Publications by authors named "Michael G Vaughn"

307 Publications

Different sized particles associated with all-cause and cause-specific emergency ambulance calls: A multicity time-series analysis in China.

Sci Total Environ 2021 Aug 18;783:147060. Epub 2021 Apr 18.

Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Electronic address:

Background: Compared with mortality and hospital admission, emergency ambulance calls (EACs) could be a more accurate outcome indicator to reflect the health effects of short-term air pollution exposure. However, such studies have been scarce, especially on a multicity scale in China.

Methods: We estimated the associations of different diameter particles [i.e., inhalable particulate matter (PM), coarse particulate matter (PM), and fine particulate matter (PM)] with EACs for all-cause, cardiovascular, and respiratory diseases in seven Chinese cities. We collected data on EACs and air pollution from 2014 to 2019. We used generalized additive models and random-effects meta-analysis to examine the city-specific and overall associations. Stratified analyses were conducted to examine the effect modifications of gender, age, and season.

Results: Significant associations of PM and PM with EACs were observed, while the PM associations were positive but not statistically significant in most analyses. Specifically, each 10 μg/m increase in 2-day moving average concentration of PM was associated with a 0.25% [95% confidence interval (CI): 0.04%, 0.47%] increase in all-cause EACs, 0.13% (95% CI: -0.01%, 0.26%) in cardiovascular EACs, and 0.35% (95% CI: 0.04%, 0.66%) in respiratory EACs. The corresponding increases in daily EACs for PM were 0.30% (95% CI, 0.03%, 0.57%), 0.13% (95% CI, -0.07%, 0.33%), and 0.46% (95% CI, 0.01%, 0.92%). Season of the year also modifies the association between particulate matter pollution and EACs.

Conclusions: Short-term exposure to PM and PM were positively associated with daily all-cause and respiratory-related EACs. The associations were stronger during warm season than cold season. Our findings suggest that the most harmful fraction of particulate matter pollution is PM, which has important implications for current air quality guidelines and regulations in China.
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http://dx.doi.org/10.1016/j.scitotenv.2021.147060DOI Listing
August 2021

Associations of perfluorooctane sulfonate alternatives and serum lipids in Chinese adults.

Environ Int 2021 Apr 30;155:106596. Epub 2021 Apr 30.

Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address:

Background: Chlorinated polyfluorinated ether sulfonic acids (Cl-PFESAs), a group of perfluorooctane sulfonate (PFOS) alternatives, can be widely observed in humans and environmental matrices. However, associations between exposure to Cl-PFESAs and serum lipid levels in adults are unknown.

Objective: To explore the relationships between Cl-PFESA levels and serum lipid levels in adults.

Methods: We analyzed 1238 adults from the Isomers of C8 Health Project, a cross-sectional study conducted in China from July 2015 to October 2016. The average age of the participants was 61.98 ± 14.40 years. We quantified two select legacy per- and perfluoroalkyl substances [perfluorooctanoic acid (PFOA) and PFOS] and their alternatives (6:2 and 8:2 Cl-PFESAs). We also measured four serum lipids: low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TG). We used generalized linear models to estimate the associations between PFASs and serum lipids, with PFASs defined as either a categorical variable divided into quartiles or as a continuous variable.

Results: We found that 6:2 Cl-PFESA was positively associated with serum TC and LDL-C. For instance, LDL-C levels in the highest quartile of 6:2 Cl-PFESA exposure (Q4) were significantly higher than those in the lowest quartile (Q1) [β: 0.19, 95% confidence interval (CI): 0.08, 0.30]. Further analysis showed that one ln-ng/mL increase in 6:2 Cl-PFESA exposure corresponded to a 0.10 mmol/L (95% CI: 0.05, 0.16) LDL-C increase, and that exposure to 8:2 Cl-PFESA was negatively correlated with HDL-C (β: -0.03, 95% CI: -0.05, -0.01). TC had a similar relationship with both 6:2 Cl-PFESA and legacy PFASs. Participants with a BMI ≥ 25 kg/m exhibited a stronger association between 6:2 Cl-PFESA and TC.

Conclusions: Our findings make the novel suggestion that exposure to Cl-PFESAs are adversely associated with serum lipid levels, and that such associations are also observed in legacy PFASs. Increased investigation into the effects of Cl-PFESAs exposure on human health is warranted.
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http://dx.doi.org/10.1016/j.envint.2021.106596DOI Listing
April 2021

Associations of perfluorooctane sulfonate alternatives and serum lipids in Chinese adults.

Environ Int 2021 Apr 30;155:106596. Epub 2021 Apr 30.

Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China. Electronic address:

Background: Chlorinated polyfluorinated ether sulfonic acids (Cl-PFESAs), a group of perfluorooctane sulfonate (PFOS) alternatives, can be widely observed in humans and environmental matrices. However, associations between exposure to Cl-PFESAs and serum lipid levels in adults are unknown.

Objective: To explore the relationships between Cl-PFESA levels and serum lipid levels in adults.

Methods: We analyzed 1238 adults from the Isomers of C8 Health Project, a cross-sectional study conducted in China from July 2015 to October 2016. The average age of the participants was 61.98 ± 14.40 years. We quantified two select legacy per- and perfluoroalkyl substances [perfluorooctanoic acid (PFOA) and PFOS] and their alternatives (6:2 and 8:2 Cl-PFESAs). We also measured four serum lipids: low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglycerides (TG). We used generalized linear models to estimate the associations between PFASs and serum lipids, with PFASs defined as either a categorical variable divided into quartiles or as a continuous variable.

