The Effect of Minority Stress Processes on Stage of Change and Nicotine Dependence Level for Sexual and Gender Minority Smokers in the Deep South.

Purpose: Minority stress has been posited as a cause for sexual and gender minority (SGM) individuals to smoke as a coping mechanism. The purpose of this study was to elucidate the relationship between minority stress processes and nicotine dependence level and stage of change for SGM smokers living in the Deep South region of the United States. Methods: A one-time, cross-sectional online survey was administered to SGM smokers living in the Deep South. Survey measurements included demographics, minority stress processes (prejudice events, perceived stigma, and internalized queerphobia), and smoking cessation outcomes (nicotine dependence level and stage of change). Multivariable linear regression was used to assess the effect of each minority stress process on smoking outcomes, after adjusting for demographics and stratifying by gender and sexual identity. Results: Across all participants (n = 1296), lower levels of perceived stigma were significantly associated with further stage of change. Greater levels of internalized queerphobia were significantly associated with greater nicotine dependence level. After stratifying by gender and sexual identity, these significant associations were only maintained in cisgender males and gay individuals. An additional significant association between lower prejudice events and further stage of change for smoking cessation was found only for individuals whose sexual identity was labeled as "other." Conclusion: Addressing minority stress in smoking cessation and prevention programs has the potential to decrease nicotine dependence and further stage of change.

Multilevel Barriers to Long-Acting Reversible Contraceptive Uptake: A Narrative Review.

Unintended pregnancies, which occur in almost half (45%) of all pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives (LARCs), namely intrauterine devices and implants. Although LARCs are highly acceptable to women at risk of unintended pregnancies, barriers to accessing LARCs hinder its uptake. These barriers are greater among racial and socioeconomic lines and persist within and across the intrapersonal, interpersonal, institutional, and policy levels. A synthesis of these barriers is unavailable in the current literature but would be beneficial to health care providers of reproductive-aged women, clinical managers, and policymakers seeking to provide equitable reproductive health care services. The aim of this narrative review was to aggregate these complex and overlapping barriers into a concise document that examines: (a) patient, provider, clinic, and policy factors associated with LARC access among populations at risk of unintended pregnancy and (b) the clinical implications of mitigating these barriers to provide equitable reproductive health care services. This review outlines numerous barriers to LARC uptake across multiple levels and demonstrates that LARC uptake is possible when the woman is informed of her contraceptive choices and when financial and clinical barriers are minimized. Equitable reproductive health care services entail unbiased counseling, a full range of contraceptive options, and patient autonomy in contraceptive choice.

Exploring Successful Implementation of Organizational Supports at the Worksite Environment: A Mixed Methods Approach.

While there is evidence that organizational supports may lead to better employee health, research on implementing such organizational supports is lacking. This research sought to understand organizational supports and implementation of those supports using an Explanatory Sequential Mixed Methods design approach. Employee survey responses (n = 202) were used to classify organizations into "high" and "low" categories for employee-reported health behavior improvement, agreement, and readiness for implementing change. For the qualitative phase of research (organization-level), semi-structured interviews were conducted with organization leads, and data were analyzed through constant comparative analysis procedure. Analyses sought to identify differences between "high" versus "low" organizations. In addition, the researcher used the "high" and "low" classifications to further review themes that emerged, to determine where there may be differences in organizations classified as "high" versus "low." Study results found the following nine themes to explain how organizations can improve implementing organizational supports: provide a contracted wellness program, formalized programming, and wellness incentives; create a culture of wellness in the organization; provide consistency in the supports offered; provide clear communication to employees; utilize leadership role modeling to show support; focus on leadership support that ensures organizational supports are implemented and sustained; and work to combat employee hesitation of organizational supports. The results of this study show that organizations have the opportunity to improve implementation of their organizational supports by applying the nine themes found.

A WeChat-based smoking cessation intervention for Chinese smokers: a feasibility study.

