Kushal Patel

An Internet Intervention as Adjunctive Therapy for Pediatric Encopresis

This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. The Web participants demonstrated greater improvements in terms of reduced fecal soiling, increased defecation in the toilet, and increased unprompted trips to the toilet (ps<.02). Both groups demonstrated similar improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.

Operationalization of community-based participatory research principles: Assessment of the National Cancer Institute's Community Network Programs

OBJECTIVES We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR). METHODS We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institutes 25 CNPs. RESULTS Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability. CONCLUSIONS Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.

Racial Disparities in the Treatment of Depression in Low-Income Persons With Diabetes

OBJECTIVE Individuals with diabetes are at higher risk for depression than the general population. Although depression can be treated with antidepressant medications, patients with diabetes and comorbid depression often go untreated. The goal of this study was to examine racial disparities in the treatment of depression with antidepressant medication in the southeastern U.S. RESEARCH DESIGN AND METHODS Cross-sectional data were collected at baseline from 69,068 participants (71% African American, 60% female, and 82% with incomes <

Factors Influencing Prostate Cancer Screening in Low-Income African Americans in Tennessee

25,000) recruited from community health centers and enrolled in the Southern Cohort Community Study (SCCS). The SCCS is a prospective epidemiological cohort study designed to explore causes of health disparities in adults aged 40–79 years. Binary logistic regression was used to identify factors associated with antidepressant use among those with diabetes (n = 14,279). RESULTS Individuals with diagnosed diabetes (14,279) were classified with no depressive symptoms (54.7%), or with mild (24.2%), moderate (12.8%), or severe depressive symptoms (8.3%). After controlling for sex, age, insurance, income, education, BMI, smoking status, alcohol consumption, and level of depression, African Americans with diabetes were much less likely to report taking antidepressant medication than whites (adjusted odds ratio 0.32 [95% CI 0.29–0.35], P < 0.0001). CONCLUSIONS Antidepressant use is much less common among African Americans than among whites with diabetes. Reasons for racial disparities in treatment of depressive symptoms are unclear but may include a combination of differential diagnosis and treatment by health professionals as well as cultural differences in seeking help for emotional distress.

Chronic illness and smoking cessation

This study examined demographic and lifestyle factors that influenced decisions to get screened for prostate cancer in low-income African Americans in three urban Tennessee cities. It also examined obstacles to getting screened. As part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American men 45 years and older (n=293) were selected from the Meharry CNP community survey database. Participants from Nashville, those who were older, obese, and who had health insurance were more likely to have been screened (p<.05). Additionally, there were associations between obstacles to screening (such as cost and transportation) and geographic region (p<.05). Educational interventions aimed at improving prostate cancer knowledge and screening rates should incorporate information about obstacles to and predictors of screening.

Community participation in health initiatives for marginalized populations.

INTRODUCTION Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker). METHODS The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 randomly selected participants. RESULTS Participants with diabetes were more likely to report being former smokers, after adjusting for sociodemographic characteristics, whereas having hypertension or high cholesterol was not associated significantly with smoking status. The likelihood of being a former smoker did not increase as number of diagnosed chronic diseases increased. Participants who were women, older (aged 65+), or single were significantly less likely to be former smokers. Participants with at least a college degree, those with incomes of 50,000+ US dollars, and those who were underweight or obese were more likely to be former smokers. DISCUSSION These findings were inconsistent with research that has suggested that having a chronic illness or experiencing a serious medical event increases the odds of smoking cessation. Supporting prior research, we found that being male, having a higher income, and being obese were associated with greater likelihood of being a former smoker.

Diabetes and Co-morbid Depression Among Racially Diverse, Low-Income Adults

Community-based participatory methods have emerged as a response to conventional approaches that have historically failed to make notable improvement in health status or reduce chronic disease among marginalized populations. The social-ecological model provides a framework to develop and implement strategies directed to affecting multiple levels (societal, community, organizational, and individual) of influence on health status. A systems approach can facilitate the identification of the complex interrelationships of factors at all levels that contribute to health disparities by making use of the unique knowledge, expertise, and resources of community partners. Community engagement in the planning, implementation, and evaluation of health initiatives builds community capacity to create sustainable changes at all levels to achieve and maintain optimal health for those who bear the greatest burden of disease.

