Background: Nearly 50 million Americans provide informal care to an older relative or friend. Man... more Background: Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the "sandwich generation", providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors. Methods: We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity. Results: The association between informal caregiving and health varied by membership in the "sandwich generation," income, and race/ethnicity. This association was significant among subjects with one (OR = 1.13, 95% CI [1.04, 1.24]) and two or more children (OR = 1.17, 95% CI = 1.09, 1.26]), but not in those without children (OR = 1.01, 95% CI [0.97, 1.05]). Associations were strongest in those earning $50,000-$75,000 annually, but these income-dependent associations varied by race/ethnicity. In Whites with two or more children, the strongest associations between caregiving and health occurred in lower income individuals. These trends were not observed for Whites without children. Conclusions: Our findings suggest that the added burden of caregiving for both children and elderly relatives may be impacted by income and race/ethnicity. These differences should be considered when developing culturally appropriate interventions to improve caregiver health and maintain this vital component of the US health care system.
Men who have sex with men (MSM) continue to be disproportionately affected by HIV in the US. HIV ... more Men who have sex with men (MSM) continue to be disproportionately affected by HIV in the US. HIV among older adults also continues to be an important public health problem. Age is associated with disclosure of HIV serostatus and self-efficacy for condom use. However, studies examining self-efficacy and disclosure among older MSM (age 50 and older) living with HIV are lacking. The aim of this study was to assess the associations between being 50 and older, and disclosure behaviors, intentions and attitudes, and self-efficacy for condom use, disclosure, and negotiation for safer sex practices among HIV-positive MSM. Data were gathered from 340 participants at the baseline assessment of a longitudinal disclosure intervention study. Linear regression was used to determine the association between being older (age 50 and older) and disclosure behaviors, intentions and attitudes, and self-efficacy for condom use, disclosure, and negotiation for safer sex practices. After adjusting for time since diagnosis and number of sexual partners, MSM aged 50 and older scored lower in disclosure behavior (β = -7.49; 95% CI: -14.8, -0.18) and in self-efficacy for negotiation of safer sex practices (β = -0.80; 95% CI: -1.57, -0.04) compared to MSM 18-34 years. Intervention and prevention programs should endeavor to improve disclosure and self-efficacy for negotiating safer sex practices among older HIV-positive MSM. More health care providers should initiate sexual health discussions, especially among older HIV-positive MSM populations, which may help to improve their disclosure behavior and self-efficacy for negotiating safer sex practices.
BACKGROUND: Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. ... more BACKGROUND: Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. OBJECTIVE: This study examined the association between ACEs and cancer diagnosis. METHODS: Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey were used. The BRFSS is the largest ongoing telephone health survey, conducted in all US states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands, and provides data on a variety of health issues among the non-institutionalized adult population. Multivariable logistic regression models were used to provide adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between ACEs and cancer, adjusting for confounders such as age, gender, race/ethnicity, income, educational status, marital status, and insurance status. RESULTS: Respondents who reported 2 ACEs were 71% more likely to have a diagnosis of cancer compared to respondents who did not report ACEs (adjusted OR: 1.71; 95% CI: ...
Over 50 million informal caregivers provide care to an aging adult, saving the national economy h... more Over 50 million informal caregivers provide care to an aging adult, saving the national economy hundreds of billions of dollars annually from hospitalization or institutionalization. Informal caregiving often negatively impacts caregiver quality-of-life. Further, increased longevity and intergenerational age have induced an increase in “sandwiched” caregivers: those who provide care both to an aging relative and a child. However, how the established associations between caregiver intensity and burden differ by whether a caregiver also cares for a child is unknown. Using a new, comprehensive, nationally representative database of 1014 informal caregivers (National Study of Caregiving-NSOC), we used generalized linear models to assess the association between caregiver intensity and four domains of caregiver burden identified through factor analyses-social, financial, positive emotional, and negative emotional, stratified by presence or absence of a child at home. Social burden from ca...
