Anne Morris

Prevalence and predictors of disability in valued life activities among individuals with rheumatoid arthritis

Objective: To identify the prevalence of disability in a wide range of life activities and identify factors associated with such disability using the Verbrugge and Jette disablement model as a framework. Methods: Data were from a panel study of 548 individuals with rheumatoid arthritis, interviewed annually by telephone. Valued life activity (VLA) disability was assessed using a 26-item scale rating difficulty in carrying out each activity. Three types of summary measure were calculated: activities unable to perform, activities affected, and mean difficulty. Subscale scores were also calculated, corresponding to obligatory, committed, and discretionary activities, as defined in the disablement model. Disease status measures were examined as predictors of VLA disability using multiple regression analyses. Results: Half the subjects were unable to do at least one VLA. Approximately 2%, 31.3%, and 40.2% were unable to do at least one obligatory, committed, and discretionary activity, respectively. Almost all (95%) reported at least one VLA affected by rheumatoid arthritis; 68.4%, 91.4%, and 92.5% reported at least one obligatory, committed, and discretionary activity, respectively, affected. Disease status measures were robust predictors of VLA disability, accounting for 22–47% of the variation in VLA disability (with one exception). Adding the health assessment questionnaire (HAQ) to these models increased (p<0.0001) all model R2 values. HAQ score mediated the effects of many disease measures, consistent with the disablement model. Conclusion: VLA disability was common, with more disability noted in committed and discretionary than obligatory activities. Because VLA disability has been linked to psychological wellbeing in previous studies, identification of factors that may protect against such disability is important.

Valued life activity disability played a significant role in self-rated health among adults with chronic health conditions

OBJECTIVE Because self-rated health (SRH) is strongly associated with health outcomes, it is important to identify factors that individuals take into account when they assess their health. We examined the role of valued life activities (VLAs), the wide range of activities deemed to be important to individuals, in SRH assessments. STUDY DESIGN AND SETTING Data were from three cohort studies of individuals with different chronic conditions--rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and chronic obstructive pulmonary disease (COPD). Each cohorts data were collected through structured telephone interviews. Logistic regression analyses identified factors associated with ratings of fair/poor SRH. All analyses included sociodemographic characteristics, general and disease-specific health-related factors, and general measures of physical functioning. RESULTS Substantial portions of each group rated their health as fair/poor (RA 37%, SLE 47%, COPD 40%). In each group, VLA disability was strongly associated with fair/poor health (RA: OR=4.44 [1.86,10.62]; SLE: OR=3.60 [2.10,6.16]; COPD: OR=2.76 [1.30,5.85]), even after accounting for covariates. CONCLUSION VLA disability appears to play a substantial role in individual perceptions of health, over and above other measures of health status, disease symptoms, and general physical functioning.

Drug use behaviors among Asian drug users in San Francisco.

Due to a pervasive bias toward Asian Americans, such as tendency to view Asian Americans as model minorities, drug use behaviors among them are often ignored by health professionals, researchers, and community members, including Asian community members. This study identified patterns of drug use behaviors in relation to cultural factors among Asian drug users in San Francisco, CA. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants and used content analyses. This study clearly revealed that the patterns of drug use among Asian drug users are unique to their ethnicity, gender, immigrant status, and age groups. Also, Asian drug users share cultural constructs related to drug use such as fear of addiction and injecting drugs, and stigma attached to drug users in the community. Therefore, drug abuse prevention programs should address both common factors among Asian drug users, as well as unique factors in specific target groups (e.g., ethnic groups, Asian immigrants, Asian women, refugees, and adolescents).

Disability in valued life activities among individuals with systemic lupus erythematosus

OBJECTIVE To identify the prevalence of disability in a wide range of valued life activities (VLAs) among individuals with systemic lupus erythematosus (SLE), 1-year changes in such disability, and predictors of and changes in VLA disability. METHODS Data were from 2 waves of a cohort of 829 individuals with SLE interviewed annually by telephone. VLA disability was assessed using a scale rating the difficulty of performing 21 activities. Scores were also calculated for subscales corresponding to obligatory, committed, and discretionary activities. Changes in VLA disability from baseline to 1-year followup were assessed. Sociodemographic and disease status measures were examined as predictors of and changes in VLA disability using multiple regression analyses. RESULTS Almost half of the subjects were unable to perform > or =1 VLA at baseline. Almost all (91%) reported > or =1 VLA affected by SLE. One-quarter of the subjects experienced a significant increase in the number of activities they were unable to perform; approximately half experienced significant increases in the number of activities affected and in difficulty scores. Proportions of individuals whose disability increased and whose disability decreased were roughly equivalent. Disease status measures accounted for 62-72% of the variation in VLA difficulty. More severe disease status was predictive of increases in VLA difficulty; few predictors of improvements were identified. CONCLUSION VLA disability was common, with more disability noted in committed and discretionary activities than in obligatory activities. Because VLA disability has been linked to psychological well-being in previous studies, identification of factors that may protect against such disability is important.

Long-term patterns of depression and associations with health and function in a panel study of rheumatoid arthritis:

Long-term patterns of depression, and associations with health and function were examined among 1115 individuals with rheumatoid arthritis, using 18 years of panel data, summarized in 9653 interviews. Depression was defined by scores on the Geriatric Depression Scale (6 or above). Participants were classified, using cluster analysis, into three distinct patterns of depression over repeated assessments: nondepressed (65.8%), intermittent (25.2%), and chronic (9.0%). GEE analyses assessed outcomes over time as a function of patterns of depression; controlling for demographic and clinical factors. Results indicated that patterns of depression had significant adverse effects on health and function over time.

