Publications by authors named "Manuel A Ocasio"

19 Publications

  • Page 1 of 1

Engaging Sexual and Gender Minority Youth in HIV Interventions Through Gay Dating Apps: Recruitment Protocol.

JMIR Res Protoc 2021 Jun 22;10(6):e28864. Epub 2021 Jun 22.

Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States.

Background: HIV continues to disproportionately impact sexual and gender minority youth (SGMY) in the United States. Public health efforts have increasingly focused on developing efficacious interventions to curb the spread of HIV among SGMY and help those living with HIV achieve and sustain viral suppression. However, recruiting and engaging SGMY in prevention and care interventions is challenging.

Objective: During the past decade, gay dating apps have quickly emerged as popular web-based spaces in which SGMY congregate. Although the recruitment of SGMY through these apps has been commonly reported, advertisement is the typical modality used, and direct recruitment approaches are not adequately described. This study aims to describe the process for developing a direct recruitment protocol for use in gay dating apps.

Methods: The Adolescent Medicine Trials Network Comprehensive Adolescent Research and Engagement Studies is a community-based research program consisting of 3 interrelated studies testing scalable behavioral interventions to improve HIV prevention and care engagement among youth aged 12-24 years in Los Angeles and New Orleans. To supplement our in-person recruitment approaches for Comprehensive Adolescent Research and Engagement Studies, the New Orleans site formed a gay dating app recruitment team. In April 2018, the team developed a loosely structured protocol that included study-specific profiles and sample language to guide initial recruitment efforts. Two self-identified Black, gay cisgender male field recruiters field-tested the protocol on the popular gay dating app Jack'd. During the field test, the recruitment team met weekly to discuss the recruiters' experiences and user reactions. For example, we learned the importance of addressing concerns about study legitimacy and identifying appropriate ways to describe the study. We iteratively incorporated these lessons learned into the final protocol and developed a training program and tracking procedures before moving to full-scale implementation at both sites.

Results: Adhering to this protocol yielded 162 enrollments in New Orleans (332 total enrollments across the two sites) throughout the recruitment period (April 2018 to August 2019). Most of these participants were sexual minority cisgender males (91%), and the remainder were identified as members of gender minority groups. We outlined step-by-step instructions on training staff, engaging users, and scheduling and tracking recruitment activities.

Conclusions: This paper provides a practical guide for researchers and community-based providers to implement a gay dating app recruitment protocol. Our experience indicates that gay dating app recruitment is feasible and fruitful when the staff members are knowledgeable, flexible, honest, and respectful to the user. Perhaps the most salient lesson we learned in approaching gay dating app users is the importance of setting clear and transparent intentions without judgment. As gay dating apps continue to increase in popularity, researchers need to stay vigilant to changing formats and develop systematic approaches to harness their potential as invaluable recruitment strategies for SGMY.

International Registered Report Identifier (irrid): RR1-10.2196/28864.
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http://dx.doi.org/10.2196/28864DOI Listing
June 2021

Using Machine Learning to Predict Young People's Internet Health and Social Service Information Seeking.

Prev Sci 2021 May 11. Epub 2021 May 11.

University of California, UCLA Center for Community Health, 10920 Wilshire Blvd Suite 350, Los AngelesLos Angeles, CA, 90024, USA.

