Arti Shankar

Self-Report of Depressive Symptoms in African American and White Women in Primary Care

OBJECTIVES Depressive symptoms are frequently seen among female patients in primary care. The majority of screening instruments are cumbersome for a busy clinic. METHOD The effectiveness of a 2-item depression screening questionnaire was compared to the mental health section of the 36-Item Short Form Health Survey (SF-36). A total of 127 consecutive patients who presented for primary care service agreed to participate and completed the questionnaire. RESULTS Of the final sample, 65.4% were African American and 44.9% of all women reported having depressive symptoms, with no significant difference in the prevalence of reported depressive symptoms between African American and white women (chi2 = 1.97, p = .16). The women reporting depressive symptoms were more likely to be in the lower-income group (chi2 = 9.02, p = .01); however, in stratified analysis this was only significant for the African American women (chi2 = 8.69, p = .01). Analysis of variance demonstrated that the women with depressive symptoms were more likely to score low on the mental health subscales of the SF-36 when adjusted for income (F = 58.32, P < .0001). Within race groups, the mean Mental Health Index scores were higher among African American women (t = -6.45, P <.0001) and White women (t = -3.59, P = .002) who reported depressive symptoms than among those who did not report depressive symptoms. The sensitivity and specificity of the 2-item depression symptom questions compared to the overall SF-36 mental health score were 70% and 77%, respectively. CONCLUSION A simple 2-item questionnaire can be used to identify depressive symptoms in white and African American women in a primary care clinic.

Therapeutic Relationship and Study Adherence in a Community Health Worker-Led Intervention

Community health workers (CHWs) are increasingly utilized to reach low-resource communities. A critical domain influencing success is the CHWs’ ability to create and maintain a therapeutic relationship with the participants they serve. A limited evidence base exists detailing this construct, and evaluating CHW-participant relationships in the context of CHW-led programs. In a longitudinal study design, data on this therapeutic relationship were collected [as captured using The Scale to Assess the Therapeutic Relationship in Community Mental Health Care (STAR)] on 141 participants who had been assigned to a CHW during their perinatal period. Results indicate that therapeutic relationship was associated with the participant’s psychosocial health, and independently predicted study adherence in the longitudinal intervention. Changes in therapeutic relationship over the months following birth were strongly associated with changes in anxiety and depression symptoms. A trustful relationship is critical in ensuring CHWs can effectively reach the population they serve. The findings offer additional psychometric evidence of the uses and benefits of STAR outside of the traditional clinical setting in the context of public health research.

Perceived Discrimination and Heavy Episodic Drinking Among African-American Youth: Differences by Age and Reason for Discrimination.

PURPOSE The purpose of this study was to examine whether associations between perceived discrimination and heavy episodic drinking (HED) vary by age and by discrimination type (e.g., racial, age, physical appearance) among African-American youth. METHODS National data from the Panel Study of Income Dynamics Transition to Adulthood Study were analyzed. Youth participated in up to four interviews (2005, 2007, 2009, 2011; n = 657) between ages 18 and 25 years. Respondents reported past-year engagement in HED (four or more drinks for females, five or more drinks for males) and frequency of discriminatory acts experienced (e.g., receiving poor service, being treated with less courtesy). Categorical latent growth curve models, including perceived discrimination types (racial, age, and physical appearance) as a time-varying predictors of HED, were run. Controls for gender, birth cohort, living arrangement in adolescence, familial wealth, parental alcohol use, and college attendance were explored. RESULTS The average HED trajectory was curvilinear (increasing followed by flattening), whereas perceived discrimination remained flat with age. In models including controls, odds of HED were significantly higher than average around ages 20-21 years with greater frequency of perceived racial discrimination; associations were not significant at other ages. Discrimination attributed to age or physical appearance was not associated with HED at any age. CONCLUSIONS Perceived racial discrimination may be a particularly salient risk factor for HED around the ages of transition to legal access to alcohol among African-American youth. Interventions to reduce discrimination or its impact could be targeted before this transition to ameliorate the negative outcomes associated with HED.

The Deepwater Horizon Oil Spill Through the Lens of Human Health and the Ecosystem.

This review examines current research ascertaining the impact of the Deepwater Horizon oil spill on human health and ecosystems. Driven by the need to strategically focus research funding, the authors also assess the implications of those findings and promote a transdisciplinary research agenda addressing critical gaps.Epidemiologic studies conducted in workers and vulnerable communities in the spill’s aftermath showed that non-chemical stressors affect resilience. Ecosystem-wise salt marsh species showed variability in structural and functional changes, attributed to species-specific tolerance, oil exposure, and belowground plant organs damage.Lacking baseline exposure assessment data hampers assessing the impact of chemical stressors. Research priorities include leveraging existing women/child dyads and worker cohorts to advance exposure characterization and counter early adverse effects in most vulnerable populations. Key policy gaps include mandated just-in-time emergency resources to ascertain immediate post-event exposures and contemporary legislation addressing human and ecosystem health in an integrated rather than silo fashion.

