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Subica AM, Soakai L, Tukumoeatu A, Johnson T, Aitaoto N. Trauma and mental health in Pacific Islanders. Int J Soc Psychiatry 2024:207640241236109. [PMID: 38491441 DOI: 10.1177/00207640241236109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
BACKGROUND Little is known about trauma and its mental health impact on Native Hawaiians/Pacific Islanders (NH/PI), an understudied Indigenous-colonized population that endures severe mental health disparities. AIMS This novel investigation assessed trauma prevalence and its mental health and substance use correlates in NH/PIs in the U.S. METHOD Using community-based participatory research methods, survey data on NH/PI trauma, depression, anxiety, substance use, and treatment need were collected from 306 NH/PI adults using online, telephone, and in-person methods. Descriptive statistics and adjusted regression models were employed. RESULTS Sixty-nine percent of participants experienced lifetime trauma, reporting mean exposure to 2.5 different trauma types. Childhood physical and sexual abuse, and lifetime forced sexual assault rates were 34%, 25%, and 27%, respectively, exceeding general population rates. Women and men reported equivalent total mean exposure to different trauma types, as well as equal prevalence for every trauma type examined (e.g. sexual abuse/assault). Confirming hypotheses, after controlling for key demographic and mental health risk factors, increased exposure to multiple trauma types uniquely associated with greater depression, anxiety, alcohol symptomology, and greater likelihood for needing treatment and using illicit substances. CONCLUSIONS Trauma is prevalent in NH/PI populations and significantly impacts NH/PI mental health; serving as an important but overlooked contributor to NH/PI mental health disparities. Current findings fill critical gaps in our knowledge of NH/PI trauma and mental health while revealing the importance of screening and treating NH/PIs for trauma exposure to alleviate existing mental health disparities.
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Affiliation(s)
- Andrew M Subica
- School of Medicine, University of California, Riverside, USA
| | - Lolofi Soakai
- Motivating Action Leadership Opportunity, Pomona, CA, USA
| | - Amen Tukumoeatu
- Empowering Pacific Islander Communities, Inc., Portland, OR, USA
| | - Taffy Johnson
- United Territories of Pacific Islanders Alliance, Kent, WA, USA
| | - Nia Aitaoto
- United Territories of Pacific Islanders Alliance, Kent, WA, USA
- Pacific Islander Center of Primary Care Excellence, San Leandro, CA, USA
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Subica AM. CRISPR in Public Health: The Health Equity Implications and Role of Community in Gene-Editing Research and Applications. Am J Public Health 2023; 113:874-882. [PMID: 37200601 PMCID: PMC10323846 DOI: 10.2105/ajph.2023.307315] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CRISPR (clustered regularly interspaced short palindromic repeats) is a Nobel Prize-winning technology that holds significant promise for revolutionizing the prevention and treatment of human disease through gene editing. However, CRISPR's public health implications remain relatively uncertain and underdiscussed because (1) targeting genetic factors alone will have limited influence on population health, and (2) minority populations (racial/ethnic, sexual and gender)-who bear the nation's greatest health burdens-historically suffer unequal benefits from emerging health care innovations and tools. This article introduces CRISPR and its potential public health benefits (e.g., improving virus surveillance, curing genetic diseases that pose public health problems such as sickle cell anemia) while outlining several major ethical and practical threats to health equity. This includes minorities' grave underrepresentation in genomics research, which may lead to less effective and accepted CRISPR tools and therapies for these groups, and their anticipated unequal access to these tools and therapies in health care. Informed by the principles of fairness, justice, and equitable access, ensuring gene editing promotes rather than diminishes health equity will require the meaningful centering and engagement of minority patients and populations in gene-editing research using community-based participatory research approaches. (Am J Public Health. 2023;113(8):874-882. https://doi.org/10.2105/AJPH.2023.307315).
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica is with the Department of Social Medicine, Population, and Public Health, University of California, Riverside School of Medicine
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Subica AM, Sampaga DS, Ortiz-Misiaszek J, Martin TKK, Okamoto SK. The Mental Health, Substance Use, Physical Health, and Mental Health Treatment Need of Community Individuals Experiencing Homelessness in Hawai'i. Community Ment Health J 2023; 59:1021-1026. [PMID: 36892628 PMCID: PMC9995740 DOI: 10.1007/s10597-022-01076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 12/13/2022] [Indexed: 03/10/2023]
Abstract
Limited research has examined the mental health of individuals experiencing homelessness in Hawai'i, which bears the nation's second highest homelessness rate. Mental health, substance use, treatment need, and health data were collected from 162 unhoused individuals in Hawai'i County by visiting community locations where they congregate (e.g., beaches, vacant buildings). 77% of participants were Native Hawaiian/Pacific Islander (NH/PI) with participants demonstrating severe rates of mental and substance use disorders including 57% experiencing major depressive disorder (MDD), 56% experiencing generalized anxiety disorder (GAD), and 64%, 74%, and 12% experiencing alcohol, methamphetamine, and opioid use disorders, respectively-heightening overdose risk. Treatment need was high (62%) but health was poor (85% reporting fair/poor health), with MDD and GAD predicting reduced general health (p < 0.05). Study findings indicate Hawai'i unhoused individuals are disproportionately Indigenous NH/PI, enduring striking mental and physical health disparities that may be reduced by increasing access/utilization of community mental health programs/services.
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Affiliation(s)
- Andrew M Subica
- Department of Social Medicine, Population, and Public Health, University of California, Riverside School of Medicine, 900 University Ave, 92521, Riverside, CA, USA.
| | | | | | - Tammy K K Martin
- School of Social Work, Hawai'i Pacific University, Honolulu, HI, USA
| | - Scott K Okamoto
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, Honolulu, HI, USA
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Subica AM, Aitaoto N, Li Q, Morey BN, Wu LT, Iwamoto DK, Guerrero EG, Moss HB. Assessing the Impact of COVID-19 on the Health of Native Hawaiian/Pacific Islander People in the United States, 2021. Public Health Rep 2023; 138:164-173. [PMID: 36113145 PMCID: PMC9482884 DOI: 10.1177/00333549221123579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Minimal research has assessed COVID-19's unique impact on the Native Hawaiian/Pacific Islander (NH/PI) population-an Indigenous-colonized racial group with social and health disparities that increase their risk for COVID-19 morbidity and mortality. To address this gap, we explored the scope of COVID-19 outcomes, vaccination status, and health in diverse NH/PI communities. METHODS NH/PI staff at partner organizations collected survey data from April through November 2021 from 319 community-dwelling NH/PI adults in 5 states with large NH/PI populations: Arkansas, California, Oregon, Utah, and Washington. Data were analyzed with descriptive statistics, Pearson χ2 tests, independent and paired t tests, and linear and logistic regression analyses. RESULTS During the COVID-19 pandemic, 30% of survey participants had contracted COVID-19, 16% had a close family member who died of the disease, and 64% reported COVID-19 vaccine uptake. Thirty percent reported fair/poor health, 21% currently smoked cigarettes, and 58% reported obesity. Survey participants reported heightened COVID-19-related psychosocial distress (mean score = 4.9 on 10-point scale), which was more likely when health outcomes (general health, sleep, obesity) were poor or a family member had died of COVID-19. Logistic regression indicated that age, experiencing COVID-19 distress, and past-year use of influenza vaccines were associated with higher odds of COVID-19 vaccine uptake (1.06, 1.18, and 7.58 times, respectively). CONCLUSIONS Our empirical findings highlight the acute and understudied negative impact of COVID-19 on NH/PI communities in the United States and suggest new avenues for improving NH/PI community health, vaccination, and recovery from COVID-19.