Machine learning creates new opportunities to design digital health interventions for youth at risk for acquiring HIV (YARH), capitalizing on YARH's health information seeking on the internet. To date, researchers have focused on descriptive analyses that associate individual factors with health-seeking behaviors, without estimating of the strength of these predictive models. We developed predictive models by applying machine learning methods (i.e., elastic net and lasso regression models) to YARH's self-reports of internet use. The YARH were aged 14-24 years old (N = 1287) from Los Angeles and New Orleans. Models were fit to three binary indicators of YARH's lifetime internet searches for general health, sexual and reproductive health (SRH), and social service information. YARH responses regarding internet health information seeking were fed into machine learning models with potential predictor variables based on findings from previous research, including sociodemographic characteristics, sexual and gender minority identity, healthcare access and engagement, sexual behavior, substance use, and mental health. About half of the YARH reported seeking general health and SRH information and 26% sought social service information. Areas under the ROC curve (≥ .75) indicated strong predictive models and results were consistent with the existing literature. For example, higher education and sexual minority identification was associated with seeking general health, SRH, and social service information. New findings also emerged. Cisgender identity versus transgender and non-binary identities was associated with lower odds of general health, SRH, and social service information seeking. Experiencing intimate partner violence was associated with higher odds of seeking general health, SRH, and social service information. Findings demonstrate the ability to develop predictive models to inform targeted health information dissemination strategies but underscore the need to better understand health disparities that can be operationalized as predictors in machine learning algorithms.
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http://dx.doi.org/10.1007/s11121-021-01255-2DOI Listing
May 2021

Optimizing screening for anorectal, pharyngeal, and urogenital C. trachomatis and N. gonorrhoeae infections in at risk adolescents and young adults in New Orleans, Louisiana and Los Angeles, California, USA.

Clin Infect Dis 2020 Dec 10. Epub 2020 Dec 10.

Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA.

Background: Public health organizations have inconsistent recommendations for screening adolescents and young adults for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) infections. Guidelines suggest different combinations of anorectal, pharyngeal, and urogenital testing based on age, sex, and sexual activity. Further evaluation of how identity and behaviors impact the anatomic distribution of C. trachomatis and N. gonorrhoeae infection is needed to optimize future screening practices.

Methods: We assessed the positivity of C. trachomatis and N. gonorrhoeae infections at different anatomic sites in a cohort of at-risk sexually active adolescents and young adults between 12-24 years old in New Orleans, Louisiana and Los Angeles, California. Participants were tested for C. trachomatis and N. gonorrhoeae at three sites (anorectum, pharynx, and urethral/cervix) every four months using self-collected swabs. We stratified anatomic distributions of infection into four gender and sexual behavior categories: (i) cisgender men who have sex with men and transgender women (MSMTW), (ii) cis-heterosexual males, (iii) cis-heterosexual females, and (iv) gender minorities assigned female at birth.

Results: While three-site testing detected all infections, two-site (anorectum and urethra/cervix) testing identified 92-100% of C. trachomatis or N. gonorrhoeae infections in participants assigned female at birth and cis-heterosexual males. For MSMTW, two site anorectal and pharyngeal testing versus single site anorectal testing increased the proportion of individuals with either infection from 74 to 93%.

Conclusion: Sexual behavioral and gender identity factors may influence detection of C. trachomatis and N. gonorrhoeae infections at specific anatomic testing sites. Testing guidelines should incorporate sexual behavior and gender identity.
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http://dx.doi.org/10.1093/cid/ciaa1838DOI Listing
December 2020

Community-based Implementation of Centers for Disease Control and Prevention's Recommended Screening for Sexually Transmitted Infections Among Youth at High Risk for HIV Infection in Los Angeles and New Orleans.

Sex Transm Dis 2020 07;47(7):481-483

From the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.

We examined whether the implementation of the Centers for Disease Control and Prevention's recommended screening of Chlamydia trachomatis/Neisseria gonorrhoeae with proactive follow-up among high-risk youth recruited from community and clinic settings reduced future C. trachomatis/N. gonorrhoeae diagnoses. After the Centers for Disease Control and Prevention's recommendations demonstrated a 41% decline in sexually transmitted infections; 3 tests in 1 year resulted in a 10% decline.
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http://dx.doi.org/10.1097/OLQ.0000000000001171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7371266PMC
July 2020

Strategies to Treat and Prevent HIV in the United States for Adolescents and Young Adults: Protocol for a Mixed-Methods Study.

JMIR Res Protoc 2019 Jan 21;8(1):e10759. Epub 2019 Jan 21.

Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States.

