Differences in Acculturation and Trajectories of Anxiety and Alcohol Consumption Among Latina Mothers and Daughters in South Florida.

This study documents generational differences in the impact of acculturation related factors on anxiety and alcohol use behaviors between adult Latino mothers and adult daughters. Findings indicate that for mothers (n = 144) and daughters (n = 149), self-reported anxiety levels decreased from baseline to follow up (p = 0.001). For mothers at follow up (n = 147), results indicate that affiliation to Latino culture is negatively associated with anxiety (p = 0.018). Conversely, employment and partner relationship stress are positively associated with anxiety (p = 0.05 and p = 0.016 respectively). In addition, self-reported anxiety is positively associated with alcohol intake (p = 0.002) and employment (p = 0.007). For daughters(n = 149), partner relationship stressors, anxiety and alcohol intake decreased significantly from baseline to follow up at a p = 0.01, p = 0.01, p = 0.05 respectively. In addition, for daughters at baseline (n = 160), affiliation to U.S. culture is positively associated with self-reported anxiety (p = 0.01). Employment is negatively associated with alcohol consumption (p = 0.027). At follow up (n = 152), daughters' partner relationship stress is positively associated with self- reported anxiety (p = 0.049). Findings in this study can be used to develop culturally appropriate interventions, support groups and individual therapy sessions by taking into consideration generational differences among Latino women.

Cross-sectional data on alcohol and marijuana use and sexual behavior among male and female secondary school students in New Providence, The Bahamas.

BACKGROUND: While The Bahamas have significantly reduced poor reproductive health outcomes among adolescents and emerging adults, data indicate that youth are engaged in sexual risk behaviors. Substance use has been linked to increased risk for HIV and sexually transmitted infections in other contexts. There are limited data on Bahamian youth in relation to consumption of alcohol and marijuana use and engagement in sexual behaviors. OBJECTIVE: This study aimed to assess potential relationships between alcohol and marijuana use and engagement in sexual behavior among government secondary school students in New Providence, The Bahamas. MATERIALS AND METHODS: Total sample size was 2572, and about 56% of respondents were female. Mean age was 14.2 (SD 2.7 years). Cross-sectional data came from a baseline survey conducted as part of a longitudinal randomized controlled evaluation of a school-based HIV prevention and reproductive health program in New Providence. RESULTS: Overall, 46.5% (519) males and 44.8% (652) females reported alcohol consumption; 7.3% (82) males and 1.7% (25) females reported use of marijuana in the last 6 months. About 43% (477) male respondents and 16% (231) female respondents reported ever having vaginal sex. Logistic regression analysis indicates that increased likelihood of engaging in sex during the past 6 months is associated with being older, male, and consuming alcohol and marijuana. CONCLUSION: These data provide a 'global correlation' between substance use and engagement in sexual behaviors among Bahamian adolescents. Longitudinal research is needed to assess event specific risks and identify mediating and moderating factors. These findings indicate the importance of integrating reproductive health and substance use education.

Associations between drug/alcohol use and emotional abuse: Who perpetrates emotional abuse against Latina women?

Emotional abuse is the most prevalent form of violence against Latinas. We examined dimensions and characteristics of Latino mothers' and daughters' exposure to emotional abuse and the associations between emotional abuse and heavy alcohol use and illicit drug illicit substance abuse. This 5-year longitudinal study included 112 Latino mothers and 121 Latino daughters. Analyses included: chi-square test and logistic regression. The proportion of women who reported being emotionally abused at Wave 2 but who did not report any emotional abuse during Wave 1 (5 years total) was 21.2% for daughters and 14.3% for mothers. Among emotionally abused women, 33.3% of mothers and 36.1% of daughters were abused by 2 or more people. Almost half of the mothers (48.0%) were emotionally abused by their son/daughter; 36.1% of daughters were emotionally abused by their mother. Mothers who abused drugs were more likely to be emotionally abused (OR = 3.86; 95% CI = 1.32, 11.34). Our findings suggest that attention should be given to emotional abuse and its potential for leading to substance abuse among Latinas.

Changes in Family Cohesion and Acculturative Stress among Recent Latino Immigrants.

