, called asymptotic size, with consequences for demography. A reduction in mean asymptotic length was documented for critically endangered North Atlantic right whales, in parallel with declines in health and vital rates resulting from human activities and environmental changes. Here, we tested whether smaller body size was associated with lower reproductive output, using a state-space model for individual health, survival and reproduction that quantifies the mechanistic links between these processes. Body size (as represented by the cube of length) was strongly associated with a female's calving probability at each reproductive opportunity. This relationship explained 62% of the variation in calving among reproductive females, along with their decreasing health (20%). The effects of decreasing mean body size on reproductive performance are another concerning indication of the worsening prospects for this species and many others affected by environmental change, requiring a focus of conservation and management interventions on improving conditions that affect reproduction as well as reducing mortality.
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Affiliation(s)
- Enrico Pirotta
- Centre for Research into Ecological and Environmental Modelling, University of St Andrews, St Andrews, UK
| | - Peter L. Tyack
- School of Biology, Scottish Oceans Institute, University of St Andrews, St Andrews, UK
| | - John W. Durban
- Southall Environmental Associates, Inc., 9099 Soquel Drive, Aptos, CA 95003, USA
| | - Holly Fearnbach
- SR3, SeaLife Response, Rehabilitation and Research, Des Moines, WA, USA
| | - Philip K. Hamilton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA, USA
| | - Catriona M. Harris
- Centre for Research into Ecological and Environmental Modelling, University of St Andrews, St Andrews, UK
| | - Amy R. Knowlton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA, USA
| | - Scott D. Kraus
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA, USA
| | - Carolyn A. Miller
- Department of Marine Chemistry and Geochemistry, Woods Hole Oceanographic Institution, Woods Hole, MA, USA
| | - Michael J. Moore
- Department of Biology, Woods Hole Oceanographic Institution, Woods Hole, MA, USA
| | - Heather M. Pettis
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA, USA
| | - Theoni Photopoulou
- Centre for Research into Ecological and Environmental Modelling, University of St Andrews, St Andrews, UK
| | | | - Robert S. Schick
- Southall Environmental Associates, Inc., 9099 Soquel Drive, Aptos, CA 95003, USA
- Marine Geospatial Ecology Lab, Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Len Thomas
- Centre for Research into Ecological and Environmental Modelling, University of St Andrews, St Andrews, UK
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5
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Pirotta E, Schick RS, Hamilton PK, Harris CM, Hewitt J, Knowlton AR, Kraus SD, Meyer‐Gutbrod E, Moore MJ, Pettis HM, Photopoulou T, Rolland RM, Tyack PL, Thomas L. Estimating the effects of stressors on the health, survival and reproduction of a critically endangered, long‐lived species. OIKOS 2023. [DOI: 10.1111/oik.09801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Enrico Pirotta
- Centre for Research into Ecological and Environmental Modelling, Univ. of St Andrews St Andrews UK
| | - Robert S. Schick
- Marine Geospatial Ecology Lab, Nicholas School of the Environment, Duke Univ. Durham NC USA
| | - Philip K. Hamilton
- Anderson Cabot Center for Ocean Life, New England Aquarium Boston MA USA
| | - Catriona M. Harris
- Centre for Research into Ecological and Environmental Modelling, Univ. of St Andrews St Andrews UK
| | - Joshua Hewitt
- Dept of Statistical Science, Duke Univ. Durham NC USA
| | - Amy R. Knowlton
- Anderson Cabot Center for Ocean Life, New England Aquarium Boston MA USA
| | - Scott D. Kraus
- Anderson Cabot Center for Ocean Life, New England Aquarium Boston MA USA
| | - Erin Meyer‐Gutbrod
- School of Earth, Ocean and Environment, Univ. of South Carolina Columbia SC USA
| | | | - Heather M. Pettis
- Anderson Cabot Center for Ocean Life, New England Aquarium Boston MA USA
| | - Theoni Photopoulou
- Centre for Research into Ecological and Environmental Modelling, Univ. of St Andrews St Andrews UK
| | | | - Peter L. Tyack
- School of Biology, Scottish Oceans Inst., Univ. of St Andrews St Andrews UK
| | - Len Thomas
- Centre for Research into Ecological and Environmental Modelling, Univ. of St Andrews St Andrews UK
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6
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Knowlton AR, Clark JS, Hamilton PK, Kraus SD, Pettis HM, Rolland RM, Schick RS. Fishing gear entanglement threatens recovery of critically endangered North Atlantic right whales. Conservat Sci and Prac 2022. [DOI: 10.1111/csp2.12736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amy R. Knowlton
- Anderson Cabot Center for Ocean Life New England Aquarium, Central Wharf Boston Massachusetts USA
| | - James S. Clark
- Nicholas School of the Environment Duke University Durham North Carolina USA
| | - Philip K. Hamilton
- Anderson Cabot Center for Ocean Life New England Aquarium, Central Wharf Boston Massachusetts USA
| | - Scott D. Kraus
- Anderson Cabot Center for Ocean Life New England Aquarium, Central Wharf Boston Massachusetts USA
| | - Heather M. Pettis
- Anderson Cabot Center for Ocean Life New England Aquarium, Central Wharf Boston Massachusetts USA
| | - Rosalind M. Rolland
- Anderson Cabot Center for Ocean Life New England Aquarium, Central Wharf Boston Massachusetts USA
| | - Robert S. Schick
- Nicholas School of the Environment Duke University Durham North Carolina USA
- Centre for Research into Ecological and Environmental Modelling School of Mathematics and Statistics, University of St Andrews St Andrews UK
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7
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Mitchell MM, Tseng TY, Cruz-Oliver D, Catanzarite Z, Hansen E, Knowlton AR. Family Conflict Non-negotiation and HIV Disclosure Associated With ART Adherence in a Disadvantaged Population. AIDS Educ Prev 2022; 34:158-167. [PMID: 35438542 DOI: 10.1521/aeap.2022.34.2.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Adherence to antiretroviral therapy (ART) is vital for reducing racial and gender disparities in morbidity and mortality among people living with HIV/AIDS (PLWH). Little research attention has been given to aspects of family functioning affecting ART adherence among PLWH vulnerable to disparities. Data were from n = 313 participants (93% African American) in the BEACON study, which recruited injection-drug-using PLWH on ART. Using factor analysis and longitudinal structural equation modeling, we found that current substance use and negative family conflict tactics (i.e., non-negotiation) predicted PLWH's lower probability of ART adherence at 12-month follow-up; and greater HIV disclosure to support network members predicted a higher probability of adherence. These findings suggest the importance of family and other support network members in this vulnerable population's ART adherence. Social network-focused interventions promoting prosocial response to conflict and negotiation skills are important for improving vulnerable PLWH's HIV outcomes and reducing health disparities.
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Affiliation(s)
| | - Tuo-Yen Tseng
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland
| | - Dulce Cruz-Oliver
- Johns Hopkins School of Medicine, Department of Medicine, Baltimore, Maryland
| | - Zachary Catanzarite
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland
| | - Eric Hansen
- Roswell Park Comprehensive Cancer Center, Department of Supportive Care, Buffalo, New York
| | - Amy R Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, Maryland
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8
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Franklin KJ, Cole TVN, Cholewiak DM, Duley PA, Crowe LM, Hamilton PK, Knowlton AR, Taggart CT, Johnson HD. Using sonobuoys and visual surveys to characterize North Atlantic right whale (Eubalaena glacialis) calling behavior in the Gulf of St. Lawrence. ENDANGER SPECIES RES 2022. [DOI: 10.3354/esr01208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Quintana-Rizzo E, Leiter S, Cole TVN, Hagbloom MN, Knowlton AR, Nagelkirk P, O’Brien O, Khan CB, Henry AG, Duley PA, Crowe LM, Mayo CA, Kraus SD. Correction: Residency, demographics, and movement patterns of North Atlantic right whales Eubalaena glacialis in an offshore wind energy development area in southern New England, USA. ENDANGER SPECIES RES 2021. [DOI: 10.3354/esr01137_c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- E Quintana-Rizzo
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
- Simmons University, Boston, MA 02115, USA
| | - S Leiter
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - TVN Cole
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - MN Hagbloom
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - AR Knowlton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - P Nagelkirk
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - O O’Brien
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - CB Khan
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - AG Henry
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - PA Duley
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - LM Crowe
- Integrated Statistics, under contract to the Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - CA Mayo
- Center for Coastal Studies, Provincetown, MA 02657, USA
| | - SD Kraus
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
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10
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Quintana-Rizzo E, Leiter S, Cole TVN, Hagbloom MN, Knowlton AR, Nagelkirk P, O’Brien O, Khan CB, Henry AG, Duley PA, Crowe LM, Mayo CA, Kraus SD. Residency, demographics, and movement patterns of North Atlantic right whales Eubalaena glacialis in an offshore wind energy development area in southern New England, USA. ENDANGER SPECIES RES 2021. [DOI: 10.3354/esr01137] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Offshore wind energy development is growing quickly around the world. In southern New England, USA, one of the largest commercial offshore wind energy farms in the USA will be established in the waters off Massachusetts and Rhode Island, an area used by the Critically Endangered North Atlantic right whale Eubalaena glacialis. Prior to 2011, little was known about the use of this area by right whales. We examined aerial survey data collected between 2011-2015 and 2017-2019 to quantify right whale distribution, residency, demography, and movements in the region. Right whale occurrence increased during the study period. Since 2017, whales have been sighted in the area nearly every month, with peak sighting rates between late winter and spring. Model outputs suggest that 23% of the species’ population is present from December through May, and the mean residence time has tripled to an average of 13 d during these months. Age and sex ratios of the individuals present in the area are similar to those of the species as a whole, with adult males the most common demographic group. Movement models showed that southern New England is an important destination for right whales, including conceptive and reproductive females, and qualitative observations included animals feeding and socializing. Implementing mitigation procedures in coordination with these findings will be crucial in lessening the potential impacts on right whales from construction noise, increased vessel traffic, and habitat disruption in this region.
