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1.
JAMA Netw Open ; 3(1): e1920010, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995215

RESUMO

Importance: Racial and ethnic disparities in access to health care may result from discrimination. Objectives: To identify differences in the rates at which patients belonging to racial/ethnic minority groups are offered primary care appointments and the number of days they wait for their primary care appointment and to understand the mechanisms by which discrimination occurs. Design, Setting, and Participants: This cross-sectional study used 7 simulated black, Hispanic, and white patient callers to request appointments from 804 randomized primary care offices in 2 urban centers in Texas from November 2017 to February 2018. Data analysis was conducted between February and December 2018. Exposures: Research assistants called randomly assigned offices to schedule an appointment, supplying the same basic information. Race and ethnicity were signaled through callers' names and voices. Main Outcomes and Measures: Appointment offer rates, days to appointment, and questions asked during the call. Results: Of the 7 callers (age range, 18-29 years), 2 (28.6%) self-identified as non-Hispanic black, 3 (42.9%) self-identified as non-Hispanic white, and 2 (28.6%) self-identified as Hispanic. Of the 804 calls they made, 299 (37.2%) were from simulated white callers, 215 (26.7%) were from simulated black callers, and 290 (36.1%) were from simulated Hispanic callers. Overall, 582 callers (72.4%) were offered appointments. In unadjusted models, black and Hispanic callers were more likely to be offered an appointment than white callers (black callers, 32.2 [95% CI, 25.1-39.3] percentage points more likely; P < .001; Hispanic callers, 21.1 [95% CI, 13.7-28.5] percentage points more likely; P < .001). However, after adjusting for whether insurance status was revealed, this statistical significance was lost. In adjusted models, black callers were 44.0 (95% CI, 36.2-51.8) percentage points more likely to be asked about their insurance status than white callers (P < .001), and Hispanic callers were 25.3 (95% CI, 17.1-33.5) percentage points more likely to be asked about their insurance status (P < .001) than white callers. Black and Hispanic callers received appointments further in the future than white callers (black callers: marginal effect estimate, 3.650; 95% CI, 0.579 to 6.721; P = .08; Hispanic callers: marginal effect estimate, 2.644; 95% CI, -0.496 to 5.784; P = .02). Conclusions and Relevance: In this study, black and Hispanic patients were more likely to be offered an appointment, but they were asked more frequently about their insurance status than white callers. Black and Hispanic callers experienced longer wait times than white patients, indicating a barrier to timely access to primary care.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Agendamento de Consultas , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos
2.
Medicine (Baltimore) ; 99(2): e18525, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914025

RESUMO

Human immunodeficiency virus (HIV) testing is important for prevention and treatment. Ending the HIV epidemic is unattainable if significant proportions of people living with HIV remain undiagnosed, making HIV testing critical for prevention and treatment. The Centers for Disease Control and Prevention (CDC) recommends routine HIV testing for persons aged 13 to 64 years in all health care settings. This study builds on prior research by estimating the extent to which HIV testing occurs during physician office and emergency department (ED) post 2006 CDC recommendations.We performed an unweighted and weighted cross-sectional analysis using pooled data from 2 nationally representative surveys namely National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2009 to 2014. We assessed routine HIV testing trends and predictive factors in physician offices and ED using multi-stage statistical survey procedures in SAS 9.4.HIV testing rates in physician offices increased by 105% (5.6-11.5 per 1000) over the study period. A steeper increase was observed in ED with a 191% (2.3-6.7 per 1000) increase. Odds ratio (OR) for HIV testing in physician offices were highest among ages 20 to 29 ([OR] 7.20, 99% confidence interval [CI: 4.37-11.85]), males (OR 1.34, [CI: 0.91-0.93]), African-Americans (OR 2.97, [CI: 2.05-4.31]), Hispanics (OR 1.80, [CI: 1.17-2.78]), and among visits occurring in the South (OR 2.06, [CI: 1.23-3.44]). In the ED, similar trends of higher testing odds persisted for African Americans (OR 3.44, 99% CI 2.50-4.73), Hispanics (OR 2.23, 99% CI 1.65-3.01), and Northeast (OR 2.24, 99% CI 1.10-4.54).While progress has been made in screening, HIV testing rates remains sub-optimal for ED visits. Populations visiting the ED for routine care may suffer missed opportunities for HIV testing, which delays their entry into HIV medical care. To end the epidemic, new approaches for increasing targeted routine HIV testing for populations attending health care settings is recommended.