WeChat is the largest social media platform in China, yet few WeChat-based smoking cessation interventions have been investigated to date. The objective of this study was to develop and test the feasibility of a WeChat-based smoking cessation intervention for smokers in China. Participants were recruited using WeChat and were then randomized into one of three groups: the Standard Group, the Enhanced Group, and the wait-list Control Group. Feasibility indicators including program reach, recruitment rate, recruitment efficiency, cost per person, attrition rate, intervention message exposure, group discussion utilization rate, intervention message engagement, satisfaction, and the likelihood of recommending to others were measured with assessed. Analyses included Chi-square and Fisher exact test, as well as analysis of variance test. A responsive participant is defined as a participant that responded to a certain assessment. A total of 1,132 individuals connected with ("friended") our project on WeChat between July 1 and August 5, 2019. Of these, 403 were eligible to participate, consented, and completed the baseline assessment. As a result, 136, 135, and 132 smokers were randomly assigned to the Standard Group, the Enhanced Group, and the Control Group, respectively. The total program recruitment rate was 35.6% and the attrition rate was 46.4%. The program cost was $0.85 per person. All responsive participants read at least one message during the intervention and engaged with intervention messages 56.8% of the time. Most responsive participants reported being very or somewhat satisfied, highly or somewhat engaged, and were willing to recommend our program to others. This study demonstrated the feasibility of a smoking cessation interventions using WeChat. The program could be expanded to deliver smoking cessation interventions to a large population of smokers.

The COVID-19 pandemic and associated increases in experiences of assault violence among black men with low socioeconomic status living in Louisiana.

Background: The COVID-19 pandemic has had mental health, social, and economic implications among communities with high levels of social disadvantage; this may have impacted community violence rates. The objective of this study was to characterize overall trends in assault and social disadvantage of patients experiencing assault before and during the COVID-19 pandemic. Methods: All trauma activations at a level one trauma center serving the entire southeast Louisiana region were included during March-August pre-COVID (2018-2019) and during COVID (2020). ICD-10 E-codes were used to identify trauma intent (assault vs. other). Assaults in this context are defined as physical injuries caused by an act of violence wherein the perpetrator was suspected or confirmed to have intended harm, injury, or death to the victim. Social disadvantage was assessed using the Area Deprivation Index (ADI). Change in the monthly rate of assault-trauma activations was assessed using negative binomial regression with adjustment for race, gender, and injury intent. The study was reviewed and approved by the Louisiana State University Health Sciences Institutional Review Board. Results: A total of 4,233 trauma activations were included. The majority of activations occurred among men. Assaults increased from 27.5% of all activations pre-Covid to 35.6% during the pandemic. Penetrating trauma similarly increased from 29.5% to 35.7% of all activations. Negative binomial regression demonstrated that in addition to this increase in proportion of assaults relative to all activations, the monthly assault rate also increased by 20% during the pandemic. These increases were driven primarily by increased assaults among Black men. ADI rank did not change between study periods. Conclusions: Health disparities in violence worsened during the pandemic: increased cases of assault occurred disproportionately among Black men, and assaults persisted in occurring primarily among low-ADI communities where burden had been high pre-pandemic. There is a critical need for resources and support to Black men, to mitigate violence and improve racial heath equity.

A WeChat-based smoking cessation intervention for Chinese smokers: A pilot study.

Background: China is the largest tobacco producer and has the highest number of tobacco consumers in the world. Extensive research has demonstrated the utility of social media for smoking cessation. WeChat is the most commonly used social media platform in China, but has not yet been utilized for smoking cessation interventions. The objectives of this study are (1) to evaluate the efficacy of a WeChat-based smoking cessation intervention; and (2) to examine a possible additive effect of integrating oral health and smoking-related information into a tailored, Transtheoretical Model (TTM) guided smoking cessation intervention. Methods: Eligible adults were recruited through WeChat from July 1 to August 6, 2019, to participate in a 3-arm, single-blinded, randomized controlled trial. We enrolled and randomized 403 participants into three groups: the Standard Group, Enhanced Group, or a Waitlist-Control Group. Participants in the Standard Group received 20 smoking cessation-related messages for 2 weeks; participants in the Enhanced Group received this same protocol plus 6 oral health-related messages over an additional week. Participants in the Control Group received smoking cessation-related messages, after the post-intervention assessment. The primary outcome was TTM Stage of Change, and the secondary outcomes were 7-day Point Prevalence Abstinence (PPA), 24-h PPA, daily cigarette use, and nicotine dependence at 4 weeks follow-up post intervention, comparing intervention groups with the control group. The overall program attrition rate was 46%. Paired t-tests, McNemar tests, and linear and logistic regression were used to examine differences in smoking cessation outcomes within and between groups. Results: Participants in the Enhanced Group (ß = -1.28, 95%CI: -2.13, -0.44) and the Standard Group (ß = -1.13, 95%CI: -1.95, -0.30) reported larger changes in nicotine dependence scores, compared to participants in the Waitlist Group. No statistically significant differences were found between the Enhanced Group and the Standard Group. Discussion: This WeChat-based intervention was effective for smoking cessation overall. The addition of oral health information did not significantly improve the intervention.

