Health care access, health care utilisation and sexual orientation disclosure among Black sexual minority men in the Deep South.

Background Black gay, bisexual, and other sexual minority men (BSMM) account for 39.1% of new HIV infections among men who have sex with men and 78.9% of newly diagnosed cases among Black men. Health care access, health care utilisation and disclosing sexuality to providers are important factors in HIV prevention and treatment. This study explored the associations among sexual orientation disclosure, health care access and health care utilisation among BSMM in the Deep South. METHODS: Secondary analysis of existing data of a population-based study in Jackson, Mississippi, and Atlanta, Georgia, was conducted among 386 BSMM. Poisson regression models were used to estimate prevalence ratios (PR) between sexual orientation disclosure to healthcare providers, health care access and health care utilisation. RESULTS: The mean (±s.d.) age of participants was 30.5 ± 11.2 years; 35.3% were previously diagnosed with HIV and 3.7% were newly diagnosed with HIV. Two-thirds (67.2%) self-identified as homosexual or gay; 70.6% reported being very open about their sexual orientation with their healthcare providers. After adjustment, BSMM who were not open about their sexual orientation had a lower prevalence of visiting a healthcare provider in the previous 12 months than those who were very open with their healthcare provider (PR 0.42; 95% confidence interval 0.18-0.97). CONCLUSION: Clinics, hospitals and other healthcare settings should promote affirming environments that support sexuality disclosure for BSMM.

Prevalence and Correlates of Rectal Douching and Enema Use Among Black Sexual Minority Men and Black Transwomen in the Deep South.

HIV/STI disparities are highest among Black sexual minority men (BSMM) and Black transwomen (BTW) in the Deep South. Exploring the prevalence and correlates of rectal douching and enema use could provide insights into risk factors and HIV/STI prevention opportunities among these groups. This study explored the prevalence and correlates of rectal douching and enema using Poisson regression models among 375 BSMM and BTW in Jackson, MS, and Atlanta GA. Approximately 95% reported their gender as male/man; 5.6% self-identified as transwomen. Most reported being single (73.1%) and were unemployed (56.0%); 36.1% were previously diagnosed with HIV. In multivariable models, BSMM and BTW who reported that their typical sexual position during anal sex was "bottom" (aPR = 2.39, 95% CI = 1.48, 3.84) or "versatile" (aPR = 2.46, 95% CI = 1.44, 4.17) had a higher prevalence of rectal douching and enema use than those who reported "top." Deeper understanding of the contexts of rectal douching, enema use, and sexual positioning practices is needed.

Improvements in the prescribing of antipsychotics in dementia and psychogeriatric units in New Zealand.

UNLABELLED: Background Despite warnings of possible serious events, and reports of little benefit, antipsychotic agents are commonly prescribed in residential care for older people with dementia. A residential care provider (RCP) in New Zealand sought to examine and improve prescribing in some of their facilities. Objective To examine changes following a range of interventions implemented by a RCP to improve the prescribing of antipsychotics. Setting Thirteen dementia and psychogeriatric units in New Zealand managed by a RCP. Method An audit (n = 228 residents) was undertaken in thirteen dementia and psychogeriatric units in New Zealand in July-September 2011. A modified Best Practice Advocacy Centre (bpac(nz)) tool was used to examine antipsychotic prescribing, the administration of "when required" (PRN) antipsychotic doses and antipsychotic-related documentation (e.g. documenting of "target behaviour identified" and "need to monitor for adverse effects"). Prescribing for some central nervous system agents and fractures and fall rates were also examined. Some educational, managerial, environmental, recreational and resident-specific interventions were implemented post-audit. The audit (n = 233) was repeated in July-September 2013. MAIN OUTCOME MEASURES: (1) Number of residents prescribed and administered antipsychotics (2) Documentation of antipsychotic-related information in residents' notes. Results The administration of antipsychotics and prescribing of regular doses (±PRN) decreased about a quarter from 2011 to 2013: 50.4-38.2, and 49.1-36.5 % (ORs 0.60, 0.57 respectively, both p < 0.001), and prescribing for any antipsychotic dose (including PRN only) decreased: 60.5-50.6 % (OR 0.67, p = 0.003). Documenting of "target behaviour identified" significantly increased from 54.3 to 71.2 %, (OR 1.99, p = 0.017) and documenting of the "need to monitor for adverse effects" increased non-significantly (30.4-46.6 %, p = 0.098); both falling short of the 90 % goal set by bpac(nz). Benzodiazepine prescribing significantly decreased [39.0-25.8 %, (OR 0.59, p < 0.001)]. Conclusions Following a range of interventions, antipsychotic prescribing, administration and some related documentation improved in dementia and psychogeriatric units in New Zealand. Future studies should aim to identify the most effective of these interventions so they can be considered for implementing in similar settings.