Assuntos
Epidemias/prevenção & controle , Infecções por HIV/epidemiologia , HIV/isolamento & purificação , Programas de Rastreamento/métodos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Pesquisas sobre Serviços de Saúde/métodos , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Consultórios Médicos/estatística & dados numéricos , Testes Sorológicos/métodos , Testes Sorológicos/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
4.
N C Med J ; 81(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908326

RESUMO

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Doença Relacionada a Viagens , Infecção por Zika virus/etnologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , North Carolina , Gravidez , Fatores de Risco , Serviços de Saúde Rural
5.
MMWR Morb Mortal Wkly Rep ; 69(2): 25-29, 2020 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-31945037

RESUMO

Birth defects are a leading cause of infant mortality in the United States, accounting for 20.6% of infant deaths in 2017 (1). Rates of infant mortality attributable to birth defects (IMBD) have generally declined since the 1970s (1-3). U.S. linked birth/infant death data from 2003-2017 were used to assess trends in IMBD. Overall, rates declined 10% during 2003-2017, but decreases varied by maternal and infant characteristics. During 2003-2017, IMBD rates decreased 4% for infants of Hispanic mothers, 11% for infants of non-Hispanic black (black) mothers, and 12% for infants of non-Hispanic white (white) mothers. In 2017, these rates were highest among infants of black mothers (13.3 per 10,000 live births) and were lowest among infants of white mothers (9.9). During 2003-2017, IMBD rates for infants who were born extremely preterm (20-27 completed gestational weeks), full term (39-40 weeks), and late term/postterm (41-44 weeks) declined 20%-29%; rates for moderate (32-33 weeks) and late preterm (34-36 weeks) infants increased 17%. Continued tracking of IMBD rates can help identify areas where efforts to reduce IMBD are needed, such as among infants born to black and Hispanic mothers and those born moderate and late preterm (32-36 weeks).


Assuntos
Anormalidades Congênitas/mortalidade , Mortalidade Infantil/tendências , Afro-Americanos/estatística & dados numéricos , Anormalidades Congênitas/etnologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Mortalidade Infantil/etnologia , Lactente Extremamente Prematuro , Recém-Nascido , Criança Pós-Termo , Recém-Nascido Prematuro , Masculino , Estados Unidos/epidemiologia
6.
MMWR Morb Mortal Wkly Rep ; 68(40): 873, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31851655

RESUMO

National Latinx AIDS Awareness Day, October 15, is observed each year to focus on the continuing and disproportionate impact of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) on Hispanics/Latinos in the United States. In 2017, 26% of newly diagnosed HIV infections occurred in Hispanics/Latinos (1). Seventy-five percent of these newly diagnosed HIV infections in Hispanics/ Latinos were in men who have sex with men (MSM), and an additional 3% were in MSM who inject drugs (1).


Assuntos
Síndrome de Imunodeficiência Adquirida/etnologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Aniversários e Eventos Especiais , Hispano-Americanos/estatística & dados numéricos , Humanos , Estados Unidos/epidemiologia
7.
Health Serv Res ; 54 Suppl 2: 1409-1418, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667831

RESUMO

OBJECTIVE: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. PRINCIPAL FINDINGS: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. CONCLUSIONS: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
8.
MMWR Morb Mortal Wkly Rep ; 68(43): 967-973, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31671083