Background: Over 20% of HIV diagnoses in the United States are among youth aged 12-24 years. Furthermore, youth have the lowest rates of uptake and adherence to antiretroviral (ARV) medications and are least aware of their HIV status.

Objective: Our objective was to design a set of interrelated studies to promote completion of each step of the HIV Prevention Continuum by uninfected youth at high risk (YHR), as well as completion of steps in the Treatment Continuum by youth living with HIV (YLH).

Methods: Gay, bisexual, and transgender youth; homeless youth; substance-abusing youth; youth with criminal justice contact; and youth with significant mental health challenges, particularly black and Latino individuals, are being recruited from 13 community-based organizations, clinics, drop-in centers, and shelters in Los Angeles and New Orleans. Youth are screened on the basis of self-reports and rapid diagnostic tests for HIV, drug use, and sexually transmitted infections and, then, triaged into one of 3 studies: (1) an observational cohort of YLH who have never received ARV medications and are then treated-half initially are in the acute infection period (n=36) and half with established HIV infection (n=36); (2) a randomized controlled trial (RCT) for YLH (N=220); and (3) an RCT for YHR (N=1340). Each study contrasts efficacy and costs of 3 interventions: an automated messaging and weekly monitoring program delivered via text messages (short message service, SMS); a peer support intervention delivered via social media forums; and coaching, delivered via text message (SMS), phone, and in-person or telehealth contacts. The primary outcomes are assessing youths' uptake and retention of and adherence to the HIV Prevention or Treatment Continua. Repeat assessments are conducted every 4 months over 24 months to engage and retain youth and to monitor their status.

Results: The project is funded from September 2016 through May 2021. Recruitment began in May 2017 and is expected to be completed by June 2019. We expect to submit the first results for publication by fall 2019.

Conclusions: Using similar, flexible, and adaptable intervention approaches for YLH and YHR, this set of studies may provide a roadmap for communities to broadly address HIV risk among youth. We will evaluate whether the interventions are cost-efficient strategies that can be leveraged to help youth adhere to the actions in the HIV Prevention and Treatment Continua.

International Registered Report Identifier (irrid): DERR1-10.2196/10759.
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http://dx.doi.org/10.2196/10759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360384PMC
January 2019

Association between Socio-Ecological Risk Factor Clustering and Mental, Emotional, and Behavioral Problems in Hispanic Adolescents.

J Child Fam Stud 2017 May 10;26(5):1266-1273. Epub 2017 Mar 10.

Compared to non-Hispanic whites, Hispanic adolescents in the U.S. report higher rates of several mental, emotional, and behavioral (MEB) problems such as substance use, sexual risk behaviors, and internalizing and externalizing problems. There is evidence of common pathways in the development of MEB problems with certain subgroups of Hispanic adolescents being at greater risk. In the present article, we report analysis of baseline data for 959 Hispanic adolescents who participated in one of two randomized controlled trials evaluating a family-based preventive intervention. Utilizing latent class analysis, we identified subgroups of Hispanic adolescents based on socio-ecological risk and protective factors (e.g., parent-adolescent communication, parental involvement in school). Three distinct socio-ecological risk subgroups (high, medium, and low risk) were identified and exhibited significant differences from each other across a majority of socio-ecological risk and protective factors. Adolescents in higher socio-ecological risk subgroups reported greater MEB problems across all outcomes. Individual comparisons revealed significant differences between the low socio-ecological risk group and both the medium and high socio-ecological risk group in lifetime alcohol use, smoking, and sex, as well as internalizing and externalizing problems. Implications for intervention include focusing on specific risk subgroups and targeting shared risk and protective factors rather than specific MEB outcomes.
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http://dx.doi.org/10.1007/s10826-016-0641-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621644PMC
May 2017

Engaging School Mental Health Professionals to Deliver Evidence-Based Interventions to Hispanic Families.

Health Promot Pract 2017 07 26;18(4):526-533. Epub 2017 Apr 26.

