Longitudinal Impacts of High Versus Low Greenness on Cardiovascular Disease Conditions.

BACKGROUND: Greenness-or vegetative presence-has been identified as a factor in chronic disease. The present study examines the longitudinal relationship between objective measures of greenness at the residential block level and incidence of 6 cardiovascular disease conditions. METHODS AND RESULTS: Analyses examined the impact of consistently high versus consistently low "precision" greenness at the Census block level on the 5-year incidence of cardiovascular disease conditions, including acute myocardial infarction, atrial fibrillation, heart failure, ischemic heart disease, stroke/transient ischemic attack, and hypertension, among 229 034 US Medicare beneficiaries in Miami-Dade County, Florida, USA. Zero-inflated Poisson regression was used to model the odds of developing any new cardiovascular disease and number of new cardiovascular disease conditions based on greenness tertiles computed across 2011 and 2016 Normalized Difference Vegetation Index values, adjusting for individual age, sex, race, ethnicity, baseline cardiovascular disease conditions, neighborhood income, and walkability in 2011 and 2016. When compared with individuals consistently in the low greenness tertile in 2011 and 2016, those consistently in the high greenness tertile in 2011 and 2016 had a 9% lower odds of having any new cardiovascular conditions (odds ratio [OR], 0.91 [95% CI, 0.84-0.99]; P=0.021). CONCLUSIONS: Over a 5-year period, consistently high greenness, when compared with consistently low greenness, was associated with lower odds of any new cardiovascular disease conditions. Identifying the role of greenness exposure in such a small geographic area, the Census block on which the older adult resides, allows for more precise, strategic decisions on where additional trees can be added-by selecting at-risk blocks rather than entire neighborhoods for tree-planting interventions.

Offering nurse care management for opioid use disorder in primary care: Impact on emergency and hospital utilization in a cluster-randomized implementation trial.

BACKGROUND: Patients with opioid use disorder (OUD) have increased emergency and hospital utilization. The PROUD trial showed that implementation of office-based addiction treatment (OBAT) increased OUD medication treatment compared to usual care, but did not decrease acute care utilization in patients with OUD documented pre-randomization (clinicaltrials.gov/study/NCT03407638). This paper reports secondary emergency and hospital utilization outcomes in patients with documented OUD in the PROUD trial. METHODS: This cluster-randomized implementation trial was conducted in 12 clinics from 6 diverse health systems (March 2015-February 2020). Patients who visited trial clinics and had an OUD diagnosis within 3 years pre-randomization were included in primary analyses; secondary analyses added patients with OUD who were new to the clinic or with newly-documented OUD post-randomization. Outcomes included days of emergency care and hospital utilization over 2 years post-randomization. Explanatory outcomes included measures of OUD treatment. Patient-level analyses used mixed-effect regression with clinic-specific random intercepts. RESULTS: Among 1988 patients with documented OUD seen pre-randomization (mean age 49, 53 % female), days of emergency care or hospitalization did not differ between intervention and usual care; OUD treatment also did not differ. In secondary analyses among 1347 patients with OUD post-randomization, there remained no difference in emergency or hospital utilization despite intervention patients receiving 32.2 (95 % CI 4.7, 59.7) more days of OUD treatment relative to usual care. CONCLUSIONS: Implementation of OBAT did not reduce emergency or hospital utilization among patients with OUD, even in the sample with OUD first documented post-randomization in whom the intervention increased treatment.

Mental Health Support Is an Unmet Need for Long-term Burn Survivors: A Web-based Survey.

A National Trauma Research Action Plan identified the involvement of burn survivors as critical informants to determine the direction of research. This study employed a web-based survey to identify care gaps in a sample of burn survivors. We surveyed burn survivors from around the United States through social media and email contact with the Phoenix Society for Burn Survivors. We elicited demographic info, burn history, and unmet needs. Statistical analysis was performed to test our hypothesis that lack of access to mental health support/professionals would be identified as an unmet need in long-term burn survivors. Of 178 survey respondents, most were at least 10 years removed from the date of their burn injury (n = 94, 53%). Compared with those less than 3 years from their burn injury, individuals greater than 10 years were at least 5 times more likely to note a lack of access to mental health support [11-20 years OR 8.7, P < .001; >20 years OR 5.7, P = .001]. About 60% of Spanish speakers reported lack of support group access was among their greatest unmet needs, compared with 37% of English speakers (P = .184). This study highlights the need for ongoing access to mental health resources in burn survivors. Our findings emphasize that burn injury is not just an acute ailment, but a complex condition that evolves into a chronic disease. Additional studies should focus on the experiences of Spanish-speaking burn survivors, given small sample size leading to a likely clinically significant but not statistically different lack of access to support groups.