Intimate partner violence (IPV) is defined as physical, sexual or psychological harm that can be ... more Intimate partner violence (IPV) is defined as physical, sexual or psychological harm that can be perpetrated by a former or current spouse. IPV has been linked to sexually transmitted infections and chronic diseases, and IPV victims tend to need more healthcare overall, compared to populations who are not victims of IPV. Research has shown that there is an important association between IPV exposure and HIV testing among Pacific Islanders. We sought to determine the extent to which IPV exposure is associated with screening behaviors including HIV, cholesterol levels, pap smear tests, and clinical breast exams among a more generalizable population. We used data from eight states that collected IPV information in the 2006 or 2007 Behavioral Risk Factor Surveillance System survey (n=44,720). Multivariable logistic regression models provided adjusted estimates of odds ratios (aOR) and 95% confidence intervals (CI). Twenty-two percent of women and 10.8% of men reported a history of IPV, w...
Introduction: There has been a rapid increase in immigration of Latino, Asian, and Caribbean popu... more Introduction: There has been a rapid increase in immigration of Latino, Asian, and Caribbean populations to the US in recent decades. However, little is known about the epidemiology of depression among these groups. Objective: To determine the association between time in the US and depression among racial/ethnic minority immigrants. Methods: Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between time in the US and suicidal behavior among racial/ethnic minority immigrant groups. Linear and non-linear trends in depression risk were assessed. Results: Among Latinos there was a positive association between time in the US and depression (Plinear trend = 0.010). Compared to individuals who had been in the US <5 years, those who have been here >20 years had 2.29 greater odds (95% CI: 1.10-4.76) of having major depressive disorder in the past 12 mont...
HIV continues to disproportionately affect men who have sex with men (MSM). Depression and substa... more HIV continues to disproportionately affect men who have sex with men (MSM). Depression and substance use have been shown to be risk factors of partner violence among male same-sex couples. However, research exploring the risk factors for partner violence victimization after HIV disclosure among MSM is limited. The aim of this study was to determine the association between depressive symptoms, substance use, and disclosure-associated verbal and/or physical violence from a partner among MSM. Data were obtained from 340 HIV-positive MSM. Multivariable logistic regression was used to determine the associations between Center for Epidemiologic Studies-Depression and substance use scores, and disclosure-associated partner violence. After adjusting for age and income, every one-unit increase in substance use scores resulted in a 9 % (OR 1.09; 95 % CI 1.01-1.16) increase in the odds of disclosure-associated partner violence. HIV disclosure interventions for MSM populations should address substance use and potential violence from partners after disclosure.
The Internet has now become a popular venue to meet sex partners. People who use the Internet to ... more The Internet has now become a popular venue to meet sex partners. People who use the Internet to meet sex partners may be at a higher risk for contracting HIV and STIs. This study examined the association between meeting sex partners from the Internet, and HIV testing, STI history, and risky sexual behavior. Data were obtained from the Virginia Department of Health STD Surveillance Network. Logistic regression models were used to obtain crude and adjusted odds ratios, and 95 % confidence intervals for the associations between meeting sex partners through the Internet and ever tested for HIV, HIV testing in the past 12 months, STI history, and risky sexual behavior. Logistic regression was also used to determine if gender and men who have sex with men interaction terms significantly improved the model. Women who met a sex partner from the Internet were more likely to have had an HIV test in the past 12 months than women who did not meet a partner in this way. On the other hand, men w...
Social psychiatry and psychiatric epidemiology, 2015
The immigration experience embodies a range of factors including different cultural norms and exp... more The immigration experience embodies a range of factors including different cultural norms and expectations, which may be particularly important for groups who become racial/ethnic minorities when they migrate to the U.S. However, little is known about the correlates of mental health indicators among these groups. The primary and secondary aims were to determine the association between duration of U.S. residence and suicidality, and 12-month mood, anxiety, and substance use disorders, respectively, among racial/ethnic minority immigrants. Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between duration of US residence, and suicidality and 12-month psychopathology. Among Afro-Caribbeans, there was a modest positive association between duration of U.S. residence and 12-month psychopathology (P linear trend = 0.016). Among Asians there was a modest posi...