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Affiliation(s)
- Andrew M. Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, Riverside, CA, USA
| | - Nia Aitaoto
- Pacific Islander Center of Primary Care Excellence, San Leandro, CA, USA
| | - Qiuxi Li
- Special Services for Groups, Los Angeles, CA, USA
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, CA, USA
| | - Li-Tzy Wu
- School of Medicine, Duke University, Durham, NC, USA
| | - Derek K. Iwamoto
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Howard B. Moss
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, Riverside, CA, USA
- Department of Psychiatry, School of Medicine, University of California, Riverside, Riverside, CA, USA
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Li Q, Douglas JA, Subica AM. Examining neighbourhood-level disparities in Black, Latina/o, Asian, and White physical health, mental health, chronic conditions, and social disadvantage in California. Glob Public Health 2023; 18:2273425. [PMID: 37902041 DOI: 10.1080/17441692.2023.2273425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Racial/ethnic minority individuals in the U.S. experience numerous health disparities versus Whites, often due to differences in social determinants. Yet, limited large-scale research has examined these differences at the neighbourhood level. We merged 2021 PLACES Project and 2020 American Community Survey data across 3,211 census tracts (neighbourhoods) defined as majority (>50%) Black, Latina/o, Asian or White. T-tests and hierarchical linear regressions were used to examine differences and associations between neighbourhoods on key health (general health, mental health, obesity, diabetes, cancer, coronary heart disease, chronic obstructive pulmonary disease, stroke), and social outcomes (income, unemployment, age, population density). Results indicated that minority neighbourhoods in California exhibited stark health and social disparities versus White neighbourhoods, displaying worse outcomes on nearly every social and health variable/condition examined; particularly for Black and Latina/o neighbourhoods. Moreover, regression findings revealed that, after considering income, unemployment, and population density, (1) fair/poor mental health and higher percentages of Black, Latina/o and Asian residents in neighbourhoods independently associated with greater neighbourhood fair/poor physical health, and (2) fair/poor mental health significantly associated with greater prevalence of obesity and COPD. This study thus underscores the need to address the profound health and social disparities experienced by minority neighbourhoods for more equitable neighbourhoods.
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Affiliation(s)
- Qiuxi Li
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| | - Jason A Douglas
- Department of Health, Society, and Behavior, Program in Public Health, Center for Environmental Health Disparities Research, University of California, Irvine, CA, USA
| | - Andrew M Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
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Subica AM, Guerrero EG, Martin TKK, Okamoto SK, Aitaoto N, Moss HB, Morey BN, Wu LT. Native Hawaiian/Pacific Islander alcohol, tobacco and other drug use, mental health and treatment need in the United States during COVID-19. Drug Alcohol Rev 2022; 41:1653-1663. [PMID: 35953887 PMCID: PMC9539247 DOI: 10.1111/dar.13522] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/13/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Before COVID-19, Native Hawaiians/Pacific Islanders (NH/PI) endured a heavy burden of alcohol, tobacco and other drug (ATOD) use in prior US data. Responding to reports that many NH/PI communities experienced severe COVID-19 disparities that could exacerbate their ATOD burden, we partnered with NH/PI communities to assess the substance use patterns and treatment needs of diverse NH/PIs during COVID-19. METHODS Collaborating with NH/PI community organisations across five states with large NH/PI populations, we conducted a large-scale investigation of NH/PI ATOD use, mental health and treatment need during COVID-19. Between April and November 2021, NH/PI-heritage research staff from our community partners collected data involving 306 NH/PI adults using several community-based recruitment methods (e-mail, telephone, in-person) and two survey approaches: online and paper-and-pencil. Multivariate regressions were conducted to examine potential predictors of NH/PI alcohol use disorder and need for behavioural health treatment. RESULTS During COVID-19, 47% and 22% of NH/PI adults reported current alcohol and cigarette use, while 35% reported lifetime illicit substance use (e.g., cannabis, opioid). Depression and anxiety were high, and alcohol use disorder, major depression and generalised anxiety disorder prevalence were 27%, 27% and 19%, respectively. One-third of participants reported past-year treatment need with lifetime illicit substance use, COVID-19 distress and major depression respectively associating with 3.0, 1.2, and 5.3 times greater adjusted odds for needing treatment. CONCLUSIONS NH/PI adults reported heavy ATOD use, depression, anxiety and treatment need during COVID-19. Targeted research and treatment services may be warranted to mitigate COVID-19's negative behavioural health impact on NH/PI communities.
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Affiliation(s)
- Andrew M. Subica
- Riverside School of Medicine, University of California, Riverside, USA
| | - Erick G. Guerrero
- Research to End Healthcare Disparities Corp, I-Lead Institute, Los Angeles, USA
| | | | - Scott K. Okamoto
- School of Social Work, Hawai‘i Pacific University, Honolulu, USA
| | - Nia Aitaoto
- Pacific Islander Center of Primary Care Excellence, Oakland, USA
| | - Howard B. Moss
- Riverside School of Medicine, University of California, Riverside, USA
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, University of California, Irvine, Irvine, USA
| | - Li-Tzy Wu
- School of Medicine, Duke University, Durham, USA
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Subica AM, Guerrero EG, Hong P, Aitaoto N, Moss HB, Iwamoto DK, Wu LT. Alcohol Use Disorder Risk and Protective Factors and Associated Harms Among Pacific Islander Young Adults. J Racial Ethn Health Disparities 2022; 9:1818-1827. [PMID: 34378172 PMCID: PMC9048749 DOI: 10.1007/s40615-021-01118-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 11/26/2022]
Abstract
Pacific Islander (PI) young adults (age 18 to 30 years) experience elevated rates of hazardous drinking, AUDs, and alcohol-related harms. Yet, we know little about the risk and protective factors that drive, or can prevent, PI young adult hazardous drinking behaviors and AUDs due to a lack of targeted alcohol disparities research. This large qualitative study presents data from 8 focus groups with 69 PIs (51 young adults, 18 informal providers) to explore the major risk factors, protective factors, and negative consequences associated with PI young adult hazardous drinking and AUDs. Findings revealed (1) major risk factors including the presence of significant life stressors that trigger alcohol self-medication, peer/social pressure to drink, permissive drinking norms, and frequent access to alcohol and (2) negative consequences involving physical fights, health and relationship problems, harm to personal reputation, and community harms including driving-under-the-influence and sexual violence. Protective factors against hazardous drinking and AUDs included the cultural norm of protecting the family's reputation by avoiding AUDs, church/religious faith, family responsibilities, and culturally relevant prosocial activities (e.g., sports, dance, choir). Obtaining this in-depth data revealed that an effective culturally grounded AUD prevention intervention for PI young adults-which does not currently exist-should (1) target these identified major risk factors for AUDs, while (2) integrating culturally responsive strategies that incorporate their reported protective factors.
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Affiliation(s)
- Andrew M Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, 900 University Ave, Riverside, CA, 92521, USA.
| | - Erick G Guerrero
- Research to End Healthcare Disparities Corp, I-Lead Institute, Santa Monica, USA
| | - Phong Hong
- School of Public Policy, University of Michigan, Ann Arbor, USA
| | - Nia Aitaoto
- College of Health, University of Utah, Salt Lake City, USA
| | - Howard B Moss
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, 900 University Ave, Riverside, CA, 92521, USA
| | - Derek K Iwamoto
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Li-Tzy Wu
- School of Medicine, Duke University, Durham, NC, USA
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Nagata S, Subica AM, Myrick KJ, Green C, Salzer MS. Community participation differences between Black and White adults with serious mental illness. Am J Orthopsychiatry 2022; 92:702-710. [PMID: 36174138 DOI: 10.1037/ort0000646] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Promoting community participation is a core goal of behavioral health services for persons with serious mental illness (SMI) regardless of their racial/ethnic background. While practitioners are trained to respect diversity and culture, little is known about how racial/ethnic minorities participate in their communities during the recovery process. This is especially true for Black adults, who are disproportionately represented in current services. This study sought to compare differences in community participation experiences and interests between Black and White adults with SMI. Secondary data (n = 799) were analyzed from studies involving Black and White adults with SMI using the Temple University Community Participation Measure. Regression analyses were conducted to identify potential differences in four areas: amount of participation in a variety of community activities; number of activities participants deemed important; number of important activities actually performed; and the percentage of important activities performed as much as desired (i.e., sufficiency). Compared to White adults, Black adults had greater amounts of community participation overall and in a number of specific community activities (e.g., worship, visiting park/recreation center). Black adults also reported more community activities as important and were more likely to engage in their important activities. Relative to White adults, results suggest that Black adults with SMI were interested in and engaged more in social activities-potentially enhancing their sense of group solidarity and personal mental health recovery. Accordingly, practitioners should be aware of, and attend to, possible racial/ethnic differences in community participation, and its possible role in promoting or hindering recovery across diverse populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Simon JD, Boyd R, Thurston H, Subica AM. Response to the Reddy, Williams-Isom, & Putnam-Hornstein's brief "Racial sensitivity training: An inadequate solution to systemic racial disparities in child protection systems". Child Abuse Negl 2022; 131:105769. [PMID: 35759879 DOI: 10.1016/j.chiabu.2022.105769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Affiliation(s)
- James David Simon
- School of Social Work, California State University, Los Angeles, United States of America.