Correlations of Biomarkers and Self-Reported Seafood Consumption among Pregnant and Non-Pregnant Women in Southeastern Louisiana after the Gulf Oil Spill: The GROWH Study

Seafood contains health-promoting fatty acids, but is often contaminated with mercury (Hg), complicating recommendations and choices around fish consumption during pregnancy. Self-reported diet may be subject to inaccuracy and this inaccuracy could differ according to pregnancy status. We investigated correlations between self-reported seafood consumption and blood levels of Hg and n-3 polyunsaturated fatty acids (PUFAs) in women affected by the Deepwater Horizon oil spill. Spearman correlation coefficients were calculated comparing log blood Hg and n-3 PUFAs to seafood consumption, then stratified by pregnancy status. Crude and adjusted linear regression models were constructed using biomarkers of Hg and n-3 PUFA and seafood consumption, adjusting for age and pregnancy status. Weak but significant correlations were found between log Hg levels and intake of Hg-containing seafood (r = 0.15) and were slightly stronger among pregnant women (r = 0.22, vs. r = 0.10). Biomarkers for n-3 PUFAs were significantly correlated with seafood consumption (r = 0.12). Hg-containing seafood consumption was associated with increased blood level Hg in the highest quartile in both unadjusted (β = 0.34, 95% CI: 0.15–0.53) and adjusted models (β = 0.28, 95% CI: 0.08–0.48). Self-reported seafood consumption was correlated with biomarkers of both n-3 PUFA and Hg, but this association was different when stratified by pregnancy status. Pregnant women may have better recall of Hg-containing seafood compared to nonpregnant women.

Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes

ABSTRACT Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

Cumulative effects of the Gulf oil spill and other disasters on mental health among reproductive-aged women: The Gulf Resilience on Women’s Health study.

Objective: To test whether effects of multiple (up to 5) disasters on mental health responses were cumulative (additive effects), or whether an earlier disaster produced sensitization (higher) or habituation (lower) responses to a later one. Method: The Gulf Resilience on Women’s Health study interviewed 1,366 southern Louisiana women regarding their exposure to Hurricanes Katrina, Rita, Gustav, and Ike and the Gulf oil spill (measured several ways), and administered validated measures of symptoms of depression and posttraumatic stress disorder (PTSD). Multiple linear and logistic regression with disaster exposures entered singly, combined, and as an interaction were used to model mental health. Results: Both exposure to the oil spill and hurricane disaster were associated with likely depression and PTSD, consistent with a cumulative model, but we did not find statistical interactions that would suggest sensitization or habituation. When results were examined with continuous symptom measures of depression and PTSD, they were similar, with the exception that exposure to the oil spill and experiencing illness or injury because of the hurricane disaster showed a significant interaction (p < .05) in a manner consistent with a sensitization effect when predicting PTSD symptoms. The results of this study point mainly to a cumulative risk for the mental health effects of multiple disasters, although some indication of sensitization occurred among those with particularly severe experiences. There was no evidence for habituation. Conclusions: These findings may guide efforts to assist those in regions experiencing multiple disasters that occur in close sequence.

Self-Reported Oil Spill Exposure and Pregnancy Complications: The GROWH Study

Adverse infant outcomes often rise in the aftermath of disaster, but few studies have assessed the effects of disaster on maternal health. 1091 southern Louisiana women were interviewed about their pregnancy history, including pregnancy complications. Associations between oil spill exposures and gestational diabetes, hypertensive disorders, and nausea/vomiting were assessed for all reported pregnancies. 631 women had a pregnancy both before and after the oil spill. Generalized estimating equations (logistic regression) with adjustment for confounders were used. To assess possible unmeasured confounding, instead of considering oil spill exposure as a time-varying exposure, women were defined as oil spill-exposed or not. If oil spill-exposed women were equally prone to complications in pregnancies that occurred prior to the oil spill as after it, it was considered that any associations were likely due to selection or reporting issues. Women who reported oil spill exposure, particularly loss of use of the coast, were more likely to report gestational diabetes; however, the level of association was similar for pregnancies before and after the spill (p for interaction >0.10 and odds ratios (ORs) for pregnancies prior to the spill > than those after the spill). No associations were found between oil spill exposure and hypertensive disorders. This analysis does not suggest an increased risk of pregnancy complications associated with exposure to the oil spill; however, future studies should assess exposure and outcomes prospectively and clinically instead of relying on self-report.

Cultural influences on the management of environmental health risks among low-income pregnant women

Following environmental health disasters such as Hurricane Katrina and the Gulf Oil Spill, U.S. Gulf residents expressed concern regarding air quality. Women with children make many decisions that mitigate household air quality risks; however, research examining culture’s influence in their risk perception and the influence which this has on their behaviour is limited. In this article we examine the cultural connection between low-income women with children along the U.S. Gulf concerning the local threat of air quality. We used cultural consensus analysis to examine the perceptions of low-income, first-time pregnant women. We undertook an interview survey of 112 women living in Southeast Louisiana, USA between May 2014 and March 2015. In this article we examine if there was a shared (cultural) understanding among these women on how to manage air quality threats, evaluate what determined cultural sharing in the group, and explore what role cultural beliefs played in their intended household strategies. We found that although air quality was rarely discussed by the women in our study, we were able to identify two multi-centric cultural models of how these women sought to make sense of air quality issues. In one model they relied on their immediate social network of family and friends while in the other model they were willing to make use of official sources of information. These two models helped explain what measures these women planned to take to address air quality issues in and around their household. Our findings show that cultural norms permeate the assessment of risk in a community and that programmes designed to improve public health need to take into account the cultural context of the population.

Some Methods of Constructing Generalized Group Divisible Designs with Two Groups

ABSTRACT In this article some simple and general methods for constructing, binary and nonbinary, generalized group divisible designs with two groups (GGDD(2)) are given. Near resolvable balanced incomplete block designs and certain classes of balanced incomplete block designs play key roles in the construction of these designs. All the constructed designs are found to be E-optimal.