Human immunodeficiency virus (HIV) is a preventable disease that can have improved outcomes with ... more Human immunodeficiency virus (HIV) is a preventable disease that can have improved outcomes with early diagnosis and treatment. The CDC recommends that HIV testing be incorporated into clinical settings as part of routine medical care. Individual, open-ended interviews were conducted with primary care providers and administrators to obtain their views regarding the meaning of routine HIV testing and the barriers and facilitators to implementing routine HIV testing in their respective practices. Most respondents supported routine HIV testing, although their definitions of routine varied. Barriers for providers included time and financial constraints to appropriately conduct HIV counseling and testing and inadequate HIV education and training. Facilitators for implementing routine HIV testing included patients' feelings of empowerment and reduced HIV stigma. The implementation of routine HIV testing in primary care practices appears to be an acceptable public health intervention. ...
Procedures to prepare cyclodextrins with carboxymethyl groups incorporated selectively at the pri... more Procedures to prepare cyclodextrins with carboxymethyl groups incorporated selectively at the primary (6-position) or secondary (2-position) are described. Complexation properties of the primary and secondary carboxymethylated derivatives of a-, b-, and ccyclodextrins are compared to native cyclodextrins and indiscriminately substituted carboxymethylated cyclodextrins, using pheniramine, chlorpheniramine, and brompheniramine as substrates. The stoichiometry of association of these substrates with the a-cyclodextrins is 1:1, whereas with the c-cyclodextrins, a 2:1 substrate:cyclodextrin complex forms. Data for the b-cyclodextrins suggest that there is a mix of 1:1 and 2:1 substrate-cyclodextrin complexes. The position of the carboxymethyl groups on the cyclodextrin does not appear to alter the geometry of substrate-cyclodextrin association. The effectiveness of the carboxymethylated cyclodextrins as chiral NMR discriminating agents is compared with the native cyclodextrins. In all cases, the indiscriminately substituted a-, b-, and c-cyclodextrins are more effective at enantiodistinction with the cationic substrates than native cyclodextrins or the derivatives with carboxymethyl groups at the primary or secondary positions. Among a-, b-, and c-indiscriminately substituted cyclodextrins, there was no clearly optimal candidate for chiral NMR discrimination studies. The indiscriminately substituted carboxymethyl cyclodextrins are effective water-soluble chiral NMR discrimination reagents for cationic substrates.
Background: Sexual debut before age 15 has been associated with increased sexual risk behaviors a... more Background: Sexual debut before age 15 has been associated with increased sexual risk behaviors among teens, but little is known about its affects beyond adolescence. This study examines the relationship between the age of first vaginal intercourse and subsequent contraceptive non-use. Methods: We identified 3,540 sexually active, fertile women participants of the National Survey on Family Growth (2006-2008). Women were classified as consistent contraceptive users or inconsistent/non-users. Age at first intercourse was determined by self-report and classified as <15, 15-17, and 18+ years. Logistic regression weighted for the complex sampling design provided estimates of the odds ratios (OR) and 95% confidence intervals (CI). Results: Twenty-three percent of women reported inconsistent or nonuse of contraceptives in the year prior to interview. After adjustment for respondent's highest level of education attained, relative to women who were 18 or older at first intercourse wom...
Background: Adverse childhood experiences (ACEs), including physical or sexual abuse, are major p... more Background: Adverse childhood experiences (ACEs), including physical or sexual abuse, are major problems in the US. A higher prevalence of ACEs are observed among sexual minorities compared to their heterosexual peers. ACEs have been linked to risky sexual behavior and sexual minorities have been identified to be “high-risk” for early sexual initiation. However, studies examining the relationship between ACEs and sexual debut among sexual minorities are scant. Objective: To determine the association between ACEs and age at sexual debut among sexual minorities. Methods: Data were obtained from the National Epidemiologic Survey on Alcohol Related Conditions (2004-2005) (N=577). Exploratory factor analysis (EFA) was used to determine ACE factors. Logistic regression was used to determine the association between ACEs and age at sexual debut (≤14, 15-17, ≥18 years) by sexual minority group. Results: EFA of ACEs indicated three factors: sexual abuse (SA), neglect/other abuse, and parental...
