Analysis of Participant Stigma and Associated Costs of a Peer-Led Social Media HIV Intervention.

HIV-related stigma is a primary barrier to seeking HIV care. Online social media interventions utilizing peer-led approaches provide an opportunity to revolutionize HIV health behavior change. Secondary analysis of the UCLA HOPE Study (6 waves) was done to examine the effectiveness of an online peer-led intervention in reducing HIV-related internalized stigma (IS), association between IS and sexual risk behaviors (SRB), and associated costs for changing the likelihood of HIV testing. Among 897 participants, an inverse relationship between IS (Discomfort with people with HIV, Stereotypes, Moral Judgment) and SRB (Number of Sexual Partners, Sexual Encounters) factors was identified over time (p < .05). Engagement in stigma conversations increased participant likelihood to request HIV tests (B = 0.02, Wald = 8.10, p = .004) when made in group versus one-on-one contact. Innovative technology has potential to improve HIV-care efforts through expanded reach to at-risk populations, improved communication maintenance, ease of accessibility, and user anonymity.

The Impact of Social Determinants of Maternal Mental Health in Marginalized Mothers.

Background: A deeper understanding of the key determinants of maternal mental health is important for improving care for women, especially women who are at an economic disadvantage. Objectives: To explore the associations of select social determinants: access, social support, and stress, with the onset of antepartum depression in low-income mothers. Participants: The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, population-based surveillance system with selected data from 2016 to 2019, establishing a randomly selected sample of women with a recent live birth at most 4 months postdelivery, between 1,300 and 3,400 women per state (n ∼ 162,558). Methods: In this cross-sectional study, the phase 8 PRAMS was adapted to measure social support, access, stress, and their relationships with the onset of antepartum depression in low-income mothers. To assess low-income marginalization, a threshold was established based on income levels within 130% of the federal poverty level; antepartum (n ∼ 41,289). Results: The defined access, social support, and stress factors showed a statistically significant association with the onset of antepartum depression among low-income mothers. Of women in this sample, 22.6% indicated antepartum depression (p < 0.001; R2 = 0.066). Negative social support indicators were associated with an increased likelihood of antepartum depression; 3.71 increased odds of depression for abuse during pregnancy, and 0.79 decreased odds with positive acknowledgment of paternity. Access indicator terms showed an association with the decreased likelihood of antepartum depression through breastfeeding information support (Info from Baby Doc, odds ratio [OR] = 0.86), prenatal care utilization (12+ visits, OR = 0.82), and specific insurance type (insurance by job, OR = 0.82). All instances of stressful life events showed an increased likelihood of depression during pregnancy (for majority of stressful life events: OR >1.12). Conclusions: Economically marginalized mothers face unmet social and health care needs leading to poorer outcomes during pregnancy. These findings provide additional support for improved policy and public health efforts, such as assessment, education, and interventions, to decrease prevalence and improve treatment for antepartum depression among marginalized mothers.

Mosquito control exposures and breast cancer risk: analysis of 1071 cases and 2096 controls from the Ghana Breast Health Study.

Epidemiologic data on insecticide exposures and breast cancer risk are inconclusive and mostly from high-income countries. Using data from 1071 invasive pathologically confirmed breast cancer cases and 2096 controls from the Ghana Breast Health Study conducted from 2013 to 2015, we investigated associations with mosquito control products to reduce the spread of mosquito-borne diseases, such as malaria. These mosquito control products were insecticide-treated nets, mosquito coils, repellent room sprays, and skin creams for personal protection against mosquitos. Multivariable and polytomous logistic regression models were used to estimate odds ratios (ORadj) and 95% confidence intervals (CI) with breast cancer risk-adjusted for potential confounders and known risk factors. Among controls, the reported use of mosquito control products were mosquito coils (65%), followed by insecticide-treated nets (56%), repellent room sprays (53%), and repellent skin creams (15%). Compared to a referent group of participants unexposed to mosquito control products, there was no significant association between breast cancer risk and mosquito coils. There was an association in breast cancer risk with reported use of insecticide-treated nets; however, that association was weak and not statistically significant. Participants who reported using repellent sprays were at elevated risks compared to women who did not use any mosquito control products, even after adjustment for all other mosquito control products (OR = 1.42, 95% CI=1.15-1.75). We had limited power to detect an association with repellent skin creams. Although only a few participants reported using repellent room sprays weekly/daily or < month-monthly, no trends were evident with increased frequency of use of repellent sprays, and there was no statistical evidence of heterogeneity by estrogen receptor (ER) status (p-het > 0.25). Our analysis was limited when determining if an association existed with repellent skin creams; therefore, we cannot conclude an association. We found limited evidence of risk associations with widely used mosquito coils and insecticide-treated nets, which are reassuring given their importance for malaria prevention. Our findings regarding specific breast cancer risk associations, specifically those observed between repellent sprays, require further study.