Cultural stress, personal identity development, and mental health among U.S. Hispanic college students.

The present study examines the extent to which culturally stressful experiences may predict impaired well-being, increased internalizing symptoms (depression and anxiety), and increased externalizing problems (social aggression, physical aggression, and rule breaking) among a sample of Hispanic college students in Miami across a 12-day period. The predictive effects of cultural stressors on these outcomes were examined both (a) directly and (b) indirectly through daily fluctuations in students' personal identity synthesis and confusion. Results indicated direct predictive effects of cultural stress on four forms of well-being (self-esteem, life satisfaction, psychological well-being, and eudaimonic well-being), on symptoms of depression and anxiety, and on physical aggression and rule breaking. The predictive effects of cultural stress on all four forms of well-being and on symptoms of depression and anxiety were partially mediated through daily fluctuations (instability) in students' sense of personal identity synthesis. Findings were consistent across genders and between U.S.- and foreign-born students. Results are discussed in terms of implications for intervention and for policy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Nurse Care Management for Opioid Use Disorder Treatment: The PROUD Cluster Randomized Clinical Trial.

Importance: Few primary care (PC) practices treat patients with medications for opioid use disorder (OUD) despite availability of effective treatments. Objective: To assess whether implementation of the Massachusetts model of nurse care management for OUD in PC increases OUD treatment with buprenorphine or extended-release injectable naltrexone and secondarily decreases acute care utilization. Design, Setting, and Participants: The Primary Care Opioid Use Disorders Treatment (PROUD) trial was a mixed-methods, implementation-effectiveness cluster randomized clinical trial conducted in 6 diverse health systems across 5 US states (New York, Florida, Michigan, Texas, and Washington). Two PC clinics in each system were randomized to intervention or usual care (UC) stratified by system (5 systems were notified on February 28, 2018, and 1 system with delayed data use agreement on August 31, 2018). Data were obtained from electronic health records and insurance claims. An implementation monitoring team collected qualitative data. Primary care patients were included if they were 16 to 90 years old and visited a participating clinic from up to 3 years before a system's randomization date through 2 years after. Intervention: The PROUD intervention included 3 components: (1) salary for a full-time OUD nurse care manager; (2) training and technical assistance for nurse care managers; and (3) 3 or more PC clinicians agreeing to prescribe buprenorphine. Main Outcomes and Measures: The primary outcome was a clinic-level measure of patient-years of OUD treatment (buprenorphine or extended-release injectable naltrexone) per 10 000 PC patients during the 2 years postrandomization (follow-up). The secondary outcome, among patients with OUD prerandomization, was a patient-level measure of the number of days of acute care utilization during follow-up. Results: During the baseline period, a total of 130 623 patients were seen in intervention clinics (mean [SD] age, 48.6 [17.7] years; 59.7% female), and 159 459 patients were seen in UC clinics (mean [SD] age, 47.2 [17.5] years; 63.0% female). Intervention clinics provided 8.2 (95% CI, 5.4-∞) more patient-years of OUD treatment per 10 000 PC patients compared with UC clinics (P = .002). Most of the benefit accrued in 2 health systems and in patients new to clinics (5.8 [95% CI, 1.3-∞] more patient-years) or newly treated for OUD postrandomization (8.3 [95% CI, 4.3-∞] more patient-years). Qualitative data indicated that keys to successful implementation included broad commitment to treat OUD in PC from system leaders and PC teams, full financial coverage for OUD treatment, and straightforward pathways for patients to access nurse care managers. Acute care utilization did not differ between intervention and UC clinics (relative rate, 1.16; 95% CI, 0.47-2.92; P = .70). Conclusions and Relevance: The PROUD cluster randomized clinical trial intervention meaningfully increased PC OUD treatment, albeit unevenly across health systems; however, it did not decrease acute care utilization among patients with OUD. Trial Registration: ClinicalTrials.gov Identifier: NCT03407638.

Predictors of COVID-19 Fatality: A Worldwide Analysis of the Pandemic over Time and in Latin America.

