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Ko MY, Rosenberg SM, Meza BPL, Dudovitz RN, Dosanjh KK, Wong MD. Perceptions of School Climate Shape Adolescent Health Behavior: A Longitudinal Multischool Study. J Sch Health 2023; 93:475-484. [PMID: 36404628 PMCID: PMC10175101 DOI: 10.1111/josh.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/05/2022] [Accepted: 11/02/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes. METHODS Data from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh-grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th-grade school climate measures (independent variables: institutional environment, student-teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates. RESULTS The 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30-day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30-day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY School health practitioners may prospectively leverage school environment, teacher-student relationships, and disciplinary style to promote health and learning. CONCLUSIONS Our findings identify specific modifiable aspects of the school environment with critical implications for life course health.
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Affiliation(s)
- Michelle Y Ko
- Medical Student, , David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sofia M Rosenberg
- Undergraduate Student, , Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin P L Meza
- Assistant Professor of Medicine , Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Rebecca N Dudovitz
- Associate Professor of Pediatrics, , Division of General Pediatrics, Department of Pediatrics and Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kulwant K Dosanjh
- Project Director, , Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mitchell D Wong
- Professor of Medicine, , Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Meza BPL, Dudovitz RN, Cooper ZD, Tucker JS, Wong MD. Adolescent Cannabis Misuse Scale: Longitudinal Associations with Substance Use, Mental Health, and Social Determinants of Health in Early Adulthood. Subst Use Misuse 2023; 58:1080-1089. [PMID: 37158563 DOI: 10.1080/10826084.2023.2201852] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Some patterns of cannabis use may presage risk for long-term negative effects. We examined associations between a novel adolescent cannabis misuse scale and early-adult life course outcomes. METHODS We performed a secondary data analysis of a cohort of Los Angeles, CA high school students from grade 9 through age 21. Participants reported baseline individual demographic and family characteristics at grade 9, adolescent cannabis misuse (8-items) and alcohol misuse (12-items) at grade 10, and outcomes at age 21. We used multivariable regression to model the associations of cannabis misuse scale score with problem substance use (defined as any of: 30-day illegal drug use, 30-day use of another's prescription to get high, hazardous drinking) and several secondary outcomes (behavioral, mental health, academic, social determinants of health), adjusting for covariates. Parallel analyses were conducted for alcohol misuse. RESULTS The 1,148 participants (86% retention) were 47% male, 90% Latinx, 87% US born, and 40% native English speakers. Approximately 11.4% and 15.9% of participants reported at least one item on the cannabis and alcohol misuse scales, respectively. At age 21, approximately 6.7% of participants reported problem substance use, which was associated with both Cannabis and Alcohol Misuse Scales (OR 1.31, 95%CI[1.16, 1.49] and OR 1.33, 95%CI[1.18, 1.49], respectively). Both scales were similarly associated with outcomes in all four categories. CONCLUSIONS The Adolescent Cannabis Misuse Scale is a promising tool for identifying early patterns of substance use that predict future negative outcomes and enabling early intervention at a critical period in youth development.
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Affiliation(s)
- Benjamin P L Meza
- Divison of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Rebecca N Dudovitz
- Division of General Pediatrics, Department of Pediatrics and Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ziva D Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Mitchell D Wong
- Divison of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Childress S, Shrestha N, Anekwe K, Wong MD, Dudovitz RN. Factors inhibiting institutional responses to domestic violence in Kyrgyzstan. Centr Asian Surv 2023; 42:254-273. [PMID: 37457923 PMCID: PMC10348350 DOI: 10.1080/02634937.2022.2147146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The study identifies factors that limit effective institutional responses to domestic violence (DV) in Kyrgyzstan, in the context of recent legislative actions aimed at reducing DV through improvements in law enforcement, judicial processes, and provision of social services. The study uses qualitative, grounded theory methods to analyze interviews and focus groups with 83 professionals working in these sectors. Two major themes emerge from the analysis: (1) barriers to effective institutional responses from internal challenges and constraints, and (2) social resources and challenges identified as important to provide a better collective response. The study highlights the need for capacity development within institutions and broader social learning to overcome existing barriers and better align outcomes with the intentions of recent legislation. Standardized training, awareness-raising, enhanced roles for educators and religious leaders, better coordinated social service provision, rehabilitation for victims and perpetrators, and family-centered school-based interventions are identified as targets for improving responsiveness.
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Affiliation(s)
| | | | - Kendall Anekwe
- School of Social Work, University of Texas-Arlington, USA
| | - Mitchell D. Wong
- David Geffen School of Medicine, University of California, Los Angeles, USA
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Dudovitz RN, Chung PJ, Dosanjh KK, Phillips M, Tucker JS, Pentz MA, Biely C, Tseng CH, Galvez A, Arellano G, Wong MD. Outcome of the AVID College Preparatory Program on Adolescent Health: A Randomized Trial. Pediatrics 2023; 151:e2022057183. [PMID: 36524331 PMCID: PMC9830585 DOI: 10.1542/peds.2022-057183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Academic tracking is a widespread practice, separating students by prior academic performance. Clustering lower performing students together may unintentionally reinforce risky peer social networks, school disengagement, and risky behaviors. If so, mixing lower performing with high performing youth ("untracking") may be protective, leading to better adolescent health. METHODS Advancement via Individual Determination (AVID), a nationally-disseminated college preparatory program, supports placing middle-performing students in rigorous college-preparatory classes alongside high-performing peers. We conducted the first randomized, controlled trial of AVID in the United States, randomizing 270 students within 5 large public high schools to receive AVID (AVID group) versus usual school programming (control group). Participants completed surveys at the transition to high school (end of eighth grade/ beginning of ninth grade) and the end of ninth grade. Intent-to-treat analyses tested whether AVID resulted in healthier social networks (primary outcome), health behaviors, and psychosocial wellbeing. RESULTS At follow-up, AVID students had lower odds of using any substance (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.48-0.89) and associating with a substance-using peer (OR 0.74, 95% CI 0.45-0.98), and higher odds of associating with a peer engaged in school (OR 1.73, 95% CI 1.11-2.70). Male AVID students had lower stress and higher self-efficacy, grit, and school engagement than control students (P < .05 for all). No adverse health effects among high-performing peers were observed. CONCLUSIONS AVID positively impacts social networks, health behaviors, and psychosocial outcomes suggesting academic untracking may have substantial beneficial spillover effects on adolescent health.
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Affiliation(s)
- Rebecca N. Dudovitz
- Departments of Pediatrics and Children’s Development and Innovation Institute
| | - Paul J. Chung
- Departments of Pediatrics and Children’s Development and Innovation Institute
- Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California
| | - Kulwant K. Dosanjh
- General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
| | | | | | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Christopher Biely
- Departments of Pediatrics and Children’s Development and Innovation Institute
| | - Chi-Hong Tseng
- General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
| | - Arzie Galvez
- Los Angeles Unified School District, Los Angeles, California
| | | | - Mitchell D. Wong
- General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
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Wong MD, Meza BPL, Dosanjh KK, Jackson NJ, Seeman TE, Orendain N, Dudovitz RN. Association of Attending a High-Performing High School With Substance Use Disorder Rate and Health Outcomes in Young Adults. JAMA Netw Open 2022; 5:e2235083. [PMID: 36201208 PMCID: PMC9539718 DOI: 10.1001/jamanetworkopen.2022.35083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Interventions directly targeting social factors, such as education, may have the potential to greatly improve health. Objective To examine the association of attending a high-performing public charter high school with rates of substance use disorder and physical and mental health. Design, Setting, and Participants This cohort study used the random school admissions lottery system of high-performing public charter high schools in low-income neighborhoods of Los Angeles, California, to examine the health outcomes of students who applied to at least 1 of 5 of these high schools. Participants attended 147 different high schools and were randomly selected from those who won the admissions lottery (intervention group) and those who were placed on a waiting list (control group). Participants were surveyed at the end of grade 8 through transition into grade 9 and then from grade 10 through 3 years after high school completion (at age 21 years). Surveys were conducted from March 2013 through November 2021. Intervention Attendance at a high-performing public charter high school. Main Outcomes and Measures Self-reported alcohol use disorder and cannabis misuse, delinquent behaviors, physical and mental health, and body mass index. Results Of the 1270 participants at baseline (mean [SD] age, 14.2 [0.47] years; 668 female individuals [52.6%]). The control group included 576 individuals (45.4%), and 694 individuals (54.6%) were in the intervention group. Both groups were similar in almost all characteristics at baseline, and the median (IQR) follow-up was 6.4 (6.0-6.7) years. Participants attending a high-performing public charter high school had a 53.33% lower rate of hazardous or dependent alcohol use disorder compared with those in the control group (5.43% vs 11.64%; difference, -6.21% [95% CI, -11.87% to -0.55%]; P = .03). Among male participants, the intervention group had a 42.05% lower rate of self-reported fair or poor physical health (13.33% vs 23.01%; difference, -9.67% [95% CI, -18.30% to -1.05%]; P = .03) and a 32.94% lower rate of obesity or overweight (29.28% vs 43.67%; difference, -14.38% [95% CI, -25.74% to -3.02%]; P = .02) compared with the control group. Among female participants, attending a high-performing public charter high school was associated with worse physical health outcomes (30.29% vs 13.47% reporting fair or poor health; difference, 16.82% [95% CI, 0.36% to 33.28%]; P = .045) and higher rates of overweight or obesity (52.20% vs 32.91%; difference, 19.30% [95% CI, 3.37% to 35.22%]; P = .02) at age 21 years. Few differences in mental health outcomes were observed. Adjusting for educational outcomes did not significantly change these findings. Conclusions and Relevance Results of this study suggest that attending a high-performing public charter high school was associated with lower rates of substance use disorder independent of academic achievement. Physical health and obesity outcomes were also better but only for young men; the intervention group had worse physical health outcomes among young women for unclear reasons. Schools are a potent social determinant of health and an important target for future health interventions.
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Affiliation(s)
- Mitchell D. Wong
- General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Benjamin P. L. Meza
- General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Kulwant K. Dosanjh
- General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Nicholas J. Jackson
- General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | | | - Natalia Orendain
- General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA (University of California, Los Angeles)
| | - Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital, Los Angeles
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Wong MD, Quartz KH, Saunders M, Meza BP, Childress S, Seeman TE, Dudovitz RN. Turning Vicious Cycles Into Virtuous Ones: the Potential for Schools to Improve the Life Course. Pediatrics 2022; 149:186909. [PMID: 35503311 PMCID: PMC9113000 DOI: 10.1542/peds.2021-053509m] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Adolescence is a critical transition period that sets the stage for adulthood and future health outcomes. Marked by key developmental milestones in brain maturation, increasing independence from parents, and greater connections to peers, adolescence is also a time of heightened risk for behavioral health problems, including substance use, violence, delinquency, and mental health issues. High school completion is a significant life course event and a powerful social determinant of health and health disparities. Jessor's Theory of Problem Behavior suggests that adolescent health behaviors and mental health problems are closely tied to poor educational outcomes and peer network formation in a reinforcing feedback loop, or vicious cycle, often leading to school failure, school disengagement, and drop-out. Schools are a novel platform through which vicious cycles can be disrupted and replaced with virtuous ones, simultaneously improving education and health. This article describes the potential for schools to transform health trajectories through interventions creating positive and supportive school climates. In addition, new models such as the Whole School Whole Community Whole Child Model promote whole child well-being, including cognitive, social, emotional, psychological, and physical development. Full-service community schools can serve as a hub coordinating and integrating all available resources to better respond to the needs of children and families. Present in every neighborhood, schools are a way to reach every school-age child and improve their health trajectories, providing an important platform for life course intervention research.
