Sociodemographic Disparities in the Tobacco Retail Environment in Washington, DC: A Spatial Perspective.

Objective: Studies assessing sociodemographic disparities in the tobacco retail environment have relied heavily on non-spatial analytical techniques, resulting in potentially misleading conclusions. We utilized a spatial analytical framework to evaluate neighborhood sociodemographic disparities in the tobacco retail environment in Washington, DC (DC) and the DC metropolitan statistical area (DC MSA). Methods: Retail tobacco availability for DC (n=177) and DC MSA (n=1,428) census tract was assessed using adaptive-bandwidth kernel density estimation. Density surfaces were constructed from DC (n=743) and DC MSA (n=4,539) geocoded tobacco retailers. Sociodemographics were obtained from the 2011-2015 American Community Survey. Spearman's correlations between sociodemographics and retail density were computed to account for spatial autocorrelation. Bivariate and multivariate spatial lag models were fit to predict retail density. Results: DC and DC MSA neighborhoods with a higher percentage of Hispanics were positively correlated with retail density (rho = .3392, P = .0001 and rho = .1191, P = .0000, respectively). DC neighborhoods with a higher percentage of African Americans were negatively correlated with retail density (rho = -.3774, P = .0000). This pattern was not significant in DC MSA neighborhoods. Bivariate and multivariate spatial lag models found a significant inverse relationship between the percentage of African Americans and retail density (Beta = -.0133, P = .0181 and Beta = -.0165, P = .0307, respectively). Conclusions: Associations between neighborhood sociodemographics and retail density were significant, although findings regarding African Americans are inconsistent with previous findings. Future studies should analyze other geographic areas, and account for spatial autocorrelation within their analytic framework.

Mediated Effects of Coping on Mental Health Outcomes of African American Women Exposed to Physical and Psychological Abuse.

Few studies have assessed the individual symptoms of posttraumatic stress disorder (PTSD) as separate mental health consequences of intimate partner abuse (IPA). This study examined the role of coping strategies associated with symptoms of PTSD in a community sample of African American women who have experienced abuse ( N = 128). The results revealed that nonphysical abuse was more prevalent than physical abuse. Specific symptoms of PTSD expressed depended on the type of abuse experienced and the type of coping strategies utilized. The findings have multiple implications on how IPA is studied as well as its clinical screening and treatment processes.

Comparison of Metabolic Syndrome Indicators in Two Samples of Central and South Americans Living in the Washington, D.C. Area in 1993-1994 and 2008-2009: Secular Changes in Metabolic Syndrome in Hispanics.

The Central and South American populations are growing rapidly in the US; however, there is a paucity of information about their health status. Objectives: we estimated the prevalence of metabolic syndrome (MetS) and its individual components from two cohorts of Central and South Americans. Methods: This cross-sectional, medical record extraction survey sampled 1641 adults from a Washington, D.C clinic. A questionnaire was used to collect socio-demographic, medical history, anthropometric, biochemical, and clinical data. Results: among the 1993-1994 cohort, the MetS prevalence was 19.7%. The most prevalent MetS components were low high-density lipoprotein (HDL) cholesterol (40.4% men and 51.3% women), elevated triglycerides (40.9% men and 33.1% women), and high body mass index (BMI) ≥ 25 kg/m² (27.6% men and 36.6% women). The overall prevalence of MetS in the 2008-2009 cohort was 28%. The most common abnormal metabolic indicator was an elevated BMI ≥ 25 kg/m² (75.6%). 43.2% of men and 50.7% of women had HDL levels below normal, while the prevalence of hypertriglyceridemia was 46.5% and 32.5% for men and women, respectively. Conclusion: the prevalence of MetS was significantly greater in 2008-2009 compared with 1993-1994 (p ≤ 0.05). Dyslipidemia and high BMI have increased. Although similar components were identified in both the 1993-1994 and 2008-2009 study populations, the risks of MetS have increased over time.

Muslim American adolescents' explanations of changing religious practices: Cultural tools in cultural contexts.

