Kristine R. Hearld

Generalized anxiety disorder in racial and ethnic minorities: a case of nativity and contextual factors.

BACKGROUND Minorities comprise more than one third of the U.S., and research on the correlates and causes of depression, anxiety, and other mental illnesses have yielded mixed results in minority groups necessitating an understanding of causes and correlates of health. Thus, the aim of this paper is to evaluate the relationship between minority status, contextual factors, and lifetime Generalized Anxiety Disorder. METHODS Logistic regression models were implemented, comparing immigrants to their American-born counterparts as well as to American-born Whites. RESULTS Foreign-born Afro-Caribbeans exhibited lower rates of lifetime GAD. A lower percentage of foreign-born minorities met the criteria for GAD as compared to their American-born counterparts, and all racial and ethnic groups met the criteria for lifetime GAD at a lower rate as compared to American-born Whites. DISCUSSION By using theory proactively and including contextual factors, this multi-faceted approach to health disparities research yielded findings which both supported historic beliefs but created opportunities for supplemental research looking at immigrants and GAD. Key findings were that health lifestyle choices and exposure to discrimination significantly affected the chance of having GAD. Nativity was protective; however, its effect was ameliorated by exposure to discrimination or engagement in alcohol abuse. Thus, this study offers practical insight into environmental factors for clinicians caring for racial and ethnic minorities diagnosed with GAD.

Symptom Burden Predicts Hospitalization Independent of Comorbidity in Community-Dwelling Older Adults

To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults.

Panic attacks in minority Americans: The effects of alcohol abuse, tobacco smoking, and discrimination

BACKGROUND Lifetime prevalence of panic attacks is estimated at 22.7%, and research on the correlates and causes of depression, anxiety, and other mental illnesses have yielded mixed results in minority groups. Therefore, the purpose of this study is to evaluate the relationship between panic attacks, minority status, and nativity by focusing on the effects of health lifestyle behaviors and discrimination. METHODS Multivariate analysis was performed using logistic regression, which was used to estimate the probability of meeting the criteria for panic attacks (n=17,249). RESULTS Demographic and socioeconomic variables had significant associations; females had over 2.4 times higher odds than males of meeting the criteria for panic attacks. The more frequently respondents were treated as dishonest, less smart, with disrespect, threatened, or called names, the more likely they met the criteria for panic attacks. Additionally, smoking and alcohol abuse were significant predictors of panic attacks. Those who abused alcohol have over 2 times the odds of having panic attacks. Similarly, smokers had 52% higher odds of panic attacks than non-smokers. LIMITATIONS The primary limitation of this project was the lack of a true acculturation measure with a secondary limitation being the inability to determine respondents׳ legal status. CONCLUSIONS Key findings were that health lifestyle choices and exposure to discrimination significantly affected the chance of having panic attacks. Nativity was protective; however, its effect was counteracted by exposure to discrimination or engagement in smoking behavior or alcohol abuse. Thus, this study offers insight into contextual factors for clinicians caring for racial and ethnic minorities diagnosed with panic attacks.

A comparison of younger and older men who have sex with men using data from Jamaica AIDS Support for Life: characteristics associated with HIV status

Jamaica is home to over 10% of the Caribbean’s HIV-positive population. Men who have sex with men (MSM) have a higher prevalence of HIV compared to the general public. Thus, the purpose of this study is to assess characteristics associated with HIV, such as condom use and number of sexual partners, comparing young, those aged 18–24, to older, aged 25 and older, MSM in Jamaica. We hypothesised, and found support for the notion, that younger MSM would have a lower rate of some risky behaviours associated with HIV seropositivity. Service data for 160 self-selected MSM aged 18–62, from Kingston, Jamaica were analysed. The majority identified as homosexual (compared to bisexual), over half of respondents completed a tertiary level of education (e.g. any post-high school training), and 59.1% were employed. Almost all participants reported agreeing to use a condom when requested (93.6%). Prevalence of HIV was 17.8%, much lower than the 32% found in national studies, and is likely an underestimation reflecting patterns of this self-selected sample. Additionally, over one-third reported experiencing sexual abuse. Statistically significant relationships were found between age group and tertiary education, employment status, condom use with a regular partner, and sexual abuse. Younger MSM were more likely to have been sexually abused and were more likely to always wear a condom with their regular partner. A limitation of this study was the extent of missing data, restricting generalisability. However, by acknowledging the heterogeneity of the Jamaican MSM population, and subsequently evaluating behaviours across age groups, nuances emerge which highlight behavioural diversity. Findings may inform public health practitioners in developing targeted interventions.