Results: We found that 6:2 Cl-PFESA was positively associated with serum TC and LDL-C. For instance, LDL-C levels in the highest quartile of 6:2 Cl-PFESA exposure (Q4) were significantly higher than those in the lowest quartile (Q1) [β: 0.19, 95% confidence interval (CI): 0.08, 0.30]. Further analysis showed that one ln-ng/mL increase in 6:2 Cl-PFESA exposure corresponded to a 0.10 mmol/L (95% CI: 0.05, 0.16) LDL-C increase, and that exposure to 8:2 Cl-PFESA was negatively correlated with HDL-C (β: -0.03, 95% CI: -0.05, -0.01). TC had a similar relationship with both 6:2 Cl-PFESA and legacy PFASs. Participants with a BMI ≥ 25 kg/m exhibited a stronger association between 6:2 Cl-PFESA and TC.

Conclusions: Our findings make the novel suggestion that exposure to Cl-PFESAs are adversely associated with serum lipid levels, and that such associations are also observed in legacy PFASs. Increased investigation into the effects of Cl-PFESAs exposure on human health is warranted.
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http://dx.doi.org/10.1016/j.envint.2021.106596DOI Listing
April 2021

LSD use in the United States: Trends, correlates, and a typology of us.

Drug Alcohol Depend 2021 Jun 20;223:108715. Epub 2021 Apr 20.

School of Social Work, Boston College, Chestnut Hill, MA, 02467, United States.

Background: Recent years have witnessed an increased interest in LSD. This study investigates current information on the trends and correlates of LSD use from years 2002-2018 and seeks to develop an initial typology of use and misuse.

Methods: Data is taken from the NSDUH (National Survey on Drug Use and Health) collected between 2002 and 2018 and trends and correlates of LSD use were analyzed with a survey adjusted logistic regression.

Results: Our findings indicate that LSD use has increased 200 % over the study period (.23 % 2002-2005 to .72 % 2015-2018, AOR = 1.10, 95 % CI = 1.08, 1.12). Our findings also indicate several correlates of LSD use including higher levels of education (college degrees: AOR = 1.62, 95 % CI = 1.23, 2.13), not being married (divorced or separated, AOR = 2.31, 95 % CI = 1.44, 3.73, and have never been married, AOR = 5.67, f 95 % CI = 4.09, 7.86), as well as higher levels of antisocial behavior (having been arrested AOR = 3.20, 95 % CI = 2.50, 4.09) and comorbid mental health and substance abuse disorders (serious psychological distress, AOR = 2.39, 95 % CI = 2.05, 2.80). Further, four distinct subclasses were also discovered within LSD users and two of these subtypes of LSD users contained comorbid mental health disturbances and heavy involvement in the criminal justice system.

Conclusion: LSD use has been on the rise within the last decades, particularly among those who are well educated. Two subclasses of LSD use (those with severe comorbid mental health disorders and those with criminal justice involvement) may require further interventions.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108715DOI Listing
June 2021

Coding of Sexual Assault by Emergency Physicians: A Nationally Representative Study.

West J Emerg Med 2021 Mar 4;22(2):291-296. Epub 2021 Mar 4.

Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri.

Introduction: Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. The American College of Emergency Physicians recommends coding such visits as sexual assault rather than adding modifiers such as "alleged."

Methods: This study reviews factors associated with coding of visits as sexual assault compared to suspected sexual assault using the 2016 Nationwide Emergency Department Sample.

Results: Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault.

Conclusion: Implications of this coding are discussed.
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http://dx.doi.org/10.5811/westjem.2020.12.49045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972378PMC
March 2021

Unpacking Racial/Ethnic Disparities in Emotional Distress Among Adolescents During Witnessed Police Stops.

J Adolesc Health 2021 Apr 1. Epub 2021 Apr 1.

School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri.

Purpose: This study aimed to investigate racial/ethnic disparities in emotional distress during witnessed police stops among a national sample of urban-born youth.

Methods: A national sample of urban-born youth in the U.S. from the most recent wave (2014-2017) of the Fragile Families & Child Wellbeing Study was used in the present study, with a particular focus on youth who report having witnessed police stops, despite not being directly stopped by the police (N = 1,488).

Results: Significant racial/ethnic disparities in feeling angry and unsafe during witnessed police stops emerged, with multiracial, black, and Hispanic youth exhibiting the highest rates of these forms of emotional distress. In the case of Black and multiracial youth, officer intrusiveness and perceptions of procedural injustice collectively explain a large portion of disparities in emotional distress during witnessed stops.

Conclusions: Youth of color are more likely to report emotional distress during witnessed police stops, largely due to the officer intrusiveness and perceived injustices that characterize these stops. Moving forward, scholars should consider whether racial/ethnic disparities in witnessing police violence and injustice may be a significant driver of mental health inequities among urban-born youth.
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http://dx.doi.org/10.1016/j.jadohealth.2021.02.021DOI Listing
April 2021

Parental Incarceration, Child Adversity, and Child Health: A Strategic Comparison Approach.

Int J Environ Res Public Health 2021 03 25;18(7). Epub 2021 Mar 25.

College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO 63103, USA.

Research points to parental incarceration as an important social determinant of child health. Even so, studies examining the health impact of parental incarceration in the context of diverse childhood stressors and adversities are lacking. The present study uses a large, nationally representative sample to compare U.S. children who were exposed to parental incarceration to a strategic comparison group of U.S. children who were not exposed to parental incarceration, but were nonetheless exposed to alternative family stressors and adversities. The initial findings generally reveal worse health among children exposed to parental incarceration compared to those who are not exposed. Even so, these differences were partially or completely attenuated when comparing the incarceration-exposed group to more comparable groups of children exposed to a varying degree of alternative stressors/adversities. Programmatic efforts targeting parental incarceration as a means of promoting child health may be enhanced by adequately addressing co-occurring family stressors and child adversities.
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http://dx.doi.org/10.3390/ijerph18073384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036687PMC
March 2021

Age bias in the criteria for antisocial personality disorder.

J Psychiatr Res 2021 05 18;137:444-451. Epub 2021 Mar 18.

School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States.

