Duan-Rung Chen

Social Support and Social Network Profiles among Women on Methadone

We examined the network profiles and social supports of 151 women on methadone, exploring to whom women turn for different types of support and how flow of support is associated with the network members personal and relational characteristics and network structure. Women reported a total of 795 network members, with an average network size of 5.9 individuals. The networks were long‐term, ethnically homogeneous, and of high density. Support within personal networks is contingent on the types of support required, the relational characteristics, and the network structures. Findings from this study may be useful in helping practitioners and program developers to better comprehend the social milieu of drug users, particularly women enrolled in methadone treatment programs.

Correlates of problem drinking among drug-using incarcerated women

The association between drug use--regular use of crack cocaine or heroin--and problem drinking was examined in a sample of 159 sentenced women at Rikers Island correction facility in New York City. Using logistic regression, this study tested the association between drug use and alcohol use, controlling for psychosocial variables (sexual abuse history, negative and positive coping skills, and depression), familial drug use (number of family members currently abusing drugs, and those currently abusing alcohol), and demographic variables and criminal history. The association between current, regular crack use and problem drinking approached significance in the final model, which adjusted for criminal behavior, demographic, familial abuse, and psychosocial variables. The results of this study point toward childhood sexual abuse, negative coping skills, and familial alcohol abuse as variables related to problem drinking among incarcerated women.

Personal social networks and HIV status among women on methadone.

This objective of this study was to examine the association between a womens HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondents demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.

Availability of convenience stores and adolescent alcohol use in Taiwan: a multi‐level analysis of national surveys

AIM To examine the association between alcohol in school environments and adolescent alcohol use over the previous 6 months. DESIGN A multi-level logistic regression analysis was performed of cross-sectional surveys conducted in 2004, 2005 and 2006. PARTICIPANTS AND SETTING A total of 52 214 students aged 11-19 years from 387 middle or high schools were selected from a nationally representative, multi-stage, stratified probability sampling across Taiwan. MEASUREMENTS Information on socio-demographic features and substance use experiences was collected using self-administered questionnaires. The alcohol in the environment was measured using the availability of convenience stores surrounding the schools. Using geographical information systems, the weighted numbers of convenience stores within 1 km, a 12-15-minute walk, of a school were calculated. The schools were later categorized into three subgroups via the tertile of nearby convenience stores. FINDINGS Considering the compositional characteristics, the availability of convenience stores was found to account for 1.5% of the school-level variance of youthful drinking. The odds ratios (95% confidence interval) of alcohol use over the previous 6 months among youth attending schools with medium and high availability were 1.04 (0.96-1.13) and 1.08 (1.00-1.17), respectively, with a P-value of 0.04 in the trend test. CONCLUSION The greater availability of convenience stores near a school is associated with an increased risk of alcohol use among adolescents over the previous 6 months.

Gender-specific responses to social determinants associated with self-perceived health in Taiwan: A multilevel approach

There are well-documented gender differences in health. However, few studies have considered that the associations of personal and household characteristics with perceived health may vary between men and women because of their different socialized gender roles. This study investigates gender differences in health and addresses gender-specific responses to individual- and household-level determinants of health. We analyze the data of the 2001 Social Development Survey on Health and Safety, which consists of a representative sample of all registered households in Taiwan. Our findings give limited support to the hypothesis that women and men are differently associated with social determinants of health. We observe a significant gender gap in self-perceived health even after controlling for various health determinants. Notwithstanding, men and women are similar in many important aspects in relation to social determinants of health. Gender-specific responses are found only in the impacts of employment status, stressful life events, own disability, and number of family members with a disability. Men report having poorer health than women when being disabled and facing stressful events. Womens perceived health is at a higher risk when family members require short-term, intensive care. Further consideration of the observed, gender-specific responses to health determinants shed insight on the possible social and cultural relevance behind gender differences in self-perceived health.

Forecasting the Incidence of Dementia and Dementia-Related Outpatient Visits With Google Trends: Evidence From Taiwan

Background Google Trends has demonstrated the capability to both monitor and predict epidemic outbreaks. The connection between Internet searches for dementia information and dementia incidence and dementia-related outpatient visits remains unknown. Objective This study aimed to determine whether Google Trends could provide insight into trends in dementia incidence and related outpatient visits in Taiwan. We investigated and validated the local search terms that would be the best predictors of new dementia cases and outpatient visits. We further evaluated the nowcasting (ie, forecasting the present) and forecasting effects of Google Trends search trends for new dementia cases and outpatient visits. The long-term goal is to develop a surveillance system to help early detection and interventions for dementia in Taiwan. Methods This study collected (1) dementia data from Taiwan’s National Health Insurance Research Database and (2) local Internet search data from Google Trends, both from January 2009 to December 2011. We investigated and validated search terms that would be the best predictors of new dementia cases and outpatient visits. We then evaluated both the nowcasting and the forecasting effects of Google Trends search trends through cross-correlation analysis of the dementia incidence and outpatient visit data with the Google Trends data. Results The search term “dementia + Alzheimer’s disease” demonstrated a 3-month lead effect for new dementia cases and a 6-month lead effect for outpatient visits (r=.503, P=.002; r=.431, P=.009, respectively). When gender was included in the analysis, the search term “dementia” showed 6-month predictive power for new female dementia cases (r=.520, P=.001), but only a nowcasting effect for male cases (r=.430, P=.009). The search term “neurology” demonstrated a 3-month leading effect for new dementia cases (r=.433, P=.008), for new male dementia cases (r=.434, P=.008), and for outpatient visits (r=.613, P<.001). Conclusions Google Trends established a plausible relationship between search terms and new dementia cases and dementia-related outpatient visits in Taiwan. This data may allow the health care system in Taiwan to prepare for upcoming outpatient and dementia screening visits. In addition, the validated search term results can be used to provide caregivers with caregiving-related health, skills, and social welfare information by embedding dementia-related search keywords in relevant online articles.

