Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. Design: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. Main Outcome Measures: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. Results: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate = 64%, control rate = 42%). Conclusion: The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting developmental outcomes at school entry using a multiple-risk model: Four American communities.

The contributions of different risk factors in predicting children's psychological and academic outcomes at the end of lst grade were examined. Using a regression model, levels of ecobehavioral risk were assessed in the following order: specific demographics, broad demographics, family psychosocial status, mother's depressive symptoms, and neighborhood quality. Participants were 337 families from 4 American communities. Predictor variables were assessed in kindergarten, and teacher, parent, and child outcomes (behavioral and academic) were assessed at the end of 1st grade. Results indicated that (a) each level of analysis contributed to prediction of most outcomes, (b) 18%–29% of the variance was predicted in outcomes, (c) a common set of predictors predicted numerous outcomes, (d) ethnicity showed little unique prediction, and (e) the quality of the neighborhood showed small but unique prediction to externalizing problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial maturity in the transition to adulthood for people with and without motor disabilities.

Objective: To identify individual, family, and community variables that contribute to psychosocial maturity in the transition to adulthood for people with and without motor disabilities (mean age = 25 years, range = 20 to 30). Participants/Design: Seventy-four people (34 men, 40 women) with developmental motor disabilities (cerebral palsy or spina bifida) and 72 people (31 men, 41 women) without motor disabilities from a Canadian province completed questionnaires and participated in a semi-structured interview. Results: In a heirarchical regression analysis, individual and family variables explained variance in psychosocial maturity for the total sample. More use of task-focused coping, lower levels of depression, and perceptions of fathers as autonomy fostering were associated with increased psychosocial maturity. These variables were also significant in a similar analysis for the group with motor disabilities with 1 addition; older age also was related to higher psychosocial maturity. Community variables did not explain variation in psychosocial maturity in either analysis. Conclusion: Knowledge about barriers to and facilitators of a successful transition to adulthood can be used to design services to maximize opportunities for young people with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Health-related quality of life measured by the SF12 in working populations: Associations with psychosocial work characteristics.

This study investigated the contribution of psychosocial work characteristics (decision latitude, job demand, social support at work, and effort-reward imbalance) to health-related quality of life. Data were derived from 2 aircraft manufacturing plants (N = 1,855) at the start of a longitudinal study. Regression analysis showed that work characteristics (1st model) explained 19% of the variance in the mental summary score of the Short Form-12 Health Survey. R2 change for work characteristics decreased to 13%, accounting for demographics, socioeconomic status, body mass index, and medical condition (5th model). Including health behavior and personality factors (full model), R2 change for work characteristics remained significant. Psychosocial work characteristics account for relevant proportions in the subjective perception of mental health beyond a wide array of medical variables and personality factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Socioeconomic position, health behaviors, and C-reactive protein: A moderated-mediation analysis.

Objective: We sought to understand the link between low socioeconomic position (SEP) and cardiovascular disease (CVD) by examining the association between SEP, health-related coping behaviors, and C-reactive protein (CRP), an inflammatory marker and independent risk factor for CVD, in a U.S. sample of adults. Design: We used a multiple mediation model to evaluate how these behaviors work in concert to influence CRP levels and whether these relationships were moderated by gender and race/ethnicity. Main outcome measures: CRP levels were divided into two categories: elevated CRP (3.1–10.0 mg/L) and normal CRP (≤3.0 mg/L). Results: Both poverty and low educational attainment were associated with elevated CRP, and these associations were primarily explained through higher levels of smoking and lower levels of exercise. In the education model, poor diet also emerged as a significant mediator. These behaviors accounted for 87.9% of the total effect of education on CRP and 55.8% the total effect of poverty on CRP. We also found significant moderation of these mediated effects by gender and race/ethnicity. Conclusion: These findings demonstrate the influence of socioeconomically patterned environmental constraints on individual-level health behaviors. Specifically, reducing socioeconomic inequalities may have positive effects on CVD disparities through reducing cigarette smoking and increasing vigorous exercise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence and risk factors for HBV infection among street youth in central Brazil

PURPOSE: A seroprevalence survey was carried out among 496 street adolescents from 9 to 20 years old in central Brazil to determine the prevalence of hepatitis B (HBV) markers, as well as to assess the role of potential risk factors. RESULTS: The findings reveal that 20.4% of the participants were homeless adolescents without family links, living and/or working on the streets. The age at first sexual intercourse was as low as 9 years old, and approximately 60% of this population had had at least one sexual relationship by the age of thirteen, indicating prepubertal initiation of sexual experiences among street adolescents. 13.5% were HBV marker-positive (anti-HBc) and 2.0% had antigenemia. Street-based youth had a higher HBV marker-positive rate when compared to home-based teens (OR = 4.1, 95% CI: 2.1-8.5) and, similarly, higher HBV prevalence was obtained for those reporting sexual activity versus the group without sexual activity (OR = 2.1, 95% CI: 1.1-3.9), even after adjusting for potential confounders. CONCLUSIONS: We have found that street youth, particularly street-based adolescents, should be considered at-risk group for hepatitis B infection in our region. These findings may be used as a baseline information for policy changes not only in hepatitis B prevention but also to reverse the scenario of adolescents sexual abuse.     