To examine the culturally embedded nature of religious practices, we conducted a mixed-methods study in which Muslim American adolescents described how and why their religious practices had changed in recent years (see Etengoff & Daiute, 2013, J. Adolesc. Res., 28, 690). Participants included 201 Muslim adolescents (ages 13-19) from predominantly immigrant families; all were contestants in a Muslim Inter-Scholastic Tournament regional competition. Participants completed surveys including an item regarding whether their religious practices had changed, and for those who answered affirmatively, open-ended questions about the change. Additional measures assessed ethnic identity and perceived discrimination. As hypothesized, the 60% of participants who reported a change in religious practices described this shift as a response to new contexts, people, and religious knowledge. Those who reported a change also reported higher levels of ethnic identity exploration and perceived discrimination. Overall, Muslim American adolescents' descriptions portrayed religious practices as developing through reciprocal interactions with culture. More generally, participants' descriptions point to the viability of a model in which religious practices change and in turn are changed by cultural contexts. Statement of contribution What is already known on this subject? Religious development is viewed as taking place in relational systems with reciprocity between individuals and surrounding contexts. Variations in contexts predict variations in religious development, but mechanisms of development are not well understood. Muslim Americans, including adolescents, show high levels of religious involvement and experience unique cultural and religious contexts. Muslim American emerging adults describe their religious practices as responsive to sociocultural contexts. What does the study add? This study focuses on Muslim American adolescents, a group that has received little research attention, especially in regard to religious development. Participants reported a wide array of changes in religious practices, and they described these changes as responses to social and cultural influences. Participants' descriptions of changing practices can be understood through a Vygotskian framework in which religious practices are cultural tools that both respond to and shape surrounding cultural contexts.

Strongyloidiasis in Latin American immigrants: a pilot study.

The United States of America (USA) has the largest international population of any nation in the world. Immigrants from Latin American countries, where intestinal parasites are endemic, comprise more than half of this population. This study aims to determine the prevalence of strongyloidiasis, a potentially deadly parasitic infection, in foreign-born individuals. We conducted a cross-sectional study in Washington, DC, to determine the seroprevalence of Strongyloides stercoralis infection using an NIE-ELISA IgG antibody assay. Multi-parallel quantitative real-time polymerase chain reaction (qPCR) was performed in stool samples of NIE-ELISA-positive patients to investigate possible polyparasitism. The NIE-ELISA assay detected an S. stercoralis prevalence of 4.2% in a group of 119 volunteers. Combining NIE-ELISA and qPCR detected a parasite prevalence of 5.0%. Our results underscore the relevance of systematic testing for gastrointestinal parasites in individuals from endemic regions. It also makes a case for a survey in the USA to identify immigrants' risk for strongyloidiasis and other gastrointestinal parasitic infections.

Reasons for Infant Feeding Decisions in Low-Income Families in Washington, DC.

BACKGROUND: Breastfeeding rates for low-income, African American infants remain low. OBJECTIVE: This study aimed to determine the barriers, support, and influences for infant feeding decisions among women enrolled in the Washington, DC, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) after revisions in the WIC package to include more food vouchers for breastfeeding mothers and their infants and improvement of in-hospital breastfeeding support. METHODS: We surveyed 100 women, using a 42-item verbally administered survey that asked about demographics, infant feeding method, and influences and support for feeding decisions. RESULTS: The majority of participants (76%) initiated breastfeeding; 31% exclusively breastfed in the hospital. Participants were more likely to breastfeed if they had some college education, were unemployed or employed full-time, had only one child, and had been breastfed themselves as infants. Barriers to prolonged breastfeeding included limited support after hospital discharge, pain, and perceived insufficient milk supply. Participants in this study had higher breastfeeding initiation and in-hospital exclusivity rates after improvement of in-hospital breastfeeding support. CONCLUSION: Clients of WIC initiated breastfeeding at a high rate but either supplemented with formula or stopped breastfeeding for reasons that could be remedied by improved prenatal education, encouragement of exclusive breastfeeding in the hospital, and more outpatient support.