| | - Reiko Boyd
- Graduate College of Social Work, University of Houston
| | | | - Andrew M Subica
- Department of Social Medicine, Population, and Public Health, University of California, Riverside
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Douglas JA, Bostean G, Miles Nash A, John EB, Brown LM, Subica AM. Citizenship Matters: Non-Citizen COVID-19 Mortality Disparities in New York and Los Angeles. Int J Environ Res Public Health 2022; 19:ijerph19095066. [PMID: 35564460 PMCID: PMC9102427 DOI: 10.3390/ijerph19095066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 12/04/2022]
Abstract
U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. Multiple linear regression analyses revealed significant positive associations between the percentage of non-citizen residents and COVID-19 mortality rates in NYC (95% CI 0.309, 5.181) and LAC (95% CI 0.498, 8.720). Despite NYC and LAC policies intended to provide sanctuary and improve healthcare access for non-citizen residents, communities with larger proportions of non-citizens appear to endure higher COVID-19 mortality rates. The challenges that non-citizens endure—e.g., inequitable access to public benefits—may discourage help-seeking behaviors. Thus, improved health surveillance, public health messaging, and sanctuary policies will be essential for reducing COVID-19 mortality disparities in communities with large shares of non-citizens.
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Affiliation(s)
- Jason A. Douglas
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
- Correspondence: ; Tel.: +1-714-516-5612
| | - Georgiana Bostean
- Sociology and Environmental Science & Policy Programs, Schmid & Wilkinson Colleges, Chapman University, Orange, CA 92866, USA;
| | - Angel Miles Nash
- Donna Ford Attallah College of Educational Studies, Chapman University, Orange, CA 92866, USA;
| | - Emmanuel B. John
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Irvine, CA 92618, USA;
| | | | - Andrew M. Subica
- Department of Social Medicine, Population & Public Health, Riverside School of Medicine, University of California, Riverside, CA 92521, USA;
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Abstract
Health disparities disproportionately affect minority cultural groups (e.g., Indigenous, immigrant, refugee) worldwide; enduring across time, disease states, and risk factors despite co-occurring advancements in health and medicine. Fundamental cause theory holds that important social factors (e.g., socioeconomic status, stigma, racism) produce health disparities by restricting equitable access to health-protective resources. Yet, extant literature has not utilized fundamental cause theory to describe the health disparities impact of cultural trauma: an overwhelming, often ongoing physical or psychological assault by an oppressive dominant group on another group's cultural resources through force, threats of force, or oppressive policies. This paper presents a novel conceptual model detailing cultural trauma and the mechanisms through which it may disrupt health and create disparities by damaging three health-protective cultural resources: cultural modes, institutions, and lands. Following cultural trauma, we propose affected groups are socially disadvantaged and exposed to pervasive stress, stigma, and diminished resources, perpetuating health disparities across generations. Consequently, cultural trauma may represent an unrecognized fundamental cause of health disparities, offering potential avenues for promoting health equity through targeted research, interventions, and policies.
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Affiliation(s)
- Andrew M. Subica
- University of California, Riverside School of Medicine, Department of Social Medicine, Population, and Public Health, 900 University Ave, Riverside, CA, 92521, USA,Corresponding author. (A.M. Subica)
| | - Bruce G. Link
- University of California, Riverside School of Public Policy, 900 University Ave, Riverside, CA, 92521, USA
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Abstract
Despite concerted efforts over the past decade to increase diversity in U.S. medical schools, persistent applicant and enrollment gaps remain for students from underrepresented racial and economic backgrounds. To understand these gaps, we propose a new theory of 'academic redlining' as a widespread practice in medical schools that systematically excludes students from underrepresented backgrounds from entry into medicine through the nearly universal use of Medical College Admissions Test (MCAT) cutoff scores. In this paper, we provide evidence that academic redlining via the MCAT disenfranchises students from underrepresented backgrounds prior to and during the admissions process due to structural racism, and describe the three core mechanisms that cause medical schools to engage in academic redlining: (1) the pursuit of institutional prestige, (2) market competition and pressure, and (3) market bands. Given the persistent lack of diversity in medicine-which contributes to devastating health care disparities-as medical schools redouble their commitments to diversity, equity, and inclusion, structural alternatives within medical schools' admissions and education practices are offered to curtail the practice of academic redlining in medical school admissions and medicine.
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Affiliation(s)
- Sunny Nakae
- Department of Medical Education, California University of Science and Medicine, 1501 Violet St, Colton, CA, 92324, USA.
| | - Andrew M Subica
- Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, 900 University Ave, Riverside, CA, 92521, USA
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Abstract
Black and Hispanic communities in the U.S. have endured a disproportionate burden of COVID-19-related morbidity and mortality. Racial and ethnic health disparities such as these are frequently aggravated by inequitable access to healthcare resources in disadvantaged communities. Yet, no known studies have investigated disadvantaged communities' access to COVID-19-related healthcare resources. The current study accordingly examined racial and ethnic differences in (1) April 2020 COVID-19 total and positive viral test rates across 177 New York City (NYC) ZIP Code Tabulation Areas (ZCTA); and (2) November 2019-April 2020 licensed and intensive care unit (ICU) hospital bed access across 194 NYC ZCTAs. Pairwise analyses indicated higher COVID-19 total and positive test rates per 1000 persons in majority Black and Hispanic vs. majority White ZCTAs (CI [0.117, 4.55]; CI [2.53, 5.14]). Multiple linear regression analyses indicated that higher percentage of Black and Hispanic residents predicted more total COVID-19 tests per 1000 persons (p < 0.05). In contrast, majority Black and Hispanic ZCTAs had fewer licensed and ICU beds (CI [6.50, 124.25]; CI [0.69, 7.16]), with social disadvantage predicting lower licensed and ICU bed access per 1000 persons (p < 0.01). While news reports of inequitable access to COVID-19-related healthcare resources in ethnocultural minority communities have emerged, this is the first study to reveal that social disadvantage may be a major driver of hospital resource inequities in Black and Hispanic communities. Thus, it will be imperative to enact policies that ensure equitable allocation of healthcare resources to socially disadvantaged communities to address current and future public health crises.
