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1.
SSM Popul Health ; 17: 101011, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35024420

RESUMO

Background: A substantial proportion of adolescent girls in Zambia lack the ability to decide their reproductive future. We examined the role of agency in early and unwanted adolescent childbearing. Methods: Using latent transition analysis, we characterized a multi-dimensional profile of adolescent agency annually over a four-year period. We investigated the influence of early life access to resources and time-varying predictors (school retention, violence, early marriage and unwanted/mistimed pregnancy and childbearing) on agency profile membership as well as transitions in agency status over time. Results: Four agency profiles were identified, with differences by age cohort (10-14 years vs. 15-19 years). Three profiles identified in both age cohorts were: Low-moderate agency, Self-assured gender conformers, and High agency. Unique to younger girls was the Gender conscious, low belief in abilities status, while among older girls was the Self-assured selective gender conscious status. While younger girls were likely to transition to the highest agency status over time, high agency membership declined among older girls. Early life resources were associated with augmented agency while exposure to negative events, particularly early marriage, were associated with detraction from high agency status. Girls who expressed high self-efficacy but gender-conforming values were most at risk of early marriage and unwanted/mistimed pregnancy while High agency girls were at comparatively low risk. Conclusions: Results show agency is dynamic but less mutable with increasing age. Early adolescent strategies which address inequitable gender norms and limit early marriage, may guard against losses to agency which contribute to unwanted fertility outcomes.

2.
Addiction ; 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34985165

RESUMO

AIMS: To estimate the impact of recreational and medical cannabis laws (RCL, MCL) on the use of cannabis and cigarettes in the United States. DESIGN: A difference-in-difference approach was applied to data from the 2004-2017 National Survey on Drug Use and Health (NSDUH). SETTING: United States PARTICIPANTS: Nationally representative cross-sectional survey of Americans ages 12 and older (combined analytic sample for 2004-2017, n=783,663). MEASUREMENTS: Data on past-month use of 1) cigarettes and 2) cannabis were used to classify respondents into four groups: cigarette and cannabis co-use, cigarette-only use, cannabis-only use, or no cigarette or cannabis use. State of residence was measured by self-report. MCL/RCL status came from state government websites. FINDINGS: Difference-in-difference analyses suggest that MCL was associated with an increase in cigarette-cannabis co-use overall (adjusted odds ratio [aOR] 1.09; 95% confidence interval [CI] 1.02-1.16), with the greatest increases among those ages 50 and above (aOR 1.60; CI 1.39-1.84), married (aOR 1.19; CI 1.07-1.31), non-Hispanic (NH) Black (aOR 1.14; CI 1.02-1.07), and with a college degree or above (aOR 1.15; CI 1.06-1.24). MCL was associated with increases in cigarette-only use among those ages 50 and above (aOR 1.07; CI 1.01-1.14) and NH Black (aOR 1.16; CI 1.06-1.27) and increases in cannabis-only use among those ages 50 and above (aOR 1.24; CI 1.07-1.44) and widowed/divorced/separated (aOR 1.18; CI 1.01-1.37). RCL was associated with an increase in cannabis-only use overall (aOR 1.21; 95% CI 1.09-1.34), a decline in cigarette-only use overall (aOR 0.89; 95% CI 0.81-0.97) and increases in co-use among those who were married (aOR 1.24; CI 1.02-1.50) and ages 50 and above (aOR 1.37; CI 1.03-1.84). CONCLUSIONS: Recreational and medical cannabis legalization have had a varying impact on the use, and co-use, of cannabis and cigarettes in the United States.