1 University of Miami Miller School of Medicine, Miami, FL, USA.

Research has demonstrated that a number of evidence-based programs can be effectively implemented in different community settings, such as schools, to target Hispanic youth and their families; however, successful implementation of such programs represents a challenge for practitioners. This article describes experiences and strategies associated with recruiting, training, and supervising school mental health professionals in the school-based implementation of an evidence-based, family-centered prevention program for Hispanic families. School mental health professionals were recruited and given intensive training, weekly supervision for adherence monitoring, and ongoing technical assistance, in addition to intervention manuals and materials. We emphasize how strategies based on the prevention program itself were used to recruit, engage, and train school mental health professionals to deliver a family-based evidence-based program, blending research and practice in a large public school system. Implications of lessons learned are discussed, as well as the specific strategies to overcome challenges when engaging and training community partners in delivering a manualized intervention with rigorous adherence to the program.
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http://dx.doi.org/10.1177/1524839917705129DOI Listing
July 2017

Parent-Centered Prevention of Risky Behaviors Among Hispanic Youths in Florida.

Am J Public Health 2017 04 16;107(4):607-613. Epub 2017 Feb 16.

Yannine Estrada, Tae Kyoung Lee, Maria I. Tapia, Maria-Rosa Velázquez, Hilda Pantin, Manuel A. Ocasio, Denise C. Vidot, Lourdes Molleda, Bryan A. Stepanenko, and Guillermo Prado are with the Department of Public Health Sciences, University of Miami, Miami, FL. Shi Huang is with the Department of Biostatistics, Vanderbilt University, Nashville, TN. Marcos J. Martinez is with the Prevention Research Center at the University of New Mexico, Albuquerque. Juan Villamar and C. Hendricks Brown are with the Department of Psychiatry and Behavioral Medicine, Northwestern University, Chicago, IL.

Objectives: To evaluate the effectiveness of an evidence-based, parent-centered intervention, Familias Unidas, delivered by nonresearch personnel, in preventing substance use (alcohol, illicit drugs) and sex without a condom among Hispanic adolescents.

Methods: A randomized controlled trial (n = 746) evaluated the effectiveness of Familias Unidas among Hispanic eighth graders (age range = 12-16 years), relative to prevention as usual, within a public school system. School personnel, including social workers and mental health counselors, were trained to deliver the evidence-based intervention. Participant recruitment, intervention delivery, and follow-up ran from September 2010 through June 2014 in Miami-Dade County, Florida.

Results: Familias Unidas was effective in preventing drug use from increasing and prevented greater increases in sex without a condom 30 months after baseline, relative to prevention as usual. Familias Unidas also had a positive impact on family functioning and parental monitoring of peers at 6 months after baseline.

Conclusions: This study demonstrated the effectiveness of a parent-centered preventive intervention program in preventing risky behaviors among Hispanic youths. Findings highlight the feasibility of training nonresearch personnel on effectively delivering a manualized intervention in a real-world setting.
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http://dx.doi.org/10.2105/AJPH.2017.303653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5343711PMC
April 2017

Substance Use and Sexual Risk Behavior in Sexual Minority Hispanic Adolescents.

J Adolesc Health 2016 11 17;59(5):599-601. Epub 2016 Aug 17.

Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida.

Purpose: This study examines substance use and sexual risk in sexual minority Hispanic adolescents (SMHAs) relative to their heterosexual counterparts.

Methods: Baseline data (total, n=1,632; SMHA, n=195) from five completed trials of a family-based intervention for Hispanic adolescents were synthesized. SMHA were identified by self-reported anal/vaginal/oral sex with a partner of the same gender (SMHA vs. non-SMHA). Dichotomous outcomes were lifetime and past 90-day cigarette, alcohol and illicit drug use, past 90-day condomless sex, and condom use at last sex. Logistic regression models controlled for sociodemographic and study-level characteristics testing the association between sexual minority status and each outcome.

Results: SMHA reported significantly more substance use than non-SMHA, including lifetime cigarette and illicit drug use. Adjusted odds of lifetime use for all substances and past 90-day cigarette use (AOR = 3.07; 95% confidence interval: 1.50-6.31) were significantly higher in SMHA.

