Hearing Managers of Deaf Workers: A Phenomenological Investigation in the Restaurant Industry.

The study examined the experiences of hearing managers of Deaf restaurant employees regarding accommodation and social integration. Deaf workers who use American Sign Language have different social and accommodation needs than hearing coworkers, but most hearing managers are unfamiliar with these needs. Using stigma theory to frame issues of workplace accommodation and social integration, the researchers collected data through site observation and in-depth semistructured interviews with 6 hearing managers of high-volume restaurants and 6 Deaf employees. It was found that while demonstrably unknowledgeable about Deaf workers' accommodation needs and work abilities, managers held Deaf workers in high esteem and positive social regard. Deaf workers largely felt respected by hearing managers and regarded them positively, but consistently expressed a desire for better, more frequent accommodations for on-the-job communication. The findings have implications for hearing managers, Deaf workers, and intermediary employment advocates.

Comparing Rural and Urban Cervical and Breast Cancer Screening Rates in a Privately Insured Population.

Low preventive screening varies by region and contributes to poor outcomes for breast and cervical cancer. Previous comparative urban and rural research on preventive screening has focused on government programs. This study quantified and compared rural and urban preventive cancer screening rates for women who were privately insured. National Quality Forum measures were used to calculate rates for women within rural and urban parts of the same Hospital Referral Region (HRR) using claims data. Mammography screening rates for women age 24 to 69 years were 77.1% in 2011 and 76.1% in 2008. Compared to urban women, mammography screening rates for women visiting rural physicians were lower in 42%, higher in 2% and identical in 56% of HRRs. Cervical cancer screening rates for women age 21 to 64 years were 82.9% in 2011 and 83.5% in 2008. Cervical cancer screening rates among women who saw rural physicians were lower in 55%, higher in 4%, and identical in 42% of HRRs. HRRs where rural areas underperformed urban areas increased between 2008 and 2011 for both screenings. Moderate but notable differences in women's preventive screening rates between rural and urban physicians highlight the need for practical solutions that increase use of screening services and reduce barriers to services in rural areas.

Minority Stress Theory: An Examination of Factors Surrounding Sexual Risk Behavior among Gay & Bisexual Men Who Use Club Drugs.

BACKGROUND: Few studies have examined the impact of minority stress theory upon sexual risk behavior among gay and bisexual men using club drugs. Similar studies have focused on ethnic minorities and women, however gay and bisexual men demonstrate greater likelihood for risk behaviors leading to HIV/AIDS. OBJECTIVE: This study examined sexual risk behavior from the perspective of minority stress theory upon substance using gay and bisexual men and their partners. METHODS: Multivariable logistic regression analysis examined minority stress associations with participant sexual risk behaviors, drug use and partner type, controlling for demographics. RESULTS: 396 gay and 54 bisexual respondents, ages 18-67 reported at least one time drug use while engaging in sexual risk behavior. In the adjusted model, expectations of rejection associated with lower odds of sexual risk behavior, while older age approached significance. CONCLUSIONS: Theoretical origins for examining risk behavior among gay and bisexual men may underscore risk and protective factors, while ultimately holding implications for prevention and treatment interventions.

The Housing First Model (HFM) fidelity index: designing and testing a tool for measuring integrity of housing programs that serve active substance users.

BACKGROUND: The Housing First Model (HFM) is an approach to serving formerly homeless individuals with dually diagnosed mental health and substance use disorders regardless of their choice to use substances or engage in other risky behaviors. The model has been widely diffused across the United States since 2000 as a result of positive findings related to consumer outcomes. However, a lack of clear fidelity guidelines has resulted in inconsistent implementation. The research team and their community partner collaborated to develop a HFM Fidelity Index. We describe the instrument development process and present results from its initial testing. METHODS: The HFM Fidelity Index was developed in two stages: (1) a qualitative case study of four HFM organizations and (2) interviews with 14 HFM "users". Reliability and validity of the index were then tested through phone interviews with staff members of permanent housing programs. The final sample consisted of 51 programs (39 Housing First and 12 abstinence-based) across 35 states. RESULTS: The results provided evidence for the overall reliability and validity of the index. CONCLUSIONS: The results demonstrate the index's ability to discriminate between housing programs that employ different service approaches. Regarding practice, the index offers a guide for organizations seeking to implement the HFM.

Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems.

This is a prospective cohort study to identify factors associated with receipt of substance abuse treatment (SAT) among adults with alcohol problems and HIV/AIDS. Data from the HIV Longitudinal Interrelationships of Viruses and Ethanol study were analyzed. Generalized estimating equation logistic regression models were fit to identify factors associated with any service utilization. An alcohol dependence diagnosis had a negative association with SAT (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [95% CI] = 0.19-0.67), as did identifying sexual orientation other than heterosexual (AOR = 0.46, CI = 0.29-0.72) and having social supports that use alcohol/drugs (AOR = 0.62, CI = 0.45-0.83). Positive associations with SAT include presence of hepatitis C antibody (AOR = 3.37, CI = 2.24-5.06), physical or sexual abuse (AOR = 2.12, CI = 1.22-3.69), social supports that help with sobriety (AOR = 1.92, CI = 1.28-2.87), homelessness (AOR = 2.40, CI = 1.60-3.62), drug dependence diagnosis (AOR = 2.64, CI = 1.88-3.70), and clinically important depressive symptoms (AOR = 1.52, CI = 1.08-2.15). While reassuring that factors indicating need for SAT among people with HIV and alcohol problems (e.g., drug dependence) are associated with receipt, nonneed factors (e.g., sexual orientation, age) that should not decrease likelihood of receipt of treatment were identified.

