Search

Few studies have compared cardiovascular disease (CVD) risk factors in sexual minority and heterosexual adults. It remains unclear whether changes in sexual identity over time are associated with increased CVD risk. The purposes of this longitudinal study were to (a) compare sex differences in CVD risk factors across sexual identity subgroups, (b) examine CVD risk factors based on changes in sexual identity, and (c) examine sex-stratified variations in CVD risk factors. Analyses of the Population Assessment of Tobacco and Health study data assessed the longitudinal association of changes in sexual identity with self-reported CVD risk factors (alcohol misuse, cigarette smoking, sedentary behavior, high cholesterol, high blood pressure, and obesity). Based on changes in sexual identity between baseline/wave 1 and wave 5, 91.7% (n = 15,884) of the sample were heterosexual-stable, 1.1% (n = 265) were gay/lesbian-stable, and 0.8% (n = 265) were bisexual-stable. Less than 2% (1.5%; n = 376) indicated one heterosexual (sexual majority)-to-sexual minority change, 1.4% (n = 299) reported one sexual minority-to-heterosexual change, 0.7% (n = 202) reported one or more sexual minority-to-sexual minority changes, 1.4% (n = 345) reported heterosexual-to-sexual minority-to-heterosexual change, and 1.3% (n = 365) indicated two or more changes with no distinct pattern. Among women, having two or more changes in sexual identity without a distinct pattern was associated with increased odds of alcohol misuse in the past 30 days compared with heterosexual stable women. Associations between changes in sexual identity and alcohol misuse among women suggest the need for greater screening among healthcare providers who work with this population. [ABSTRACT FROM AUTHOR]

Objective: Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants). Methods: National longitudinal multicohort panels (baseline cohort years 2005–2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19–24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM. Results: Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood. Conclusions: Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM. [ABSTRACT FROM AUTHOR]

Background: Many national studies fail to account for discordance between sexual orientation dimensions (e.g. a mismatch between sexual identity and sexual attraction) or sexual identity fluidity (e.g. changes in sexual identity over time). Objective: To examine the longitudinal relationships among sexual identity fluidity/stability, sexual orientation discordance/concordance, and alcohol and other drug use disorder symptoms. Methods: The study used nationally representative longitudinal data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health (PATH) study of US adolescents and adults (N = 24,591). Results: Substance use disorder symptoms were most prevalent (45.8%) among bisexual-stable females relative to all other sexual identity subgroups. The adjusted odds ratios (AORs) of substance use disorder symptoms were significantly higher among bisexual-stable females vs. heterosexual-stable females in all models (AOR range: 1.94–2.32), while no such associations were found for males. Sexual identity-attraction discordant females had significantly greater AORs (17/20 instances) of substance use disorder symptoms compared to concordant females; this finding was not as consistent for males (6/20 instances). Conclusion: Sexual orientation discordance was significantly associated with substance use disorder symptoms, especially among females discordant in their sexual identity and attraction. Bisexual-stable and discordant females are at highest risk of developing symptomatic substance use; it is vital that they receive screening, no matter where they are in their coming out process. This study highlights pitfalls of relying solely on cross-sectional data using a single sexual orientation dimension to understand the relationship between sexual orientation and substance use disorder. [ABSTRACT FROM AUTHOR]

Background: To assess whether age of onset and duration of stimulant therapy for attention‐deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription stimulant misuse during adolescence. Methods: Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self‐administered questionnaires from 16 annual surveys (2005–2020). Results: An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past‐year prescription stimulant misuse (10.4%)—past‐year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non‐ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past‐year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past‐year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past‐year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non‐stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years). Conclusions: An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse. [ABSTRACT FROM AUTHOR]

More than 100 symptoms have been reported for post-coronavirus disease 2019 (COVID-19) and this study aimed to organize self-reported symptoms by identifying symptom clusters. We used a cross-sectional survey with a convenience sample of 491 adults who reported experiencing prolonged symptoms of COVID. A list of 25 symptoms of post-COVID-19 was used to measure the symptoms, and exploratory factor analysis was undertaken to identify symptom clusters for people with symptoms lasting 5 to 8 weeks and 9 weeks or longer. Six symptom clusters were identified for each of the two groups, and five clusters were similar across both groups: respiratory, general viral, smell/taste, cognitive cardiac, and mental health. The >9-week group reported symptoms primarily from two factors: respiratory-muscular and mental health. Post-COVID-19 symptom clusters differ across timeframes. Symptom clusters were useful in establishing coherent patterns of multiple complex symptoms. [ABSTRACT FROM AUTHOR]