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Affiliation(s)
- Mitchell D. Wong
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California,Address correspondence to Mitchell D. Wong, MD, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave, Suite 850, Los Angeles, CA 90024. E-mail:
| | - Karen Hunter Quartz
- University of California, Los Angeles School of Education and Information Studies, Los Angeles, California
| | - Marisa Saunders
- University of California, Los Angeles School of Education and Information Studies, Los Angeles, California
| | - Ben P.L. Meza
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | | | - Teresa E. Seeman
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Rebecca N. Dudovitz
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Furukawa D, Dieringer TD, Wong MD, Tong JT, Cader IA, Wisk LE, Han MA, Gupta SM, Kerbel RB, Uslan DZ, Graber CJ. Evaluation of antibiotic escalation in response to nurse-driven inpatient sepsis screen. Antimicrob Steward Healthc Epidemiol 2021; 1:e59. [PMID: 36168494 PMCID: PMC9495422 DOI: 10.1017/ash.2021.232] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the frequency and predictors of antibiotic escalation in response to the inpatient sepsis screen at our institution. DESIGN Retrospective cohort study. SETTING Two affiliated academic medical centers in Los Angeles, California. PATIENTS Hospitalized patients aged 18 years and older who had their first positive sepsis screen between January 1, 2019, and December 31, 2019, on acute-care wards. METHODS We described the rate and etiology of antibiotic escalation, and we conducted multivariable regression analyses of predictors of antibiotic escalation. RESULTS Of the 576 cases with a positive sepsis screen, antibiotic escalation occurred in 131 cases (22.7%). New infection was the most documented etiology of escalation, with 76 cases (13.2%), followed by known pre-existing infection, with 26 cases (4.5%). Antibiotics were continued past 3 days in 17 cases (3.0%) in which new or existing infection was not apparent. Abnormal temperature (adjusted odds ratio [aOR], 3.00; 95% confidence interval [CI], 1.91-4.70) and abnormal lactate (aOR, 2.04; 95% CI, 1.28-3.27) were significant predictors of antibiotic escalation. The patient already being on antibiotics (aOR, 0.54; 95% CI, 0.34-0.89) and the positive screen occurred during a nursing shift change (aOR, 0.36; 95% CI, 0.22-0.57) were negative predictors. Pneumonia was the most documented new infection, but only 19 (50%) of 38 pneumonia cases met full clinical diagnostic criteria. CONCLUSIONS Inpatient sepsis screening led to a new infectious diagnosis in 13.2% of all positive sepsis screens, and the risk of prolonged antibiotic exposure without a clear infectious source was low. Pneumonia diagnostics and lactate testing are potential targets for future stewardship efforts.
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Affiliation(s)
- Daisuke Furukawa
- Division of Infectious Disease, Department of Medicine, University of California–Los Angeles, California
| | - Thomas D. Dieringer
- Division of Infectious Disease, Department of Medicine, University of California–Los Angeles, California
| | - Mitchell D. Wong
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Julia T. Tong
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Isa A. Cader
- David Geffen School of Medicine, University of California–Los Angeles, California
| | - Lauren E. Wisk
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Maria A. Han
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Summer M. Gupta
- Quality Management Services, UCLA Health, Los Angeles, California
| | - Russell B. Kerbel
- Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles, California
| | - Daniel Z. Uslan
- Division of Infectious Disease, Department of Medicine, University of California–Los Angeles, California
| | - Christopher J. Graber
- Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Wong MD, Dosanjh KK, Jackson NJ, Rünger D, Dudovitz RN. The longitudinal relationship of school climate with adolescent social and emotional health. BMC Public Health 2021; 21:207. [PMID: 33485308 PMCID: PMC7825179 DOI: 10.1186/s12889-021-10245-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Schools and school climate are thought to influence academic outcomes as well as child and adolescent development, health and well-being. We sought to examine the relationship between several aspects of the school climate with adolescent social-emotional health outcomes. Methods We analysed data from the Reducing Inequities through Social and Educational change Follow-up (RISE UP) Study, a longitudinal natural experimental study of Los Angeles high school students collected from 2013 to 2018. We analysed data on the portion of the sample that completed the baseline, 10th grade and 11th grade surveys (n=1114). Students reported their perceptions of school climate at 10th grade and social-emotional outcomes including grit, self-efficacy, depression, hopelessness, and stress at baseline (9th grade) and at 11th grade. Multivariable regressions adjusted for student and parental demographics and baseline social-emotional states tested associations between school climate and each outcome. Results Students who reported being in authoritative school environments in 10th grade, one that is highly supportive and highly structured, had subsequently higher levels of self-efficacy (p< 0.001) and grit (p=0.01). They also had fewer depressive symptoms (p=0.008), and less hopelessness (p = 0.01), stress at school (p=0.002) and stress about the future (p=0.03) reported in 11th grade. Conclusions School climate, and particularly an authoritative school environment, is strongly associated with better social-emotional health among adolescents. Relationship with teachers and their disciplinary style may be a focus for future interventions to improve the social-emotional health of children.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA.
| | - Kulwant K Dosanjh
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA
| | - Nicholas J Jackson
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA
| | - Dennis Rünger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, USA
| | - Rebecca N Dudovitz
- Division of General Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Omoumi FH, Ghani MU, Wong MD, Li Y, Zheng B, Yan A, Jenkins PA, Wu X, Liu H. The Potential of Utilizing Mid-Energy X-Rays for In-Line Phase Sensitive Breast Cancer Imaging. Biomed Spectrosc Imaging 2020; 9:89-102. [PMID: 34141562 PMCID: PMC8208526 DOI: 10.3233/bsi-200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The objective of this study is to demonstrate the potential of utilizing mid-energy x-rays for in-line phase-sensitive breast cancer imaging by phantom studies. METHODS The midenergy (50-80kV) in-line phase sensitive imaging prototype was used to acquire images of the contrast-detail mammography (CDMAM) phantom, an ACR accreditation phantom, and an acrylic edge phantom. The low-dose mid-energy phase-sensitive images were acquired at 60 kV with a radiation dose of 0.9 mGy, while the high-energy phase-sensitive images were acquired at 90 kV with a radiation dose of 1.2 mGy. The Phase-Attenuation Duality (PAD) principle for soft tissue was used for the phase retrieval. A blind observer study was conducted and paired-sample T-test were performed to compare the mean differences in the two imaging systems. RESULTS The correct detection ratio for the CDMAM phantom for phase-contrast images acquired by the low-dose mid-energy system was 56.91%, whereas images acquired by the high-energy system correctly revealed only 40.97% of discs. The correct detection ratios were 57.88% and 43.41% for phase-retrieved images acquired by the low-dose mid-energy and high-energy imaging systems, respectively. The reading scores for all three groups of objects in the ACR phantom were higher for the mid energy imaging system as compared to the high-energy system for both phase-contrast and phase- retrieved images. The calculated edge enhancement index (EEI) from the acrylic edge phantom image for the mid-energy system was higher than that calculated for the high-energy imaging system. The quantitative analyses showed a higher Contrast to Noise Ratio (CNR) as well as a higher Figure of Merit (FOM) in images acquired by the low-dose mid-energy imaging system. CONCLUSION The PAD based retrieval method can be applied in mid-energy system without remarkably affecting the image quality, and in fact, it improves the lesion detectability with a patient dose saving of 25%.
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Affiliation(s)
- F H Omoumi
- Advanced Medical Imaging Center and School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK 73019, U.S.A
| | - M U Ghani
- Advanced Medical Imaging Center and School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK 73019, U.S.A
| | - M D Wong
- Advanced Medical Imaging Center and School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK 73019, U.S.A
| | - Y Li
- Advanced Medical Imaging Center and School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK 73019, U.S.A
| | - B Zheng
- Advanced Medical Imaging Center and School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK 73019, U.S.A
| | - A Yan
- Department of Radiology, The University of Alabama at Birmingham, AL 35249, U.S.A
| | - P A Jenkins
- Department of Radiology and Imaging Science, The University of Utah School of Medicine, Salt Lake- City, UT 74132, U.S.A
| | - X Wu
- Department of Radiology, The University of Alabama at Birmingham, AL 35249, U.S.A
| | - H Liu
- Advanced Medical Imaging Center and School of Electrical and Computer Engineering, The University of Oklahoma, Norman, OK 73019, U.S.A
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Baghdadi JD, Uslan DZ, Wong MD. SEP-1 Septic Shock Bundle Guidelines Not Applicable to Inpatients-Reply. JAMA Intern Med 2020; 180:1713-1714. [PMID: 32865559 PMCID: PMC11042505 DOI: 10.1001/jamainternmed.2020.2768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Daniel Z Uslan
- Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles
| | - Mitchell D Wong
- Division of General Internal Medicine, David Geffen School of Medicine at the University of California, Los Angeles
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Baghdadi JD, Brook RH, Uslan DZ, Needleman J, Bell DS, Cunningham WE, Wong MD. Association of a Care Bundle for Early Sepsis Management With Mortality Among Patients With Hospital-Onset or Community-Onset Sepsis. JAMA Intern Med 2020; 180:707-716. [PMID: 32250412 PMCID: PMC7136852 DOI: 10.1001/jamainternmed.2020.0183] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE The Early Management Bundle for Severe Sepsis/Septic Shock (SEP-1) is a quality metric based on a care bundle for early sepsis management. Published evidence on the association of SEP-1 with mortality is mixed and largely excludes cases of hospital-onset sepsis. OBJECTIVE To assess the association of the SEP-1 bundle with mortality and organ dysfunction in cohorts with hospital-onset or community-onset sepsis. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from 4 University of California hospitals from October 1, 2014, to October 1, 2017. Adult inpatients with a diagnosis consistent with sepsis or disseminated infection and laboratory or vital signs meeting the Sepsis-3 (Third International Consensus Definitions for Sepsis and Septic Shock) criteria were divided into community-onset sepsis and hospital-onset sepsis cohorts based on whether time 0 of sepsis occurred after arrival in the emergency department or an inpatient area. Data were analyzed from April to October 2019. Additional analyses were performed from December 2019 to January 2020. EXPOSURES Administration of SEP-1 and 4 individual bundle components (serum lactate level testing, blood culture, broad-spectrum intravenous antibiotic treatment, and intravenous fluid treatment). MAIN OUTCOMES AND MEASURES The primary outcome was in-hospital mortality. The secondary outcome was days requiring vasopressor support, measured as vasopressor days. RESULTS Among the 6404 patient encounters identified (3535 men [55.2%]; mean [SD] age, 64.0 [18.2] years), 2296 patients (35.9%) had hospital-onset sepsis. Among 4108 patients (64.1%) with community-onset sepsis, serum lactate level testing within 3 hours of time 0 was associated with reduced mortality (absolute difference, -7.61%; 95% CI, -14.70% to -0.54%). Blood culture (absolute difference, -1.10 days; 95% CI, -1.85 to -0.34 days) and broad-spectrum intravenous antibiotic treatment (absolute difference, -0.62 days; 95% CI, -1.02 to -0.22 days) were associated with fewer vasopressor days. Among patients with hospital-onset sepsis, broad-spectrum intravenous antibiotic treatment was the only bundle component significantly associated with any improved outcome (mortality difference, -5.20%; 95% CI, -9.84% to -0.56%). Care that was adherent to the complete SEP-1 bundle was associated with increased vasopressor days in patients with community-onset sepsis (absolute difference, 0.31 days; 95% CI, 0.11-0.51 days) but was not significantly associated with reduced mortality in either cohort (absolute difference, -0.07%; 95% CI, -3.02% to 2.88% in community-onset; absolute difference, -0.42%; 95% CI, -6.77% to 5.93% in hospital-onset). CONCLUSIONS AND RELEVANCE SEP-1-adherent care was not associated with improved outcomes of sepsis. Although multiple components of SEP-1 were associated with reduced mortality or decreased days of vasopressor therapy for patients who presented with sepsis in the emergency department, only broad-spectrum intravenous antibiotic treatment was associated with reduced mortality when time 0 occurred in an inpatient unit. Current sepsis quality metrics may need refinement.