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Affiliation(s)
- E Quintana-Rizzo
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
- Simmons University, Boston, MA 02115, USA
| | - S Leiter
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - TVN Cole
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - MN Hagbloom
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - AR Knowlton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - P Nagelkirk
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - O O’Brien
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
| | - CB Khan
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - AG Henry
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - PA Duley
- Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - LM Crowe
- Integrated Statistics, under contract to the Northeast Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Woods Hole, MA 02543, USA
| | - CA Mayo
- Center for Coastal Studies, Provincetown, MA 02657, USA
| | - SD Kraus
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA 02110, USA
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Stewart JD, Durban JW, Knowlton AR, Lynn MS, Fearnbach H, Barbaro J, Perryman WL, Miller CA, Moore MJ. Decreasing body lengths in North Atlantic right whales. Curr Biol 2021; 31:3174-3179.e3. [PMID: 34087102 DOI: 10.1016/j.cub.2021.04.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
Whales are now largely protected from direct harvest, leading to partial recoveries in many previously depleted species.1 However, most populations remain far below their historical abundances and incidental human impacts, especially vessel strikes and entanglement in fishing gear, are increasingly recognized as key threats.2 In addition, climate-driven changes to prey dynamics are impacting the seasonal foraging grounds of many baleen whales.2 In many cases these impacts result directly in mortality. But it is less clear how widespread and increasing sub-lethal impacts are affecting life history, individual fitness, and population viability. We evaluated changes in body lengths of North Atlantic right whales (NARW) using aerial photogrammetry measurements collected from crewed aircraft and remotely operated drones over a 20-year period (Figure 1). NARW have been monitored consistently since the 1980s and have been declining in abundance since 2011 due primarily to deaths associated with entanglements in active fishing gear and vessel strikes.3 High rates of sub-lethal injuries and individual-level information on age, size and observed entanglements make this an ideal population to evaluate the effects that these widespread stressors may have on individual fitness. We find that entanglements in fishing gear are associated with shorter whales, and that body lengths have been decreasing since 1981. Arrested growth may lead to reduced reproductive success4,5 and increased probability of lethal gear entanglements.6 These results show that sub-lethal stressors threaten the recoveries of vulnerable whale populations even in the absence of direct harvest.
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Affiliation(s)
- Joshua D Stewart
- National Research Council Postdoctoral Fellow for Marine Mammal and Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla Shores Drive, La Jolla, CA, 92037, USA.
| | - John W Durban
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla Shores Drive, La Jolla, CA, 92037, USA; Southall Environmental Associates, Inc., Soquel Dr., Aptos, CA, 95003, USA
| | - Amy R Knowlton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, MA, 02110, USA
| | - Morgan S Lynn
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla Shores Drive, La Jolla, CA, 92037, USA
| | - Holly Fearnbach
- Marine Mammal Research Program, SR3, SeaLife Response, Rehabilitation and Research, S 216th St., Des Moines, WA, 98198, USA
| | - Jacob Barbaro
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla Shores Drive, La Jolla, CA, 92037, USA
| | - Wayne L Perryman
- Marine Mammal and Turtle Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla Shores Drive, La Jolla, CA, 92037, USA
| | - Carolyn A Miller
- Department of Biology, Woods Hole Oceanographic Institution, Woods Hole Rd., Woods Hole, MA, 02543, USA
| | - Michael J Moore
- Department of Biology, Woods Hole Oceanographic Institution, Woods Hole Rd., Woods Hole, MA, 02543, USA
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Nesoff ED, Milam AJ, Morrison C, Weir BW, Branas CC, Furr-Holden DM, Knowlton AR, Martins SS. Alcohol outlets, drug paraphernalia sales, and neighborhood drug overdose. Int J Drug Policy 2021; 95:103289. [PMID: 33984684 DOI: 10.1016/j.drugpo.2021.103289] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 04/13/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Alcohol outlets have been associated with various forms of injury and may contribute to neighborhood disparities in drug overdose. Few studies have examined the associations between alcohol outlets and drug overdose. This study investigated whether alcohol outlets were associated with the neighborhood drug overdose rate and whether the sale of drug paraphernalia contributes to this association. METHODS A cross-sectional ecological spatial analysis was conducted within census block groups in Baltimore City (n = 653). Outcomes were counts of EMS calls for any drug overdose in 2015 (n = 3,856). Exposures of interest were counts of alcohol outlets licensed for off-premise and on-premise consumption and the proportion of off-premise outlets selling drug paraphernalia (e.g., blunt wrappers, baggies, pipes). Negative binomial regression was used to assess the relationship between outlet count and overdose rate, and if paraphernalia sales altered this relationship, controlling for other neighborhood factors. Spatial autocorrelation was assessed and regression inference adjusted accordingly. RESULTS Each additional off-premise alcohol outlet was associated with a 16.6% increase in the neighborhood overdose rate (IRR=1.17, 95%CI=(1.11, 1.23)), adjusted for other neighborhood variables. On-premise alcohol outlets were not significantly associated with overdose rate when adjusting for off-premise alcohol outlets (IRR=1.01, 95% CI=(0.97, 1.06)). The proportion of off-premise outlets that sold drug paraphernalia was negatively associated with overdose rate (IRR=0.55, 95% CI=(0.41, 0.74)) and did not alter the relationship between off-premise outlets and overdose. CONCLUSION This study provides preliminary public health evidence for informing policy decisions about alcohol outlet licensing and zoning. Alcohol outlets could be potential community partners for harm reduction strategies such as health communication in identifying overdose symptoms or Good Samaritan Laws.
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Affiliation(s)
- Elizabeth D Nesoff
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics, Epidemiology, and Informatics, 423 Guardian Dr, Philadelphia, PA, 19104, USA; Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA.
| | - Adam J Milam
- Michigan State University College of Human Medicine, Department of Epidemiology and Biostatics, 200 East First Street, Flint, MI, 48502, USA
| | - Christopher Morrison
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA
| | - Brian W Weir
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, 7th floor, Baltimore, MD, 21205, USA
| | - Charles C Branas
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA
| | - Debra M Furr-Holden
- Michigan State University College of Human Medicine, Department of Epidemiology and Biostatics, 200 East First Street, Flint, MI, 48502, USA
| | - Amy R Knowlton
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624N. Broadway, 7th floor, Baltimore, MD, 21205, USA
| | - Silvia S Martins
- Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W168th St, 5th floor, New York, NY, 10032, USA
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Maragh-Bass AC, Hendricks Sloan D, Aimone EV, Knowlton AR. 'The Woman Gives': Exploring gender and relationship factors in HIV advance care planning among African American caregivers. J Clin Nurs 2021; 30:2331-2347. [PMID: 33829592 DOI: 10.1111/jocn.15772] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/24/2021] [Accepted: 03/17/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE Advance care planning (ACP) is the communication process of documenting future healthcare preferences in case patients are unable to make healthcare decisions for themselves. Research suggests ACP discussions among persons living with HIV (PLHIV) are infrequent overall and may differ by gender and/or race. BACKGROUND Previous literature has displayed that African Americans are less likely than other racial groups to use advanced care planning, palliative care or hospice, but does not conclusively account for ACP among PLHIV. African American PLHIV rely on informal care that may be differ by gender and represents an important pathway to increase ACP. DESIGN The study was mixed methods and observational. METHODS Participants completed self-report surveys (N = 311) and were interviewed (n = 11). Poisson regression (quantitative) and grounded theory analyses (qualitative) were implemented, using COREQ checklist principles to ensure study rigor. RESULTS Less than half had discussed ACP (41.2%; N = 267). More ACP knowledge predicted 76% lower likelihood of ACP discussions among women. Men who spent more time caregiving in a given week were nearly 3 times more likely to discuss ACP than men who spent less time caregiving. Women were more likely than men to be caregivers and were also expected to serve in that role more than men, which was qualitatively described as 'being a woman'. CONCLUSIONS The present study is one of few studies exploring ACP among caregivers in African American populations hardest hit by HIV. Results suggest that ACP skill building and education are critical for African Americans living with HIV to promote ACP discussions with their caregivers. Knowledge about ACP topics was low overall even when healthcare had recently been accessed. Support reciprocity and gender-specific communication skill building may facilitate ACP in African American HIV informal caregiving relationships. RELEVANCE TO CLINICAL PRACTICE Results underscore the need for ACP education which includes healthcare providers and caregivers, given African Americans' preference for life-sustaining treatments at end-of-life. ACP is crucial now more than ever, as COVID-19 complicates care for older adults with HIV at high risk of complications.
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Affiliation(s)
- Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Danetta Hendricks Sloan
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth V Aimone
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Duke Global Health Institute, Durham, North Carolina, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Moore MJ, Rowles TK, Fauquier DA, Baker JD, Biedron I, Durban JW, Hamilton PK, Henry AG, Knowlton AR, McLellan WA, Miller CA, Pace RM, Pettis HM, Raverty S, Rolland RM, Schick RS, Sharp SM, Smith CR, Thomas L, der Hoop JMV, Ziccardi MH. REVIEW: Assessing North Atlantic right whale health: threats, and development of tools critical for conservation of the species. Dis Aquat Organ 2021; 143:205-226. [PMID: 33629663 DOI: 10.3354/dao03578] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Whaling has decimated North Atlantic right whales Eubalaena glacialis (NARW) since the 11th century and southern right whales E. australis (SRW) since the 19th century. Today, NARWs are Critically Endangered and decreasing, whereas SRWs are recovering. We review NARW health assessment literature, NARW Consortium databases, and efforts and limitations to monitor individual and species health, survival, and fecundity. Photographs are used to track individual movement and external signs of health such as evidence of vessel and entanglement trauma. Post-mortem examinations establish cause of death and determine organ pathology. Photogrammetry is used to assess growth rates and body condition. Samples of blow, skin, blubber, baleen and feces quantify hormones that provide information on stress, reproduction, and nutrition, identify microbiome changes, and assess evidence of infection. We also discuss models of the population consequences of multiple stressors, including the connection between human activities (e.g. entanglement) and health. Lethal and sublethal vessel and entanglement trauma have been identified as major threats to the species. There is a clear and immediate need for expanding trauma reduction measures. Beyond these major concerns, further study is needed to evaluate the impact of other stressors, such as pathogens, microbiome changes, and algal and industrial toxins, on NARW reproductive success and health. Current and new health assessment tools should be developed and used to monitor the effectiveness of management measures and will help determine whether they are sufficient for a substantive species recovery.