A Protection Motivation Theory application to date rape education.

Date rape risk communication is a key component of education-based Date Rape Prevention Programs, common across colleges. In such programs, risk assessment in date rape is approached cautiously in order to avoid a tone of "victim blaming." Since it is important in the assessment of any risk to understand the surrounding social context of the risky situation and the individual's unique relationship with that social context, this study examines Protection Motivation Theory as it applies to handling the risk of date rape without victim blaming. The paper links individual personality and social contexts with risk communication. The study sample comprised 367 undergraduate women enrolled in a large Southern Public University. The study examines the relationships between dating activity, social competency, and type of information provided with the dependents variables of date rape related protection behavior (intent), belief, and knowledge. A factorial multiple analysis of covariance analysis found that the dependent variables had a significant relationship with aspects of social competency and dating activity. The exposure to varying information about date rape was not significantly related to the dependent variables of date rape-related protection behavior (intent), belief, and knowledge. The identification of social competency and dating activity status as protective factors in this study makes a significant contribution to the practice and research efforts in date rape education.

Medicare's policy to limit payment for hospital-acquired conditions: the impact on safety net providers.

In 2008, Medicare implemented a policy limiting reimbursement to hospitals for treating avoidable hospital-acquired conditions (HACs). Although the policy will expand nationally to Medicaid programs in 2011, little is known about the impact on safety-net hospitals. Using data from the 2006 American Hospital Association Annual Survey and MEDPAR, we compared the incidence of cases that met the HACs criteria at safety-net and non-safety-net hospitals. We found that safety-net hospitals had an average of 65.5 HACs per 1,000 Medicare discharges compared with 57.6 at non-safety-net hospitals. Hospitals in the lowest quintile for financial margins had higher rates of HACs on average than other hospitals. Safety-net hospitals and hospitals with the lowest financial margins may be more likely than others to be affected by policies that reduce payment for HACs.

Factors associated with attendance in 12-step groups (Alcoholics Anonymous/Narcotics Anonymous) among adults with alcohol problems living with HIV/AIDS.

BACKGROUND: Despite the value of 12-step meetings, few studies have examined factors associated with attendance among those living with HIV/AIDS, such as the impact of HIV disease severity and demographics. OBJECTIVE: This study examines predisposing characteristics, enabling resources and need on attendance at Alcoholic Anonymous (AA) and Narcotics Anonymous (NA) meetings among those living with HIV/AIDS and alcohol problems. METHODS: Secondary analysis of prospective data from the HIV-Longitudinal Interrelationships of Viruses and Ethanol study, a cohort of 400 adults living with HIV/AIDS and alcohol problems. Factors associated with AA/NA attendance were identified using the Anderson model for vulnerable populations. Generalized estimating equation logistic regression models were fit to identify factors associated with self-reported AA/NA attendance. RESULTS: At study entry, subjects were 75% male, 12% met diagnostic criteria for alcohol dependence, 43% had drug dependence and 56% reported attending one or more AA/NA meetings (past 6 months). In the adjusted model, female gender negatively associated with attendance, as were social support systems that use alcohol and/or drugs, while presence of HCV antibody, drug dependence diagnosis, and homelessness associated with higher odds of attendance. CONCLUSIONS: Non-substance abuse related barriers to AA/NA group attendance exist for those living with HIV/AIDS, including females and social support systems that use alcohol and/or drugs. Positive associations of homelessness, HCV infection and current drug dependence were identified. These findings provide implications for policy makers and treatment professionals who wish to encourage attendance at 12-step meetings for those living with HIV/AIDS and alcohol or other substance use problems.

A randomized trial of telemonitoring heart failure patients.

The purpose of this study was to measure the ability of telemonitoring to reduce hospital days and total costs for Medicare managed care enrollees diagnosed with heart failure. Patients were recruited and randomly assigned for six months to either telemonitoring or standard care. Telemonitoring transmitted vital signs and clinical alerts daily to a central nursing station. Utilization of covered services was analyzed for the six-month telemonitoring period to test for hypothesized reductions in hospital days and changes in utilization of the emergency department (ED), urgent care, and primary care. Negative binomial regressions adjusted for gender, age, co-occurring diabetes, co-occurring chronic obstructive pulmonary disease, and residence neighborhood were used to analyze units of service, and two-part (hurdle) multivariable models were used for expenditures. The main finding was a tendency for lower total number of hospital days for patients assigned to telemonitoring. Results for other covered services were generally consistent with hypothesized direction and magnitude; however, statistical power was reduced because of lower-than-expected recruitment rates into the study. Within a managed-care environment, telemonitoring appears to facilitate better ambulatory management of heart failure patients, including fewer ED visits, which were offset by more frequent primary care and urgent care visits.