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Affiliation(s)
- Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland, Baltimore
| | - Robert H Brook
- RAND Corporation, Santa Monica, California.,David Geffen School of Medicine, UCLA (University of California, Los Angeles)
| | | | - Jack Needleman
- Department of Health Policy and Management, Fielding School of Public Health, UCLA
| | | | - William E Cunningham
- Department of Health Policy and Management, Fielding School of Public Health, UCLA.,Division of General Internal Medicine, UCLA
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Baghdadi JD, Wong MD, Uslan DZ, Bell D, Cunningham WE, Needleman J, Kerbel R, Brook R. Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study. J Gen Intern Med 2020; 35:1153-1160. [PMID: 32040837 PMCID: PMC7174506 DOI: 10.1007/s11606-020-05653-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 09/26/2019] [Accepted: 12/10/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis. OBJECTIVE To compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis. DESIGN Retrospective cohort study using multivariable analysis of clinical data. PARTICIPANTS A total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection. SETTING Four university hospitals in California between 2014 and 2016. MAIN OUTCOMES AND MEASURES The primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen. KEY RESULTS Compared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29-0.38, p < 0.001). With the exception of vasopressors (RR 1.11, p = 0.002), each component of SEP-1 evaluated-blood cultures (RR 0.76, p < 0.001), serum lactate (RR 0.51, p < 0001), broad-spectrum antibiotics (RR 0.62, p < 0.001), intravenous fluids (0.47, p < 0.001), and follow-up lactate (RR 0.71, p < 0.001)-was less likely to be performed within the recommended time frame in hospital-onset sepsis. Within the hospital, cases of hospital-onset sepsis arising on the ward were less likely to receive SEP-1-adherent care than were cases arising in the intensive care unit (RR 0.68, p = 0.004). CONCLUSIONS Inpatients with hospital-onset sepsis receive different management than individuals with community-onset sepsis. It remains to be determined whether system-level factors, provider-level factors, or factors related to measurement explain the observed variation in care or whether variation in care affects outcomes.
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Affiliation(s)
- Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Mitchell D Wong
- UCLA Division of General Internal Medicine, Los Angeles, CA, USA
| | - Daniel Z Uslan
- UCLA Division of Infectious Diseases, Los Angeles, CA, USA
| | - Douglas Bell
- UCLA Division of General Internal Medicine, Los Angeles, CA, USA
| | - William E Cunningham
- UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | - Jack Needleman
- UCLA Fielding School of Public Health, Department of Health Policy and Management, Los Angeles, CA, USA
| | | | - Robert Brook
- UCLA Department of Medicine, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
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Bergman P, Dudovitz RN, Dosanjh KK, Wong MD. Engaging Parents to Prevent Adolescent Substance Use: A Randomized Controlled Trial. Am J Public Health 2019; 109:1455-1461. [PMID: 31415193 DOI: 10.2105/ajph.2019.305240] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To test whether providing information to parents about their child's academic performance and behavior in school will lead to lower rates of adolescent substance use.Methods. We performed a randomized controlled trial in Los Angeles, California. We enrolled 318 seventh graders and their parents in 2014 and collected data through 2016. Half of the participants had parents with income less than $15 000, and 81% were Latino. During this intervention, Linking Information and Families Together, we sent parents weekly text messages, telephone calls, or e-mails about missed assignments, grades, and behavior. Parents reported their monitoring and parenting self-efficacy; students reported their use and intentions to use alcohol, marijuana, and other drugs.Results. By the end of eighth grade, lifetime use of alcohol or marijuana was 18.2% in the control group and 10.2% in the intervention group (P = .02). Parenting self-efficacy, parent-child relationship, and student's grades were similar between groups.Conclusions. The intervention successfully reduced adolescent alcohol and marijuana initiation between grades 7 and 8. The intervention cost $15 per student per year but could be automated, reducing the marginal cost toward zero. The intervention holds promise as a scalable and innovative approach to reducing substance use.Trial Registration. ClinicalTrials.gov Identifier: NCT02129153.
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Affiliation(s)
- Peter Bergman
- Peter Bergman is with Teachers College, Columbia University, New York, NY. Rebecca N. Dudovitz, Kulwant K. Dosanjh, and Mitchell D. Wong are with the David Geffen School of Medicine, University of California, Los Angeles
| | - Rebecca N Dudovitz
- Peter Bergman is with Teachers College, Columbia University, New York, NY. Rebecca N. Dudovitz, Kulwant K. Dosanjh, and Mitchell D. Wong are with the David Geffen School of Medicine, University of California, Los Angeles
| | - Kulwant K Dosanjh
- Peter Bergman is with Teachers College, Columbia University, New York, NY. Rebecca N. Dudovitz, Kulwant K. Dosanjh, and Mitchell D. Wong are with the David Geffen School of Medicine, University of California, Los Angeles
| | - Mitchell D Wong
- Peter Bergman is with Teachers College, Columbia University, New York, NY. Rebecca N. Dudovitz, Kulwant K. Dosanjh, and Mitchell D. Wong are with the David Geffen School of Medicine, University of California, Los Angeles
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Dudovitz RN, Chung PJ, Wong MD. School Mobility and Its Impact on Student Health-Reply. JAMA Pediatr 2019; 173:497-498. [PMID: 30882869 PMCID: PMC7486085 DOI: 10.1001/jamapediatrics.2019.0228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery, & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Paul J. Chung
- Department of Pediatrics and Children’s Discovery, & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital, University of California, Los Angeles,Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles,Kaiser Permanente School of Medicine, Pasadena, California
| | - Mitchell D. Wong
- General Internal Medicine and Health Services Research, University of California, Los Angeles
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Wong MD, Chung PJ, Hays RD, Kennedy DP, Tucker JS, Dudovitz RN. THE SOCIAL ECONOMICS OF ADOLESCENT BEHAVIOR AND MEASURING THE BEHAVIORAL CULTURE OF SCHOOLS. J Child Fam Stud 2019; 28:928-940. [PMID: 31745385 PMCID: PMC6863439 DOI: 10.1007/s10826-018-01325-0] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Schools are thought to have an important impact on adolescent behaviors, but the mechanisms are not well understood. We hypothesize that there are measurable constructs of peer- and teacher-related extrinsic motivations for adolescent behaviors and sought to develop measures of school culture that would capture these constructs. METHODS We developed several survey items to assess school behavioral culture and collected self-reported data from a sample of adolescents age 14-17 attending high school in low income neighborhoods of Los Angeles. We conducted exploratory and confirmatory factor analysis to inform the creation of simple-summated multi-item scales. We also conducted a cultural consensus analysis to identify the existence of shared pattern of responses to the items among respondents within the same school. RESULTS From 1159 adolescents, six factors were identified: social culture regarding popular (Cronbach's alpha=0.84) and respected (alpha=0.83) behaviors, teacher support (alpha=0.86) and monitoring of school rules (alpha=0.85), valued student traits (alpha=0.67) and school order (alpha=0.68). Cultural consensus analysis identified a shared pattern of responses to the items among respondents at 8 of the 13 schools. School academic performance, which is based on standardized test results, is strongly correlated with social culture regarding popular behaviors (Pearson's correlation coefficient r=0.64), monitoring of school rules (r= 0.71), and school order (r= 0.83). CONCLUSIONS The exploratory and confirmatory factor analyses did not support a single, overall factor that measures school culture. However, the six identified sub-scales might be used individually to examine school influence on academic performance and health behaviors.
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Affiliation(s)
- Mitchell D Wong
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1736
| | - Paul J Chung
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1736
| | - Ron D Hays
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1736
- RAND Corporation, 1776 Main Street, Santa Monica, California 90401-3208
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, California 90401-3208
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, California 90401-3208
| | - Rebecca N Dudovitz
- David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1736
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Dudovitz RN, Wong MD, Perez-Aguilar G, Kim G, Chung PJ. Update on How School Environments, Social Networks, and Self-Concept Impact Risky Health Behaviors. Acad Pediatr 2019; 19:133-134. [PMID: 30287394 PMCID: PMC6401257 DOI: 10.1016/j.acap.2018.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/03/2018] [Accepted: 09/25/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Rebecca N Dudovitz
- Department of Pediatrics, UCLA Children's Discovery and Innovation Institute (RN Dudovitz and PJ Chung); Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung).
| | - Mitchell D Wong
- Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung); Department of Internal Medicine, General Internal Medicine and Health Services Research (MD Wong)
| | | | - Grace Kim
- Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung)
| | - Paul J Chung
- Department of Pediatrics, UCLA Children's Discovery and Innovation Institute (RN Dudovitz and PJ Chung); Department of Pediatrics, UCLA David Geffen School of Medicine (RN Dudovitz, MD Wong, G Kim, and PJ Chung); Department of Health Policy and Management, Fielding School of Public Health (PJ Chung), University of California, Los Angeles; RAND Corporation (PJ Chung), Santa Monica, Calif
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Dudovitz RN, Chung PJ, Reber S, Kennedy D, Tucker JS, Shoptaw S, Dosanjh KK, Wong MD. Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use: A Natural Experiment. JAMA Pediatr 2018; 172:1135-1144. [PMID: 30383092 PMCID: PMC6350909 DOI: 10.1001/jamapediatrics.2018.3074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown. OBJECTIVE To test whether exposure to high-performing schools is associated with risky adolescent health behaviors. DESIGN, SETTING, AND PARTICIPANTS This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018. EXPOSURES Schools were considered high performing if they placed in the top tercile of public high schools in LA County on 2012 state standardized tests. Most students attended that same school for 3 years (9th-11th grades). MAIN OUTCOMES AND MEASURES Primary self-reported outcomes were 30-day and high-risk self-reported marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex, and past-year delinquency. Potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support for college, and proportion of substance-using peers in students' social networks) were also examined. RESULTS Among the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P < .05). Stratified analyses suggest that among boys, intervention participants had significantly lower marijuana use (mean misuse score, 0.43 vs 0.88; difference, -0.45; 95% CI, -0.78 to -0.13) and alcohol misuse (mean misuse score, 0.52 vs 0.97; difference, -0.44; 95% CI, -0.80 to -0.09) scores compared with control participants, whereas no significant health outcomes were noted for girls. CONCLUSIONS AND RELEVANCE This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.
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Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital
| | - Paul J. Chung
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,Department of Health Policy & Management, UCLA Fielding School of Public Health,RAND Health, RAND Corporation
| | - Sarah Reber
- Department of Public Policy, UCLA Luskin School of Public Affairs and National Bureau of Economic Research
| | | | | | - Steve Shoptaw
- Department of Family Medicine and Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA, Department of Psychiatry, University of Cape Town
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Palar K, Wong MD, Cunningham WE. Competing subsistence needs are associated with retention in care and detectable viral load among people living with HIV. J HIV AIDS Soc Serv 2018; 17:163-179. [PMID: 30505245 PMCID: PMC6261356 DOI: 10.1080/15381501.2017.1407732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Competing priorities between subsistence needs and health care may interfere with HIV health. Longitudinal data from the Los Angeles-based HIV Outreach Initiative were analyzed to examine the association between competing subsistence needs and indicators of poor retention-in-care among hard-to-reach people with HIV. Sacrificing basic needs for health care in the previous six months was associated with a 1.55 times greater incidence of missed appointments (95% CI 1.17, 2.05), 2.32 times greater incidence of emergency department visits (95% CI 1.39, 3.87), 3.66 times greater incidence of not receiving ART if CD4 < 350 (95% CI 1.60, 8.37), and 1.35 times greater incidence of detectable viral load (95% CI 1.07, 1.70) (all p < 0.01). Among hard-to-reach PLHIV, sacrificing basic needs for health care delineates a population with exceptional vulnerability to poor outcomes along the HIV treatment cascade. Efforts to identify and reduce competing needs for this population are crucial to HIV health outcomes.