Effects of Mental Illness Amongst Adults in the United States Living With Diabetes Mellitus on Hospital Admissions.

OBJECTIVE: To examine the influence of comorbid mental illness on hospitalization among adults reporting diabetes mellitus. METHODS: This cross-sectional observational study used National Health Interview Survey (NHIS) data from 2000-2018 to examine hospitalization. Mental illness was defined as no to low psychological distress (NLPD), moderate psychological distress (MPD), and serious psychological distress (SPD) as per the Kessler-6 scale. Socio-demographic factors and health status were added as covariates in binary logistic regression. RESULTS: This study involved 48,807 survey participants and reflected an estimated population of 17,524,418 adults with diabetes in the United States, of whom 19.9% were hospitalized in the year prior to the survey. Among those who were hospitalized, 71.5% exhibited None to Low Psychological Distress (NLPD), 17.7% reported Moderate Psychological Distress (MPD), and 10.8% reported Serious Psychological Distress (SPD). Conversely, among non-hospitalized individuals, the percentages were as follows: 83.2% had NLPD, 11.4% had MPD, and 5.3% had SPD. The odds ratio (OR) for hospitalization was found to be OR=1.31 (95% CI: 1.20, 1.43, p<0.0001) for MPD and OR=1.42 (95% CI: 1.28, 1.58, p<0.0001) for SPD, in comparison to those with no or low psychological distress. CONCLUSION: Among adults with diabetes mellitus, those with mental illness were more likely to be hospitalized than those without mental illness. Programs and policies to improve care among adults with both mental illness and diabetes may help to reduce hospitalizations.

Understanding multi-level barriers to medication adherence among adults living with sickle cell disease.

There is limited research that identifies and examines multi-level barriers to medication adherence among adults with Sickle Cell Disease (SCD); Identify multi-level barriers to medication adherence among adults with SCD; and Examine the relationship between multi-level barriers and medication adherence levels. A cross-sectional study included 130 adults (ages ≥ 18 years old) living with SCD who receive treatment/care from one of the 10 adult SCD clinics within the Networking California for sickle cell care initiative. Study measures included the medication adherence report scale (Professor Rob Horne), Beliefs about Medicine Questionnaire (Professor Rob Horne), and patient reported outcomes measurement information system. Participants reported barriers to medication adherence across 3 levels: Community-level barriers (e.g., COVID-19 pandemic); Institutional-level barriers (e.g., bad experiences with the health care system); and Individual-level barriers (e.g., beliefs and depression severity). Depression severity and patient concerns about SCD medication were inversely correlated with medication adherence (rs = -0.302, P < .001; rs = -0.341, P < .001 respectively). Patient beliefs about the necessity of SCD medication were insignificantly correlated with medication adherence (rs = 0.065, P = .464). Medication adherence was higher among patients who had fewer adherence barriers than multiple adherence barriers (Median medication adherence: fewer barriers = 22 vs multiple barrier = 20.50, P = .085), suggesting clinical significance although statistically insignificant. Identifying multi-level adherence barriers and examining their relationship with medication adherence will help develop targeted public health strategies to promote improved medication adherence and wellness among adults with SCD.

Risk Factors for Serious Psychological Distress among Pregnant Women and Mothers with Children less than One Year of Age: An Evaluation of National Health Interview Survey Data (1997-2016).