Personal, medical, and healthcare utilization among homeless veterans served by metropolitan and nonmetropolitan veteran facilities.

This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention and Health Promotion: Decades of Progress, New Challenges, and an Emerging Agenda.

Daily habits (e.g., smoking, diet, and exercise) and their immediate consequences (e.g., obesity) confer risk for most of the major health problems in industrialized nations. Hence, determinants of these behaviors and their modifications have been central topics in health psychology. Considerable scientific and applied progress has been made, but the field faces important challenges and opportunities in the future. These challenges and opportunities include changes in demographics and patterns of health, the need for a more comprehensive model of the domain of health behavior and prevention, the need to integrate behavioral and psychosocial risk and resilience, the incorporation of new technologies, and addressing a variety of professional and economic barriers to the implementation of prevention in health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical illness and symptoms of depression among elderly outpatients.

Elderly outpatients were assessed to clarify relations between symptoms of depression and physical illness, disability, pain, and selected psychosocial variables. Three types of assessments were made: (1) medical evaluations by physicians, (2) self-reported symptoms of depression and physical health, and (3) demographic and psychosocial data relating to participants' life circumstances. Both objective (physician-rated illness symptoms) and subjective (self-reported health, activity restriction, and use of pain medications) indicators of health accounted for independent variance in symptoms of depression. After controlling for these factors, additional variance was explained by health-related concerns (e.g., health care expenses, service needs), social support, and "other worries" (e.g., feeling useless, becoming a burden to others). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychosocial and situational variables on substance abuse among homeless adults.

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly

The psychosocial model of mental health posits that late-life depression arises from the loss of self-esteem, loss of meaningful roles, loss of significant others, and diminished social contacts. This study examined the unique, combined, and interactive contribution of existential variables (personal meaning, choice/responsibleness, optimism) and traditional measures (social resources, physical health) as predictors of depression in institutionalized and community-residing older adults, average age 77.8 years. Using multiple hierarchical regression, the results showed that choice/responsibleness, social resources, and physical health predicted depression in community elderly; personal meaning, optimism, social resources, and physical health predicted depression in institutionalized elderly. In both samples, the existential variables accounted for unique variance in depression over and above that accounted for by traditional measures. The important role of existential constructs in transcending personal and social losses and feelings of depression are discussed.     

Patterns of sedentary behavior among adolescents.

Objective: Reducing certain sedentary behaviors (e.g., watching television, using a computer) can be an effective weight loss strategy for youth. Knowledge about whether behaviors cluster together could inform interventions. Study Design: Estimates of time spent in 6 sedentary behaviors (watching television, talking on the telephone, using a computer, listening to music, doing homework, reading) were cluster analyzed for a sample of 878 adolescents (52% girls, mean age = 12.7 years, 58% Caucasian). Main Outcome Measures: The clusters were based on the sedentary behaviors listed above and compared on environmental variables (e.g., household rules), psychosocial variables (e.g., self-efficacy, enjoyment), and health behaviors (e.g., physical activity, diet). Results: Four clusters emerged: low sedentary, medium sedentary, selective high sedentary, and high sedentary. Analyses revealed significant cluster differences for gender (p     

Health-promoting behaviors of rural adolescent women

A part of a larger study of the health behaviors of adolescent women, this investigation examined health-promoting behaviors and the influence of cognitive, social, and environmental factors on these health-promoting behaviors of rural adolescent women. The sample consisted of 128 rural African-American and white adolescent women. Forty-four percent of the variance in health-promoting behavior of this sample was explained by five variables: self-image, problem solving, mother's education, employment status, and family structure. Self-image was the most salient predictor of health-promoting behavior, explaining 33% of the variance.     