SARS-CoV-2 has infected over one hundred million people worldwide and has affected Latin America particularly severely in terms of both cases and deaths. This study aims to determine the association between SARS-CoV-2 testing and COVID-19 fatality rate worldwide over 8 months and to examine how this relationship differs between Latin America and all other countries. This cross-sectional study used March 2021 data from 169 countries. Multivariate regressions predicted COVID-19 fatality (outcome) from the number of SARS-CoV-2 tests (exposure), while controlling for other predictors. Results for March 2021 were compared to results from June 2020. Additionally, results for Latin America were also compared to all other countries except Latin American for March 2021. SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in both June 2020 and March 2021 (RR = 0.92; 95% CI 0.87-0.96 and RR = 0.86; 95% CI 0.74-1.00, respectively). SARS-CoV-2 testing was associated with a significant decrease in COVID-19 fatality rate in Latin American countries but not in all other countries (RR = 0.45; 95% CI 0.23-0.89 and RR = 0.95; 95% CI 0.82-1.11, respectively). However, the difference between the risk ratios for June 2020 and March 2021 and between the risk ratios for Latin America and all other countries were not statistically significant. Increased SARS-CoV-2 testing may be a significant predictor of lower COVID-19 case fatality rate, specifically in Latin American countries, due to the existence of a strong association, which may have driven the worldwide results.

Longitudinal change in adolescent hope among recent immigrant Latinx adolescents: Links with adolescent and parent cultural stress, family functioning, emotional well-being, and behavioral health.

Adolescent hope can promote the emotional and behavioral well-being of Latinx families. Positive family functioning may foster adolescent hope, whereas cultural stress may compromise adolescent hope and well-being. We examined how adolescent hope changed over time, and whether cultural stress and family functioning predicted emotional and behavioral health via adolescent hope intercept and slope. Recent Latinx immigrant adolescents (Mage  = 14.51) and parents (Mage  = 41.09; N = 302; n = 150 from Los Angeles; n = 152 from Miami) completed measures of above constructs over 3 years (Summer 2010 to Spring 2013). Latent growth curve modeling indicated that adolescent hope increased over time. Higher cultural stress predicted lower initial hope. Higher family functioning predicted higher initial levels of and less steep increase in hope. Increase in hope predicted better emotional and behavioral health. Family functioning predicted better health outcomes by way of hope.

Racial/ethnic equity in substance use treatment research: the way forward.

BACKGROUND: Opioid use and opioid-related overdose continue to rise among racial/ethnic minorities. Social determinants of health negatively impact these communities, possibly resulting in poorer treatment outcomes. Research is needed to investigate how to overcome the disproportionate and deleterious impact of social determinants of health on treatment entry, retention, drug use and related outcomes among racial/ethnic minorities. The current commentary provides recommendations that may help researchers respond more effectively to reducing health disparities in substance use treatment. We begin with recommendations of best research practices (e.g., ensuring adequate recruitment of racial/ethnic minorities in research, central components of valid analysis, and adequate methods for assessing effect sizes for racial/ethnic minorities). Then, we propose that more NIDA research focuses on issues disproportionately affecting racial/ethnic minorities. Next, techniques for increasing the number of underrepresented racial/ethnic treatment researchers are suggested. We then recommend methods for infusing racial/ethnic expertise onto funding decision panels. This commentary ends with a case study that features NIDA's National Drug Abuse Treatment Clinical Trials Network (CTN). CONCLUSIONS: The proposed recommendations can serve as guidelines for substance use research funders to promote research that has the potential to reduce racial/ethnic disparities in substance use treatment and to increase training opportunities for racial/ethnic minority researchers.

A global public health convention for the 21st century.

As shown by COVID-19, infectious diseases with a pandemic potential present a grave threat to health and wellbeing. Although the International Health Regulations provide a framework of binding legal obligations for pandemic prevention, preparedness, and response, many countries do not comply with these regulations. There is a need for a renewed framework for global collective action that ensures conformity with international regulations and promotes effective prevention and response to pandemic infectious diseases. This Health Policy identifies the necessary characteristics for a new global public health security convention designed to optimise prevention, preparedness, and response to pandemic infectious diseases. We propose ten recommendations to strengthen global public health governance and promote compliance with global health security regulations. Recommendations for a new global public health security convention include greater authority for a global governing body, an improved ability to respond to pandemics, an objective evaluation system for national core public health capacities, more effective enforcement mechanisms, independent and sustainable funding, representativeness, and investment from multiple sectors, among others. The next steps to achieve these recommendations include assembling an invested alliance, specifying the operational structures of a global public health security system, and overcoming barriers such as insufficient political will, scarcity of resources, and individual national interests.

