Peter Messeri

The impact of ancillary HIV services on engagement in medical care in New York City

The advent of antiretroviral therapies in 1996 prompted an interest in the role played by ancillary services in improving access to and retention in medical care, particularly since the success of the new therapies is often contingent upon ongoing and appropriate primary medical care. Using self-reported survey data from a longitudinal representative sample of 577 HIV-positive adults in New York City, this paper explores the impact of such supportive services as drug treatment, case management, housing assistance, mental health treatment and transportation on engagement with medical care. The studys principal finding was that specific ancillary services were significantly associated with an increase in an individuals likelihood of entering medical care and maintaining appropriate medical care services for HIV, particularly when the services addressed a corresponding need.

Organizational theory social supports and mortality rates: a theoretical convergence.

Theorists and researchers have explicitly or implicitly made use of primary groups to explain a wide range of social behaviors such as work productivity mass media communication combat morale job search services to elderly and mortality rates. Typically they have not systematically distinguished primary group from formal organization effects. Consequently it is not known what primary groups uniquely contribute to social behavior. An expanded organizational contingency theory of group structure is advanced which fills in this gap and shows that primary group theory and organizational contingency theory share a common framework. To demonstrate the power of this formulation [U.S.] national data on mortality are analyzed to predict which causes of death can and which cannot be reduced by primary groups. (EXCERPT)

Housing Need, Housing Assistance, and Connection to HIV Medical Care

HIV infection has become a chronic condition that for most persons can be effectively managed with regular monitoring and appropriate medical care. However, many HIV positive persons remain unconnected to medical care or have less optimal patterns of health care utilization than recommended by good clinical practice standards. This paper investigates housing status as a contextual factor affecting access and maintenance in appropriate HIV medical care. Data provided from 5,881 interviews conducted from 1994 to 2006 with a representative sample of 1,661 persons living with HIV/AIDS in New York City demonstrated a strong and consistent relationship between housing need and remaining outside of or marginal to HIV medical care. In contrast, housing assistance increased access and retention in medical care and appropriate treatment. The relationship between housing and medical care outcomes remain controlling for client demographics, health status, insurance coverage, co-occurring mental illness, and problem drug use and the receipt of supportive services to address co-occurring conditions. Findings provide strong evidence that housing needs are a significant barrier to consistent, appropriate HIV medical care, and that receipt of housing assistance has an independent, direct impact on improved medical care outcomes.

SOCIAL SUPPORT, DISCLOSURE, AND USE OF ANTIRETROVIRAL THERAPY

This paper investigates the association between social support, disclosure of HIV/AIDS, and odds of initiating combination antiretroviral drug therapy in its first years on the market. Data are drawn from the first three rounds of the Community Health Advisory and Information Network (CHAIN) survey, collected between 1994 and 1997. CHAIN documents service needs and rates of service utilization among a representative sample of persons with HIV/AIDS in New York City. A two-step logistic regression estimated associations between (1) perceived social support and use of combination antiretroviral therapy, and (2) the interaction between concealing HIV/AIDS and perceived social support. Results offered evidence that the positive association between social support and use of highly active antiretroviral treatment (HAART) and other combination antiretroviral therapies is contingent upon disclosure of HIV status within the household or among friend and acquaintance networks. A positive association between social support and odds of using combination therapy was only observed among those who disclosed their HIV status.

Conceptualizing Youth Empowerment within Tobacco Control

This article presents a conceptual framework that was developed to guide a national evaluation of the American Legacy Foundation’s (Legacy) Statewide Youth Movement Against Tobacco Use (SYMATU) program. This program was designed to develop youth-led, youth-directed initiatives within local communities. Two evaluation studies were designed and implemented from 2000 through 2003: a cross-site study that collected standard data elements across all 17 programs and a case study of five programs that collected formative data on variables thought to affect program implementation. In developing the youth empowerment (YE) conceptual framework, the authors started by reviewing literature to identify the concepts necessary for these types of initiatives and present a summary of their findings here. This article focuses on the development of the authors’overarching conceptual framework used to guide their evaluation studies. Other articles contained within this special issue present results from each of the SYMATU evaluation studies.

Antiretroviral therapy and declining AIDS mortality in New York City.