The prevalence of antisocial personality disorder (ASPD) decreases with age. As such, research regarding ASPD typically focuses on children and younger adults. The apparent age-specific prevalence of ASPD may be due, in part, to diagnostic criteria informed by research excluding older adults. The present study sought to better understand the manifestation of ASPD in older adults and investigate potential age bias in the diagnostic criteria. Item response theory methods were used to the diagnostic criteria for ASPD with data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III. The measurement of three ASPD criteria showed uniform differential item functioning (DIF), suggesting that older adults were less likely to endorse the item than younger adults despite having the same level of underlying personality disorder. The items with DIF are related to the following criteria for ASPD: Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest (3 items with DIF); irritability and aggressiveness, as indicated by repeated physical fights or assaults (1 item with DIF); and consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (1 item with DIF). Results of the present study can be used to inform the development of criteria that better capture the age-specific experience of this disorder. Improved criteria will result in increased diagnostic accuracy, systematic estimation of the prevalence, improved assessments, and more effective treatment options for this complex population.
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http://dx.doi.org/10.1016/j.jpsychires.2021.03.025DOI Listing
May 2021

Prevalence and Correlates of Driving Under the Influence of Cannabis in the U.S.

Am J Prev Med 2021 Jun 13;60(6):e251-e260. Epub 2021 Mar 13.

Graduate School of Social Welfare, College of Social Sciences, Yonsei University, Seoul, Republic of Korea; School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri.

Introduction: As cannabis use rises among adults in the U.S., driving under the influence of cannabis represents a public health concern.

Methods: In 2020, public-use data from the National Survey on Drug Use and Health were examined, using an analytic sample of 128,205 adults interviewed between 2016 and 2018. The annual prevalence of driving under the influence of cannabis was computed overall, by state, by demographic group, and among cannabis users. Demographic, psychosocial, and behavioral correlates of driving under the influence were tested by multivariate logistic regression.

Results: The self-reported annual prevalence of driving under the influence of cannabis was 4.5% (95% CI=4.3, 4.6) among U.S. adults, ranging from 3.0% (Texas) to 8.4% (Oregon) in individual U.S. states. Among cannabis users, 29.5% (95% CI=28.6, 30.3) reported driving under the influence of cannabis; the predicted probabilities of driving under the influence of cannabis were highest for those with more frequent use, with daily cannabis users evidencing a 57% predicted probability. Among individuals with symptoms suggestive of a cannabis use disorder, the prevalence of driving under the influence of cannabis was 63.8% (95% CI=60.8, 66.6). Among cannabis users, those reporting driving under the influence of cannabis had higher odds of driving under the influence of other illicit substances, using other illicit drugs, taking part in illegal behavior, and suffering from mental distress, after adjusting for demographic characteristics and psychosocial/behavioral correlates.

Conclusions: Findings suggest that prevention efforts should focus on frequent and problem cannabis users and should include content related to other illicit drug use and other drug-impaired driving.
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http://dx.doi.org/10.1016/j.amepre.2021.01.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154651PMC
June 2021

Emergency Department Admissions for Physical Child Abuse: Evidence from the 2006-2017 Nationwide Emergency Department Sample.

J Interpers Violence 2021 Mar 15:8862605211001479. Epub 2021 Mar 15.

Saint Louis University, St. Louis, MO, USA.

Physical child abuse continues to be a serious public health issue in the United States. This study expands on previous research by exploring trends in physical child abuse diagnoses among children admitted to emergency departments (EDs) across the United States. The analysis aimed to explicate the association between physical child abuse and both sociodemographic and behavioral health covariates to better inform and identify risk factors associated with ED admissions for abuse. The study also explicated differences between confirmed and suspected physical child abuse cases. The study utilized a nationally representative sample of hospital-owned EDs that included 319,676,625 ED admissions between 2006 and 2017 for children under 18-years-old. The analysis included a trend analysis, bivariate descriptive statistics, and multivariate logistic regression models were employed. Children with a physical child abuse diagnosis were less likely to be from higher income communities (a = 0.61, 95% CI [0.53, 0.71]), less likely to be female (a = 0.93, 95% CI [0.90, 0.96]), and more likely to be uninsured (a = 1.65, 95% CI [1.48, 1.84]). Children with attention-deficit hyperactivity disorder (a = 1.36, 95% CI [1.14, 1.62]) and a conduct disorder (a = 1.28, 95% CI [1.04, 1.58]) were more likely to have a physical abuse diagnosis. The sex-stratified analyses found that the higher rates of physical abuse among children with attention-deficit hyperactivity disorder were driven by the male subsample, while higher rates of abuse for those with conduct disorders were the result of the female subsample. A supplemental analysis of suspected versus confirmed physical child abuse for the fourth quarter of 2015 through 2017 also revealed sociodemographic and behavioral health differences. This study supports the need to consider sociodemographic and behavioral risk factors associated with physical child abuse to inform treatment and potential reoccurrence of abuse.
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http://dx.doi.org/10.1177/08862605211001479DOI Listing
March 2021

Trends in Therapeutic Services Participation among U.S. Adolescents Affected by Substance Use, 2002-2017.

Subst Use Misuse 2021 24;56(4):567-570. Epub 2021 Feb 24.

School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA.

Substance use continues to pose threats to adolescent health and development in the United States (U.S.). Despite evidence of effectiveness, little is known about adolescent participation in self-help groups (e.g., Alcoholic Anonymous, Alateen) and individual/group counseling for coping with own and another family member's substance use. This study provides new information on the prevalence and trends of adolescent participation in self-help groups and counseling for substance use using a nationally-representative sample. Data was derived from the 2002-2017 National Survey on Drug Use and Health, which include cross-sectional samples of U.S. adolescents aged 12-17 (n=243,618). Specifically, year-by-year prevalence of program participation was estimated, and then the trends were tested using logistic regression analyses while controlling for sociodemographic factors. We found that U.S. adolescents' participation in self-help groups and counseling for substance use decreased from 5.6% in 2002 to 3.4% in 2017, a 39 percent decline that was significant while controlling for sociodemographic confounds (AOR = 0.969, 95% CI = 0.963-0.974). The decreases were most notable among low-income (-39%) and Hispanic (-49%) adolescents. Findings suggest that barriers to therapeutic service use and potential unmet needs among U.S. adolescents, especially low-income and Hispanic adolescents affected by own and family member's substance use, need to be alleviated to promote healthy recovery.
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http://dx.doi.org/10.1080/10826084.2021.1887245DOI Listing
February 2021

Psychopathy and violent video game playing: Multiple associations in a juvenile justice system involved sample.