OBJECTIVE: This study examined individual factors associated with serious psychological distress (SPD) in mothers. METHODS: The study used National Health Interview Survey data (1997-2016), with analysis being restricted to pregnant women and non-pregnant mothers whose youngest child was 12 months old or younger. The Andersen framework, a reliable tool to study health services, was used to examine the effect of individual predisposing, enabling, and need factors. RESULTS: Of 5,210 women, 13.3% had SPD, as determined by the Kessler-6 scale. Compared to those without SPD, those with SPD were more likely to be 18 to 24 years old (39.0% vs. 31.7%; all P values < .001), never have been married (45.5% vs. 33.3%), not have completed high school (34.4% vs. 21.1%), have a family income below 100% of the federal poverty level (52.5% vs. 32.0%), and have public insurance (51.9% vs. 36.3%). Furthermore, women with SPD had a lower proportion of "excellent" health status (17.5% vs. 32.7%). Multivariable regression found that having any formal education was associated with a lower likelihood of perinatal SPD than was not completing high school. For example, the bachelor's degree odds ratio was 0.48 (95% CI: 0.30, 0.76). A receiver operator curve analysis revealed that individual predisposing factors (e.g. age, marital status, and education), accounted for more explained variation than did enabling or need factors. CONCLUSION: There are high levels of poor maternal mental health. Prevention and clinical services should focus on mothers with less than a high school education and those reporting poor physical health.

Comfort in seeking support from sexual violence prevention education health services among college women.

Objective: Explores racial differences of sexual violence-(SV) health service-(HS) outcomes among college women: (1) seeking support from a confidential-resource-(CR) and (2) reporting SV to the Title IX office. Participants: Data was collected from all ages of women (N = 583) and grade levels from one-large university on the Pacific-coast. Methods: Logistic-regression of HS outcomes were performed using the Fall 2016 American College Health Association-NCHA-II-survey. Results: The following variables increased the likelihood of women seeking support from the two health-services: (#1CR) relationship-status, race, and experiencing sexual-violence. WOC were 7x more likely to seek support if physically-assaulted, and WW were 3.9x more likely to seek support if a graduate student. (#2Title IX) year in school, physical-assault, and receiving prevention-education after the first-year in college. Overall, there were significant differences by race in the variables that influenced WW and WOC's comfort or likelihood to seek support. Conclusion: Colleges need to consider the disproportionate impact of SV on WOC.

Use of Electronic Health Records and Quality of Ambulatory Healthcare.

Background This study aimed to measure the association between electronic health record (EHR) use and quality measures in ambulatory healthcare. Methodology A quantitative, retrospective, cross-sectional design was used by examining secondary data from the 2015-2016 National Ambulatory Medical Care Survey. The relationship between EHR use and seven quality measures was examined using the Donabedian model as a framework. Quality measures included (a) diabetes measures, (b) obesity measures, (c) blood pressure screening, (d) depression screening, and (e) breast cancer screening. A total of 37,290 office visits were included, representing 817 million national office visits. For each of the quality measures, we determined the (a) associations using unadjusted and adjusted regression models based on subsets of the sample that met the inclusion criteria for quality measures; and (b) the changes in the area under the curve (AUC). Results Approximately 75% of office visits fulfilled all EHR use. Positive associations were found between EHR use and better quality for the following three out of seven measures: higher odds of screening for obesity (odds ratio (OR) = 2.2; p = <0.0001), blood pressure (OR = 2.5; p = <0.0001), and breast cancer (OR = 1.8; p = 0.0166). Receiver operating curve results showed the highest gain in the AUC for process-grouped measures. Hence, it was considered to be a strong predictor for all quality measures. Conclusions Evidence showed improvement in some quality measures (screening for obesity, blood pressure, and breast cancer). Common and standardized health processes were more likely to be completed and recorded than others. Future policies concerning health information technology can shift the focus from improving EHR use to enhancing patient and quality outcomes. Further research is needed to identify circumstances where quality is improved.

Addressing the challenges of conducting community-engaged research during COVID-19: Rapid development and evaluation of a COVID-19 Research Patient and Community Advisory Board (PCAB).