3.
Clin Infect Dis ; 2021 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-34893813

RESUMO

BACKGROUND: Dolutegravir is being rolled out globally as part of preferred antiretroviral therapy (ART) regimens, including among treatment-experienced patients. The role of viral load (VL) testing before switching patients already on ART to a dolutegravir-containing regimen is less clear in real-world settings. METHODS: We included patients from the Central and East Africa regions of the International epidemiology Databases to Evaluate AIDS consortium who switched from a nevirapine- or efavirenz-containing regimen to one with dolutegravir. We used multivariable cause-specific hazards regression to estimate the association of most recent VL test in the 12 months before switching with HIV treatment outcomes. RESULTS: We included 36,393 patients at 37 sites in 5 countries (Democratic Republic of the Congo, Kenya, Rwanda, Tanzania, Uganda) who switched to dolutegravir from 7/2017 through 2/2020, with a median follow-up of approximately 11 months for all outcomes. Compared with those who switched with a VL <200 copies/mL, patients without a recent VL test or with a pre-switch VL ≥1000 copies/mL were significantly more likely to have an incident VL ≥1000 copies/mL (adjusted hazard ratio [aHR] 2.89, 95% confidence interval [CI]: 1.99-4.19 and aHR 6.60, 95% CI 4.36-9.99, respectively) and pulmonary tuberculosis or a World Health Organization Clinical Stage 4 event (aHR 4.78, 95% CI: 2.77-8.24 and aHR 13.97, 95% CI: 6.62-29.50, respectively). CONCLUSIONS: A VL test before switching to dolutegravir may help identify patients who need additional clinical monitoring and/or adherence support. Further surveillance of patients who switched to dolutegravir with an unknown or unsuppressed VL is needed.

4.
J Forensic Leg Med ; 84: 102272, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34743036

RESUMO

The purpose of this study was to investigate the impact of forensic medical evaluations on grant rates for applicants seeking immigration relief in the United States (U.S.) and to identify significant correlates of grant success. We conducted a retrospective analysis of 2584 cases initiated by Physicians for Human Rights between 2008 and 2018 that included forensic medical evaluations, and found that 81.6% of applicants for various forms of immigration relief were granted relief, as compared to the national asylum grant rate of 42.4%. Among the study's cohort, the majority (73.7%) of positive outcomes were grants of asylum. A multivariable regression analysis revealed that age, continent of origin, history of sexual or gender-based violence, gang violence, LGB sexual orientation, and being detained by the U.S. government at the time of evaluation request were statistically associated with case outcomes. Forensic physical evaluation was more strongly associated with a positive outcome than forensic psychological evaluation. Our findings strengthen and expand prior evidence that forensic medical evaluations can have a substantial positive impact on an applicant's immigration relief claim. Given the growing applicant pool in the U.S., there is an urgent need for more trained clinicians to conduct forensic medical evaluations as well as to educate adjudicators, immigration lawyers, and policy makers about the traumatic nature of the life-altering events that applicants for immigration relief experience.

5.
Sci Rep ; 11(1): 21844, 2021 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-34737319

RESUMO

This study assesses attitudes towards COVID-19 vaccination and the predictive value of COVID-VAC, a novel scale, among adults in the four largest US metropolitan areas and nationally. A 36-item survey of 6037 Americans was conducted in mid-April 2021. The study reports factors for COVID-19 vaccine acceptance among: (1) already vaccinated; (2) unvaccinated but willing to accept a vaccine; and (3) unvaccinated and unwilling to vaccinate. More than 20% were unwilling to vaccinate, expressing concerns about vaccine efficacy and safety and questioning the disease's severity. Poverty, working outside of the home and conservative political views are predictors of unwillingness. Conversely, those who either personally tested positive for COVID-19, or had a family member who did so, were more likely to accept vaccination. Majorities of all respondents supported vaccination mandates for employees and university students. Respondents preferred to receive vaccines in their doctor´s office. Lower income and conservative ideology, but not race, were strongly associated with vaccine unwillingness. The predictive value of COVID-VAC was demonstrated. While vaccination mandates are likely to be accepted, additional effective, targeted interventions to increase vaccine uptake are needed urgently.


Assuntos
COVID-19/psicologia , Recusa de Vacinação/psicologia , Recusa de Vacinação/tendências , Adulto , Atitude , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/provisão & distribuição , Feminino , Fidelidade a Diretrizes/tendências , Política de Saúde/tendências , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/patogenicidade , Inquéritos e Questionários , Estados Unidos , Vacinação/psicologia , Vacinação/tendências , Vacinas/farmacologia
6.
Artigo em Inglês | MEDLINE | ID: mdl-34811878