Aggress Behav 2021 Jul 15;47(4):385-393. Epub 2021 Feb 15.

School of Social Work, Saint Louis University, St. Louis, Missouri, USA.

Violent video game playing is a consistent risk factor for aggression, but research on its psychopathology and trait underpinnings are primarily based on community or university student samples, thus the ecological validity to adjudicated and juvenile justice system-involved youth lacks clarity. This is an important void in the literature because relative to youth in the general population, adjudicated and detained youth evince greater psychopathology, more severe delinquency and violence histories, and clinical psychopathic features. Negative binomial regression models using data from 252 youth in residential placements found that several psychopathic features are significantly associated with violent video gaming. The role of psychopathy operated differently across gender and arrest chronicity, and across models remorselessness emerged as an important correlate. Given the desensitization that can occur with violent video game play, it is of particular concern among delinquent youth with psychopathic personality features.
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http://dx.doi.org/10.1002/ab.21956DOI Listing
July 2021

Margin for error: examining racial and ethnic trends in adolescent risk propensity.

Soc Psychiatry Psychiatr Epidemiol 2021 Jun 19;56(6):993-1002. Epub 2021 Jan 19.

School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.

Background: Relatively little research has accrued examining risk propensity across racial and ethnic groups, especially across time and at the population level.

Aims: Using a margin for error framework to conceptualize risk variation among major racial and ethnic groups, we hypothesize that African American and Hispanic adolescents will be less likely to report engaging in dangerous risk taking acts compared to White adolescents.

Methods: This study examines public-use data collected on risk propensity and risky behaviors among adolescents 12-17 between 2002 and 2018 as part of the National Survey on Drug Use and Health (NSDUH).

Results: While we observed decreased trends in risk propensity, controlling for demographic factors, we see significantly greater odds of reporting "never" engaging in risk for fun among NH Black (AOR 2.01, 95% CI 1.85-2.18) and Hispanic youth (AOR 1.47, 95% CI 1.37-1.58) as compared to NH White youth. NH Black (AOR 0.74, 95% CI 0.61-0.89) and Hispanic (AOR 0.83, 95% CI 0.71-0.98) youth are also less likely than NH White youth to report "always" taking risks for fun. Moreover, the risk propensity-risky behaviors link was weaker among African American and Hispanic adolescents.

Conclusions: We find compelling evidence that African American and Hispanic adolescents are less likely to endorse deriving positive reinforcement from potentially dangerous risk taking acts compared to White adolescents. These findings suggest that African American and Hispanic youth may perceive less "margin for error" when navigating their environments.
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http://dx.doi.org/10.1007/s00127-021-02026-8DOI Listing
June 2021

Trends in cannabis views and use among American adults: Intersections with alcohol consumption, 2002-2018.

Addict Behav 2021 05 7;116:106818. Epub 2021 Jan 7.

Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea; School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States.

Purpose: The present study aims to examine trends in cannabis views and use among US adults who are alcohol abstainers, non-binge drinkers, and binge drinkers.

Methods: We used data from the 2002-2018 National Survey on Drug Use and Health (US adults ages 18 and older, n = 664,152). Consistent with the Centers for Disease Control and Prevention guidelines, we conducted survey-adjusted logistic regression analyses to examine the significance of survey year in relation to cannabis views/use while controlling for demographic factors.

Results: Between 2002 and 2018, the proportion of adults reporting strong disapproval of cannabis use initiation decreased significantly (AOR = 0.947, CI = 0.945-948). While the prevalence of cannabis use increased significantly for non-binge (AOR = 1.070, CI = 1.065-1.076) and binge drinkers (AOR = 1.039, CI = 1.035-1.042), the trend increase was greatest among abstainers (OR = 1.099, CI = 1.088-1.111). The association between disapproval and cannabis use did not change between 2003 and 2018 among alcohol abstainers, but weakened among both non-binge (2003-2006: AOR = 0.154, CI = 0.135-0.176; 2014-2018: AOR = 0.221, CI = 0.200-0.246) and binge drinkers (2003-2006: AOR = 0.297, CI = 0.275-0.321; 2014-2018: AOR = 0.361, CI = 0.333-0.391).

Conclusion: Cannabis disapproval has decreased and cannabis use increased among alcohol abstainers, non-binge drinkers, and binge drinkers between 2002 and 2018. The impact of cannabis disapproval on use attenuated during the study period among drinkers but not among abstainers, suggesting that the effect of anti-cannabis attitudes may be weakening among those most likely to use cannabis.
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http://dx.doi.org/10.1016/j.addbeh.2021.106818DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7887096PMC
May 2021

Incarcerated Women in Spain: The Salience of Traumatic Exposure.

J Interpers Violence 2021 Jan 12:886260520985483. Epub 2021 Jan 12.

Saint Louis University, Saint Louis, MO, USA.

Incarcerated women are at high risk of exposure to traumatic events with subsequent development of post-traumatic stress disorder (PTSD). The present study builds on prior research by adding new findings from Spain on the association between childhood and prison victimization, and negative emotional states with PTSD symptoms during incarceration among women. The study sample ( = 174) included female prison inmates enrolled from two prisons located in Southeast Spain. Participants completed self-report questionnaires including demographic and criminal variables, childhood and prison victimization (including emotional, physical and sexual victimization), negative emotional states (including depression, anxiety, and stress symptoms) and PTSD symptoms. Logistic regression analysis revealed that women screening positive for trauma had significantly greater odds for the assortment of childhood victimization, prison victimization (specifically physical victimization) and depression, anxiety, and stress. Current findings suggest a need to include these construct assessments in the screening and identification of PTSD among incarcerated women in Spain.
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http://dx.doi.org/10.1177/0886260520985483DOI Listing
January 2021

Traumatic Brain Injury and School Readiness Among Preschool-Aged Children in the United States.