Socio-spatial patterns of neighborhood effects on adult obesity in Taiwan: a multi-level model.

Obesity, one of the most significant health problems now facing developed countries, has been increasing steadily in Taiwan. This study addresses how neighborhood factors affect individual obesity by simultaneously examining individual-level socioeconomic status and neighborhood-level characteristics using a multi-level approach combined with a spatial analysis. The data are from Taiwans 2001 Social Development Survey on Health and Safety; a representative sample of 27,593 adults over 262 townships (i.e. neighborhoods). A spatial autocorrelation model is employed to investigate the spatial clustering of neighborhood affluence. A two-level Generalized Hierarchical Linear Model (GHLM) is used to combine neighborhood-level (level-2) characteristics (i.e., spatial patterns of neighborhood affluence and ethnic composition), and individual-level SES position (level-1) to examine the factors associated with adult obesity risk. Three principal findings were obtained. First, individual obesity risk is significantly higher in spatially clustered neighborhoods of economic affluence. Neighborhood factors associated with obesity are likely to operate over a wide geographical area and are not limited to conditions in the immediate residential neighborhood. Second, aboriginal people living adjacent to the most affluent cluster in northern Taiwan have elevated obesity risk, revealing possible spatial diffusion and ethnic acculturation. Third, adult obesity is, however, associated with socioeconomically disadvantaged groups in different neighborhood contexts. These findings suggest that accounting for spatial interdependencies among neighborhoods enhances the accuracy of estimated neighborhood effects on obesity.

Prevalence of Poor Sleep Quality and its Relationship with Body Mass Index among Teenagers: Evidence from Taiwan.

BACKGROUND The linkage between sleep quality and weight status among teenagers has gained more attention in the recent literature and health policy but no consensus has been reached. METHODS Using both a propensity score method and multivariate linear regression for a cross-sectional sample of 2,113 teenagers, we analyzed their body mass index (BMI) in relation to sleep quality while controlling for family characteristics (household income, parent/guardian level of education, disability status, work night shift, and smoking) and individual factors (age, sex, regular exercise, smoking, employment, and feeling secure in the neighborhood). Sleep quality was assessed using 3 scales: difficulty in initiating sleep, difficulty in maintaining sleep, and non-restorative sleep, based on Diagnostic and Statistical Manual of Mental Disorders-IV-defined insomnia. RESULTS Considering all 3 types of poor sleep quality, 20.9% of teenagers in Taiwan experienced some form of sleep problems. After adjusting for the other variables, 2 factors independently and statistically predicted sleep problems: current smoking and working night shifts by the head of the household. Teens experiencing difficulty in initiating sleep had higher BMIs ranging from 0.86 to 1.41 units. CONCLUSIONS Efforts to address childhood obesity need to take into consideration sleep problems that are highly prevalent among teenagers.

Elucidating the changing socio-spatial dynamics of neighborhood effects on adult obesity risk in Taiwan from 2001 to 2005

Obesity poses a significant health threat in industrialized countries, with its incidence increasing steadily in Taiwan. This study addresses how neighborhood contexts influence individuals, using a multilevel spatial analysis of obesity risk from 2001 to 2005. A priority concern was whether contextual influences on health are limited to the immediate neighborhood or extend to a wider geographical area. The results led to the following conclusions. First, neighborhood factors related to obesity risk are likely to operate over a broad geographical area and are not limited to the focal neighborhood of residence. Second, a geographically based epidemiological change in the likelihood of obesity risk was observed from 2001 to 2005 in Taiwan. Third, the spatial lag model revealed significant spatial spillover of obesity risk in the study area in 2005. Policy interventions are recommended for the neighborhoods associated with the strong spillover effect. The results demonstrate that, in addition to enhancing the accuracy of prediction regarding the effects of neighborhood factors on obesity, incorporating spatial dynamics at the neighborhood level can encourage the development of contextually sensitive policy interventions.

Career stress and female managers' health in Taiwan's hospitals: a multilevel model approach.

Purpose: This study investigates how perception-induced stress (barrier) and social capital (facilitator) affect the health of female managers. Methods and Measurement: On the basis of the responses of 229 valid questionnaires of middle- and high-level female managers in large-scale hospitals, using a multilevel data analysis approach, this study investigates how perception-induced stress and social capital influence self-reported poor health of female managers. Results: Analysis results indicate that all 3 perception-induced stresses (i.e., promotion-related procedural justice, promotion rate, and work-family conflict) and 2 social capital variables (i.e., mentor-assisted promotion and higher ranking mentor in other departments) are significantly associated with the health of female mangers. Factors involving the career success of women also affect their health. Implications and Conclusions: Health care organizations expecting to benefit from the long-term contribution of female elites must promote organizational equity and more heavily emphasize flexible work schedules, family-friendly policies, and perception management practices. In addition, adequately designed mentorship practices can greatly benefit female managers.