Arts and Culture: A Necessary Component to Address Unmet Social Needs and Advance Individual and Community Well-Being.

U.S. healthcare institutions increasingly integrate screenings for social needs into standard care, and help meet those needs by referring patients to community-based resources. However, community arts/culture assets are not commonly included among those resources. Given growing evidence of the positive health impacts of arts/culture, and given that access to these benefits remains inequitable, this article argues for the integration of arts/culture resources into healthcare referral networks. It highlights two early models, the CultureRx initiative in Massachusetts and Creative Forces, both of which piloted this integration with promising results. It also offers suggestions for better utilizing local arts/culture assets, emphasizing that these existing community resources can and should be applied to advance whole-person strategies and better address social drivers of health.

Associations among ACEs, Health Behavior, and Veteran Health by Service Era.

Objectives: Despite substantial research linking adverse childhood experiences (ACEs) and health, it is unclear how associations differ by veteran status and military service era (draft, volunteer era). The current study evaluated differences in ACEs and health by veteran status and era, increasing understanding important for service provision as the volunteer era veteran population increases. Methods: Behavioral Risk Factor Surveillance System 2012 data were used in univariate and weighted multivariable logistic regression models to assess associations among veteran status, service era, ACEs, and health. Results: Volunteer era veterans experienced the most ACEs (M = 2.42); draft era veterans experienced the fewest (M = 1.04). Individuals reporting 3 or more ACEs were 3.67 times (95% CI = 3.22-4.19) more likely to endorse depression, 1.32 times (95% CI = 1.17-1.48) more likely to report poorer general health, and 1.77 times (95% CI = 1.58-1.97) more likely to endorse poorer physical health, compared to those reporting none. Volunteer era veterans were 2.43 times more likely to report poorer physical health (95% CI = 1.49-3.97) than draft era veterans, adjusting for ACEs. Conclusions: ACEs were associated with poorer health independent of veteran status and service era. Volunteer era veterans experienced more ACEs; need for trauma-informed services supporting whole health may increase.

A Latent Class Analysis of the Co-occurrence of Risk Behaviors among Adolescents.

Objectives: In this study, we examined the co-occurrence of multiple health-risk behaviors to determine whether there are any differences in the pattern of co-occurrence by sex. Methods: We conducted latent class analysis using the national 2013 Youth Risk Behavior Survey data for the overall sample, and separately by sex (N = 13,583). Results: Over half of the sample (53%) belonged to the low risk subgroup (Class 1). Class 2 accounted for 15% of adolescents, and over 40% in this subgroup reported riding with a drunk driver, and 63% reported texting while driving a vehicle. Over 14% belonged to Class 3, which had a higher probability of being depressed and suicidal (81% and 64%, respectively). Class 4 accounted for over 9% of adolescents who reported high probabilities for current cigarette (97%), tobacco (99%), and alcohol use (73%); and over half reported current marijuana use (52%). Class 5 accounted for 8.5% of adolescents identified as high-risk polysubstance users. Analyses showed differences by sex in the pattern of co-occurrences. Conclusion: Several adolescent risk behaviors are interrelated regardless of sex. However, sex differences in the higher probability of depressive symptoms and suicidality among girls highlight the need for interventions that consider the demographic composition of adolescents.

Tobacco and Other Drug Use among Foster Care Adolescents in West Virginia.

OBJECTIVES: This study presents tobacco and other drug use prevalence data from a statewide health screening program of foster care (FC) children in West Virginia, and explores associations with demographic and placement variables. METHODS: Logistic regression analyses adjusted for age, sex, and body mass index were conducted to determine if placement type and geographic region were associated with tobacco and other drug use among FC adolescents screened in 2012-2013 by the Early Periodic Screening Diagnosis and Treatment (EPSDT), or HealthCheck WV. RESULTS: One-third of the 12-17 year-olds used tobacco and 24% used other drugs. Results from the logistic regression analyses showed that significant associations between tobacco and drug use and placement variables persisted after controlling for covariates. Adolescents in home placements were significantly less likely to use tobacco (AOR=0.294; 95% CI: 0.196-0.441) or drugs (AOR=0.269; 95%, CI: 0.164-0.443) than those in agency placements. Details of significant regional variations also are presented. CONCLUSIONS: This study provides evidence of tobacco and drug use in West Virginia's FC adolescents and highlights a need for appropriate interventions for this vulnerable population.

Adolescent Pregnancy and Smoking in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) 2005-2010.

Objective The purpose of this study was to examine the association between prenatal smoking and small for gestational age (SGA) infants among adolescent women in West Virginia, taking into account sociodemographic and health-related factors. Methods Secondary data analysis was conducted using the 2005-2010 West Virginia Pregnancy Risk Assessment and Monitoring Systems weighted dataset. The study population using complete case analysis procedure consisted of 886 adolescent women ages 19 and younger who delivered a live singleton infant in West Virginia. Results The prevalence of smoking among adolescents during the last 3 months of pregnancy was 67 %. Nearly a quarter (22.0 %) of the adolescents gave birth to SGA infants. Results from the logistic regression analysis showed that after controlling for sociodemographic and health-related variables, adolescents who smoked during the last 3 months of pregnancy were more likely to have SGA infants than those who did not smoke during the last 3 months of pregnancy (OR = 1.86, 95 % CI 1.06-3.27, P = 0.0307). Conclusion This study highlights the importance of recognizing that prenatal smoking is an issue among West Virginia adolescents and the need for evidence-based, culturally, and developmentally appropriate interventions for this Appalachian population.

Factors Associated with Receipt of Pre-pregnancy Preventive Dental Care Among Women in West Virginia: Pregnancy Risk Assessment Monitoring System (PRAMS) Survey 2009-2010.

PURPOSE: To examine the association between sociodemographic, economic and health-related lifestyle factors and receipt of pre-pregnancy dental cleaning in West Virginia. MATERIALS AND METHODS: A population-based secondary data analysis was conducted using the 2009-2010 West Virginia Pregnancy Risk Assessment Monitoring System (PRAMS) dataset. The study population consisted of 3050 women who answered the survey question about pre-pregnancy dental cleaning. RESULTS: Approximately 47% of the participants visited a dentist during the 12 months before pregnancy. Results from the logistic regression model showed that pre-pregnant Non-Hispanic white women were more likely to get their teeth cleaned compared to women from other racial/ethnic backgrounds (OR = 1.75; 95% CI: 1.01-3.04). Women with more than a high-school education (OR = 1.79; 95% CI: 1.22-2.62), young women < 20 years of age (OR = 2.75; 95% CI: 1.86-4.06), women with private health insurance (OR = 2.65; 95% CI: 1.98-3.55) and women who had intended pregnancy (OR = 1.3; 95% CI: 1.04-1.64) were more likely to have dental cleaning before pregnancy compared to women with less than a high-school education, women between the ages of 20-29, uninsured women and women who had unintended pregnancy, respectively. CONCLUSION: Identifying factors associated with dental cleaning can aid healthcare providers and policy makers in developing approaches to promoting oral care among women of childbearing age.