Dodecylphosphocholine micelles as a membrane-like environment: new results from NMR relaxation and paramagnetic relaxation enhancement analysis

PURPOSE: To identify specific alcohol use beliefs and behaviors among local high school students; to determine whether relationships exist between alcohol use and various sociodemographic and lifestyle behaviors; and to assist in the development and implementation of alcohol abuse prevention programs. METHODS: This cross-sectional study involved the completion of a questionnaire by 1236 Grade 9-13 students (86% response rate) from 62 randomly selected classrooms in three Canadian urban schools. Data analyzed here are part of a larger lifestyle survey. RESULTS: A total of 24% of students reported never having tasted alcohol, 22% have tasted alcohol but do not currently drink, 39% are current moderate drinkers, 11% are current heavy drinkers (five or more drinks on one occasion at least once a month), and 5% did not answer. Reasons stated most often for not drinking were "bad for health" and "upbringing," while reasons stated most often for drinking were "enjoy it" and "to get in a party mood." Student drinking patterns were significantly related to gender, ethnicity, grade, and the reported drinking habits of parents and friends. Older male adolescents who describe their ethnicity as Canadian are at higher risk for heavy drinking than students who are younger or female, or identify their ethnicity as European or Asian. Current heavy drinkers are at higher risk than other students for engaging in other high-risk behaviors such as drinking and driving, being a passenger in a car when the driver is intoxicated, and daily smoking. CONCLUSIONS: Heavy alcohol use in adolescents remains an important community health concern. Older self-described Canadian and Canadian-born male adolescents are at higher risk for heavy drinking. Current and heavy drinking rises significantly between Grades 9 and 12. Students who drink heavily are more likely to drink and drive, to smoke daily, and to have friends and parents who drink alcohol.     

Should infection control practitioners do follow-up of staff exposures to patient blood and body fluids?

BACKGROUND: The purpose of this study was to determine the efficiency of a joint infection control/occupational health program for the follow-up of accidental blood or bloody body fluid exposures in health care workers. METHODS: A comprehensive staff follow-up program for all blood exposures with known patient sources was initiated in 1989, consisting of patient follow-up by the Infection Control Department (risk assessment for hepatitis B virus [HBV] and [HIV] infection and obtaining of consent for HIV testing) and staff follow-up by the Occupational Health Department. In 1992 a mailed survey was conducted to examine exposure follow-up policies and responsibilities in large teaching hospitals across Canada. RESULTS: A total of 924 blood exposures with known patient sources were reported between January 1989 and December 1993. HIV and HBV screening was obtained for 67.9% and 87.6% of patients assessed as at low risk and 82.3% and 92.2% of those assessed as at high risk for infection, respectively. Two previously unknown HIV-seropositive patients were identified, one of whom had been classified as at low risk (one of 530 [0.19%] patients at low risk who underwent screening). Primary reasons for screening being missed were patient discharge (46.3%) or communication problems (18.0%). The requirement for informed written consent before HIV screening accounted for the difference in completed HIV and HBV screens. Results of the hospital survey indicated that 40.8% of Canadian hospitals follow up all patients who are involved in blood exposures; however, most hospitals still rely on the physician to obtain consent (87.6%). CONCLUSIONS: Use of ICPs to screen patients involved in staff blood exposures during regular hours may be the most efficient method of follow-up, particularly if supplemented by a backup team of health professionals on nights and weekends. Although screening all patients for HBV/HIV may detect patients with undisclosed high-risk behaviors, institutions must decide whether the practice is cost-effective in areas of low prevalence.     

The performance of the Aedes aegypti eradication program in 2 towns of Ciudad de La Habana province, 1990-1992

BACKGROUND AND METHODS: The present study examined the ways in which demographic, psychosocial, and objective risk factors were related to perceived risk of skin cancer among 384 hospital employees who participated in a screening program. It was hypothesized that pyschosocial risk factors would account for a significant portion of the variance in risk perception beyond that accounted for by the other risk factors. RESULTS: The risk factors accounted for approximately 44% of the variance in risk perception. Psychosocial risk factors accounted for a statistically significant portion of the variance in risk perception beyond that accounted for by other risk factors. Worry, family history of skin cancer, and race/ethnicity were most strongly related to perceived risk. CONCLUSIONS: Results are discussed in terms of the need for educational programs that emphasize the relationship between level of risk and skin cancer and provide specific information regarding steps that can be taken to prevent skin cancer.     

