Maureen Lahiff

Acculturation and parental attachment in Asian-American adolescents' alcohol use.

PURPOSE To test whether the degree of acculturation predicts subsequent alcohol use among Asian-American adolescents, and to test the moderating effect of parental attachment. METHODS This was a prospective study using a subsample of the National Longitudinal Adolescent Health data set. A nationally representative sample of 714 Asian-American boys (n = 332) and girls (n = 382) in grades 7-12 was analyzed. In-home self-report data were collected on two types of acculturation status, alcohol use, demographics, and parental attachment. After controlling for acculturation status and background variables at Wave I, logistic regression analysis was used to estimate the odds ratios to assess the association between acculturation and alcohol use at Wave II for adolescents. RESULTS Asian-American adolescents with the highest level of acculturation (English use at home, born in the United States) were identified as the highest risk group. For adolescents with low parental attachment, the odds of alcohol use were 11 times greater in the highly acculturated group than in the least acculturated group. However, the odds of alcohol use for adolescents with moderate or high levels of parental attachment did not vary across acculturation groups. CONCLUSIONS Overall, a greater level of acculturation was associated with greater alcohol use. However, when parental attachment was taken into account, highly acculturated adolescents with moderate or high parental attachment had no greater risk than adolescents with same levels of parental attachment who were less acculturated. Thus, it appears that acculturation per se was not a risk factor unless it was accompanied by a low level of parental attachment.

Getting off the streets: Economic resources and residential exits from homelessness

Based on a 15-month prospective study, the following variables demonstrated an association with residential stability in a countywide probability sample of 397 homeless adults: female gender, a history of less than 1-year homelessness, absence of a health problem that limited work ability, entitlement-benefit income, and use of subsidized housing. Multivariate analyses show that two forms of public support—entitlement income and subsidized housing—were the most important variables associated with exits from homelessness into stable housing. Homeless adults with substance use disorders were more likely than other homeless adults to obtain unstable, but not stable housing. Homeless adults with mental disorders were no less likely than other homeless adults to report stable housing. Stable housing is necessary to break the cycle of homelessness, and economic resources such as entitlement income and subsidized housing are associated with stable housing for homeless adults.© 1999 John Wiley & Sons, Inc.

Weight gain and spontaneous preterm birth: the role of race or ethnicity and previous preterm birth.

OBJECTIVE: To study how the relationship between gestational weight gain and spontaneous preterm birth interacts with maternal race or ethnicity and previous preterm birth status. METHODS: This was a retrospective cohort study of singleton births to women of normal or low prepregnancy body mass index. Gestational weight gain was measured as total weight gain divided by weeks of gestation at delivery, and weight gain was categorized as low (less than 0.27 kg/wk,), normal (0.27–0.52 kg/wk), or high (more than 0.52 kg/wk). Univariable and multivariable analyses were performed on the relationship between weight gain categories and spontaneous preterm birth, stratified by maternal race or ethnicity and history of previous preterm birth. RESULTS: Overall, low weight gain was associated with spontaneous preterm birth (adjusted odds ratio [AOR] 2.5, 95% confidence interval [CI] 2.0–3.1). Although low gain was consistently associated with increased spontaneous preterm birth, some differences were found in subgroup analysis. Among African Americans with a previous preterm birth, both low and high weight gain were associated with increased odds of spontaneous preterm birth (AOR for low weight gain 4.3, 95% CI 1.2–15.5; AOR for high weight gain 6.1, 95% CI 1.8–20.2). For all other groups, high weight gain was not associated with spontaneous preterm birth. Among Asians with a previous preterm birth, low weight gain was not statistically significantly associated with spontaneous preterm birth (AOR 1.9, 95% CI 0.5–7.7). Among Asians there was also a non–statistically significant inverse relationship between high weight gain and spontaneous preterm birth (AOR 0.5, 95% CI 0.3–1.1). CONCLUSION: These results confirm an association between low maternal weight gain and spontaneous preterm birth. The effect modification of maternal race or ethnicity and history of previous preterm birth on this association deserves further study. LEVEL OF EVIDENCE: II-2

Association between phthalates and attention deficit disorder and learning disability in U.S. children, 6-15 years.

