This course will examine the challenges and methods in the implementation of health disparities r... more This course will examine the challenges and methods in the implementation of health disparities research and interventions. It is intended to both complement and expand the knowledge gained in other BCHS courses by focusing specifically on minority/underserved populations. The course will explore readings and foster discussions that will include: ethics and research in minority/underserved communities; issues, barriers and facilitators to engaging minority/underserved communities in health research; examining basic research questions in minority health; understanding the application of research findings to program development; how to integrate theory and research, and issues and challenges of program implementation. An overarching goal is to increase awareness and knowledge of research on minority health, as well as unique issues to consider when engaging in public health research and practice in these communities. The purpose of this class is to introduce basic issues, challenges, and opportunities that are encountered in health disparities research and interventions. Current research and resources from minority health and health disparities literature will provide the background for student assignments.
Objective-To understand how affect for characterizing flavors influences little cigar and cigaril... more Objective-To understand how affect for characterizing flavors influences little cigar and cigarillo (LCC) smoking uptake behaviors among young adults. Methods-A convenience sample of multi-ethnic young adults (N = 90; mean age = 25.1 years; 53.1% male; 47.4% African-American, 35.5% white, 17.1% Hispanic) who were dual (LCC+ cigarette) and cigarette-only smokers participated in 12 focus groups and a semi-structured interview in the southeastern United States. Results-Though they self-identified at enrollment as dual or cigarette-only smokers, 64.4% reported LCC-only smoking, 27.8% dual smoking, and 7.8% cigarette-only smoking. Participants acknowledged that the flavored tobacco made smoking LCCs more palatable, and it enhanced their moods. The variety of available sweet and fruit flavored LCCs and the visual, smell, and taste cues from the LCC packaging influenced the young adults' affect, their susceptibility to and initiation of LCC smoking, and their switch from cigarettes to flavored LCC smoking. Conclusions-Characterizing flavored tobacco in LCCs contributed to young adults' susceptibility and initiation of use. The FDA is proposing to deem LCCs under its authority. Once these products are deemed, our results suggest that the FDA make a product standard restricting characterizing flavors in LCCs.
Annales africaines de chirurgie thoracique et cardio-vasculaire, Aug 31, 2021
Major socioeconomic disparities persist in the management and outcomes of peripheral artery disea... more Major socioeconomic disparities persist in the management and outcomes of peripheral artery disease (PAD) globally. Allostatic load, which is described as a measure of physiologic adaptation to socioenvironmental stress, has been reported to partially explain higher mortality rates in US Blacks. However, it is not clear if allostatic load is associated with PAD severity. The National Health and Nutrition Examination Survey (NHANES), 2003-2004 data was used to identify individuals with PAD based on the calculated Ankle-Brachial Index (ABI). After allostatic load was calculated for each individual, the cohort was stratified into tertiles of allostatic load and survey weights were used to generate nationally representative estimates. Factors associated with increased severity of PAD were evaluated using multivariate regression analyses. There were 5589 individuals included in the survey and 239 (5.9%) had PAD (ABI ≤ 0.9). Using survey weights, this corresponded to 5.9 million individuals. Individuals with PAD were more likely in the highest tertile of allostatic load (71%) compared to the middle (28%) or lowest (6%) tertiles. However, when severity of PAD was examined, the odds of moderate-to-severe PAD were not significantly different among individuals in the middle [adjusted Odds Ratio: 2.02 (0.52-7.80)] or highest [adjusted Odds Ratio: 2.53 (0.69-9.26)] tertiles compared to those in the lowest tertile. This study suggests that PAD severity is not associated with allostatic load. Increased efforts are necessary to identify factors that explain the socioeconomic disparities observed in the management and treatment of PAD.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 4, 2013
ABSTRACT The well-documented underrepresentation of racial and ethnic minority populations in pub... more ABSTRACT The well-documented underrepresentation of racial and ethnic minority populations in public health and biomedical research demands action. Racial and ethnic diversity in research is an essential strategy in the campaign to eliminate health disparities to achieve health equity. However, the ever-growing field of health disparities research lacks scientific consensus about how best to respectfully engage minority populations into research. We conducted in-depth, semi-structured, telephone interviews with accomplished investigators (N=31), experienced in the recruitment and retention of minority populations. We used a novel data analysis technique, Co-Analysis, with a qualitative research consulting company. The method promotes shared decision-making between two entities examining one dataset. As a result, six core modules (Data Inventory, Written Reflection, Reflective Diagrams, Categorization, Bridging, and Data Presentation) were employed in this multidimensional qualitative analysis plan. Respondents reported that the racial and ethnic background of investigators was important, but alone, not a sufficient strategy to effectively engage minority community members in research studies. This presentation will highlight pertinent themes and subthemes from the investigators' perspective regarding challenges and approaches in the recruitment of underrepresented minority populations into research. For example, the nuanced role race and ethnicity play in the research recruitment process; critical factors associated with building authentic relationships with minority communities; and, the importance of self-reflection by investigators to effectively engage minority participants in research relationships. Lessons learned will be incorporated into a comprehensive curriculum designed to train investigators on best practices for the respectful and ethical recruitment of minority populations.