Background: Understanding the self-management practices of persistent symptoms of SARS-Cov-2 (COVID-19) is critical given the misinformation that has been presented about this disease in the U.S. The purpose of this descriptive study is to assess the self-management of persistent symptoms of COVID-19 with commonly used and misused substances (i.e., alcohol, marijuana and commonly prescribed medications) among adults in the U.S. Methods: The data for this study comes from a cross-sectional survey of U.S. adults that was designed to broadly assess symptom burden, persistent symptom patterns, self-efficacy for symptom management and self-management strategies among people who experienced persistent/Long COVID. Multiple logistic regression analyses were used to assess how symptom length of COVID-19 was associated with the use of several substances to manage these persistent symptoms. Results: The analysis found that adults who had COVID-19 symptoms that persisted for 13 weeks or longer had higher rates of using alcohol (27.3%), marijuana (30.9%) and prescription tranquilizers (21.4%) to manage these symptoms when compared to their adult peers who had COVID-19 symptoms persist for only 4 weeks or less. For instance, the odds of indicating the use of marijuana (AOR = 4.21 95% CI = 1.68,10.5) to manage COVID-19 related symptoms was roughly four times higher for respondents who had COVID-19 symptoms persist for 13 weeks or longer when compared to respondents whose COVID-19 symptoms persisted for only 4 weeks or less. Conclusion: The findings suggest that screening of substance use disorders should be considered among healthcare providers who are treating adults who have persistent symptoms of COVID-19. [ABSTRACT FROM AUTHOR]

The objective of this study was to examine the extent to which involvement in high-contact, semicontact, or noncontact sports during the 12th grade is associated with the initiation and developmental course of prescription drug misuse (PDM) between ages 17/18 years and 27/28 years. Data were collected from a national multicohort panel sample of US 12th-graders (cohorts 2006–2017; n  = 4,772) from the Monitoring the Future Study who were followed for a decade, through age 27/28 years. Approximately 31% of high school seniors indicated PDM at baseline (age 17/18 years). While past-year PDM remained relatively stable between ages 17/18 years and 27/28 years, participation in both noncontact (adjusted odds ratio = 1.40, 95% confidence interval: 1.02, 1.91) and contact (adjusted odds ratio = 1.57, 95% confidence interval: 1.08, 2.28) sports in the 12th grade increased the odds of initiating prescription stimulant misuse during the 10 years following high school as compared with respondents who did not participate in these types of sports in the 12th grade. To our knowledge, this is the first national study to have assessed how sports participation during high school is associated with the initiation and developmental course of PDM from adolescence to young adulthood. These findings reinforce the need for PDM screening during adolescence, as nearly 1 in 3 high school seniors engage in PDM. Increased prescription stimulant misuse following high school warrants ongoing monitoring during young adulthood, especially among athletes. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the proportion of the United States adolescents and adults who are variable (ie, at least one change in gender identity) versus stable in their gender identities over time, and whether they differ significantly in their nicotine/tobacco use after adjusting for key covariates.Methods: We fit multivariable logistic regression models to data from Waves 2-4 (2014/15-2016/18) of the Population Assessment of Tobacco and Health (PATH), a nationally representative study (n = 33 197 U.S. adolescents and adults aged ≥14 years). We examined associations of gender stability/variability over three waves with tobacco use at wave 4 (2016-2018). Differences in any past 30-day tobacco, cigarette, e-cigarette, other tobacco, and poly-tobacco use were assessed among cisgender-stable, transgender-stable, and gender-varying respondents.Results: An estimated 1.0% of adolescents and adults were classified as gender-varying. Prevalence of any past 30-day tobacco use was higher among gender-varying individuals (42.7%) than among gender-stable individuals (transgender-stable, 37.8% and cisgender-stable, 26.7%). There were no significant differences in the odds of nicotine/tobacco use between the two gender-stable groups. However, gender-varying respondents had significant increased odds of any past 30-day tobacco use (adjusted odds ratio [AOR] = 2.0, 95% confidence interval [CI] = 1.3 to 3.0), cigarette use (AOR = 1.7, 95% CI = 1.1 to 2.5), e-cigarette use (AOR = 2.2, 95% CI = 1.4-3.5), other tobacco use (AOR = 2.2, 95% CI = 1.4 to 3.4), and poly-tobacco use (AOR = 2.0, 95% CI = 1.3 to 3.1) compared with cisgender-stable individuals.Conclusions: Gender-varying individuals are at higher risk for nicotine/tobacco use, placing them at greater risk for tobacco-related health consequences.Implications: Despite increased knowledge about transgender health in recent years, there remains a paucity of research about gender-varying individuals. This study is the first to examine the proportion of gender-varying individuals in the United States using a longitudinal, nationally representative sample and to explore differences in nicotine/tobacco use among gender-varying and gender-stable individuals. Our findings suggest that gender-varying people have an increased risk for nicotine/tobacco use, placing them at higher risk for tobacco-related health consequences. This study increases knowledge about nicotine/tobacco use among this under-represented population in research and underscores the importance of developing an awareness of gender diversity. [ABSTRACT FROM AUTHOR]