OBJECTIVE This study investigates the association between urinary phthalate metabolite levels and attention deficit disorder (ADD), learning disability (LD), and co-occurrence of ADD and LD in 6-15-year-old children. METHODS We used cross-sectional data from the National Health and Nutrition Examination Survey (NHANES, 2001-2004). Phthalate metabolites with ≥75% detection in urine samples were examined. The study population comprised 1493 children with parent-reported information on ADD or LD diagnosis and phthalate concentrations in urine. Phthalate concentrations were creatinine-adjusted and log10-transformed for analysis. All models controlled for child sex, age, race, household income, blood lead, and maternal smoking during pregnancy. RESULTS There were 112 ADD cases, 173 LD cases, and 56 ADD and LD cases in the sample. After adjusting for potential confounders, we found increased odds of ADD with increasing urinary concentration of di-2-ethylhexyl phthalates (OR: 2.1; 95% CI: 1.1, 3.9) and high molecular weight phthalates (OR: 2.7; 95% CI: 1.2, 6.1). In addition, dibutyl phthalates (OR: 3.3; 95% CI: 0.9, 12.7) and high molecular weight phthalates (OR: 3.7; 95% CI: 0.9, 14.8) were marginally associated with increased odds of co-occurring ADD and LD. We did not find associations for any phthalate and LD alone. We observed stronger associations between phthalates and ADD and both ADD and LD in girls than boys in some models. CONCLUSIONS We found cross-sectional evidence that certain phthalates are associated with increased odds of ADD and both ADD and LD. Further investigations with longitudinal data are needed to confirm these results.

Sexual Abuse in Childhood and Adolescence and the Risk of Early Pregnancy Among Women Ages 18–22

PURPOSE This clinic- and community-based study of young women investigated the relationship between previous sexual abuse and early pregnancy, examining the effect of the developmental period in which sexual abuse occurred and type of sexual abuse, while also providing methodological advances in the assessment of distinctive sexual abuse and its sequelae. METHODS Secondary data analysis using Cox proportional hazards models was conducted to determine the association between sexual abuse in childhood, in adolescence, or both, and risk of early pregnancy among 1,790 young women. In addition, this study examined the type of sexual abuse that occurred during each period. RESULTS As compared with women with no history of sexual abuse, women who experienced sexual abuse only in childhood had a 20% greater hazard of pregnancy; women who experienced sexual abuse only in adolescence had a 30% greater hazard of pregnancy; and women who experienced sexual abuse in both childhood and adolescence had an 80% greater hazard of pregnancy. Across these periods, attempted rape and rape were associated with an increased hazard of pregnancy. The association between sexual abuse and pregnancy was mediated by age at first intercourse and moderated by a womans education level. CONCLUSION This study provides evidence that both the developmental timing and the type of sexual abuse contributes to an increased risk for early pregnancy. The study findings indicate that sexual abuse leads to an earlier age of first sexual intercourse, which in turn increases the likelihood of an early pregnancy. Women with higher educational attainment are less likely to experience early pregnancy as a result of abuse.

Management Without Borders? A Survey of Landowner Practices and Attitudes toward Cross-Boundary Cooperation

Ecosystem management requires cross-jurisdictional problem-solving and, when private lands are involved, cross-boundary cooperation from many individual landowners. Fragmented ownership patterns and variation in ownership values, as well as distrust and transaction costs, can limit cooperation. Results from a landowner survey in California were analyzed using an audience segmentation approach. Landowners were grouped into four clusters according to ownership motivations: rural lifestyle, working landscape, natural amenity, and financial investment. All clusters showed willingness to cooperate for all three topics addressed in the survey (pest and disease control, fire hazard reduction, and wildlife conservation), but their degree of willingness differed by cluster, who they were expected to cooperate with, and the natural resource problem addressed. All were more willing to cooperate with neighbors and local groups than with state and federal agencies. Landowners were most willing to cooperate to reduce fire hazard, which is the most direct threat to property and well-being.

Unpredicted Trajectories: The Relationship Between Race/Ethnicity, Pregnancy During Adolescence, and Young Women's Outcomes

PURPOSE Adolescents who become pregnant in the United States are at higher risk for a myriad of health concerns. One would predict even more adverse health outcomes among pregnant adolescents who are from disadvantaged racial/ethnic groups; however, previous studies indirectly suggest the opposite. This study examines whether adolescents from racial/ethnic minority groups are less affected by adolescent pregnancy compared to white adolescents. METHODS We used data from 1,867 adolescents participating in the National Longitudinal Study of Adolescent Health (1995-2001). Our predictor variable was self-reported race/ethnicity. Self-perception of health, educational attainment, and public assistance use in young adulthood were outcome measures. We conducted weighted multivariate logistic regressions and analyzed how adolescent pregnancy modified the relationship between our predictor and outcome variables. RESULTS Black and American Indian young women had significantly higher odds than white young women of receiving public assistance (OR, 2.6 and 2.7, respectively; p <.01) and even higher odds if ever pregnant in adolescence (OR, 4.2 and 19.0, respectively; p = .03). White young women had significantly lower odds of high educational attainment if they had a live birth in adolescence as compared to those who had not (OR, 0.1; CI = 0.1-0.4). CONCLUSIONS These findings support studies that found adolescent pregnancy increases the risk of public assistance use and low educational attainment. The study shows that, for educational attainment, black young women who become pregnant may not be as disadvantaged as their peers, whereas white young women who become pregnant are more disadvantaged.