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Affiliation(s)
- Jason A Douglas
- Chapman University, Crean College of Health and Behavioral Sciences, Department of Health Sciences, Orange, CA, United States of America.
| | - Andrew M Subica
- University of California, Riverside School of Medicine, Department of Social Medicine, Population, & Public Health, Riverside, CA, United States of America
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Douglas JA, Subica AM, Franks L, Johnson G, Leon C, Villanueva S, Grills CT. Using Participatory Mapping to Diagnose Upstream Determinants of Health and Prescribe Downstream Policy-Based Interventions. Prev Chronic Dis 2020; 17:E138. [PMID: 33155972 PMCID: PMC7665598 DOI: 10.5888/pcd17.200123] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Participatory mapping is a powerful methodology for working with community residents to examine social and environmental determinants of public health disparities. However, this empowering methodology has only been applied sparingly in public health research and practice, with limited examples in the literature. To address this literature gap, we 1) review participatory mapping approaches that may be applied to exploring place-based factors that affect community health, and 2) present a mixed-methods participatory geographic information systems (PGIS) examination of neighborhood assets (eg, streetlights) and challenges (eg, spaces of crime and violence) related to access to public parks in South Los Angeles, California. By taking a participatory, fine-grained spatial approach to examining public park access with input from 40 South Los Angeles adolescent and adult residents, our community-engaged PGIS approach identified tobacco shops as previously unrecognized community institutions that are associated with increased neighborhood crime and violence. Our investigation revealed unique challenges in community-level public park access that would likely have been overlooked by conventional spatial epidemiology and social science methods, such as surveys and questionnaires. Furthermore, our granular community-informed approach supported resident and stakeholder advocacy efforts toward reducing the proliferation of tobacco shops through community organizing and policy change initiatives. We thus contend that it would benefit public health research and practice to further integrate empowering, grassroots-based participatory mapping approaches toward informing advocacy efforts and policies that promote health and well-being in disadvantaged communities.
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Affiliation(s)
- Jason A Douglas
- Chapman University, Crean College of Health and Behavioral Sciences, Department of Health Sciences, Orange, California.,Chapman University, Crean College of Health and Behavioral Sciences, Department of Health Sciences, One University Dr, Orange, CA 92866.
| | - Andrew M Subica
- University of California, Riverside School of Medicine, Department of Social Medicine, Population, and Public Health, Riverside, California
| | | | | | - Carlos Leon
- Community Coalition, Los Angeles, California
| | - Sandra Villanueva
- Loyola Marymount University, Psychology Applied Research Center, Los Angeles, California
| | - Cheryl T Grills
- Loyola Marymount University, Psychology Applied Research Center, Los Angeles, California
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Tringale R, Subica AM. COVID-19 innovations in medication for addiction treatment at a Skid Row syringe exchange. J Subst Abuse Treat 2020; 121:108181. [PMID: 33129635 PMCID: PMC7577224 DOI: 10.1016/j.jsat.2020.108181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/11/2020] [Accepted: 10/13/2020] [Indexed: 10/29/2022]
Abstract
Syringe exchange patients in Los Angeles' Skid Row endure conditions such as deep poverty, polysubstance use, underlying health problems, and living on the streets or in homeless encampments/shelters that make them uniquely vulnerable to acquiring and dying from COVID-19. In this commentary, we discuss two essential changes that Homeless Health Care Los Angeles (HHCLA) made to modify existing medication for addiction treatment (MAT) services to address the specific treatment needs of this high-risk population during COVID-19. First, HHCLA implemented a novel "telephone booth" model that allowed socially distanced on-site "face-to-face" treatment of syringe exchange patients; this model helped us to overcome the inherent challenges of using traditional telemedicine approaches (e.g., video, mobile telephone) with this disadvantaged patient population. Second, HHCLA transitioned from on-site direct dispensing of MAT medications in our providers' offices to a less contact- and time-intensive "coordinated pharmacy" model that allowed patients the freedom to obtain MAT medications off-site from participating pharmacies. Our data indicate that implementing these COVID-19-related changes effectively maintained patient enrollment and engagement in MAT-illuminating new, potentially effective models for delivering MAT that meet the critical health and safety needs of syringe exchange patients following COVID-19.
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Affiliation(s)
- Rolando Tringale
- Homeless Health Care Los Angeles, Los Angeles, CA, United States of America
| | - Andrew M Subica
- University of California, Riverside School of Medicine, United States of America.
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16
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Abstract
Background: E-cigarette use is rapidly increasing among US young adults, heightening their risk for vaping-related illnesses. Yet, little is known about e-cigarette use among young adult Native Hawaiians and Pacific Islanders (NHPI): an indigenous-colonized US racial group rarely described in research literature. This exploratory study provides the first known data on e-cigarette use and potential risk factors in NHPI young adults. Method: Self-report data were collected from 143 NHPI young adults (age 18-30 years) living in two large NHPI communities: Samoans in urban Los Angeles County and Marshallese in rural Arkansas. We assessed rates of e-cigarette, cigarette, alcohol, and marijuana use, and positive and negative outcome expectancies from e-cigarettes, that is expected outcomes from e-cigarette use. To identify potential risk factors for NHPI e-cigarette use, regressions explored associations between participants' current e-cigarette use with current cigarette, alcohol, and marijuana use, and e-cigarette outcome expectancies. Results: Among NHPI young adults, lifetime e-cigarette use rate was 53% and current use rate was 39%. Current rate of dual e-cigarette/cigarette, e-cigarette/alcohol, and e-cigarette/marijuana use was 38%, 35%, and 25%, respectively. In our regression models, current marijuana use and positive e-cigarette outcome expectancies were significantly associated with current e-cigarette use. Conclusions: E-cigarette use is common among NHPI young adults, exceeding rates for other at-risk racial groups. Marijuana use and positive expectations about e-cigarette use may represent potential e-cigarette use risk factors. Collectively, findings underscore the need for additional research to further explore the scope of, and risk and protective factors for, e-cigarette use in this understudied high-risk population.
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Affiliation(s)
| | - Erick Guerrero
- I-Lead Institute, Research to End Healthcare Disparities Corp
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17
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Subica AM, Guerrero E, Aitaoto N, Moss HB, Iwamoto D, Wu LT. Hazardous drinking, alcohol use disorders, and need for treatment among Pacific Islander young adults. Am J Orthopsychiatry 2020; 90:557-566. [PMID: 32352815 PMCID: PMC9048751 DOI: 10.1037/ort0000456] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Pacific Islander (PI) young adults are suspected to bear heavy risk for hazardous drinking, alcohol use disorders (AUD), and alcohol-related harms. Yet, PIs remain among the most understudied racial groups in the United States-creating a lack of empirical data documenting their alcohol use problems and treatment needs. The present study presents the first known data on PI young adults' hazardous drinking, possible AUDs, alcohol-related harms, and treatment needs. Survey data were collected from 156 community-dwelling PI young adults (40% women, age 18-30 years) in 2 large PI communities: Los Angeles County and Northwest Arkansas. We screened participants for alcohol, cigarette, and marijuana use, hazardous drinking, possible AUD, alcohol-related harms, and past-year need for mental health and substance use disorder (SUD) treatment. Logistic regressions examined whether experiencing possible AUD and alcohol-related harms were associated with past-year need for treatment. PI young adults reported 78% lifetime rate of alcohol use with 56% screening positive for hazardous drinking, 49% for any possible AUD, and 40% experiencing significant alcohol-related harm (e.g., health, finances). Yet, just 25% of participants reported past-year need for SUD treatment. Although having possible AUD was not associated with perceived SUD treatment need, experiencing any alcohol-related harm associated with 4.7-13.2 times greater adjusted odds for needing treatment. Therefore, despite having low self-perceived treatment need, PI young adults experience excessive burden of hazardous drinking and alcohol-related harms. Given the profound negative social and health effects of AUDs, culturally grounded interventions should be designed to reduce PI young adults' elevated rates of hazardous drinking and alcohol-related harms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Andrew M. Subica
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside
| | | | | | - Howard B. Moss
- Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside
| | - Derek Iwamoto
- Department of Psychology, University of Maryland, College Park
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18
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Abstract
Health disparities adversely affect millions of people living in disadvantaged communities, resisting public health interventions that do not address the specific conditions, driving forces, or health problems in these communities. Drawing from the underutilized science of deliberative methods, we introduce the innovative citizens' panels for health equity approach-a novel methodology that engages public expertise and knowledge of community health needs, risks, and priorities to tailor public health research and interventions for greater relevance and impact on disadvantaged communities.By engaging affected residents and stakeholders in informed deliberation and decision-making about community health disparities, citizens' panels provide important guidance for (1) designing research studies to target the major health disparities affecting disadvantaged communities and (2) tailoring evidence-based interventions to the perspectives, practices, and preferences of disadvantaged residents.Employed as the primary methodology in 2 federally funded projects conducted in California and Arkansas between 2017 and 2019, citizens' panels offer a systematic method for obtaining rich community insight into health disparities, shaping community-informed solutions, and affording disadvantaged communities influence over public health decision-making to stimulate grassroots change and health equity.