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Affiliation(s)
- Michael J Moore
- Woods Hole Oceanographic Institution, Woods Hole MA 02543, USA Co-authors' addresses given in a supplement; www.int-res.com/articles/suppl/d143p205_supp.pdf
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15
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Affiliation(s)
- Richard M. Pace
- Northeast Fisheries Science Center Woods Hole Massachusetts USA
| | | | - Scott D. Kraus
- Anderson Cabot Center for Ocean Life New England Aquarium Boston Massachusetts USA
| | - Amy R. Knowlton
- Anderson Cabot Center for Ocean Life New England Aquarium Boston Massachusetts USA
| | - Heather M. Pettis
- Anderson Cabot Center for Ocean Life New England Aquarium Boston Massachusetts USA
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16
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Knowlton AR, Nguyen TQ, Isenberg S, Tseng TY, Catanzarite Z, Mitchell MM, Cruz-Oliver D. Quality of Life Among Caregivers of a Vulnerable Population Living with HIV: Caregiving and Relationship Factors. AIDS Behav 2021; 25:360-376. [PMID: 32715410 PMCID: PMC10696639 DOI: 10.1007/s10461-020-02975-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Literature on health-related quality of life (HRQOL) has focused on people living with chronic conditions, with less attention given to HRQOL among informal caregivers. We used cross-sectional dyadic data from both care recipients (CR) living with HIV and the person they identified as their primary informal (unpaid) caregiver (CG) to identify psychosocial and caregiving relationship factors (including, CG role ambivalence and caregiving-related stress) associated with CG HRQOL. We conducted confirmatory factor analysis and structural equation modeling testing. The results highlight interdependent effects of the CG-CR relationship and reveal pathways whereby relationship interactions positively and negatively impact CGs' HRQOL. Affiliative stigma, CG-CR communication, CRs' reciprocity of support and other psychosocial factors indirectly and differentially affected physical and mental HRQOL through effects on secondary stress and role ambivalence. Dyad-focused intervention on interpersonal communication and support exchange may improve HRQOL and resilience of CGs of vulnerable people living with HIV.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Trang Q Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarina Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Family and Community Medicine, University of Toronto, Toronto, USA
| | - Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Maragh-Bass AC, Sloan DH, Alghanim F, Knowlton AR. A mixed-methods exploration of faith, spirituality, and health program interest among older African Americans with HIV. Qual Life Res 2020; 30:507-519. [PMID: 33052513 DOI: 10.1007/s11136-020-02656-6] [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] [Accepted: 09/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Persons living with HIV (PLWH) are living into old age with more complex care needs that non-PLWH. Promoting quality of life should include advance care planning (ACP) education, particularly among African Americans. We explored faith/spirituality-related correlates of interest in a future quality of life program among African American PLWH. METHODS Data were from the AFFIRM study. Participants were recruited from an HIV clinic and completed surveys, interviews, and focus groups. Quantitative analyses included Logistic regression. Qualitative data were coded using grounded theory. RESULTS Nearly half of participants had less than a high school education (47.9%), and roughly 90% had heard of at least one ACP-related topic (86.6%; N = 315). Qualitative themes related to quality of life and faith/spirituality were: (1) Coping with life challenges; (2) Motivation to improve health for loved ones; and (3) Support programs for people with HIV (N = 39). Satisfaction with religion/spirituality was associated with greater interest in a future program (p < .05); discussing ACP before getting sick was associated with less interest (p < .05). CONCLUSIONS/PRACTICE IMPLICATIONS Prioritizing skill-building and grounding in spirituality with input from faith leaders can reduce ACP inequities and improve health outcomes among African Americans.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA. .,FHI 360, Behavioral, Epidemiological, and Clinical Sciences Division, Durham, NC, USA.
| | - Danetta Hendricks Sloan
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
| | - Fahid Alghanim
- Internal Medicine Residency Program, Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd floor, Baltimore, MD, 21205, USA
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18
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Cruz-Oliver DM, Tseng TY, Mitchell MM, Catanzarite Z, Budhathoki C, Smith TJ, Rushton CH, Knowlton AR. Support Network Factors Associated With Naming a Health Care Decision-Maker and Talking About Advance Care Planning Among People Living With HIV. J Pain Symptom Manage 2019; 58:1040-1047. [PMID: 31446009 PMCID: PMC6915303 DOI: 10.1016/j.jpainsymman.2019.08.019] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 08/11/2019] [Accepted: 08/12/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Little attention has been given to social environmental factors associated with advance care planning (ACP) among African Americans or people living with advanced HIV (PLHIV). OBJECTIVES The present study aimed to identify support network factors that affect the likelihood of naming a decision-maker and of talking to family/friends and doctors about ACP among vulnerable PLHIV. METHODS PLHIV were recruited from a large urban HIV clinic. A social support network inventory was used to calculate number of persons available for various types of support. Characteristics of network members were also collected. Multivariable logistic regression models were fit to examine associations between social network factors and ACP discussion, adjusting for age, sex, education, and total number of network members. RESULTS The sample (N = 370) was mostly African American (95%), male (56%), and 48% had less than a high school education. Almost half the sample (48%) had talked to their family/friends or doctor about ACP, and 34% had named a medical decision-maker. Adjusted analysis revealed that talking about ACP with family/friends was associated with female sex and a larger closer support network who provided health information and physical assistance. Talking to doctors about ACP was associated with larger support networks who provided physical assistance but lower numbers from whom emotional support was received. Naming a decision-maker was associated with greater numbers of network members who provided emotional support, health information, and medication adherence reminders. CONCLUSION The findings revealed aspects of family/support network structures and caregiving function associated with ACP in a population with often vital yet vulnerable networks.
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Affiliation(s)
- Dulce M Cruz-Oliver
- Internal Medicine, Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Thomas J Smith
- Palliative Medicine Program, JHMI, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Cynda H Rushton
- Berman Institute of Bioethics-Research Program, Johns Hopkins School of Nursing, Maryland, USA
| | - Amy R Knowlton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Maragh-Bass AC, Fields JC, Catanzarite Z, Knowlton AR. "We get tunnel vision": Emergency medical service providers' views on the opioid epidemic in Baltimore City. J Opioid Manag 2019; 15:295-306. [PMID: 31637682 DOI: 10.5055/jom.2019.0515] [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: 11/05/2022]
Abstract
OBJECTIVE To understand the needs of Emergency Medical Service (EMS) providers caring for substance users in an urban setting. DESIGN Qualitative interviews with EMS providers regarding perceptions of substance users and treatment programs. SETTING Baltimore City. PARTICIPANTS Twenty-two Baltimore City Fire Department EMS providers. INTERVENTIONS Semistructured in-depth interviews were conducted with 22 EMS providers. Topics included experiences caring for substance-using patients and attitudes about local harm reduction approaches. MAIN OUTCOME MEASURE Providers were asked their views on receiving training to deliver a brief motivational intervention to encourage patients to enter drug treatment. Interviews were transcribed and analyzed using constant comparison. RESULTS Participants were mostly Male (68.2 percent), White (66.6 percent), and had Advanced Life Skills training (90.9 percent). Mean experience was 8.7 years. Many providers described EMS misusers as mostly male and middle-aged, although there were variations in substance use patterns among all races and income levels. Most stated that repeated care provision to a small number of substance-users negatively impacted care quality. Provider demands included departmental policies and resource limitations. Many expressed willingness to deliver motivational messages to substance-using patients to consider drug treatment. Other stated that behavioral interventions were beyond their job duties and most reported having little-to-no knowledge of local treatment programs. CONCLUSIONS EMS providers may be uniquely positioned to deliver substance use treatment messages to substance users. This could be a life- and cost-saving improvement to EMS in Baltimore City with incentivized training. More research is needed to inform opioid use preparedness in urban settings, which remain at the center of the opioid epidemic.
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Affiliation(s)
- Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie C Fields
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zachary Catanzarite
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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20
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Latkin CA, Kennedy RD, Davey-Rothwell MA, Tseng TY, Czaplicki L, Baddela A, Edwards C, Chander G, Moran MB, Knowlton AR. The Relationship Between Neighborhood Disorder and Barriers to Cessation in a Sample of Impoverished Inner-City Smokers in Baltimore, Maryland, United States. Nicotine Tob Res 2019; 20:1451-1456. [PMID: 29126121 DOI: 10.1093/ntr/ntx252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/08/2017] [Indexed: 11/13/2022]
Abstract
Introduction Economic disparities in rates of smoking have been well documented in many countries. These disparities exist on an individual and geographic or neighborhood level. This cross-sectional study examined the relationship between neighborhood physical and social disorder and barriers to smoking cessation among an impoverished urban sample. Methods A sample of current smokers were recruited through street outreach, posted advertisements, and word of mouth from impoverished neighborhoods in Baltimore, Maryland, USA for a study of psychosocial factors and smoking behaviors. Neighborhood disorder was assessed with a 10-item scale from the Block Environmental Inventory and barriers to cessation with a 9-item scale. Results In the multiple logistic regression model, perceived stress (aOR = 1.60, 95% CI = 1.32 to 1.95), neighborhood disorder (aOR= 1.34, 95% CI = 1.11 to 1.63), and level of nicotine dependence (aOR = 1.97), 95% CI = 1.62 to 2.40) were all strongly associated with barriers to cessation. Conclusion The results of this study suggest that neighborhood disorder may lead to barriers to cessation among low-income populations. The findings also indicate that tobacco control interventions should examine and address social and physical aspects of impoverished neighborhoods. Implications In many countries, tobacco control programs and policies have been less effective among low-income populations as compared to more affluent populations. Little is known about how neighborhood factors influence smoking cessation. This study examined the relationship between neighborhood disorder and barriers to cessation among a low-income population. We recruited a convenience sample of hard-to-reach cigarette smokers from low-income neighborhoods. Even after controlling for level of nicotine dependence and stress, neighborhood disorder was found to be associated with barriers to cessation. The findings suggest the important role of neighborhood disorder as a barrier to smoking cessation.