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Affiliation(s)
- Kartika Palar
- Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Mitchell D. Wong
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - William E. Cunningham
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA, Los Angeles, CA, USA
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Wong MD, Strom D, Guerrero LR, Chung PJ, Lopez D, Arellano K, Dudovitz R. The Role of Social-Emotional and Social Network Factors in the Relationship Between Academic Achievement and Risky Behaviors. Acad Pediatr 2017; 17:633-641. [PMID: 28434912 PMCID: PMC5545150 DOI: 10.1016/j.acap.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/01/2017] [Accepted: 04/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND We examined whether standardized test scores and grades are related to risky behaviors among low-income minority adolescents and whether social networks and social-emotional factors explained those relationships. METHODS We analyzed data from 929 high school students exposed by natural experiment to high- or low-performing academic environments in Los Angeles. We collected information on grade point average (GPA), substance use, sexual behaviors, participation in fights, and carrying a weapon from face-to-face interviews and obtained California math and English standardized test results. Logistic regression and mediation analyses were used to examine the relationship between achievement and risky behaviors. RESULTS Better GPA and California standardized test scores were strongly associated with lower rates of substance use, high-risk sexual behaviors, and fighting. The unadjusted relative odds of monthly binge drinking was 0.72 (95% confidence interval, 0.56-0.93) for 1 SD increase in standardized test scores and 0.46 (95% confidence interval, 0.29-0.74) for GPA of B- or higher compared with C+ or lower. Most associations disappeared after controlling for social-emotional and social network factors. Averaged across the risky behaviors, mediation analysis revealed social-emotional factors accounted for 33% of the relationship between test scores and risky behaviors and 43% of the relationship between GPA with risky behaviors. Social network characteristics accounted for 31% and 38% of the relationship between behaviors with test scores and GPA, respectively. Demographic factors, parenting, and school characteristics were less important explanatory factors. CONCLUSIONS Social-emotional factors and social network characteristics were the strongest explanatory factors of the achievement-risky behavior relationship and might be important to understanding the relationship between academic achievement and risky behaviors.
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Affiliation(s)
- Mitchell D. Wong
- David Geffen School of Medicine at UCLA, Department of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Danielle Strom
- David Geffen School of Medicine at UCLA, Department of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Lourdes R Guerrero
- David Geffen School of Medicine at UCLA, Department of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Paul J. Chung
- David Geffen School of Medicine at UCLA, Department of Pediatrics, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Desiree Lopez
- David Geffen School of Medicine at UCLA, Department of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Katherine Arellano
- David Geffen School of Medicine at UCLA, Department of Medicine, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Rebecca Dudovitz
- David Geffen School of Medicine at UCLA, Department of Pediatrics, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Green JB, Shapiro MF, Ettner SL, Malin J, Ang A, Wong MD. Physician variation in lung cancer treatment at the end of life. Am J Manag Care 2017; 23:216-223. [PMID: 28554208 PMCID: PMC5762116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine whether a treating oncologist's characteristics are associated with variation in use of chemotherapy for patients with advanced non-small cell lung cancer (aNSCLC) at the end of life. STUDY DESIGN Retrospective cohort. METHODS Using the 2009 Surveillance, Epidemiology, and End Results-Medicare database, we studied chemotherapy receipt within 30 days of death among Medicare enrollees who were diagnosed with aNSCLC between 1999 and 2006, received chemotherapy, and died within 3 years of diagnosis. A multilevel model was constructed to assess the contribution of patient and physician characteristics and geography to receiving chemotherapy within 30 days of death. RESULTS Among 21,894 patients meeting eligibility criteria, 43.1% received chemotherapy within 30 days of death. In unadjusted bivariate analyses, female sex, Asian or black race, older age, and a greater number of comorbid diagnoses predicted lower likelihood of receiving chemotherapy at the end of life (P ≤.038 for all comparisons). Adjusting for patient and physician characteristics, physicians in small independent practices were substantially more likely than those employed in other practice models, particularly academic practices or nongovernment hospitals, to order chemotherapy for a patient in the last 30 days of life (P <.001 for all comparisons); female physicians were less likely than males to prescribe such treatment (P = .04). CONCLUSIONS Patients receiving care for aNSCLC in small independent oncology practices are more likely to receive chemotherapy in the last 30 days of life.
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Affiliation(s)
- Jonas B Green
- Cedars-Sinai Medical Care Foundation, Los Angeles, CA. E-mail:
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Dudovitz RN, Perez-Aguilar G, Kim G, Wong MD, Chung PJ. How Urban Youth Perceive Relationships Among School Environments, Social Networks, Self-Concept, and Substance Use. Acad Pediatr 2017; 17:161-167. [PMID: 28259338 PMCID: PMC5340077 DOI: 10.1016/j.acap.2016.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 04/08/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Studies suggest adolescent substance use aligns with academic and behavioral self-concept (whether teens think of themselves as good or bad students and as rule followers or rule breakers) as well as peer and adult social networks. Schools are an important context in which self-concept and social networks develop, but it remains unclear how school environments might be leveraged to promote healthy development and prevent substance use. We sought to describe how youth perceive the relationships among school environments, adolescent self-concept, social networks, and substance use. METHODS Semistructured interviews with 32 low-income minority youth (aged 17-22 years) who participated in a prior study, explored self-concept development, school environments, social networks, and substance use decisions. Recruitment was stratified by whether, during high school, they had healthy or unhealthy self-concept profiles and had engaged in or abstained from substance use. RESULTS Youth described feeling labeled by peers and teachers and how these labels became incorporated into their self-concept. Teachers who made students feel noticed (eg, by learning students' names) and had high academic expectations reinforced healthy self-concepts. Academic tracking, extracurricular activities, and school norms determined potential friendship networks, grouping students either with well-behaving or misbehaving peers. Youth described peer groups, combined with their self-concept, shaping their substance use decisions. Affirming healthy aspects of their self-concept at key risk behavior decision points helped youth avoid substance use in the face of peer pressure. CONCLUSIONS Youth narratives suggest school environments shape adolescent self-concept and adult and peer social networks, all of which impact substance use.
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Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics/Children's Discovery & Innovation Institute, University of California Los Angeles, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA 90095,David Geffen School of Medicine at UCLA, BOX 951720, 12-159 CHS Los Angeles, CA 90095-1720
| | - Giselle Perez-Aguilar
- Department of Pediatrics/Children's Discovery & Innovation Institute, University of California Los Angeles, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA 90095
| | - Grace Kim
- David Geffen School of Medicine at UCLA, BOX 951720, 12-159 CHS Los Angeles, CA 90095-1720
| | - Mitchell D. Wong
- Department of Internal Medicine, General Internal Medicine & Health Services Research, UCLA, 911 Broxton Ave., Ste 101, Los Angeles, CA 90024
| | - Paul J. Chung
- Department of Pediatrics/Children's Discovery & Innovation Institute, University of California Los Angeles, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA 90095,David Geffen School of Medicine at UCLA, BOX 951720, 12-159 CHS Los Angeles, CA 90095-1720, Department of Health Policy and Management, Fielding School of Public Health, UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA 90095, RAND, 1776 Main Street, Santa Monica, CA 90401-3208
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Dudovitz RN, Chung PJ, Wong MD. Teachers and Coaches in Adolescent Social Networks Are Associated With Healthier Self-Concept and Decreased Substance Use. J Sch Health 2017; 87:12-20. [PMID: 27917487 PMCID: PMC5415305 DOI: 10.1111/josh.12462] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 04/04/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Poor academic (eg, "I am a bad student") and behavioral (eg, "I am a troublemaker") self-concepts are strongly linked to adolescent substance use. Social networks likely influence self-concept. However, little is understood about the role teachers and athletic coaches play in shaping both academic and behavioral self-concepts. METHODS We analyzed cross-sectional surveys of 929 9th-12th grade low-income minority adolescents in Los Angeles assessing self-concept, social networks, and 30-day use of alcohol, marijuana and other drugs. We performed generalized estimating equations, accounting for clustering at the school level and controlling for family and peer influences and contextual factors. We also tested whether self-concept-mediated associations between relationships with teachers or coaches and 30-day substance use. RESULTS More perceived teacher support was associated with lower odds of marijuana and other drug use and better academic and behavioral self-concepts. Behavioral self-concept mediated the associations between teacher support and substance use. CONCLUSIONS By facilitating relationships with adults and improving teachers' capacity to build supportive environments, schools may positively shape how adolescents see themselves, which might help reduce adolescent substance use.
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Affiliation(s)
- Rebecca N Dudovitz
- Department of Pediatrics/Children's Discovery & Innovation Institute, University of California Los Angeles, 10833 Le Conte Ave., 12-358 CHS, Los Angeles, CA 90095
| | - Paul J Chung
- Department of Pediatrics/Children's Discovery & Innovation Institute, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, RAND, 10833 Le Conte Ave., 12-358 CHS, Los Angeles, CA 90095
| | - Mitchell D Wong
- Department of Internal Medicine-General Internal Medicine & Health Services Research, University of California Los Angeles, 911 Broxton Avenue, Los Angeles, CA 90024
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Guerrero LR, Dudovitz R, Chung PJ, Dosanjh KK, Wong MD. Grit: A Potential Protective Factor Against Substance Use and Other Risk Behaviors Among Latino Adolescents. Acad Pediatr 2016; 16:275-81. [PMID: 26796576 PMCID: PMC4821776 DOI: 10.1016/j.acap.2015.12.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/30/2015] [Accepted: 12/31/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Grit, defined as "working strenuously toward challenges, maintaining effort and interest over years despite failure, adversity, and plateaus in progress," is strongly associated with academic achievement and life success and may also be associated with health outcomes and behaviors. We examined predictors of grit, and the association between grit and health behaviors among at-risk Latino adolescents. METHODS We analyzed baseline survey data collected in 2013-2014 from a sample of 1270 9th graders in low-income neighborhoods of Los Angeles. We examined factors associated with grit and whether grit is associated with substance use and delinquent behaviors, controlling for adolescent and parent sociodemographic factors. RESULTS In a sample of mostly Latino adolescents (89.5%), compared to those with low grit, those with high grit had significantly lower odds of alcohol use in the last 30 days (odds ratio 0.30, P < .001), marijuana use (odds ratio 0.21, P < .05), and fighting (odds ratio 0.58, P < .05). Involvement in delinquent behavior was also lower (β = -0.71, P < .001). Factors associated with more grit included authoritative parenting style, parental employment, and high self-efficacy scores. CONCLUSIONS Grit may be an important candidate protective factor against substance use and other risk behaviors among Latino adolescents.