Abstract Background: Intimate partner violence (IPV) is defined as physical, sexual, or psycholog... more Abstract Background: Intimate partner violence (IPV) is defined as physical, sexual, or psychological harm that can be perpetrated by a former/current spouse. IPV has been linked to adverse health outcomes and risky behaviors, and victims of IPV tend to need more healthcare overall than nonvictims of IPV. The purpose of this study was to determine the association between IPV and preventive screening among women. Methods: The study used data from eight states/territories, which collected IPV information in the 2006 and 2007 Behavioral Risk Factor Surveillance System (n=30,182). IPV and preventive screening for HIV, cervical cancer, colorectal cancer, cholesterol, and breast cancer were determined by self-report. Multivariable logistic regression models provided adjusted estimates of odds ratios (aOR) and 95% confidence intervals (CI). Results: Approximately one in four women reported a history of lifetime IPV. Relative to those who did not report a history of IPV, IPV victims were tw...
Background Nearly 50 million Americans provide informal care to an older relative or friend. Many... more Background Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the sandwich generation, providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors. Methods We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity. Results The association between informal caregiving and health varied by membership in the sandwich generation, income, and race/ethnicity. This association was significant among subjects with one (OR = 1.13, 95% CI [1.04, 1.24]) and two or more children (OR = 1.17, 95% CI = 1.09, 1.26]),...
Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found... more Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and ...
Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is... more Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is an established association between many classes of psychotropic medications and fracture risk among older adults, and growing evidence that some classes of medications may also impact bone mineral density (BMD). In this paper we review recent epidemiologic research on the association between psychotropic medications and osteoporosis, and discuss current controversies and unresolved issues surrounding this relationship. Key areas in need of focused inquiry include resolving whether the apparent association between psychotropic medications and BMD is due to confounding by indication, whether this relationship differs for men and women, and whether the implications of these medications for bone health vary over the life course. Clinical research to delineate the risk/benefit ratio of psychotropic medications for older adults, particularly those who are at high risk for fracture, is also ne...
Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. This study e... more Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. This study examined the association between ACEs and cancer diagnosis. Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey were used. The BRFSS is the largest ongoing telephone health survey, conducted in all US states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands, and provides data on a variety of health issues among the non-institutionalized adult population. Principal component analysis (PCA) was used to derive components for ACEs. Multivariable logistic regression models were used to provide adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between ACE components and overall, childhood and adulthood cancer, adjusting for confounders such as age, gender, race/ethnicity, income, educational status, marital status, and insurance status. Approximately 62% of respondents reported being exposed to ACEs and about one in ten respondents reported ever having been diagnosed with cancer. Component 1, which had the sexual abuse variables with the highest weights, was significantly associated with adulthood cancer (adjusted OR: 1.21; 95% CI: 1.03-1.43). The association between ACEs and adulthood cancer may be attributable to disease progression through association of ACEs with risk factors for other chronic diseases. More research should focus on the impact of sexual abuse ACEs and adverse health outcomes.
Background: Nearly 50 million Americans provide informal care to an older relative or friend. Man... more Background: Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the "sandwich generation", providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors. Methods: We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity. Results: The association between informal caregiving and health varied by membership in the "sandwich generation," income, and race/ethnicity. This association was significant among subjects with one (OR = 1.13, 95% CI [1.04, 1.24]) and two or more children (OR = 1.17, 95% CI = 1.09, 1.26]), but not in those without children (OR = 1.01, 95% CI [0.97, 1.05]). Associations were strongest in those earning $50,000-$75,000 annually, but these income-dependent associations varied by race/ethnicity. In Whites with two or more children, the strongest associations between caregiving and health occurred in lower income individuals. These trends were not observed for Whites without children. Conclusions: Our findings suggest that the added burden of caregiving for both children and elderly relatives may be impacted by income and race/ethnicity. These differences should be considered when developing culturally appropriate interventions to improve caregiver health and maintain this vital component of the US health care system.