RESUMO

Among the 47,600 opioid-involved overdose deaths in the United States in 2017, 59.8% (28,466) involved synthetic opioids (1). Since 2013, synthetic opioids, particularly illicitly manufactured fentanyl (IMF), including fentanyl analogs, have been fueling the U.S. overdose epidemic (1,2). Although initially mixed with heroin, IMF is increasingly being found in supplies of cocaine, methamphetamine, and counterfeit prescription pills, which increases the number of populations at risk for an opioid-involved overdose (3,4). With the proliferation of IMF, opioid-involved overdose deaths have increased among minority populations including non-Hispanic blacks (blacks) and Hispanics, groups that have historically had low opioid-involved overdose death rates (5). In addition, metropolitan areas have experienced sharp increases in drug and opioid-involved overdose deaths since 2013 (6,7). This study analyzed changes in overdose death rates involving any opioid and synthetic opioids among persons aged ≥18 years during 2015-2017, by age and race/ethnicity across metropolitan areas. Nearly all racial/ethnic groups and age groups experienced increases in opioid-involved and synthetic opioid-involved overdose death rates, particularly blacks aged 45-54 years (from 19.3 to 41.9 per 100,000) and 55-64 years (from 21.8 to 42.7) in large central metro areas and non-Hispanic whites (whites) aged 25-34 years (from 36.9 to 58.3) in large fringe metro areas. Comprehensive and culturally tailored interventions are needed to address the rise in drug overdose deaths in all populations, including prevention strategies that address the risk factors for substance use across each racial/ethnic group, public health messaging to increase awareness about synthetic opioids in the drug supply, expansion of naloxone distribution for overdose reversal, and increased access to medication-assisted treatment.


Assuntos
Analgésicos Opioides/envenenamento , Grupos de Populações Continentais/estatística & dados numéricos , Overdose de Drogas/etnologia , Overdose de Drogas/mortalidade , Grupos Étnicos/estatística & dados numéricos , Medicamentos Sintéticos/envenenamento , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
9.
BMC Public Health ; 19(1): 1429, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31672141

RESUMO

BACKGROUND: The feminization and ethnic diversification of HIV infection, has resulted in a call for gender- and culture-specific prevention strategies for at-risk groups including Latinos in the United States. The steadily changing demographic profile of the AIDS epidemic challenges prevention strategies to remain relevant and up-to-date, particularly in populations of women midlife and older where an understanding of risk remains under explored. As the CDC requests country-specific HIV risk profiles for Latino communities in the US, understanding the socio-economic, behavioral and personal risk reasons of HIV risk for older Dominican women is critical for prevention. METHODS: We conducted focus group discussions informed by the Theory of Gender and Power (TGP). The three constructs of the TGP: 1) Affective influences/social norms; 2) Gender-specific norms and. 3) Power and Authority guided the thematic analysis and identified themes that described the socio-cultural and contextual reasons that that contribute to perceptions of HIV risk. RESULTS: Sixty Dominican American women ages 57-73 participated in our focus group discussions. Sexual Division of Labour: 1) Economic Dependence; 2) Financial Need and 3) Education and Empowerment. Sexual Division of Power: 4) HIV Risk and 5) Relationship Dynamics. Cathexis: Affective Influences/Social Norms: 6) HIV/AIDS Knowledge and 7) Prevention and Testing. Importantly, participants were concerned about partner fidelity when visiting the Dominican Republic, as the country accounts for the second highest HIV rates in the Caribbean. CONCLUSIONS: Our results confirm previous findings about perceptions of HIV risk and provide additional insight into aging-related aspects of HIV risk for Latino women midlife and older.


Assuntos
Atitude Frente a Saúde/etnologia , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Hispano-Americanos/psicologia , Idoso , República Dominicana/etnologia , Feminino , Grupos Focais , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Medição de Risco , Comportamento Sexual/etnologia , Parceiros Sexuais/psicologia , Estados Unidos
10.
Sleep Health ; 5(6): 532-538, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31708438

RESUMO

BACKGROUND: Suboptimal sleep has been documented in at-risk groups such as urban minority children, particularly those with asthma. It is therefore critical to examine differences in sleep outcomes across specific racial and ethnic groups and to identify factors that contribute to such variations in sleep outcomes to inform tailored interventions to improve sleep health. OBJECTIVES: The objectives were to examine racial/ethnic differences in sleep outcomes among urban children with and without asthma and to evaluate the extent to which asthma status and aspects of sleep hygiene and the sleep environment contribute to racial/ethnic differences in sleep outcomes in this sample. METHODS: Two hundred and sixteen African American, Latino, or non-Latino white (NLW) urban children, ages 7-9 years, with (n = 216) and without asthma (n = 130) and their primary caregivers were included. Objective sleep duration and efficiency were assessed via actigraphy. Asthma status was assessed by a study clinician. Caregiver-reported sleep hygiene and exposure to noise were assessed using a questionnaire. RESULTS: Minority children in the sample had, on average, shorter sleep duration compared to NLW children during the monitoring period (mean difference Latino vs NLW = -22.10, SE = 5.02; mean difference AA vs NLW = -18.69, SE = 5.28) Additionally, several racial/ethnic group differences in sleep outcomes emerged and were dependent on whether or not children had asthma. Specifically, Latinos had lower mean number of awakenings compared to NLWs but only among control participants with no asthma. Furthermore, specific aspects of sleep hygiene and exposure to nighttime noise in the home and neighborhood contributed to racial/ethnic differences in sleep outcomes. CONCLUSION: Considering urban stressors and asthma status when treating pediatric populations is important, as factors related to urban stress and asthma management may influence sleep hygiene practices and sleep outcomes.