Measuring Symptoms in Community-dwelling Older Adults: The Psychometric Properties of a Brief Symptom Screen

Background:With aging, the probability of experiencing multiple chronic conditions has increased, along with symptoms associated with these conditions. Symptoms form a central component of illness burden, and distress. To date, most symptom measures have focused on a particular disease population. Objective:We aimed to develop and evaluate a simple symptom screen using data obtained from a representative sample of community-dwelling older adults. Methods:Psychometric analyses were conducted on 10 self-reported dichotomous symptom indicators collected during in-person interviews from a sample of 1000 community-dwelling older adults. Symptoms included shortness of breath, feeling tired or fatigued, problems with balance or dizziness, perceived weakness in legs, constipation, daily pain, stiffness, poor appetite, anxiety, and anhedonia. Results:Over one third of the individuals (37.4%) had 5 or more concurrent symptoms. Stiffness and feeling tired were the most common symptoms. Confirmatory factor analyses were performed on the 10 symptoms for single factor and bifactor (physical and affective) models of symptom reporting. Goodness-of-fit indices indicated better fit for the bifactor model (&khgr;2df=10=89.6; P<0.001), but the practical significance of the improvement in fit was negligible. Differential item functioning analyses showed some differences of relatively high magnitude in location parameters by race; however, because the differential item functioning was in different directions, the impact on the overall measure was most likely lessened. Conclusions:Among community-dwelling older adults, a large proportion experienced multiple co-occurring symptoms. This Brief Symptom Screen can be used to quickly measure the overall symptom load in older adult populations, including those with multiple chronic conditions.

Explanatory Factors of Quality of Care from Cataract Patients’ Perspectives

ABSTRACT Purpose: The purpose of this study is to examine explanatory factors of perceived quality of care among cataract surgery patients. Methods: This study was administered to 264 cataract patients within one eye hospital located in Ankara, Turkey. The study was designed to determine the latent structure of quality of care. In order to assess cataract surgery patients’ views about quality of care, the QUOTE-Cataract survey was used. The questionnaire’s internal consistency was assessed using Cronbach’s Alpha (0.96) and appropriateness of the factor analytic model was assessed using KMO (0.50) and Bartlett’s test (=2004.959, p<0.001). Explanatory factor analysis with Varimax rotation was performed in order to determine the underlying factors in the model. Results: Four factors emerge from the explanatory factor analysis: relaying information about care process and behaviors; diagnosis and treatment process; accessibility/punctuality of physicians; and hospital facilities. The four factors explain 86% of total variance. Conclusion: The results of this study highlight the importance of sharing information with patients about treatment processes and accessibility/punctuality of physicians in the perception of quality of care among cataract surgery patients.

Engaging patients as partners in research: Factors associated with awareness, interest, and engagement as research partners

Objectives: There is growing interest in engaging patients in healthcare research, which raises important questions about the factors that may promote such engagement. The purpose of this study was to examine the association between patient characteristics and three aspects of patient engagement in the medical research process: awareness, interest, and actual participation. Methods: Cross-sectional, bivariate analyses were employed using the 2014 Health Information National Trends Survey. Results: Analyses suggest modest levels of interest among respondents engaging as patient partners in the research process (37.7% of respondents), low level of awareness of what patient engagement in research was (15.3% of respondents), and a very low level of actual participation (2.7% of respondents). Respondents of higher socioeconomic status and with more positive patient attitudes regarding their health and healthcare were more likely to be interested in research. In comparison, relatively few patient characteristics were significantly associated with patient awareness and actual participation in research. Conclusion: Although it is promising that people are interested in being engaged in research, the results suggest that there is work to be done to raise awareness of these engagement opportunities. Likewise, the gap between awareness and participation highlights opportunities to identify why patients may be reluctant to participate even when they are aware of research opportunities.