PTSD treatment reduces risk of trauma recidivism in a diverse community at a safety-net hospital: A propensity score analysis of data from a level one trauma center.

BACKGROUND: Physically-traumatic injuries result in PTSD for approximately 10% of Americans, and this rate is higher among individuals of color and those living in poverty. Individuals of color living in poverty experience lower access to PTSD and other mental health services. Untreated PTSD is associated with increased risk of trauma recidivism, but it is unknown if provision of treatment is actually associated with a subsequent reduction in recidivism risk. METHODS: For this observational cross-sectional study, data were collected retrospectively from the Trauma Registry of a level one trauma center, safety-net hospital in New Orleans between 2018 and 2020. Receipt of outpatient PTSD treatment at this same hospital was evaluated via chart review of the electronic health record. Propensity score matching was used to balance confounding variables of trauma type (assault vs. non-assault), gender, and race. McNemar test and Cox proportional hazard model were used with the propensity-balanced dataset to assess differences in trauma recidivism according to PTSD treatment status. RESULTS: Among 5916 trauma activations that occurred in the study period, 92 instances of recidivism occurred. 91 pairs were established after balancing with the propensity score. 1-year recidivism was 2.2% (n = 2) of all treated individuals versus 15.4% (n = 14) of non-treated individuals (p < 0.0001). The marginal risk from the Cox proportional hazard model demonstrated an 82% reduction in risk of recidivism (p = 0.02). CONCLUSIONS: This study demonstrated that mental health treatment can be used to reduce trauma recidivism. These data were shown among a high-risk population of disproportionately Black men living in a low-income community. Ensuring access to quality mental health care is one way to address the health disparities associated with physically-traumatic injuries.

Transitioning Behavioral Healthcare in Louisiana Through the COVID-19 Pandemic: Policy and Practice Innovations to Sustain Telehealth Expansion.

A statewide COVID-19 quarantine order forced an abrupt shift for Louisiana's behavioral health providers who provide mental health and substance abuse treatment services. The Center for Evidence to Practice conducted a study of this unprecedented shift to better understand the disruption and continuation of care during early statewide adoption of telemental health. The Center performed a mixed-method assessment including a series of focus groups and key informant interviews followed by a survey of over 300 responding providers. Over 85% of providers reported sustaining behavioral health services using a variety of telemental health strategies. While traditional referral networks and client volume were significantly disrupted, temporary relaxation of Medicaid regulatory and reimbursement policies appeared to be a key facilitator of telemental health adoption and continued services. Shifting to telemental health relied on provider's quick adaptations, engaging clients with a hybrid of teleconferencing platforms, calls/texts, and socially-distanced in-person visits. Larger multi-clinician providers and evidence-based practice (EBP) providers were better equipped to support the adoption of telemental health. Rural and EBPs providers disproportionately discontinued services. Although many practitioners viewed the original COVID-19 pandemic as a short-lived condition, the recent emergence of Delta and other variants has shown the impact on the BH care system may be lasting. Flexibility across policies and a variety of telemental health platforms are keys to telehealth adaptation. However, the contraction of the client base raises concerns of increasing disparities among vulnerable and hard-to-reach populations if telemental health becomes a sustained approach in response to future COVID-19 variants.

Implementation of a WeChat-Based Smoking Cessation Program for Chinese Smokers.