RESUMO

AIM: Identification of individuals with psychosis risk (PR) through screening and specialized assessment is becoming more widespread in an effort to promote early intervention and improve recovery outcomes. PR individuals report interest in psychoeducation, though such interventions are currently lacking. Our goal was to develop a structured PR psychoeducation intervention grounded in theory and stakeholder feedback. METHODS: By following a step-by-step intervention development model, we identified relevant conceptual frameworks, developed the content and format, and obtained stakeholder feedback. This process resulted in a 5-session PR psychoeducation intervention, Brief Educational Guide for Individuals in Need (BEGIN), with content conveyed visually via a slideshow presentation. PR individuals (n = 5) and parents of PR individuals (n = 5) reviewed BEGIN's content and format, and provided feedback through semi-structured qualitative interviews. Major themes were identified through iterative thematic analysis. RESULTS: PR individuals and parents had a positive impression of BEGIN's materials and step-by-step format and psychoeducation about the PR condition. They indicated that the intervention was likely to encourage agency. PR participants emphasized the importance of a patient's decision regarding whether their family member(s) should participate in BEGIN. Parents reported that BEGIN is an important first step in treatment and offers a safe therapeutic environment. Feedback was then utilized to modify the intervention. CONCLUSIONS: BEGIN is desired by consumers and may lay the foundation for future engagement with treatment by facilitating agency. A feasibility trial is underway and future studies are needed to measure outcomes (e.g., treatment engagement) and evaluate BEGIN as an evidence-based PR psychoeducation model.

7.
Ann Intern Med ; 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34843382

RESUMO

BACKGROUND: The transition to dolutegravir-containing antiretroviral therapy (ART) in low- and middle-income countries (LMICs) was complicated by an initial safety signal in May 2018 suggesting that exposure to dolutegravir at conception was possibly associated with infant neural tube defects. On the basis of additional evidence, in July 2019, the World Health Organization recommended dolutegravir for all adults and adolescents living with HIV. OBJECTIVE: To describe dolutegravir uptake and disparities by sex and age group in LMICs. DESIGN: Observational cohort study. SETTING: 87 sites that began using dolutegravir in 11 LMICs in the Asia-Pacific; Caribbean, Central and South America network for HIV epidemiology (CCASAnet); and sub-Saharan African regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. PATIENTS: 134 672 patients aged 16 years or older who received HIV care from January 2017 through March 2020. MEASUREMENTS: Sex, age group, and dolutegravir uptake (that is, newly initiating ART with dolutegravir or switching to dolutegravir from another regimen). RESULTS: Differences in dolutegravir uptake among females of reproductive age (16 to 49 years) emerged after the safety signal. By the end of follow-up, the cumulative incidence of dolutegravir uptake among females 16 to 49 years old was 29.4% (95% CI, 29.0% to 29.7%) compared with 57.7% (CI, 57.2% to 58.3%) among males 16 to 49 years old. This disparity was greater in countries that began implementing dolutegravir before the safety signal and initially had highly restrictive policies versus countries with a later rollout. Dolutegravir uptake was similar among females and males aged 50 years or older. LIMITATION: Follow-up was limited to 6 to 8 months after international guidelines recommended expanding access to dolutegravir. CONCLUSION: Substantial disparities in dolutegravir uptake affecting females of reproductive age through early 2020 are documented. Although this disparity was anticipated because of country-level restrictions on access, the results highlight its extent and initial persistence. PRIMARY FUNDING SOURCE: National Institutes of Health.

8.
J Nutr Sci ; 10: e80, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34616551

RESUMO

Dietary acculturation may explain the increasing risk of diet-related diseases among African immigrants in the United States (US). We interviewed twenty-five Ghanaian immigrants (Youth n 13, Age (Mean ± sd) 20 y ± 5⋅4, Parents (n 6) and Grandparents (n 6) age 58⋅7 ± 9⋅7) living in New York City (NYC) to (a) understand how cultural practices and the acculturation experience influence dietary patterns of Ghanaian immigrants and (b) identify intergenerational differences in dietary acculturation among Ghanaian youth, parents and grandparents. Dietary acculturation began in Ghana, continued in NYC and was perceived as a positive process. At the interpersonal level, parents encouraged youth to embrace school lunch and foods outside the home. In contrast, parents preferred home-cooked Ghanaian meals, yet busy schedules limited time for cooking and shared meals. At the community level, greater purchasing power in NYC led to increased calories, and youth welcomed individual choice as schools and fast food exposed them to new foods. Global forces facilitated nutrition transition in Ghana as fast and packaged foods became omnipresent in urban settings. Adults sought to maintain cultural foodways while facilitating dietary acculturation for youth. Both traditional and global diets evolved as youth and adults adopted new food and healthy social norms in the US.