Assuntos
Afro-Americanos/estatística & dados numéricos , Asma/etnologia , Disparidades nos Níveis de Saúde , Hispano-Americanos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Sono , Saúde da População Urbana/etnologia , Cuidadores , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , New England , Higiene do Sono , Inquéritos e Questionários , Fatores de Tempo
11.
Eat Behav ; 35: 101336, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31731234

RESUMO

The Power of Food Scale (PFS) is an instrument designed to examine individual differences in the drive to eat for pleasure (as opposed to in response to physiological hunger) and the effect of living in an obesogenic environment. Previous research supports the validity and reliability of the PFS, however, it had yet to be validated in an ethnically diverse college sample. The purpose of the current study was to test the factor structure and measurement invariance of the PFS across gender, ethnicity, and weight status. A sample of 432 college students completed the PFS (males=113, females = 319; non-Hispanic white=181, Hispanic=251; non-overweight=302, overweight=130). Confirmatory factor analysis was used to test a second-order, 3-factor (food available, food present, food tasted) structure of the PFS in each group separately (males, females, Hispanic, non-Hispanic white, non-overweight, and overweight) and tests of measurement invariance were conducted to test the equivalency of the measure across gender, ethnicity, and weight status. Results supported the measure's original factor structure (second-order, 3-factor model) and indicated that the measure is equivalent across each of these groups, respectively. Although the small, unbalanced groups may impact the stability of the findings, the results nonetheless suggest that the PFS is a psychometrically valid measure in a diverse college sample, and that mean comparisons on this measure are meaningful across gender, ethnicity, and weight status. Given the measurement invariance of the PFS, there is support for use of the PFS among diverse college students in future work.


Assuntos
Comportamento Alimentar/psicologia , Estudantes/psicologia , Inquéritos e Questionários , Adolescente , Adulto , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Análise Fatorial , Comportamento Alimentar/etnologia , Feminino , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico , Sobrepeso/etnologia , Sobrepeso/psicologia , Psicometria , Reprodutibilidade dos Testes , Fatores Sexuais , Estudantes/estatística & dados numéricos , Universidades , Adulto Jovem
12.
Health Serv Res ; 54 Suppl 2: 1467-1471, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31650534

RESUMO

OBJECTIVE: To summarize findings from this Special Issue, which examine reported experiences of discrimination among six underrepresented groups in public opinion research-blacks, Latinos, Native Americans, Asian Americans, lesbian, gay, bisexual, transgender, or queer (LGBTQ) adults, and women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. METHODS: We calculated the percent of adults reporting discrimination in several domains, including health care. PRINCIPAL FINDINGS: In health care encounters, 32 percent of black adults reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Significant shares also reported experiencing racial, gender, or LGBTQ identity-based violence against themselves or family members, including 51 percent of LGBTQ adults, 42 percent of blacks, 38 percent of Native Americans, and 21 percent of women. At least one in seven blacks (22 percent), LGBTQ adults (18 percent), Latinos (17 percent), and Native Americans (15 percent) reported avoiding health care for themselves or family members over concerns of anticipated discrimination or unfair treatment. CONCLUSIONS: Taken together, this polling effort illustrates the significant and widespread level of discrimination against many groups in America today, as well as the complex manifestation of these experiences across different groups and different areas of life. While it is beyond the scope of these results to make specific recommendations for how to end discrimination in each area of life we studied, this Special Issue provides important evidence that more research and practice on discrimination are sorely needed in health services research.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
13.
Am Surg ; 85(10): 1166-1170, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657317