Introduction: We created a COVID-19 Research Patient and Community Advisory Board (PCAB) to provide patient and community input into clinical and translational research studies. The purpose of this article is to describe the PCAB creation, implementation, and evaluation. Methods: We identified PCAB members who had participated in previous stakeholder engaged activities at our institution and invited their participation. We created a systematic consultation process where researchers could submit plain language research summaries and questions for the PCAB. A facilitated 1-hour virtual consultation was then held where PCAB members provided feedback. We assessed satisfaction of PCAB members and researchers who received consultations using surveys. We also reviewed video recordings of PCAB consultations and reflections from team meetings to identify key lessons learned. Results: Twenty-seven PCAB members took part in 23 consultation sessions. Twenty-two completed an evaluation survey (81% response rate). Most members agreed or strongly agreed their opinions were valued (86%), it was a productive use of time (86%) and were satisfied (86%). Nineteen researchers completed an evaluation survey (83% response rate). Researchers reported positive experiences of working with the PCAB. Additional insights include limited funding in COVID-19 research for equitable community engagement, deficiencies in researcher communication skills, and a lack of cultural humility incorporated into study activities. Conclusions: PCAB members provided recommendations that maximized the patient-centeredness and health equity focus of COVID-19 research. The detailed description of the process of developing, implementing, and evaluating our PCAB can be used as a template for others wishing to replicate this engagement model.

Burden of Mental Illness among Primary HIV Discharges: A Retrospective Analysis of Inpatient Data.

Background: Empirical evidence demonstrates the substantial burden of mental illness among people living with HIV and AIDS (PLWHA). Current literature also notes the co-morbidity of these two illnesses and its impact on quality of life and mortality. However, little evidence exists on patient outcomes, such as hospital length of stay or post-discharge status. Methods: A retrospective analysis of National Inpatient Sample data was conducted. The study population was defined as discharges having a primary diagnosis of HIV based on International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes in primary diagnosis field. Clinical Classification Software (CCS) codes are used to identify comorbid mental illness. Length of stay was defined as number of days between hospital admission and discharge. Disposition (or post-discharge status) was defined as routine versus not routine. Patient and hospital characteristics were used as control variables. All regression analyses were survey-weighted and adjusted for control variables. Results: The weighted population size (N) for this study was 26,055 (n = 5211). Among primary HIV discharges, presence of any mental illness as a secondary discharge was associated with 12% higher LOS, when compared to a lack of such comorbidity (incidence rate ratio [IRR] = 1.12, 95% confidence interval [CI] = 1.05, 1.22, p < 0.01). Likewise, among primary HIV discharges, those with mental illness had a 21% lower routine disposition, when compared to those without any mental illness (OR = 0.79, 95% CI = 0.68, 0.91, p < 0.001). Conclusion: Our results highlight the need for improved mental health screening and coordinated care to reduce the burden of mental illness among HIV discharges.

Examining the association of student mental health and food security with college GPA.

BACKGROUND: Low food security and poor mental health are a persistent concern for college students. OBJECTIVE: Examine how food security and mental health are associated with college student's grade point average (GPA). METHODS: American College Health Association (ACHA)-National College Health Assessment III survey data Spring 2020 of students from 75 US universities (n = 48,103) were utilized to examine relationships among mental health, food security and academic performance (GPA). RESULTS: The majority of the population self-reported high food security (58.3%) and moderate psychological distress (50.8%). Very low food security (B = -.523, OR = .59, p < .001) and moderate psychological distress (B = -0.19, OR = .83, p < .001) were inversely associated with high GPA. Reduced food security was associated with worse mental health measures. CONCLUSIONS: Food security and mental health are negatively associated with GPA. To improve student success, universities must enhance services that address food insecurity and mental health.

Cost Barriers to Health Services in U.S. Adults Before and After the Implementation of the Affordable Care Act.