Family relationships can serve as an important source of support during the acculturation process; yet, how the stress related to acculturation, or acculturative stress, may impact family functioning across time is not clear. Participants (n = 479), between the ages of 18-34 were recruited using respondent driven sampling methodology. Findings suggest family cohesion decreased over time; however, it decreased less for those reporting more acculturative stress. The implication is that for those Latino immigrants who struggle to adapt to their new host culture, family remains a source of support more so than for those who do not struggle as much.

Assessment of the safety and efficacy of three concentrations of topical ivermectin lotion as a treatment for head lice infestation.

BACKGROUND: Ivermectin is a broad-spectrum parasiticide in widespread systemic use, including as an off-label treatment for head lice infestation. The potential of the topical use of ivermectin as a treatment for head lice infestation was suggested by an in vitro report of a novel lotion formulation. OBJECTIVES: This study investigated the relative effectiveness of three ivermectin lotion concentrations (0.15, 0.25, and 0.5%) compared with vehicle placebo in eliminating head lice infestation. METHODS: In this randomized, blinded study, 78 head lice-infested subjects, aged 2-62 years, received a single, 10-minute application of product on day 1. Evaluations were completed at two and six hours post-application, and on days 2, 8 (±1), and 15 (+2). Safety was assessed according to the evaluations of trained observers and adverse event (AE) reports. Efficacy was assessed according to scalp and hair examinations. RESULTS: Compared with placebo, all ivermectin concentrations resulted in the statistically significant (P ≤ 0.003) eradication of head lice through to day 15, with the highest level of eradication (73.7%) in subjects who received the 0.5% concentration. The severity of pruritus decreased from baseline in all treatment groups, including the placebo group, from six hours post-treatment to day 15, with the greatest reduction in the 0.5% concentration group. No ocular irritation was observed. All three ivermectin treatment strengths and vehicle were well tolerated. CONCLUSIONS: A single application of a 0.5% concentration of this ivermectin lotion formulation shows promise as a safe and effective treatment for head lice infestation and the associated signs of pruritus.

A Longitudinal Study of Social Capital and Acculturation-Related Stress Among Recent Latino Immigrants in South Florida.

This study uses social capital to assess the effects of social support on acculturation-related stress among recently immigrated Hispanics in South Florida before and after immigration. At baseline (N = 527), first 12 months in the United States, acculturative stress was negatively related to support from friends (p < .044) and positively related to support from parents (p < .023). At first follow-up (n = 415), 24 months in the United States, emotional/informational support was negatively associated with acculturation-related stress (p < .028). In the second follow-up (n = 478), 36 months in the United States, support from children was negatively associated with acculturation-related stress (p < .016). Limited English proficiency was found to be negatively associated with acculturation stress at all three points (p < .001, p < .025, and p < .001, respectively). Implications of this study can be used in the design of culturally appropriate and family-oriented interventions for recent immigrants to ease the acculturation process.

Health beliefs and attitudes of Latino immigrants: rethinking acculturation as a constant.

Health disparities among Latinos have been associated with acculturation, but there is a lack of consensus about how acculturation variables translate into health beliefs that can be used to target attitude and behavior change interventions. Transcripts from three qualitative studies including 64 Latino immigrant adults were analyzed through inductive reasoning to assess relationships between more or less acculturated attitudes, and demographic variables. In the three topic areas of gender roles, sex education, and seeking professional help, attitudes ranged from conservative (less acculturated) to liberal (more acculturated), but did not seem associated with age, education or years in the United States. When dealing with specific health topics, it is not possible to infer specific attitudes, strength of attitudes or level of acculturation of intervention recipients. To develop sound, culturally competent interventions, it is necessary to assess the targets' beliefs and attitudes and tailor messages in specific contexts.

A randomized, investigator-blinded, time-ranging study of the comparative efficacy of 0.5% malathion gel versus Ovide Lotion (0.5% malathion) or Nix Crème Rinse (1% permethrin) used as labeled, for the treatment of head lice.