Pediatr Neurol 2021 Mar 10;116:2-6. Epub 2020 Dec 10.

College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri.

Background: The aim of this study is to examine the association between traumatic brain injury (TBI) and school readiness using a nationally representative sample of preschool-aged children in the United States.

Methods: Using data on 15,402 preschool-aged children (ages three to five years) from the 2016 to 2018 cohorts of the National Survey of Children's Health, this study investigates the association between lifetime measure of TBI in children and four domains of school readiness: early learning skills, self-regulation, social-emotional development, and physical health/motor development.

Results: Among this sample of preschool-aged children, 252 (1.64%) had experienced a TBI during their lifetime. Within school readiness domains, TBI was associated with a 62% to 99% increase in the rate of needs support/at-risk items and a 129% to 322% increase in the rate of at-risk items, contingent on the exact domain examined. Additional analyses reveal that, net of covariates, TBI reduced the predicted probability of being on-track across all four domains from approximately 0.424 for children with no history of TBI to 0.224 for children with a history of TBI.

Conclusions: A history of TBI was associated with reductions in school readiness within and across domains. Facilitating better communication between parents, pediatricians, and schools about both TBI and responses to TBI may result in the implementation of services and individualized, tailored instructional approaches that can improve educational outcomes.
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http://dx.doi.org/10.1016/j.pediatrneurol.2020.11.016DOI Listing
March 2021

Adverse childhood experiences and traumatic brain injury among adolescents: findings from the 2016-2018 National Survey of Children's Health.

Eur Child Adolesc Psychiatry 2021 Jan 2. Epub 2021 Jan 2.

Department of Criminology and Criminal Justice, College for Health, Community, and Policy, The University of Texas At San Antonio, San Antonio, TX, USA.

Exposure to adverse childhood experiences (ACEs) is a significant public health issue for youth. However, traumatic brain injury (TBI) has been almost entirely overlooked in the ACEs and health outcomes literature, which has largely focused on the significant mental and behavioral health impact of ACEs. The goal the current study is to examine the association between ACEs and TBI among a nationally representative sample of adolescents in the United States and the extent to which ADHD and conduct problems inform this association. To assess this relationship, we use a sample of 42,204 adolescents (ages 12-17 years) in the United States whose caregivers were surveyed during the three most recent cohorts (2016-2018) of the National Survey of Children's Health (NSCH). The results revealed a dose-response relationship between ACEs and TBI, even after accounting for an array of confounding variables. Findings also indicated that associations were of a greater magnitude among youth who are not sports-involved. Supplemental mediation analyses showed that ADHD and conduct problems attenuated associations between ACE exposure and TBI, but only in the absence of youth sports involvement. Given that both ACEs and TBI carry long-term consequences for health and well-being, the findings from this study draw attention to the need for early intervention and prevention programming (e.g. home visiting) that can reduce the prevalence of ACEs and a history of TBI among adolescents.
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http://dx.doi.org/10.1007/s00787-020-01687-1DOI Listing
January 2021

Substance Misuse Profiles of Women in Families Receiving Temporary Assistance for Needy Families (TANF) Benefits: Findings from a National Sample.

J Stud Alcohol Drugs 2020 11;81(6):798-807

College of Social Work, The Ohio State University, Columbus, Ohio.

Objective: Women in families receiving Temporary Assistance for Needy Families (TANF) cash assistance are twice as likely to have a substance use disorder (SUD) than their non-TANF counterparts in the past year. However, evidence is limited about substance misuse patterns and comorbid mental health problems among women in TANF families.

Method: Data from the 2015-2018 National Survey on Drug Use and Health were used to examine the prevalence of substance misuse and use disorders among women age 18 or older in TANF families. We used latent class analysis to identify subgroups of distinctive substance misuse behaviors and tested the associations between SUD/serious psychological distress (SPD) and the group classification.

Results: Despite higher odds of having an SUD in all substance categories than their non-TANF counterparts, more than 84% of the women in TANF families were considered to have low substance misuse risks. Of the three identified at-risk groups, the polysubstance and the prescription pain reliever and alcohol misuse groups reported higher risks of having an SUD and SPD than the low-risk group. Individuals at risk of marijuana and alcohol misuse, represented by young, Black mothers, reported the lowest rates of treatment receipt despite having past-year SUD, SPD, or both.

Conclusions: Although special attention needs to be paid to integrated care for those at risk of multiple substance misuse, additional efforts are required to increase substance abuse and mental health treatment among women at risk of marijuana and alcohol misuse.
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November 2020

Improvement in life expectancy for ischemic heart diseases by achieving daily ambient PM standards in China.

Environ Res 2021 02 23;193:110512. Epub 2020 Nov 23.

Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China. Electronic address:

Background: The potential impacts of daily ambient fine particulate pollution (PM) exposure on year of life lost (YLL) due to ischemic heart diseases (IHD) remain uncertain. We aimed to estimate the improvement in IHD-related life expectancy by attaining the daily air quality standards of ambient PM in China.