Background: Sedentary behavior is a significant health risk. Emerging research suggests that mentally active sedentary behaviors (e.g., computer use and reading) are associated with better health than mentally passive sedentary behaviors (e.g., watching TV). However, these relationships are not well established in the literature, and little is known about the oldest old (age ≥ 80). Aims: The aims of this study were to (1) identify distinct subgroups of oldest old adults based on six domains of sedentary behavior (watching TV, using a computer/tablet, talking to friends or family members, doing hobby or other activities, transportation, and resting/napping); and (2) compare health-related outcomes across identified subgroups, using the National Health and Aging Trends Study (NHATS) dataset. Methods: Latent profile analysis was used to identify distinct profiles of sedentary behavior. Design-based linear and logistic regressions were used to examine associations between different profiles and health outcomes, accounting for socio-demographic characteristics. Results: A total of 852 participants were included. We identified four profiles and named them based on total sedentary time (ST) and passive/active pattern: "Medium-passive", "High-passive", "Low", "High-mentally active". Compared to the "High-passive" group, "Low" group and "High-mentally active" group were associated with fewer difficulties with activities of daily living, fewer problems limiting activities and higher cognitive function. Conclusion: This study, with a national representative sample of the oldest old population, suggests that both total ST and sedentary behavior pattern matter when evaluating health outcomes of being sedentary. Interventions should encourage oldest old adults to reduce ST and especially target mentally passive ST. [ABSTRACT FROM AUTHOR]

Purpose: Perioperative exercise could improve health outcomes of surgical lung cancer patients, but less is known about their natural physical activity (PA) behavior before exercise interventions. This review aimed to synthesize evidence on PA, regarding the following: (1) proportion of patients meeting PA guidelines, (2) amount of PA, (3) PA trajectory following surgery, and (4) correlates of PA before or after surgery. Methods: We conducted a systematic review using PubMed, CINHAL, Scopus, and SPORTDiscus (July 2021). Observational or experimental studies that measure PA of lung cancer patients before/after surgery were included. We assessed methodological quality using the NIH Quality Assessment Tools and extracted data using a standardized form. Results: Seventeen studies (25 articles, N = 1737 participants) published between 2009 and 2021 were included. Fourteen studies had sample sizes less than 100. Thirteen studies were of fair quality and four studies were of good quality. Only 23–28% of patients met PA guideline (150 min/week moderate-vigorous PA) at 6 months–6 years after surgery. Patients took an average of 3822–10,603 daily steps before surgery and 3934–8863 steps at 1–3 months after surgery. Physical activity was lower at 1 day–3 months after surgery, compared with preoperative levels. Perioperative PA was positively associated with exercise capacity, quality of life and reduced postoperative complications. Conclusion: This review suggests that PA is low among surgical lung cancer patients, and it may not recover within 3 months following surgery. Physical activity has the potential to improve postoperative outcomes. However, the existing evidence is weak, and future larger longitudinal studies are needed. [ABSTRACT FROM AUTHOR]

Objective: To describe postpartum depression and associated risk factors among postpartum patients in the United States (US) between February and July 2020. This study used a cross-sectional descriptive design to collect survey data from a convenience sample of postpartum patients who lived in the US and delivered a live infant after the US declared COVID-19 a public health emergency. Results: Our sample included 670 postpartum patients who completed an online survey inclusive of the Edinburgh Postnatal Depression Scale (EPDS) and selected demographic items (e.g. NICU admission status, infant gestational age, infant feeding method). In our sample, 1 in 3 participants screened positive for postpartum depression and 1 in 5 had major depressive symptoms. Participants who fed their infants formula had 92% greater odds of screening positive for postpartum depression and were 73% more likely to screen positive for major depressive symptoms compared to those who breastfed or bottle-fed with their own human milk. Participants with infants admitted to a NICU had 74% greater odds of screening positive. Each 1 week increase in weeks postpartum increased the odds of screening positive by 4%. Participants who worried about themselves and their infants contracting COVID-19 had 71% greater odds of screening positive. [ABSTRACT FROM AUTHOR]

