Michael A. Joseph

Attitudes and Perceptions of the HPV Vaccine in Caribbean and African-American Adolescent Girls and their Parents

OBJECTIVE To describe attitudes and perceptions toward acceptability of human papilloma virus (HPV) vaccination among inner city Caribbean (CA) and African American (AA) adolescents and their parents, and discuss correlates that may be associated with these factors. DESIGN Questionnaire survey. SETTING An adolescent medicine clinic. PARTICIPANTS A convenience sample was recruited of 175 adolescent girls aged 13 to 19 years and 74 parents attending adolescent clinic. INTERVENTION Participants completed an anonymous confidential 10-minute questionnaire. MAIN OUTCOME MEASURES Data on knowledge about HPV, cervical cancer (CC), attitudes and acceptance of the HPV vaccine. RESULTS Responses of 175 adolescent girls and 74 parents were analyzed. Overall, 48.9% of the teens were sexually active (SA) and had a 2.2-fold greater odds (OR = 2.21; 95% CI = 1.13-4.36) of being interested in HPV vaccination versus girls who were not SA. While only 55.8% of girls knew what HPV is, this knowledge was significantly associated with knowing that most CC is caused by HPV (P < 0.001) and with interest in receiving HPV vaccination (P < 0.001). Less than half (44.5%) of adolescent girls were interested in receiving the HPV vaccine and only 37.5% of parents. There were no significant influences in parental acceptance of the vaccine with regard to age, ethnicity and educational level, insurance, and living situation.The majority of parents wanted the vaccine for its role in preventing CC. CONCLUSIONS Although controversy surrounds HPV vaccine in regard to its supposed role in promoting SA, only a minority of our parents showed concern for that association. The level of acceptance of the HPV vaccine was overall lower than what has been reported among other racial/ethnic populations. Knowledge about HPV and its association with CC were significantly associated with interest in getting the HPV vaccine and both parents and teens seem to accept the HPV vaccine more for its role in CC prevention.

Barbershop Talk With Brothers: using community-based participatory research to develop and pilot test a program to reduce HIV risk among Black heterosexual men.

There is a need for feasible, evidence-based interventions that support HIV risk reduction among heterosexual Black men. In this article, we describe the process for development of the Barbershop Talk With Brothers (BTWB) program and evaluation. The BTWB program is a theoretically grounded and community-based HIV prevention program that seeks to improve individual skills and motivation to decrease sexual risk, and that builds mens interest in and capacity for improving their communitys health. Formative data collection included barbershop observations and barber focus groups, brief behavioral risk assessments of men in barbershops, and focus groups and individual interviews. Based on this information and in consultation with our steering committee, we developed the BTWB program and accompanying program evaluation. From April through November 2011, 80 men were recruited and completed a baseline assessment of a pilot test of the program; 78 men completed the program and 71 completed a 3-month assessment. The pilot evaluation procedures were feasible to implement, and assessments of pre- and post-test measures indicate that key behavioral outcomes and proposed mediators of those outcomes changed in hypothesized directions. Specifically, attitudes and self-efficacy toward consistent condom use improved, and respondents reported lower levels of sexual risk behavior from baseline to follow-up (all p < 0.05). Perceptions of community empowerment also increased (p = 0.06). While HIV stigma decreased, this difference did not reach statistical significance. Our approach to community-engaged program development resulted in an acceptable, feasible approach to reaching and educating heterosexual Black men about HIV prevention in community settings.

Perceived financial need and sexual risk behavior among urban, minority patients following sexually transmitted infection diagnosis.