Methods And Results: This study was based on daily mortality data covering 96 Chinese cities from 2013 to 2016. Regional- and national-associations between IHD-related YLLs and daily PM were estimated by generalized additive models. We further evaluated the IHD-related avoidable YLLs with an assumption that the daily PM was below the ambient air quality standards of World Health Organization (WHO) and China, and calculated the improvement of life expectancy by dividing the avoidable YLLs by the overall number of IHD mortality. We totally recorded 1,485,140 IHD deaths from 2013 to 2016. At the national level, we found a positive association between IHD-related YLLs and daily PM. Per 10 μg/m increment of four-day averaged ambient PM related to an increase of 0.40 IHD-related YLLs (95% CI: 0.28, 0.51). By achieving the WHO's air quality guideline, we estimated that an averaged number of 1346.94 (95% CI: 932.61, 1761.27) YLLs can be avoided for the IHD deaths in each city. On average, the life expectancy can be improved by 0.15 years (95% CI: 0.11, 0.19) for each death.

Conclusions: Our study provides a nationwide picture of the life expectancy improvements by reaching the daily PM standards in China, indicating that people can live longer in an environment with higher air quality.
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http://dx.doi.org/10.1016/j.envres.2020.110512DOI Listing
February 2021

Adverse Childhood Experiences and School Readiness Among Preschool-Aged Children.

J Pediatr 2021 03 24;230:191-197.e5. Epub 2020 Nov 24.

College for Public Health and Social Justice, Saint Louis University, St. Louis, MO.

Objective: To examine the association between preschool-aged children's exposure to adverse childhood experiences (ACEs) and multiple, intersecting domains of school readiness using a nationally representative sample.

Study Design: A sample of 15 402 preschool-aged children (3-5 years) in the US from the 3 most recent cohorts (2016-2018) of the National Survey of Children's Health were employed. Primary caregivers were asked survey questions about the adversities experienced by focal children. Four distinct domains of school readiness among the children were also derived from the survey: early learning skills, self-regulation, social-emotional development, and physical health and motor development.

Results: Although nearly one-half of children who had not been exposed to ACEs were on-track across all domains, only 1 in 5 children exposed to 3 or more ACEs were on-track across all domains. Follow-up analyses identified parenting stress and reduced positive parenting practices as significant mediators of this association. Multivariate results also indicated that, regardless of the school readiness domain examined, an accumulation of ACEs increased the rate of items on which a child needs support or is at-risk.

Conclusions: An accumulation of ACEs among preschool-aged children elevates risk within and across school readiness domains. These findings highlight the urgent need to identify best practices to reduce ACE exposure, as well as improve school readiness during early childhood.
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http://dx.doi.org/10.1016/j.jpeds.2020.11.023DOI Listing
March 2021

PFAS exposure and overweight/obesity among children in a nationally representative sample.

Chemosphere 2021 Apr 3;268:128852. Epub 2020 Nov 3.

Department of Epidemiology and Biostatistics, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA. Electronic address:

Purpose: Perfluoroalkyl substances (PFASs) are a class of manmade chemicals commonly used in consumer product manufacturing. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are two of the most highly studied PFASs. Both are present in the blood of the most Americans. PFASs are associated with intermediate cardiovascular disease (CVD) outcomes, but their relationship with obesity, a risk factor for intermediate and advanced CVD, remains largely unconfirmed. In this context, we aimed to explore the relationship between PFASs and both overweight/obesity and abdominal obesity among children.

Methods: We examine associations between PFOA and PFOS levels, and Body Mass Index (BMI) and waist circumference (WC) in a representative sample (N = 2473) of US children, aged 12-18 years from the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey 1999-2012. Overweight/obesity is defined as age-, sex-specific BMI z-score ≥ 85th percentile; abdominal obesity is defined as age-, sex-specific waist circumference ≥90th percentile.

Results: Associations between PFASs and anthropometric outcomes show a dose-response relationship overall. For overweight/obese BMI z-score, findings indicate OR = 1.42 and 95% CI: 0.85-2.38 for quartile 2 of PFOA exposure; OR = 2.22 (95% CI: 1.20-4.13) for quartile 3 of PFOA exposure; and OR = 2.73 (95% CI:1.10-6.74) for quartile 4 of PFOA exposure.

Discussion: Findings indicate an association between elevated PFOA and overweight/obesity among children after multivariable adjustment.
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http://dx.doi.org/10.1016/j.chemosphere.2020.128852DOI Listing
April 2021

Prevalence and correlates of antisocial personality disorder in older adults.

Aging Ment Health 2020 Oct 27:1-10. Epub 2020 Oct 27.

School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.

Objectives: There is a paucity of research on antisocial personality disorder (ASPD) in the geriatric population and the majority of knowledge on the disorder is drawn from young adult samples. Researchers posit that the prevalence of ASPD as well as other personality disorders (PDs) is underestimated among older adults. Using a nationally representative sample, the present study examines the prevalence and correlates of ASPD in adults ages 50 and older.

Methods: We analyzed data from the National Epidemiologic Survey on Alcohol and Related Conditions Waves I and III. Multivariate logistic regression analyses were employed to investigate associations between ASPD and sociodemographic characteristics. A series of logistic regression analyses were also conducted to study associations between ASPD and medical conditions (liver and cardiovascular disease, arthritis, and stomach ulcer), major psychiatric disorders (lifetime major depressive disorder, mania, and generalized anxiety disorder), and substance use disorders (lifetime alcohol, marijuana, cocaine, heroin, and nicotine use disorders).

Results: Findings indicated that the prevalence of ASPD increases through early adulthood, with a peak at 3.91% in younger adults and decline to 0.78% in adults ages ≥65. Older adults with ASPD are more likely to be diagnosed with a substance use disorder, major depression, mania, and generalized anxiety disorder as well as each medical condition.

Conclusion: Older adults with ASPD experience increased rates of medical and psychiatric comorbidities. These conditions exacerbate the existing challenges associated with diagnosing and treating this population and may have serious consequences for the patient, their caregivers and society.
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http://dx.doi.org/10.1080/13607863.2020.1839867DOI Listing
October 2020

Trends and correlates of Internet support group participation for mental health problems in the United States, 2004-2018.

J Psychiatr Res 2021 01 16;132:136-143. Epub 2020 Oct 16.