BACKGROUND: The Affordable Care Act (ACA) was passed in 2010 and implemented in 2014 in the United States (U.S.). It was partly intended to reduce the cost burden to health coverage and care. OBJECTIVE: To determine if ACA implementation reduced the odds of experiencing cost barriers to needed healthcare services for vulnerable groups. METHODOLOGY: National Health Interview Survey Data from the Integrated Public Use Microdata Set (2011-2013; 2015-2017) were used to examine cost barriers to primary health, mental health, dental services, and prescription medications particularly for adults living in poverty, those of color, and unmarried individuals before and after implementation of the ACA. The study sample included 112,245 individuals, representing an annual average of 138 million adults (aged 26 to 64 years of age), including 59,367 survey respondents from 2011 to 2013 and 52,878 from 2015 to 2017. RESULTS: Pre/post-ACA, cost barriers to medical care decreased from 9.6% to 7.0% of adults, mental care from 3.0% to 2.4%, dental care 15.0 to 11.7%, and prescriptions from 9.9% to 7.0% (all comparisons p<.001). Survey design-adjusted regression results indicated significant decreases in the odds of experiencing cost barriers to physical, mental, dental health services and prescription medications after the implementation of the ACA for people living under 200% poverty, unmarried adults, and people of color. While the race was not a substantial barrier post-ACA, living in poverty and being unmarried remained the biggest predictors of cost barriers to services. Cost barriers for all services increased post ACA for adults with private coverage, and among older adults for prescription and dental services. CONCLUSIONS: While the ACA was largely successful in reducing the number of uninsured adults in the U.S., remaining barriers suggest the need to strengthen the ACA and reduce cost barriers to healthcare services for everyone.

Predictors of fall-related injuries due to common consumer products among elderly adult emergency department visits in the United States during 2007-2017.

Falls are the leading cause of injuries and death among the elderly in the United States (U.S.). This study examined unintentional fall related-injuries and potential associations between various consumer products. Data was analyzed from the National Electronic Injury Surveillance System (NEISS) of hospital emergency department (ED) visits for unintentional injuries among the elderly between 2007 and 2017. Multiple logistic regression was used to examine the association between consumer products and fall-related injury ED visits. A total of 537,703 injury-related ED visits were analyzed. Two-thirds of visits were fall-related. Of those, 33% were among those 85 years and older, 62.5% occurred at home, 37.6% had head trauma, and 28.7% resulted in hospitalization. Flooring materials accounted for 29.1% of injuries. Ladders were significantly associated with fall-related injuries (adjusted odds ratio [AOR] 5.48, 95% confidence interval [CI] 4.72-6.36), followed by flooring materials (AOR 3.09, 95% CI 2.60-3.67), and porches and balconies (AOR 2.61, 95% CI 2.30-2.96). Several common consumer products are associated with fall-related injuries among the elderly. Increased awareness and education are critical.

A Patient-Centered Environmental Scan of Inpatient Visitor Policies During the COVID-19 Pandemic.

Researchers and patients conducted an environmental scan of policy documents and public-facing websites and abstracted data to describe COVID-19 adult inpatient visitor restrictions at 70 academic medical centers. We identified variations in how centers described and operationalized visitor policies. Then, we used the nominal group technique process to identify patient-centered information gaps in visitor policies and provide key recommendations for improvement. Recommendations were categorized into the following domains: 1) provision of comprehensive, consistent, and clear information; 2) accessible information for patients with limited English proficiency and health literacy; 3) COVID-19 related considerations; and 4) care team member methods of communication.

Socio-demographics and asthma prevalence, management, and outcomes among children 1-11 years of age in California.