Statistical Effects of Religious Participation and Marriage on Substance Use and Abuse in Racial and Ethnic Minorities

Substance use and abuse, which includes alcohol use, alcohol dependence, drug use, and drug dependence, inflicts a substantial toll on Americans. Although studies have demonstrated the protective effect of social support, such as religious participation and via marriage, understanding their influence on racial and ethnic minorities is limited. Thus, the aim of this study is to assess the impact of social support on substance use and abuse in racial and ethnic minorities. The Collaborative Psychiatric Epidemiology Surveys, sponsored by the National Institute of Mental Health, a repository of race, ethnicity, and mental health data, was leveraged to develop four models using multivariate analysis, specifically logistic regression to estimate the probability of meeting the criteria for substance use and abuse. Racial and ethnic minorities were found to have lower rates of substance use and abuse compared to Whites, and foreign-born individuals were consistently less likely to use or abuse substances compared to American-born minorities. Mental health conditions were highly associated with substance use and abuse, and social support by way of religious participation and marriage was protective against substance use and abuse. In racial and ethnic minorities, nativity and social support were protective against substance use and abuse; however, these protective factors did not completely eliminate risk. Thus, although race and ethnicity are important to understanding health outcomes and health behaviors, such as substance use and abuse, it is the intersection of multiple factors, representing internal and external forces, which may be more informative and offer a more comprehensive picture of the landscape influencing drug and alcohol use and dependence. Targeted interventions should consider leveraging religious spaces and bilingual materials when attempting to reach racial and ethnic minorities.

Examining the Relationship Between Individual Characteristics, Community-Level Traits, Multidimensional Empowerment, and Maternal Health Care Utilization in the Islamic Republic of Pakistan

Introduction The Islamic Republic of Pakistan’s maternal mortality ratio is particularly high, and the nation ranks 126 out of 149 countries on the Human Development Report-Gender Inequality Index. This is because Pakistani women have low levels of empowerment, make limited economic contributions, and underutilization of maternal health care. The aim of this study is to create a multidimensional index of women’s empowerment and assess the association between this index and maternal health care utilization in Pakistan, controlling for individual characteristics and community-level traits. Methods Data from the 2012–2013 Pakistan Demographic and Health Surveys were employed to investigate the relationship between this index and the latent construct of maternal health care utilization. Results Using exploratory factor analysis, four indicators of maternal health care utilization were loaded onto a single latent factor. Multivariate analyses found support for the association between empowerment and health care utilization, despite adjustments for individual and area level factors. Positive associations between education, wealth, and maternal health care utilization were found. Conclusions Although we find support for the association of educational attainment with maternal health care utilization, the multidimensional women’s empowerment index was independently a consistent associate of maternal health care utilization. This illustrates a complex mechanism with both—education and empowerment, being necessary for improved maternal health care utilization. Policy makers seeking to improve outcomes should expand their focus beyond simply improving rates of education to examining effects of cultural norms which constrain the independence of women in making decisions about their own health care.

Evidence that patient-centered medical homes are effective in reducing emergency department admissions for patients with depression

The patient-centered medical home (PCMH) has increasingly been touted as one means of integrating behavioral health and primary care and more holistically caring for patients with chronic disease. With its whole person orientation, the PCMH presents an opportunity to reduce emergency department visits for patients with depression by focusing on the patient and his/her health care needs, facilitating communication among providers and patients, and improving patients’ access to care providers across settings. This study examines the relationship between PCMH capacity – defined as the ability to offer a service identified as a component part of the PCMH – and the number of emergency department visits for patients with depression. Health plan claims data, self-report data from physician practices on their PCMH characteristics, and the Area Resource File were analyzed. Results show that overall PCMH capacity is associated with fewer emergency department visits for patients with depression, and interpersonal aspects of the PCMH in particular, were associated with fewer emergency department visits while technical capabilities were not. Interpersonal activities that facilitate care coordination, patient engagement, and connect patients with community resources might be more effective in keeping patients out of the emergency department for unnecessary reasons as compared to technical activities focused on reporting and information management.