School of Social Work, Boston College, Boston, MA, 02467, United States.

Purpose: This study sought to examine the trends in Internet support group (ISG) participation among U.S. adults and to investigate the sociodemographic and behavioral health profiles of ISG participants.

Methods: Data was derived from the National Survey on Drug Use and Health (2004-2018, n = 625,883). Logistic regression was used to examine significance of trend year and correlates of ISG participation. Latent class analysis was conducted to identify subtypes of ISG participants.

Results: The proportion of U.S. adults participating in ISG increased significantly from 2.29% (2004-2007) to 3.55% (2016-2018). ISG participants were less likely to be male, 35 or older, be part of an ethnic/racial minority group, or have household incomes between $20,000 and $49,999. Black/African American participants and those classified as "other" race showed the largest percent increases, while Hispanics showed no change. ISG participants were more likely to have experienced a depressive episode and to have used cannabis. Three subtypes of ISG participants were identified, including the Lower Behavioral Health Risk group (62%), the Elevated Behavioral Health Risk group (24%), and the Depression, Cigarettes, and Cannabis group (14%).

Conclusion: Overall, we found an increasing trend in seeking mental health care through ISG among US adults since the early 2000s. While disparities among some disadvantaged groups such as Blacks/African Americans and individuals with lower household income were diminishing, continuing efforts to engage men, older adults, and Hispanics in ISG are needed. This investigation also identified distinct subtypes of ISG participants and provides important implications for future research on ISG.
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http://dx.doi.org/10.1016/j.jpsychires.2020.10.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566800PMC
January 2021

Toward a Typology of Transnational Communication among Venezuelan Immigrant Youth: Implications for Behavioral Health.

J Immigr Minor Health 2020 Oct 8. Epub 2020 Oct 8.

Department of Public Health Sciences, Division of Prevention Science & Community Health, University of Miami, Miami, FL, USA.

We identify subtypes of Venezuelan youth based on patterns of technology-based communication with friends in their receiving (US) and sending (Venezuela) countries and, in turn, examine the behavioral health characteristics among different "subtypes" of youth. Using data from 402 recently-arrived Venezuelan immigrant youth (ages 10-17), latent profile analysis and multinomial regression are employed to examine the relationships between technology-based communication and key outcomes. We identified a four-class solution: [#1] "Daily Contact in US, In Touch with Venezuela" (32%), [#2] "Daily Communication in Both Countries" (19%), [#3] "Weekly Contact: More Voice/Text Than Social Media" (35%), and [#4] "Infrequent Communication with US and Venezuela" (14%). Compared to Class #1, youth in Classes #2 and #3 report elevated depressive symptomatology and more permissive substance use views. Findings suggest that how youth navigate and maintain transnational connections varies substantially, and that technology-based communication is related to key post-migration outcomes.
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http://dx.doi.org/10.1007/s10903-020-01099-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026776PMC
October 2020

Investigation of simple, objective, and effective indicators for predicting acute paraquat poisoning outcomes.

Toxicol Ind Health 2020 Jun;36(6):417-426

Guangzhou Twelfth People's Hospital, Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou Key Medical Disciplines and Specialties Program, Guangzhou Key Laboratories, Guangzhou, China.

Initial symptoms of paraquat (PQ) toxicity are often not obvious, and the lack of advanced testing equipment and medical conditions in the primary hospital make it difficult to provide early diagnosis and timely treatment. To explore simple, objective, and effective indicators of prognosis for primary clinicians, we retrospectively analyzed acute PQ poisoning in 190 patients admitted to our hospital from 2008 to 2017. Based on their condition at the time of discharge, patients were categorized into either the survival group ( = 71) or the mortality group ( = 119). Age, PQ ingested amount, urinary PQ, urinary protein, white blood cell (WBC), and serum creatinine (Cr) were the key factors associated with the prognosis for PQ poisoning. We identified specific diagnostic thresholds for these key indicators of PQ poisoning: PQ ingested amount (36.50 mL), urinary PQ (semiquantitative result "++"), urinary protein (semiquantitative result "±"), WBC (16.50 × 10/L), and serum Cr (102.10 µmol/L). Combining these five indicators to identify poisoning outcomes was considered objective, accurate, and convenient. When the combined score was <1, the predicted probability of patient death was 6%. When the combined score was ≥3, the predicted probability of patient death was 96%. These findings provide metrics to assist primary clinicians in predicting outcomes of acute PQ poisoning at earlier stages, a basis for administering treatment.
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http://dx.doi.org/10.1177/0748233720933522DOI Listing
June 2020

Criminal offending trajectories from adolescence through young adulthood and the risk of food insecurity: evidence from the Add Health study.

Ann Epidemiol 2020 10 8;50:20-26.e1. Epub 2020 Jun 8.

College of Medicine, Drexel University, Philadelphia, PA.

Purpose: High-rate, persistent criminal offending has substantial negative health consequences. This study examines how criminal offending trajectories during adolescence influence the risk of food insecurity in early adulthood.

Methods: The study uses four waves of the National Longitudinal Study of Adolescent to Adult Health to determine the association between criminal offending trajectory membership and food insecurity. The analysis controls for individual- and neighborhood-level risk factors and assesses the mediating effects of depression and household income.

Results: Five distinct offending trajectories were established using a group-based trajectory model. Membership in various offending trajectories predicts an increased risk for food insecurity. Those in high-rate, chronic-offending trajectories have the highest risk of food insecurity in early adulthood (OR = 2.062; P < .01). These effects are significantly attenuated by depressive symptoms.

Conclusions: This is the first study to test the association between criminal offending trajectory membership from adolescence through young adulthood and the risk of food insecurity in adulthood. Access to nutrition assistance and support among individuals with chronic-offending histories may minimize the risk of food insecurity. Those embedded in disadvantaged contexts are likely at a heightened risk. Improvements to mental health services and employment opportunities may reduce food insecurity among these vulnerable populations.
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http://dx.doi.org/10.1016/j.annepidem.2020.06.002DOI Listing
October 2020

Cultural Stress and Substance Use Risk among Venezuelan Migrant Youth in the United States.