Background: Previous studies have shown that racial/ethnic and gender disparities in human immunodeficiency virus (HIV)/sexually transmitted infections (STI) may be due in part to factors such as poverty and income-inequality. Little has been published in the HIV/STI literature on the effect of the perception of having unmet basic needs on sexual risk behavior. Methods: Data on perceived financial need and sexual risk were collected as part of a behavioral intervention aimed at promoting STI partner notification and reducing sexual behavior among minority patients presenting for care at 1 of 2 STI treatment centers in Brooklyn, NY, between January 2002 and December 2004. Data from 528 participants collected at the 6-month follow-up visit were used for the current study. Results: Forty-three percent of participants were categorized as having unmet needs. Those with unmet needs were more likely to report unprotected anal or vaginal sex (unprotected anal or vaginal intercourse [UAVI]; 62%) versus those who had met needs (53%). This association was significant (adjusted odds ratio = 1.28; 95% confidence interval = 1.04–1.53), after controlling for age, sex, site of recruitment, intervention group membership, and country of origin. Stratified analyses indicated that, in the group that did not receive the intervention, there was a statistically significant interaction between sex and basic needs such that women with unmet needs were more likely to report any UAVI (78%) than those with met needs (54%) (adjusted odds ratio = 1.18; 95% confidence interval = 1.07–1.24). No such relationship was detected for men in this sample. Conclusions: The significant association between perceived unmet needs and UAVI appears to be particularly relevant for women. These findings provide preliminary evidence that HIV/STI intervention components that seek to directly deal with issues of reduction in partner conflict might be beneficial to women with high perceived unmet basic needs, and for whom a potential dissolution of a relationship may represent a further loss in ability to meet basic needs.

Stress, Socializing, and Other Motivations for Smoking Among the Lesbian, Gay, Bisexual, Transgender, and Queer Community in New York City

Purpose: This study contributes to the emerging literature on lesbian, gay, bisexual, transgendered, and queer (LGBTQ) health disparities and tobacco use by examining the motivations for smoking among the New York City (NYC) LGBTQ population. Approach: We used grounded theory and blended methods from 3 grounded theorists—Strauss, Corbin, and Charmaz—for data collection, coding, and analysis. Setting: NYC has extensive legislation to prevent smoking; however, the current smoking prevalence of homosexuals is double that of heterosexuals. Participants: Study participants were leaders from 23 NYC LGBTQ organizations. Leaders were chosen to establish a relationship with community and to ensure cultural sensitivity. Eligibility criteria required holding a leadership position in an organization serving the NYC LGBTQ community. Methods: Interviews were transcribed verbatim and uploaded into Dedoose for analysis. An initial code list was developed from the interview guide. Key themes were identified as the themes with the most number of quotes. Results: Three key themes emerged from our interviews: image, socializing, and stress. Smoking was reported to be a socialization aid and a maladaptive coping technique for stress arising from interactions of conflicting identities. Conclusion: Future smoking cessation interventions among the LGBTQ community should equip smokers with healthy coping mechanisms that address the stressors that arise from the intersections of smokers’ many identities.

Patterns of Orofacial Clefting in New York City From 1983 to 2010: Trends by Racial Background, Birthplace, and Public Health Strategies

Objective: To determine the role of racial background, public health initiatives, and residence on the prevalence of orofacial clefts (OFCs) in New York City (NYC). Design/Methods: Retrospective review of OFC cases from the New York State Congenital Malformations Registry. Patients/Participants: Patients born with an OFC and all live births to mothers residing in NYC between 1983 and 2010. Main Outcome Measures: Orofacial cleft birth prevalence by cleft type, race, and borough of maternal residence for each year and by time period around the implementation of public health interventions including folate supplementation. Results: A total of 3557 cases were reviewed. The prevalence remained stable for cleft palate and cleft lip with or without cleft palate (CL ± P) in sequential time periods of the study. Among CL ± P cases, cleft lip prevalence decreased early in the study compared to increases in cleft lip and palate prevalence. For most years, the prevalence of OFCs was lower among African Americans than whites. A total of 12% to 26% of mothers in 4 of the NYC boroughs deliver outside of their borough of residence, choosing to give birth in Manhattan most often. No difference in OFC prevalence was shown in any of the 5 NYC boroughs. Conclusions: The period prevalence remained relatively stable during the time periods before and after the implementation of folate supplementation for OFCs in NYC. Prevalence of OFC subtypes was lower for most time periods during this study among African Americans compared to whites. Several factors may explain the choice of birthplace outside of the mother’s borough of residence.