Mammography Use in the Southern Community Cohort Study (United States)

BackgroundResearch suggests individuals with diabetes are twice as likely as those without diabetes to be clinically depressed. Still unknown is the relationship between diabetes and depression in socioeconomically disadvantaged populations.PurposeWe examined the relationship between diabetes and depressive symptoms in a large, racially diverse, low-income cohort in the southeastern USA.MethodsA total of 69,068 adults were recruited from community health centers in 12 southeastern states. A fully adjusted polytomous logistic regression model tested the relationship between demographics, lifestyle behaviors, antidepressant use, body mass index, diabetes diagnosis, diabetes duration, diabetes medication compliance, and depressive symptoms using the Centers for Epidemiological Studies Depression scale.ResultsDiabetes was present in 21.7% of sample. While a diabetes diagnosis was associated with having severe depressive symptoms (AOR, 1.24; 95% CI, 1.14–1.34), demographics, lifestyle behaviors, body mass index and antidepressant use were more strongly associated with severe depressive symptoms than a diabetes diagnosis.ConclusionsHaving diabetes was associated with the presence and severity of depressive symptoms in a large, low-income sample of racially diverse adults. However, the relationship between diabetes and depressive symptoms was weaker than in other studies with higher socioeconomic groups.

Plasma Selenium Biomarkers in Low Income Black and White Americans from the Southeastern United States

Purpose: This paper examines the rates of recent mammography use among African American and White women, the influence of demographic characteristics, socioeconomic status, health insurance coverage, and breast cancer risk factors on recent mammography use and reasons for not having a mammogram. Methods: Cross-sectional data from the Southern Community Cohort Study were used to analyze mammography use among African American and White women. Results: Among 27,123 mostly low-income women age 42–79 in the Southern Community Cohort Study, the rate of recent (within the past 2 years) mammography use was 73% among African Americans and 68% among Whites. Health insurance coverage, age, household income, education, family history of breast cancer, hormone replacement therapy use, and post-menopausal status were positively associated with recent mammography, whereas consumption of 2 or more alcoholic drinks/day was negatively associated. These associations were observed in both African American and White women who never had received a mammogram (non-users) although some variation existed. Differential effects of these factors on recent mammography were also examined in non-users and past users. Doctor has not recommended this test and cost were the two most commonly self-reported reasons for non-use. Conclusions: Characteristics of non-users and past users identified may provide valuable information for maintaining the progress made and for further improving adherence to the screening guidelines.

A Tailored Prostate Cancer Education Intervention for Low-income African Americans: Impact on Knowledge and Screening

Biomarkers of selenium are necessary for assessing selenium status in humans, since soil variation hinders estimation of selenium intake from foods. In this study, we measured the concentration of plasma selenium, selenoprotein P (SEPP1), and glutathione peroxidase (GPX3) activity and their interindividual differences in 383 low-income blacks and whites selected from a stratified random sample of adults aged 40–79 years, who were participating in a long-term cohort study in the southeastern United States (US). We assessed the utility of these biomarkers to determine differences in selenium status and their association with demographic, socio-economic, dietary, and other indicators. Dietary selenium intake was assessed using a validated food frequency questionnaire designed for the cohort, matched with region-specific food selenium content, and compared with the US Recommended Dietary Allowances (RDA) set at 55 µg/day. We found that SEPP1, a sensitive biomarker of selenium nutritional status, was significantly lower among blacks than whites (mean 4.4±1.1 vs. 4.7±1.0 mg/L, p = 0.006), with blacks less than half as likely to have highest vs. lowest quartile SEPP1 concentration (Odds Ratio (OR) 0.4, 95% Confidence Interval (CI) 0.2–0.8). The trend in a similar direction was observed for plasma selenium among blacks and whites, (mean 115±15.1 vs. 118±17.7 µg/L, p = 0.08), while GPX3 activity did not differ between blacks and whites (136±33.3 vs. 132±33.5 U/L, p = 0.320). Levels of the three biomarkers were not correlated with estimated dietary selenium intake, except for SEPP1 among 10% of participants with the lowest selenium intake (≤57 µg/day). The findings suggest that SEPP1 may be an effective biomarker of selenium status and disease risk in adults and that low selenium status may disproportionately affect black and white cohort participants.