Subst Use Misuse 2020 24;55(13):2175-2183. Epub 2020 Jul 24.

Raices Venezolanas, Doral, Florida, USA.

Background: Since 2015, more than four million Venezuelans have fled their once prosperous nation, prompting an ever-intensifying refugee crisis. Recent research with Venezuelan parents suggests that many are exposed to elevated migration-related stress, experience behavioral health problems, and express profound concern for their children's post-migration wellbeing. We examine the relationships between stress, family functioning, and substance use risk with a cultural stress theoretical lens. Survey data were collected between November 2018 and June 2019 from 402 recently-arrived Venezuelan immigrant youth ages 10-17. Outcomes include perceived discrimination, negative context of reception, family support/communication, and substance use intentions and normative beliefs. Structural equation modeling was used to examine the relationships between variables. : Structural equation modeling results indicated that negative context of reception was associated with permissive substance use norms ( family communication;  = 0.070,  < .01) and intentions to use ( family support;  = 0.051,  < .01). Discrimination was not mediated by family functioning, rather it exerted a direct effect on substance use norms ( = 0.20,  < .01) and intentions ( = 0.33,  < .001). : We see clear evidence that negative context of reception and discrimination are related to substance use risk, both directly (in the case of discrimination) and indirectly (in the case of negative context of reception). Given the manifold stressors faced by Venezuelan immigrants both prior to migration and in the process of resettling in the US, it is critical that practitioners and policymakers support this rapidly-growing population.
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http://dx.doi.org/10.1080/10826084.2020.1795684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487208PMC
July 2020

Cocaine use and overdose mortality in the United States: Evidence from two national data sources, 2002-2018.

Drug Alcohol Depend 2020 09 15;214:108148. Epub 2020 Jul 15.

School of Social Work, St. Louis University, 3550 Lindell Blvd., St. Louis, MO, 63103, USA; Graduate School of Social Welfare and College of Social Science, Yonsei University, Republic of Korea.

Background: Cocaine-involved overdose mortality has recently risen in the United States (US), yet it is unclear to what extent patterns in cocaine-involved overdose mortality parallel patterns in cocaine use. This study: examined time trends (2002-2018) in past-year cocaine use and cocaine-involved overdose mortality in the US; and compared demographics and drug involvement of adults who reported past-year cocaine use versus adults who died of a cocaine-involved overdose.

Methods: Data from two sources were utilized: (1) the National Survey on Drug Use and Health (n = 1,334 adults self-reporting cocaine use in 2018); and (2) the Multiple Cause of Death dataset of the National Center for Health Statistics (N = 14,630 adults who died of a cocaine-involved overdose in 2018). The study examined prevalence of past-year cocaine use, mortality rates for cocaine-involved overdose, 2002-2018 trends, demographic characteristics, and involvement of other drugs.

Results: Results of Joinpoint Regression indicated that the prevalence of past-year cocaine use increased after 2011, with an annual percent change of 5.13, while age-adjusted cocaine-involved overdose mortality rates escalated after 2012, with an annual percent change of 26.54. In 2018, prevalence of past-year cocaine use did not significantly differ (p = 0.09) by racial/ethnic group, yet Non-Hispanic Blacks had an age-adjusted cocaine-involved overdose mortality rate more than double the rate in Non-Hispanic Whites and significantly higher (p < 0.001) than in any other group.

Conclusions: While the prevalence of cocaine use has increased modestly, cocaine-involved overdose mortality has risen dramatically. Cocaine-involved overdose mortality is disproportionately affecting individuals who are Black, older, or with lower educational attainment.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423708PMC
September 2020

Food deserts and cardiovascular health among young adults.

Public Health Nutr 2021 01 9;24(1):117-124. Epub 2020 Jul 9.

School of Social Work, Saint Louis University, St. Louis, MO, USA.

Objective: This study assesses the association between living in a food desert and cardiovascular health risk among young adults in the USA, as well as evaluates whether personal and area socioeconomic status moderates this relationship.

Design: A cross-sectional analysis was performed using data from Wave I (1993-1994) and Wave IV (2008) from the National Longitudinal Study of Adolescent to Adult Health. Ordinary least squares regression models assessing the association between living in a food desert and cardiovascular health were performed. Mediation and moderation analyses assessed the degree to which this association was conditioned by area and personal socioeconomic status.

Setting: Sample of respondents living in urban census tracts in the USA in 2008.

Participants: Young adults (n 8896) aged 24-34 years.

Results: Net of covariates living in a food desert had a statistically significant association with cardiovascular health risk (range 0-14) (β = 0·048, P < 0·01). This association was partially mediated by area and personal socioeconomic status. Further analyses demonstrate that the adverse association between living in a food desert and cardiovascular health is concentrated among low socioeconomic status respondents.

Conclusions: The findings from this study suggest a complex interplay between food deserts and economic conditions for the cardiovascular health of young adults. Developing interventions that aim to improve health behaviour among lower-income populations may yield benefits for preventing the development of cardiovascular health problems.
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http://dx.doi.org/10.1017/S1368980020001536DOI Listing
January 2021

Health risk behavior and cultural stress among Venezuelan youth: a person centered approach.

Soc Psychiatry Psychiatr Epidemiol 2021 Feb 23;56(2):219-228. Epub 2020 Jun 23.

Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA.

Background: In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited.

Objectives: Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support).

Method: Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10-17; 56% male).

Results: We identified five subtype classes: (1) "Abstainer" (36%), (2) "Alcohol Only" (24%), (3) "Alcohol/Tobacco" (24%), (4) "Aggression" (8%), and (5) "Multidimensional Risk" (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US.

Conclusion: It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.
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http://dx.doi.org/10.1007/s00127-020-01905-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755753PMC
February 2021