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica and Brandon J. Brown are with the Department of Social Medicine, Population, and Public Health, Riverside School of Medicine, University of California, Riverside
| | - Brandon J Brown
- Andrew M. Subica and Brandon J. Brown are with the Department of Social Medicine, Population, and Public Health, Riverside School of Medicine, University of California, Riverside
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19
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Yamada AM, Vaivao DES, Subica AM. Addressing Mental Health Challenges of Samoan Americans in Southern California: Perspectives of Samoan Community Providers. Asian Am J Psychol 2019; 10:227-238. [PMID: 33777325 PMCID: PMC7992925 DOI: 10.1037/aap0000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While a variety of health concerns have been documented, little is presently known about the mental health challenges facing Samoan Americans in Southern California. This community-based research study investigated the perspectives of Samoan healthcare providers affiliated with two Los Angeles County agencies regarding: 1) mental health challenges; 2) obstacles to use of formal services to address mental health concerns, and 3) recommendations and needed resources for development of culturally responsive interventions to address mental health challenges. Eleven healthcare advocates affiliated with two agencies specializing in health and social services for Samoans participated in a 90-minute group discussion and/or an individual interview. Qualitative data were analyzed using a thematic data analytic approach based on grounded theory. Participants strongly self-identified as Samoan or mixed-race Samoan and were primarily female (73%). Key themes from these discussions are presented to highlight this seminal discussion. Despite concerns regarding substance use, depression, and suicide, significant cultural resources were noted as sources of resilience that could be incorporated into prevention and intervention for Samoan Americans coping with mental health problems. The perspectives of these community advocates for the Samoan community reflect a low level of mental health awareness and identify urgent unmet mental health needs among Samoan Americans in Southern California. Findings support prioritization of mental health awareness interventions and education regarding available services. Systemic efforts to integrate physical and mental health care services may be aligned with traditional Pacific Islander concepts of mental health and facilitate addressing the unmet mental health needs of underserved Samoan Americans.
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Affiliation(s)
- Ann-Marie Yamada
- Suzanne Dworak-Peck School of Social Work, University of Southern California
| | | | - Andrew M Subica
- University of California Riverside, Center for Healthy Communities, School of Medicine
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20
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Abstract
OBJECTIVE This study examined the mental health status, need for services, and unmet need of community-dwelling Native Hawaiian and other Pacific Islanders (NHPI). METHODS Survey data were collected from 223 NHPI adults of Samoan or Marshallese heritage. Surveys were translated into Samoan and Marshallese by using back-translation, with feedback from cultural experts. Severity of depression, anxiety, and alcohol use were measured, as were perceived need for and avoidance of, or delay in, seeking mental health services. Logistic regressions calculated adjusted odds ratios for past-year perceived need for services and avoidance or delay of needed services, controlling for depression, anxiety, and alcohol use. RESULTS Participants' screened prevalence of major depression, generalized anxiety disorder, and alcohol use disorder was 21%, 12%, and 22%, respectively. In the past year, 35% and 26% of participants reported needing services and avoiding or delaying needed services, respectively. Urban Samoan and rural Marshallese participants did not differ significantly in measures of depression, anxiety, or alcohol use, even though the groups had significant demographic differences. Female gender and greater familiarity-contact with persons with mental illness were significant predictors of both reporting service need and reporting avoiding or delaying services. CONCLUSIONS Community-dwelling NHPIs reported a heavy burden of depression, anxiety, and alcohol use, and high perceived need for services, yet low levels of help-seeking. The large unmet need in the sample suggests that a gap may exist between service need and engagement in U.S. NHPI communities that could be targeted with culturally tailored approaches that promote engagement in care.
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Affiliation(s)
- Andrew M. Subica
- University of California, Riverside Center for Healthy Communities, School of Medicine
| | | | - Bruce G. Link
- University of California, Riverside School of Public Policy
| | - Ann Marie Yamada
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work
| | - Benjamin F. Henwood
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work
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21
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Subica AM, Douglas JA. Engaging Disadvantaged Communities in Targeting Tobacco-Related Health Disparities and Other Health Inequities. Int Q Community Health Educ 2019; 40:3-6. [PMID: 30943856 DOI: 10.1177/0272684x19839866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tobacco-related health disparities (TRHD) (e.g., respiratory disease, cancer) have been repeatedly shown to disproportionately affect individuals living in disadvantaged communities. In our recent community-guided geospatial study, we found evidence for a previously unrecognized TRHD involving tobacco shops, which were associated with increased crime and violence in South Los Angeles: a large, disadvantaged urban community. Our findings revealed tobacco shops may directly endanger the health of community residents in South Los Angeles by negatively shaping neighborhood crime and violence. In this commentary, we explore reasons why tobacco shops may perpetuate TRHDs and other health disparities in disadvantaged communities. Using our study as a case example, we further describe how community-partnered research grounded in community-based participatory research principles may empower stakeholders in disadvantaged communities to generate positive downstream outcomes such as tobacco-related policy changes.
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Affiliation(s)
- Andrew M Subica
- 1 Department of Social Medicine, Population, and Public Health, School of Medicine, University of California, Riverside, CA, USA
| | - Jason A Douglas
- 2 Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
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22
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Subica AM, Aitaoto N, Sullivan JG, Henwood BF, Yamada AM, Link BG. Mental illness stigma among Pacific Islanders. Psychiatry Res 2019; 273:578-585. [PMID: 30716597 PMCID: PMC6561790 DOI: 10.1016/j.psychres.2019.01.077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Received: 12/04/2018] [Revised: 01/19/2019] [Accepted: 01/19/2019] [Indexed: 12/12/2022]
Abstract
Native Hawaiians and other Pacific Islanders (NHPI) rarely seek mental health treatment for reasons that are minimally understood. To assess the mental illness stigma context in NHPI communities that may be contributing to low help-seeking, this study collected novel stigma data from two large U.S. NHPI communities from October 2017 to January 2018, then compared this data to national stigma data from the U.S. public. Survey data were collected from 222 community-dwelling NHPI participants recruited by research-trained NHPI staff. Surveys incorporated well-established vignettes describing persons with major depression and schizophrenia. Study data were compared to U.S. general public data from the 2006 General Social Survey: the largest U.S. stigma study. Compared to the U.S. public, NHPI participants reported greater stigma toward mental illness in ways likely to impede help-seeking including: (1) more frequently endorsing stigmatizing causal attributions of depression and schizophrenia, (2) less frequently perceiving disorders as serious, and (3) more commonly desiring social distance from persons with depression. Study data are the first to reveal the presence of a strongly stigmatizing context in NHPI communities likely to hinder NHPI help-seeking. Thus, culturally tailoring anti-stigma interventions to appropriately target NHPI mental health attitudes and beliefs may prove effective in promoting NHPI help-seeking.
