Surveillance of the Initiation of, Participation in, and Completion of Cardiac Rehabilitation in Minnesota, 2017-2018.

INTRODUCTION: Cardiac rehabilitation (CR) is an evidence-based secondary prevention program designed to improve cardiovascular health after a cardiac event. The objective of our study was to identify gaps in CR use among publicly and privately insured people in Minnesota to assist in developing shared goals among public health, cardiac rehabilitation professionals, and program delivery sites to improve CR delivery. METHODS: We applied a published claims-based surveillance methodology to the Minnesota All Payer Claims Database to assess eligibility for, initiation of, participation in, and completion of CR by patients with qualifying events in 2017. We stratified results by sociodemographic and geographic factors and qualifying condition and used adjusted prevalence ratios to make statistical comparisons. RESULTS: Less than half (47.6%) of qualifying patients initiated CR within 1 year of their qualifying event; the rate was higher among men (vs women), adults aged 45 to 64 years (vs ≥65 y), and patients with commercial or Medicaid insurance coverage (vs Medicare). Among those who initiated CR, only 14.0% completed the full series of 36 sessions. Participation in at least 12 sessions and completion of 36 sessions was less likely among adults aged 18 to 64 (vs 65-74 y) and among patients covered by Medicaid (vs Medicare). Patterns of CR initiation, participation, and completion also varied geographically. CONCLUSION: This analysis expands on previous Medicare fee-for-service population CR surveillance and provides a first detailed look at the CR landscape in Minnesota, renewing attention to CR as a key secondary prevention strategy. Collaboration and sharing with partners has established the Minnesota Department of Health as a valuable partner in driving health system change to improve equitable provision of CR in Minnesota.

Correlates of a Single-Item Indicator Versus a Multi-Item Scale of Outness About Same-Sex Attraction.

In this study, we investigated if a single-item indicator measured the degree to which people were open about their same-sex attraction ("out") as accurately as a multi-item scale. For the multi-item scale, we used the Outness Inventory, which includes three subscales: family, world, and religion. We examined correlations between the single- and multi-item measures; between the single-item indicator and the subscales of the multi-item scale; and between the measures and internalized homonegativity, social attitudes towards homosexuality, and depressive symptoms. In addition, we calculated Tjur's R (2) as a measure of predictive power of the single-item indicator, multi-item scale, and subscales of the multi-item scale in predicting two health-related outcomes: depressive symptoms and condomless anal sex with multiple partners. There was a strong correlation between the single- and multi-item measures (r = 0.73). Furthermore, there were strong correlations between the single-item indicator and each subscale of the multi-item scale: family (r = 0.70), world (r = 0.77), and religion (r = 0.50). In addition, the correlations between the single-item indicator and internalized homonegativity (r = -0.63), social attitudes towards homosexuality (r = -0.38), and depression (r = -0.14) were higher than those between the multi-item scale and internalized homonegativity (r = -0.55), social attitudes towards homosexuality (r = -0.21), and depression (r = -0.13). Contrary to the premise that multi-item measures are superior to single-item measures, our collective findings indicate that the single-item indicator of outness performs better than the multi-item scale of outness.

An updated protocol to detect invalid entries in an online survey of men who have sex with men (MSM): how do valid and invalid submissions compare?

Researchers use protocols to screen for suspicious survey submissions in online studies. We evaluated how well a de-duplication and cross-validation process detected invalid entries. Data were from the Sexually Explicit Media Study, an Internet-based HIV prevention survey of men who have sex with men. Using our protocol, 146 (11.6 %) of 1254 entries were identified as invalid. Most indicated changes to the screening questionnaire to gain entry (n = 109, 74.7 %), matched other submissions' payment profiles (n = 56, 41.8 %), or featured an IP address that was recorded previously (n = 43, 29.5 %). We found few demographic or behavioral differences between valid and invalid samples, however. Invalid submissions had lower odds of reporting HIV testing in the past year (OR 0.63), and higher odds of requesting no payment compared to check payments (OR 2.75). Thus, rates of HIV testing would have been underestimated if invalid submissions had not been removed, and payment may not be the only incentive for invalid participation.

Strengthening the Role of Unmarried Fathers: Findings from the Co-Parent Court Project.