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Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan D Kennedy
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Melissa A Davey-Rothwell
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tuo-Yen Tseng
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lauren Czaplicki
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Anirudh Baddela
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Catie Edwards
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Geetanjali Chander
- Division of Infectious diseases, Johns Hopkins School of Medicine, Baltimore, MD
| | - Meghan B Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Amy R Knowlton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Davies KTA, Brown MW, Hamilton PK, Knowlton AR, Taggart CT, Vanderlaan ASM. Variation in North Atlantic right whale Eubalaena glacialis occurrence in the Bay of Fundy, Canada, over three decades. ENDANGER SPECIES RES 2019. [DOI: 10.3354/esr00951] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Hansen ED, Mitchell MM, Cruz Oliver DM, Alghanim FA, Walter M, Case AA, Smith T, Knowlton AR. Chronic Pain, Functional Status, and Life Satisfaction Are Associated With Patients Living With HIV Discussing Advance Care Planning With Their Family or Friends. J Pain Symptom Manage 2019; 57:961-965. [PMID: 30818027 PMCID: PMC6486419 DOI: 10.1016/j.jpainsymman.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV from a universally fatal disease to a serious chronic illness, warranting discussions between patients and their loved ones about advance care planning (ACP). Evidence is needed on factors associated with patients' likelihood to discuss ACP with loved ones. OBJECTIVES To further characterize factors associated with successful ACP in PLWHAs with their loved ones, we examined associations between patients having ACP discussions with the need for assistance with personal care, chronic pain, life satisfaction, prior family disagreements over health care decisions, sex, age, and interference in daily routines due to memory problems. METHODS Data were from the Affirm Care study (N = 370), which examined social and environmental factors associated with health outcomes among PLWHAs and their informal caregivers. RESULTS Slightly more than half of respondents discussed ACP with loved ones (57%). In adjusted analysis, higher levels of chronic pain (odds ratio [OR] = 2.09, P = 0.045), needing assistance with personal care (OR = 1.63, P = 0.023), greater life satisfaction (OR = 1.02, P = 0.002), prior family arguments over health care decisions (OR = 2.80, P < 0.001), and female sex (OR = 2.22, P = 0.001) were associated with higher odds of discussing ACP with loved ones, whereas age, drug use, education level, depression, and memory problems were nonsignificant. CONCLUSION These results suggest that interventions to increase ACP among PLWHAs and their loved ones should target males. The findings also suggest PLWHAs with chronic pain, the need for assistance with personal care, and those with a history of prior family arguments over health care decisions may be primed for ACP.
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Affiliation(s)
- Eric D Hansen
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
| | | | - Dulce M Cruz Oliver
- Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Fahid A Alghanim
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Michelle Walter
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Amy A Case
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Tom Smith
- Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amy R Knowlton
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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23
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Gowan TA, Ortega-Ortiz JG, Hostetler JA, Hamilton PK, Knowlton AR, Jackson KA, George RC, Taylor CR, Naessig PJ. Temporal and demographic variation in partial migration of the North Atlantic right whale. Sci Rep 2019; 9:353. [PMID: 30674941 PMCID: PMC6344554 DOI: 10.1038/s41598-018-36723-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022] Open
Abstract
Animal movement plays a fundamental role in the ecology of migratory species, and understanding migration patterns is required for effective management. To evaluate intrinsic and environmental factors associated with probabilities of endangered North Atlantic right whales Eubalaena glacialis migrating to a wintering ground off the southeastern United States (SEUS), we applied a multistate temporary emigration capture-recapture model to 22 years of photo-identification data. Migration probabilities for juveniles were generally higher yet more variable than those for adults, and non-calving adult females were the least likely group to migrate. The highest migration probabilities for juveniles and adult males coincided with years of relatively high calving rates, following years of higher prey availability in a fall feeding ground. Right whale migration to the SEUS can be classified as condition-dependent partial migration, which includes skipped breeding partial migration for reproductive females, and is likely influenced by tradeoffs among ecological factors such as reproductive costs and foraging opportunities that vary across individuals and time. The high variability in migration reported in this study provides insight into the ecological drivers of migration but presents challenges to right whale monitoring and conservation strategies.
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Affiliation(s)
- Timothy A Gowan
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, Florida, 33701, USA. .,Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, Florida, 32611, USA.
| | - Joel G Ortega-Ortiz
- Cooperative Institute for Marine and Atmospheric Studies, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, Florida, 33149, USA
| | - Jeffrey A Hostetler
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, Florida, 33701, USA
| | - Philip K Hamilton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, Massachusetts, 02110, USA
| | - Amy R Knowlton
- Anderson Cabot Center for Ocean Life, New England Aquarium, Boston, Massachusetts, 02110, USA
| | - Katharine A Jackson
- Fish and Wildlife Research Institute, Florida Fish and Wildlife Conservation Commission, St. Petersburg, Florida, 33701, USA
| | - R Clay George
- Georgia Department of Natural Resources, Wildlife Conservation Section, Brunswick, Georgia, 31520, USA
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Krzystan AM, Gowan TA, Kendall WL, Martin J, Ortega-Ortiz JG, Jackson K, Knowlton AR, Naessig P, Zani M, Schulte DW, Taylor CR. Characterizing residence patterns of North Atlantic right whales in the southeastern USA with a multistate open robust design model. ENDANGER SPECIES RES 2018. [DOI: 10.3354/esr00902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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25
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Nesoff ED, Milam AJ, Branas CC, Martins SS, Knowlton AR, Furr-Holden DM. Alcohol Outlets, Neighborhood Retail Environments, and Pedestrian Injury Risk. Alcohol Clin Exp Res 2018; 42:1979-1987. [PMID: 30102415 DOI: 10.1111/acer.13844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol outlet density has been associated with increased pedestrian injury risk. It is unclear whether this is because alcohol outlets are located in dense retail areas with heavy pedestrian traffic or whether alcohol outlets contribute a unique neighborhood risk. We aimed to compare the pedestrian injury rate around alcohol outlets to the rate around other, similar retail outlets that do not sell alcohol. METHODS A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury emergency medical services (EMS) records from January 1, 2014 to April 15, 2015 (n = 848); locations of alcohol outlets licensed for off-premise (n = 726) and on-premise consumption (n = 531); and corner (n = 398) and convenience stores (n = 192) that do not sell alcohol. Negative binomial regression was used to determine the relationship between retail outlet count and pedestrian injuries, controlling for key confounding variables. Spatial autocorrelation was also assessed and variable selection adjusted accordingly. RESULTS Each additional off-premise alcohol outlet was associated with a 12.3% increase in the rate of neighborhood pedestrian injury when controlling for convenience and corner stores and other confounders (incidence rate ratio [IRR] = 1.123, 95% confidence interval [CI] = 1.065, 1.184, p < 0.001). The attributable risk was 4.9% (95% CI = 0.3, 8.9) or 41 additional injuries. On-premise alcohol outlets were not significant predictors of neighborhood pedestrian injury rate in multivariable models (IRR = 0.972, 95% CI = 0.940, 1.004, p = 0.194). CONCLUSIONS Off-premise alcohol outlets are associated with pedestrian injury rate, even when controlling for other types of retail outlets. Findings reinforce the importance of alcohol outlets in understanding neighborhood pedestrian injury risk and may provide evidence for informing policy on liquor store licensing, zoning, and enforcement.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Adam J Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Charles C Branas
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Amy R Knowlton
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Debra M Furr-Holden
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, Michigan
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Mitchell MM, Hansen ED, Tseng TY, Shen M, Rushton C, Smith T, Hutton N, Wolfe J, Bone L, Keruly J, Wissow L, Catanzarite Z, Knowlton AR. Correlates of Patterns of Health Values of African Americans Living With HIV/AIDS: Implications for Advance Care Planning and HIV Palliative Care. J Pain Symptom Manage 2018; 56. [PMID: 29526613 PMCID: PMC6015532 DOI: 10.1016/j.jpainsymman.2018.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Advance care planning rates remain low, especially among people who are HIV positive, disadvantaged, and African American. Although advance care planning can be a sensitive topic for clinicians and patients to discuss, health values clarification can be an important initial step. OBJECTIVES The purpose of the study was to explore health values of African Americans living with HIV/AIDS and to examine correlates of these values. METHODS Data were from the first 325 participants in the AFFIRM Care study, which enrolled adults living with HIV/AIDS in Baltimore, Maryland, who had histories of illicit drug use. Respondents were asked whether (yes/no) they thought any of six health states would be worse than death: severe unremitting pain, total dependency on others, irreversible coma, being on mechanical ventilation, nursing home residence, and severe dementia. Latent class analysis was used to group individuals by their pattern of responses, interpretable as preference for aggressive (life-sustaining) or nonaggressive (palliative) end-of-life care. Latent class regression analysis was used to examine associations between class membership and background, health status, and social variables. RESULTS We found statistical support for a three-class latent class analysis model: 1) the nonaggressive treatment class, comprising 43% of cases, in which members perceived that every state was worse than death; 2) the aggressive treatment class, comprising 33% of cases, in which members perceived that none of the states was worse than death; and 3) the mixed class (24% of cases), in which members perceived that only four of the six states were worse than death. CONCLUSION Three-quarters of participant response patterns had clear preferences for treatment decisions. Further research is needed to ensure inclusion of end-of-life scenarios relevant to this population.
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Affiliation(s)
- Mary M Mitchell
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Eric D Hansen
- Harry J. Duffey Family Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Tuo-Yen Tseng
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meng Shen
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cynda Rushton
- Department of Acute and Chronic Care, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tom Smith
- Harry J. Duffey Family Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nancy Hutton
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wolfe
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee Bone
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lawrence Wissow
- Department of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zachary Catanzarite
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy R Knowlton
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mitchell MM, Isenberg SR, Maragh-Bass AC, Knowlton AR. Chronic Pain Predicting Reciprocity of Support Among Vulnerable, Predominantly African-American Persons Living with HIV/AIDS. AIDS Behav 2018; 22:2002-2007. [PMID: 28451889 DOI: 10.1007/s10461-017-1775-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Among persons living with HIV/AIDS (PLHIV), approximately two-thirds report moderate to severe pain. Chronic pain can negatively affect PLHIVs' health behaviors and outcomes by interfering with their reciprocity (mutual exchange) of support in their caregiving relationships, which has been found to be associated with PLHIVs' antiretroviral adherence and viral suppression. Data were longitudinal (baseline, 6- and 12-month follow-up) from 383 PLHIV who were formerly or currently using drugs. Utilizing a longitudinal lagged fixed effects structural equation model, we found that never having pain in the past 6 months was predictive of increased reciprocity of support. Sub-analyses by care relationship type revealed never having pain was a significant predictor of greater reciprocity for sexual partner caregiving dyads, but not for kin or friend caregiving dyads. Our study emphasizes the importance of pain management in quality caregiving relationships characterized by reciprocity, which has consistently been found to be associated with stronger, more supportive caregiving relationships and better quality of life. Our findings suggest the importance of pain management intervention for improving reciprocity between vulnerable PLHIVs and their primary caregivers, especially between PLHIVs and caregivers who are current or former sexual partners.
