Exploring the Correlates of Linkage to HIV Medical Care Among Persons Living with HIV Infection (PLWH) in the Deep South: Results and Lessons Learned from the Louisiana Positive Charge Initiative.

We explored the correlates of linkage to HIV medical care and barriers to HIV care among PLWH in Louisiana. Of the 998 participants enrolled, 85.8% were successfully linked to HIV care within 3 months. The majority of participants were male (66.2%), African American (81.6%), and had limited education (74.4%). Approximately 22% of participants were Black gay and bisexual men. The most common reported barrier to care was lack of transportation (27.1%). Multivariable analysis revealed that compared with Black gay and bisexual men, White gay and bisexual men were significantly more likely to be linked to HIV care (adjusted prevalence ratio, aPR 1.08, 95% CI 1.02-1.13). Additionally, participants reporting moderate to high levels of stigma at intake (p < 0.05) were significantly more likely to be linked to HIV care compared with those reporting low or no stigma at enrollment. Study findings highlight the continued importance of client-centered interventions and multi-sector collaborations to link PLWH to HIV medical care.

Assessing Potentially Preventable Hospitalizations at the County Level: A Comparison of Measures Using Medicare Data and State Hospital Discharge Data.

This study examined the representativeness of the County Health Rankings and Roadmaps (CHR) measure of potentially preventable hospitalizations, which is derived from Medicare inpatient claims data, as an indicator of potentially preventable hospitalizations for adults aged ≥18 years. Potentially preventable hospitalizations were evaluated using rates of ambulatory care sensitive conditions (ACSCs). CHR rates of hospitalization for ACSCs based on Medicare data for 2010, Agency for Healthcare Research and Quality Prevention Quality Indicator #90 Overall Composite (PQI #90 Composite) rates of ACSCs based on hospital inpatient data for adults aged ≥18 years for 2011, and 2011 total mortality rates for adults aged ≥18 years for 212 counties in 3 US states were evaluated. Pearson correlation analyses were used to assess the linear association between the PQI #90 Composite and CHR rates of hospitalization for ACSCs as well as associations of these measures with total mortality. Steiger's Z-test was conducted to examine whether the PQI #90 Composite and CHR measures of health care quality were similarly correlated with total mortality. The age- and sex-adjusted PQI #90 Composite for adults ≥18 years was moderately correlated with the CHR rate of hospitalization for ACSCs. The PQI #90 Composite and CHR measures of hospitalization for ACSCs were similarly correlated with mortality. These findings suggest that in the absence of easily accessible, high-quality data for adults aged ≥18 years, the CHR measure of potentially preventable hospitalizations provides a modest but acceptable approximation of county-level disparities in potentially preventable hospitalizations for the US adult population.

Clergy referral of suicidal individuals: a qualitative study.

In a national study, 25% of help-seekers contacted clergy; suicidal behavior was one of the significant predictors for making contact. Clergy have been found to refer 10% of help-seekers to mental health providers. This qualitative study explored the referral practices of 15 northeastern Mainline and Evangelical Protestant clergy when contacted by suicidal individuals; all referred to mental health providers. Participants reported low confidence with risk identification and provided moving examples of pastoral care.

An ecological analysis of alcohol-outlet density and campus-reported violence at 32 U.S. colleges.

OBJECTIVE: The purpose of this study was to assess the relationships among campus violence, student drinking levels, and the physical availability of alcohol at off-campus outlets in a multisite design. METHOD: An ecological analysis of on-campus violence was conducted at 32 U.S. colleges. Dependent variables included campus-reported rates of rape, robbery, assault, and burglary obtained from a U.S. Department of Education online database for the years 2000-2004. Measures of student alcohol use and demographics were obtained from student surveys conducted for the Social Norms Marketing Research Project from 2000 to 2004. Measures of alcohol-outlet density within 3 miles of each campus were obtained from state alcohol-licensing authorities for 2004. RESULTS: Both on- and off-premise alcohol-outlet densities were associated with the campus rape-offense rate but not with the assault or robbery rates. Student drinking level was associated with both campus rape and assault rates but not with the campus robbery rate. The apparent effect of on-premise outlet density on campus rape-offense rates was reduced when student drinking level was included in the model, suggesting that the effect of on-premise outlet density may be mediated by student drinking level. Separate analyses revealed a similar mediational role for off-premise outlet density. CONCLUSIONS: These findings demonstrate that there is a campus-level association between sexual violence and the campus-community alcohol environment.