Men who have sex with men (MSM) continue to be disproportionately affected by HIV in the US. HIV ... more Men who have sex with men (MSM) continue to be disproportionately affected by HIV in the US. HIV among older adults also continues to be an important public health problem. Age is associated with disclosure of HIV serostatus and self-efficacy for condom use. However, studies examining self-efficacy and disclosure among older MSM (age 50 and older) living with HIV are lacking. The aim of this study was to assess the associations between being 50 and older, and disclosure behaviors, intentions and attitudes, and self-efficacy for condom use, disclosure, and negotiation for safer sex practices among HIV-positive MSM. Data were gathered from 340 participants at the baseline assessment of a longitudinal disclosure intervention study. Linear regression was used to determine the association between being older (age 50 and older) and disclosure behaviors, intentions and attitudes, and self-efficacy for condom use, disclosure, and negotiation for safer sex practices. After adjusting for time since diagnosis and number of sexual partners, MSM aged 50 and older scored lower in disclosure behavior (β = -7.49; 95% CI: -14.8, -0.18) and in self-efficacy for negotiation of safer sex practices (β = -0.80; 95% CI: -1.57, -0.04) compared to MSM 18-34 years. Intervention and prevention programs should endeavor to improve disclosure and self-efficacy for negotiating safer sex practices among older HIV-positive MSM. More health care providers should initiate sexual health discussions, especially among older HIV-positive MSM populations, which may help to improve their disclosure behavior and self-efficacy for negotiating safer sex practices.
BACKGROUND: Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. ... more BACKGROUND: Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. OBJECTIVE: This study examined the association between ACEs and cancer diagnosis. METHODS: Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey were used. The BRFSS is the largest ongoing telephone health survey, conducted in all US states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands, and provides data on a variety of health issues among the non-institutionalized adult population. Multivariable logistic regression models were used to provide adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between ACEs and cancer, adjusting for confounders such as age, gender, race/ethnicity, income, educational status, marital status, and insurance status. RESULTS: Respondents who reported 2 ACEs were 71% more likely to have a diagnosis of cancer compared to respondents who did not report ACEs (adjusted OR: 1.71; 95% CI: ...
Over 50 million informal caregivers provide care to an aging adult, saving the national economy h... more Over 50 million informal caregivers provide care to an aging adult, saving the national economy hundreds of billions of dollars annually from hospitalization or institutionalization. Informal caregiving often negatively impacts caregiver quality-of-life. Further, increased longevity and intergenerational age have induced an increase in “sandwiched” caregivers: those who provide care both to an aging relative and a child. However, how the established associations between caregiver intensity and burden differ by whether a caregiver also cares for a child is unknown. Using a new, comprehensive, nationally representative database of 1014 informal caregivers (National Study of Caregiving-NSOC), we used generalized linear models to assess the association between caregiver intensity and four domains of caregiver burden identified through factor analyses-social, financial, positive emotional, and negative emotional, stratified by presence or absence of a child at home. Social burden from ca...
Intimate partner violence (IPV) is defined as physical, sexual or psychological harm that can be ... more Intimate partner violence (IPV) is defined as physical, sexual or psychological harm that can be perpetrated by a former or current spouse. IPV has been linked to sexually transmitted infections and chronic diseases, and IPV victims tend to need more healthcare overall, compared to populations who are not victims of IPV. Research has shown that there is an important association between IPV exposure and HIV testing among Pacific Islanders. We sought to determine the extent to which IPV exposure is associated with screening behaviors including HIV, cholesterol levels, pap smear tests, and clinical breast exams among a more generalizable population. We used data from eight states that collected IPV information in the 2006 or 2007 Behavioral Risk Factor Surveillance System survey (n=44,720). Multivariable logistic regression models provided adjusted estimates of odds ratios (aOR) and 95% confidence intervals (CI). Twenty-two percent of women and 10.8% of men reported a history of IPV, w...