Objective. This study estimates the impact of Highly Active Antiretroviral Therapy (HAART) and other antiretroviral therapy combinations on reducing mortality risk for a cohort of HIV-infected persons living in New York City. Materials and methods. Data for this study come from the CHAIN project, an ongoing multiwave longitudinal study of HIV-infected persons is living in New York City (n = 700) initiated in 1994. The study sample is drawn from the clients of 43 medical and social service agencies and is broadly representative of New York City residents, who were aware of their positive serostatus at time of enrollment. Occurrences of deaths were obtained through routine field tracking and searches of death certificates and an online death registry. Information on other study variables was obtained through in-person interviews. A Cox proportional hazard model was applied to estimate the effects of medication on mortality risk. Results. Mortality rates for the CHAIN cohort dropped steadily from a high of 131 deaths per 1000 persons/year in 1995 to 31 deaths per 1000 persons/year in 1999, with the historically low mortality rates continuing through 2000. Current use of HAART was associated with a 50% reduction in mortality risk (hazard ratio = 0.51, P <0.01). Conclusions. These results demonstrate that in the case of HAART, the therapeutic benefits of an innovative but costly medical treatment are reaching populations that traditionally have poor access to quality health care.

Modeling Psychological Empowerment Among Youth Involved in Local Tobacco Control Efforts

The American Legacy Foundation funded 13 state health departments for their Statewide Youth Movement Against Tobacco Use in September 2000. Its goal was to create statewide tobacco control initiatives implemented with youth leadership. The underlying theory behind these initiatives was that tobacco control efforts can best be accomplished by empowering youth. To evaluate these initiatives, the authors developed a conceptual framework for youth empowerment that was used as a guide in developing standardized cross-site measures. This article describes the domains and attributes used to operationalize psychological empowerment as an outcome of youth involvement in these initiatives and presents results of our two-stage structural equation modeling. We conclude with a summary of lessons learned to date and recommendations for applying these findings to work in the field.

How state counter-industry campaigns help prime perceptions of tobacco industry practices to promote reductions in youth smoking

Objective: This study assessed the impact of state media campaigns that prominently feature counter-industry messages on youth cigarette smoking, beyond the effects of price, secular trends, tobacco control efforts, and the national truth® campaign. Methods: Rates of youth smoking were compared in three groups of states: (1) those with long funded counter-industry campaigns (California, Florida, and Massachusetts); (2) states with more recently funded counter-industry media campaigns (Indiana, Minnesota, Mississippi, and New Jersey); and (3) other states. An analysis was performed for a series of national telephone surveys of 12–17 year olds between 1999 and 2002, controlling for differences in demographic background, the price of cigarettes, and exposure to the national truth® campaign. Results: Between 1999 and 2002, rates of current smoking and established smoking decreased significantly faster in states with established or more newly funded counter-industry campaigns than in other states. State counter-industry campaigns appear to prime, or make more salient, negative perceptions about tobacco industry practices. Conclusion: Results highlight the value of continued state counter-industry campaigns.

The effect of video interventions on improving knowledge and treatment compliance in the sexually transmitted disease clinic setting: Lesson for hiv health education

Eight intervention studies investigating patient education and treatment adherence in the sexually transmitted disease (STD) clinic setting are reviewed. Across the eight studies selected for analysis, meta-analytic procedures were applied to compare the impact of educational and prevention approaches. The effect of video was compared with that of other modes of health education on: 1) knowledge and attitudes about STDs and condoms and 2) treatment compliance, as measured by return for test of cure, drug compliance, premature resumption of sexual activity, and condom coupon redemption rates. The largest effects were those for video on knowledge and attitudes about STDs and condoms, followed by the effects of other non-video interventions on STD knowledge. Lower effects were found among video and non-video interventions targeting treatment compliance outcomes. These results are consistent with prior prevention studies that have demonstrated difficulty in achieving behavior change.

Computer Access and Internet Use Among Urban Youths

This report presents data on computer access, Internet use, and factors associated with health information seeking on the Internet among a sample of youths aged 15 to 30 years in New York City. Findings from street intercept surveys indicate substantial computer access at home (62%) and frequent (everyday or a few times a week) Internet use (66%). Fifty-five percent of the sample reported seeking health information on the Internet, which was associated with positive beliefs about getting a health checkup and frequent Internet use.