9.
Psychiatry Res ; 302: 114036, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34098157

RESUMO

In May of 2020, the Substance Abuse and Mental Health Service Administration (SAMSA) issued guidelines for state psychiatric hospitals, recommending that these facilities adopt universal testing for COVID-19 and "three-space" triage protocols for dedicated COVID-19 positive, negative, and quarantine spaces to mitigate the risk of nosocomial infection. The Westchester Behavioral Health Center of New York Presbyterian Hospital (WBHC-NYP) adopted a comprehensive infection control protocol consistent with these recommendations in April, 2020. We reviewed the records of 1,139 patients treated on the inpatient service at WBHC-NYP between March 14th and June 10th, 2020, dates corresponding to the first COVID-19 surge in the New York City metropolitan region. The incidence of detected nosocomial or possible nosocomial infections before and during the implementation of the protocol was 0.096 (16/167), or 0.96 infections per 10 at-risk patients. The incidence of nosocomial or possible nosocomial infections after complete implementation was 0.0110 (2/182), or 1.1 infections per 100 at-risk patients. The difference in incidence between the two time points was statistically significant (p<.0003) and represents a 9-fold decrease.  Our findings support the institutional use of a combined testing and space allocation protocol to mitigate risk of outbreaks in confined settings.


Assuntos
Teste para COVID-19/métodos , COVID-19/prevenção & controle , Infecção Hospitalar/prevenção & controle , Hospitais Psiquiátricos , Triagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Criança , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Adulto Jovem
10.
Front Public Health ; 9: 656988, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33959584

RESUMO

Physical and social environments of parks and neighborhoods influence park use, but the extent of their relative influence remains unclear. This cross-sectional study examined the relationship between the physical and social environment of parks and both observed and self-reported park use in low-income neighborhoods in New York City. We conducted community- (n = 54 parks) and individual-level (n = 904 residents) analyses. At the community level, observed park use was measured using a validated park audit tool and regressed on the number of facilities and programmed activities in parks, violent crime, stop-and-frisk incidents, and traffic accidents. At the individual level, self-reported park use was regressed on perceived park quality, crime, traffic-related walkability, park use by others, and social cohesion and trust. Data were collected in 2016-2018 and analyzed in 2019-2020. At the community level, observed park use was negatively associated with stop-and-frisk (ß = -0.04; SE = 0.02; p < 0.05) and positively associated with the number of park facilities (ß = 1.46; SE = 0.57; p < 0.05) and events (ß = 0.16; SE = 0.16; p < 0.01). At the individual level, self-reported park use was positively associated with the social cohesion and trust scale (ß = 0.02; SE = 0.01; p < 0.05). These results indicate that physical and social attributes of parks, but not perceptions of parks, were significantly associated with park use. The social environment of neighborhoods at both community and individual levels was significantly related to park use. Policies for increasing park use should focus on improving the social environment of parks and surrounding communities, not only parks' physical attributes. These findings can inform urban planning and public health interventions aimed at improving the well-being of residents in low-income communities.


Assuntos
Planejamento Ambiental , Meio Social , Estudos Transversais , Humanos , Cidade de Nova Iorque , Autorrelato
11.
BMJ Open ; 11(3): e047310, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789857