Objective Increased exposure to cigarette advertisements is associated with increases in adolesce... more Objective Increased exposure to cigarette advertisements is associated with increases in adolescent smoking but the reasons for this association are not known. This study evaluated whether the developmental maturity of the self-concept, operationalized as self-conflict, moderated smoking intentions following exposure to cigarette advertisements among adolescents who have never smoked. Methods Eighty-seven adolescents (ages 11-17): (a) completed measures of self-conflict; (b) were exposed to 30 contemporary cigarette advertisements; and (c) rated their intentions to smoke following exposure to each ad. Results Younger adolescents with higher numbers of self-conflicts who also said that cigarette advertising was relevant to them had stronger smoking intentions compared to younger adolescents with lower numbers of self-conflicts after exposure to cigarette advertising. Self-conflict did not play as strong a role with older adolescents. Conclusions Younger adolescents (i.e., middle school aged) who are having the most difficulty figuring out ''who they are'' are most susceptible to the effects of cigarette advertising.
Background-Little is known about how adolescents who smoke both cigarettes and cigar products obt... more Background-Little is known about how adolescents who smoke both cigarettes and cigar products obtain and use these products. This study sought to explore cigarette and cigar acquisition and situational use among high school smokers. Methods-Data are drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Analysis was limited to youth who smoke cigarettes as well as cigars, cigarillos, and little cigars (CCLC) in the past month (N=649). Consumption of both products was calculated and used to create four subtypes of users based on high or low use of each product (Dual High, Dual Low, High CCLC/Low Cigarette, and Low CCLC/High Cigarette users). Current users were asked to identify situations in which they use cigarettes and CCLCs and ways in which they obtain these products. Data were analyzed overall and by user subtype. Results-Youth reported acquiring cigarettes and CCLC in similar ways, although youth were more likely to take cigarettes from family members than CCLC (11.1% vs. 4.8%). Several differences were observed between cigarettes and CCLC for situational use. While both products are frequently used in social situations (e.g., with friends), cigarettes were more likely to be used in solitary situations (e.g., before bed). Further, significant differences were observed among the four user subtypes.
Introduction Local governments are pursuing policies to limit the availability of menthol cigaret... more Introduction Local governments are pursuing policies to limit the availability of menthol cigarettes at the point-of-sale. Although African Americans are disproportionately impacted by menthol cigarettes, little is known about African American smokers’ perspectives on emerging menthol policy. The purpose of this study was to fill a gap in the literature by exploring African American adult (25+) smoker perspectives on menthol and a local menthol sales restriction. Methods In-depth semi-structured interviews were conducted with African American smokers (n = 27) in the Minneapolis–St. Paul area June–September 2017. Interviews explored smoking behaviors, harm perceptions, perspectives of menthol in the community and reactions to local menthol sales restrictions. The framework method guided identification of key themes and synthesis of findings. Results Almost all (96%) participants smoked Newport cigarettes. The majority of participants indicated that menthol cigarettes were more harmful than non-menthol cigarettes, citing strength and additives and because they were targeted to African Americans. Some participants were receptive to policy change while others viewed the policy as inconvenient and unfair. Overall, there was a lack of understanding of the policy’s intended public health impact. Some participants indicated that the policy would have no impact on their purchasing or smoking behaviors while others who were contemplating quitting noted that a menthol restriction was encouragement to prompt a quit attempt. Conclusions Sales restrictions can provide a unique opportunity to persuade menthol smokers to quit. Efforts are needed to increase awareness and support of these policies as well as to support African American menthol smokers achieve cessation. Implications There is growing momentum to restrict local menthol tobacco sales; however, little is known about perceptions among populations most impacted. In Minneapolis–St. Paul, where menthol restrictions were passed in 2017, African American smokers expressed limited awareness and uneven policy support. While some participants were unconvinced the restriction would impact smoking, others indicated it would encourage decreased consumption and prompt quit attempts. There is a need for public education to increase awareness of menthol’s harms, to help menthol smokers quit, and to increase support for menthol policies.