Ethnic differences in ischemic stroke subtypes in young-onset stroke: the Stroke Prevention in Young Adults Study.

BACKGROUND: Prior studies indicate that young African-Americans (AA) have a greater frequency of ischemic stroke than similarly aged European-Americans (EA). We hypothesized that differences in stroke subtype frequency mediated through sex and differing risk factor profiles may play a role in ethnicity-specific stroke. Utilizing our biracial young-onset stroke population, we explored these relationships. METHODS: Fifty nine hospitals in the Baltimore-Washington area participated in a population-based study of young-onset stroke in men (218-AA, 291-EA) and women (219-AA, 222-EA) aged 16-49. Data on age, sex, ethnicity and stroke risk factors (hypertension (HTN) and smoking) were gathered through standardized interview. A pair of vascular neurologists adjudicated each case to determine TOAST subtype. Logistic regression analyses evaluating for differences in stroke risk factors by TOAST subtype were performed. RESULTS: Analyses controlling for age and sex demonstrated that AA were more likely to have a lacunar stroke than EA (OR = 1.61; 95% CI = 1.12-2.32; p = 0.011) when utilizing the other TOAST subtypes as the reference group. This effect was mediated by HTN, which increases the risk of lacunar stroke (OR = 2.03; 95% CI = 1.38-2.98; p = 0.0003) and large artery stroke (OR = 1.70; 95% CI = 1.01-2.88; p = 0.048) when controlling for sex, ethnicity, and age. Cases below age 40 were more likely to have a cardioembolic stroke than those above age 40 (OR = 1.62; 95% CI = 1.15-2.27; p = 0.006), controlling for sex and ethnicity. Lastly, current smokers were more likely to have a large artery stroke than non-smokers (OR = 1.79; 95% CI = 1.08-2.98; p = 0.024). CONCLUSIONS: Our population-based data demonstrate ethnic differences in ischemic stroke subtypes. These findings may help clarify mechanisms of stroke in young adults which may in part be driven by ethnic-specific differences in early-onset traditional risk factors, thereby indicating differing emphasis on workup and prevention.

Deleterious BRCA1/2 mutations in an urban population of Black women.

Information on the prevalence of deleterious BRCA1 and BRCA2 (BRCA1/2) mutations in clinic-based populations of Black women is limited. In order to address this gap, we performed a retrospective study to determine the prevalence of deleterious BRCA1/2 mutations, predictors of having a mutation, and acceptance of risk-reducing surgeries in Black women. In an urban unselected clinic-based population, we evaluated 211 self-identified Black women who underwent genetic counseling for hereditary breast-ovarian cancer syndrome. BRCA1/2 mutations were identified in 13.4% of the participants who received genetic testing. Younger age at diagnosis, higher BRCAPRO score, significant family history, and diagnosis of triple-negative breast cancer were associated with identification of a BRCA1/2 mutation. Of the affected patients found to have a deleterious mutation, almost half underwent prophylactic measures. In our study population, 1 in 7 Black women who underwent genetic testing harbored a deleterious BRCA1/2 mutation independent of age at diagnosis or family history.

Growing up as "man of the house": adultification and transition into adulthood for young men in economically disadvantaged families.

Many children in economically disadvantaged communities assume adult roles in their families. Negotiating the responsibilities and expectations associated with becoming what some young men describe as "man of the house" has important implications for how adolescent boys move into adulthood. In this study, we share insights from field work and life-history interviews with low-income, young African American men and Salvadoran men in the Washington, DC/Baltimore region to illustrate how adultification may deliver contradictory expectations for adolescents. The findings also show how the accelerated responsibilities that accompany the experience of adultification create difficulties in the young men's transition into adulthood. These findings indicate that the age period of emerging adulthood may begin earlier for economically disadvantaged young men.

Correlates of group sex among a community-based sample of men who have sex with men (MSM) in Washington, DC.