Relationship of Neighborhood Greenness to Alzheimer's Disease and Non-Alzheimer's Dementia Among 249,405 U.S. Medicare Beneficiaries.

BACKGROUND: Neighborhood greenness (vegetative presence) has been linked to multiple health outcomes, but its relationship to Alzheimer's disease (AD) and non-Alzheimer's (non-AD) dementia has been less studied. OBJECTIVE: This study examines the relationship of greenness to both AD and non-AD dementia in a population-based sample of Medicare beneficiaries. METHODS: Participants were 249,405 US Medicare beneficiaries aged > 65 years living in Miami-Dade County, FL, from 2010 to 2011. Multi-level analyses examined the relationship of greenness, assessed by mean Census block level Normalized Difference Vegetation Index (NDVI), to odds of each of AD, Alzheimer's disease and related dementias (ADRD), and non-AD dementia, respectively. Covariates included age, gender, race/ethnicity, number of comorbid health conditions, and neighborhood income. RESULTS: Higher greenness was associated with reduced risk of AD, ADRD, and non-AD dementia, respectively, adjusting for individual and neighborhood sociodemographics. Compared to the lowest greenness tertile, the highest greenness tertile was associated with reduced odds of AD by 20%(odds ratio, 0.80; 95%CI, 0.75-0.85), ADRD by 18%(odds ratio, 0.82; 95%CI, 0.77-0.86), and non-AD dementia by 11%(odds ratio, 0.89; 95%CI, 0.82-0.96). After further adjusting for number of comorbidities, compared to the lowest greenness tertile, the highest greenness tertile was associated with reduced odds of AD (OR, 0.94; 95%CI, 0.88-1.00) and ADRD (OR, 0.93; 95%CI, 0.88-0.99), but not non-AD dementia (OR, 1.01; 95%CI, 0.93-1.08). CONCLUSION: High neighborhood greenness may be associated with lower odds of AD and ADRD. Environmental improvements, such as increasing neighborhood vegetation, may be a strategy to reduce risk for AD and possibly other dementias.

A longitudinal study of paternal and maternal involvement and neighborhood risk on recent immigrant Latino/a youth prosocial behaviors.

The goal of the current study was to examine the role of neighborhood risk and maternal and paternal involvement on multiple forms of prosocial behaviors among recent immigrant US Latino/a adolescents. Additionally, we examined the interactions between parental involvement and neighborhood risk in order to test protective effects of mothers' and fathers' involvement. Participants were 302 adolescents (53.3% male, Mage = 14.51 years, range = 13-17) and their primary caregiver. Data were collected from adolescents in two US cities: Los Angeles (n = 150) and Miami (n = 152). The results demonstrated that maternal involvement was positively associated with emotional, dire, compliant, and anonymous prosocial behaviors. Paternal involvement was positively associated with emotional prosocial behaviors, but this result became non-significant when maternal involvement was also included in the model. While there were no direct links between neighborhood risk and prosocial behaviors, compliant helping increased only when neighborhood risk increased and paternal involvement decreased. Discussion focuses on the role of multiple influences in shaping prosocial behaviors among immigrant youth, with a focus on parental involvement.

PRimary Care Opioid Use Disorders treatment (PROUD) trial protocol: a pragmatic, cluster-randomized implementation trial in primary care for opioid use disorder treatment.

BACKGROUND: Most people with opioid use disorder (OUD) never receive treatment. Medication treatment of OUD in primary care is recommended as an approach to increase access to care. The PRimary Care Opioid Use Disorders treatment (PROUD) trial tests whether implementation of a collaborative care model (Massachusetts Model) using a nurse care manager (NCM) to support medication treatment of OUD in primary care increases OUD treatment and improves outcomes. Specifically, it tests whether implementation of collaborative care, compared to usual primary care, increases the number of days of medication for OUD (implementation objective) and reduces acute health care utilization (effectiveness objective). The protocol for the PROUD trial is presented here. METHODS: PROUD is a hybrid type III cluster-randomized implementation trial in six health care systems. The intervention consists of three implementation strategies: salary for a full-time NCM, training and technical assistance for the NCM, and requiring that three primary care providers have DEA waivers to prescribe buprenorphine. Within each health system, two primary care clinics are randomized: one to the intervention and one to Usual Primary Care. The sample includes all patients age 16-90 who visited the randomized primary care clinics from 3 years before to 2 years after randomization (anticipated to be > 170,000). Quantitative data are derived from existing health system administrative data, electronic medical records, and/or health insurance claims ("electronic health records," [EHRs]). Anonymous staff surveys, stakeholder debriefs, and observations from site visits, trainings and technical assistance provide qualitative data to assess barriers and facilitators to implementation. The outcome for the implementation objective (primary outcome) is a clinic-level measure of the number of patient days of medication treatment of OUD over the 2 years post-randomization. The patient-level outcome for the effectiveness objective (secondary outcome) is days of acute care utilization [e.g. urgent care, emergency department (ED) and/or hospitalizations] over 2 years post-randomization among patients with documented OUD prior to randomization. DISCUSSION: The PROUD trial provides information for clinical leaders and policy makers regarding potential benefits for patients and health systems of a collaborative care model for management of OUD in primary care, tested in real-world diverse primary care settings. Trial registration # NCT03407638 (February 28, 2018); CTN-0074 https://clinicaltrials.gov/ct2/show/NCT03407638?term=CTN-0074&draw=2&rank=1.