RESUMO

OBJECTIVE: We assessed the impact of key population variables (age, gender, income and education) on perceptions of governmental effectiveness in communicating about COVID-19, helping meet needs for food and shelter, providing physical and mental healthcare services, and allocating dedicated resources to vulnerable populations. DESIGN: Cross-sectional study carried out in June 2020. PARTICIPANTS AND SETTING: 13 426 individuals from 19 countries. RESULTS: More than 60% of all respondents felt their government had communicated adequately during the pandemic. National variances ranged from 83.4% in China down to 37.2% in Brazil, but overall, males and those with a higher income were more likely to rate government communications highly. Almost half (48.8%) of the respondents felt their government had ensured adequate access to physical health services (ranging from 89.3% for Singapore to 27.2% for Poland), with higher ratings reported by younger and higher-income respondents. Ratings of mental health support were lower overall (32.9%, ranging from 74.8% in China to around 15% in Brazil and Sweden), but highest among younger respondents. Providing support for basic necessities of food and housing was rated highest overall in China (79%) and lowest in Ecuador (14.6%), with higher ratings reported by younger, higher-income and better-educated respondents across all countries. The same three demographic groups tended to rate their country's support to vulnerable groups more highly than other respondents, with national scores ranging from around 75% (Singapore and China) to 19.5% (Sweden). Subgroup findings are mostly independent of intercountry variations with 15% of variation being due to intercountry differences. CONCLUSIONS: The tendency of younger, better-paid and better-educated respondents to rate their country's response to the pandemic more highly, suggests that government responses must be nuanced and pay greater attention to the needs of less-advantaged citizens as they continue to address this pandemic.


Assuntos
COVID-19/prevenção & controle , Programas Governamentais , Pandemias/legislação & jurisprudência , Fatores Etários , COVID-19/epidemiologia , Estudos Transversais , Status Econômico , Governo , Humanos , Masculino , SARS-CoV-2 , Fatores Sexuais , Fatores Socioeconômicos
12.
Psychiatry Res ; 298: 113833, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33657449

RESUMO

Some psychiatric hospitals have instituted mandatory COVID-19 testing for all patients referred for admission. Others have permitted patients to decline testing. Little is known about the rate of COVID-19 infection in acute psychiatric inpatients. Characterizing the proportion of infected patients who have an asymptomatic presentation will help inform policy regarding universal mandatory versus symptom-based or opt-out testing protocols. We determined the COVID-19 infection rate and frequency of asymptomatic presentation in 683 consecutively admitted patients during the surge in the New York City region between April 3rd, 2020 and June 8th, 2020. Among these psychiatric inpatients, there was a 9.8 % overall rate of COVID-19 infection. Of the COVID-19 infected patients, approximately 76.1 % (51/67) either had no COVID-19 symptoms or could not offer reliable history of symptoms at the time of admission. Had they not been identified by testing and triaged to a COVID-19 positive unit, they could have infected others, leading to institutional outbreak. These findings provide justification for psychiatric facilities to maintain universal mandatory testing policies, at least until community infection rates fall and remain at very low levels.


Assuntos
Teste para COVID-19/normas , COVID-19/diagnóstico , COVID-19/epidemiologia , Hospitais Psiquiátricos/normas , Transtornos Mentais/terapia , Admissão do Paciente/normas , Adulto , Comorbidade , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Encaminhamento e Consulta , Triagem/normas
13.
Addiction ; 116(10): 2770-2778, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33730400

RESUMO

BACKGROUND AND AIMS: Cannabis use among parents may be increasing with legalization, but perception of associated risk has declined. The study investigated the association between cannabis legalization and cannabis use among adults with children in the home over time in the United States (US). DESIGN: A difference-in-difference approach was applied to public and restricted-use data from the 2004-2017 National Survey on Drug Use and Health (NSDUH), an annual cross-sectional survey. SETTING: A representative sample of the United States. PARTICIPANTS/CASES: Respondents ages 18+ with children living in the home drawn from the NSDUH (n = 287,624), which is administered to non-institutionalized civilians in the 50 states and District of Columbia. MEASUREMENTS: Exposures were year and state-level cannabis policy in state of residence annually. Outcomes were past-30-day cannabis use and daily cannabis use. Sociodemographic variables included age, gender, marital status, annual family income, race/ethnicity, educational attainment, and strength of state-level tobacco control. FINDINGS: In 2017, past-month cannabis use (11.9%, 9.3%, and 6.1%) and daily cannabis use (4.2%, 3.2%, and 2.3%) were more common in states with recreational marijuana laws (RML), followed by states with medical marijuana laws (MML) and without legal cannabis use, respectively. RML and MML were associated with significantly higher prevalence of past-month cannabis use (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [CI] = 1.12-1.46; AOR = 1.12, 95% CI = 1.03-1.22) and daily cannabis use (AOR = 1.25, 95% CI = 1.03-1.51; AOR = 1.16, 95% CI = 1.02-1.32), respectively. The impact of MML was particularly salient among adults ages 50+ and the highest income and education subgroups. CONCLUSIONS: Among adults with children living in the home, cannabis use appears to be more common in US states with legalized cannabis use compared with states with no legal cannabis use. Recreational legalization appears to increase use among adults with children in the home broadly across nearly all sociodemographic groups, whereas the effect of legalization for medical use is heterogeneous by age and socioeconomic status.