Participation of MSM in group sex events (GSEs) is an understudied phenomenon. Studies on GSEs identified significant proportions of MSM engaging in unprotected anal intercourse (UAI). We sought to identify the prevalence of group sex participation among MSM in Washington, DC and to characterize these experiences. Data were collected for NHBS-MSM-3 in 2011. More than one-quarter of MSM (27.2 %) reported engaging in group sex in the prior year, with one-third reporting no condom use with their sex partners (33.0 %). In multivariable logistic regression, men who participated in a GSE in the prior year were significantly younger, more likely to be white, and to have used crystal meth, poppers, and downers in the past year. The high prevalence of UAI during GSEs, especially in view of the fact that HIV-positive MSM were significantly less likely to report condom use, offers an opportunity to develop risk reduction interventions specific to GSE attendees.

Association of chronic kidney disease with cerebral microbleeds in patients with primary intracerebral hemorrhage.

BACKGROUND AND PURPOSE: To investigate the relationship between chronic kidney disease (CKD) and MRI-defined cerebral microbleeds (CMB), a harbinger of future intracerebral hemorrhage (ICH), among patients with a recent history of primary ICH. METHODS: Using data from a predominantly black cohort of patients with a recent ICH-enrolled in an observational study between September 2007 and June 2011, we evaluated the association between CKD (defined as estimated low glomerular filtration rate<60 mL/min per 1.73 m(2)) and CMB on gradient-echo MRI. Multivariable models were generated to determine the contribution of CKD to the presence, number, and location of CMB. RESULTS: Of 197 subjects with imaging data, mean age was 59 years, 48% were women, 73% were black, 114 (58%) had ≥1 CMBs, and 52 (26%) had CKD. Overall, CKD was associated with presence of CMB (adjusted odds ratio, 2.70; 95% confidence interval [CI], 1.10-6.59) and number of CMB (adjusted relative risk, 2.04; 95% CI, 1.27-3.27). CKD was associated with CMB presence (adjusted odds ratio, 3.44; 95% CI, 1.64-7.24) and number (adjusted relative risk, 2.46; 95% CI, 1.11-5.42) in black patients, but not CMB presence (adjusted odds ratio, 3.00; 95% CI, 0.61-14.86) or number (adjusted relative risk, 1.03; 95% CI: 0.22-4.89) in non-Hispanic white patients (interactions by race were statistically not significant). CONCLUSIONS: CKD is associated with a greater presence and number of CMB in ICH patients, particularly in patients of black race. Future studies should assess whether low estimated glomerular filtration rate may be a CMB risk marker or potential therapeutic target for mitigating the development of CMB.

Racial and socioeconomic disparities in epilepsy in the District of Columbia.

We investigated social and demographic factors as they relate to prevalence and incidence of epilepsy in Washington, DC, a culturally diverse area. Probability-based sampling was used to select 20,000 households to complete a mailed epilepsy screening survey on all household members. Screened individuals with a history of epilepsy were sent a detailed case survey about seizures and treatment. Prevalence and incidence of epilepsy were estimated using weighted data. Lifetime prevalence was 1.53% overall; 0.77% in Whites, 2.13% in Blacks, and 3.4% in those with less than a high school diploma. Prevalence of active epilepsy was 0.79% and followed similar subgroup comparisons as lifetime prevalence. Age-adjusted lifetime and active epilepsy from multivariate analyses demonstrated significantly higher rates for Blacks compared to Whites and for those not completing high school compared to those that attended graduate school. The incidence of epilepsy was 71 per 100,000 persons. Adults with active epilepsy were significantly less likely to live alone than those without epilepsy. Residents of DC for <4 years had the lowest prevalence and incidence of all subgroups indicating a possible healthy mover effect. This is the first study to provide estimates and profiles of the epilepsy population in DC which can help better target resources to improve the health and outcomes of people with epilepsy and their families.

African American participation and success in telephone counseling for smoking cessation.