Conclusions: SMHA substance use etiology should be explored to inform tailored intervention development.
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http://dx.doi.org/10.1016/j.jadohealth.2016.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5436306PMC
November 2016

Cost of a community-based diabetic retinopathy screening program.

Diabetes Care 2014 Nov;37(11):e236-7

Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.

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http://dx.doi.org/10.2337/dc14-0834DOI Listing
November 2014

The health of young US workers.

J Occup Environ Med 2014 Oct;56(10):1011-8

From the Department of Public Health Sciences (Mr Ocasio, Ms Fernandez, Dr LeBlanc, Ms Lin, Dr Caban Martinez, Dr Kachan, and Dr Lee), University of Miami Miller School of Medicine, Fla; European Centre for Environment and Human Health (Dr Fleming and Ms Hollenbeck), University of Exeter Medical School, Truro, Cornwall, UK; Environmental and Occupational Medicine and Epidemiology Program (Dr Caban Martinez), Department of Environmental Health, Harvard University, School of Public Health, Boston, Mass; Department of Human Development and Family Studies (Dr Christ), Purdue University, West Lafayette, Ind; and National Institute for Occupational Safety and Health (Mr Sestito), Division of Surveillance, Health Evaluations and Field Studies, Cincinnati, Ohio.

Objectives: To provide an overview of the health status of young US workers across four domains: functional health, physical and psychological health, health behavior, and health care utilization.

Methods: Pooled data from the 2004 to 2010 National Health Interview Survey were analyzed for 11,279 US workers aged 18 to 24 years, representing an estimated 16.9 million workers annually. Thirty-nine health indicators were examined and compared across nine occupational groups.

Results: Compared with other occupational groups, craft workers and laborers and helpers had the highest prevalence of risky health behaviors, including current smoking and risky drinking, as well as fewer reported visits to a primary care physician in the past year.

Conclusions: Young workers engage in risky health behaviors, and may benefit from targeted workplace interventions to mitigate the potentially negative long-term effects on health and well-being.
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http://dx.doi.org/10.1097/JOM.0000000000000256DOI Listing
October 2014

Influence of socio-demographic characteristics on eye care expenditure: data from the Medical Expenditure Panel Survey 2007.

Ophthalmic Epidemiol 2015 Feb 10;22(1):28-33. Epub 2013 May 10.

Miami Veterans Affairs Medical Center , Miami, FL , USA .

Objective: To evaluate the association between sociodemographic factors and eye care expenditure and to assess the burden of ocular expenditure compared to total health care expenditure.

Methods: A retrospective analysis of ocular expenditure in participants of the 2007 Medical Expenditure Panel Survey. Data from 20,620 unique participants aged ≥18 years were evaluated for eye care expenditure by demographic characteristics.

Results: A total of 22% of the studied population had eye care expenditures in 2007. Demographic factors significantly associated with higher probability of having eye care expenditures included older age (65+ years 35%, 45-64 years 23%, <45 years 17%), female sex (female 26%, male 19%), higher educational attainment (greater than high school education 25%, less than high school education 17%), having insurance (private 24%, uninsured 13%), and visual impairment (mild 31%, none 22%). Older age, female sex, higher educational attainment, having insurance, and presence of visual impairment were also significantly associated with higher mean eye care expenditure. In those with eye care expenditure, the mean ratio between eye care and total medical expenditure was 24%, with uninsured patients spending 42% of their medical care expenditure on eye care.

Conclusions: Demographic factors are associated with both the probability of having ocular expenditure and the amount of expenditure. Of all factors examined, insurance status has the most potential for modification. Policy makers should consider these numbers when devising the terms by which eye care coverage will be provided under the Patient Protection and Affordable Care Act.
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http://dx.doi.org/10.3109/09286586.2013.783081DOI Listing
February 2015

Sociodemographic correlates of eye care provider visits in the 2006-2009 Behavioral Risk Factor Surveillance Survey.