Misspecification of the effect of race in fixed effects models of health inequalities.

The purpose of this study is to characterize the different results obtained when analyzing health inequalities data in which individuals are nested within their neighborhoods and a single level model is used to characterize risk rather than a multilevel model. The inability of single level models to characterize between neighborhood variance in risk may affect the level of risk attributed to black race if blacks are differentially distributed in high risk neighborhoods. The research replicates in Los Angeles an approach applied by a different group of researchers in Massachusetts (Subramanian, Chen, Rehkopf, Waterman, & Krieger, 2005). Single level and multilevel models were used to analyze Los Angeles County, California, US all-cause mortality data for the years 1989-1991, modeled as 29,936 cells (deaths and population denominators cross-tabulated by age, gender, and race/ethnicity) nested within 1552 census tracts. Overall blacks had 1.27 times the risk of mortality compared to whites. However, multilevel models demonstrated considerable between census tract variance in mortality for both blacks and whites which was partially explained by neighborhood poverty. Comparing the results of equivalent single level and multilevel models, the mortality odds ratio for blacks compared to the white reference group reversed itself, indicating greater risk for blacks in the single level model and lower risk in the multilevel model. Adding an area based socioeconomic measure (ABSM) to the single level model reduced but did not remove the discrepancy. Predictions of mortality risk for the interaction of race and age group demonstrate that all single level models exaggerated the mortality risk associated with black race. We conclude that characterizing health inequalities in mortality for blacks using single level models, which do not account for the cross level interaction created by the greater likelihood of black residence in neighborhoods where the risk of mortality is greater regardless of race, can exaggerate the risk of mortality attributable to the individual level effects of black race.

A multisite randomized trial of social norms marketing campaigns to reduce college student drinking: a replication failure.

A 14-site randomized trial tested the effectiveness of social norms marketing (SNM) campaigns, which present accurate student survey data in order to correct misperceptions of subjective drinking norms and thereby drive down alcohol use. Cross-sectional student surveys were conducted by mail at baseline and at posttest 3 years later. Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking into account the nonindependence of students grouped in the same college. Controlling for other predictors, having a SNM campaign was not significantly associated with lower perceptions of student drinking levels or lower self-reported alcohol consumption. This study failed to replicate a previous multisite randomized trial of SNM campaigns, which showed that students attending institutions with a SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions (W. DeJong et al. J Stud Alcohol. 2006;67:868-879). Additional research is needed to explore whether SNM campaigns are less effective in campus communities with relatively high alcohol retail outlet density.

A multisite randomized trial of social norms marketing campaigns to reduce college student drinking.

OBJECTIVE: An 18-site randomized trial was conducted to determine the effectiveness of social norms marketing (SNM) campaigns in reducing college student drinking. The SNM campaigns are intended to correct misperceptions of subjective drinking norms and thereby drive down alcohol consumption. METHOD: Institutions of higher education were randomly assigned to treatment and control groups. At the treatment group institutions, SNM campaigns delivered school-specific, data-driven messages through a mix of campus media venues. Cross-sectional student surveys were conducted by mail at baseline (n = 2,771) and at posttest 3 years later (n = 2,939). Hierarchical linear modeling was applied to examine multiple drinking outcomes, taking intraclass correlation into account. RESULTS: Controlling for other predictors, having an SNM campaign was significantly associated with lower perceptions of student drinking levels and lower alcohol consumption, as measured by a composite drinking scale, recent maximum consumption, blood alcohol concentration for recent maximum consumption, drinks consumed when partying, and drinks consumed per week. A moderate mediating effect of normative perceptions on student drinking was demonstrated by an attenuation of the Experimental Group x Time interaction, ranging from 16.4% to 39.5% across measures. Additional models that took into account the intensity of SNM campaign activity at the treatment institutions suggested that there was a dose-response relationship. CONCLUSIONS: This study is the most rigorous evaluation of SNM campaigns conducted to date. Analysis revealed that students attending institutions that implemented an SNM campaign had a lower relative risk of alcohol consumption than students attending control group institutions.

AIDS, drought, and child malnutrition in southern Africa.

OBJECTIVE: To investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3. DESIGN: Epidemiological analysis of sub-national and national surveys with related data. SETTING: Data from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices. SUBJECTS: Secondary data: children 0-5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance. RESULTS: Child nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997-2002), 17 to 32% in Copperbelt (Zambia, 1999-2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999-2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas--with greater reliance on trade and wage employment--have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status. CONCLUSIONS: First, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.