One hundred seventy-two subjects with head lice participated in a five-way, investigator-blinded, parallel-group, active-controlled study comparing 0.5% malathion gel (30, 60, and 90 minutes applications), Ovide Lotion (0.5% malathion), and Nix Crème Rinse (1% permethrin). All subjects were treated on day 1. Participants were reevaluated at day 8 +/- 1 and those with live lice were retreated with the same product, for the same duration as day 1. Cure, defined as the absence of live lice, was evaluated 14 +/- 2 days after the last treatment and 161 subjects completed the study according to the protocol. Compared to Nix, treatment success rates were statistically superior for all malathion gel and Ovide groups. Retreatment rate for Nix was 70%, which was statistically more than the malathion groups. The highest treatment success rates were observed for the 30-minute malathion gel (98% intent-to-treat and 100% per-protocol [PP]) and the 8 to 12 hour Ovide application (97% intent-to-treat and 100% PP). In conclusion, the 30-minute malathion gel, which contains the same ingredients and concentrations as Ovide, provides comparable efficacy, offers increased safety and is more cosmetically acceptable than Ovide.

Cost and utilization analysis of a pediatric emergency department diversion project.

OBJECTIVE: States are struggling to find effective means to decrease Medicaid costs. The objective of this pilot study was to compare emergency department (ED) cost and utilization by members who were enrolled in a pilot program (designed to reduce the use of hospital EDs) with the costs and utilization incurred by a control group. METHODS: A large, private, primary care pediatric practice launched a pilot ED diversion program that provided extended office hours, multiple access locations, and care coordination. Participants in the program were Medicaid recipients who were younger than 18 years. Enrollment in the program was through either patient self-selection or mandatory assignment by the state Medicaid agency. A total of 17,382 children who were enrolled in the enhanced access program (intervention group) and 26,066 Medicaid-eligible children who received services from other local community primary care providers (control group) were included in the study. Children who had chronic health conditions and were receiving Supplemental Security Income benefits were excluded from this analysis. Regression analyses and t tests were applied to analyze the medical claim data that were collected for this project. Three variables were used as dependent variables to measure different aspects of the ED cost and utilization: per member per month cost, per thousand member per month encounter frequency, and per encounter cost. These variables were used to compare the intervention group with the control group for ED claims, as well as for the overall cost of care during the study period. RESULTS: In the 12-month period subsequent to program initiation, the average per member per month cost for ED utilization of the intervention group was 1.36 dollars less than that of the control group. However, there was no significant difference in terms of per-visit cost related to ED utilization. Therefore, the savings seemed to come as a result of a reduction in ED visits, not from reduced cost per visit. On average, children in the intervention group visited the ED approximately 8 fewer times per thousand members per month than the control group, yet there was no significant difference in the overall (ED and non-ED) cost of care between the intervention and control groups. CONCLUSION: Analysis from the first year of this pilot program demonstrates that by providing enhanced, coordinated, primary care access to Medicaid children, the utilization of the ED was significantly lowered among healthy children, whereas the overall cost of care remained the same.

Efficacy of a reduced application time of Ovide lotion (0.5% malathion) compared to Nix creme rinse (1% permethrin) for the treatment of head lice.

Our objective was to conduct a randomized, investigator-blinded evaluation of the pediculicidal and ovicidal activity of a reduced application time (20 minutes) of Ovide (0.5% malathion) compared to Nix (1% permethrin) in a south Florida population infested with Pediculus humanus capitis. Either Ovide or Nix was applied according to the label instructions. However, Ovide application time was reduced to 20 minutes. At day 8, subjects with live lice were re-treated with the same product and procedure as on day 1. Ovicidal and pediculicidal efficacy were evaluated at days 8 and 15. A subject free of lice and viable eggs at day 15 was considered to be a treatment success. Percent efficacy was calculated using the number of subjects free of lice and viable eggs per total number of subjects treated. We found that a 20-minute application of Ovide was significantly more pediculicidal and ovicidal (98%) compared to Nix (55%) at day 15 (p < 0.0001). The percentage of Ovide subjects who required treatment at day 8 was half that of the Nix group. The reinfestation rate was 0% with Ovide and 33% with Nix. In conclusion, a 20-minute treatment with Ovide, instead of the approved 8- to 12-hour application, cured 40 of 41 subjects (98%), demonstrating superior efficacy to Nix. The poor efficacy of Nix confirms the resistance of head lice to permethrin in south Florida.

Are "accidental" gun deaths as rare as they seem? A comparison of medical examiner manner of death coding with an intent-based classification approach.