OBJECTIVE While it has been shown that patient socioeconomic status (SES) is associated with the ... more OBJECTIVE While it has been shown that patient socioeconomic status (SES) is associated with the surgical treatments chosen for severe peripheral arterial disease (PAD), the association between SES and outcomes of arterial reconstruction have not been well studied. The objective of this study was to determine if SES is associated with outcomes following lower extremity arterial reconstruction. METHODS Patients 40 years and older who had surgical revascularization for severe lower extremity PAD were identified in the Nationwide Readmissions Database, 2010 - 2014. Measures of SES including median household income (MHI) quartiles of patients' residential ZIP codes were extracted. Factors associated with repeat revascularization, subsequent major amputations, hospital mortality and 30-day all-cause readmission were evaluated using multivariable regression analyses. RESULTS Of the 131,529 patients identified, majority (61%) were male and the average age was 69 years. On unadjusted analyses, subsequent amputations were higher among patients in the lowest MHI quartile compared to patients in the highest MHI quartile (13% vs. 10%, Overall P <0.001). On multivariable analyses, compared to patients in the lowest quartile, those in the highest quartile had lower amputation [adjusted Odds Ratio (aOR): 0.70, 95% Confidence Interval (CI): 0.63 - 0.77] (Overall P <0.001) and readmission (aOR: 0.91, 95% CI: 0.84 - 0.99) (Overall P = 0.028) rates. However, subsequent revascularization (aOR: 1.04, 95% CI: 0.94 - 1.15) and mortality (aOR: 1.01, 95% CI: 0.79 - 1.28) rates were not different across the groups. CONCLUSION Lower SES is associated with disproportionally worse outcomes following lower extremity arterial reconstruction for severe PAD. These data suggest that improving outcomes of lower extremity arterial reconstruction may involve addressing socioeconomic disparities.
Introduction Tobacco use among young people is a complex and serious global dilemma that demands ... more Introduction Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology. Methods Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research. Results We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs. Conclusions The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.
Introduction-Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been in... more Introduction-Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them. Methods-Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014. Results-Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only. Conclusions-These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.
Journal of the National Medical Association, Sep 1, 2010
Objectives-Utilization of health care services and participation in medical research are 2 distin... more Objectives-Utilization of health care services and participation in medical research are 2 distinct yet closely related areas. The goal of this study was to investigate the similarities and differences in factors that are associated with health care service utilization and future participation in medical research, and the influence of race and social support. Method-We used data from the Greater Pittsburgh Randomized Household Health Survey, which consisted of a weighted sample of 741 white and 277 black respondents from Allegheny County, Pennsylvania. Results-Logistic regression analyses revealed that utilization of health care services was associated with being younger (OR, 0.98; p < .001), being female (OR, 1.55; p < .05), high selfrated health (OR poor health, 2.29; OR average health, 2.18; p < .001; both in comparison to high self-rated health group) and high perceived quality of health care (OR poor quality, 3.63; OR average quality, 1.79; p < .001; both in comparison to high perceived quality group), while future participation in medical research was associated with greater awareness of the Tuskegee Syphilis Study (none OR, 0.07; p < .01; only a little OR, 0.13; p < .01), more favorable opinions toward medical research (unfavorable OR; p < .001; neutral OR, 0.35; p < .05), and increased research incentives (free medical care OR, 1.27; p < .05; free transportation OR, 1.29; p < .05; money OR, 1.25; p < .05; free medication OR, 1.50; p < .001). Conclusions-While utilization of health care services and willingness to participate in future research are related, the factors associated with each vary greatly. Implications for health research and policy are discussed.
BACKGROUND: Substance use is prevalent and is associated with academic performance among adolesce... more BACKGROUND: Substance use is prevalent and is associated with academic performance among adolescents. Few studies have examined the association between abstinence from all substances and academic achievement. METHODS: Data from a nationally representative sample of 9,578 twelfth graders from the 2015 Monitoring the Future survey were analyzed to examine relationships between abstinence from substance use and four academic variables: skipping school, grades, academic self-efficacy, and emotional academic engagement. Participants were categorized as lifetime non-users, former users, and past-year users based on the use of 14 substances. RESULTS: Approximately one-quarter of participants had never used cigarettes, alcohol, or other drugs during their lifetime, and 8% wt used at least one substance during their lifetime but not during the past year. Adjusting for demographic variables, past-year substance users had 2.71 greater odds of skipping school during the past month than lifetime non-users and 1.74 greater odds of having low grades. Lifetime non-users reported greater academic self-efficacy and emotional academic engagement than past-year users. CONCLUSIONS: Many twelfth graders have abstained from all substance use during their lifetime, and these adolescents experience better academic outcomes than their substance-using Human Subjects Approval Statement Monitoring the Future is approved by the University of Michigan Institutional Review Board (IRB). The IRB at the University of Maryland determined that this secondary data analysis was exempt from IRB review.