Background: Community mobilization (CM) is recommended as a best practice intervention for low resource settings to reduce maternal mortality. Measurement of process outcomes are lacking and little is known about how CM impacts individuals or how community members perceive its function. Given the complex and recursive nature of CM interventions, research that describes the CM process at multiple levels is needed. This study examines change in CM domains at baseline and endline in rural Zambia. Methods: This secondary analysis uses data from a large maternity waiting homes intervention in rural Zambia that employed CM over 3 years as part of a package of interventions. A 19-item CM survey was collected from three groups (women with babies < 1, health workers, community members; n = 1202) with focus groups (n = 76) at two timepoints from ten intervention and ten comparison sites. Factor analysis refined factors used to assess temporal change through multivariable regression. Independent covariates included time (baseline vs endline), intervention vs comparison site, group (women with babies, healthworkers, community members), and demographic variables. Interaction effects were checked for time and group for each factor. Results: Final analyses included 1202 individuals from two districts in Zambia. Factor analysis maintained domains of governance, collective efficacy, self-efficacy, and power in relationships. CM domains of self-efficacy, power in relationships, and governance showed significant change over time in multivariable models. All increases in the self-efficacy factor were isolated within intervention communities (b = 0.34, p < 0.001) at endline. Between groups comparison showed the women with babies groups consistently had lower factor scores than the healthworkers or community member groups. Conclusions: Community mobilization interventions increase participation in communities to address health as a human right as called for in the 1978 Alma Ata Declaration. Grounded in empowerment, CM addresses socially prescribed power imbalances and health equity through a capacity building approach. These data reflect CM interventions function and have impact in different ways for different groups within the same community. Engaging directly with marginalized groups, using the community action cycle, and simultaneous quality improvement at the facility level may increase benefit for all groups, yet requires further testing in rural Zambia. [ABSTRACT FROM AUTHOR]

Savings and Internal Lending Communities (SILCs) are a type of informal microfinance mechanism adapted in many low- and middle-income countries (LMICs) to improve financial resources for poor and rural communities. Although SILCs are often paired with other health and non-health-related interventions, few studies have examined SILCs in the context of maternal health. This study examined the association between SILC participation, household wealth and financial preparedness for birth. The study also examined the association between sex and financial preparedness for birth. A secondary analysis was conducted on individual survey data collected from SILC participants in two rural districts of Zambia between October 2017 and February 2018. A convenience sample of 600 participants (Lundazi: n = 297; Mansa: n = 303) was analysed. Descriptive analyses were run to examine SILC participation and household wealth. Multiple binary logistic regression models were fit to assess the unadjusted and adjusted relationship between (1) SILC participation and household wealth, (2) SILC participation and financial preparedness for birth and (3) sex and financial preparedness for birth. The results show that SILC participation led to an average increase of 7.32 items of the 13 household wealth items. SILC participants who had their most recent childbirth after joining SILCs were more likely to be financially prepared for birth [adjusted odds ratio (AOR): 2.99; 95% confidence interval (95% CI): 1.70-5.26; P < 0.001] than participants who had their most recent childbirth before joining SILCs. Females were more likely to be financially prepared for birth than males if they had their most recent birth before joining an SILC (AOR: 1.79; 95% CI: 1.16-2.66; P < 0.01). SILC participation is shown to increase household wealth and financial preparedness for birth for both men and women. SILCs are a promising intervention that can help poor and rural populations by increasing financial resources and financially preparing parents for birth. [ABSTRACT FROM AUTHOR]