While the importance of fathers in unmarried coparent families is a strong area of social and political interest, a dearth of community-based interventions exists for supporting the role of fathers in at-risk families. The Co-Parent Court (CPC) was a 3-year demonstration project evaluating the effectiveness of a collaborative intervention to support unmarried coparents establishing paternity and improving their coparenting relationships and paternal involvement in their child's life. A randomized-control experimental design was employed. The paper will explore father involvement and coparent relationship outcomes.

Examining the relationship between use of sexually explicit media and sexual risk behavior in a sample of men who have sex with men in Norway.

The purpose of this study was to investigate consumption patterns of gay-oriented sexually explicit media (SEM) among men who have sex with men (MSM) in Norway, with a particular emphasis on a possible relationship between gay SEM consumption and HIV risk behavior. Participants included 529 MSM living in Norway recruited online to complete a SEM consumption and sexual risk survey. Of the 507 participants who responded to the all items measuring exposure to SEM, 19% reported unprotected anal intercourse with a casual partner (UAI) in last 90 days, and 14% reported having had sero-discordant UAI. Among those with UAI experience, 23% reported receptive anal intercourse (R-UAI) and 37% reported insertive anal intercourse (I-UAI). SEM consumption was found to be significantly associated with sexual risk behaviors. Participants with increased consumption of bareback SEM reported higher odds of UAI and I-UAI after adjusting for other factors using multivariable statistics. MSM who started using SEM at a later age reported lower odds of UAI and I-UAI than MSM who started earlier. Future research should aim at understanding how MSM develop and maintain SEM preferences and the relationship between developmental and maintenance factors and HIV sexual risk behavior.

Open, closed, or in between: relationship configuration and condom use among men who use the internet to seek sex with men.

Nearly 70 % of HIV+ men who have sex with men (MSM) are estimated to have contracted HIV from a main partner. We examine whether condom use varies by relationship configuration, including open relationships with and without cheating. 656 MSM in committed relationships were recruited through a sexually explicit social networking website. Of the 55 % of MSM who had anal sex with a non-main partner in the past 90 days, two-thirds did not use a condom. Adjusting for covariates, MSM in relationships characterized as open with cheating versus monogamous were more likely to have unprotected anal sex with both main and non-main partners. MSM who perceived that their partner played around or cheated were more likely to have unprotected anal sex with a non-main partner. Prevention messages should attempt to reduce cheating and increase personal responsibility for protecting partners from HIV. Messages should be tailored to reflect open and monogamous relationships.

Application and modification of the integrative model for environmental health.

The Integrative Model for Environmental Health (IMEH) has guided research, literature reviews, and practice initiatives since 2002. This article presents the Modified IMEH that was developed based on using the IMEH as a guiding conceptual framework in a community-based participatory research environmental health project. Concepts from the Model of Risk Information Seeking and Processing as well as emergent themes from the data analysis were instrumental in this process. The Modified IMEH alters the structure of the IMEH in that the Vulnerability and Epistemological Domains are more prominent and feedback between domains is included.

Driving contradictions: behaviors and attitudes regarding handheld and hands-free cellphone use while driving among young drivers.

BACKGROUND: Cellphone use while driving (CUWD) is a frequent source of distraction for young drivers. These distractions commonly lead to motor vehicle crashes and, in some cases, death. Crash risk differs depending on if the driver is engaging in handheld or hands-free CUWD. This pilot study sought to investigate the differences between handheld versus hands-free CUWD behaviors in younger drivers and the attitudes and social norms that inform them. METHODS: Young drivers (mean age: 19.6 years, standard deviation: 0.8 years) were recruited from a large Midwestern city in the United States as part of a pilot study. The 62 enrolled drivers (51 females, 43 non-Hispanic white) completed an online survey measuring behavioral frequencies, attitudes, and social norms regarding talking on the phone, sending messages, and reading messages. These cross-sectional data were then categorized and used for a descriptive analysis. RESULTS: The majority of young drivers reported participating in some form of handheld CUWD, with reading messages being the most popular (95%). Only 43% of participants used hands-free technology for sending messages and 30% for reading messages, while half reported not using the technology at all. Whereas handheld messaging behaviors were viewed negatively by the participants, they were unsure of the impact on their driving ability and the legality surrounding hands-free messaging behaviors. CONCLUSIONS: Handheld CUWD behaviors were more popular among young drivers compared to hands-free CUWD. Further, even though young drivers understood handheld cellphone use while driving is unsafe, they engaged in it anyway. The findings of this pilot study highlight the importance of better educational initiatives and optimizing hands-free interventions for young driver use cases.