Introduction: There has been a rapid increase in immigration of Latino, Asian, and Caribbean popu... more Introduction: There has been a rapid increase in immigration of Latino, Asian, and Caribbean populations to the US in recent decades. However, little is known about the epidemiology of depression among these groups. Objective: To determine the association between time in the US and depression among racial/ethnic minority immigrants. Methods: Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between time in the US and suicidal behavior among racial/ethnic minority immigrant groups. Linear and non-linear trends in depression risk were assessed. Results: Among Latinos there was a positive association between time in the US and depression (Plinear trend = 0.010). Compared to individuals who had been in the US <5 years, those who have been here >20 years had 2.29 greater odds (95% CI: 1.10-4.76) of having major depressive disorder in the past 12 mont...
HIV continues to disproportionately affect men who have sex with men (MSM). Depression and substa... more HIV continues to disproportionately affect men who have sex with men (MSM). Depression and substance use have been shown to be risk factors of partner violence among male same-sex couples. However, research exploring the risk factors for partner violence victimization after HIV disclosure among MSM is limited. The aim of this study was to determine the association between depressive symptoms, substance use, and disclosure-associated verbal and/or physical violence from a partner among MSM. Data were obtained from 340 HIV-positive MSM. Multivariable logistic regression was used to determine the associations between Center for Epidemiologic Studies-Depression and substance use scores, and disclosure-associated partner violence. After adjusting for age and income, every one-unit increase in substance use scores resulted in a 9 % (OR 1.09; 95 % CI 1.01-1.16) increase in the odds of disclosure-associated partner violence. HIV disclosure interventions for MSM populations should address substance use and potential violence from partners after disclosure.
The Internet has now become a popular venue to meet sex partners. People who use the Internet to ... more The Internet has now become a popular venue to meet sex partners. People who use the Internet to meet sex partners may be at a higher risk for contracting HIV and STIs. This study examined the association between meeting sex partners from the Internet, and HIV testing, STI history, and risky sexual behavior. Data were obtained from the Virginia Department of Health STD Surveillance Network. Logistic regression models were used to obtain crude and adjusted odds ratios, and 95 % confidence intervals for the associations between meeting sex partners through the Internet and ever tested for HIV, HIV testing in the past 12 months, STI history, and risky sexual behavior. Logistic regression was also used to determine if gender and men who have sex with men interaction terms significantly improved the model. Women who met a sex partner from the Internet were more likely to have had an HIV test in the past 12 months than women who did not meet a partner in this way. On the other hand, men w...
Social psychiatry and psychiatric epidemiology, 2015
The immigration experience embodies a range of factors including different cultural norms and exp... more The immigration experience embodies a range of factors including different cultural norms and expectations, which may be particularly important for groups who become racial/ethnic minorities when they migrate to the U.S. However, little is known about the correlates of mental health indicators among these groups. The primary and secondary aims were to determine the association between duration of U.S. residence and suicidality, and 12-month mood, anxiety, and substance use disorders, respectively, among racial/ethnic minority immigrants. Data were obtained from the National Survey of American Life and the National Latino and Asian American Survey. Multivariable logistic regression was used to determine the association between duration of US residence, and suicidality and 12-month psychopathology. Among Afro-Caribbeans, there was a modest positive association between duration of U.S. residence and 12-month psychopathology (P linear trend = 0.016). Among Asians there was a modest posi...