Background and Purpose: An exploratory latent class analysis (LCA) was performed assessing the association between maternity waiting home (MWH) use and maternal–newborn care knowledge. Methods: A two-group comparison design using a face-to-face interview (n = 250) was conducted to understand if MWH use was associated with greater maternal knowledge of newborn care. Results: High levels of maternal knowledge of newborn care were associated with MWH use. Mothers with low levels of knowledge were less likely to use an MWH prior to delivery and more likely to have fewer pregnancies, attend less than four antenatal care (ANC) visits, and receive no education about newborn health problems during ANC. Conclusions: Nurses need to target younger, primigravida mothers attending fewer ANC visits with educational opportunities while advocating for expansion of health education at MWHs to potentiate long-term benefits for improved maternal–newborn health and delivery outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Skilled care is indicated as a measure to prevent the deaths of pregnant women across sub‐Saharan Africa. Despite this, many women continue to give birth at home. There has been little attention as to how the experience of intimate partner violence (IPV) or autonomous decision‐making about place of birth influences home births in rural Zambia. This study explores how markers of sociocultural gender inequities (prevalence of IPV and autonomous decision‐making) correlate with home birth in rural Zambia. Methods: This secondary analysis uses quantitative data from a baseline household survey with women who had given birth within the past 13 months in rural Zambia. Control variables shown to be significant in the literature were included in the model, and binary logistic regression was used to assess the influence of IPV and autonomous decision‐making on home birth. Results: This sample included 2381 women from rural Zambia, of whom 384 reported a home birth within the past 13 months. Women who were autonomously making the decision about where to give birth were more likely to have a home birth (adjusted odds ratio [AOR], 1.729; SE, 0.210; 95% CI, 1.362‐2.194; P <.001). Self‐report of experiencing physical IPV in the past 2 weeks was not significant in predicting home birth (AOR, 0.783; SE, 0.181; 95% CI, 0.496‐1.234; P =.293). Women who self‐identified as Tumbuka or other, were able to afford school fees, had completed secondary education or higher, were married, and had 4 or more antenatal care visits were significantly less likely to report a home birth. Discussion: This quantitative analysis did not corroborate findings from other research that implicates IPV as a predictor of home birth. Additionally, autonomous decision‐making was not associated with a decrease in home births. Future work should incorporate qualitative or mixed methods strategies to comprehensively explore household‐ and facility‐level interventions to promote facility birth. [ABSTRACT FROM AUTHOR]

As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, family planning use, and vaccination rates for mothers who gave birth to a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Before-and-after community surveys were carried out. Multivariable logistic regression were used to assess the association between Core MWH Model use and ANC and PNC attendance. The total sample includes 4711 mothers. Mothers who used the Core MWH Model had better ANC and PNC attendance, family planning use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. We found an association between Core MWH Model use and better ANC and PNC attendance, family planning use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers. [ABSTRACT FROM AUTHOR]

Introduction: Financial constraints are one of the biggest barriers for women of low-income countries to receive necessary reproductive health services. Educating women about the importance of saving money has been incorporated as a component of antenatal care (ANC) contacts, but little is known whether ANC contacts influence women's saving. Methods: A secondary analysis was conducted on data from a cross-sectional household survey study of 1109 women who recently gave birth in two rural districts of Zambia. Results: Receiving ANC contacts early and often and discussing saving money during ANC were associated with saving money for the mother's birth, but not with saving enough money for the most recent birth. Discussion: Continued effort is needed to encourage women to attend ANC contacts earlier and more frequently. Additionally, the importance of saving money for birth should be discussed during ANC contacts. Future studies need to explore why women's action in saving does not necessarily lead to saving enough for childbirth. [ABSTRACT FROM AUTHOR]

Objective: The authors examined psychiatric comorbidities associated with alcohol use disorders and tobacco use disorders among heterosexual, bisexual, and gay and lesbian men and women in the United States and whether stress-related factors were predictive of comorbidities.Methods: The authors used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, N=36,309) to examine the co-occurrence of past-year alcohol or tobacco use disorder with past-year anxiety disorders, mood disorders, and posttraumatic stress disorder by sexual identity (heterosexual, bisexual, gay or lesbian) and sex. The authors also examined the association of stress-related factors and social support with the presence of comorbidities.Results: Comorbidities were more prevalent among women and sexual minorities, particularly bisexual women. More than half of bisexual (55%) and gay or lesbian (51%) individuals who met criteria for a past-year alcohol use disorder had a psychiatric comorbidity, while only one-third of heterosexual individuals who met criteria for a past-year alcohol use disorder did. Similar differences were found among those who met criteria for a past-year tobacco use disorder. Among sexual minorities, the frequency of sexual orientation discrimination (adjusted odds ratio range=1.08-1.10), number of stressful life events (adjusted odds ratio range=1.25-1.43), and number of adverse childhood experiences (adjusted odds ratio range=1.04-1.18) were significantly associated with greater odds of comorbidities. Greater social support was significantly inversely associated with tobacco use disorder comorbidities (adjusted odds ratio range=0.96-0.97).Conclusions: This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities. The increased stressors experienced by sexual minority individuals may be important drivers of these high levels of comorbidities. [ABSTRACT FROM AUTHOR]