Introduction: Although smoking prevalence has recently declined, the smoking prevalence in China remains high. Extensive research has demonstrated ways that social media can assist in quitting smoking. WeChat is the most commonly used social media platform in China but has not been used for smoking cessation. A process evaluation of a novel WeChat-based smoking cessation intervention was conducted to measure its efficacy of content delivery, participant satisfaction, engagement, and likelihood of recommendation to others. Methods: A three-week, three-arm, single-blind randomized control trial was established. WeChat was used to recruit 403 participants and to deliver intervention messages and process evaluation surveys to them. Recruitment advertisements were posted on an official WeChat account and were forwarded to WeChat Moments. Intervention messages were delivered once a day during weekdays, using the WeChat broadcasting messages function, with two messages being sent each time. Process evaluation surveys were organized using Wenjuanwang and were delivered via WeChat. Process assessments were conducted every Friday to assess intervention message receipt, satisfaction level, engagement level, and recommendation to others. The receipt of intervention messages was measured by a self-reported question indicating which messages were read each week. Satisfaction was measured by a five-item Likert scale survey. Engagement was measured by a one-item Likert scale survey. Recommendation to others was measured by one self-reported question. Results: Participants read an average of 4.76 (out of 10), 5.80 (out of 10), and 4.25 (out of 6) messages at week 1, week 2, and week 3, respectively. The second messages were less likely to be read compared to the first messages (52.3% vs. 61.6%, respectively). Moreover, within each single week, the number of participants who read the intervention messages gradually decreases over time. Picture-based intervention messages tended to be less likely to be read than video-based intervention messages. Total program satisfaction scores ranged between 5 and 25, and the overall scores for satisfaction for each week were 21.55, 22.27, and 22.76, respectively. No significant differences were found in all the satisfaction indicators between groups. More than 60% of participants reported being either highly engaged or somewhat engaged each week. In addition, most participants (93.0% at week 1, 95.8% at week 2, and 96.2% at week 3) reported that they were willing to recommend our program to others. Discussion: A WeChat-based smoking cessation intervention for Chinese smokers was implemented and evaluated. For future studies, one should consider sending messages of a higher importance as the first message of a given day. Smokers had a higher rate of reading intervention messages at the beginning part of each week, during which, relatively important messages should be prioritized. One might also consider alternating the topics and formats of the messages for a better engagement of the users in future studies.

Urban and Rural Disparities in a WeChat-Based Smoking Cessation Intervention among Chinese Smokers.

INTRODUCTION: Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy. METHODS: WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher's exact test, ANOVA test, linear regression, and logistic regression were used for analysis. RESULTS: Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (ß = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup. DISCUSSION: Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers; however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.

Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma.

INTRODUCTION: The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. METHODS: Databases were searched in using terms "trauma" or "violence" and "COVID-19," yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. RESULTS: Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. CONCLUSIONS: A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.

Holistic representation in juvenile defense: An evaluation of a multidisciplinary children's defense team.

This study describes the results of an evaluation of a holistic defense model for juvenile clients. Longitudinal, retrospective analysis of de-identified data from clients (N = 308) measured individual variable outcomes, relationships, and project performance. Bivariate and multivariate analyses examined the strength of association and interrelationships among client and defense team variables. Findings indicate that holistic defense was significantly associated with improved outcomes among juvenile clients, including increased mental health assessment resulting in treatment, increased employment and educational attainment, and decreased odds of recidivism. Favorable court or dispositional outcomes, including lower adjudication or early termination from custody, were also reported. Further practice-level, controlled research is necessary to evaluate these models and offer comparison to other models for holistic defense.

Social support modifies the negative effects of acculturation on obesity and central obesity in Mexican men.

Background: This study examined the moderating role of social support in the acculturation-obesity/central obesity relationship in Mexican American (MA) men and women. Methods: Data from NHANES 1999-2008 were used. Acculturation derived from language use, country of birth and length of residence in the U.S. Social support assessed emotional and financial support. BMI (≥30) and waist circumference (≥88 cm for women; ≥102 cm for men) measured obesity and central obesity, respectively. Weighted multivariate logistic regression models were used to describe associations. Results: Compared to less acculturation, more acculturation was associated with higher odds of obesity (ORs 2.48; 95% CI 1.06-5.83) and central obesity (2.90; 1.39-6.08) among MA men with low/no social support, but not among MA men reporting high social support. The modifying effects was not observed among women. Conclusion: Higher amounts of social support appeared to attenuate the risk of obesity/central obesity associated with acculturation. Interventions enhancing social support maybe effective among acculturated MAs, particularly among men.