Human immunodeficiency virus (HIV) is a preventable disease that can have improved outcomes with ... more Human immunodeficiency virus (HIV) is a preventable disease that can have improved outcomes with early diagnosis and treatment. The CDC recommends that HIV testing be incorporated into clinical settings as part of routine medical care. Individual, open-ended interviews were conducted with primary care providers and administrators to obtain their views regarding the meaning of routine HIV testing and the barriers and facilitators to implementing routine HIV testing in their respective practices. Most respondents supported routine HIV testing, although their definitions of routine varied. Barriers for providers included time and financial constraints to appropriately conduct HIV counseling and testing and inadequate HIV education and training. Facilitators for implementing routine HIV testing included patients' feelings of empowerment and reduced HIV stigma. The implementation of routine HIV testing in primary care practices appears to be an acceptable public health intervention. ...
Procedures to prepare cyclodextrins with carboxymethyl groups incorporated selectively at the pri... more Procedures to prepare cyclodextrins with carboxymethyl groups incorporated selectively at the primary (6-position) or secondary (2-position) are described. Complexation properties of the primary and secondary carboxymethylated derivatives of a-, b-, and ccyclodextrins are compared to native cyclodextrins and indiscriminately substituted carboxymethylated cyclodextrins, using pheniramine, chlorpheniramine, and brompheniramine as substrates. The stoichiometry of association of these substrates with the a-cyclodextrins is 1:1, whereas with the c-cyclodextrins, a 2:1 substrate:cyclodextrin complex forms. Data for the b-cyclodextrins suggest that there is a mix of 1:1 and 2:1 substrate-cyclodextrin complexes. The position of the carboxymethyl groups on the cyclodextrin does not appear to alter the geometry of substrate-cyclodextrin association. The effectiveness of the carboxymethylated cyclodextrins as chiral NMR discriminating agents is compared with the native cyclodextrins. In all cases, the indiscriminately substituted a-, b-, and c-cyclodextrins are more effective at enantiodistinction with the cationic substrates than native cyclodextrins or the derivatives with carboxymethyl groups at the primary or secondary positions. Among a-, b-, and c-indiscriminately substituted cyclodextrins, there was no clearly optimal candidate for chiral NMR discrimination studies. The indiscriminately substituted carboxymethyl cyclodextrins are effective water-soluble chiral NMR discrimination reagents for cationic substrates.
Background: Sexual debut before age 15 has been associated with increased sexual risk behaviors a... more Background: Sexual debut before age 15 has been associated with increased sexual risk behaviors among teens, but little is known about its affects beyond adolescence. This study examines the relationship between the age of first vaginal intercourse and subsequent contraceptive non-use. Methods: We identified 3,540 sexually active, fertile women participants of the National Survey on Family Growth (2006-2008). Women were classified as consistent contraceptive users or inconsistent/non-users. Age at first intercourse was determined by self-report and classified as <15, 15-17, and 18+ years. Logistic regression weighted for the complex sampling design provided estimates of the odds ratios (OR) and 95% confidence intervals (CI). Results: Twenty-three percent of women reported inconsistent or nonuse of contraceptives in the year prior to interview. After adjustment for respondent's highest level of education attained, relative to women who were 18 or older at first intercourse wom...
Background: Adverse childhood experiences (ACEs), including physical or sexual abuse, are major p... more Background: Adverse childhood experiences (ACEs), including physical or sexual abuse, are major problems in the US. A higher prevalence of ACEs are observed among sexual minorities compared to their heterosexual peers. ACEs have been linked to risky sexual behavior and sexual minorities have been identified to be “high-risk” for early sexual initiation. However, studies examining the relationship between ACEs and sexual debut among sexual minorities are scant. Objective: To determine the association between ACEs and age at sexual debut among sexual minorities. Methods: Data were obtained from the National Epidemiologic Survey on Alcohol Related Conditions (2004-2005) (N=577). Exploratory factor analysis (EFA) was used to determine ACE factors. Logistic regression was used to determine the association between ACEs and age at sexual debut (≤14, 15-17, ≥18 years) by sexual minority group. Results: EFA of ACEs indicated three factors: sexual abuse (SA), neglect/other abuse, and parental...