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Affiliation(s)
- Lourdes R. Guerrero
- Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine, UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA
| | - Paul J. Chung
- Department of Pediatrics, David Geffen School of Medicine, UCLA Children's Discovery & Innovation Institute, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA,The RAND Corporation, Santa Monica, CA,Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Kulwant K. Dosanjh
- Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
| | - Mitchell D. Wong
- Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA
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Wong MD, Guerrero L, Sallam T, Frank JS, Fogelman AM, Demer LL. Outcomes of a Novel Training Program for Physician-Scientists: Integrating Graduate Degree Training With Specialty Fellowship. J Grad Med Educ 2016; 8:85-90. [PMID: 26913109 PMCID: PMC4763397 DOI: 10.4300/jgme-d-15-00135.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although physician-scientists generally contribute to the scientific enterprise by providing a breadth of knowledge complementary to that of other scientists, it is a challenge to recruit, train, and retain physicians in a research career pathway. OBJECTIVE To assess the outcomes of a novel program that combines graduate coursework and research training with subspecialty fellowship. METHODS A retrospective analysis was conducted of career outcomes for 123 physicians who graduated from the program during its first 20 years (1993-2013). Using curricula vitae, direct contact, and online confirmation, data were compiled on physicians' subsequent activities and careers as of 2013. Study outcomes included employment in academic and nonacademic research, academic clinical or private practice positions, and research grant funding. RESULTS More than 80% of graduates were actively conducting research in academic, institutional, or industrial careers. The majority of graduates (71%) had academic appointments; a few (20%) were in private practice. Fifty percent had received career development awards, and 19% had received investigator-initiated National Institutes of Health (NIH) R01 or equivalent grants. Individuals who obtained a PhD during subspecialty training were significantly more likely to have major grant funding (NIH R series or equivalent) than those who obtained a Master of Science in Clinical Research. Trainees who obtained a PhD in a health services or health policy field were significantly more likely to have research appointments than those in basic science. CONCLUSIONS Incorporation of graduate degree research, at the level of specialty or subspecialty clinical training, is a promising approach to training and retaining physician-scientists.
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Affiliation(s)
| | | | | | | | | | - Linda L. Demer
- Corresponding author: Linda L. Demer, MD, PhD, University of California, Los Angeles, Department of Medicine, 10833 LeConte Avenue, Los Angeles, CA 90095-1679, 310.206.2677,
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Chatterjee A, Gillman MW, Wong MD. Chaos, Hubbub, and Order Scale and Health Risk Behaviors in Adolescents in Los Angeles. J Pediatr 2015; 167:1415-21. [PMID: 26394824 PMCID: PMC6023620 DOI: 10.1016/j.jpeds.2015.08.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/29/2015] [Accepted: 08/21/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the relationship between household chaos and substance use, sexual activity, and violence-related risk behaviors in adolescents. STUDY DESIGN We analyzed cross-sectional data among 929 high-school students in Los Angeles who completed a 90-minute interview that assessed health behaviors and household chaos with the 14-question Chaos, Hubbub, and Order Scale (CHAOS). Using the generalized estimating equation and adjusting for personal, parental, and family covariates, we examined associations of CHAOS score with substance use, sexual activity, and violent behavior outcome variables. We also examined the role of depression and school engagement as mediators. RESULTS Mean (SD) age of the 929 students was 16.4 (1.3) years, 516 (55%) were female, and 780 (84%) were Latino. After adjustment, compared with students with CHAOS score 0, those students with the greatest scores (5-14) had ORs of 3.1 (95% CI 1.1-8.7) for smoking, 2.6 (95% CI 1.6-4.4) for drinking, 6.1 (95% CI 1.8-21) for substance use at school, and 1.9 (95% CI 1.1-3.3) for fighting in the past 12 months. Associations between CHAOS score and sexual risk and other violent behaviors were not significant. Depression and school engagement attenuated the associations. CONCLUSIONS In this group of adolescents, greatest CHAOS score was associated with increased odds of risky health behaviors, with depression and school engagement as potential mediators. In the future, CHAOS score could be measured to assess risk for such behaviors or be a target for intervention to reduce chances of engaging in these behaviors.
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Affiliation(s)
- Avik Chatterjee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA.
| | - Matthew W Gillman
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA
| | - Mitchell D Wong
- Division of General Internal Medicine, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Gase LN, Kuo T, Coller K, Guerrero LR, Wong MD. Assessing the connection between health and education: identifying potential leverage points for public health to improve school attendance. Am J Public Health 2014; 104:e47-54. [PMID: 25033134 PMCID: PMC4143243 DOI: 10.2105/ajph.2014.301977] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined multiple variables influencing school truancy to identify potential leverage points to improve school attendance. METHODS A cross-sectional observational design was used to analyze inner-city data collected in Los Angeles County, California, during 2010 to 2011. We constructed an ordinal logistic regression model with cluster robust standard errors to examine the association between truancy and various covariates. RESULTS The sample was predominantly Hispanic (84.3%). Multivariable analysis revealed greater truancy among students (1) with mild (adjusted odds ratio [AOR] = 1.57; 95% confidence interval [CI] = 1.22, 2.01) and severe (AOR = 1.80; 95% CI = 1.04, 3.13) depression (referent: no depression), (2) whose parents were neglectful (AOR = 2.21; 95% CI = 1.21, 4.03) or indulgent (AOR = 1.71; 95% CI = 1.04, 2.82; referent: authoritative parents), (3) who perceived less support from classes, teachers, and other students regarding college preparation (AOR = 0.87; 95% CI = 0.81, 0.95), (4) who had low grade point averages (AOR = 2.34; 95% CI = 1.49, 4.38), and (5) who reported using alcohol (AOR = 3.47; 95% CI = 2.34, 5.14) or marijuana (AOR = 1.59; 95% CI = 1.06, 2.38) during the past month. CONCLUSIONS Study findings suggest depression, substance use, and parental engagement as potential leverage points for public health to intervene to improve school attendance.
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Affiliation(s)
- Lauren N Gase
- Lauren N. Gase is with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, and the Clinical and Translational Science Institute, University of California, Los Angeles. Tony Kuo is with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, and the Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles. Karen Coller, Lourdes R. Guerrero, and Mitchell D. Wong are with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
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Wong MD, Coller KM, Dudovitz RN, Kennedy DP, Buddin R, Shapiro MF, Kataoka SH, Brown AF, Tseng CH, Bergman P, Chung PJ. Successful schools and risky behaviors among low-income adolescents. Pediatrics 2014; 134:e389-96. [PMID: 25049339 PMCID: PMC4187228 DOI: 10.1542/peds.2013-3573] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We examined whether exposure to high-performing schools reduces the rates of risky health behaviors among low-income minority adolescents and whether this is due to better academic performance, peer influence, or other factors. METHODS By using a natural experimental study design, we used the random admissions lottery into high-performing public charter high schools in low-income Los Angeles neighborhoods to determine whether exposure to successful school environments leads to fewer risky (eg, alcohol, tobacco, drug use, unprotected sex) and very risky health behaviors (e.g., binge drinking, substance use at school, risky sex, gang participation). We surveyed 521 ninth- through twelfth-grade students who were offered admission through a random lottery (intervention group) and 409 students who were not offered admission (control group) about their health behaviors and obtained their state-standardized test scores. RESULTS The intervention and control groups had similar demographic characteristics and eighth-grade test scores. Being offered admission to a high-performing school (intervention effect) led to improved math (P < .001) and English (P = .04) standard test scores, greater school retention (91% vs. 76%; P < .001), and lower rates of engaging in ≥1 very risky behaviors (odds ratio = 0.73, P < .05) but no difference in risky behaviors, such as any recent use of alcohol, tobacco, or drugs. School retention and test scores explained 58.0% and 16.2% of the intervention effect on engagement in very risky behaviors, respectively. CONCLUSIONS Increasing performance of public schools in low-income communities may be a powerful mechanism to decrease very risky health behaviors among low-income adolescents and to decrease health disparities across the life span.
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Affiliation(s)
- Mitchell D. Wong
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Karen M. Coller
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Rebecca N. Dudovitz
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | | | | | - Martin F. Shapiro
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Sheryl H. Kataoka
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Arleen F. Brown
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Chi-Hong Tseng
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Peter Bergman
- Teachers College, Columbia University, New York, New York
| | - Paul J. Chung
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
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Bharmal N, Kaplan RM, Shapiro MF, Kagawa-Singer M, Wong MD, Mangione CM, Divan H, McCarthy WJ. The association of religiosity with overweight/obese body mass index among Asian Indian immigrants in California. Prev Med 2013; 57:315-21. [PMID: 23769898 DOI: 10.1016/j.ypmed.2013.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/31/2013] [Accepted: 06/02/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association between religiosity and overweight or obese body mass index among a multi-religious group of Asian Indian immigrants residing in California. METHODS We examined cross-sectional survey data obtained from in-language telephone interviews with 3228 mostly immigrant Asian Indians in the 2004 California Asian Indian Tobacco Survey using multivariate logistic regression. RESULTS High self-identified religiosity was significantly associated with higher BMI after adjusting for socio-demographic and acculturation measures. Highly religious Asian Indians had 1.53 greater odds (95% CI: 1.18, 2.00) of being overweight or obese than low religiosity immigrants, though this varied by religious affiliation. Religiosity was associated with greater odds of being overweight/obese for Hindus (OR 1.54; 95% CI: 1.08, 2.22) and Sikhs (OR 1.88; 95% CI: 1.07, 3.30), but not for Muslims (OR 0.69; 95% CI: 0.28, 1.70). CONCLUSIONS Religiosity in Hindus and Sikhs, but not immigrant Muslims, appears to be independently associated with greater body mass index among Asian Indians. If this finding is confirmed, future research should identify potentially mutable mechanisms by which religion-specific religiosity affects overweight/obesity risk.
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Affiliation(s)
- Nazleen Bharmal
- Department of Medicine, General Internal Medicine & Health Services Research, University of California, Los Angeles, CA, USA.
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Abstract
OBJECTIVE To explore state patterns in the racial life expectancy gap. DATA SOURCES The 1997-2004 Multiple Cause of Death PUF, 2000 U.S. Census. STUDY DESIGN We calculated life expectancy at birth for black and white men and women. DATA EXTRACTION METHODS Data were obtained by the NCHS and U.S. Census Bureau. PRINCIPAL FINDINGS States with small racial differences are due to higher-than-expected life expectancy for blacks or lower-than-expected for whites. States with large disparity are explained by higher-than-average life expectancy among whites or lower-than-average life expectancy among blacks. CONCLUSIONS Heterogeneous state patterns in racial disparity in life expectancy exist. Eliminating disparity in states with large black populations would make the greatest impact nationally.
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Affiliation(s)
- Nazleen Bharmal
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, AHA/PRT-Spina Outcomes Center at UCLA710 Westwood Plaza, C109 RNRC, Los Angeles, CA 90095-1796
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of MedicineLos Angeles, CA
| | - Robert Kaplan
- Office of Behavioral and Social Sciences Research, National Institutes of HealthBethesda, MD
| | - Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of MedicineLos Angeles, CA
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Rickard DG, Dudovitz RN, Wong MD, Jen HC, Osborn RD, Fernandez HE, Donkor CI. Closing the gap between insecticide treated net ownership and use for the prevention of malaria. Prog Community Health Partnersh 2011; 5:123-31. [PMID: 21623014 DOI: 10.1353/cpr.2011.0018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Malaria is the leading cause of morbidity and mortality in children younger than 5 years old and pregnant women in sub-Saharan Africa. Insecticide-treated nets (ITNs) reduce clinical malaria by more than 50% and all cause mortality in young children by 15% to 30%. However, use of these nets is poor across sub-Saharan Africa, limiting the potential impact of this effective tool in the fight against malaria. OBJECTIVE We sought to improve the use of ITNs using a community-created and -implemented approach, and measure the change in ITN use over the year after implementation. METHODS Using a community-based participatory research approach, we created and implemented an intervention to improve ITN use in a rural village. Our intervention involved providing hands-on instructions and assistance in hanging of nets, in-home small group education, and monthly follow-up by trained community members. ITN use was measured for all individuals in a subset of the community (61 households, 759 individuals) at baseline and at 6 months and 1 year after distribution. RESULTS Rates of individual usage increased significantly from 29% at baseline to 88.7% (p < .001) at 6 months and to 96.6% (p < .001) at 12 months. For children under age 5, usage rates increased from 46% at baseline to 95.7% (p < .001) at 6 months and 95.4% (p < .001) at 12 months. CONCLUSION Our study demonstrates that rapidly achieving and sustaining almost universal ITN usage rates is possible using a community-based approach. Closing the gap between ITN ownership and use will help communities to realize the full potential of ITNs in the prevention of malaria.