Assuntos
Cannabis , Alucinógenos , Maconha Medicinal , Adolescente , Adulto , Criança , Estudos Transversais , Humanos , Legislação de Medicamentos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
14.
JMIR Form Res ; 5(3): e18591, 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33759799

RESUMO

Longitudinal, natural experiments provide an ideal evaluation approach to better understand the impact of built environment interventions on community health outcomes, particularly health disparities. As there are many participant engagement challenges inherent in the design of large-scale community-based studies, adaptive and iterative participant engagement strategies are critical. This paper shares practical lessons learned from the Physical Activity and Redesigned Community Spaces (PARCS) study, which is an evaluation of the impact of a citywide park renovation initiative on physical activity, psychosocial health, and community well-being. The PARCS study, although ongoing, has developed several approaches to improve participant engagement: building trust with communities, adapting the study protocol to meet participants' needs and to reflect their capacity for participation, operational flexibility, and developing tracking systems. These strategies may help researchers anticipate and respond to participant engagement challenges in community-based studies, particularly in low-income communities of color.

15.
Drug Alcohol Depend ; 218: 108364, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33143941

RESUMO

BACKGROUND: Cannabis policy has shifted toward legalization in many parts of the United States (US). While attention has been focused on whether legalization will lead to changes in cannabis use, it is conceivable that legalization will also affect use of substances that individuals frequently use with cannabis. This study assessed whether cannabis legalization impacted the prevalence of poly use of cannabis and alcohol from 2004 to 2017 and estimated the prevalence of cannabis and alcohol poly use in 2017. METHODS: Public and restricted-use data from the US 2004-2017 National Survey on Drug Use and Health were analyzed. Data on past-month cannabis and alcohol use were assessed each year. Cannabis legalization was determined by the presence or absence of medical marijuana laws (MML) and recreational marijuana laws (RML) in each state. Difference-in-difference approach was used to estimate the association of MML and RML on cannabis and alcohol use overall and by sociodemographic subgroups (e.g., age, income, education). RESULTS: Between 2004 and 2017, poly use of cannabis and alcohol increased while alcohol-only use decreased. MML were associated with increases in poly use only among adults over age 50 and among those with higher annual incomes and higher education, while RML were associated with increases in poly use broadly among adults across sociodemographic groups. CONCLUSIONS: Legalization of cannabis was associated with increases in cannabis-alcohol poly use in the US. RML were associated with increases across demographics, while the impact of MML was more limited to certain sociodemographic groups.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Legislação de Medicamentos , Fumar Maconha/legislação & jurisprudência , Adolescente , Adulto , Cannabis , Estudos Transversais , Etanol , Feminino , Alucinógenos , Humanos , Masculino , Fumar Maconha/epidemiologia , Maconha Medicinal , Pessoa de Meia-Idade , Prevalência , Transtornos Relacionados ao Uso de Substâncias , Estados Unidos/epidemiologia , Adulto Jovem
16.
AIDS Behav ; 25(3): 798-808, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32948921

RESUMO

To explore the relationships among individual-, social-, and contextual- (state-level characteristics, including LBGTQ + and racial inequality) level factors and PrEP use. A cross-sectional survey was conducted in 2015-2016 among a geographically diverse group of men who have sex with men (MSM). Survey data was linked to publicly available state-level data based on participant zip code. Multivariable multilevel logistic regression was used to explore the association between multilevel variables and PrEP use. Of 4165 HIV-negative MSM, 13.4% were taking PrEP. In the regression analysis, several demographic and behavioral factors were associated with higher odds of PrEP use. Importantly, after adjusting for individual- and social-level factors, residents of states with high LGBTQ + equality had significantly higher odds of taking PrEP (OR 1.57; 95% CI 1.119, 2.023) compared to low equality states. LGBTQ + inequality between states may hinder PrEP use. States may need to take proactive measures to reduce LGBTQ + inequality as this may negatively impact the ability to reach the federal administration's stated goal to end the HIV epidemic in the US.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Acesso aos Serviços de Saúde , Homossexualidade Masculina/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Profilaxia Pré-Exposição/métodos , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Atitude Frente a Saúde , Estudos Transversais , Infecções por HIV/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Minorias Sexuais e de Gênero , Estados Unidos/epidemiologia , Adulto Jovem
17.
J Clin Psychol ; 77(1): 7-19, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32633089