Patterns of psychosocial risk and long-term outcomes in rheumatoid arthritis

This study examined the extent to which patterns of psychosocial risk were uniquely associated with long-term outcomes of rheumatoid arthritis (RA), after demographic factors and self-reported symptom severity over time were accounted for. Data were collected over an 8‐year period from 561 individuals with RA who were participants in the ongoing UCSF RA Panel Study in 1995. Panel members were interviewed annually, using a comprehensive structured telephone interview. Psychosocial factors assessed included mastery, perceptions about adequacy of social support, the impact of RA and self-assessed ability to cope with RA and satisfaction with health and function. Cluster analysis of psychosocial factors identified three distinctive patterns/levels of psychosocial risk (high, medium and low risk). The unique effects of psychosocial risk status on changes in depressive symptoms, basic functional limitations, global pain ratings and average annual doctor visits over an 8‐year period were estimated, using growth curve analyses. Analyses controlled for demographic factors (gender, marital/partner status, education, age and ethnicity), disease duration and year in the panel and time-varying self-reported symptom severity (morning stiffness, swollen joint counts, co-morbid medical conditions, extra-articular RA symptoms and changes in joint appearance), as well as self-reported medications taken over time (disease-modifying antirheumatic drugs [DMARDS], and prednisone). Overall, 32.4% of total variance in depressive symptoms was accounted for by the fully-estimated model, with 12.9% uniquely associated with psychosocial risk status. Half of the total variance (50.0%) in basic functional limitations was explained, with 12.1% of variance uniquely predicted by psychosocial risk status. Psychosocial risk status accounted for comparatively little total explained variance in global pain ratings (total = 38.6%, incremental = 3.2%), and average annual total doctor visits (total = 10.9%, incremental = 1.5%). Thus, psychosocial risk factors are more closely linked to depressive symptoms and function over time. Global pain and utilization appear to be more closely related to disease factors.

Subclinical Disability in Valued Life Activities among Individuals with Rheumatoid Arthritis

OBJECTIVE Subclinical disability, the need for modifications in task performance or frequency without reported difficulty with the task, has been identified as a stage along the disability continuum. We estimated the prevalence of subclinical disability in valued life activities (VLAs) among individuals with rheumatoid arthritis (RA), identified characteristics of individuals with VLA subclinical disability, and estimated the ability of VLA subclinical disability to predict later decrements in functioning. METHODS Data were from 3 years of a longitudinal panel study of individuals with RA, for which annual structured telephone interviews are conducted (n=508 in year 1, n=442 in year 3). Respondents rated difficulty in VLAs and then reported whether they used any of 4 behavioral modifications (limitations, extra time, help, or equipment) for each. Subclinical disability was defined for each VLA as no reported difficulty with use of any modification. Multiple regression analyses identified predictors of subclinical disability in year 1 and the role of year 1 subclinical disability in development of overt disability between year 1 and year 3. RESULTS Almost three-quarters of the subjects exhibited subclinical disability in at least 1 VLA in year 1. Duration of RA was consistently associated with subclinical disability. Individuals with subclinical disability at baseline were significantly more likely to experience increases in functional limitations (odds ratio [OR] 1.09, 95% confidence interval [95% CI] 1.01-1.18) and VLA disability (OR 1.14, 95% CI 1.06-1.23) over a prospective 2-year period. CONCLUSION Subclinical disability may be a valuable marker of individuals in a disability transition phase who are particularly susceptible to intervention that would enable them to maintain functioning.

TARGETED EXPANSION PROJECT FOR OUTREACH AND TREATMENT FOR SUBSTANCE ABUSE AND HIV RISK BEHAVIORS IN ASIAN AND PACIFIC ISLANDER COMMUNITIES

Access to culturally competent HIV/AIDS and substance abuse treatment and prevention services is limited for Asian and Pacific Islanders (APIs). Based on the intake data for a community outreach project in the San Francisco Bay Area (N = 1,349), HIV risk behaviors were described among the targeted API risk groups. The self-reported HIV prevalence was 6% among MSM. Inconsistent condom use for vaginal sex with casual partners in the past 6 months was reported among substance users (43%) and incarcerated participants (60%), whereas 26% of men who have sex with men reported inconsistent condom use for anal sex with casual partners. Overall, 56% and 29% had engaged in sex with casual partners under the influence of alcohol and drugs in the past 6 months, respectively. Although API organizations in the Bay Area have spearheaded HIV prevention, future programs must address substance use issues in relation to sexual risk behaviors, specific to API risk groups.

Contexts of HIV-Related Risk Behaviors among Male Customers at Asian Massage Parlors in San Francisco

Based on focus groups for male customers who frequented Asian massage parlors in San Francisco, the present study described their sexual and drug use behaviors and attitudes toward practicing safe sex with Asian masseuses. A pervasive view among patrons was that they could engage in sex with masseuses without using a condom if they offered extra money. Their sexual behaviors with Asian masseuses were influenced by perceptions about vulnerability toward HIV/STIs, substance use behaviors, and masseuses’ initiation of condom use, which was often governed by unspoken rules at parlors. Customers perceived massage parlors as being a safe place compared with street sex venues. Some customers sought emotional attachment with Asian masseuses and expressed stereotypical views toward them as being docile and submissive. Culturally appropriate HIV/STI prevention programs (e.g., communication about and practicing 100% condom use) are needed to target both customers and Asian masseuses at multiple levels (individual, owner/manager, work environment, and community levels). Also, customers’ and masseuses’ perceptions toward relationships at massage parlors and power dynamics need further investigation to promote safe work environments and 100% condom use at massage parlors.