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Affiliation(s)
- Diana G Rickard
- Department of Health Services, University of California Los Angeles, USA
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Rickard DG, Dudovitz RN, Wong MD, Jen HC, Osborn RD, Fernandez HE, Donkor CI. Closing the Gap Between Insecticide Treated Net Ownership and Use for the Prevention of Malaria. Prog Community Health Partnersh 2011. [DOI: 10.1353/cpr.2011.0014] [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: 11/11/2022]
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Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med 2009; 24:1101-8. [PMID: 19653047 PMCID: PMC2762503 DOI: 10.1007/s11606-009-1068-8] [Citation(s) in RCA: 253] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Revised: 10/30/2008] [Accepted: 07/06/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care. OBJECTIVES To estimate the association between HIV stigma and: self-reported access to care, regular source of HIV care, and antiretroviral therapy adherence; and to test whether mental health mediates these associations. DESIGN Cross-sectional study. PARTICIPANTS 202 PLHA living in Los Angeles County in 2007. MEASUREMENTS Participants completed an anonymous survey, assessing internalized HIV stigma (28-items, alpha = 0.93), self-reported access to medical care (six items, alpha = 0.75), regular source of HIV care, and antiretroviral therapy (ART) adherence. RESULTS One-third of participants reported high levels of stigma; 77% reported poor access to care; 42.5% reported suboptimal ART adherence; and 10.5% reported no regular source of HIV care. In unadjusted analysis, those reporting a high level of stigma were more likely to report poor access to care (OR = 4.97, 95% CI 2.54-9.72), regular source of HIV care (OR = 2.48, 95% CI 1.00-6.19), and ART adherence (OR = 2.45, 95% CI 1.23-4.91). In adjusted analyses, stigma was significantly associated with poor access to care (OR = 4.42, 95% CI 1.88-10.37), but not regular source of HIV care or ART adherence. Mental health mediated the relationship between stigma and ART adherence, but not poor access to care or regular source of HIV care. CONCLUSIONS The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and its mediators.
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Affiliation(s)
- Jennifer N Sayles
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California-Los Angeles, 911 Broxton Ave., Los Angeles, CA 90024, USA.
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Wong MD, Ettner SL, Boscardin WJ, Shapiro MF. The contribution of cancer incidence, stage at diagnosis and survival to racial differences in years of life expectancy. J Gen Intern Med 2009; 24:475-81. [PMID: 19189193 PMCID: PMC2659154 DOI: 10.1007/s11606-009-0912-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 12/17/2008] [Accepted: 12/30/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND African Americans have higher cancer mortality rates than whites. Understanding the relative contribution of cancer incidence, stage at diagnosis and survival after diagnosis to the racial gap in life expectancy has important implications for directing future health disparity interventions toward cancer prevention, screening and treatment. OBJECTIVE We estimated the degree to which higher cancer mortality among African Americans is due to higher incidence rates, later stage at diagnosis or worse survival after diagnosis. DESIGN Stochastic model of cancer incidence and survival after diagnosis. PATIENTS Surveillance and Epidemiology End Result cancer registry and National Health Interview Survey data. MEASUREMENTS Life expectancy if African Americans had the same cancer incidence, stage and survival after diagnosis as white adults. RESULTS African-American men and women live 1.47 and 0.91 fewer years, respectively, than whites as the result of all cancers combined. Among men, racial differences in cancer incidence, stage at diagnosis and survival after diagnosis account for 1.12 (95% CI: 0.52 to 1.36), 0.17 (95% CI: -0.03 to 0.33) and 0.21 (95% CI: 0.05 to 0.34) years of the racial gap in life expectancy, respectively. Among women, incidence, stage and survival after diagnosis account for 0.41 (95% CI: -0.29 to 0.60), 0.26 (95% CI: -0.06 to 0.40) and 0.31 (95% CI: 0.05 to 0.40) years, respectively. Differences in stage had a smaller impact on the life expectancy gap compared with the impact of incidence. Differences in cancer survival after diagnosis had a significant impact for only two cancers-breast (0.14 years; 95% CI: 0.05 to 0.16) and prostate (0.05 years; 95% CI 0.01 to 0.09). CONCLUSIONS In addition to breast and colorectal cancer screening, national efforts to reduce disparities in life expectancy should also target cancer prevention, perhaps through smoking cessation, and differences in survival after diagnosis among persons with breast and prostate cancer.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA 90024, USA.
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Hsiao AF, Wong MD, Miller MF, Ambs AH, Goldstein MS, Smith A, Ballard-Barbash R, Becerra LS, Cheng EM, Wenger NS. Role of religiosity and spirituality in complementary and alternative medicine use among cancer survivors in California. Integr Cancer Ther 2009; 7:139-46. [PMID: 18815145 DOI: 10.1177/1534735408322847] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Cancer survivors often turn to religion, spirituality, and complementary and alternative medicine (CAM) because they perceive these areas as being more holistic and patient-centered than conventional medicine. Because increased religiosity and spirituality have been found to be associated with higher CAM use in the general population, it was hypothesized that these factors would be important predictors of CAM use in cancer survivors. DESIGN AND SUBJECTS The study included a subsample of 1844 people with cancer or a history of cancer from the 2003 California Health Interview Survey of CAM, a cross-sectional survey of a population-based sample of adults in California. Prevalence and predictors of religious/spiritual forms of CAM (R/S CAM) and nonreligious/nonspiritual forms of CAM (non-R/S CAM) were compared. Multivariate logistic regression was used to identify the predictors of R/S CAM and non-R/S CAM. RESULTS Nearly two thirds of participants reported using at least 1 type of R/S CAM, and 85% reported ever using non-R/S CAM. The majority of cancer survivors reported that they were very/moderately religious or spiritual. Both religiosity and spirituality were strongly related to non-R/S CAM use, but in opposite directions. Very or moderately religious cancer survivors were less likely (odds ratio=0.30; 95% confidence interval, 0.12-0.40) than nonreligious cancer survivors to use non-R/S CAM. In contrast, very or moderately spiritual cancer survivors were more likely (odds ratio=2.42; 95% confidence interval, 1.16-6.02) than nonspiritual cancer survivors to use non-R/S CAM. CONCLUSIONS The use of R/S CAM and non-R/S CAM is very high in cancer survivors. It may be helpful for clinicians to ascertain their patients' use of these types of CAM to integrate all forms of care used to managing their cancer.
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Affiliation(s)
- An-Fu Hsiao
- VA Long Beach Healthcare System, Long Beach, California 90822, USA.
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Sohler NL, Wong MD, Cunningham WE, Cabral H, Drainoni ML, Cunningham CO. Type and pattern of illicit drug use and access to health care services for HIV-infected people. AIDS Patient Care STDS 2007; 21 Suppl 1:S68-76. [PMID: 17563292 DOI: 10.1089/apc.2007.9985] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Approximately 28% of HIV-infected people in treatment in the United States report using illicit drugs. Illicit drug users have poorer course of HIV disease than non-drug users, which is thought to be due to their irregular use of HIV medical services. We examined associations between type (cocaine versus opioids) and pattern of drug use (drug use at baseline, 6-month follow-up, both periods, and nonuse) and health care utilization for a large sample of HIV-infected individuals drawn from a multisite project that evaluated the impact of medical outreach interventions for populations at risk of poor retention in HIV care. Across all types and patterns of drug use, drug users were more likely to have suboptimal ambulatory care, miss scheduled appointments, use the emergency department, have unmet support services needs, and were less likely to take antiretroviral medications. Additionally, while people who started using drugs during the follow-up period and consistently used drugs across both periods differed from nonusers on missed appointments (odds ratio [OR] = 2.20 for starters versus nonusers, OR = 2.92 for consistent users versus nonusers), emergency department use (OR = 4.93 for starters versus nonusers, OR = 2.24 for consistent users versus nonusers), and antiretroviral medication use at follow-up (OR = 0.23 starters versus nonusers, OR = 0.19 for consistent users versus nonusers), those who stopped using drugs after the baseline period did not differ from nonusers. We conclude that health care utilization is poorer for people who use illicit drugs than those who do not, and stopping drug use may facilitate improvements in health care utilization and HIV outcomes for this population.
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Affiliation(s)
- Nancy L Sohler
- Sophie Davis School of Biomedical Education, City College of New York, New York, New York 10031, USA.
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Wong MD, Sarkisian CA, Davis C, Kinsler J, Cunningham WE. The association between life chaos, health care use, and health status among HIV-infected persons. J Gen Intern Med 2007; 22:1286-91. [PMID: 17597350 PMCID: PMC2219764 DOI: 10.1007/s11606-007-0265-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 05/31/2007] [Accepted: 06/12/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Whether having a stable and predictable lifestyle is associated with health care use and health status among HIV patients is unknown. OBJECTIVE To develop and test the reliability and validity of a measure of life chaos for adults with HIV and examine its association with health care use and health status. DESIGN Prospective cohort study. PARTICIPANTS Two hundred twenty HIV-infected persons recruited from those who tested positive in a mobile testing van and from HIV clinics serving low-income populations. MEASUREMENTS Participants completed a survey every 6 months, assessing their health care use, SF-12 mental and physical health status and life chaos. RESULTS Cronbach's alpha for the six-item measure of chaos was .67. Those without a spouse or partner and those with one or more unmet social service needs, such as housing or transportation, had higher chaos scores. Compared to those with less chaos, those with more chaos were less likely to have two or more outpatient visits (adjusted odds ratio [OR] 0.48, 95% confidence interval [CI]: 0.24-0.98), more likely to have two or more missed visits (adjusted OR 2.30, 95%CI: 1.20-4.41) in the 6 months before study enrollment and had lower mental health status at enrollment and at follow-up. Life chaos was not associated with emergency department visits or physical health status. CONCLUSIONS We created a new measure of life chaos, which was associated with outpatient visits and mental health status. Chaos may be an important barrier to regular medical care. Future studies need to test this measure in more diverse populations and those with other diseases.
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Affiliation(s)
- Mitchell D Wong
- UCLA Division of General Internal Medicine and Health Services Research, University of California, 911 Broxton Avenue, Suite 101, Los Angeles, CA 90024, USA.
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Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDS 2007; 21:584-92. [PMID: 17711383 DOI: 10.1089/apc.2006.0202] [Citation(s) in RCA: 228] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Perceived stigma in clinical settings may discourage HIV-infected individuals from accessing needed health care services. Having good access to care is imperative for maintaining the health, well being, and quality of life of persons living with HIV/AIDS (PLWHAs). The purpose of this prospective study, which took place from January 2004 through June 2006, was to evaluate the relationship between perceived stigma from a health care provider and access to care among 223 low income, HIV-infected individuals in Los Angeles County. Approximately one fourth of the sample reported perceived stigma from a health care provider at baseline, and about one fifth reported provider stigma at follow up. We also found that access to care among this population was low, as more than half of the respondents reported difficulty accessing care at baseline and follow up. Perceived stigma was found to be associated with low access to care both at baseline (odds ratio [OR] = 3.29; 95% confidence interval [CI] = 1.55, 7.01) and 6-month follow up (2.85; 95% CI = 1.06, 7.65), even after controlling for sociodemographic characteristics and most recent CD4 count. These findings are of particular importance because lack of access or delayed access to care may result in clinical presentation at more advanced stages of HIV disease. Interventions are needed to reduce perceived stigma in the health care setting. Educational programs and modeling of nonstigmatizing behavior can teach health care providers to provide unbiased care.