OBJECTIVES: Unintentional firearm death is often considered a nearly negligible proportion of overall gun death. These rates are based on medical examiner (ME) and coroner death classifications, which affect derived epidemiologic data and subsequent prevention measures. The aim of this study was to compare the proportion of pediatric unintentional gun deaths in Miami-Dade County based on manner of death coding by the ME with an intent-based classification of child gun deaths. METHODS: ME and police records for all pediatric firearm fatalities in Miami-Dade County from 1994 to 1998 were reviewed. The ME's assignment of manner of death as homicide, suicide, or accident was compared with an intent-based classification of intentional homicide, intentional suicide, and unintentional firearm death based on expressed or implied evidence of intent to harm. RESULTS: There were 123 pediatric firearm deaths in Miami-Dade County from 1994 to 1998. A significant difference between ME coding and the intent-based classification was found for homicide (94 vs 78) but not for suicide. A significant difference was also found between the ME's coding for "accident" and the investigator's classification of "unintentional" firearm death (4 vs 26). CONCLUSIONS: The incidence of unintentional pediatric firearm deaths is significantly underreported by the Miami-Dade County ME when the classification of "accidental" firearm death is used. Reviewing the manner of death classification criteria or establishing an intent code on official death documentation is recommended. Furthermore, clinicians should be aware that the true incidence of unintentional gun death may be higher than that reported as accidental.

An observer-blinded study of 1% permethrin creme rinse with and without adjunctive combing in patients with head lice.

OBJECTIVES: To determine if NIX (Warner Lambert Healthcare, Morris Plains, NJ) 1% Permethrin Creme Rinse Lice Treatment (1% PLT) without combing will effectively treat >/=95% of patients on day 2 or on day 15; to determine whether combing influences efficacy. STUDY DESIGN: A randomized, observer-blinded study enrolled 95 infested adults and children. All patients were treated with 1% PLT on day 1 and, if still infested, on day 8. One third of households were randomized to the combing group and two thirds to the no-combing group. Efficacy was assessed by: (1) visual inspection on days 1, 2, 8, 9, and 15 and, (2) shampooing/straining on days 2, 9, and 15. The target efficacy was 95%. RESULTS: In the no-combing group, the lice-free rate was 83.1% on day 2 (95% CI, 71.0-91.6), 45.8% on day 8 (before second treatment) (95% CI, 32.7-59.2), 77.6% on day 9 (95% CI, 64.7-87.5), and 78.3% on day 15 (95% CI, 65.8-87.9). Adjunctive combing did not improve efficacy on any day. CONCLUSIONS: In this population, 1% PLT was significantly less than 95% effective and suggests resistance to 1% PLT. The failure of nit removal combing by nonprofessional caregivers to improve efficacy demonstrates the unreliability of combing as adjunctive treatment in this setting.

Comparative in vitro pediculicidal efficacy of treatments in a resistant head lice population in the United States.

OBJECTIVE: To compare the pediculicidal activity of 5 head lice products available in the United States on head lice from south Florida. DESIGN: In vitro pediculicidal product comparison. SETTING: Lice Source Services, Inc, located in Plantation, Fla, a clinic for the treatment and grooming of individuals with pediculosis capitis. PARTICIPANTS: Head lice were collected from healthy clients with Pediculus capitis that came to Lice Source Services, Inc, to seek their services. INTERVENTIONS: Within 2 to 6 hours of capture, lice were placed in continuous direct contact with the pediculicide products and observed at regular intervals. Results were compared with findings of a recent study of a treatment-sensitive population of head lice conducted in Panama. MAIN OUTCOME MEASURE: Percentage of lice dead at regular observation intervals between 5 minutes and 3 hours of continuous exposure to the pediculicides. RESULTS: Two prescription products, Ovide lotion (0.5% malathion) and 1% lindane shampoo, were ranked in the same order as in 2 previous studies (first and last, respectively). The order of effectiveness from most to least effective was as follows: Ovide lotion, A-200 shampoo (a natural pyrethrin product synergized with piperonyl butoxide), undiluted Nix (1% permethrin), diluted Nix, RID (a natural pyrethrin product synergized with piperonyl butoxide), and 1% lindane shampoo. CONCLUSIONS: There were statistically significant differences in the efficacy of all the products when compared with the results found in the recent study in Panama, except for Ovide lotion. Of those tested, Ovide was the only pediculicide in the United States that had not become less effective. The difference in efficacy of 1% lindane, Nix, and pyrethrins between the Panama and Florida studies supports the argument that some head lice in the United States have become resistant to these treatments.