BMC Res Notes 2012 May 23;5:253. Epub 2012 May 23.

Department of Epidemiology & Public Health, University of Miami, Miller School of Medicine, Clinical Research Building, Room 1075, 1120 N.W. 14th Street, 10th Floor (R-669), Miami, FL 33136, USA.

Background: Research has suggested that adults 40 years old and over are not following eye care visit recommendations. In the United States, the proportion of older adults is expected to increase drastically in the coming years. This has important implications for population ocular disease burden, given the relationship between older age and the development of many ocular diseases and conditions. Understanding individual level determinants of vision health could support the development of tailored vision health campaigns and interventions among our growing older population. Thus, we assessed correlates of eye care visits among participants of the Behavior Risk Factor Surveillance System (BRFSS) survey. We pooled and analyzed 2006-2009 BRFSS data from 16 States (N = 118,075). We assessed for the proportion of survey respondents 40 years of age and older reporting having visited an eye care provider within the past two years, two or more years ago, or never by socio-demographic characteristics.

Results: Nearly 80% of respondents reported an eye care visit within the previous two years. Using the 'never visits' as the referent category, the groups with greater odds of having an ocular visit within the past two years included those: greater than 70 years of age (OR = 6.8 [95% confidence interval = 3.7-12.6]), with college degree (5.2[3.0-8.8]), reporting an eye disease, (4.74[1.1-21.2]), diagnosed with diabetes (3.5[1.7-7.5]), of female gender (2.9[2.1-3.9]), with general health insurance (2.7[1.8-3.9]), with eye provider insurance coverage (2.1[1.5-3.0]), with high blood pressure (1.5[1.1-2.2]), and with moderate to extreme near vision difficulties (1.42[1.11-2.08]).

Conclusion: We found significant variation by socio-demographic characteristics and some variation in state-level estimates in this study. The present findings suggest that there remains compliance gaps of screening guidelines among select socio-demographic sub-groups, as well as provide evidence and support to the CDC's Vision Health Initiative. This data further suggests that there remains a need for ocular educational campaigns in select socio-demographic subgroups and possibly policy changes to enhance insurance coverage.
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http://dx.doi.org/10.1186/1756-0500-5-253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444410PMC
May 2012

Worker populations at risk for work-related injuries across the life course.

Am J Ind Med 2012 Apr 13;55(4):361-6. Epub 2011 Dec 13.

Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA.

Background: Workplace injuries can have a substantial economic impact. Rates of workplace injuries differ across age groups, yet occupations/industry sectors at highest risk within age groups have not been identified. We examined workplace injury risk across industry sectors for three age groups using nationally representative U.S. data.

Methods: Data from 1997 to 2009 National Health Interview Survey (NHIS) were pooled for employed adults by age groups: (1) 18-25 (n = 22,261); (2) 26-54 (n = 121,559); and (3) 55+ (n = 24,851). Workplace injury risk comparisons were made using logistic regression, with the Services sector as the referent and adjustment for sample design, gender, education, race/ethnicity, age, and income-to-poverty ratio.

Results: Overall 3-month injury prevalence was 0.88%. Highest risk sectors for workers aged 18-25 included: Agriculture/forestry/fisheries (odds ratio = 4.80; 95% confidence interval 2.23-10.32), Healthcare/social assistance (2.71; 1.50-4.91), Construction (2.66; 1.56-4.53), Manufacturing (2.66; 1.54-4.61); for workers 26-54: Construction (2.30; 1.76-3.0), Agriculture/forestry/fisheries (1.91; 1.16-3.15), and Manufacturing (1.58; 1.28-1.96); for workers 55+: Agriculture/forestry/fisheries (3.01; 1.16-7.81), Transportation/communication/other public utilities (2.55; 1.44-4.49), and Construction (2.25; 1.09-4.67).