Exposure to interparental violence in childhood and psychosocial adjustment in young adulthood

OBJECTIVE: To study the relationships between retrospective reports of exposure to interparental violence in childhood and rates of psychosocial adjustment problems in young adulthood in a birth cohort of New Zealand subjects. METHOD: Data were gathered during the course of an 18 year longitudinal study of a birth cohort of 1,265 New Zealand children. At age 18 retrospective reports of exposure to interparental violence were obtained. At this time the cohort was also assessed on measures of psychosocial adjustment including mental health problems, substance abuse behaviors, and criminal offending. RESULTS: Young people reporting high levels of exposure to interparental violence had elevated rates of adjustment problems at age 18. These problems included mental health problems, substance abuse behaviors and criminal offending. Analyses using multiple logistic regression showed that much of this elevated risk was explained by social and contextual factors associated with exposure to interparental violence. However, even after adjustment for confounding factors, exposure to father initiated violence was associated with increased risks of anxiety, conduct disorder and property crime, while exposure to mother initiated violence was associated only with increased risks of later alcohol abuse/dependence. CONCLUSION: Children exposed to high levels of interparental violence are an at risk population for psychosocial adjustment problems in young adulthood. Much of the elevated risk of these children arises from the social context within which interparental violence occurs. Nonetheless, exposure to interparental violence, and particularly father initiated violence, may be associated with later increased risks of anxiety, conduct disorder, problems with alcohol, and criminal offending.     

Hepatitis B injury, male gender, aflatoxin, and p53 expression each contribute to hepatocarcinogenesis in transgenic mice

The major risk factors for human liver cancer: hepatitis B virus (HBV) related liver injury, male gender, aflatoxin exposure, and p53 expression, are evaluated and compared in experimental transgenic mouse models. Transgenic mice that express hepatitis B surface antigen (HBsAg) in their liver and develop liver tumors at 18 months of age (HBV+ mice) were bred to p53 null mice (p53-/-) to produce mice p53+/-, HBV+ mice. These mice and control littermates ([p53+/+, HBV+], [p53+/-, HBV-], and [p53+/+, HBV-) were divided into groups that did or did not receive an injection of aflatoxin at 1 week of age. At sacrifice at 13 months of age, 100% (7/7) of male mice with each of the three risk factors (p53+/-, HBV+, AFB1+) developed high-grade hepatocellular carcinomas (HCC). If any one of the risk factors was absent, the incidence drops: if both p53 alleles are present, 62% (10/16); if HBsAg is not expressed, 14% (1/7); if AFB1 is not given, 25% (2/8). If only one of the risk factors is present no tumors above grade I are found. Similar results were observed in female mice except that HCC incidence in each group is less than in male mice. Some of the tumors in mice with more than one risk factor are of unusual histological types, such as hepatocholangio-carcinomas, adenocarcinomas and undifferentiated carcinomas that are not usually seen in HBV transgenic C57BL/6 mice. No loss or mutation of the p53 gene is detected in any of the tumors. Possibilities of how the four major risk factors for HCC interact to produce malignant liver tumors in these transgenic mouse models of hepatocarcinogenesis are discussed.     

Molecular epidemiology of HIV-1 infection in the Philippines, 1985 to 1997: transmission of subtypes B and E and potential emergence of subtypes C and F

OBJECTIVES: to identify the risk factors for hepatitis B (HBV) and hepatitis C (HCV) virus infections in drug users attending two drug treatment centres in Northwest England, and to evaluate the effect of both needle exchange and hepatitis B vaccination on the prevalence of hepatitis B and hepatitis C infections. METHODS: a retrospective, cross-sectional study performed at the Regional Infectious Disease Unit and a Primary Care Centre for drug users in Liverpool. The study population included 773 drug users who had hepatitis serology performed between January 1992 and April 1996. Information on risk factors was obtained from clinical records; hepatitis serology data were obtained from the Liverpool Public Health Laboratory database. RESULTS: the overall seroprevalences of exposure markers for HBV (anti-HBc antibody) and HCV (anti-HCV antibody) were 48% and 67%, respectively. Duration of injecting drug use was the strongest predictor of HCV infection, with a crude odds ratio of 8.9 (95% confidence interval (CI): 4.5-17) for >10 compared to <3 years of injecting, and was also a strong predictor of HBV infection, with an adjusted odds ratio (controlled for the effects of HBV vaccination) of 5.7 (95% CI: 3.2-10) for >10 compared to <3 years' injecting. Vaccination against HBV was associated with greatly reduced HBV seroprevalence (crude odds ratio 0.11, 95% CI: 0.06-0.18). Overall, HCV was acquired earlier in the injecting career than HBV, but drug users who were not vaccinated against HBV acquired markers for HBV even more rapidly than for HCV. We found no independent protective effect for either anti-HBc or anti-HCV acquisition after the introduction of a needle-exchange scheme. CONCLUSIONS: hepatitis C is highly prevalent among Merseyside drug users and is likely to prove difficult to control because of rapid acquisition early in the injecting career. Vaccination against hepatitis B is the best means of protecting drug users from hepatitis B, and should be offered before injecting is commenced.