RESUMO

Youth and young adult interpersonal violence (IPV) is a unique clinical challenge which merits study. This study defined the demographics and clinical outcomes of youth and young adult victims of IPV presenting to our hospital while examining violent injury recidivism. We reviewed patients aged 10 to 30 years admitted to our trauma bay as a victim of gunshot wound (GSW), stabbing wound, or blunt assault from 1998 to 2015 (n = 12,549). Logistic regression analysis was conducted to compare patient mortality across demographic characteristics, and Cox proportional hazards regression was used to determine risk factors for recidivism. Male (92%) and Hispanic patients (75%) constituted the majority of admissions. We observed differences in the mortality rate by gender (9% in males vs 5% in females, P < 0.001), race/ethnicity (5% non-Hispanic white vs 9% Hispanic, P = 0.001), insurance status (3% insured vs 10% uninsured, P < 0.001), and mechanism of injury (13% GSW, 2% stabbing wound, and 0.3% blunt assault, P < 0.001). Male gender, younger age, GSW, and amphetamine placed patients at higher risk for IPV recidivism (P < 0.05). This study demonstrates the need to better understand how demographics and economics are associated with youth and young adult IPV. In addition, future IPV prevention and intervention initiatives can be tailored to suit the unique needs of our population.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Reincidência/estatística & dados numéricos , Ferimentos por Arma de Fogo/mortalidade , Ferimentos não Penetrantes/mortalidade , Ferimentos Perfurantes/mortalidade , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Criança , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Violência com Arma de Fogo/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Razão de Chances , Reincidência/etnologia , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/etnologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/etnologia , Ferimentos Perfurantes/epidemiologia , Ferimentos Perfurantes/etnologia , Adulto Jovem
14.
MMWR Morb Mortal Wkly Rep ; 68(40): 873-879, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31600183

RESUMO

Correct and consistent condom use and human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) are protective against sexual transmission of HIV (1,2). The incidence of HIV infection among Hispanic/Latino men who have sex with men (MSM) in the United States is increasing (3). HIV risk among Hispanic/Latino MSM differs based on their place of birth and years of U.S. residence (4). Data from CDC's National HIV Behavioral Surveillance (NHBS)* for 2011-2017 were analyzed to assess changes in sexual risk behaviors among Hispanic/Latino MSM by place of birth and years of U.S. residence. Overall, condomless anal sex during the previous 12 months increased from 63% in 2011 to 74% in 2017, and PrEP use during the previous 12 months increased from 3% in 2014 to 24% in 2017. Regardless of place of birth, nearly 75% of Hispanic/Latino MSM reported condomless anal sex during 2017. However, because of PrEP use, <60% of non-U.S.-born Hispanic/Latino MSM and <50% of U.S.-born Hispanic/Latino MSM reported unprotected anal sex (condomless anal sex and no PrEP use) during 2017. Results indicate that PrEP can be a vital tool for reducing HIV transmission among Hispanic/Latino MSM, especially those who have condomless anal sex. Interventions to prevent HIV acquisition, including increasing PrEP uptake, could address cultural and linguistic needs of Hispanic/Latino MSM, as well as other barriers to prevention of HIV infection typically faced by all MSM.


Assuntos
Hispano-Americanos/psicologia , Homossexualidade Masculina/etnologia , Assunção de Riscos , Sexo sem Proteção/etnologia , Adolescente , Adulto , Infecções por HIV/etnologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
15.
MMWR Morb Mortal Wkly Rep ; 68(37): 801-806, 2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31536484

RESUMO

In 2017, preliminary data show that gay, bisexual, and other men who have sex with men (MSM) accounted for 67% of new diagnoses of human immunodeficiency virus (HIV) infection, that MSM who inject drugs accounted for an additional 3%, and that African American/black (black) and Hispanic/Latino (Hispanic) MSM were disproportionately affected (1). During 2010-2015, racial/ethnic disparities in HIV incidence increased among MSM; in 2015, rates among black and Hispanic MSM were 10.5 and 4.9 times as high, respectively, as the rate among white MSM (compared with 9.2 and 3.8 times as high, respectively, in 2010) (2). Increased use of preexposure prophylaxis (PrEP), which reduces the risk for sexual acquisition of HIV infection by approximately 99% when taken daily as prescribed,* would help to reduce these disparities and support the Ending the HIV Epidemic: A Plan for America initiative† (3). Although PrEP use has increased among all MSM since 2014 (4), racial/ethnic disparities in PrEP use could increase existing disparities in HIV incidence among MSM (5). To understand racial/ethnic disparities in PrEP awareness, discussion with a health care provider, and use (steps in the HIV PrEP continuum of care) (6), CDC analyzed 2017 National HIV Behavioral Surveillance (NHBS) data. Black and Hispanic MSM were significantly less likely than were white MSM to be aware of PrEP, to have discussed PrEP with a health care provider, or to have used PrEP within the past year. Among those who had discussed PrEP with a health care provider within the past year, 68% of white MSM, 62% of Hispanic MSM, and 55% of black MSM, reported PrEP use. Prevention efforts need to increase PrEP use among all MSM and target eliminating racial/ethnic disparities in PrEP use.§.