Directional Effects in Cultural Identity: A Family Systems Approach for Immigrant Latinx Families.

Although there is a substantial body of work focusing on the processes underlying cultural identity in general, less is known regarding how these processes might operate within the context of Latinx families. Moreover, among the limited research that has included the adolescent and caregiver cultural identity, most of the research has primarily focused on how caregivers influence their adolescent's cultural identity. In the present study, the directional pathways between recently immigrated adolescents' and caregivers' ethnic and U.S. identity belonging were examined using data from a longitudinal study of acculturation and identity development among recently arrived Latinx immigrant families. The sample consisted of 302 primary caregivers (Mage = 41.09, SD = 7.13 at baseline; 67.5% mothers) and their adolescents (Mage = 14.51, SD = 0.88 at baseline; 46.7% female). The results indicated that caregivers' ethnic identity belonging significantly predicted adolescents' ethnic identity belonging over time. At the same time, adolescents' ethnic identity negatively predicted caregivers' ethnic identity belonging over time, whereas adolescents' U.S. identity belonging positively predicted caregivers' later ethnic identity belonging. The findings indicate that immigrant caregivers may retain their native culture to direct and respond to their children's changing cultural identifications.

The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017.

BACKGROUND: There were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC. SETTING: This cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. Data on PLWH's viral load, age, gender, mode of HIV transmission, and race/ethnicity were aggregated to the ZIP code level. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. METHODS: Descriptive analyses on all study variables and a principal component analysis on the SDOH variables were performed. To account for overdispersion, multivariate negative binomial regressions were run while controlling for confounders and testing for significant interactions. RESULTS: The results of the regression analysis indicated that an increase in Factor 1 (economic stability, education, and health and healthcare determinants) was associated with a statistically significant increase in the number of PLWH with uncontrolled HIV. Additionally, we found a significant interaction between Factor 1 and White race. Among persons of low socioeconomic status, White race is associated with a reduction in PLWH with uncontrolled HIV. CONCLUSIONS: These results suggest that reducing poverty and increasing education and rates of health insurance should result in significant reductions in PLWH with uncontrolled HIV. These results have the potential to influence future policy, interventions for retention, adherence, and continuity of care to improve suppression rates in MDC.

A Parallel Process Model of Integration and Multidimensional Prosocial Behaviors in Recent Immigrant U.S. Latinx Adolescents.

With a growing population of Latinx youth immigrating to the United States, it is important to understand how Latinx youth adapt to mainstream U.S. culture. Given that the majority of research examining social development among recent immigrant adolescents has focused on negative adjustment outcomes, research examining positive social behaviors is needed to avoid deficit approaches to their development, gain a holistic understanding of youth development, and improve interventions with this population.This study examined the associations among trajectories in cultural integration and multiple prosocial behaviors among recent immigrant U.S. Latinx adolescents in Miami, Florida and Los Angeles, California. Adolescents (N = 302; 53.3% males; M age = 14.51 years) completed measures of integration and prosocial behaviors across six time points. Latent growth curve models indicated that integration significantly increased, though this growth tapered off over time. The growth in prosocial behaviors depended on the specific form of helping assessed. While the growth in altruistic and compliant prosocial behaviors was stagnant, there was an increase in anonymous prosocial behaviors and a decrease in public and dire prosocial behaviors. Emotional behaviors did not linearly change, though slightly tapered off by the final time points. Parallel process latent growth curve model results indicated positive correlations between the slopes of cultural integration and most forms of prosocial behaviors. These findings highlight the positive role of cultural integration as an acculturative process for U.S. Latinx youth and the multidimensionality of prosocial behaviors.