INTRODUCTION: Quitlines that provide telephone counseling for smoking cessation have been proved to be effective. All 50 states currently provide free quitline access to their residents; however, little research has been published on African American utilization of quitlines or their success rates. METHODS: This study evaluated how effectively African Americans are served by telephone counseling (quitline) for smoking cessation based on empirical data from 45,510 callers from Texas, Louisiana, Washington, and District of Columbia and randomized clinical trial data from 3,522 participants. RESULTS: African Americans tended to use a quitline in proportions greater than their proportional representation in the smoking communities in both states and the District. African American quit rates were equivalent to those of non-Hispanic "Whites" as were their levels of satisfaction with the service and the number of counseling sessions they completed. African Americans were more likely to request counseling than non-Hispanic Whites. CONCLUSIONS: This study demonstrates that telephone counseling is a promising tool for addressing health disparities related to smoking among African Americans.

Religious involvement, beliefs about God, and the sense of mattering among older adults.

Using data from a 2001­2002 sample of adults aged 65 and older living in the Washington, DC metropolitan area, we examine the associations among religious involvement (as measured by the frequency of attendance at religious services and praying), the belief in divine control, and the sense of mattering­a key component of the self-concept. We also assess the extent to which these patterns vary by gender, race, and education. Findings indicate indirect effects of religious attendance on mattering through divine control beliefs and the frequency of social contact. Praying increases mattering indirectly only through divine control beliefs. Moreover, divine control beliefs are more strongly associated with mattering among women, African Americans, and individuals with less education. We discuss the contribution of these findings for theory about the links between religious involvement, beliefs about God, and psychosocial resources, and the influence of core dimensions of social status and stratification.

The association between self-reported major life events and the presence of uterine fibroids.

PURPOSE: Uterine fibroids are the most common benign tumors in reproductive-age women. Factors associated with this condition such as psychosocial stress are still being elucidated. This paper explores the association between major life events (MLE) stress and fibroids. METHODS: Prevalence ratios (PR) and 95% confidence intervals (CI) were used to determine the association between MLE stress (number of events and stress intensity) and fibroids in 556 Black and 373 White women in the Uterine Fibroid Study, 1996-1999. MAIN FINDINGS: Fibroids were prevalent in 74% and 50% of the Black and White women, respectively. The mean number of MLE reported by each race group was two. Among White women, the PR for those who reported at least one event compared with those with no events were significant after adjusting for age and study identified fibroid risk factors (PR [1 and 2 events], 1.7; 95% CI, 1.2-2.5), (PR [3 events], 1.9; 95% CI, 1.3-2.7), and (PR [4 events], 1.5; 95% CI, 1.0-2.1), respectively. At all levels of stress compared with no events, significant associations with fibroids were found among White women. For Black women, the PR for fibroids was only significant in the high stress group compared with those without an experienced event, after adjusting for fibroid risk factors (PR, 1.2; 95% CI, 1.1-1.4). CONCLUSION: Examining the number and stress intensity of MLE enriched our understanding of this stressor and fibroids. Further research is needed to understand the role of stress on fibroids among women.

Disparities despite coverage: gaps in colorectal cancer screening among Medicare beneficiaries.

BACKGROUND: Despite its effectiveness in reducing mortality, colorectal cancer (CRC) screening rates are low, especially among low-income and minority groups; however, physician recommendation can increase screening rates. METHODS: We performed a multilevel analysis of the Medicare Current Beneficiary Survey data linked to Medicare claims and the Area Resource File to identify determinants of racial and socioeconomic disparities in CRC screening among 9985 Medicare Parts A and B beneficiaries with a usual physician. Recent CRC screening was defined as receipt of either a home fecal occult blood test, flexible sigmoidoscopy, or colonoscopy at recommended intervals. RESULTS: Unadjusted rates of screening were 48% for white and 39% for black beneficiaries (P<.001). Racial differences in CRC screening receipt were eliminated after adjustment for socioeconomic status as measured by income and education. Socioeconomic status disparities decreased but remained significant after adjustment for personal and health system factors. Awareness of CRC (adjusted odds ratio, 2.76; 95% confidence interval, 2.29-3.33) and having a primary care generalist (vs another specialist) as one's usual physician (adjusted odds ratio, 1.31; 95% confidence interval, 1.12-1.53) were associated with higher odds of screening, controlling for other factors. The odds of screening were also higher among those whose usual physician was rated more highly on information-giving skills. CONCLUSIONS: Racial differences in CRC screening rates among Medicare beneficiaries with a usual physician are explained by differences in socioeconomic status. Beneficiaries with a primary care generalist as their usual physician had higher rates of CRC screening receipt. Increased efforts to make Medicare beneficiaries aware of the benefits of CRC screening may capitalize on the associations found in this study between CRC knowledge, physician information giving, and timely screening.