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Affiliation(s)
- Andrew M. Subica
- University of California, Riverside Department of Social Medicine, Population, & Public Health, School of Medicine, 900 University Ave, Riverside, CA 92521
| | - Nia Aitaoto
- University of Utah, College of Health, 383 Colorow Building, Room 391, Salt Lake City, UT 84108
| | | | - Benjamin F. Henwood
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Ann Marie Yamada
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work, 669 W 34th St, Los Angeles, CA 90089
| | - Bruce G. Link
- University of California, Riverside School of Public Policy, 900 University Ave, Riverside, CA 92521
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23
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica is with the Department of Social Medicine, Population, and Public Health, University of California, Riverside School of Medicine, Riverside
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Subica AM, Wu LT. Substance Use and Suicide in Pacific Islander, American Indian, and Multiracial Youth. Am J Prev Med 2018; 54:795-805. [PMID: 29656915 PMCID: PMC6706273 DOI: 10.1016/j.amepre.2018.02.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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] [Received: 09/12/2017] [Revised: 12/18/2017] [Accepted: 02/01/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION National estimates of U.S. Native Hawaiian and other Pacific Islander (NHPI), American Indian/Alaskan Native (AIAN), and multiracial adolescent substance use and suicidality are scarce because of their small population sizes. The aim was to estimate the national prevalence of, and disparities in, substance use and suicidality among these understudied adolescents. METHODS Analyses conducted in 2017 of U.S. adolescents (grades ninth to 12th) from the 1991-2015 Combined National Youth Behavioral Risk Surveys estimated (1) prevalence of lifetime and current (past 30-day) substance use, past 12-month depressed mood, and suicidality by racial group; and (2) AORs for depressed mood and suicidality regressed on current alcohol, cigarette, and marijuana use. RESULTS Among 184,494 U.S. adolescents, alcohol, cigarettes, and marijuana were commonly used with lifetime prevalence of 75.32%, 58.11%, and 40.55%, respectively, and current prevalence of 44.51%, 24.58%, and 22.01%, respectively. Past 12-month prevalence of suicidal thoughts, suicide planning, and attempted suicide were 18.87%, 14.75%, and 7.98%, respectively. Relative to non-Hispanic whites, NHPI, AIAN, and multiracial adolescents had higher prevalence of using many illicit substances (e.g., marijuana, heroin), depressed mood, and suicidal thoughts, planning, and attempts (p<0.05). Except for NHPIs and current alcohol use, current alcohol and cigarette use were independently associated with 2.0-2.3 times greater AORs (p<0.05) for attempted suicide among the target adolescents. CONCLUSIONS U.S. NHPI, AIAN, and multiracial adolescents are disproportionately burdened by illicit substance use, depressed mood, and suicidality. Current alcohol and cigarette use may predispose these adolescents toward suicidality, offering potential pathways to alleviate suicide risk.
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Affiliation(s)
- Andrew M Subica
- University of California, Riverside Center for Healthy Communities, School of Medicine, Riverside, California.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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Douglas JA, Briones MD, Bauer EZ, Trujillo M, Lopez M, Subica AM. Social and environmental determinants of physical activity in urban parks: Testing a neighborhood disorder model. Prev Med 2018; 109:119-124. [PMID: 29366818 DOI: 10.1016/j.ypmed.2018.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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] [Received: 08/17/2017] [Revised: 12/26/2017] [Accepted: 01/16/2018] [Indexed: 11/26/2022]
Abstract
The current study examined the nexus of neighborhood disorder-in the form of physical disorder (e.g., broken glass and vandalism) and social disorder (e.g., public drinking and lewd conduct)-and physical activity (PA) in urban public parks to inform public policy addressing chronic disease in at-risk populations. Five hundred and twenty-two unique observations were conducted in 22 public parks from March to September 2016. The study utilized the System for Observing Play and Recreation in Communities (SOPARC) to document age, gender, ethnicity, and PA level of park users. The Physical Activity Resource Assessment (PARA) was used to document observed physical and social disorder incivilities in public parks included in the current study. Males, adults, and Latina/os accounted for the largest number of park users, respectively. Significant PA differences were observed across gender, age, and ethnicity. Multiple linear regression controlling for gender, age, and ethnicity found physical disorder, but not social disorder, generally predicted PA reductions. While it has been demonstrated that physical disorder predicts PA reductions in low-income communities of color, this is the first study to reveal that physical disorder may lead to decreased PA in urban public parks. Thus, remediation of public park incivilities characterized by physical disorder, paired with community outreach, may lead to increased PA in at-risk communities.
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Affiliation(s)
- Jason A Douglas
- San José State University, Department of Environmental Studies, San José, CA, United States.
| | - Maya D Briones
- San José State University, Department of Environmental Studies, San José, CA, United States
| | - Eliane Z Bauer
- San José State University, Department of Environmental Studies, San José, CA, United States
| | - Melissa Trujillo
- San José State University, Department of Environmental Studies, San José, CA, United States
| | - Melissa Lopez
- San José State University, Department of Environmental Studies, San José, CA, United States
| | - Andrew M Subica
- University of California, Riverside School of Medicine, Riverside, CA, United States
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26
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Subica AM, Douglas JA, Kepple NJ, Villanueva S, Grills CT. The geography of crime and violence surrounding tobacco shops, medical marijuana dispensaries, and off-sale alcohol outlets in a large, urban low-income community of color. Prev Med 2018; 108:8-16. [PMID: 29277409 DOI: 10.1016/j.ypmed.2017.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022]
Abstract
Tobacco shops, medical marijuana dispensaries (MMD), and off-sale alcohol outlets are legal and prevalent in South Los Angeles, California-a high-crime, low-income urban community of color. This research is the first to explore the geographic associations between these three legal drug outlets with surrounding crime and violence in a large low-income urban community of color. First, spatial buffer analyses were performed using point-location and publically accessible January-December 2014 crime data to examine the geography of all felony property and violent crimes occurring within 100, 200, 500, and 1000-foot buffers of these three legal drug outlet types across South Los Angeles. Next, spatial regression analyses explored the geographic associations between density of these outlets and property and violent crimes at the census tract level. Results indicated that mean property and violent crime rates within 100-foot buffers of tobacco shops and alcohol outlets-but not MMDs-substantially exceeded community-wide mean crime rates and rates around grocery/convenience stores (i.e., comparison properties licensed to sell both alcohol and tobacco). Spatial regression analyses confirmed that tobacco shops significantly positively associated with property and violent crimes after controlling for key neighborhood factors (poverty, renters, resident mobility, ethnic/racial heterogeneity). Thus, study findings provide the first empirical evidence that tobacco shops may constitute public health threats that associate with crime and violence in U.S. low-income urban communities of color. Implementing and enforcing control policies that regulate and monitor tobacco shops in these communities may promote community health by improving public safety.
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Affiliation(s)
- Andrew M Subica
- University of California Riverside, School of Medicine, Riverside, CA, United States.
| | - Jason A Douglas
- San Jose State University, Environmental Studies, San Jose, CA, United States
| | - Nancy J Kepple
- University of Kansas, School of Social Welfare, Lawrence, KS, United States
| | - Sandra Villanueva
- Loyola Marymount University, Psychology Applied Research Center, Los Angeles, CA, United States
| | - Cheryl T Grills
- Loyola Marymount University, Psychology Applied Research Center, Los Angeles, CA, United States
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27
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Abstract
OBJECTIVE Spirituality offers a vital coping resource that can bolster mental health and psychosocial well-being for individuals with serious mental illnesses (SMI). However, limited research on spirituality-infused evidence-based interventions exists to assist providers in mobilizing spirituality as a mental health resource. This article presents the cognitive-behavioral intervention Spiritual Strategies for Psychosocial Recovery (SSPR), developed to promote recovery among ethnoculturally diverse individuals with SMI by strengthening their coping mechanisms for internal and external distress through spiritual means. METHODS SSPR was developed in 5 steps: (1) observation of current recovery services at a partnering psychosocial rehabilitation center; (2) creation of a treatment manual based on extant literature, the authors' evidence-based practice expertise, and observational data; (3) testing of specific SSPR skills with consumers; (4) refinement of the manual by using testing data; and (5) testing of the manual for feasibility with 37 consumers. RESULTS Initial feasibility testing indicated that the intervention was accepted and valued by participants and providers; did not trigger psychiatric disturbances; and provided accessible spirituality-based distress coping tools for helping participants manage psychological difficulties in the community. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE SSPR and its nondenominational spirituality-based distress coping skills appear to be well tolerated by consumers and providers. Thus, SSPR might be useful for providers seeking to address consumers' distress coping by capitalizing on their existing or potential spiritual strengths. Future research is needed to evaluate the intervention's effectiveness with randomized controlled trial designs in clinical and community settings. (PsycINFO Database Record
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Affiliation(s)
- Andrew M Subica
- Psychology Applied Research Center, Loyola Marymount University
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28
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Subica AM, Agarwal N, Sullivan JG, Link BG. Obesity and Associated Health Disparities Among Understudied Multiracial, Pacific Islander, and American Indian Adults. Obesity (Silver Spring) 2017; 25:2128-2136. [PMID: 29071803 DOI: 10.1002/oby.21954] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/01/2017] [Accepted: 07/13/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study examined the state of obesity, diabetes, and associated health disparities among understudied multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults. METHODS Aggregated data for 184,617 adults from the California Health Interview Survey (2005 to 2011) were analyzed to determine obesity, diabetes, poor/fair health, and physical disability prevalence by racial group. Logistic regressions controlling for age, gender, and key social determinants (education, marital status, poverty, health insurance) generated multiracial, NHOPI, and AIAN adults' odds ratios (ORs) for our targeted health conditions versus non-Hispanic white adults. RESULTS Obesity, diabetes, and other targeted health conditions were highly prevalent among multiracial, NHOPI, and AIAN adults, who displayed significantly greater adjusted odds than non-Hispanic white adults for obesity (ORs = 1.2-1.9), diabetes (ORs = 1.6-2.4), poor/fair health (ORs = 1.4-1.7), and, with the exception of NHOPI adults, physical disability (ORs = 1.5-1.6). Multiracial and AIAN adults with obesity also had significantly higher adjusted odds of diabetes (OR = 1.5-2.6) than non-Hispanic white adults with obesity. CONCLUSIONS Multiracial, NHOPI, and AIAN adults experience striking obesity-related disparities versus non-Hispanic white adults, urging further disparities research with these vulnerable minority populations.