Little is known about the psychosocial adjustment of older adults in the assisted living environment. A sense of belonging has been linked to psychological health and a lack of belonging could lead to loneliness. We conducted a cross-sectional descriptive study to examine relationships between social engagement, sense of belonging, and psychological outcomes. Seventy female and 30 male assisted living residents participated. The mean age was 83.9 (range 65–99) years. Structural equation modeling (SEM) revealed that older age, higher physical function, and greater sense of belonging were associated with fewer negative psychosocial outcomes (depression and loneliness) and that sense of belonging functioned as a mediator between social engagement and psychosocial outcomes. Additional work is needed to fully understand how sense of belonging and other factors influence psychosocial outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is a significant modifiable risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. Evidence is emerging showing disparities in CVD risk between sexual minorities and heterosexuals. Engagement in CVD risk reduction behaviors may account for differences. We examined CVD risk reduction for hypertension between sexual minorities and heterosexuals using data from the 2017 Behavioral Risk Factor Surveillance System. Methods: Using bivariate and multivariable logistic regression analyses, we compared medical advice and actions taken (taking medicine, changing eating habits, cutting down on sale, reducing alcohol, and exercising) to control blood pressure in sexual minority and heterosexual respondents. Analyses were conducted in 2019. Results: Approximately 35% of the sample indicated being told by a health professional they had high blood pressure. Sexual minorities were less likely to report reduced alcohol intake to lower their blood pressure (AOR =.52, 95% CI =.30,.88). One sex-specific difference between sexual minority women and heterosexual women was found; sexual minority women were less likely to indicate being advised by a health professional to take medications to lower blood pressure when compared to heterosexual women. Conclusions: Strategies are needed to reduce alcohol consumption in sexual minority individuals. Uncovering the reasons for the lack of adherence by both sexual minority patients and healthcare providers can guide future interventions to improve adherence and reduce hypertension as a CVD risk. [ABSTRACT FROM AUTHOR]

Objective: Maternity waiting homes (MWHs) have been identified as one solution to decrease maternal morbidity and mortality by bringing women living in hard-to-reach areas closer to a hospital or health center that provides emergency obstetric care. The objective of this study was to obtain data on current MWH characteristics and the women who use them as well as women’s perceptions and experiences with MWHs among seven Saving Mothers Giving Life (SMGL) supported districts in Zambia. Methods: A cross-sectional household survey design was used to collect data from 2381 mothers who delivered a child in the past 13 months from catchment areas associated with 40 health care facilities in seven districts. Multi-stage random sampling procedures were employed with probability proportionate to population size randomly selected. Logistic regression models, Chi-square, and independent t-tests were used to analyze the data. Results: Women who lived 15–24 km from a health care facility were more likely to use a MWH when compared to women who lived 9.5–9.9 km from the nearest facility (AOR: 1.722, 95% CI: 1.450, 2.045) as were women who lived 25 km or more (AOR: 2.098, 95% CI: 1.176, 3.722.881). Women who were not married had lower odds of utilizing a MWH when compared to married women (AOR: 0.590, 95% CI: 0.369, 0.941). Over half of mothers using a MWH prior to delivery reported problems at the MWH related to boredom (42.4%), management oversight (33.3%), safety (33.4%), and quality (43.7%). While the study employs a robust design, it is limited by its focus in Saving Mothers Giving Life districts. Conclusion: MWHs, which currently take many forms in Zambia, are being used by over a third of women delivering at a health facility in our study. Although over half of women using the existing MWHs noted crowdedness and nearly a third reported problems with the physical quality of the building as well as with their interaction with staff, these MWHs appear to be bridging the distance barrier for women who live greater than 9.5 km from a health care facility. [ABSTRACT FROM AUTHOR]