Increased exposure to cigarette advertisements is associated with increases in adolescent smoking... more Increased exposure to cigarette advertisements is associated with increases in adolescent smoking but the reasons for this association are not well established. This study evaluated whether self-concept development (operationalized as level of self-conflict) and identifying with the models used in cigarette print advertising contributed to smoking intentions among adolescents. Ninety-five adolescents (ages 11-17) participated in this two session study. In session 1, they rated the extent to which they identified with the models used in 10 current cigarette print ads (the models were isolated digitally from the cigarette advertisements) and their level of self-conflict was assessed. In session 2, participants viewed each of the 10 cigarette advertisements from which the models were drawn and rated their intentions to smoke following exposure to each ad. Model identification was associated with similar levels of post ad exposure smoking intentions for both younger and older adolescents when they also exhibited no self-conflict. A contrasting set of findings emerged for younger and older adolescents when they exhibited high levels of self-conflict: Young adolescents who strongly identified with the models used in cigarette advertisements had higher post ad exposure smoking intentions compared to younger adolescents who weakly identified with the models used in the advertisements; in contrast, older adolescents who weakly identified with the models used in cigarette advertisements had stronger post ad exposure smoking intentions compared to older adolescents who strongly identified with the models used in the advertisements. These results point to the importance of examining developmentally-relevant moderators for the effects of cigarette advertising exposure.
International Journal of Environmental Research and Public Health, Nov 18, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Although Hispanic women have the highest cervical cancer incidence rate, African Amer... more Background: Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women. Objective: The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years. Methods: Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years. Results: Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility. Conclusions: The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities.
Introduction: In 2016, the Food and Drug Administration announced that it would regulate little c... more Introduction: In 2016, the Food and Drug Administration announced that it would regulate little cigars and cigarillos (LCCs) and expressed concern about the concomitant use of combustible tobacco products. To understand LCC use among socially-disadvantaged cigarette smokers, we assessed (1) the prevalence of concomitant use of subtypes of LCCs: LCC-tobacco, LCC-blunt, and LCC-poly use, which includes use of both LCC-tobacco and LCC-blunt and (2) and its association with sociodemographic factors and substance use behaviors using race/ethnicity and gender stratified models. Methods: In 2015, a web-based survey was administered to a national probability sample of black/ African American, Hispanic/Latino, and white cigarette smokers aged 18-44 (n = 1018). Weighted estimates were used to assess current LCC-tobacco, LCC-blunt, and LCC-poly use. Multinomial regression models assessed sociodemographic, other tobacco and substance use correlates associated with LCC user subtypes. Results: Of cigarette smokers, 63% did not smoke LCCs; 15.1% were LCC-tobacco users; 11.1% were LCC-blunt users; and 10.5% were LCC-poly users. Black/African American and Hispanic/Latino cigarette smokers had higher odds of LCC-tobacco, LCC-blunt, and LCC-poly use compared to white cigarette smokers. Blacks/African Americans who initiated cigarette smoking before age 18 and smoked other tobacco products had greater odds of LCC-tobacco use than whites. Male cigarette smokers who smoked other tobacco products and females who had early onset of cigarette use also had greater odds of LCC-tobacco use. Conclusions: Over 30% of cigarette smokers concomitantly used LCCs, which may prolong smoking. Accurate estimates of diverse LCC use behaviors may increase our understanding of the potential harms of concomitant use. Implications: Aggregate measures of LCC smoking do not distinguish subtypes of use among sociallydisadvantaged cigarette smokers (ie, young adults, blacks/African Americans, Hispanics/Latinos), who may engage in these unique smoking behaviors. We document the prevalence of young adult cigarette smokers who dual use LCC-tobacco and LCC-blunts and are poly users of LCC-tobacco + LCC-blunts, and identify sociodemographic groups at risk for use. The Food and Drug Administration is concerned about concomitant behavior, which may increase chronic disease risk and addiction. Accurate estimates of LCC smoking behaviors may increase our understanding of the harms of concomitant use; which can inform prevention programs that specifically target LCC subtypes.
This course will examine the challenges and methods in the implementation of health disparities r... more This course will examine the challenges and methods in the implementation of health disparities research and interventions. It is intended to both complement and expand the knowledge gained in other BCHS courses by focusing specifically on minority/underserved populations. The course will explore readings and foster discussions that will include: ethics and research in minority/underserved communities; issues, barriers and facilitators to engaging minority/underserved communities in health research; examining basic research questions in minority health; understanding the application of research findings to program development; how to integrate theory and research, and issues and challenges of program implementation. An overarching goal is to increase awareness and knowledge of research on minority health, as well as unique issues to consider when engaging in public health research and practice in these communities. The purpose of this class is to introduce basic issues, challenges, and opportunities that are encountered in health disparities research and interventions. Current research and resources from minority health and health disparities literature will provide the background for student assignments.