Assuntos
Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades em Assistência à Saúde/etnologia , Homossexualidade Masculina/etnologia , Profilaxia Pré-Exposição/estatística & dados numéricos , Adolescente , Adulto , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/psicologia , Hispano-Americanos/estatística & dados numéricos , Homossexualidade Masculina/psicologia , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , População Urbana/estatística & dados numéricos , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-31546681

RESUMO

BACKGROUND: Although other mechanisms are also involved, at least one reason high educational attainment (EA) is associated with better health is lower employment stress in individuals with high EA. Minorities' Diminished Returns, however, refer to the smaller protective health effects of EA for racial- and ethnic-minority individuals, particularly African Americans (AAs) and Hispanics, as compared to Whites. We are, however, not aware of many studies that have explored differential associations between EA and work-related stress across racial and ethnic groups. AIMS: We aimed to compare racial and ethnic groups for the association between EA and occupational stress in a national sample of American adults. METHODS: The National Health Interview Survey (NHIS 2015), a cross-sectional survey, included 15,726 employed adults. Educational attainment was the dependent variable. Occupational stress was the outcome. Race and ethnicity were the moderators. Age, gender, number of jobs, and years in the job were the covariates. RESULTS: Overall, higher EA was associated with lower levels of occupational stress. Race and ethnicity both interacted with EA, suggesting that the association between high EA and reduced occupational stress is systemically smaller for AAs and Hispanics than it is for Whites. CONCLUSIONS: In the United States, race and ethnicity limit the health gains that follow EA. While EA helps individuals avoid environmental risk factors, such as occupational stress, this is more valid for non-Hispanic Whites than AAs and Hispanics. The result is additional physical and mental health risks in highly educated AAs and Hispanics. The results are important, given racial and ethnic minorities are the largest growing section of the US population. We should not assume that EA is similarly protective across all racial and ethnic groups. In this context, EA may increase, rather than reduce, health disparities.


Assuntos
Afro-Americanos/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Estresse Ocupacional , Sucesso Acadêmico , Adulto , Estudos Transversais , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
17.
Clin Nephrol ; 92(5): 221-225, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31496515

RESUMO

BACKGROUND: Multiple studies have revealed disparity in renal healthcare access and outcomes in racial/ethnic minorities with the socioeconomic status explaining the majority but not all of the disparity. We wanted to determine if racial/ethnic disparities existed at the first step toward renal transplantation, the renal transplant referral process. MATERIALS AND METHODS: A cohort of 200 adult end-stage renal disease patients was followed retrospectively for 2 years from January 2016 to February 2018. The study exposure was based on self-declared race/ethnicity of the patients, who were categorized as Black, White, and Hispanic. The study outcome was based on medical team patient evaluation and consisted of the patients who refused referral, who were not referred, and who were referred for transplant. Medical and demographic factors collected were age, gender, socioeconomic status, hemoglobin A1c ≥ 7, body mass index ≥ 40, left ventricular ejection fraction ≤ 40%, the presence of coronary or peripheral arterial disease, albumin level, history of smoking, cirrhosis, and cancer. The data were analyzed using univariate analyses and multinomial logistic regression. RESULTS: In the adjusted analysis, there was no difference in the likelihood of transplant referral between Black and White patients (OR = 0.71, 95% CI 0.22 - 2.3, p = 0.56). However, both Black (OR = 16, 95% CI 3.3 - 77, p = 0.0006) and White (OR = 22, 95% CI 3.4 - 150, p = 0.0013) patients were more likely to be referred for transplant when compared with Hispanic patients. Odds of transplant refusal were not different across race/ethnic groups. CONCLUSION: Hispanic patients are disadvantaged in the referral for renal transplant when compared to Black and White patients for reasons unclear at this time.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Estudos Retrospectivos
18.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501233