RESUMO

OBJECTIVE: This study elucidates the association between acceptance, mindfulness, and psychological well-being in a community-based sample participating in a Mindfulness-Based Stress Reduction (MBSR) program. METHOD: Participants (n = 52) completed an 8-week MBSR program at an academic medical center. Participants completed the Profile of Mood States (POMS), Mindfulness Attention Awareness Scale (MAAS), and Acceptance and Action Questionnaire (AAQ-II) at pre- and post-MSBR programs. RESULTS: Serial mediation analysis suggested that changes in mindfulness preceded changes in acceptance, which improved well-being (indirect effect = -6.57, 95% confidence interval [CI; -13.38, -1.57]). Participants with low pre-MSBR acceptance significantly increased acceptance and well-being (p < .001). Moderated mediation models suggested that the pre-MBSR acceptance level moderated the mindfulness-acceptance and the acceptance-well-being link. CONCLUSIONS: Acceptance may be related to mindfulness and pre-MSBR acceptance may differentially affect outcomes. Limitations include a nonclinical sample and a lack of a control group. Future research may examine mindfulness "dose" and other mechanisms that facilitate improvements in outcomes.


Assuntos
Atenção Plena , Afeto , Atenção , Humanos , Estresse Psicológico/terapia , Inquéritos e Questionários
18.
Neuropsychopharmacology ; 46(4): 844-850, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33244149

RESUMO

The remarkably high and growing placebo response rates in clinical trials for CNS indications, such as depression and schizophrenia, constitute a major challenge for the drug development enterprise. Despite extensive literature on participant expectancies and other potent psychosocial factors that perpetuate placebo response, no empirically validated participant-focused strategies to mitigate this phenomenon have been available. This study evaluated the efficacy of the Placebo-Control Reminder Script (PCRS), a brief interactive procedure that educates participants about factors known to cause placebo response, which was administered prior to the primary outcome assessments to subjects with major depressive or psychotic disorders who had at least moderate depression. Participants were informed they would participate in a 2-week randomized clinical trial with a 50% chance of receiving either an experimental antidepressant medication or placebo. In actuality, all participants received placebo. Participants randomly assigned to receive the PCRS (n = 70) reported significantly smaller reductions (i.e., less placebo response) in depression than those who did not receive the PCRS (n = 67). The magnitude of this effect was medium (Cohen's d = 0.40) and was not significantly impacted by diagnostic status. The number of adverse events (i.e., nocebo effect) was also lower in the PCRS group, particularly in the first week of the study. These findings suggest that briefly educating participants about placebo response factors can help mitigate the large placebo response rates that are increasingly seen in failed CNS drug development programs.


Assuntos
Transtorno Depressivo Maior , Transtornos Psicóticos , Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Método Duplo-Cego , Humanos , Efeito Placebo , Transtornos Psicóticos/tratamento farmacológico , Método Simples-Cego , Resultado do Tratamento
19.
JAMA Netw Open ; 3(11): e2024385, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33151318