Objective-To understand how affect for characterizing flavors influences little cigar and cigaril... more Objective-To understand how affect for characterizing flavors influences little cigar and cigarillo (LCC) smoking uptake behaviors among young adults. Methods-A convenience sample of multi-ethnic young adults (N = 90; mean age = 25.1 years; 53.1% male; 47.4% African-American, 35.5% white, 17.1% Hispanic) who were dual (LCC+ cigarette) and cigarette-only smokers participated in 12 focus groups and a semi-structured interview in the southeastern United States. Results-Though they self-identified at enrollment as dual or cigarette-only smokers, 64.4% reported LCC-only smoking, 27.8% dual smoking, and 7.8% cigarette-only smoking. Participants acknowledged that the flavored tobacco made smoking LCCs more palatable, and it enhanced their moods. The variety of available sweet and fruit flavored LCCs and the visual, smell, and taste cues from the LCC packaging influenced the young adults' affect, their susceptibility to and initiation of LCC smoking, and their switch from cigarettes to flavored LCC smoking. Conclusions-Characterizing flavored tobacco in LCCs contributed to young adults' susceptibility and initiation of use. The FDA is proposing to deem LCCs under its authority. Once these products are deemed, our results suggest that the FDA make a product standard restricting characterizing flavors in LCCs.
Annales africaines de chirurgie thoracique et cardio-vasculaire, Aug 31, 2021
Major socioeconomic disparities persist in the management and outcomes of peripheral artery disea... more Major socioeconomic disparities persist in the management and outcomes of peripheral artery disease (PAD) globally. Allostatic load, which is described as a measure of physiologic adaptation to socioenvironmental stress, has been reported to partially explain higher mortality rates in US Blacks. However, it is not clear if allostatic load is associated with PAD severity. The National Health and Nutrition Examination Survey (NHANES), 2003-2004 data was used to identify individuals with PAD based on the calculated Ankle-Brachial Index (ABI). After allostatic load was calculated for each individual, the cohort was stratified into tertiles of allostatic load and survey weights were used to generate nationally representative estimates. Factors associated with increased severity of PAD were evaluated using multivariate regression analyses. There were 5589 individuals included in the survey and 239 (5.9%) had PAD (ABI ≤ 0.9). Using survey weights, this corresponded to 5.9 million individuals. Individuals with PAD were more likely in the highest tertile of allostatic load (71%) compared to the middle (28%) or lowest (6%) tertiles. However, when severity of PAD was examined, the odds of moderate-to-severe PAD were not significantly different among individuals in the middle [adjusted Odds Ratio: 2.02 (0.52-7.80)] or highest [adjusted Odds Ratio: 2.53 (0.69-9.26)] tertiles compared to those in the lowest tertile. This study suggests that PAD severity is not associated with allostatic load. Increased efforts are necessary to identify factors that explain the socioeconomic disparities observed in the management and treatment of PAD.
141st APHA Annual Meeting and Exposition (November 2 - November 6, 2013), Nov 4, 2013
ABSTRACT The well-documented underrepresentation of racial and ethnic minority populations in pub... more ABSTRACT The well-documented underrepresentation of racial and ethnic minority populations in public health and biomedical research demands action. Racial and ethnic diversity in research is an essential strategy in the campaign to eliminate health disparities to achieve health equity. However, the ever-growing field of health disparities research lacks scientific consensus about how best to respectfully engage minority populations into research. We conducted in-depth, semi-structured, telephone interviews with accomplished investigators (N=31), experienced in the recruitment and retention of minority populations. We used a novel data analysis technique, Co-Analysis, with a qualitative research consulting company. The method promotes shared decision-making between two entities examining one dataset. As a result, six core modules (Data Inventory, Written Reflection, Reflective Diagrams, Categorization, Bridging, and Data Presentation) were employed in this multidimensional qualitative analysis plan. Respondents reported that the racial and ethnic background of investigators was important, but alone, not a sufficient strategy to effectively engage minority community members in research studies. This presentation will highlight pertinent themes and subthemes from the investigators&#39; perspective regarding challenges and approaches in the recruitment of underrepresented minority populations into research. For example, the nuanced role race and ethnicity play in the research recruitment process; critical factors associated with building authentic relationships with minority communities; and, the importance of self-reflection by investigators to effectively engage minority participants in research relationships. Lessons learned will be incorporated into a comprehensive curriculum designed to train investigators on best practices for the respectful and ethical recruitment of minority populations.