Influence of caregiver network support and caregiver psychopathology on child mental health need and service use in the LONGSCAN study.

Using structural equation modeling, this study examined the relationship of caregiver network support on caregiver and child mental health need, as well as child mental health service use among 1075 8-year-old children participating in the LONGSCAN study. The final model showed acceptable fit (χ(2) = 301.476, df = 136, p<0.001; RMSEA = 0.052; CFI = 0.95). Caregiver and child mental health needs were positively related. As predicted, caregiver network support exerted a protective effect, with greater levels of caregiver network support predictive of lower caregiver and child need. Contrary to prediction, however, caregiver network support was not directly related to child service use. Higher child need was directly related to child service use, especially among children whose caregivers had mental health problems. The findings appear to indicate that lower levels of caregiver network support may exert its impact on child service use indirectly by increasing caregiver and child need, rather than by directly increasing the likelihood of receiving services, especially for African American children.

Early sexual experience and later onset of illegal drug use among African American students on HBCU campuses.

Few studies examine whether early sexual experience is associated with subsequent illegal drug use among adolescents. A sample of 7,372 African American students who had not used illegal drugs before the age of 14 were identified in the dataset of the 2001 Historically Black Colleges and Universities (HBCU) Substance Use Survey. Using self-reported ages of onset, discrete-time survival models estimated the hazard of illegal drug use onset after age 13 subsequent to first sexual intercourse. Early sex was modestly associated with subsequent illegal drug initiation, particularly among females. Drug use prevention services should be provided to youth engaged in early sexual activity.

Sex differences in perceived weight-based stigmatization among African Americans.

This study examined sex differences in calculated and perceived weights and weight-based stigmatization. 371 African Americans (females=258) responded to a health and wellness survey. Body mass index (BMI) was calculated from self-reported height and weight and categorized as underweight (7.0%), normal (48.2%), overweight (29.9%), and obese (14.8%). Perceived weight was measured by asking participants, "Do you consider yourself to be overweight?" Responses were then dichotomized as accurate or inaccurate. Stigmatization was constructed from 16 statements regarding perceived treatment due to weight status. Males and females differed in their perceptions of their weights. More than 20% of the participants had inaccurate perceptions of their weights, with the majority of the inaccurate participants (82.5%) perceiving their weight status lower than their actual weight status. More overweight or obese males than overweight or obese females did not perceive themselves as overweight (60.3% vs. 28.3%, respectively, P <.001). While male and female perceptions of weight-based stigmatization were not statistically different (P = .071), participants who accurately perceived themselves to be overweight had higher perceived weight-based stigma scores than inaccurate participants who were overweight (P =.001). Males and females who were inaccurate were less likely to perceive weight-based stigmatization.

Web-based data collection: an effective strategy for increasing African Americans' participation in health-related research.

The study sought to explore response modes (via web-based vs paper surveys) and rates to a follow-up health questionnaire and to examine respondent characteristics by response modes. 192 young adult African Americans responded online or by paper. We found observable differences in follow-up responses, with more participants completing the online version first. No statistical differences were revealed in response modes based on academic discipline, sex, income or health status. The 60% followup response rate supports web-based data collection as a viable means of assessing health information from African Americans. This research provides evidence of the Internet as a viable alternative for increasing participation of young African American adults, a relatively understudied group, to obtain data on health status and behaviors, over time.