Extending Our Understanding of Burnout and Its Associated Factors: Providers and Staff in Primary Care Clinics.

Burnout has been identified as an occupational hazard in the helping professions for many years and is often overlooked, as health-care systems strive to improve cost and quality. The Maslach Burnout Inventory (MBI) and the Areas of Worklife Survey (AWS) are tools for assessing burnout prevalence and its associated factors. We describe how we used them in outpatient clinics to assess burnout for multiple job types. Traditional statistical techniques and seemingly unrelated regression were used to describe the sample and evaluate the association between work life domains and burnout. Of 838 eligible participants, 467 (55.7%) were included for analysis. Burnout prevalence varied across three job categories: providers (37.5%), clinical assistants (24.6%), and other staff (28.0%). It was not related to age, gender, or years of tenure but was lower in part-time workers (24.6%) than in full-time workers (33.9%). Analysis of the AWS subscales identified organizational correlates of burnout. Accurately identifying and defining the operative system factors associated with burnout will make it possible to create successful interventions. Using the MBI and the AWS together can highlight the relationship between system work experiences and burnout.

Typologies of sexually explicit media use among MSM: An application of latent class analysis.

The viewing of sexually explicit media (SEM) is widespread, especially among men, and research linking SEM viewing and sexual behavior has shown a variety of results, some positive (e.g., sexuality education) and some negative (e.g., poorer body image). These results might be due to limitations in measuring SEM consumption, particularly around typology. The goal of the current study was to examine potential patterns of SEM viewing activities. Using data from an online survey of men who have sex with men (MSM), we conducted latent class analyses of 15 SEM activities. Results suggested a three-class solution. The most prevalent class included over 60% of men and was characterized by viewing primarily safer-sex or conventional behaviors. The second class included 32% of men and had a similar albeit amplified pattern of viewing. The final class included just 7% of men and was marked by high levels of viewing of all activities, including fetish and kink. Compared to the conventional or safer-sex class, the other classes had lower internalized homonegativity, lower condom use self-efficacy, and higher SEM consumption or dose. Implications for HIV prevention, sexuality research and the SEM industry are discussed.

Preferred aspects of sexually explicit media among men who have sex with men: where do condoms fit in?

Sexually explicit media (SEM) is viewed by many men who have sex with men (MSM) and is widely available via the Internet. Though research has investigated the link between SEM and sexual risk behaviour, little has been published about preferences for characteristics of SEM. In an Internet-based cross-sectional study, 1390 adult MSM completed an online survey about their preferences for nine characteristics of SEM and ranked them in order of importance. Respondents preferred free, Internet-based, anonymous SEM portraying behaviours they would do. Cost and looks were the most important characteristics of SEM to participants, while condom use and sexual behaviours themselves were least important. Results suggest that while participants may have preferences for specific behaviours and condom use, these are not the most salient characteristics of SEM to consumers when choosing.

Challenges, coping strategies, and recommendations related to the HIV services field in the HAART era: a systematic literature review of qualitative studies from the United States and Canada.

Qualitative research methods have been utilized to study the nature of work in the HIV services field. Yet current literature lacks a Highly Active Anti-Retroviral Treatment (HAART) era compendium of qualitative research studying challenges and coping strategies in the field. This study systematically reviewed challenges and coping strategies that qualitative researchers observed in the HIV services field during the HAART era, and their recommendations to organizations. Four online databases were searched for peer-reviewed research that utilized qualitative methods, were published from January 1998 to February 2012, utilized samples of individuals in the HIV services field; occurred in the U.S. or Canada, and contained information related to challenges and/or coping strategies. Abstracts were identified (n=846) and independently read and coded for inclusion by at least two of the four first authors. Identified articles (n=26) were independently read by at least two of the four first authors who recorded the study methodology, participant demographics, challenges and coping strategies, and recommendations. A number of challenges affecting those in the HIV services field were noted, particularly interpersonal and organizational issues. Coping strategies were problem- and emotion-focused. Summarized research recommendations called for increased support, capacity-building, and structural changes. Future research on challenges and coping strategies must provide up-to-date information to the HIV services field while creating, implementing, and evaluating interventions to manage current challenges and reduce the risk of burnout.