Conclusions: Agriculture/forestry/fisheries and Construction were among the sectors with highest workplace injury risk for workers across all age groups. Differences in highest risk industries were identified between the youngest and oldest industry groups. Our results indicate a need for age-specific interventions in some industries, and a need for more comprehensive measures in others.
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http://dx.doi.org/10.1002/ajim.21994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322113PMC
April 2012

Utilization of the National Health and Nutrition Examination (NHANES) Survey for Symptoms, Tests, and Diagnosis of Chronic Respiratory Diseases and Assessment of Second hand Smoke Exposure.

Epidemiology (Sunnyvale) 2011 Oct 25;1(2). Epub 2011 Oct 25.

Department of Epidemiology and Public Health, University of Miami Leonard Miller School of Medicine, Miami, Florida, USA.

Background: Respiratory diseases encompass a number of complex disorders that constitute a major cause of both morbidity and mortality worldwide with a major burden to the afflicted as well as the health care systems that care for them. Although the prevalence of chronic respiratory diseases (CRDs) has been decreasing in industrialized countries due to a decreasing number of smokers and stricter laws aimed at reducing exposure to secondhand smoke (SHS), the burden of CRDs in developing world populations is expected to worsen due to communicable disease prevention programs, aging populations, environmental air pollution, and continued tobacco smoke exposure. Although tobacco smoking has been shown to be significantly associated with many CRDs, evidence linking SHS exposure to different CRDs is mixed, especially with low levels of SHS exposure.

Methods: The National Health and Nutrition Examination Survey (NHANES) is a series of studies designed to assess the health and nutritional status of non-institutionalized adults and children in the United States (U.S.). In addition to being used to monitor the health of the U.S. population, NHANES data allow for research into prevalent health problems and their risk factors in the population, such with CRDs and SHS exposure. NHANES data can be utilized to explore a variety of issues related to the assessment of SHS exposure and its association to respiratory symptoms and illnesses.

Results: First, we provide a brief review of NHANES including its strengths and limitations. We then provide a summary of the variables and publically available population based data that can be used to study associations between SHS exposure and CRD symptoms, testing and diagnoses.

Conclusion: Rich and cost effective, NHANES data provide a unique opportunity for research into the risk factors for CRDs in the U.S. population, particularly into the possible health effects of low levels of SHS exposure.
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http://dx.doi.org/10.4172/2161-1165.1000104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456667PMC
October 2011

Cardiovascular fitness levels among American workers.

J Occup Environ Med 2011 Oct;53(10):1115-21

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.

Objective: To explore cardiovascular fitness in 40 occupations using a nationally representative sample of the US population.

Methods: Respondents aged 18 to 49 years (N = 3354) from the 1999 to 2004 National Health and Nutrition Examination Survey were evaluated for cardiovascular fitness and classified into low, moderate, and high levels. Comparisons were made among occupations.

Results: Of all the US workers, 16% had low, 36% moderate, and 48% high cardiovascular fitness. Administrators, health occupations, wait staff, personal services, and agricultural occupations had a lesser percentage of workers with low cardiovascular fitness compared with all others. Sales workers, administrative support, and food preparers had a higher percentage of workers with low cardiovascular fitness compared with all others.

Conclusions: Cardiovascular fitness varies significantly across occupations, and those with limited physical activity have higher percentages of low cardiovascular fitness. Workplace strategies are needed to promote cardiovascular fitness among high-risk occupations.
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http://dx.doi.org/10.1097/JOM.0b013e31822cfe8eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3190024PMC
October 2011

Working with cancer: health and disability disparities among employed cancer survivors in the U.S.

Prev Med 2011 Oct 23;53(4-5):331-4. Epub 2011 Aug 23.

Department of Epidemiology & Public Health, Miller School of Medicine, University of Miami, Miami, FL, USA.

Introduction: Approximately 40% of Americans annually diagnosed with cancer are working-age adults. Using a nationally representative database, we characterized differences in health status and occupation of working cancer survivors and persons without cancer.

