Racial, Ethnic, and Sex Disparities in Mental Health Among US Service Members and Veterans: Findings From the Millennium Cohort Study.

Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014-2016; n = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans.

Risk and Protective Factors for Cancer Mortality among United States Service Members and Veterans (2001-2018).

BACKGROUND: Prior research linking military factors with cancer-specific mortality has shown inconsistent findings, with few studies examining these associations among U.S. service members and veterans who served in Operation Iraqi Freedom/Operation Enduring Freedom conflicts. METHODS: Cancer mortality between 2001 and 2018 was ascertained from the Department of Defense Medical Mortality Registry and National Death Index for 194,689 Millennium Cohort Study participants. Cause-specific Cox proportional hazard models were used to examine links between military characteristics and cancer mortality [overall, early (<45 years), and lung]. RESULTS: Compared with individuals who deployed with no combat experiences, non-deployers had a greater risk of overall [HR = 1.34; 95% confidence interval (CI) = 1.01-1.77] and early cancer mortality (HR = 1.80; 95% CI = 1.06-3.04). Enlisted individuals had a greater risk of lung cancer mortality compared with officers (HR = 2.65; 95% CI = 1.27-5.53). No associations by service component, branch, or military occupation and cancer mortality were observed. Higher education was associated with reduced overall, early and lung cancer mortality risk and smoking and life stressors were associated with elevated overall and lung cancer mortality risk. CONCLUSIONS: These findings are consistent with the healthy deployer effect in which military personnel who were deployed tend to be healthier than those who did not deploy. Further, these findings highlight the importance of considering socioeconomic factors, such as military rank, that may have long-term implications for health. IMPACT: These findings highlight military occupational factors that may predict long-term health outcomes. Additional work is necessary to investigate more nuanced environmental and occupational military exposures and cancer mortality.

Intravaginal practices are associated with greater odds of high-risk HPV infection in Haitian women.

OBJECTIVE: Haitian women have the highest incidence of cervical cancer within the Western hemisphere. Intravaginal hygiene practices have been linked with human papilloma virus (HPV) infection and cervical dysplasia. These practices, known as 'twalet deba' in Haitian Creole, are common among Haitian women and are performed with various natural and synthetic agents. As part of a community-based participatory research initiative aimed at reducing cervical cancer disparities in rural Haiti, we explored the use of intravaginal agents and their associations with high-risk HPV infection. DESIGN: Community Health Workers recruited 416 women for cervical self-sampling from two neighborhoods within Thomonde, Haiti. Participants were interviewed regarding intravaginal hygiene practices and completed a cervical self-sampling procedure. Cervical samples were analyzed for the presence of high-risk HPV infection. Associations between each intravaginal agent and high-risk HPV infection were examined via univariate logistic regression analyses, as well as via multivariate analyses controlling for sociodemographic factors and concurrent agent use. RESULTS: Nearly all women (97.1%) performed twalet deba, using a variety of herbal and commercially produced intravaginal agents. Approximately 11% of the participants tested positive for high-risk HPV. Pigeon pea and lime juice were the only agents found to be associated with high-risk HPV in the univariate analyses, with women who used these agents being approximately twice as likely to have high-risk HPV as those who did not. Only pigeon pea remained significantly associated with high-risk HPV after controlling for sociodemographic factors and concurrent agent use. CONCLUSION: Two agents, pigeon pea and lime juice, may contribute to risk for HPV infection in this population. Results suggest that in addition to cervical cancer screening interventions, future preventive initiatives should focus on minimizing risk by advocating for the use of less-toxic twalet deba alternatives.

Cancer Screening Utilization Among Immigrant Women in Miami, Florida.

BACKGROUND: Routine cancer screening for cervical, breast, and colorectal cancers reduces disease-associated morbidity and mortality through early detection and treatment. Lack of access to health care is a major barrier to screening in immigrant populations. OBJECTIVES: We aimed to characterize compliance with national cancer screening guidelines and to assess predictors of screening compliance among women residing in each of two distinct immigrant communities in Miami-Dade County--Little Haiti (Haitian) and Hialeah (Cuban). METHODS: Through a collaborative community-based participatory research (CBPR) initiative, researchers, key community stakeholders, and community members developed the study design. Data were collected from a total of 234 women via a rapid assessment survey administered by community health workers (CHWs). RESULTS: Compliance with national screening guidelines for breast, cervical, and colorectal screening was low in both community samples relative to national averages, and for cervical cancer screening was significantly lower in Little Haiti than Hialeah (p<.01). In addition, knowledge of cervical cancer etiology was significantly greater in Hialeah than in Little Haiti (p<.01). Health insurance and having a usual source of health care were significant correlates of cancer screening. CONCLUSION: Given the disparities in cancer screening between our samples and the larger sociodemographic groups in which they are often included, targeted approaches that address structural barriers (lack of health insurance or usual source of care) may improve access to cancer screening among recent immigrants. Community partnerships may be essential in facilitating the interventions needed to overcome cancer-related disparities in these groups.

Depression, deficits in functional capacity, and impaired glycemic control in urban African Americans with type 2 diabetes.