Abstract Background: Intimate partner violence (IPV) is defined as physical, sexual, or psycholog... more Abstract Background: Intimate partner violence (IPV) is defined as physical, sexual, or psychological harm that can be perpetrated by a former/current spouse. IPV has been linked to adverse health outcomes and risky behaviors, and victims of IPV tend to need more healthcare overall than nonvictims of IPV. The purpose of this study was to determine the association between IPV and preventive screening among women. Methods: The study used data from eight states/territories, which collected IPV information in the 2006 and 2007 Behavioral Risk Factor Surveillance System (n=30,182). IPV and preventive screening for HIV, cervical cancer, colorectal cancer, cholesterol, and breast cancer were determined by self-report. Multivariable logistic regression models provided adjusted estimates of odds ratios (aOR) and 95% confidence intervals (CI). Results: Approximately one in four women reported a history of lifetime IPV. Relative to those who did not report a history of IPV, IPV victims were tw...
Background Nearly 50 million Americans provide informal care to an older relative or friend. Many... more Background Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the sandwich generation, providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors. Methods We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity. Results The association between informal caregiving and health varied by membership in the sandwich generation, income, and race/ethnicity. This association was significant among subjects with one (OR = 1.13, 95% CI [1.04, 1.24]) and two or more children (OR = 1.17, 95% CI = 1.09, 1.26]),...
Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found... more Adverse childhood experiences (ACEs) have been linked to early sexual debut, which has been found to be associated with multiple adverse health outcomes. Sexual minorities and men tend to have earlier sexual debut compared to heterosexual populations and women, respectively. However, studies examining the association between ACEs and early sexual debut among men and sexual minorities are lacking. The aim of this study was to examine the sex and sexual orientation disparities in the association between ACEs and age at sexual debut. Data were obtained from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to obtain crude and adjusted estimates and 95% confidence intervals adjusting for age, race/ethnicity, income, education, insurance and marital status for the association between ACEs (neglect, physical/psychological abuse, sexual abuse, parental violence, and parental incarceration and psychopathology) and ...
Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is... more Psychotropic drugs are a crucial element of treatment for psychiatric disorders; however there is an established association between many classes of psychotropic medications and fracture risk among older adults, and growing evidence that some classes of medications may also impact bone mineral density (BMD). In this paper we review recent epidemiologic research on the association between psychotropic medications and osteoporosis, and discuss current controversies and unresolved issues surrounding this relationship. Key areas in need of focused inquiry include resolving whether the apparent association between psychotropic medications and BMD is due to confounding by indication, whether this relationship differs for men and women, and whether the implications of these medications for bone health vary over the life course. Clinical research to delineate the risk/benefit ratio of psychotropic medications for older adults, particularly those who are at high risk for fracture, is also ne...
Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. This study e... more Adverse childhood experiences (ACEs) are linked to multiple adverse health outcomes. This study examined the association between ACEs and cancer diagnosis. Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) survey were used. The BRFSS is the largest ongoing telephone health survey, conducted in all US states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands, and provides data on a variety of health issues among the non-institutionalized adult population. Principal component analysis (PCA) was used to derive components for ACEs. Multivariable logistic regression models were used to provide adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between ACE components and overall, childhood and adulthood cancer, adjusting for confounders such as age, gender, race/ethnicity, income, educational status, marital status, and insurance status. Approximately 62% of respondents reported being exposed to ACEs and about one in ten respondents reported ever having been diagnosed with cancer. Component 1, which had the sexual abuse variables with the highest weights, was significantly associated with adulthood cancer (adjusted OR: 1.21; 95% CI: 1.03-1.43). The association between ACEs and adulthood cancer may be attributable to disease progression through association of ACEs with risk factors for other chronic diseases. More research should focus on the impact of sexual abuse ACEs and adverse health outcomes.
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Papers by Monique Brown