Methods: Cross-sectional data pooled from the 1997-2009 US National Health Interview Survey for adults with self-reported physician-diagnosed cancer (n=22,952) and those without (n=358,495), were analyzed. Multivariable logistic regression was used to compare the health and disability status of employed cancer survivors across occupational sectors relative to workers without a cancer history and unemployed cancer survivors.

Results: Relative to workers with no cancer history, cancer survivors were more likely (OR; 95%CI) to be white-collar workers and less likely to be service workers. Working cancer survivors were significantly less likely than unemployed survivors, but more likely than workers with no cancer history, to report poor-fair health (0.25; 0.24-0.26) and (2.06; 1.96-2.17) respectively, and ≥ 2 functional limitations (0.37; 0.35-0.38) and (1.72; 1.64-1.80) respectively. Among employed cancer survivors, blue-collar workers reported worse health outcomes, yet they reported fewer workdays missed than white-collar workers.

Conclusion: Blue-collar cancer survivors are working with high levels of poor health and disability. These findings support the need for workplace accommodations for cancer survivors in all occupational sectors, especially blue-collar workers.
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http://dx.doi.org/10.1016/j.ypmed.2011.07.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208802PMC
October 2011

Occupational vs. industry sector classification of the US workforce: which approach is more strongly associated with worker health outcomes?

Am J Ind Med 2011 Oct 13;54(10):748-57. Epub 2011 Jun 13.

Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Florida, USA.

Objectives: Through use of a nationally representative database, we examined the variability in both self-rated health and overall mortality risk within occupations across the National Occupational Research Agenda (NORA) Industry Sectors, as well as between the occupations within the NORA Industry sectors.

Methods: Using multiple waves of the National Health Interview Survey (NHIS) representing an estimated 119,343,749 US workers per year from 1986 to 2004, age-adjusted self-rated health and overall mortality rates were examined by occupation and by NORA Industry Sector.

Results: There was considerable variability in the prevalence rate of age-adjusted self-rated poor/fair health and overall mortality rates for all US workers. The variability was greatest when examining these data by the Industry Sectors. In addition, we identified an overall pattern of increased poor/fair self-reported health and increased mortality rates concentrated among particular occupations and particular Industry Sectors.

Conclusions: This study suggests that using occupational categories within and across Industry Sectors would improve the characterization of the health status and health disparities of many subpopulations of workers within these Industry Sectors.
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http://dx.doi.org/10.1002/ajim.20973DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168588PMC
October 2011

Trends in glaucoma medication expenditure: Medical Expenditure Panel Survey 2001-2006.

Arch Ophthalmol 2011 Oct 13;129(10):1345-50. Epub 2011 Jun 13.

Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL 33136, USA.

Objective: To study trends of glaucoma medication expenditure from 2001 to 2006 using a nationally representative sample of US adults.

Methods: We analyzed glaucoma medication expenditure trends among participants of the 2001-2006 Medical Expenditure Panel Survey, a subsample of the National Health Interview Survey, which is a continuous multipurpose, multistage area probability survey of the US civilian noninstitutionalized population. After adjusting for survey design and inflation using the 2009 inflation index, data from 1404 participants 18 years and older using glaucoma medication were analyzed.

Results: Mean annual glaucoma medication expenditure per subject increased from $445 in 2001 to $557 in 2006 (slope = 20.8; P < .001). Subgroup analysis showed expenditure increased significantly in women (P = .02), those with public-only insurance (P < .001), and those with less than a high school education (P < .008). Over the survey period, a significant decrease in expenditures on β-blockers (P = .048) and significant increases in expenditures on prostaglandin analogs (P = .01) and α-agonists (P = .01) were found.

Conclusions: Factors associated with increasing glaucoma medication expenditure trends include the increasing use of prostaglandin analogs, changes in insurance coverage, and possibly more aggressive glaucoma treatment. The findings are pertinent to the development of cost-effective strategies that optimize treatment and reduce expenditures.
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http://dx.doi.org/10.1001/archophthalmol.2011.142DOI Listing
October 2011