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Affiliation(s)
- Andrew M Subica
- Center for Healthy Communities, School of Medicine, University of California, Riverside, Riverside, California, USA
| | - Neha Agarwal
- Department of Economics, University of California, Riverside, Riverside, California, USA
| | - J Greer Sullivan
- Center for Healthy Communities, School of Medicine, University of California, Riverside, Riverside, California, USA
| | - Bruce G Link
- School of Public Policy, University of California, Riverside, Riverside, California, USA
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Douglas JA, Grills CT, Villanueva S, Subica AM. Empowerment Praxis: Community Organizing to Redress Systemic Health Disparities. Am J Community Psychol 2016; 58:488-498. [PMID: 27859407 DOI: 10.1002/ajcp.12101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Social and environmental determinants of childhood obesity present a public health dilemma, particularly in low-income communities of color. Case studies of two community-based organizations participating in the Robert Wood Johnson Foundation's Communities Creating Healthy Environments (CCHE) childhood obesity initiative demonstrate multilevel, culturally situated community organizing strategies to address the root causes of this public health disparity. Informed by a 3-lens prescription-Social Justice, Culture-Place, and Organizational Capacity-contained in the CCHE Change Model and Evaluation Frame, we present examples of individual, organizational, and community empowerment to redress systemic inequities that manifest in poor health outcomes for people of color. These case studies offer compelling evidence that public health disparities in these communities may effectively be abated through strategies that employ bottom-up, community-level approaches for (a) identifying proximal and distal determinants of public health disparities, and (b) empowering communities to directly redress these inequities. Guided by this ecological framework, application of the CCHE evaluation approach demonstrated the necessity to document the granularity of community organizing for community health, adding to the community psychology literature on empowering processes and outcomes.
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Affiliation(s)
- Jason A Douglas
- Environmental Studies, College of Social Sciences, San Jose State University, San Jose, CA, USA
| | - Cheryl T Grills
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA, USA
| | - Sandra Villanueva
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA, USA
| | - Andrew M Subica
- Center for Healthy Communities, School of Medicine, University of California, Riverside, CA, USA
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Subica AM, Grills CT, Villanueva S, Douglas JA. Community Organizing for Healthier Communities: Environmental and Policy Outcomes of a National Initiative. Am J Prev Med 2016; 51:916-925. [PMID: 27712948 DOI: 10.1016/j.amepre.2016.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Childhood obesity is disproportionately prevalent in communities of color, partially because of structural inequities in the social and built environment (e.g., poverty, food insecurity, pollution) that restrict healthy eating and active living. Community organizing is an underexamined, grassroots health promotion approach that empowers and mobilizes community residents to advocate for, and achieve, environmental and policy changes to rectify these structural inequities. This paper presents outcomes of the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative: the first national program to apply community organizing to combat childhood obesity-causing structural inequities in communities of color. METHODS Twenty-one community-based organizations and tribal nations (grantees) conducted 3-year community organizing-based interventions primarily designed to increase children's healthy food and safe recreational access. Grantees' policy wins (environmental and policy changes resulting from grantee interventions) were measured from 2009 to 2014 using semi-structured interviews conducted quarterly and 6 months post-grant, and independently coded and reviewed in 2015 by researchers and expert community organizers. RESULTS The 21 grantees achieved 72 policy wins (mean=3.43, SD=1.78) across six domains: two directly addressed childhood obesity by enhancing children's healthy food (37.50%) and recreational access (33.33%), whereas four indirectly addressed obesity by promoting access to quality health care (8.33%); clean environments (9.73%); affordable housing (8.33%); and discrimination- and crime-free neighborhoods (2.78%). CONCLUSIONS These findings provide compelling evidence that community organizing-based interventions designed and led by community stakeholders can achieve diverse environmental and policy solutions to the structural inequities that foment childhood obesity in communities of color.
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Affiliation(s)
- Andrew M Subica
- Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, California
| | - Cheryl T Grills
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, California.
| | - Sandra Villanueva
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, California
| | - Jason A Douglas
- Environmental Studies, San Jose State University, San Jose, California
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Subica AM, Grills CT, Douglas JA, Villanueva S. Communities of Color Creating Healthy Environments to Combat Childhood Obesity. Am J Public Health 2016; 106:79-86. [PMID: 26562108 PMCID: PMC4695934 DOI: 10.2105/ajph.2015.302887] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/04/2022]
Abstract
Ethnic and racial health disparities present an enduring challenge to community-based health promotion, which rarely targets their underlying population-level determinants (e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens prescription for using community organizing to treat these determinants in communities of color based on the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative, the first national project to combat childhood obesity in communities of color using community organizing strategies. The lenses--Social Justice, Culture-Place, and Organizational Capacity-Organizing Approach--assist health professional-community partnerships in planning and evaluating community organizing-based health promotion programs. These programs activate community stakeholders to alter their community's disease-causing, population-level determinants through grassroots policy advocacy, potentially reducing health disparities affecting communities of color.
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Cheryl T Grills
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Jason A Douglas
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Sandra Villanueva
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
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Subica AM, Allen JG, Frueh BC, Elhai JD, Fowler JC. Disentangling depression and anxiety in relation to neuroticism, extraversion, suicide, and self-harm among adult psychiatric inpatients with serious mental illness. Br J Clin Psychol 2015; 55:349-370. [DOI: 10.1111/bjc.12098] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/25/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | - Jon G. Allen
- The Menninger Clinic; Houston Texas USA
- Baylor College of Medicine; Houston Texas USA
| | - B. Christopher Frueh
- The Menninger Clinic; Houston Texas USA
- Baylor College of Medicine; Houston Texas USA
- University of Hawaii; Hilo Hawaii USA
| | | | - J. Christopher Fowler
- The Menninger Clinic; Houston Texas USA
- Baylor College of Medicine; Houston Texas USA
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Kelly EL, Subica AM, Fulginiti A, Brekke JS, Novaco RW. A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital. J Adv Nurs 2014; 71:1110-22. [DOI: 10.1111/jan.12609] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Erin L. Kelly
- Health Services Research Center; University of California, Los Angeles; California USA
| | - Andrew M. Subica
- Psychology Applied Research Center; Loyola Marymount University; Los Angeles California USA
| | - Anthony Fulginiti
- School of Social Work; University of Southern California; Los Angeles California USA
| | - John S. Brekke
- School of Social Work; University of Southern California; Los Angeles California USA
| | - Raymond W. Novaco
- School of Social Ecology; University of California; Irvine California USA
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Grills C, Villanueva S, Subica AM, Douglas JA. Communities Creating Healthy Environments: improving access to healthy foods and safe places to play in communities of color. Prev Med 2014; 69 Suppl 1:S117-9. [PMID: 25450492 DOI: 10.1016/j.ypmed.2014.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Cheryl Grills
- Psychology Applied Research Center, Loyola Marymount University, 1 LMU Drive, University Hall Suite 4753, Los Angeles, CA 90045, USA.