Seasonal variation in mood in African American college students in the Washington, D.C., metropolitan area.

OBJECTIVE: The authors attempted to estimate the occurrence, frequency, and pattern (winter versus summer) of seasonal affective disorder in African American college students. They hypothesized that winter seasonal affective disorder would be more prevalent than summer seasonal affective disorder. METHOD: Undergraduate and graduate college students who identified themselves as African Americans living in the Washington, D.C., metropolitan area were invited to participate in the study. The Seasonal Pattern Assessment Questionnaire was used to calculate a global seasonality score and to estimate the frequency of seasonal affective disorder and subsyndromal seasonal affective disorder. The frequency of the summer versus winter pattern of seasonality of seasonal affective disorder was compared by using multinomial probability distribution tests. The effects of gender and the awareness of seasonal affective disorder were evaluated with a two-way analysis of variance. RESULTS: Of 646 students who were invited to participate, 597 returned the questionnaires, and 537 (83.1%) fully completed them. Winter seasonal affective disorder was significantly more prevalent than summer seasonal affective disorder. The mean global seasonality score was 8.3 (SD=5.3). The majority of the subjects (80%) were not aware of the existence of seasonal affective disorder. CONCLUSIONS: The authors found that the frequency, magnitude, and pattern of seasonality of mood in African American students were similar to those previously reported in the general population at similar latitude, but that awareness of the existence of seasonal affective disorder, a condition with safe and effective treatment options, was lower.

The role of trust in use of preventive services among low-income African-American women.

BACKGROUND: This study explored factors that predict higher trust in primary care providers, and examined the role of patient trust on the use of preventive services for low-income African-American women. METHODS: We conducted a cross-sectional, population-based telephone survey of 961 African-American women over age 40 in Washington, DC. Two dimensions of trust were examined: overall trust in one's regular primary care provider, and trust that the regular provider had no financial conflict of interest. Self-reported use of mammography, Pap tests, clinical breast exams, colorectal cancer screening, blood pressure, height and weight measurement, diet counseling, and depression screening, as delivered by one's primary care provider, were assessed. An index summarizing overall use of these interventions was the main outcome variable. RESULTS: More than two-thirds of respondents reported high trust in their physician. Older respondents (>65) were more trusting of their physicians overall than were younger respondents (P < 0.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust than were sociodemographic, health status, and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3, 95% CI: 1.3, 4.0), controlling for the effects of insurance status, primary care, and patient characteristics. CONCLUSIONS: Trust is associated with use of recommended preventive services in low-income African-American women. Stronger patient-provider relationships, with high levels of trust, may indirectly lead to better health through adherence to recommended preventive services for low income African-American women.

Correlates of exercise adherence in an African American church community.

This study identified correlates of attendance to a community-based exercise program in an African American church congregation. After medical clearance, 48 participants completed measures of social support, health-related quality of life, depression, exercise self-efficacy, and exercise motivation and then participated in an exercise program for 6 months (attendance rate = 27%). Age, a sense of affiliation as a motivator to exercise, and weekly caloric expenditure derived from yard work were positively associated with program attendance, and full- or part-time employment was negatively associated with attendance. The authors concluded that exercise adherence is a complicated phenomenon that is influenced by a variety of environmental, personal, and social factors. Social factors, in particular, may be important in promoting adherence to an exercise program in African Americans.