Objective Increased exposure to cigarette advertisements is associated with increases in adolesce... more Objective Increased exposure to cigarette advertisements is associated with increases in adolescent smoking but the reasons for this association are not known. This study evaluated whether the developmental maturity of the self-concept, operationalized as self-conflict, moderated smoking intentions following exposure to cigarette advertisements among adolescents who have never smoked. Methods Eighty-seven adolescents (ages 11-17): (a) completed measures of self-conflict; (b) were exposed to 30 contemporary cigarette advertisements; and (c) rated their intentions to smoke following exposure to each ad. Results Younger adolescents with higher numbers of self-conflicts who also said that cigarette advertising was relevant to them had stronger smoking intentions compared to younger adolescents with lower numbers of self-conflicts after exposure to cigarette advertising. Self-conflict did not play as strong a role with older adolescents. Conclusions Younger adolescents (i.e., middle school aged) who are having the most difficulty figuring out ''who they are'' are most susceptible to the effects of cigarette advertising.
Background-Little is known about how adolescents who smoke both cigarettes and cigar products obt... more Background-Little is known about how adolescents who smoke both cigarettes and cigar products obtain and use these products. This study sought to explore cigarette and cigar acquisition and situational use among high school smokers. Methods-Data are drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Analysis was limited to youth who smoke cigarettes as well as cigars, cigarillos, and little cigars (CCLC) in the past month (N=649). Consumption of both products was calculated and used to create four subtypes of users based on high or low use of each product (Dual High, Dual Low, High CCLC/Low Cigarette, and Low CCLC/High Cigarette users). Current users were asked to identify situations in which they use cigarettes and CCLCs and ways in which they obtain these products. Data were analyzed overall and by user subtype. Results-Youth reported acquiring cigarettes and CCLC in similar ways, although youth were more likely to take cigarettes from family members than CCLC (11.1% vs. 4.8%). Several differences were observed between cigarettes and CCLC for situational use. While both products are frequently used in social situations (e.g., with friends), cigarettes were more likely to be used in solitary situations (e.g., before bed). Further, significant differences were observed among the four user subtypes.
Introduction Local governments are pursuing policies to limit the availability of menthol cigaret... more Introduction Local governments are pursuing policies to limit the availability of menthol cigarettes at the point-of-sale. Although African Americans are disproportionately impacted by menthol cigarettes, little is known about African American smokers’ perspectives on emerging menthol policy. The purpose of this study was to fill a gap in the literature by exploring African American adult (25+) smoker perspectives on menthol and a local menthol sales restriction. Methods In-depth semi-structured interviews were conducted with African American smokers (n = 27) in the Minneapolis–St. Paul area June–September 2017. Interviews explored smoking behaviors, harm perceptions, perspectives of menthol in the community and reactions to local menthol sales restrictions. The framework method guided identification of key themes and synthesis of findings. Results Almost all (96%) participants smoked Newport cigarettes. The majority of participants indicated that menthol cigarettes were more harmful than non-menthol cigarettes, citing strength and additives and because they were targeted to African Americans. Some participants were receptive to policy change while others viewed the policy as inconvenient and unfair. Overall, there was a lack of understanding of the policy’s intended public health impact. Some participants indicated that the policy would have no impact on their purchasing or smoking behaviors while others who were contemplating quitting noted that a menthol restriction was encouragement to prompt a quit attempt. Conclusions Sales restrictions can provide a unique opportunity to persuade menthol smokers to quit. Efforts are needed to increase awareness and support of these policies as well as to support African American menthol smokers achieve cessation. Implications There is growing momentum to restrict local menthol tobacco sales; however, little is known about perceptions among populations most impacted. In Minneapolis–St. Paul, where menthol restrictions were passed in 2017, African American smokers expressed limited awareness and uneven policy support. While some participants were unconvinced the restriction would impact smoking, others indicated it would encourage decreased consumption and prompt quit attempts. There is a need for public education to increase awareness of menthol’s harms, to help menthol smokers quit, and to increase support for menthol policies.