RESUMO

Importance: Secondhand smoke (SHS) exposure is associated with many health conditions in children and adults. Millions of individuals in the US are currently exposed to SHS in their homes. Objective: To investigate whether a federal ban on smoking in public housing settings was associated with a decrease in indoor SHS levels in New York City public housing developments 12 months after the policy's implementation. Design, Setting, and Participants: This cohort study tracked indoor air quality longitudinally from April 2018 to September 2019 and used difference-in-differences analysis to examine SHS exposure before vs after implementation of the 2018 federal smoke-free housing (SFH) policy in 10 New York City Housing Authority (NYCHA) buildings vs 11 matched low-income buildings not subject to the SFH policy (ie, Section 8 buildings). Exposures: Federal SFH policy implementation, beginning July 30, 2018. Main Outcomes and Measures: Comparison of nicotine concentration levels from passive, bisulfate-coated filters before vs 12 months after implementation of the federal SFH policy. Secondary outcomes included changes in particulate matter less than 2.5 µm in diameter, measured with low-cost particle monitors, and counts of cigarette butts in common areas. Results: Air quality was measured repeatedly in a total of 153 NYCHA and 110 Section 8 nonsmoking households as well as in 91 stairwells and hallways. Before the SFH policy implementation, air nicotine was detectable in 19 of 20 stairwells (95.0%) in NYCHA buildings and 15 of 19 stairwells (78.9%) in Section 8 buildings (P = .19) and in 17 of 19 hallways (89.5%) in NYCHA buildings and 14 of 23 hallways (60.9%) in Section 8 buildings (P = .004). Nicotine was detected less frequently inside nonsmoking apartments overall (26 of 263 [9.9%]) but more frequently in NYCHA apartments (20 of 153 [13.1%]) than in Section 8 apartments (6 of 110 [5.5%]) (P = .04). One year after policy implementation, there was no differential change over time in nicotine concentrations measured in stairwells (DID, 0.03 µg/m3; 95% CI, -0.99 to 1.06 µg/m3) or inside nonsmoking households (DID, -0.04 µg/m3; 95% CI, -0.24 to 0.15 µg/m3). Larger decreases in nicotine concentration were found in NYCHA hallways than in Section 8 hallways (DID, -0.43 µg/m3; 95% CI, -1.26 to 0.40 µg/m3). Conclusions and Relevance: The findings suggest that there was no differential change in SHS in NYCHA buildings 12 months after SFH policy implementation. Additional support may be needed to ensure adherence to SFH policies.


Assuntos
Habitação Popular/legislação & jurisprudência , Política Antifumo/legislação & jurisprudência , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Poluição do Ar/análise , Poluição do Ar em Ambientes Fechados/análise , Criança , Estudos de Coortes , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Masculino , Cidade de Nova Iorque/epidemiologia , Nicotina/análise , Material Particulado/análise , Habitação Popular/estatística & dados numéricos , Inquéritos e Questionários
20.
J Infect Dis ; 222(Suppl 5): S335-S345, 2020 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-32877560

RESUMO

BACKGROUND: Hepatitis C virus (HCV) remains endemic among people who use drugs (PWUD). Measures of HCV community viral load (CVL) and HCV care continuum outcomes may be valuable for ascertaining unmet treatment need and for HCV surveillance and control. METHODS: Data from patients in an opioid treatment program during 2013-2016 were used to (1) identify proportions of antibody and viral load (VL) tested, linked-to-care, and treated, in 2013-2014 and 2015-2016, and pre- and postimplementation of qualitative reflex VL testing; (2) calculate engaged-in-care HCV CVL and "documented" and "estimated" unmet treatment need; and (3) examine factors associated with linkage-to-HCV-care. RESULTS: Among 11 267 patients, proportions of HCV antibody tested (52.5% in 2013-2014 vs 73.3% in 2015-2016), linked-to-HCV-care (15.7% vs 51.8%), and treated (12.0% vs 44.7%) all increased significantly. Hispanic ethnicity was associated with less linkage-to-care, and Manhattan residence was associated with improved linkage-to-care. The overall engaged-in-care HCV CVL was 4 351 079 copies/mL (standard deviation = 7 149 888); local HCV CVLs varied by subgroup and geography. Documented and estimated unmet treatment need decreased but remained high. CONCLUSIONS: After qualitative reflex VL testing was implemented, care continuum outcomes improved, but gaps remained. High rates of unmet treatment need suggest that control of the HCV epidemic among PWUD will require expansion of HCV treatment coverage.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C/terapia , Tratamento de Substituição de Opiáceos/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/complicações , Adolescente , Adulto , Idoso , Continuidade da Assistência ao Paciente , Doenças Endêmicas/prevenção & controle , Doenças Endêmicas/estatística & dados numéricos , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hepatite C/diagnóstico , Hepatite C/epidemiologia , Hepatite C/transmissão , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Epidemia de Opioides/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Lacunas da Prática Profissional/organização & administração , Lacunas da Prática Profissional/estatística & dados numéricos , Carga Viral , Adulto Jovem
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