Racial/ethnic differences in parental concern about their child's drug use in a nationally representative sample in the United States.

INTRODUCTION: Parental concern and negative attitudes toward drug use may prevent youth from being involved in drug use. However, few studies have addressed parental concern about children's drug use and its possible variation by race/ethnicity. In this study, we explored the potential racial/ethnic differences in parental concern about their children's drug use with a nationally representative sample. METHODS: The data were from the 2003 National Survey of Children's Health, a random household telephone survey of parents of children up to age 17 (n = 102353). The analytic sample was restricted to parents of children aged 6 to 17 years (n = 61046). Multivariate logistic regression models, controlling for children's age, gender, family structure, and family poverty level, were fitted, simultaneously accommodating the complex survey design. RESULTS: Parents of African American and Hispanic children expressed more concern than parents of white children, even after controlling for potential confounders (adjusted odds ratio (AOR), 1.9; 95% CI, 1.8-2.1 and AOR, 1.9; 95% Cl, 1.7-2.1, respectively). CONCLUSIONS: The level of parental concern about adolescent drug use was different across race/ethnicity groups. The results may have implications for parental participation in school-based adolescent prevention programs.

Drug use and high-risk sexual behaviors among african american men who have sex with men and men who have sex with women.

OBJECTIVES: We investigated covariates related to risky sexual behaviors among young African American men enrolled at historically Black colleges and universities (HBCUs). METHODS: Analyses were based on data gathered from 1837 male freshmen enrolled at 34 HBCUs who participated in the 2001 HBCU Substance Use Survey. The covariates of risky sexual behavior assessed included condom nonuse, engaging in sexual activity with multiple partners, and history of a sexually transmitted disease. RESULTS: Young Black men who had sex with men were more likely to engage in risky sexual behaviors than were young men who had sex with women. Two additional factors, early onset of sexual activity and consumption of alcohol or drugs before sexual activity, were independently associated with modestly higher odds of sexual risk behaviors. CONCLUSIONS: Services focusing on prevention of sexually transmitted diseases should be provided to all male college students, regardless of the gender of their sexual partners. Such a general approach should also address drug and alcohol use before sexual activity.

Difference in condom use among sexually active males at historically black colleges and universities.

UNLABELLED: Black men who have sex with men (MSM) and black men who have sex with both men and women (MSMW) may not perceive themselves to be part of the larger gay community and hence may not heed prevention messages aimed at the community. OBJECTIVE AND PARTICIPANTS: To better understand the participants behaviors, the authors examined differences in condom use between black MSM/W (including MSM and MSMW) and men who have sex with women (MSW) at historically black colleges and universities (HBCUs). METHODS: A paper-and-pencil questionnaire survey investigated sexual behaviors of 1,865 freshmen from 35 HBCUs during the 2001-2002 school year. RESULTS: MSM/W were about 0.37 times less likely to always use condoms compared with MSW (adjusted odds ratio = 0.63, 95% confidence interval = 0.42-0.95). Sexual behavior, age at survey, total family income, and religion were also associated with condom use. CONCLUSIONS: These findings offer new directions for sexually transmitted disease and HIV prevention aimed at a highly marginalized population that remains at high risk for infection.

Depressed mood and the effect of two universal first grade preventive interventions on survival to the first tobacco cigarette smoked among urban youth.