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Affiliation(s)
- Janni J Kinsler
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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Beran MS, Cunningham W, Landon BE, Wilson IB, Wong MD. Clinician gender is more important than gender concordance in quality of HIV care. ACTA ACUST UNITED AC 2007; 4:72-84. [PMID: 17584629 DOI: 10.1016/s1550-8579(07)80010-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have examined the impact of physician gender and gender concordance on preventive care, satisfaction, and communication. Less is known about how physician gender and gender concordance affect care for chronic illnesses, including HIV. OBJECTIVE This study sought to determine whether patient-clinician gender concordance (patient and clinician are of the same gender) influences receipt of protease inhibitor (PI) therapy and ratings of care among HIV-infected patients. METHODS We reviewed data from 1860 patients and 397 clinicians in the HIV Cost and Services Utilization Study, a nationally representative the association between gender concordance and time to first PI use, and multivariable logistic regression was utilized to examine the association of gender concordance with patients' problems with care and their overall rating of care. RESULTS Patients who had a male clinician received PIs earlier than those who had a female clinician (adjusted time ratio = 0.69 for having a male vs having a female clinician; P <or= 0.01). Gender concordance was not a significant predictor of time to PI use. Gender discordance was associated with problems with feeling respected by clinicians. Female patients with a male clinician were most likely, and female patients with female clinicians were least likely, to report a problem with being treated with respect (P <or= 0.01 for the interaction term). Gender discordance was not associated with other problems with care or with overall ratings of care. CONCLUSIONS Gender discordance was associated with perceived problems of being treated with respect by clinicians, but not with time to receipt of PIs, overall ratings of care, coordination of care, or obtaining information. The perception of not being respected may represent a significant barrier to care that is particularly worse for women, in that most HIV-infected women receive their care from male clinicians.
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Affiliation(s)
- Mary Sue Beran
- Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, Los Angeles, California, USA.
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Abstract
GOAL The purpose of this study was to examine time trends of failure to return for HIV test results among a mobile van population in Los Angeles. STUDY DESIGN This study examined administrative records from 9340 patients of the Mobile HIV Testing van between January 1997 and December 2004. RESULTS Between 1997 and 2004, a worsening trend was found in the percentage of clients who failed to return for HIV test results. Multivariate analyses showed that the adjusted odds of returning for test results significantly increased relative to 1997, the first year tested. The odds of returning for test results ranged from 1.56 (95% CI = 1.21, 2.00) in 1998 to 2.46 (95% CI = 1.89, 3.19) in 2004. CONCLUSION The proportion of MoHOP clients failing to return for test results was high and increased substantially between 1997 and 2004. Given the importance of identifying HIV-infected persons, understanding ways to improve return rates for test results is critical, especially for public health officials, clinicians, and researchers implementing and evaluating HIV prevention strategies.
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Affiliation(s)
- Janni J Kinsler
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California, Los Angeles, California, USA.
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Tobias CR, Cunningham W, Cabral HD, Cunningham CO, Eldred L, Naar-King S, Bradford J, Sohler NL, Wong MD, Drainoni ML. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDS 2007; 21:426-34. [PMID: 17594252 DOI: 10.1089/apc.2006.0138] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This cross-sectional study examined factors associated with the receipt of HIV medical care among people who know their HIV status and are not newly diagnosed with HIV. Interviews were conducted with 1133 HIV-positive individuals between October 2003 and July 2005 who enrolled in 1 of 10 outreach programs across the country. The sample was predominantly non-white (86%), male (59%), and unstably housed (61%), with a past history of cocaine use (68%). Twelve percent had received no HIV medical care in the 6 months prior to the interview. Those with no care were similar to those who received some HIV care in sociodemographic characteristics, but in multivariate analysis were less likely to have a case manager (p < 0.001) or use mental health services (p < .001), had lower mental health status scores (p < 0.05), were more likely to be active drug users (p < 0.01), had greater unmet support service needs (p < 0.05) and reported that health beliefs were a barrier to care (p < 0.001). Interventions to engage people in HIV medical care need to address barriers to care through linkages with mental health, substance abuse treatment and support services, and address the health beliefs that deter people from seeking care.
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Affiliation(s)
- Carol R Tobias
- Boston University School of Public Health, Boston, Massachusetts
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Hsiao AF, Wong MD, Goldstein MS, Becerra LS, Cheng EM, Wenger NS. Complementary and alternative medicine use among Asian-American subgroups: prevalence, predictors, and lack of relationship to acculturation and access to conventional health care. J Altern Complement Med 2007; 12:1003-10. [PMID: 17212572 DOI: 10.1089/acm.2006.12.1003] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Acculturation and access to conventional health care have been found to be predictors of complementary and alternative medicine (CAM) use in the general population. We hypothesized that these factors would be predictors of CAM use in Asian-American subgroups. Because of differences in health and cultural beliefs, we also hypothesized that patterns and predictors of CAM use would vary among Asian-American subgroups. METHODS Cross-sectional survey of a sample of 9187 adults representative of the California population. RESULTS Nearly three quarters of Asian-Americans used at least one type of CAM in the past 12 months, which was significantly higher than the national prevalence rate. Chinese Americans had the highest prevalence of any CAM use, whereas South Asians had the lowest prevalence (86% vs. 67%, respectively). Acculturation and access to conventional medical care was unrelated to any CAM use for most Asian-American subgroups. Spirituality was the strongest predictor of any CAM use for most Asian-American subgroups. CONCLUSIONS CAM use varies across Asian-American subgroups. Acculturation and access to conventional medical care is unrelated to any CAM use for most Asian-American subgroups.
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Affiliation(s)
- An-Fu Hsiao
- Center for Health Policy Research, University of California, Irvine, CA 92697-5800, USA.
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Cunningham CO, Sohler NL, Wong MD, Relf M, Cunningham WE, Drainoni ML, Bradford J, Pounds MB, Cabral HD. Utilization of health care services in hard-to-reach marginalized HIV-infected individuals. AIDS Patient Care STDS 2007; 21:177-86. [PMID: 17428185 DOI: 10.1089/apc.2006.103] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
To benefit from HIV treatment advances individuals must utilize ambulatory primary care services. Few studies focus on marginalized populations, which tend to have poor health care utilization patterns. This study examined factors associated with health care utilization in hard-to-reach marginalized HIV-infected individuals. As part of a multisite initiative evaluating outreach programs that target underserved HIV-infected individuals, 610 participants were interviewed about their HIV disease, health services utilization, substance use, mental health, and case management. Primary outcomes included ambulatory, emergency department, and inpatient visits. Generalized estimating equations were used in logistic regression analyses. On regression analyses ambulatory visits were associated with having insurance (adjusted odds ratio [AOR] = 2.46), mental health medications (AOR = 7.46), and case management (AOR = 4.81). Emergency department visits were associated with having insurance (AOR = 1.74), homelessness (AOR = 2.23), poor health status (AOR = 2.02), length of HIV infection (AOR = 2.02), mental health care (AOR = 1.47), mental health medications (AOR = 1.59), and heavy alcohol intake (AOR = 1.46). Hospitalizations were associated with high school education (AOR = 1.57), having insurance (AOR = 10.45), homelessness (AOR = 2.18), poor health status (AOR = 2.64), length of HIV infection (AOR = 2.03), and mental health medications (AOR = 1.87). In hard-to-reach marginalized HIV-infected individuals, having insurance, case management and mental health care were associated with increased ambulatory visits. These findings support HIV multidisciplinary care with marginalized populations. Understanding factors associated with health care utilization is essential for outreach programs to facilitate engagement in HIV care.
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Affiliation(s)
- Chinazo O Cunningham
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Wong MD, Chung AK, Boscardin WJ, Li M, Hsieh HJ, Ettner SL, Shapiro MF. The contribution of specific causes of death to sex differences in mortality. Public Health Rep 2007; 121:746-54. [PMID: 17278410 PMCID: PMC1781916 DOI: 10.1177/003335490612100615] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Men have higher mortality rates than women for most causes of death. This study was conducted to determine the contribution of specific causes of death to the sex difference in years of potential life lost (YPLL). METHODS The authors examined data from the National Health Interview Survey with linked mortality data through 1997. Using survival analysis estimates, a stochastic simulation model to simulate death events for cohorts of white, African American, and Latino adults was created. RESULTS YPLL from all causes were greater among men than women. Homicide, motor vehicle accidents, and suicide accounted for 33% of YPLL sex difference among whites, 36% among African Americans, and 52% among Latinos. For all three racial/ethnic groups, cardiovascular disease (principally ischemic heart disease) was the second largest contributor to the sex difference in YPLL (29% among whites, 23% among African Americans, and 25% among Latinos). Lung cancer was also important among whites and African Americans, accounting for 15% and 17% of the sex difference in YPLL from all causes, respectively. CONCLUSIONS Ischemic heart disease, lung cancer, and traumatic deaths account for as much as three-quarters of the excess YPLL among men, suggesting that a few modifiable behaviors such as the use of tobacco, alcohol.
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Affiliation(s)
- Mitchell D Wong
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, 911 Broxton Ave., Ste. 101, Los Angeles, CA 90024, USA.
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Cunningham WE, Sohler NL, Tobias C, Drainoni ML, Bradford J, Davis C, Cabral HJ, Cunningham CO, Eldred L, Wong MD. Health services utilization for people with HIV infection: comparison of a population targeted for outreach with the U.S. population in care. Med Care 2006; 44:1038-47. [PMID: 17063136 DOI: 10.1097/01.mlr.0000242942.17968.69] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services. OBJECTIVE This study compared the sociodemographic, clinical, and health care utilization characteristics of a multisite sample of HIV-positive persons who were hard to reach with a nationally representative cohort of persons with HIV infection who were receiving care from known HIV providers in the United States and examined whether the independent correlates of low ambulatory utilization differed between the 2 samples. METHODS We compared sociodemographic, clinical, and health care utilization characteristics in 2 samples of adults with HIV infection: 1286 persons from 16 sites across the United States interviewed in 2001-2002 for the Targeted HIV Outreach and Intervention Initiative (Outreach), a study of underserved persons targeted for supportive outreach services; and 2267 persons from the HIV Costs and Services Utilization Study (HCSUS), a probability sample of persons receiving care who were interviewed in 1998. We conducted logistic regression analyses to identify differences between the 2 samples in sociodemographic and clinical associations with ambulatory medical visits. RESULTS Compared with the HCSUS sample, the Outreach sample had notably greater proportions of black respondents (59% vs. 32%, P = 0.0001), Hispanics (20% vs. 16%), Spanish-speakers (9% vs. 2%, P = 0.02), those with low socioeconomic status (annual income < Dollars 10,000 75% vs. 45%, P = 0.0001), the unemployed, and persons with homelessness, no insurance, and heroin or cocaine use (58% vs. 47%, P = 0.05). They also were more likely to have fewer than 2 ambulatory visits (26% vs. 16%, P = 0.0001), more likely to have emergency room visits or hospitalizations in the prior 6 months, and less likely to be on antiretroviral treatment (82% vs. 58%, P = 0.0001). Nearly all these differences persisted after stratifying for level of ambulatory utilization (fewer than 2 vs. 2 or more in the last 6 months). In multivariate analysis, several variables showed significantly different associations in the 2 samples (interacted) with low ambulatory care utilization. The variables with significant interactions (P values for interaction shown below) had very different adjusted odds ratios (and 95% confidence intervals) for low ambulatory care utilization: age greater than 50 (Outreach 0.55 [0.35-0.88], HCSUS 1.17 [0.65-2.11)], P = 0.05), Hispanic ethnicity (Outreach 0.81 [0.39-1.69], HCSUS 2.34 [1.56-3.52], P = 0.02), low income (Outreach 0.73 [0.56-0.96], HCSUS 1.35 [1.04-1.75], P = 0.002), and heavy alcohol use (Outreach 1.74 [1.23-2.45], HCSUS 1.00 [0.73-1.37], P = 0.02). Having CD4 count less than 50 was associated with elevated odds of low ambulatory medical visits in the Outreach sample (1.53 [1.00-2.36], P = 0.05). CONCLUSIONS Compared with HCSUS, the Outreach sample had far greater proportions of traditionally vulnerable groups, and were less likely to be in care if they had low CD4 counts. Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations.