Medicaid Utilization Before and After a Natural Disaster in the 2016 Baton Rouge-Area Flood.

Objectives. To understand changes in behavioral health services utilization and expenditures before and after natural disaster with an adult Medicaid population affected by the Baton Rouge, Louisiana-area flood (August 2016).Methods. We examined de-identified behavioral health claims data for Medicaid-insured adults in the affected region for 10 months before and after flooding (October 2015-June 2017). This constituted 273 233 provider claims for 22 196 individuals. Claims data included patient gender, behavioral health diagnoses, treatment dates, and costs. We made adjustments for Medicaid expansion by using monthly enrollment data.Results. Overall, most male patient behavioral health care visits were for substance use disorders (33.6%) and most female patient behavioral health care visits were for depression-related disorders (30%). Both diagnostic categories increased after the flood by 66% and 44%, respectively. Expansion accounted for a 4% increase in claims. Postflood claims reflected 8% to 10% higher costs.Conclusions. Greater amounts of behavioral health care services were sought in all 10 months of the postflood study period. We observed gender differences in use of services and diagnoses. Behavioral health care services following natural disasters must be extended longer than traditionally expected, with consideration for specific population needs.

Long-acting reversible contraceptive utilization after policy change increasing device reimbursement to wholesale acquisition cost in Louisiana.

BACKGROUND: Unintended pregnancies, occurring in nearly 1 out of every 2 (45%) pregnancies in the United States, are associated with adverse health and social outcomes for the infant and the mother. The risk of unintended pregnancies is significantly reduced when women use long-acting reversible contraceptives, namely intrauterine devices and implants. Inadequate reimbursement for long-acting reversible contraceptive devices may be an access barrier to long-acting reversible contraceptive uptake. In 2014, the Louisiana Department of Health Bureau of Health Services Financing implemented a policy change that increased the Medicaid reimbursement rates for acquiring long-acting reversible contraceptive devices to the wholesale acquisition cost. OBJECTIVE: To examine the association of a Medicaid policy change that increased the long-acting reversible contraceptive device reimbursement rate to the wholesale acquisition cost (ie, price set by the manufacturers) on long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. MATERIALS AND METHODS: This retrospective, repeated cross-sectional study used 2013-2015 Louisiana Medicaid claims data and contraceptive provision measures to assess associations between patient (age, race, urban/rural residence, postpartum status) and provider (urban/rural location, specialty) characteristics and long-acting reversible contraceptive uptake among contraceptive users (N = 193,623) using bivariate and logistic regression analyses. RESULTS: After long-acting reversible contraceptive reimbursement increased, there was a 2-fold likelihood increase in use in 2015 vs 2013 (odds ratio, 2.08; 95% confidence interval, 1.69-2.55). Long-acting reversible contraceptive uptake was more likely across all patient and provider subgroups in 2015 vs 2013 but notably among patients receiving contraceptive care from family planning clinics (odds ratio, 3.93; 95% confidence interval, 2.34-6.62). CONCLUSION: Removal of a provider-level financial barrier to long-acting reversible contraceptive provision was associated with increased long-acting reversible contraceptive uptake among women at risk for unintended pregnancy. Efforts to improve long-acting reversible contraceptive access should focus on equitable healthcare reimbursement for healthcare providers of reproductive-aged women.

Case Study of Resilient Baton Rouge: Applying Depression Collaborative Care and Community Planning to Disaster Recovery.