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Affiliation(s)
- Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA.
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, 21205, MD, USA
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Isenberg SR, Maragh-Bass AC, Ridgeway K, Beach MC, Knowlton AR. A qualitative exploration of chronic pain and opioid treatment among HIV patients with drug use disorders. J Opioid Manag 2018; 13:5-16. [PMID: 28345742 PMCID: PMC5560049 DOI: 10.5055/jom.2017.0363] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The study explored high-risk participants' experiences with pain management regarding clinical access to and use of prescription opioids. DESIGN Qualitative semistructured interviews and focus groups. SETTING Data were collected August 2014 to May 2015 at an urban community-based research facility in Baltimore City, MD. PARTICIPANTS HIV participants with chronic pain and a history of illicit drug use. METHODS Qualitative coding and analysis used an iterative, inductive, and thematic approach and coders achieved inter-coder consistency. RESULTS The authors identified two major themes. First, participants had positive and negative interactions with healthcare providers regarding chronic pain treatment. Participants perceived that providers lacked empathy for their pain and/or were not adequately managing their pain. These interactions resulted in participants seeking new providers or mistrusting the medical system. Further, providers' surveillance of participants' pain treatment regimen contributed to distress surrounding pain management. The second theme centered on participants' pain management experiences with prescribed opioid analgesics. Participants felt they were receiving dosages and classes of analgesics that did not sufficiently address their pain, and consequently modified their dosages or rationed prescription opioids. Other participants were reluctant to take analgesics due to their history of illicit drug use. Some participants relapsed to illicit drug use when they felt their prescription opioids did not adequately address their pain needs. CONCLUSIONS Participant struggles with receiving and managing prescribed opioid analgesics suggest a need for: therapies beyond these medications; guidelines for providers specific to this population; and harm reduction trainings for providers.
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Affiliation(s)
- Sarina R Isenberg
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allysha C Maragh-Bass
- Doctoral Candidate, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kathleen Ridgeway
- Graduate of the MSPH program, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary C Beach
- Professor of Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Amy R Knowlton
- Associate Professor, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Nesoff ED, Pollack KM, Knowlton AR, Bowie JV, Gielen AC. Local vs. national: Epidemiology of pedestrian injury in a mid-Atlantic city. Traffic Inj Prev 2018; 19:440-445. [PMID: 29341801 PMCID: PMC5918155 DOI: 10.1080/15389588.2018.1428961] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/14/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Understanding pedestrian injury trends at the local level is essential for program planning and allocation of funds for urban planning and improvement. Because we hypothesize that local injury trends differ from national trends in significant and meaningful ways, we investigated citywide pedestrian injury trends to assess injury risk among nationally identified risk groups, as well as identify risk groups and locations specific to Baltimore City. METHODS Pedestrian injury data, obtained from the Baltimore City Fire Department, were gathered through emergency medical services (EMS) records collected from January 1 to December 31, 2014. Locations of pedestrian injuries were geocoded and mapped. Pearson's chi-square test of independence was used to investigate differences in injury severity level across risk groups. Pedestrian injury rates by age group, gender, and race were compared to national rates. RESULTS A total of 699 pedestrians were involved in motor vehicle crashes in 2014-an average of 2 EMS transports each day. The distribution of injuries throughout the city did not coincide with population or income distributions, indicating that there was not a consistent correlation between areas of concentrated population or concentrated poverty and areas of concentrated pedestrian injury. Twenty percent (n = 138) of all injuries occurred among children age ≤14, and 22% (n = 73) of severe injuries occurred among young children. The rate of injury in this age group was 5 times the national rate (Incident Rate Ratio [IRR] = 4.81, 95% confidence interval [CI], [4.05, 5.71]). Injury rates for adults ≥65 were less than the national average. CONCLUSIONS As the urban landscape and associated pedestrian behavior transform, continued investigation of local pedestrian injury trends and evolving public health prevention strategies is necessary to ensure pedestrian safety.
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Affiliation(s)
- Elizabeth D Nesoff
- a Columbia University Mailman School of Public Health , Department of Epidemiology , New York , New York
| | - Keshia M Pollack
- b Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management , Johns Hopkins Center for Injury Research and Policy , Baltimore , Maryland
| | - Amy R Knowlton
- c Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society , Johns Hopkins Center for Injury Research and Policy , Baltimore , Maryland
| | - Janice V Bowie
- c Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society , Johns Hopkins Center for Injury Research and Policy , Baltimore , Maryland
| | - Andrea C Gielen
- c Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society , Johns Hopkins Center for Injury Research and Policy , Baltimore , Maryland
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Nesoff ED, Milam AJ, Pollack KM, Curriero FC, Bowie JV, Knowlton AR, Gielen AC, Furr-Holden DM. Neighbourhood alcohol environment and injury risk: a spatial analysis of pedestrian injury in Baltimore City. Inj Prev 2018; 25:350-356. [PMID: 29588410 DOI: 10.1136/injuryprev-2018-042736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the contribution of neighbourhood disorder around alcohol outlets to pedestrian injury risk. METHODS A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury EMS records from 1 January 2014 to 15 April 2015 (n=858), off-premise alcohol outlet locations for 2014 (n=693) and neighbourhood disorder indicators and demographics. Negative binomial regression models were used to determine the relationship between alcohol outlet count and pedestrian injuries at the block group level, controlling for other neighbourhood factors. Attributable risk was calculated by comparing the total population count per census block group to the injured pedestrian count. RESULTS Each one-unit increase in the number of alcohol outlets was associated with a 14.2% (95% CI 1.099 to 1.192, P<0.001) increase in the RR of neighbourhood pedestrian injury, adjusting for traffic volume, pedestrian volume, population density, per cent of vacant lots and median household income. The attributable risk was 10.4% (95% CI 7.7 to 12.7) or 88 extra injuries. Vacant lots was the only significant neighbourhood disorder indicator in the final adjusted model (RR=1.016, 95% CI 1.007 to 1.026, P=0.003). Vacant lots have not been previously investigated as possible risk factors for pedestrian injury. CONCLUSIONS This study identifies modifiable risk factors for pedestrian injury previously unexplored in the literature and may provide evidence for alcohol control strategies (eg, liquor store licencing, zoning and enforcement).
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Adam J Milam
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keshia M Pollack
- Department of Health Policy and Management, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank C Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Janice V Bowie
- Department of Health, Behavior, and Society, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amy R Knowlton
- Department of Health, Behavior, and Society, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea C Gielen
- Department of Health, Behavior, and Society, Johns Hopkins Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Debra M Furr-Holden
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Flint, Michigan, USA
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Denison JA, Mitchell MM, Maragh-Bass AC, Knowlton AR. Caregivers' Support Network Characteristics Associated with Viral Suppression among HIV Care Recipients. AIDS Behav 2017; 21:3599-3606. [PMID: 28315082 DOI: 10.1007/s10461-017-1746-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Informal care receipt is associated with health outcomes among people living with HIV. Less is known about how caregivers' own social support may affect their care recipient's health. We examined associations between network characteristics of informal caregivers and HIV viral suppression among former or current drug using care recipients. We analyzed data from 258 caregiver-recipient dyads from the Beacon study, of whom 89% of caregivers were African American and 59% were female. In adjusted logistic regression analysis, care recipients had lower odds of being virally suppressed if their caregiver was female, was caring for youth involved in the criminal justice system, and had network members who used illicit drugs. Caregivers' greater numbers of non-kin in their support network was positively associated with viral suppression among care recipients. The findings reveal contextual factors affecting ART outcomes and the need for interventions to support caregivers, especially HIV caregiving women with high-risk youth.
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Hansen ED, Mitchell MM, Smith T, Hutton N, Keruly J, Knowlton AR. Chronic Pain, Patient-Physician Engagement, and Family Communication Associated With Drug-Using HIV Patients' Discussing Advanced Care Planning With Their Physicians. J Pain Symptom Manage 2017; 54:508-513. [PMID: 28743661 DOI: 10.1016/j.jpainsymman.2017.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV into a serious chronic illness, warranting patient-provider discussion about advanced care planning (ACP). Evidence is needed to inform physicians on how to approach ACP for these patients. Chronic pain is common in PLWHA, particularly in those who have substance use disorders; although it is known that this population is at risk for poorer patient-physician engagement, the effects on ACP are unknown. OBJECTIVES To further characterize factors associated with successful ACP in PLWHA, we examined associations between patient-physician relationship, chronic pain, family communication and problem-solving skills, and rates of patients discussing ACP with their physicians. METHODS Data were from the Affirm Care study (N = 325), which examined social and environmental factors associated with health outcomes among PLWHA and their informal caregivers. RESULTS In multivariate analysis, higher odds of patient reports of discussing ACP with their physicians were associated with their higher rating of their relationship with their physician (adjusted odds ratio [AOR] 1.73; P < 0.05), higher levels of chronic pain (AOR 2.16; P < 0.05), experiencing prior family arguments about end-of-life medical decisions (AOR 2.43; P < 0.01), and feeling comfortable talking to family members about problems (AOR 1.33; P < 0.05). CONCLUSION These results suggest that interventions to increase ACP among HIV patients and their physicians should promote patient-centered patient-provider relationships and PLWHAs' family communication and family problem-solving skills. The findings also suggest that PLWHA with chronic pain and prior family discord over end-of-life medical decisions may be primed for ACP.