INTRODUCTION: As part of an evaluation of two first-grade, universal preventive interventions whose proximal targets were early learning and behavior, we investigated the influence of depressed mood, the interventions, and their interaction on survival to the first tobacco cigarette smoked through age 19. One intervention focused on improving teacher behavior management and instructional skills (Classroom-Centered, CC) as a means of improving student behavior and learning and the other on the family-school partnership (FSP). Variation in the relationship between depressed mood and first cigarette smoked by gender and grade was also examined. METHODS: Self-reports of smoking behavior and depressed mood were collected on an annual basis from grade 6 through age 19. The present analyses were restricted to the 563 youth who had never smoked by grade 6, or 83% of the original sample of first grade participants. Discrete-time survival analysis was used to examine the effects of depressed mood and the interventions on survival to the first tobacco cigarette smoked. RESULTS: Depressed mood was associated with reduced survival time to the first cigarette smoked (adjusted hazard ratio, aHR: 1.4; 95% CI: 1.1-1.9), whereas the CC intervention prolonged survival time (aHR: 0.8; 95% CI: 0.7-0.9). No significant variation in the effect of depressed mood on survival was found by gender or grade, nor was the effect of the CC intervention moderated by depressed mood. CONCLUSIONS: Strategies to prevent tobacco cigarette smoking should include both a focus on depressed mood in adolescence as well as on early success in elementary school.

Exploring health disparities in integrated communities: overview of the EHDIC study.

Progress in understanding the nature of health disparities requires data that are race-comparative while overcoming confounding between race, socioeconomic status, and segregation. The Exploring Health Disparities in Integrated Communities (EHDIC) study is a multisite cohort study that will address these confounders by examining the nature of health disparities within racially integrated communities without racial disparities in socioeconomic status. Data consisted of a structured questionnaire and blood pressure measurements collected from a sample of the adult population (age 18 and older) of two racially integrated contiguous census tracts. This manuscript reports on baseline results from the first EHDIC site, a low-income urban community in southwest Baltimore, Maryland (EHDIC-SWB). In the adjusted models, African Americans had lower rates of smoking and fair or poor self-rated health than whites, but no race differences in obesity, drinking, or physical inactivity. Our findings indicate that accounting for race differences in exposure to social conditions reduces or eliminates some health-related disparities. Moreover, these findings suggest that solutions to the seemingly intractable health disparities problem that target social determinants may be effective, especially those factors that are confounded with racial segregation. Future research in the area of health disparities should seek ways to account for confounding from SES and segregation.

Mediators of the development and prevention of violent behavior.

The purpose of this investigation was to determine if the Aban Aya Youth Project, a culturally grounded intervention, produced differences in changes over time in core intervening variables (i.e., communal value orientation, empathy, violence avoidance efficacy beliefs) and whether these variables mediated intervention effects on the development of youth violent behavior. Fifth grade cohorts at 12 schools were randomly assigned to one of two intervention conditions or an attention placebo control condition and followed longitudinally through eighth grade. A total of 668 students (49% male) participated in the study. Mediation analyses suggested that both program conditions (as compared to the control condition) led to steeper increases over time in empathy which, in turn were related to reductions in the likelihood of violent behavior over time. No other significant program effects were detected, although changes over time in violence avoidance efficacy were associated with reduced likelihood of violent behavior. Findings are discussed in terms of theory development, program development and points of refinement of the Aban Aya Youth Project and implications for future research.

The influence of family environment on mental health need and service use among vulnerable children.

Children in child welfare are especially likely to have unmet mental health needs. The role of family factors in children's use of mental health services was examined in a longitudinal sample of 1075 maltreated or at-risk children. Vulnerable family environment (poor family functioning, low social support, and caregiver psychological distress) is an important predictor of children's mental health needs. It also predicts them not having these needs met.

The College Health and Wellness Study: baseline correlates of overweight among African Americans.