BACKGROUND: Asthma disproportionately affects minority and low-income children. We examined asthma prevalence, management and outcomes, focusing on race/ethnicity and acculturation of parents (particularly English language proficiency). METHODS: This cross-sectional, correlational analysis used a de-identified population-based survey, the California Health Interview Survey, for years 2001-2015. Survey-weighted analysis with SAS 9.4 was used to determine asthma prevalence among children 1 to 11 years of age. Descriptive analysis was conducted, adjusting for survey design and combination of multiple years of data. The Pearson test, using design-based F values was used to determine statistically significant differences between those having/not having a doctor diagnosis of asthma. Multivariable logistic regression, with jackknife approach to obtain confidence intervals, was used to examine associations of child and parental characteristics with asthma prevalence, management, and outcomes. RESULTS: The 61,625 completed surveys represented an estimated annual population of 5.7 million children, of which 12.9 % had asthma. There were significant (p < 0.001) differences by age, gender, race, and language proficiency, with higher asthma prevalence for children 6 to 11 years of age (15.5 %), males (15.3 %), African Americans (19.5 %), and parents speaking English very well (14.1 %). Compared to children whose parents spoke English very well, those whose parents spoke English not well or not at all were less likely to achieve optimal asthma management, i.e. to have received a management plan from doctor (OR 0.30; 95 % Confidence Interval 0.20-0.46)), to be currently taking medication to control asthma (OR 0.52; 95 % CI 0.36-0.74)), or to be not confident in ability to control asthma (OR 3.10; 95 % CI 1.49-6.42). Children whose parents spoke English fairly well rather than very well had worse outcomes, i.e. were more likely to have an emergency room visit in past 12 months (OR 1.92; 95 % CI 1.03-3.61) and were more likely to miss school due to asthma in past 12 months (OR 0.71; 1.01-2.94). CONCLUSIONS: Socio-demographics had a limited role in explaining differences across a handful of asthma management and outcome measures in California. Parental English language proficiency had the most consistent influence, underscoring the need for culturally and linguistically competent care.

Schizophrenia hospitalization in the US 2005-2014: Examination of trends in demographics, length of stay, and cost.

ABSTRACT: Primarily we aimed to examine the crude and standardized schizophrenia hospitalization trend from 2005 to 2014. We hypothesized that there will be a statistically significant linear trend in hospitalization rates for schizophrenia from 2005 to 2014. Secondarily we also examined trends in hospitalization by race/ethnicity, age, gender, as well as trends in hospitalization Length of Stay (LOS) and inflation adjusted cost.In this observational study, we used Nationwide Inpatient Sample data and International Classification of Diseases, Eleventh Revisions codes for Schizophrenia, which revealed 6,122,284 cases for this study. Outcomes included crude and standardized hospitalization rates, race/ethnicity, age, cost, and LOS. The analysis included descriptive statistics, indirect standardization, Rao-Scott Chi-Square test, t-test, and adjusted linear regression trend.Hospitalizations were most prevalent for individuals ages 45-64 (38.8%), African Americans were overrepresented (25.8% of hospitalizations), and the gender distribution was nearly equivalent. Mean LOS was 9.08 days (95% confidence interval 8.71-9.45). Medicare was the primary payer for most hospitalizations (55.4%), with most of the costs ranging from $10,000-$49,999 (57.1%). The crude hospitalization rates ranged from 790-1142/100,000 admissions, while the US 2010 census standardized rates were 380-552/100,000 from 2005-2014. Linear regression trend analysis showed no significant difference in trend for race/ethnicity, age, nor gender (P > .001). The hospitalizations' overall rates increased while LOS significantly decreased, while hospitalization costs and Charlson's co-morbidity index increased (P < .001).From 2005-2014, the overall US hospitalization rates significantly increased. Over this period, observed disparities in hospitalizations for middle-aged and African Americans were unchanged, and LOS has gone down while costs have gone up. Further studies addressing the important disparities in race/ethnicity and age and reducing costs of acute hospitalization are needed.

Meaningful Use of Electronic Health Records and Ambulatory Healthcare Quality Measures.