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Affiliation(s)
- Eric D Hansen
- Harry J. Duffey Family Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Mary M Mitchell
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tom Smith
- Harry J. Duffey Family Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nancy Hutton
- Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeanne Keruly
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Amy R Knowlton
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Maragh-Bass AC, Zhao Y, Isenberg SR, Mitchell MM, Knowlton AR. Have You Talked about It: Advance Care Planning among African Americans Living with HIV in Baltimore. J Urban Health 2017; 94:730-745. [PMID: 28560611 PMCID: PMC5610122 DOI: 10.1007/s11524-017-0157-y] [Citation(s) in RCA: 4] [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: 12/12/2022]
Abstract
Advance care planning (ACP) is the process of planning for when individuals are unable to make their own healthcare decisions. Research suggests ACP is understudied among HIV-positive African Americans. We explored ACP knowledge, preferences, and practices with HIV-positive African Americans from an urban HIV-specialty clinic (AFFIRM study). Participants completed surveys and interviews. Descriptive analyses and Poisson regression were conducted on survey data. Qualitative interviews were coded using grounded theory/constant comparative method. Participants were mostly male (55.1%). Half rated their current pain as at least six out of ten (50.8%). Two-thirds had discussed ACP with providers or supporters (66.2%). Qualitative themes were: (1) impact of managing pain on quality of life and healthcare, (2) knowledge/preferences for ACP, and (3) sources of HIV supportive care and coping (N = 39). Correlates of having discussed ACP included: moderate pain intensity (p < 0.10), including supporters in health decisions (p < 0.001), religious attendance (p < 0.05), and knowledge of healthcare mandates (p < 0.01; N = 276). Findings highlight the need for patient education to document healthcare preferences and communication skills development to promote inclusion of caregivers in decision-making.
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Affiliation(s)
- Allysha C Maragh-Bass
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA.
| | - Yiqing Zhao
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
| | - Sarina R Isenberg
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
| | - Mary M Mitchell
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
| | - Amy R Knowlton
- The Lighthouse Studies at Peer Point, Department of Health, Behavior, Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street 2nd Floor, Baltimore, MD, 21205, USA
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Mitchell MM, Nguyen TQ, Maragh-Bass AC, Isenberg SR, Beach MC, Knowlton AR. Patient-Provider Engagement and Chronic Pain in Drug-Using, Primarily African American Persons Living with HIV/AIDS. AIDS Behav 2017; 21:1768-1774. [PMID: 27787673 DOI: 10.1007/s10461-016-1592-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Among disadvantaged persons living with HIV/AIDS (PLHIV), patient-provider engagement, which has been defined as patient-provider relationships that promote the use of health care services and are characterized by active listening and supportive decision making, has been associated with antiretroviral therapy (ART) maintenance and viral suppression. However, chronic pain, depression, and substance use, all of which are prevalent in this population, can reduce the quality of patient-provider engagement. We hypothesized a model in which chronic pain, depression, and substance use would be associated with poorer patient-provider engagement, which would be positively associated with adherence, with the latter associated positively with viral suppression. We analyzed data from the BEACON study, which included surveys from 383 PLHIV who were primarily African American, on ART, and had histories of drug use. Due to six missing cases on the chronic pain variable, we used data from 377 respondents in a structural equation model. Chronic pain and depressive symptoms were significantly associated with poorer patient-provider engagement, while substance use was associated with better engagement. Patient-provider engagement in turn was associated with better ART adherence, which was associated with higher viral suppression. Results suggest the role of chronic pain in poor patient-physician engagement in this population, which has potential implications for quality of HIV patient care and health outcomes. Findings suggest the need for attention to patient-provider engagement in PLHIV.
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Affiliation(s)
- Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA.
| | - Trang Q Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allysha C Maragh-Bass
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA
| | - Sarina R Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St., 2nd Floor, Baltimore, MD, 21205, USA
| | | | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 745, Baltimore, MD, 21205, USA
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Mitchell MM, Nguyen TQ, Isenberg SR, Maragh-Bass AC, Keruly J, Knowlton AR. Psychosocial and Service Use Correlates of Health-Related Quality of Life Among a Vulnerable Population Living with HIV/AIDS. AIDS Behav 2017; 21:1580-1587. [PMID: 27787675 DOI: 10.1007/s10461-016-1589-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Among people living with HIV/AIDS (PLHIV), health-related quality of life (HRQOL) is an important clinical metric of perceived well-being. Baseline data from the BEACON study (N = 383) were used to examine relationships between HRQOL and negative social support, HIV-related stigma, viral suppression, and physical and mental health service use among a vulnerable population of low-income, urban PLHIV who currently or formerly used substances, and were primarily African American. Factor analyses and structural equation modeling indicated that increases in negative social support, stigma, mental health care visits and HIV physician visits were associated with lower HRQOL, while viral suppression was associated with greater HRQOL. The association between negative social support and HRQOL suggests the importance of intervening at the dyad or network levels to shape the type of social support being provided to PLHIV. HIV-related stigma is another negative social factor that is prevalent in this sample and could be addressed by intervention. Results indicate that greater mental and physical health service use can be used to identify individuals with lower HRQOL. Therefore, findings increase an understanding of HRQOL in this understudied population and have implications for designing interventions to improve HRQOL among PLHIV.
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Pettis HM, Rolland RM, Hamilton PK, Knowlton AR, Burgess EA, Kraus SD. Body condition changes arising from natural factors and fishing gear entanglements in North Atlantic right whales Eubalaena glacialis. ENDANGER SPECIES RES 2017. [DOI: 10.3354/esr00800] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Maragh-Bass AC, Denison JA, Thorpe RJ, Knowlton AR. The interactive effects of social support and physical functioning on HIV medical outcomes among African Americans whom inject drugs. J Ethn Subst Abuse 2017. [PMID: 28632094 DOI: 10.1080/15332640.2016.1264337] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests a syndemic of substance use, mental illness, and familial conflict is associated with poor HIV medical outcomes among African American persons living with HIV (PLHIV). Social support may facilitate positive health outcomes. This study explores psychosocial correlates of HIV medical outcomes, defined as undetectable viral load (UVL) and acute care minimization. Data were from baseline of the BEACON study (N = 351). UVL was ≤40 copies/mL. Acute care minimization was defined as no ER visits and/or hospitalizations in 6 months. Descriptive statistics and Poisson regression were implemented (N = 351). Moderate syndemic burden was associated with viral suppression. Individuals with main partner caregivers had 35% higher likelihood of viral suppression than individuals whose main supporters were neither kin nor main partners (adjusted point-prevalence rate ratio [APR] = 1.35; 95% CI [1.05, 1.74]). Surprisingly, individuals with more health-related support were more likely to use acute care than individuals with less health-related support (p<.05). Interaction analyses showed that physical function modified the relationship between main supporter type and acute care minimization. Results suggest that social support receipt was not consistently associated with HIV medical outcomes. Conversely, higher syndemic burden may have facilitated positive outcomes through necessitating increased rates of health care engagement. Health care professionals should elicit discussion of social support to strengthen PLHIVs' and their supporters' relationships to improve their health. Results highlight the need for culturally tailored interventions to improve HIV medical outcomes among African American PLHIV substance users.
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Affiliation(s)
| | - Julie A Denison
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Roland J Thorpe
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Amy R Knowlton
- a Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
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van der Hoop JM, Corkeron P, Henry AG, Knowlton AR, Moore MJ. Predicting lethal entanglements as a consequence of drag from fishing gear. Mar Pollut Bull 2017; 115:91-104. [PMID: 27923466 DOI: 10.1016/j.marpolbul.2016.11.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Abstract
Large whales are frequently entangled in fishing gear and sometimes swim while carrying gear for days to years. Entangled whales are subject to additional drag forces requiring increased thrust power and energy expenditure over time. To classify entanglement cases and aid potential disentanglement efforts, it is useful to know how long an entangled whale might survive, given the unique configurations of the gear they are towing. This study establishes an approach to predict drag forces on fishing gear that entangles whales, and applies this method to ten North Atlantic right whale cases to estimate the resulting increase in energy expenditure and the critical entanglement duration that could lead to death. Estimated gear drag ranged 11-275N. Most entanglements were resolved before critical entanglement durations (mean±SD 216±260days) were reached. These estimates can assist real-time development of disentanglement action plans and U.S. Federal Serious Injury assessments required for protected species.
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Affiliation(s)
- Julie M van der Hoop
- Massachusetts Institute of Technology-Woods Hole Oceanographic Institution Joint Program in Oceanography and Applied Ocean Science and Engineering, Cambridge, MA 02139, USA; Biology Department, Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA.
| | - Peter Corkeron
- NOAA Fisheries, Northeast Fisheries Science Center, Woods Hole, MA 02543, USA
| | - Allison G Henry
- NOAA Fisheries, Northeast Fisheries Science Center, Woods Hole, MA 02543, USA
| | - Amy R Knowlton
- New England Aquarium, Central Wharf, Boston, MA 02110, USA
| | - Michael J Moore
- Biology Department, Woods Hole Oceanographic Institution, Woods Hole, MA 02543, USA
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Nguyen TQ, Poteat T, Bandeen-Roche K, German D, Nguyen YH, Vu LKC, Nguyen NTT, Knowlton AR. The Internalized Homophobia Scale for Vietnamese Sexual Minority Women: Conceptualization, Factor Structure, Reliability, and Associations With Hypothesized Correlates. Arch Sex Behav 2016; 45:1329-1346. [PMID: 27007469 PMCID: PMC4945363 DOI: 10.1007/s10508-016-0694-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 12/07/2015] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
We developed the first Vietnamese Internalized Homophobia (IH) scale for use with Vietnamese sexual minority women (SMW). Drawing from existing IH scales in the international literature and based on prior qualitative research about SMW in the Viet Nam context, the scale covers two domains: self-stigma (negative attitudes toward oneself as a sexual minority person) and sexual prejudice (negative attitudes toward homosexuality/same-sex relations in general). Scale items, including items borrowed from existing scales and items based on local expressions, were reviewed and confirmed by members of the target population. Quantitative evaluation used data from an anonymous web-based survey of Vietnamese SMW, including those who identified as lesbian (n = 1187), or as bisexual (n = 641) and those who were unsure about their sexual identity (n = 353). The scale was found to consist of two highly correlated factors reflecting self-stigma (not normal/wholesome and self-reproach and wishing away same-sex sexuality) and one factor reflecting sexual prejudice, and to have excellent internal consistency. Construct validity was evidenced by subscale associations with a wide range of hypothesized correlates, including perceived sexual stigma, outness, social support, connection to other SMW, relationship quality, psychological well-being, anticipation of heterosexual marriage, and endorsement of same-sex marriage legalization. Self-stigma was more strongly associated with psychosocial correlates, and sexual prejudice was more associated with endorsement of legal same-sex marriage. The variations in these associations across the hypothesized correlates and across sexual identity groups were consistent with the minority stress model and the IH literature, and exhibited context-specific features, which are discussed.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 896, Baltimore, MD, 21205, USA.