Attitudes and Perceptions of the Human Papillomavirus Vaccine in Caribbean and African American Adolescent boys and Their Parents

STUDY OBJECTIVE Human papillomavirus (HPV) is the most common sexually transmitted infection in the world. The prevalence of HPV in men ranges from 20% to 65% and is high at all ages. HPV vaccine has high efficacy in preventing HPV infection, cervical cancer, and genital warts. The study objectives were to describe attitudes and perceptions toward acceptability of HPV vaccination among inner-city Caribbean and African American adolescent boys and their parents and to identify and discuss correlates that may be associated with these factors. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional survey, administered in a general adolescent medicine clinic. Participants were recruited from a convenience sample of adolescent boys aged 13 to 19 years currently under care at an adolescent medicine clinic. RESULTS Responses of 101 adolescent boys and 35 parents were analyzed. Consistent condom use was associated with less interest in HPV vaccination; those reporting consistent condom use had an 88% decreased odds of being interested in HPV vaccination compared with those reporting inconsistent condom uses. Interest in receiving the HPV vaccine was significantly associated with having increased numbers of sexual partners. CONCLUSION Overall, most adolescent males (65%) were interested in receiving the HPV vaccine and a majority believed their parents would allow the vaccination (77.2%). Parental knowledge that the majority of cervical and rectal cancers are caused by HPV increased the odds of parents believing their sons need HPV vaccination; however, it is not statistically significant.

Correction to: Examining the Associations Between Immigration Status and Perceived Stress Among HIV-Infected and Uninfected Women

The original version of this article unfortunately published with the incorrect article title.

Correction to: Introducing Students of Color to Health Sciences Research: An Evaluation of the Health Disparities Summer Internship Program

The original version of this article unfortunately contained a mistake.

Introducing Students of Color to Health Sciences Research: An Evaluation of the Health Disparities Summer Internship Program

The goal of this analysis is to assess the effectiveness of a summer program designed to introduce high school students of color to health disparities research. A total of 73 students (69.9% Black, 68.5% female and 80.6% either junior/senior) participated in the 4-week Health Disparities Summer Internship Program (HDSIP) during the years 2012–2015. Students attended lectures covering topics such as health disparities, community-based participatory research (CBPR), immigrant health, and policy and advocacy. While working with community-based organizations, students gained hands-on experience related to issues discussed in class. Students completed research projects and provided suggestions for health policy change. Pre/post surveys were completed to evaluate the program. After participating in the HDSIP, students demonstrated heightened awareness of the social determinants of health, especially in regards to racial discrimination (p = .023); borderline statistically significant increases were shown for income (p = .082), community safety (p = .058), and healthcare access (p = .076). Most students (82.1%) planned to advocate for changes in their community; an increase from the initial 65.2% (p = .052). About nine out of ten students (89.6%) reported being satisfied with the summer program; the majority reported improvement in analytical skills, CBPR methods, and oral/communication skills. Increasing diversity in the health workforce has widely been proposed as a means of addressing health disparities. Introducing minority students to health professions can serve as a catalyst for lasting changes in health outcomes. The HDSIP has increased students’ awareness of social determinants of health and has fostered their interest in improving the health of minority populations.

Antihypertensive Medications and Change in Stages of Chronic Kidney Disease

Objectives The goal of this study is to estimate the change in the relationships between use of five classes of antihypertensive medications and stages of Chronic Kidney Disease (CKD) in American adults treated for hypertension. Methods The US National Health and Nutrition Examination Survey (NHANES) data sets 1999–2012 were used with the final analytical sample of 3,045 participants. Population prevalence estimates were calculated using the NHANES survey design weights. Inferential analyses were done with binomial logistic regression models. Results The odds of advanced (3, 4, and 5 combined) versus early CKD stages (1 and 2 combined) were significantly higher among patients treated with Angiotensin Receptor Blockers (ARB) versus those not treated with ARB in 2009–2012 (adjusted odds ratio (95% confidence interval) = 2.52 (1.32–4.80)). From 1999 to 2012, the increase in this relationship was significant (p = 0.0023) for users of ARB polytherapy and in users of ARB in patients with albuminuria (p = 0.0031). Conclusion Aggressive pharmacological management of hypertension with ARB as add-on therapy may have accelerated kidney damage in American adults. However, prospective longitudinal studies are needed to establish proper temporal sequence in this relationship.