Introduction Electronic Health Record (EHR) adoption rates for office-based physicians doubled between 2008 and 2015, from 42% to 89%, and more than 60% of all office-based physicians achieved meaningful use by 2016. The US government has paid billions of dollars in incentives to promote EHR meaningful use. Nonetheless, evidence linking EHR meaningful use to quality measures improvements is limited. Objective This study aims to examine the relationship between EHR meaningful use and capabilities among four quality measures in an ambulatory healthcare setting. Study design A cross-sectional study design of the 2015-2016 National Ambulatory Medical Care Survey dataset. Methods We used adjusted multivariate regression models to examine associations between (a) EHR meaningful use and (b) 10 EHR-computerized capabilities, with four quality measures (blood pressure screening, tobacco use screening, obesity screening, and obesity education). Results We analyzed 30,787 office visits, representing an annual estimate of 680 million national office visits. Results showed that 95% of visits were to offices meeting EHR meaningful use criteria. We found one positive association between EHR meaningful use and obesity screening (OR= 3.5, 95% CI [1.742-6.917]). We also found eight positive associations between EHR capabilities and three quality measures (screening for blood pressure and obesity, and obesity education). These associations included five EHR-computerized capabilities: "record patient problem list", "view lab results", "Reminders for interventions/screening", "Order lab results" and "Recording clinical notes". No EHR capability was associated with screening for tobacco use. Conclusions We looked at a handful of screening-oriented quality measures in ambulatory healthcare and found limited associations with EHR meaningful use but multiple positively significant associations with EHR capabilities. Although EHR meaningful use has become more commonly used, offering substantial administrative efficiency over paper records, current patterns of EHR meaningful use do not always appear to translate into a better quality of care in physician offices. However, quality measures used represent limited procedures for a handful of specific conditions and not the overall healthcare aspect.

Social Media Use for Health Purposes by Chronic Disease Patients in the United States.

BACKGROUND: Social media can be a cost-effective instant tool for exchanging health information among those with chronic diseases. However, few studies have analyzed the nexus between chronic disease and patients' use of the internet for health-related purposes. OBJECTIVE: The objective of this study is to determine if chronic disease patients in the United States use social media platforms to share health information and/or join groups of similar condition. MATERIALS AND METHODS: This cross-sectional study conducted a secondary analysis of the Health Information Trends Survey dataset 5 (cycle 1 of 2017 and cycle 2 of 2018) (N = 6650), which is nationally representative of American adults. A series of chi-square tests was carried to examine the association between using social media by chronic disease patients and (a) sharing health information and (b) participating in relevant health groups. Logistic regression analysis was used to determine significant findings. RESULTS: In terms of sharing health information on social media sites, those who were aged 18-49 years (P < 0.0001) and underweight (P = 0.04) were more likely to share health information on social media, while males were less likely to do so (P < 0.0001). In terms of joining relevant health groups on social media, predictors were being aged 35-49 years (P = 0.008), having a Bachelor's or postbaccalaureate degree (P < 0.02) and having depression or anxiety disorder (P = 0.004); males were less likely to join such groups (P = 0.0004). CONCLUSION: Individuals with chronic conditions, except depression or anxiety disorder, were not likely to participate in social media support groups. Future studies should explore how social media can be used to effectively engage those with chronic diseases, which may assist in disease management.

Assessing the validity, reliability and efficacy of the Cross-Cultural Stress Scale (CCSS) for psychosomatic studies.

OBJECTIVE: The impact of stressful life events (SLEs) on health has been empirically studied with significant correlations documented. We developed a comprehensive stress rating toolkit, the Cross-Cultural Stress Scale (CCSS) from a triangulated qualitative research study. This article describes our pilot test of the scale to explore demographic-specific patterns of SLE scores and evaluate the scale's aptitude in assessing the stress-health correlation. METHODS: The face and content-validated CCSS was shared via a web-based survey to diverse individuals grouped by: (a) gender, (b) age, (c) race and ethnicity, (d) native, foreign-born or first-generation, (e) educational attainment, and (f) income. Participants from the Amazon crowdsourcing marketplace MTurk (N = 216) first indicated perceived stress intensities assuming experiences of all the SLEs in the CCSS. They then selected SLEs they had personally experienced in the last 12 months (N = 176). Multivariable analyses were conducted on perceived intensities. Correlations of experienced SLEs with self-reported health based on the Centers for Disease Control and Prevention (CDC) Health Related Quality of Life (HRQOL) indicators measured by the Behavioral Risk Factors Surveillance System (BRFSS) were analyzed. RESULTS: We validated the CCSS and obtained a high internal reliability (Cronbach's alpha >0.9). We found significant differences in stress rating by and within demographics. We also correlated stress to perceived health using the HRQOL and presence of a chronic disease ascertaining the stress-health hypothesis. LIMITATION: Sampling limitations observed include data drawn from a convenience sample. CONCLUSION: Despite sampling limitations, our research highlights demographic-specific stressors and offers an updated methodology in the stress-health correlation.