This study examines associations between adolescent problem behaviors and adolescent-parent disagreement in ratings of adolescent depression and anxiety symptoms. Adolescent-parent dyads (N = 463; mean age = 12.68 years; 48.5% female; 78.2% White and 21.8% non-White) reported on adolescent depression and anxiety using parallel scales from the Youth Self Report (Achenbach et al., J Emot Behav Disord 10:194-203, 2002) and the Child Behavior Checklist (Achenbach and Rescorla, The manual for the ASEBA school-age forms & profiles, University of Vermont, Research Center for Children, Youth, and Families, Burlington, 2001) across four waves. Generalized estimating equations were used to examine the relationship between discrepancy scores and adolescent behavioral outcomes: incidence of adolescent past-year substance use (alcohol use, binge drinking, marijuana use, and nonmedical use of controlled medications), delinquency, self-harm behavior, and aggression. Findings showed that larger adolescent-parent divergence scores of depression were associated with higher odds of marijuana use, non-medical use of controlled medications, alcohol use, binge drinking, in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Results further revealed that larger divergence scores on anxiety were associated with higher odds of in-school delinquency, illegal behavior, self-harm behavior, and clinically significant levels of aggressive behavior. Adolescent-parent reporting discrepancy on adolescent’s depression and anxiety symptoms may be indicative of adolescent’s social, emotional, and behavioral problems, and the disagreement may signal further need for assessment of the adolescent. [ABSTRACT FROM AUTHOR]

Objective: To examine whether a recent prescription for stimulant medication is associated with peer victimization among youth with attention deficit/hyperactivity disorder (ADHD).Methods: Data from 4,965 adolescents attending five public schools who completed an annual web survey over 4 years were used to examine recent stimulant medication prescription and self-reported frequent victimization.Results: Adolescents with ADHD and recent stimulant prescription reported more victimization than those without ADHD, but similar to adolescents with ADHD and no recent prescription. Adolescents with ADHD and past 12-month diversion of their prescribed stimulants were at greatest risk of 12-month frequent victimization compared with adolescents without ADHD and adolescents with ADHD but no recent prescription. Youth approached to divert reported more victimization than youth not approached. Youth who diverted reported more victimization than those who did not divert.Conclusions: Close parent-prescriber collaboration is needed to ensure effective medical treatment for ADHD without greater risk for victimization and treatment failure. [ABSTRACT FROM AUTHOR]

Background: Savings and Internal Lending Communities (SILCs) are a type of informal microfinance mechanism widely adapted in Zambia. The benefits of SILCs paired with other interventions have been studied in many countries. However, limited studies have examined SILCs in the context of maternal health. This study examined the association between having access to SILCs and: 1) household wealth, 2) financial preparedness for birth, and 3) utilization of various reproductive health services (RHSs).Methods: Secondary analysis was conducted on baseline and endline household survey data collected as part of a Maternity Waiting Home (MWH) intervention trial in 20 rural communities across seven districts of Zambia. Data from 4711 women who gave birth in the previous year (baseline: 2381 endline: 2330) were analyzed. The data were stratified into three community groups (CGs): CG1) communities with neither MWH nor SILC, CG2) communities with only MWH, and CG3) communities with both MWH and SILC. To capture the community level changes with the exposure to SILCs, different women were randomly selected from each of the communities for baseline and endline data, rather than same women being surveyed two times. Interaction effect of CG and timepoint on the outcome variables - household wealth, saving for birth, antenatal care visits, postnatal care visits, MWH utilization, health facility based delivery, and skilled provider assisted delivery - were examined.Results: Interaction effect of CGs and timepoint were significantly associated only with MWH utilization, health facility delivery, and skilled provider delivery. Compared to women from CG3, women from CG1 had lower odds of utilizing MWHs and delivering at health facility at endline. Additionally, women from CG1 and women from CG2 had lower odds of delivering with a skilled provider compared to women from CG3.Conclusion: Access to SILCs was associated with increased MWH use and health facility delivery when MWHs were available. Furthermore, access to SILCs was associated with increased skilled provider delivery regardless of the availability of MWH. Future studies should explore the roles of SILCs in improving the continuity of reproductive health services.Trial Registration: NCT02620436. [ABSTRACT FROM AUTHOR]

We assessed the nonmedical use of prescription opioids (NMUPO) among adolescents who participate in competitive sports. Using data from Monitoring the Future, we found that adolescent participants in high-injury sports had 50% higher odds of NMUPO than adolescents who did not participate in these types of sports (i.e., nonparticipants and participants in other sports). Detecting certain subpopulations of youths at risk for NMUPO should be a central concern among health care providers. [ABSTRACT FROM AUTHOR]