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Institute for Studies of Society, Economy and Environment, Ha Noi, Viet Nam.
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Nam Thi-Thu Nguyen
- Institute for Studies of Society, Economy and Environment, Ha Noi, Viet Nam
- Health Policy and Strategy Institute, Ha Noi, Viet Nam
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Schick RS, Kraus SD, Rolland RM, Knowlton AR, Hamilton PK, Pettis HM, Thomas L, Harwood J, Clark JS. Effects of Model Formulation on Estimates of Health in Individual Right Whales (Eubalaena glacialis). Adv Exp Med Biol 2016; 875:977-85. [PMID: 26611058 DOI: 10.1007/978-1-4939-2981-8_121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Right whales are vulnerable to many sources of anthropogenic disturbance including ship strikes, entanglement with fishing gear, and anthropogenic noise. The effect of these factors on individual health is unclear. A statistical model using photographic evidence of health was recently built to infer the true or hidden health of individual right whales. However, two important prior assumptions about the role of missing data and unexplained variance on the estimates were not previously assessed. Here we tested these factors by varying prior assumptions and model formulation. We found sensitivity to each assumption and used the output to make guidelines on future model formulation.
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Affiliation(s)
- Robert S Schick
- Centre for Research into Ecological and Environmental Modelling (CREEM), The Observatory, University of St. Andrews, St. Andrews, Fife, KY16 9LZ, UK.
| | - Scott D Kraus
- John H. Prescott Marine Laboratory, New England Aquarium, Boston, MA, 02110, USA.
| | - Rosalind M Rolland
- John H. Prescott Marine Laboratory, New England Aquarium, Boston, MA, 02110, USA.
| | - Amy R Knowlton
- John H. Prescott Marine Laboratory, New England Aquarium, Boston, MA, 02110, USA.
| | - Philip K Hamilton
- John H. Prescott Marine Laboratory, New England Aquarium, Boston, MA, 02110, USA.
| | - Heather M Pettis
- John H. Prescott Marine Laboratory, New England Aquarium, Boston, MA, 02110, USA.
| | - Len Thomas
- Centre for Research into Ecological and Environmental Modelling (CREEM), The Observatory, University of St. Andrews, St. Andrews, Fife, KY16 9LZ, UK.
| | - John Harwood
- Centre for Research into Ecological and Environmental Modelling (CREEM), The Observatory, University of St. Andrews, St. Andrews, Fife, KY16 9LZ, UK.
| | - James S Clark
- Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA.
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Nguyen TQ, Bandeen-Roche K, German D, Nguyen NTT, Bass JK, Knowlton AR. Negative Treatment by Family as a Predictor of Depressive Symptoms, Life Satisfaction, Suicidality, and Tobacco/Alcohol Use in Vietnamese Sexual Minority Women. LGBT Health 2016; 3:357-65. [PMID: 27219025 DOI: 10.1089/lgbt.2015.0017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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 Research linking family rejection and health outcomes in sexual minority people is mostly limited to North America. We assessed the associations between negative treatment by family members and depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use in sexual minority women (SMW) in Viet Nam. METHODS Data were from an anonymous internet survey (n = 1936). Latent class analysis characterized patterns of negative treatment by family members experienced by respondents. Latent class with distal outcome modeling was used to regress depressive symptoms, life satisfaction, suicidality, and tobacco/alcohol use on family treatment class, controlling for predictors of family treatment and for two other types of sexual prejudice. RESULTS Five latent family treatment classes were extracted, including four negative classes representing varying patterns of negative family treatment. Overall, more than one negative class predicted lower life satisfaction, more depressive symptoms, and higher odds of attempted suicide (relative to the non-negative class), supporting the minority stress hypothesis that negative family treatment is predictive of poorer outcomes. Only the most negative class had elevated alcohol use. The association between family treatment and smoking status was not statistically significant. The most negative class, unexpectedly, did not have the highest odds of having attempted suicide, raising a question about survivor bias. CONCLUSION This population requires public health attention, with emphasis placed on interventions targeting the family to promote acceptance and to prevent negative treatment, and interventions supporting those SMW who encounter the worst types of negative family treatment.
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Affiliation(s)
- Trang Quynh Nguyen
- 1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.,2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.,3 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.,4 Institute for Studies of Society , Economy and Environment, Ha Noi, Viet Nam
| | - Karen Bandeen-Roche
- 3 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Danielle German
- 2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Nam T T Nguyen
- 4 Institute for Studies of Society , Economy and Environment, Ha Noi, Viet Nam.,5 Health Strategy and Policy Institute , Ha Noi, Viet Nam
| | - Judith K Bass
- 1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
| | - Amy R Knowlton
- 2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland
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Knowlton AR, Weir B, Fields J, Cochran G, McWilliams J, Wissow L, Lawner BJ. Pediatric Use of Emergency Medical Services: The Role of Chronic Illnesses and Behavioral Health Problems. PREHOSP EMERG CARE 2016; 20:362-8. [PMID: 27142996 PMCID: PMC5002223 DOI: 10.3109/10903127.2015.1115928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The increasing use of prehospital emergency medical services (EMS) and its contribution to rising emergency department use and healthcare costs point to the need for better understanding factors associated with EMS use to inform preventive interventions. Understanding patient factors associated with pediatric use of EMS will inform pediatric-specific intervention. We examined pediatric patient demographic and health factors associated with one-time and repeat use of EMS. METHODS We reviewed data from Baltimore City Fire Department EMS patient records over a 23-month period (2008-10) for patients under 21 years of age (n = 24,760). Repeat use was defined as involvement in more than one EMS incident during the observation period. Analyses compared demographics of EMS users to the city population and demographics and health problems of repeat and one-time EMS users. Health comparisons were conducted at the patient and incident levels of analysis. RESULTS Repeat users (n = 1,931) accounted for 9.0% of pediatric users and 20.8% of pediatric incidents, and were over-represented among the 18-20 year age group and among females. While trauma accounted for approximately one-quarter of incidents, repeat versus one-time users had a lower proportion of trauma-related incidents (7.2% vs. 26.7%) and higher proportion of medical-related incidents (92.6% vs. 71.4%), including higher proportions of incidents related to asthma, seizures, and obstetric/gynecologic issues. In patient-level analysis, based on provider or patient reports, greater proportions of repeat compared to one-time users had asthma, behavioral health problems (mental, conduct and substance use problems), seizures, and diabetes. CONCLUSIONS Chronic somatic conditions and behavioral health problems appear to contribute to a large proportion of the repeat pediatric use of this EMS system. Interventions may be needed to engage repeat users in primary care and behavioral health services, to train EMS providers on the recognition and management of behavioral health emergencies, and to improve family care and self-management of pediatric asthma and other chronic conditions.
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Nachega JB, Skinner D, Jennings L, Magidson JF, Altice FL, Burke JG, Lester RT, Uthman OA, Knowlton AR, Cotton MF, Anderson JR, Theron GB. Acceptability and feasibility of mHealth and community-based directly observed antiretroviral therapy to prevent mother-to-child HIV transmission in South African pregnant women under Option B+: an exploratory study. Patient Prefer Adherence 2016; 10:683-90. [PMID: 27175068 PMCID: PMC4854240 DOI: 10.2147/ppa.s100002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the acceptability and feasibility of mobile health (mHealth)/short message service (SMS) and community-based directly observed antiretroviral therapy (cDOT) as interventions to improve antiretroviral therapy (ART) adherence for preventing mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). DESIGN AND METHODS A mixed-method approach was used. Two qualitative focus group discussions with HIV-infected pregnant women (n=20) examined the acceptability and feasibility of two ART adherence interventions for PMTCT: 1) SMS text messaging and 2) patient-nominated cDOT supporters. Additionally, 109 HIV-infected, pregnant South African women (18-30 years old) receiving PMTCT services under single-tablet antiretroviral therapy regimen during pregnancy and breastfeeding and continuing for life ("Option B+") were interviewed about mobile phone access, SMS use, and potential treatment supporters. SETTING A community primary care clinic in Cape Town, South Africa. PARTICIPANTS HIV-infected pregnant women. MAIN OUTCOMES Acceptability and feasibility of mHealth and cDOT interventions. RESULTS Among the 109 women interviewed, individual mobile phone access and SMS use were high (>90%), and 88.1% of women were interested in receiving SMS ART adherence support messages such as reminders, motivation, and medication updates. Nearly all women (95%) identified at least one person close to them to whom they had disclosed their HIV status and would nominate as a cDOT supporter. Focus group discussions revealed that cDOT supporters and adherence text messages were valued, but some concerns regarding supporter time availability and risk of unintended HIV status disclosure were expressed. CONCLUSION mHealth and/or cDOT supporter as interventions to improve ART adherence are feasible in this setting. However, safe HIV status disclosure to treatment supporters and confidentiality of text messaging content about HIV and ART were deemed crucial.
