Lucia Juarez

Gender Differences of Neighborhood and Social Control Processes: A Study of the Timing of First Intercourse among Low-achieving, Urban, African American Youth

This study examines the gender-specific contextual and individual socioeconomic predictors of the timing of first intercourse among low-achieving African American youth. Following financial deprivation and collective socialization theories, the authors test separate models for males and females and include neighborhood poverty and race composition, family social class position, and social control mechanisms such as family structure, parental involvement, and prosocial activities as predictors. The sample comprises 558 African American high school students followed over a 3-year period. For young women, the significant predictors are age, mothers education, time with mother, and involvement in church activities. For young men, the significant factors are school achievement, an interaction between living in an two-parent family and time with father, participation in family decision making, and neighborhood poverty level. Thus, males and females are differently affected by social control processes and neighborhood poverty plays a significant role in young African American mens sexual behaviors.

Profile of arthritis disability.

Using the 1994–95 National Health Interview Supplement Disability Supplement, the authors study levels of disabilities and accommodations among US adults with arthritis disability, compared to people with disability due to other conditions. Arthritis-disabled people are defined in two ways. One definition covers a broad range of arthritis and rheumatic conditions, and the other concentrates solely on arthritis. The authors find that arthritis-disabled people have more total disabilities than other-disabled people. However, their disabilities are less severe, have shorter durations, and accumulate more gradually over time. Despite more disabilities, people with arthritis disability use fewer assistive and service accommodations than other-disabled people. They do use more mobility aids. Because arthritis is the leading chronic condition for middle-aged and older adults, this profile of extensive but mild-to-moderate disability is experienced by many millions of adults. Accommodations for arthritis may also be extensive but aimed more toward self-care than toward assistive and medical services.

Arthritis disability and heart disease disability

OBJECTIVE Arthritis is the most common health condition in midlife and late life, and heart disease is the leading cause of death. This article compares disability impacts of these 2 preeminent health problems. METHODS Using data from the National Health Interview Survey Disability Supplement, we studied specific limitations and disabilities, accommodations used (buffers), and accommodations needed (barriers) for US population groups of adults with arthritis disability, heart disease disability, both arthritis and heart disease disability, and disability due to other conditions. Weights and complex SE adjusted for sample design. We hypothesized that arthritis disability is more extensive and troublesome than heart disease disability. RESULTS People with arthritis disability had more numerous, longer, and more bothersome disabilities than people with heart disease disability. People with arthritis disability used more equipment and rehabilitation, whereas people with heart disease disability emphasized personal assistance, medications, and medical services. People with arthritis disability experienced more barriers and needs in activities and services. People with disabilities from both arthritis and heart disease were especially disadvantaged, with high levels of limitations and accommodations. People with disability from other conditions had the highest social participation, fewest disabilities, and most tailored accommodations of all groups. CONCLUSION Arthritis had higher and more extensive disability impact than heart disease. Both groups had more difficulty, buffers, and barriers in their lives than people disabled by other conditions. Therefore, arthritis and heart disease are premier conditions for disability attention and alleviation in the US population.

Severity, timing, and structure of disability

SummaryObjectives: Severity and timing are key aspects of disability experience for individuals. They also generate a population’s disability structure (prevalence, counts, patterns). We study links among severity, duration, and structure for community-dwelling adults in the US. Methods: The data source is the National Health Interview Survey Disability Supplement. Disabilities in personal care (ADL), household management (IADL), and physical functions (PLIM) are analyzed. Results: Many combinations of disabilities are possible, but just a few are frequent; the top-10 patterns cover 70% of ADL, 89% of IADL, and 47% of PLIM disabled adults. Hierarchical patterns are common for ADLs and IADLs. People with many disabilities also have more-severe ones, and their disabilities often started at the same time. Conclusions: Disability structure reflects severity and timing of specific disabilities, sometimes strongly, and other times weakly due to exit processes from the community. Assumptions that disability occurs in “hard” tasks first and “easy” ones last, and that hard-and-early connotes mild disability whereas easy-and-late connotes severe, need direct empirical testing.

What does the U.S. Medicare administrative claims database tell us about initial antiepileptic drug treatment for older adults with new-onset epilepsy?

Disparities in epilepsy treatment are not uncommon; therefore, we examined population‐based estimates of initial antiepileptic drugs (AEDs) in new‐onset epilepsy among racial/ethnic minority groups of older US Medicare beneficiaries.

Obesity Modifies the Association of Race/Ethnicity with Medication Adherence in the CARDIA Study

AbstractObjective: To assess associations between race/ethnicity and medication adherence, and the potential modifying effects of weight category (normal, overweight, obese) in a community-based sample. Study design and setting: We studied 1355 participants from the CARDIA (Coronary Artery Risk Development in Young Adults) study who were taking prescription medications in 2000-1. Medication adherence, as rated on the four-item Morisky medication adherence scale (score of 4 = maximum adherence), was reported for all participants. Results: The mean age ± SD of participants was 40 ± 3.6 years; 45% were African American and 36% were male. Overall, Whites had a higher proportion of maximum adherence than African Americans (59 vs 41%, respectively; p = 0.001). However, this difference was statistically significant only for participants within the normal weight category, of whom 54% of Whites were maximally adherent versus 35% of African Americans (p < 0.05). After adjustment for possible confounding covariates, race/ethnicity was associated with adherence only in those of normal weight: the odds ratio for maximum adherence in Whites versus African Americans of normal weight was 1.98 (95% CI 1.13, 3.47). Within race/ethnicity subgroups, weight category was associated with adherence in Whites but not in African Americans. Conclusion: Weight category modifies the association of race/ethnicity with medication adherence. The high levels of non-adherence observed among African Americans and obese and overweight Whites bodes poorly for treatment of obesity-associated diseases such as cardiovascular disease or diabetes mellitus.

Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk

To determine the frequency of older Americans with epilepsy receiving concomitant prescriptions for antiepileptic drugs (AEDs) and non‐epilepsy drugs (NEDs) which could result in significant pharmacokinetic (PK) interaction, and to assess the contributions of racial/ethnic, socioeconomic, and demographic factors.

Adherence to antiepileptic drugs among diverse older Americans on Part D Medicare

INTRODUCTION Older minority groups are more likely to have poor AED adherence. We describe adherence to antiepileptic drugs (AEDs) among older Americans with epilepsy. METHODS In retrospective analyses of 2008-2010 Medicare claims for a 5% random sample of beneficiaries augmented by minority representation, epilepsy cases in 2009 were those with ≥1 claim with ICD-9345.x or ≥2 with 780.3x, and ≥1 AED. New-onset cases had no such claims or AEDs in the year before the 2009 index event. We calculated the Proportion of Days Covered (PDC) (days with ≥1 AED over total follow-up days) and used logistic regression to estimate associations of non-adherence (PDC <0.8) with minority group adjusting for covariates. RESULTS Of 36,912 epilepsy cases (19.2% White, 62.5% African American (AA), 11.3% Hispanic, 5.0% Asian and 2% American Indian/Alaskan Native), 31.8% were non-adherent (range: 24.1% Whites to 34.3% AAs). Of 3706 new-onset cases, 37% were non-adherent (range: 28.7% Whites to 40.5% AAs). In adjusted analyses, associations with minority group were significant among prevalent cases, and for AA and Asians vs. Whites among new cases. Among other findings, beneficiaries from high-poverty ZIP codes were more likely to be non-adherent than their counterparts, and those in cost-sharing drug benefit phases were less likely to be non-adherent than those in deductible phases. CONCLUSION About a third of older adults with epilepsy have poor AED adherence; minorities are more likely than Whites. Investigations of reasons for non-adherence, and interventions to promote adherence, are needed with particular attention to the effect of cost-sharing and poverty.

Quality of Antiepileptic Treatment Among Older Medicare Beneficiaries With Epilepsy: A Retrospective Claims Data Analysis.

Background: Enzyme-inducing antiepileptic drugs (EI-AEDs) are not recommended for older adults with epilepsy. Quality Indicator for Epilepsy Treatment 9 (QUIET-9) states that new patients should not receive EI-AEDs as first line of treatment. In light of reported racial/ethnic disparities in epilepsy care, we investigated EI-AED use and QUIET-9 concordance across major racial/ethnic groups of Medicare beneficiaries. Research Design: Retrospective analyses of 2008–2010 Medicare claims for a 5% random sample of beneficiaries 67 years old and above in 2009 augmented for minority representation. Logistic regressions examined QUIET-9 concordance differences by race/ethnicity adjusting for individual, socioeconomic, and geography factors. Subjects: Epilepsy prevalent (≥1 International Classification of Disease-version 9 code 345.x or ≥2 International Classification of Disease-version 9 code 780.3x, ≥1 AED), and new (same as prevalent+no seizure/epilepsy events nor AEDs in 365 d before index event) cases. Measures: Use of EI-AEDs and QUIET-9 concordance (no EI-AEDs for the first 2 AEDs). Results: Cases were 21% white, 58% African American, 12% Hispanic, 6% Asian, 2% American Indian/Alaskan Native. About 65% of prevalent, 43.6% of new cases, used EI-AEDs. QUIET-9 concordance was found for 71% Asian, 65% white, 61% Hispanic, 57% African American, 55% American Indian/Alaskan new cases: racial/ethnic differences were not significant in adjusted model. Beneficiaries without neurology care, in deductible drug benefit phase, or in high poverty areas were less likely to have QUIET-9 concordant care. Conclusions: EI-AED use is high, and concordance with recommendations low, among all racial/ethnic groups of older adults with epilepsy. Potential socioeconomic disparities and drug coverage plans may affect treatment quality and opportunities to live well with epilepsy.

Diffusion of troponin testing in unstable angina patients: adoption prior to guideline release

BACKGROUND We examined diffusion of troponin testing in Medicare patients with unstable angina before the release of year 2000 American College of Cardiology/American Heart Association guidelines recommending measurement in all patients with acute coronary syndromes. METHODS We identified unstable angina admissions from Medicare administrative files for 22 Alabama hospitals over two time periods: 03/1997-02/1998 and 01/99-12/1999. Data were obtained from chart abstraction. Patients not confirmed for unstable angina by a clinical algorithm were eliminated. RESULTS For 1997-1998, 1116 (87.7%) of all identified cases were clinically confirmed for unstable angina, and 1176 (90.3%) were confirmed for 1999. In 1997-1998, 235 (21%) of unstable angina patients had troponin measured, compared to 822 (70%) in 1999. From 1999, patients with troponin measurement, vs. those without, more likely had typical angina (50.9%, 37.4%), chest pain on arrival (72.8%, 57.1%), and chest pain at rest (45.4%, 37.2%) and more often received EKG within 20 min of presentation (46.3%, 27.9%) (P<.0005 for all). Patients with abnormal troponin levels more often received angiotensin converting enzyme inhibitors (54.6%, 18.3%), cardiac catheterization (45.4%, 31.2%), and percutaneous coronary intervention (18.6%, 4.8%) (P<.05 for all). These associations remained significant after multivariable adjustment for patient and hospital characteristics. CONCLUSIONS This study demonstrates increasing and appropriate use of troponin before guideline release. Our findings suggest that guidelines may codify currently accepted practice rather than always disseminate new knowledge. The same forces that lead to guideline development and release may also lead to changes in clinical practice before guideline release.