RESUMO

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Assuntos
Desenvolvimento Infantil , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Nível de Saúde , Obesidade Pediátrica/epidemiologia , Magreza/epidemiologia , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Arkansas/epidemiologia , Baltimore/epidemiologia , Boston/epidemiologia , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Minnesota/epidemiologia , Inquéritos Nutricionais , Philadelphia/epidemiologia , Pobreza , Análise de Regressão
19.
Artigo em Inglês | MEDLINE | ID: mdl-31480556

RESUMO

This study contributes to previous research by advancing a "racialized structural vulnerability" framework and presenting a new empirical analysis of the relationship between neighborhood Asian, Black, and Latinx composition; extrinsic and intrinsic vulnerability; and PM2.5 exposures in California with secondary data from 2004-2014. Principal component analyses revealed that tract Latinx composition was highly correlated with extrinsic vulnerability (economic disadvantage and limited English-speaking ability), and that tract Black composition was highly correlated with intrinsic vulnerability (elevated prevalence of asthma-related emergency department visits and low birth weight). Spatial lag regression models tested hypotheses regarding the association between Asian, Black, and Latinx population vulnerability factors and the 2009-2011 annual average PM2.5 percentile rankings, net of emissions and spatial covariates. Results indicated that the percent Latinx population, followed by the regional clustering of PM2.5, and the percent of non-Latinx Black and non-Latinx Asian population were the strongest positive multivariable correlates of PM2.5 percentile rankings, net of other factors. Additional analyses suggested that despite shifting demographic and spatial correlates of 2012-2014 PM2.5 exposures, the tracts' Black and Latinx composition and location in the San Joaquin Valley remain important vulnerability factors with implications for future research and policy.


Assuntos
Poluição do Ar/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Material Particulado , Características de Residência/estatística & dados numéricos , Poluentes Atmosféricos , Asma , California , Análise por Conglomerados , Serviço Hospitalar de Emergência , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Análise de Componente Principal , Fatores de Risco , Populações Vulneráveis
20.
Med Care ; 57(10): 773-780, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415338

RESUMO

INTRODUCTION: Colorectal cancer (CRC) is a common but largely preventable malignancy. Screening is recommended for all adults aged 50-75 years; however, screening rates are low nationally and vary by patient factors and across health care systems. It is currently unknown whether there are inequities in CRC screening rates by patient sociodemographic and/or clinical factors in the Veterans Health Administration (VA) where the majority of patients are CRC screening-eligible age and CRC is the third most commonly diagnosed cancer. METHODS: We performed a retrospective cohort study using VA national clinical performance and quality data to determine the overall CRC screening rate, rates by patient sociodemographic and clinical factors, and predictors of screening adjusting for patient and system factors. We also determined whether disparities in screening exist in VA. RESULTS: The overall CRC screening rate in VA was 81.5%. Screening rates were lowest among American Indians/Alaska Natives [75.3%; adjusted odds ratio (aOR)=0.77, 95% confidence interval (CI)=0.65-0.90], those with serious mental illness (75.8%; aOR=0.65, 95% CI=0.61-0.69), those with substance abuse (76.9%; aOR=0.76, 95% CI=0.72-0.80), and those in the lowest socioeconomic status quintile (79.5%; aOR=1.10-1.31 for quintiles 2-5 vs. lowest quintile 1). Increasing age, Hispanic ethnicity, black race, Asian race, and high comorbidity were significant predictors of screening uptake. CONCLUSIONS: Many racial/ethnic disparities in CRC screening documented in non-VA settings do not exist in VA. Nonetheless, overall high VA CRC screening rates have not reached American Indians/Alaska Natives, low socioeconomic status groups, and those with mental illness and substance abuse. These groups might benefit from additional targeted efforts to increase screening uptake.


Assuntos
Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde dos Veteranos/estatística & dados numéricos , Idoso , Neoplasias Colorretais/etnologia , Neoplasias Colorretais/psicologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Saúde Mental/etnologia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Razão de Chances , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pobreza/etnologia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Fatores Socioeconômicos , Estados Unidos , United States Department of Veterans Affairs , Saúde dos Veteranos/etnologia
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