OBJECTIVE While it has been shown that patient socioeconomic status (SES) is associated with the ... more OBJECTIVE While it has been shown that patient socioeconomic status (SES) is associated with the surgical treatments chosen for severe peripheral arterial disease (PAD), the association between SES and outcomes of arterial reconstruction have not been well studied. The objective of this study was to determine if SES is associated with outcomes following lower extremity arterial reconstruction. METHODS Patients 40 years and older who had surgical revascularization for severe lower extremity PAD were identified in the Nationwide Readmissions Database, 2010 - 2014. Measures of SES including median household income (MHI) quartiles of patients' residential ZIP codes were extracted. Factors associated with repeat revascularization, subsequent major amputations, hospital mortality and 30-day all-cause readmission were evaluated using multivariable regression analyses. RESULTS Of the 131,529 patients identified, majority (61%) were male and the average age was 69 years. On unadjusted analyses, subsequent amputations were higher among patients in the lowest MHI quartile compared to patients in the highest MHI quartile (13% vs. 10%, Overall P <0.001). On multivariable analyses, compared to patients in the lowest quartile, those in the highest quartile had lower amputation [adjusted Odds Ratio (aOR): 0.70, 95% Confidence Interval (CI): 0.63 - 0.77] (Overall P <0.001) and readmission (aOR: 0.91, 95% CI: 0.84 - 0.99) (Overall P = 0.028) rates. However, subsequent revascularization (aOR: 1.04, 95% CI: 0.94 - 1.15) and mortality (aOR: 1.01, 95% CI: 0.79 - 1.28) rates were not different across the groups. CONCLUSION Lower SES is associated with disproportionally worse outcomes following lower extremity arterial reconstruction for severe PAD. These data suggest that improving outcomes of lower extremity arterial reconstruction may involve addressing socioeconomic disparities.
Introduction Tobacco use among young people is a complex and serious global dilemma that demands ... more Introduction Tobacco use among young people is a complex and serious global dilemma that demands innovative and diverse research approaches. The purpose of this methodological review was to examine the current use of mixed methods research in tobacco control with youth and young adult populations and to develop practical recommendations for tobacco control researchers interested in this methodology. Methods Using PubMed, we searched five peer-reviewed journals that publish tobacco control empirical literature for the use of mixed methods research to study young populations, age 12-25 years. Our team analyzed the features of each article in terms of tobacco control topic, population, youth engagement strategies, and several essential elements of mixed methods research. Results We identified 23 mixed methods studies published by authors from five different countries reported between 2004 and 2015. These 23 articles examined various topics that included tobacco use behavior, tobacco marketing and branding, and cessation among youth and young adults. The most common mixed methods approach was variations of the concurrent design in which the qualitative and quantitative strands were administered at the same time and given equal priority. This review documented several innovative applications of mixed methods research as well as challenges in the reporting of the complex research designs. Conclusions The use of mixed methods research in tobacco control has great potential for advancing the understanding of complex behavioral and sociocultural issues for all groups, especially youth and young adults.
Introduction-Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been in... more Introduction-Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them. Methods-Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014. Results-Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only. Conclusions-These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.
Journal of the National Medical Association, Sep 1, 2010
Objectives-Utilization of health care services and participation in medical research are 2 distin... more Objectives-Utilization of health care services and participation in medical research are 2 distinct yet closely related areas. The goal of this study was to investigate the similarities and differences in factors that are associated with health care service utilization and future participation in medical research, and the influence of race and social support. Method-We used data from the Greater Pittsburgh Randomized Household Health Survey, which consisted of a weighted sample of 741 white and 277 black respondents from Allegheny County, Pennsylvania. Results-Logistic regression analyses revealed that utilization of health care services was associated with being younger (OR, 0.98; p < .001), being female (OR, 1.55; p < .05), high selfrated health (OR poor health, 2.29; OR average health, 2.18; p < .001; both in comparison to high self-rated health group) and high perceived quality of health care (OR poor quality, 3.63; OR average quality, 1.79; p < .001; both in comparison to high perceived quality group), while future participation in medical research was associated with greater awareness of the Tuskegee Syphilis Study (none OR, 0.07; p < .01; only a little OR, 0.13; p < .01), more favorable opinions toward medical research (unfavorable OR; p < .001; neutral OR, 0.35; p < .05), and increased research incentives (free medical care OR, 1.27; p < .05; free transportation OR, 1.29; p < .05; money OR, 1.25; p < .05; free medication OR, 1.50; p < .001). Conclusions-While utilization of health care services and willingness to participate in future research are related, the factors associated with each vary greatly. Implications for health research and policy are discussed.
BACKGROUND: Substance use is prevalent and is associated with academic performance among adolesce... more BACKGROUND: Substance use is prevalent and is associated with academic performance among adolescents. Few studies have examined the association between abstinence from all substances and academic achievement. METHODS: Data from a nationally representative sample of 9,578 twelfth graders from the 2015 Monitoring the Future survey were analyzed to examine relationships between abstinence from substance use and four academic variables: skipping school, grades, academic self-efficacy, and emotional academic engagement. Participants were categorized as lifetime non-users, former users, and past-year users based on the use of 14 substances. RESULTS: Approximately one-quarter of participants had never used cigarettes, alcohol, or other drugs during their lifetime, and 8% wt used at least one substance during their lifetime but not during the past year. Adjusting for demographic variables, past-year substance users had 2.71 greater odds of skipping school during the past month than lifetime non-users and 1.74 greater odds of having low grades. Lifetime non-users reported greater academic self-efficacy and emotional academic engagement than past-year users. CONCLUSIONS: Many twelfth graders have abstained from all substance use during their lifetime, and these adolescents experience better academic outcomes than their substance-using Human Subjects Approval Statement Monitoring the Future is approved by the University of Michigan Institutional Review Board (IRB). The IRB at the University of Maryland determined that this secondary data analysis was exempt from IRB review.