Aspects of culturally competent care are associated with less emotional burden among patients with diabetes.

Background:Diabetes distress is associated with poor diabetes self-management and worse clinical outcomes. Whether there is an association between patient experience of health care and degree of emotional burden (EB) of diabetes distress is not known. Objective:To investigate whether aspects of culturally competent care are associated with the EB of diabetes distress. Design:Cross-sectional survey consisting of face-to-face interviews. Subjects:A total of 502 ethnically diverse patients with diabetes receiving care in safety-net clinics in 2 cities. Measures:The main outcome measure was high EB on the Diabetes Distress Scale (mean score ≥3). The predictors were 3 domains (Doctor Communication—Positive Behaviors, Trust, and Doctor Communication-Health Promotion) of the Consumer Assessment of Healthcare Providers and Systems—Cultural Competence (Consumer Assessments of Healthcare Providers and Systems’ Cultural Competence Item Set) instrument. Results:Of 502 patients, 263 (52%) reported high EB. In adjusted logistic regressions controlling for sociodemographic and clinical factors, patient report of optimal Doctor Communication-Positive Behaviors (adjusted odds ratio, 0.46; 95% confidence interval, 0.39–0.54), and optimal Trust (adjusted odds ratio, 0.65; 95% confidence interval, 0.54–0.78) were associated with lower EB. Doctor Communication-Health Promotion Communication was not associated with EB. Discussion:Patient report of better doctor communication behavior and higher trust in physician are inversely associated with high EB among patients with diabetes. Further research should determine whether interventions improving patient physician communication and trust can lower the EB of diabetes.

Examining Depressive Symptoms and Use of Counseling in the Past Year Among Filipino and Non-Hispanic White Adolescents in California

Objective: We compared measures of depressive symptoms and use of counseling in the past year for Filipino versus non-Hispanic white adolescents in California. Methods: This cross-sectional study used data from 4421 adolescents who completed the 2003 and 2005 California Health Interview Survey. Bivariate analyses, linear regression, and logistic regression were performed. Results: Compared to non-Hispanic white adolescents, Filipino adolescents had higher mean 8-item version of Center for Epidemiologic Studies Depression Scale scores (5.43 vs 3.94) and were more likely to report a clinically significant level of depressive symptoms (defined as 8-item version of Center for Epidemiologic Studies Depression Scale score ≥7) (29.0 vs 17.9%). Filipino adolescents are just as likely as their non-Hispanic white counterparts to report low use of counseling in the past year (17.6 vs 28.4%). Multivariate analyses indicate that depressive symptoms were positively associated with Filipino ethnicity, female gender, living in a single parent household, lower parental education, and poverty. The effect that ethnicity had on use of counseling in the past year varied by gender, income level, and parental education level. Filipino male adolescents with family incomes ≥300% federal poverty level and parents with more than a college degree were significantly less likely than their non-Hispanic white counterparts to report use of counseling in the past year (odds ratio, 0.01; confidence interval, 0.0004–0.44). Filipino female adolescents with family incomes <300% federal poverty level and parental education less than a college degree were significantly more likely to report use of counseling than their non-Hispanic white counterparts (odds ratio, 3.99; confidence interval, 1.00–15.89). Conclusion: Further studies and interventions are needed to effectively screen for and treat depression among Filipino adolescents.

Variation in adherence to the treatment guidelines for Neisseria gonorrhoeae by clinical practice setting, California, 2009 to 2011.

Background Declining susceptibility of Neisseria gonorrhoeae to available antimicrobial agents has prompted repeated updates of the Centers for Disease Control and Prevention (CDC) treatment guidelines. The only regimen currently recommended as first-line treatment is dual therapy consisting of an intramuscular dose of ceftriaxone together with azithromycin or doxycycline. The objective of this analysis is to identify how adherence to the CDC guidelines varies by clinical practice setting. Methods A geographically representative random sample of N. gonorrhoeae cases reported from 2009 to 2011 was analyzed. Weighted generalized linear models were fit to calculate cumulative incidence ratios for receipt of non-recommended treatment regimen in relation to clinical practice setting, adjusted for age, race, and whether or not the participant was a man who has sex with men. Results Data from 3178 participants were available for analysis. Overall, 14.9% (weighted) of participants received non-recommended treatment. Among participants with gonorrhea identified by surveillance data as having received non-recommended treatment, the largest proportions were treated at private physicians’ offices or health maintenance organizations (34.7% of participants receiving non-recommended treatment), family planning facilities (22.3%), and emergency departments/urgent care centers (12.8%). Conclusions Barriers to adherence to the CDC treatment guidelines for gonorrhea seem to be experienced in a variety of clinical practice settings. Despite only moderate rates of nonadherence, interventions targeting private physicians/health maintenance organizations and family planning facilities may produce the largest absolute reductions in guideline-discordant treatment.