BACKGROUND: Effective depression treatment does not reliably reduce glycosylated hemoglobin (HbA1c) in depressed patients with type 2 diabetes, possibly in part due to deficits in functional capacity, i.e. performance of certain everyday living skills, essential for effective diabetes self-management. We sought to determine: a) the magnitude of deficits in functional capacity among urban, African American (AA) patients with type 2 diabetes, and b) whether these deficits were associated with poorer glycemic control. METHODS: At their initial visit to an inner-city diabetes clinic, 172 AA patients with type 2 diabetes were assessed with a variety of instruments, including the Mini International Neuropsychiatric Interview (MINI) and the UCSD Performance Skills Assessment-Brief (UPSA-B). They then entered a comprehensive diabetes management intervention, whose success was indexed by HbA1c levels at up to four reassessments over a one-year period. A mixed-effects model repeated-measures method was used to predict HbA1c. RESULTS: The prevalence of depression was 19%; the mean UPSA-B score was 81 ± 17. After multivariate adjustment, increased HbA1c levels over time were predicted by the presence of major depression (B = .911, p = .002) and decreasing (worse) scores on the UPSA-B (B = -.016, p = .027), respectively. Further adjustment for increasing the dosage of oral or insulin during the treatment eliminated the association between the UPSA score and HbA1c level (B = -.010, p = .115). CONCLUSIONS: Depression, as well as deficits in functional capacity, predicted reduced effectiveness of a diabetes self-management intervention. Future studies will determine whether interventions targeted at both improve glycemic control.

Ethnicity moderates the relationship between perceived stress and benefit finding in HIV+ men who have sex with men (MSM).

BACKGROUND: Numerous studies conducted within the USA demonstrate higher levels of benefit finding in ethnic minority individuals compared to nonminority individuals living with chronic disease. PURPOSE: As benefit finding may be a salient buffer for the effects of stress, the current study examined the association between perceived stress and benefit finding in human immunodeficiency virus (HIV)+ men who have sex with men (MSM) living in the southeast USA and investigated whether ethnicity was a moderator of this relationship. We hypothesized that benefit finding would be greater in ethnic minority MSM than in white MSM and that ethnic minority MSM with high levels of stress would experience greater benefit finding than their white MSM counterparts. METHOD: The current study utilized baseline (T1) and 3-month follow-up (T2) data drawn from a previous trial of a psychosocial intervention in HIV+ MSM. Participants were 130 HIV+ MSM; 52 % were white and 48 % belonged to minority ethnic groups (African-American, Caribbean-American, Hispanic). RESULTS: Analyses revealed that benefit finding was greater in ethnic minority MSM at baseline; however, this difference became nonsignificant when age, education level, highly active antiretroviral therapy adherence, and CD4 count were added to the model. Moderated regression analyses revealed a significant interaction between T1 perceived stress and ethnicity in predicting T2 benefit finding, such that higher levels of T1 perceived stress predicted lower levels of T2 benefit finding in ethnic minority MSM only. This association was independent of intervention group assignment. CONCLUSION: The current study's results highlight potential differences in the relationship between stress and benefit finding processes in white and ethnic minority HIV+ MSM.

Self-reported sleep disturbance is associated with lower CD4 count and 24-h urinary dopamine levels in ethnic minority women living with HIV.

BACKGROUND: Sleep disturbance is associated with dopamine dysregulation, which can negatively impact immune status. Individuals living with HIV experience more sleep difficulties, and poor sleep may compound immune decrements associated with HIV infection. Little research has examined associations between sleep, dopamine, and immune status (CD4 count) in individuals with HIV. As ethnic minority women living with HIV (WLWH) are at heightened risk for HIV disease progression, we related sleep reports to both CD4 count and dopamine levels in a cohort of ethnic minority WLWH. METHODS: Participants were 139 low-income WLWH (ages 20-62; 78.3% African-American or Caribbean) who reported both overall sleep quality and sleep disturbance on the Pittsburgh sleep quality index (PSQI). CD4 count and HIV viral load were measured via morning peripheral venous blood samples, and concentrations of dopamine were measured via 24-h urine collection. Covariates included HIV viral load, length of time since HIV diagnosis, HAART adherence, perceived stress and depression. RESULTS: After controlling for all covariates, greater sleep disturbance was associated with significantly lower CD4 count (ß=-.20, p=.03) and lower levels of dopamine (ß=-.25, p=.04). Poorer overall sleep quality was marginally associated with lower CD4 count (ß=-.16, p=.08), and was not associated with dopamine. CONCLUSION: Our analyses suggest that sleep disturbance is independently related with immune status and dopamine levels in WLWH. Lower levels of dopamine may indicate neuroendocrine dysregulation and may impact immune and health status. Results highlight sleep disturbance rather than overall sleep quality as potentially salient to neuroendocrine and immune status in ethnic minority WLWH.

Cognitive vulnerability for depression in HIV.

UNLABELLED: Biased inhibitory processing, frequency and valence of automatic thoughts, and inability to use positive schemas to regulate negative mood are cognitive factors linked to depression. These processes may underlie the established link between adaptive cognitive coping strategies (acceptance and positive reframing) and depression in persons with HIV. How individual differences in HIV-related neurocognitive deficits moderate such effects is unknown. In a secondary analysis, we tested the direct effects of coping on depressed affect as mediated by the frequency and valence of automatic thoughts and how this model was moderated by neurocognitive function in a cohort of HIV+ men and women. METHODS: HIV+ adults (mage=39.8, SD=9.5) provided data for the baseline assessment of a randomized trial that investigated the effects of a cognitive-behavioral stress management intervention. Measures included coping, depressive symptoms, positive (PAT) and negative automatic thoughts (NAT), and HIV-dementia. RESULTS: After controlling for covariates, cognitive coping was related to depressed mood as mediated via NAT (ß=-.92) and PATs (ß=.61), (R(2)=.42, F(7, 325)=33.50, p<.0001). The indirect effect of coping on depressive symptoms via NAT and PAT was moderated by neurocognitive function. LIMITATION: Cross-sectional design does not allow for the inference of causation among the variables. CONCLUSION: Results support a cognitive vulnerability model for depression whereby HIV-related neurocognitive deficits interfere with the ability to use acceptance and positive reframing strategies to increase the frequency of PAT and decrease NAT in adults living with symptoms of depression.