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Affiliation(s)
- Jean B Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Department of Medicine, Centre for Infectious Diseases, and ACTG Clinical Trial Unit (CTU)/Family Clinical Research Unit (FAMCRU), Stellenbosch University, Cape Town, South Africa
| | - Donald Skinner
- Research on Health and Society, Department of Interdisciplinary Health Studies, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Larissa Jennings
- Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica F Magidson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Frederick L Altice
- Division of Infectious Diseases, AIDS Program, Yale University School of Medicine, New Haven, CT, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Richard T Lester
- Department of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK
- Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark F Cotton
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Gerhard B Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Mitchell MM, Maragh-Bass AC, Nguyen TQ, Isenberg S, Knowlton AR. The role of chronic pain and current substance use in predicting negative social support among disadvantaged persons living with HIV/AIDS. AIDS Care 2016; 28:1280-6. [PMID: 27050708 DOI: 10.1080/09540121.2016.1168916] [Citation(s) in RCA: 14] [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: 01/02/2023]
Abstract
Chronic pain and substance use can strain the supportive relationships of persons with serious chronic illness, which may increase the likelihood of receiving negative, rather than positive, social support from informal caregivers and social network members. To our knowledge, this is the first study to longitudinally examine the effects of chronic pain and substance use on negative social support. The sample (N = 383) comprised disadvantaged, primarily African-American, persons living with HIV/AIDS with a history of injection drug use, 32.4% of whom reported frequent or constant pain in the prior 6 months. Using factor analysis and structural equation modeling, current substance use and greater levels of chronic pain positively predicted negative social support 12 months later, after controlling for baseline negative support, viral load, age and sex. We also found a significant interaction effect such that among those not using substances, there was a significant positive association between pain and negative support, but no such association among those currently using substances. The findings emphasize the importance of treatment of chronic pain and substance use in the supportive functioning of social networks of a disadvantaged population with serious chronic conditions and persistent health disparities.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allysha C Maragh-Bass
- b Department of Surgery, Harvard School of Medicine, Harvard School of Public Health, Center for Surgery and Public Health , Brigham and Women's Hospital , Boston , MA , USA
| | - Trang Q Nguyen
- c Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sarina Isenberg
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Amy R Knowlton
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Knowlton AR, Robbins J, Landry S, McKenna HA, Kraus SD, Werner TB. Effects of fishing rope strength on the severity of large whale entanglements. Conserv Biol 2016; 30:318-328. [PMID: 26183819 DOI: 10.1111/cobi.12590] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 06/04/2023]
Abstract
Entanglement in fixed fishing gear affects whales worldwide. In the United States, deaths of North Atlantic right (Eubalaena glacialis) and humpback whales (Megaptera novaeangliae) have exceeded management limits for decades. We examined live and dead whales entangled in fishing gear along the U.S. East Coast and the Canadian Maritimes from 1994 to 2010. We recorded whale species, age, and injury severity and determined rope polymer type, breaking strength, and diameter of the fishing gear. For the 132 retrieved ropes from 70 cases, tested breaking strength range was 0.80-39.63 kN (kiloNewtons) and the mean was 11.64 kN (SD 8.29), which is 26% lower than strength at manufacture (range 2.89-53.38 kN, mean = 15.70 kN [9.89]). Median rope diameter was 9.5 mm. Right and humpback whales were found in ropes with significantly stronger breaking strengths at time of manufacture than minke whales (Balaenoptera acuturostrata) (19.30, 17.13, and 10.47 mean kN, respectively). Adult right whales were found in stronger ropes (mean 34.09 kN) than juvenile right whales (mean 15.33 kN) and than all humpback whale age classes (mean 17.37 kN). For right whales, severity of injuries increased since the mid 1980s, possibly due to changes in rope manufacturing in the mid 1990s that resulted in production of stronger ropes at the same diameter. Our results suggest that broad adoption of ropes with breaking strengths of ≤ 7.56 kN (≤ 1700 lbsf) could reduce the number of life-threatening entanglements for large whales by at least 72%, and yet could provide sufficient strength to withstand the routine forces involved in many fishing operations. A reduction of this magnitude would achieve nearly all the mitigation legally required for U.S. stocks of North Atlantic right and humpback whales. Ropes with reduced breaking strength should be developed and tested to determine the feasibility of their use in a variety of fisheries.
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Affiliation(s)
- Amy R Knowlton
- New England Aquarium, Central Wharf, Boston, MA, 02110, U.S.A
| | - Jooke Robbins
- Center for Coastal Studies, 5 Holway Avenue, Provincetown, MA, 02657, U.S.A
| | - Scott Landry
- Center for Coastal Studies, 5 Holway Avenue, Provincetown, MA, 02657, U.S.A
| | | | - Scott D Kraus
- New England Aquarium, Central Wharf, Boston, MA, 02110, U.S.A
| | - Timothy B Werner
- New England Aquarium, Central Wharf, Boston, MA, 02110, U.S.A
- Department of Biology, Boston University, 5 Cummington Mall, Boston, MA, 02215, U.S.A
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46
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Knowlton AR, Nguyen TQ, Robinson AC, Harrell PT, Mitchell MM. Pain Symptoms Associated with Opioid Use among Vulnerable Persons with HIV: An exploratory study with implications for palliative care and opioid abuse prevention. J Palliat Care 2016; 31:228-33. [PMID: 26856123 DOI: 10.1177/082585971503100404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Current or former injection drug users with human immunodeficiency virus (HIV) are at high risk for pain, which adversely affects their quality of life and may increase their risk for illicit drug use or relapse. We explored associations between pain symptoms and substance use among injection-drug-using study participants with HIV who had histories of heroin use. Using generalized estimating equations and controlling for prior substance use, we found that pain in each six-month period was associated with the use of heroin and prescription opioids, but not the use of nonopioid drugs or alcohol. Routine clinical assessment and improved management of pain symptoms may be needed for persons with HIV and a history of injection drug use, particularly those with chronic pain, for whom there is increased risk for heroin use.
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47
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Nguyen TQ, Bandeen-Roche K, Bass JK, German D, Nguyen NTT, Knowlton AR. A tool for sexual minority mental health research: The Patient Health Questionnaire (PHQ-9) as a depressive symptom severity measure for sexual minority women in Viet Nam. J Gay Lesbian Ment Health 2016; 20:173-191. [PMID: 27642381 DOI: 10.1080/19359705.2015.1080204] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 01/10/2023]
Abstract
In a context with limited attention to mental health and prevalent sexual prejudice, valid measurements are a key first step to understanding the psychological suffering of sexual minority populations. We adapted the Patient Health Questionnaire as a depressive symptom severity measure for Vietnamese sexual minority women, ensuring its cultural relevance and suitability for internet-based research. Psychometric evaluation found that the scale is mostly unidimensional and has good convergent validity, good external construct validity, and excellent reliability. The sample's high endorsement of scale items emphasizes the need to study minority stress and mental health in this population.
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Affiliation(s)
- Trang Quynh Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA; Institute for Studies of Society, Economy and Environment, Viet Nam
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, USA
| | - Judith K Bass
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Danielle German
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Nam Thi Thu Nguyen
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA; Health Strategy and Policy Institute, Viet Nam
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
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48
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Knowlton AR, Mitchell MM, Robinson AC, Nguyen TQ, Isenberg S, Denison J. Informal HIV Caregiver Proxy Reports of Care Recipients' Treatment Adherence: Relationship Factors Associated with Concordance with Recipients' Viral Suppression. AIDS Behav 2015; 19:2123-9. [PMID: 26036463 DOI: 10.1007/s10461-015-1092-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the role of informal caregivers in adherence, we compared adherence reports by caregivers to those of care recipients. We identified individual-level and relationship factors associated with agreement between caregivers' reports of recipients' adherence and assessed viral suppression. Participants were care recipients, who were on ART and had ever injected drugs, and their caregivers (N = 258 dyads). Nearly three-fourths of caregivers' reports of recipients' ART adherence agreed with recipients' viral suppression status. Agreement was associated with recipient age and expressing affection or gratitude to the caregiver, caregiver's having been close to someone who died of HIV/AIDS, and caregiver's fear of caregiving-related HIV (re)infection, while it was negatively associated with recipient's limited physical functioning. Our findings support the utility of caregiver proxy reports of care recipients' ART adherence and suggest ways to identify and promote HIV caregiver attention to and support of this vulnerable population's ART adherence.
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Affiliation(s)
- Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA.
| | - Mary M Mitchell
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Allysha C Robinson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Trang Q Nguyen
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Sarina Isenberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 745, Baltimore, MD, 21205, USA
| | - Julie Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, USA
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Mitchell MM, Robinson AC, Nguyen TQ, Knowlton AR. Informal Caregiver Characteristics Associated with Viral Load Suppression Among Current or Former Injection Drug Users Living with HIV/AIDS. AIDS Behav 2015; 19:2117-22. [PMID: 25969180 DOI: 10.1007/s10461-015-1090-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Few studies have examined the association between having an informal (unpaid) caregiver and viral suppression among persons living with HIV/AIDS (PLHIV) who are on antiretroviral therapy. The current study examined relationships between caregivers' individual and social network characteristics and care recipient viral suppression. Baseline data were from the BEACON study caregivers and their HIV seropositive former or current drug using care recipients, of whom 89 % were African American (N = 258 dyads). Using adjusted logistic regression, care recipient's undetectable viral load was positively associated with caregiver's limited physical functioning and negatively associated with caregivers having few family members to turn to for problem solving, a greater number of current drug users in their network, and poorer perceptions of the care recipient's mental health. Results further understandings of interpersonal relationship factors important to PLHIV's health outcomes, and the need for caregiving relationship-focused intervention to promote viral suppression among PLHIV.
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Mitchell MM, Robinson AC, Nguyen TQ, Knowlton AR. Latent growth curve analyses of emotional support for informal caregivers of vulnerable persons with HIV/AIDS. AIDS Care 2015; 27:1108-11. [PMID: 25884910 DOI: 10.1080/09540121.2015.1032202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 10/23/2022]
Abstract
People living with HIV/AIDS (PLHIV) have growing rates of morbidity and need for informal care, especially among drug-using PLHIV. Informal caregivers, or persons providing unpaid emotional or instrumental support, have protective effects on the health and well-being of PLHIV. Research suggests that social support, including care recipients' reciprocity of emotional support, is important to sustained caregiving. This study examined HIV caregivers' perceived emotional support over time from their current or former injection drug-using care recipients. Data were from baseline, 6-month, and 12-month follow-up of the BEACON study. Latent growth curve analysis showed a decline in reciprocated emotional support reports over time, particularly among caregivers themselves HIV seropositive or currently substance using. Researchers should develop interventions to strengthen the caregiving relationship by promoting reciprocity of emotional support, with implications for sustaining caregiving to vulnerable PLHIV and improving their health outcomes. Interventions should especially target dyads in which caregivers are also HIV positive or using substances.
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Affiliation(s)
- Mary M Mitchell
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allysha C Robinson
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Trang Q Nguyen
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Amy R Knowlton
- a Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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