Increased exposure to cigarette advertisements is associated with increases in adolescent smoking... more Increased exposure to cigarette advertisements is associated with increases in adolescent smoking but the reasons for this association are not well established. This study evaluated whether self-concept development (operationalized as level of self-conflict) and identifying with the models used in cigarette print advertising contributed to smoking intentions among adolescents. Ninety-five adolescents (ages 11-17) participated in this two session study. In session 1, they rated the extent to which they identified with the models used in 10 current cigarette print ads (the models were isolated digitally from the cigarette advertisements) and their level of self-conflict was assessed. In session 2, participants viewed each of the 10 cigarette advertisements from which the models were drawn and rated their intentions to smoke following exposure to each ad. Model identification was associated with similar levels of post ad exposure smoking intentions for both younger and older adolescents when they also exhibited no self-conflict. A contrasting set of findings emerged for younger and older adolescents when they exhibited high levels of self-conflict: Young adolescents who strongly identified with the models used in cigarette advertisements had higher post ad exposure smoking intentions compared to younger adolescents who weakly identified with the models used in the advertisements; in contrast, older adolescents who weakly identified with the models used in cigarette advertisements had stronger post ad exposure smoking intentions compared to older adolescents who strongly identified with the models used in the advertisements. These results point to the importance of examining developmentally-relevant moderators for the effects of cigarette advertising exposure.
International Journal of Environmental Research and Public Health, Nov 18, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Background: Although Hispanic women have the highest cervical cancer incidence rate, African Amer... more Background: Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women. Objective: The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years. Methods: Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years. Results: Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility. Conclusions: The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities.
Introduction: In 2016, the Food and Drug Administration announced that it would regulate little c... more Introduction: In 2016, the Food and Drug Administration announced that it would regulate little cigars and cigarillos (LCCs) and expressed concern about the concomitant use of combustible tobacco products. To understand LCC use among socially-disadvantaged cigarette smokers, we assessed (1) the prevalence of concomitant use of subtypes of LCCs: LCC-tobacco, LCC-blunt, and LCC-poly use, which includes use of both LCC-tobacco and LCC-blunt and (2) and its association with sociodemographic factors and substance use behaviors using race/ethnicity and gender stratified models. Methods: In 2015, a web-based survey was administered to a national probability sample of black/ African American, Hispanic/Latino, and white cigarette smokers aged 18-44 (n = 1018). Weighted estimates were used to assess current LCC-tobacco, LCC-blunt, and LCC-poly use. Multinomial regression models assessed sociodemographic, other tobacco and substance use correlates associated with LCC user subtypes. Results: Of cigarette smokers, 63% did not smoke LCCs; 15.1% were LCC-tobacco users; 11.1% were LCC-blunt users; and 10.5% were LCC-poly users. Black/African American and Hispanic/Latino cigarette smokers had higher odds of LCC-tobacco, LCC-blunt, and LCC-poly use compared to white cigarette smokers. Blacks/African Americans who initiated cigarette smoking before age 18 and smoked other tobacco products had greater odds of LCC-tobacco use than whites. Male cigarette smokers who smoked other tobacco products and females who had early onset of cigarette use also had greater odds of LCC-tobacco use. Conclusions: Over 30% of cigarette smokers concomitantly used LCCs, which may prolong smoking. Accurate estimates of diverse LCC use behaviors may increase our understanding of the potential harms of concomitant use. Implications: Aggregate measures of LCC smoking do not distinguish subtypes of use among sociallydisadvantaged cigarette smokers (ie, young adults, blacks/African Americans, Hispanics/Latinos), who may engage in these unique smoking behaviors. We document the prevalence of young adult cigarette smokers who dual use LCC-tobacco and LCC-blunts and are poly users of LCC-tobacco + LCC-blunts, and identify sociodemographic groups at risk for use. The Food and Drug Administration is concerned about concomitant behavior, which may increase chronic disease risk and addiction. Accurate estimates of LCC smoking behaviors may increase our understanding of the harms of concomitant use; which can inform prevention programs that specifically target LCC subtypes.
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