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Affiliation(s)
- William E Cunningham
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, Los Angeles, California 90095, USA.
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Sayles JN, Pettifor A, Wong MD, MacPhail C, Lee SJ, Hendriksen E, Rees HV, Coates T. Factors associated with self-efficacy for condom use and sexual negotiation among South african youth. J Acquir Immune Defic Syndr 2006; 43:226-33. [PMID: 16951647 PMCID: PMC2819666 DOI: 10.1097/01.qai.0000230527.17459.5c] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To use logistic regression modeling to identify factors associated with high self-efficacy for sexual negotiation and condom use in a sample of South African youth. METHODS The Reproductive Health and HIV Research Unit (RHRU) National Youth Survey examined a nationally representative sample of 7409 sexually active South African youth aged 15 to 24 years. We used logistic regression modeling in this sample to identify factors associated with the main outcome of high self-efficacy. RESULTS Among female respondents (n = 3890), factors associated with high self-efficacy in the adjusted model were knowing how to avoid HIV (odds ratio [OR] = 2.30, 95% confidence interval [CI]: 1.05 to 5.00), having spoken with someone other than a parent or guardian about HIV/AIDS (OR = 1.46, 95% CI: 1.01 to 2.10), and having life goals (OR = 1.28, 95% CI: 1.10 to 1.48). Not using condoms during their first sexual encounter (OR = 0.61, 95% CI: 0.50 to 0.76), a history of unwanted sex (OR = 0.66, 95% CI: 0.51 to 0.86), and believing that condom use implies distrust in one's partner (OR = 0.57, 95% CI: 0.51 to 0.86) were factors associated with low self-efficacy among female respondents. Male respondents (n = 3519) with high self-efficacy were more likely to take HIV seriously (OR = 4.03, 95% CI: 1.55 to 10.52), to believe they are not at risk for HIV (OR = 1.38, 95% CI: 1.12 to 1.70), to report that getting condoms is easy (OR = 1.85, 95% CI: 1.23 to 2.77), and to have life goals (OR = 1.30, 95% CI: 1.10 to 1.54). Not using condoms during their first sexual experience (OR = 0.51, 95% CI: 0.39 to 0.67), a history of having unwanted sex (OR = 0.47, 95% CI: 0.34 to 0.64), believing condom use is a sign of not trusting one's partner (OR = 0.63, 95% CI: 0.46 to 0.87), and refusing to be friends with HIV-infected persons (OR = 0.52, 95% CI: 0.32 to 0.85) were factors associated with low self-efficacy among male respondents in the fully adjusted model. CONCLUSIONS We used the social cognitive model (SCM) to identify factors associated with self-efficacy for condom use and sexual negotiation. Many of these factors are modifiable and suggest potential ways to improve self-efficacy and reduce HIV sexual risk behavior in South African youth.
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Affiliation(s)
- Jennifer N Sayles
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1736, USA.
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Hsiao AF, Wong MD, Goldstein MS, Yu HJ, Andersen RM, Brown ER, Becerra LM, Wenger NS. Variation in complementary and alternative medicine (CAM) use across racial/ethnic groups and the development of ethnic-specific measures of CAM use. J Altern Complement Med 2006; 12:281-90. [PMID: 16646727 DOI: 10.1089/acm.2006.12.281] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The use of complementary and alternative medicine (CAM) is likely to vary among racial/ethnic groups because its use is related to cultural and health beliefs. Understanding patterns of CAM use among ethnic groups could inform clinical practice and the study of CAM use in a diverse population. The authors compared CAM use among Asian-Americans, American Indians, African Americans, Latinos, whites, and other racial/ethnic groups in order to develop ethnic-specific measures of CAM use and explore factors associated with such CAM use across ethnic groups. DESIGN A cross-sectional survey of a sample of 9187 adults representative of the California population was performed. OUTCOME MEASURES Ethnic-specific constructs for Asian-Americans, American Indians, African Americans, Latinos, and whites were devised. RESULTS The authors identified ethnic-specific CAM modalities for each ethnic group. Demographic and clinical factors associated with use of ethnic-specific CAM differed from the predictors of overall CAM use in the general population and varied by ethnicity. CONCLUSIONS Patterns of CAM use and ethnic-specific CAM use vary across racial/ethnic groups. Evaluation of CAM use in ethnically diverse populations should recognize ethnic-specific modalities and variation across ethnicity.
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Affiliation(s)
- An-Fu Hsiao
- UCI Center for Health Policy Research, Irvine, CA 92697-5800, USA.
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Abstract
Although racial segregation is associated with health status, few studies have examined this relationship among Latinos. We examined the effect of race/ethnic group concentration of Latinos, blacks and whites on all-cause mortality rates within a highly segregated metropolitan area, New York City (NYC). We linked NYC mortality records from 1999 and 2000 with the 2000 U.S. Census data by zip code area. Age-adjusted mortality rates by race/ethnic concentration were calculated. Linear regression was used to determine the association between population characteristics and mortality. Blacks living in predominantly black areas had lower all-cause mortality rates than blacks living in other areas regardless of gender (1616/100,000 vs. 2014/100,000 for men; 1032/100,000 vs. 1362/100,000 for women). Amongst whites, those living in predominantly white areas had the lowest mortality rates. Latinos living in predominantly Latino areas had lower mortality rates than those in predominantly black areas (1187/100,000 vs.1950/100,000 for men; 760/100,000 vs. 779/100,000 for women). After adjustment for socioeconomic conditions, whites, older blacks, and young Latino men experienced decreasing mortality rates when living in areas with increasing similar race/ethnic concentrations. Increasing residential concentration of blacks is independently associated with lower mortality in older blacks; similarly, increasing residential concentration of Latinos and whites is associated with lower mortality in young Latino men and whites, respectively.
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Affiliation(s)
- Sanae Inagami
- Veterans Affairs, VA Greater Los Angeles Health Care System, Division of General Internal Medicine (111G), 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
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48
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Sayles JN, Wong MD, Cunningham WE. The Inability to Take Medications Openly at Home: Does It Help Explain Gender Disparities in HAART Use? J Womens Health (Larchmt) 2006; 15:173-81. [PMID: 16536681 DOI: 10.1089/jwh.2006.15.173] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Previous studies have shown that HIV-positive women underuse highly active antiretroviral therapy (HAART), but the reasons for this gender disparity are not completely understood. We examined whether one reason for this disparity is that women are less likely to use HAART when they have difficulty taking HIV medications openly at home. METHODS This was a prospective cohort study of a national probability sample of 2864 adults receiving HIV care. RESULTS Among the 1910 people who participated in the follow-up survey and reported taking HIV medications, 11.8% reported they could not take HIV medications openly at home. Those who reported they had difficulty taking medications openly at home were more likely to be women, to be black, to live in the northeast United States, to have an annual income <5,000 US dollars, and to have no health insurance. In bivariate analysis, women had twice the odds of reporting difficulty taking medications openly (odds ratio [OR] 2.07, 95% confidence interval [CI] 1.36-3.15) compared with gay/bisexual men, although this gender difference was no longer significant in the adjusted model. For women, having difficulty taking medications openly at home was associated with a substantial decrease in the probability of being on HAART in the adjusted model (0.59, 95% CI 0.47-0.70 vs. 0.78, 95% CI 0.74-0.83), whereas no significant differences were observed for heterosexual or gay/bisexual men. CONCLUSIONS These results suggest that having difficulty taking medications openly is a barrier to antiretroviral treatment among women, but not among men, and may contribute to gender disparities in HAART use.
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Affiliation(s)
- Jennifer N Sayles
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, Los Angeles, California, USA.
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49
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Abstract
BACKGROUND Understanding differences in cause-specific mortality between Latinos and whites is important for targeting future public health interventions and research aimed at eliminating health disparities. OBJECTIVES We sought to determine the contribution of specific causes of death to Latino-white differences in mortality. RESEARCH DESIGN Using nationally representative data, we estimated cause-specific mortality risks, which were then used in a simulation model to estimate mortality events for a cohort of persons starting at age 25 and followed until death or age 75. SUBJECTS Subjects were 507,820 Latino and white adults, age 25 or older, who participated in the 1986-1994 National Health Interview Surveys. MEASURES Outcomes were years of potential life lost before age 75 from specific causes of death and age-specific mortality rate ratios for Latinos compared with whites. RESULTS Latinos had higher mortality rates than whites before age 45 and similar mortality rates at older ages. Latino women lost 315 (95% confidence interval [CI], 229-2423) more years of potential life (per 1000 persons before the age of 75) than white women and Latino men lost 595 (95% CI, 513-1675) more years than white men. For both men and women, whites lost substantially more years of potential life than Latinos from lung cancer. Homicide, diabetes, HIV, and liver disease contributed most to the excess years of potential life lost among Latino men, and diabetes and HIV contributed most to the excess years of potential life lost among Latino women. CONCLUSIONS To eliminate health disparities between Latinos and whites, future health policy and public health efforts should target diabetes, homicide, HIV, and liver disease among Latinos and lung cancer among whites.
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Affiliation(s)
- Mitchell D Wong
- UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, California 90095-1736, USA.
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50
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Abstract
BACKGROUND New strategies to increase physical activity among sedentary older adults are urgently needed. OBJECTIVE To examine whether low expectations regarding aging (age-expectations) are associated with low physical activity levels among older adults. DESIGN Cross-sectional survey. PARTICIPANTS Six hundred and thirty-six English- and Spanish-speaking adults aged 65 years and above attending 14 community-based senior centers in the Los Angeles region. Over 44% were non-Latino whites, 15% were African American, and 36% were Latino. The mean age was 77 years (range 65 to 100). MEASUREMENTS Self-administered written surveys including previously tested measures of age-expectations and physical activity level in the previous week. RESULTS Over 38% of participants reported <30 minutes of moderate-vigorous physical activity in the previous week. Older adults with lower age-expectations were more likely to report this very low level of physical activity than those with high age-expectations, even after controlling for the independent effect of age, sex, ethnicity, level of education, physical and mental health-related quality of life, comorbidity, activities of daily living impairment, depressive symptoms, self-efficacy, survey language, and clustering at the senior center. Compared with the quintile of participants having the highest age-expectations, participants with the lowest quintile of age-expectations had an adjusted odds ratio of 2.6 (95% confidence intervals: 1.5, 4.5) of reporting <30 minutes of moderate-vigorous physical activity in the previous week. CONCLUSIONS In this diverse sample of older adults recruited from senior centers, low age-expectations are independently associated with very low levels of physical activity. Harboring low age-expectations may act as a barrier to physical activity among sedentary older adults.
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Affiliation(s)
- Catherine A Sarkisian
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095-1687, USA.
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