BACKGROUND: Addressing behavioral health impacts of major disasters is a priority of increasing national attention, but there are limited examples of implementation strategies to guide new disaster responses. We provide a case study of an effort being applied in response to the 2016 Great Flood in Baton Rouge. METHODS: Resilient Baton Rouge was designed to support recovery after major flooding by building local capacity to implement an expanded model of depression collaborative care for adults, coupled with identifying and responding to local priorities and assets for recovery. For a descriptive, initial evaluation, we coupled analysis of documents and process notes with descriptive surveys of participants in initial training and orientation, including preliminary comparisons among licensed and non-licensed participants to identify training priorities. RESULTS: We expanded local behavioral health service delivery capacity through subgrants to four agencies, provision of training tailored to licensed and non-licensed providers and development of advisory councils and partnerships with grassroots and government agencies. We also undertook initial efforts to enhance national collaboration around post-disaster resilience. CONCLUSION: Our partnered processes and lessons learned may be applicable to other communities that aim to promote resilience, as well as planning for and responding to post-disaster behavioral health needs.

Role of Age and Acculturation in Diet Quality Among Mexican Americans - Findings From the National Health and Nutrition Examination Survey, 1999-2012.

Age and acculturation may play a role in diet quality among Mexican Americans. This study examined diet quality in Mexican Americans by age and whether acculturation influences diet quality across different age groups, using data from the National Health and Nutrition Examination Survey (NHANES). Diet quality, measured by the Healthy Eating Index 2010, improved with age except in categories of dairy, sodium, and refined grains. More acculturation was associated with lower scores in overall diet quality and categories of vegetables, fruits, and sodium and empty calories across almost all ages, but higher scores in grain categories, especially in younger groups. A diet rich in fruits and vegetables but low in fat and sodium should be promoted among more acculturated Mexican Americans, and whole-grain foods should be promoted among young but less acculturated Mexican Americans.

Incarcerated Black Women in the Southern USA: A Narrative Review of STI and HIV Risk and Implications for Future Public Health Research, Practice, and Policy.

Incarcerated black women in the southern USA are understudied despite the high prevalence of sexually transmitted infections (STI) and human immunodeficiency virus (HIV). These incarceration and health disparities are rooted in centuries of historically inequitable treatment. Amidst the current dialogue on mass incarceration in the south and its relationship to the health of the black community, individual and environmental risk factors for STI/HIV transmission are seldom paired with discussions of evidence-based solutions. A narrative review of the literature from January 1995 to May 2015 was conducted. This sample of the literature (n = 18) revealed that partner concurrency, inconsistent condom use, sex work, previous STI, and drug abuse augmented individual STI/HIV risk. Recommended interventions include those which promote healthier relationships, cultural competence, and gender specificity, as well as those that enhance prevention skills. Policy recommendations include improving cultural sensitivity, cultural competence, and cultural humility training for clinicians, as well as substantially increasing funding for prevention, treatment, and rehabilitative services. These recommendations are timely given the recent national attention to incarceration, STI, and HIV disparities, particularly in the southern USA.

Diet quality and its relationship with central obesity among Mexican Americans: findings from National Health and Nutrition Examination Survey (NHANES) 1999-2012.

OBJECTIVE: Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women. DESIGN: Cross-sectional data from NHANES 1999-2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity. SETTING: National Health and Nutrition Examination Survey (NHANES) 1999-2012. SUBJECTS: A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status. RESULTS: Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women. CONCLUSIONS: HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity.

Examining the Screening Practices of Physicians for Postpartum Depression: Implications for Improving Health Outcomes.

PURPOSE: Postpartum depression (PPD), the most common complication of childbirth, remains largely undetected by providers. Pediatricians, obstetricians/gynecologists, and family practitioners have a responsibility to identify PPD as the condition has long-term adverse effects on their patients. METHODS: Using PubMed and PsycInfo databases, this review explores and summarizes studies on the screening practices of physicians. FINDINGS: The prevalence and method of screening their patients for PPD was low and variable among the three types of physicians. Pediatricians were the least likely to screen compared with obstetricians/gynecologists and family practitioners. However, the majority of all physicians felt it was within their professional purview to screen for PPD and were willing to learn more about PPD detection. CONCLUSIONS: Screening rates can increase if physicians are educated about PPD and trained on the ease of routinely using a validated tool to identify PPD. This is critical, because more detection can lead to improved access to treatment, and the long-term detrimental impact that untreated PPD has on a mother and her children might be mitigated.