| | - Sandra Villanueva
- Psychology Applied Research Center, Loyola Marymount University, 1 LMU Drive, University Hall Suite 4753, Los Angeles, CA 90045, USA
| | - Andrew M Subica
- Psychology Applied Research Center, Loyola Marymount University, 1 LMU Drive, University Hall Suite 4753, Los Angeles, CA 90045, USA
| | - Jason A Douglas
- Psychology Applied Research Center, Loyola Marymount University, 1 LMU Drive, University Hall Suite 4753, Los Angeles, CA 90045, USA
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Raab PA, Claypoole KH, Rhoads Merriam K, Subica AM, Larsen JD, Chow M, Golis K. Indicators of success: academic research partnerships to implement performance indicator systems in Clubhouses. Psychiatr Rehabil J 2014; 37:55-7. [PMID: 24274063 DOI: 10.1037/prj0000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/08/2022]
Abstract
TOPIC This article describes a collaboration between academic researchers and Clubhouses to develop and implement a statewide Clubhouse performance indicator system. PURPOSE Given the challenging funding climate, it is important that Clubhouses are able to gather service provision and performance data. However, establishing the necessary data structures can be a daunting task, and partnerships with academic researchers can aid in this process. We detail one such collaboration, utilizing a participatory research public-academic liaison framework, between researchers and Hawai'i's Clubhouses. SOURCES USED Sources used include published literature, personal communication, and personal observation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Lessons learned during the collaboration include the importance of face-to-face contact, technology training, duplicated and unduplicated variables, and tailoring data structures to the culture and work-ordered day of each Clubhouse. Experiences in this collaboration confirm that with support Clubhouse members are capable of fulfilling the rigorous responsibilities of contributing to a performance indicator system.
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Affiliation(s)
- Phillip A Raab
- Department of Psychology, University of Hawai'i at Manoa
| | | | | | | | - James D Larsen
- Department of Psychology, University of Hawai'i at Manoa
| | - Michelle Chow
- Ko'olau Clubhouse, State of Hawai'i Department of Health, Adult Mental Health Division
| | - Kim Golis
- Waipahu Aloha Clubhouse, State of Hawai'i Department of Health, Adult Mental Health Division
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Yamada AM, Subica AM, Kim MA, Van Nguyen K, Lim CS, Mancuso LL. State of spirituality-infused mental health services in Los Angeles County wellness and client-run centers. Adm Policy Ment Health 2014; 41:835-44. [PMID: 24464481 DOI: 10.1007/s10488-014-0536-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Spiritual coping is associated with positive mental health outcomes for individuals with serious mental illness, yet spirituality-infused services are seldom offered in public sector mental health agencies. The Los Angeles County Department of Mental Health introduced a policy addressing spirituality in 2012. This study explored the breadth and degree to which spirituality-infused activities were being offered in 53 Los Angeles wellness and recovery centers after the policy was widely disseminated. More than 98 % of the centers offered options for spirituality-infused activities; one-third offered spirituality-focused groups. Los Angeles's progress may guide implementation of spirituality-infused services in other state or local public mental health systems.
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Affiliation(s)
- Ann-Marie Yamada
- School of Social Work, University of Southern California, 669 West 34th Street, Montgomery Ross Fisher Bldg, 102C, Los Angeles, CA, 90089, USA,
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Subica AM, Fowler JC, Elhai JD, Frueh BC, Sharp C, Kelly EL, Allen JG. Factor structure and diagnostic validity of the Beck Depression Inventory–II with adult clinical inpatients: Comparison to a gold-standard diagnostic interview. Psychol Assess 2014; 26:1106-15. [DOI: 10.1037/a0036998] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Subica AM. Psychiatric and physical sequelae of childhood physical and sexual abuse and forced sexual trauma among individuals with serious mental illness. J Trauma Stress 2013; 26:588-96. [PMID: 24115301 DOI: 10.1002/jts.21845] [Citation(s) in RCA: 17] [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] [Indexed: 11/06/2022]
Abstract
Trauma and posttraumatic stress disorder (PTSD) frequently co-occur with serious mental illness, yet the unique mental and physical health influences of childhood physical abuse (CPA), childhood sexual abuse (CSA), and forced sexual trauma on individuals with serious mental illness remain unevaluated. The present study of 172 individuals with serious mental illness investigated the adverse effects of CPA, CSA, and forced sexual trauma on severity of PTSD and depression, and overall mental and physical health functioning. Data analysis consisted of chi-square tests, independent t tests, bivariate odds ratios, and linear regressions. Prevalence of CPA (44.8%), CSA (29.1%), and forced sexual trauma (33.1%) were elevated, and nearly one third of participants (31.4%) reported clinical PTSD. Participants exposed to CSA or forced sexual trauma evidenced bivariate ORs ranging from 4.13 to 7.02 for PTSD, 2.44 to 2.50 for major depression, and 2.14 to 2.31 for serious physical illness/disability. Sexual trauma exposure associated with heightened PTSD and depression, and reduced mental and physical health functioning, with CSA uniquely predicting PTSD, depression, and physical health difficulties. CPA less significantly affected these clinical domains. Sexual traumas have profound negative effects on mental and physical health outcomes among individuals with serious mental illness; increased screening and treatment of sexual traumas is needed.
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Affiliation(s)
- Andrew M Subica
- Postdoctoral Scholar, School of Social Work, University of Southern California, Los Angeles, California, USA
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Subica AM, Claypoole KH, Wylie AM. PTSD'S mediation of the relationships between trauma, depression, substance abuse, mental health, and physical health in individuals with severe mental illness: evaluating a comprehensive model. Schizophr Res 2012; 136:104-9. [PMID: 22104139 DOI: 10.1016/j.schres.2011.10.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 10/26/2011] [Accepted: 10/28/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Following trauma exposure and PTSD, individuals with severe mental illness (SMI) frequently suffer a complex course of recovery complicated by reduced mental and physical health and increased substance abuse. The authors evaluated a theoretical PTSD-SMI model which theorizes that trauma, PTSD, depression, substance abuse, mental health, and physical health are interrelated and that PTSD mediates these relationships. METHOD Participants were ethnoracially diverse individuals diagnosed with SMI (N=175) who were assessed for trauma exposure, severity of PTSD and depression, substance abuse, and overall mental and physical health functioning. Pearson's correlations were utilized to examine the relationships between study domains. The mediating effects of PTSD were assessed using regression coefficients and the Sobel test for mediation. RESULTS A majority of participants with SMI (89%) reported trauma exposure and 41% reported meeting diagnostic criteria for PTSD. On average, participants were exposed to over four types of traumatic events. Trauma, severity of PTSD and depression, substance abuse, and overall mental and physical health functioning were significantly interrelated. PTSD partially mediated the relationships between trauma and severity of depression and between trauma and overall mental health; PTSD fully mediated the trauma and overall physical health relationship. DISCUSSION Within an ethnoracially diverse SMI sample, trauma exposure and PTSD comorbidity were high and associated with severity of depression, substance abuse, overall mental health and physical health functioning. Supporting our theoretical PTSD-SMI model, PTSD mediated the adverse effects of trauma exposure on participants' current severity of depression and overall mental and physical health functioning.
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Affiliation(s)
- Andrew M Subica
- University of Hawai'i at Mānoa, 2350 Dole Street, Sakamaki C400, Honolulu, HI 96822, USA.
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