Overweight and obesity are epidemic in the United States, particularly among minority populations. This epidemic contributes to the development of chronic conditions that occur later in life such as type 2 diabetes and hypertension. Therefore, it is important to identify factors associated with the development of obesity during young adulthood. We conducted a cross-sectional survey among students graduating from a Historically Black College or University (HBCU) in the Mid-Atlantic region. Participants were 392 predominantly African American seniors graduating in the spring of 2003. Data were collected using a self-administered paper and pencil questionnaire which focused on weight, weight management activities, individual and familial weight history, and health status indicators. Participants were on average 24 +/- 5 years of age and 69% female; over 90% identified as African American or Black. According to NIH guidelines, about 30% of males and 28% of females were considered overweight, 12% of males and 7% of females were considered obese, and 7% of males and females were considered extremely obese. Significant correlates of being more overweight were being married, having children, lower socio-economic status, weight-loss attempts, personal and family history of overweight, and poorer health status. These data suggest that among this sample, the prevalence of overweight and obesity is similar to other populations of young African American adults. Familial factors such as socio-economic status and family weight history were important correlates of overweight. Overweight is a significant problem in this population, and these data should be useful for developing weight loss interventions aimed at young adults.

College-age, African-American males' misperceptions about weight status, body size, and shape.

This study examined actual and perceived weight status and body satisfaction of college-age African-American males. We predicted that, in general, males would be accurate about their weight status and satisfied with their body sizes and shapes. The study population was 123 male from a cross-sectional survey of 406 seniors who were scheduled to graduate in the spring 2003 from a historically Black university located in the mid-Atlantic region. These students were administered a survey on health and wellness that addressed a myriad of health concerns, most of which addressed weight, exercise, and related areas. This paper presents analyses on males who were overweight or obese according to the National Institutes of Health guidelines (body mass index > or = 25 kg/m2). 50.4% were overweight or obese (OW/O). Of the OW/O males, 59.7% inaccurately classified their own weight status as normal and chose ideal weights (F(2,59)=3.8, P<.04) and healthy weights (F(2,59)=8.0, P<.001) that were heavier than males with accurate weight perceptions. Specifically, OW/O males desired larger upper torsos (chi2=7.2, df=1, P<.01) and larger body parts (ie, arms, legs, chest area; F(2,59)=11.0, P<.0001). Inaccurate, overweight males were less likely to agree that losing weight supported healthiness (chi2=26.5, df=4, P<.001) or that losing weight would make them more attractive (chi2=14.4, df=4, P<.01). These findings point to the need for effective interventions and strategies for helping those affected and those interested in overweight prevention to understand the role of weight perception, body satisfaction, and their influence on weight loss and lifestyle changes for health.

Gender and the tobacco-depression relationship: a sample of African American college students at a Historically Black College or University (HBCU).

This study examined the relationship between tobacco use and depression and its possible variation by gender among African American young adults. A paper-and-pencil survey was administered to African American college students graduating in 2003 from a Historically Black College or University (HBCU). Tobacco use measures included lifetime involvement. Depression symptoms were assessed using a revised version of the CES-D. Male smokers were found to be four times more likely to be depressed than male non-smokers (OR=4.4; 95% CI, 1.4, 14.3; p=0.012). However, female smokers were not more likely to be depressed than female non-smokers (OR=1.0; 95% CI, 0.5, 2.1). Findings from this study suggest the need of gender-specific tobacco or depression interventions among HBCU students.

Gender differences in body image and health perceptions among graduating seniors from a historically black college.

This study's purpose was to identify gender differences in body size awareness and perceived impact of weight on social interactions and risk for disease among young African-American adults. A cross-sectional survey of 318 African-American graduating seniors from a historically black college or university (HBCU) was conducted. Data were collected on anthropometrics, body image, ideal weight, perceived risk for disease due to weight, and impact of weight on social interactions. Only 39% of males who were overweight perceived themselves as overweight compared with 68% of overweight females. Eighty percent of females and 63% of males expressed some body size dissatisfaction. Fewer obese males (38%) perceived a risk for disease due to their weight compared with obese females (64%), p<0.01. Males perceived greater impact than females of their weight on social interactions, with extremely obese males perceiving the greatest impact. Perceived risk for disease due to weight was related to body mass index, family weight history, body awareness and income, but not body size satisfaction. Findings suggest gender differences in the self-perception of body size, accuracy of body size perception, and understanding of acceptable weight ranges. Awareness of acceptable weight ranges and consequences of overweight needs to be raised.