Search

Adults with serious mental illness and substance use disorders have elevated risk of mortality and higher healthcare costs compared to the general population. As these disparities have been linked to poor management of co-occurring chronic conditions in primary care, the behavioral health setting may be a preferred setting for routine medical screening and treatment. This qualitative study describes early stages of integrating care teams in emerging medical homes based in mental health and addiction treatment settings. Clinicians and staff from ten agencies engaged in the Behavioral Health Home Learning Collaborative participated in qualitative interviews exploring local definitions of "behavioral health home" and initial barriers and facilitators to integration. Facilitators included clear staff roles, flexible scheduling, and interdisciplinary huddles and staff trainings. Challenges included workforce, limited use of electronic health records, and differing professional cultures. Participants advocated for new workflows and payment structures to accommodate scheduling demands and holistic case management.

Secondhand smoke exposure is a concern in multiunit housing, where smoke can migrate between apartments. In 2012, the New York City (NYC) Department of Health and Mental Hygiene conducted a cross-sectional mail and phone survey among a random sample of low-income and market-rate multiunit housing owners and managers in NYC. The study compared experiences and attitudes regarding smoke-free policies between owners/managers (owners) with and without low-income units. Logistic regression analysis was used to assess the correlates of smoke-free residential unit rules and interest in adopting new smoke-free rules. Perceived benefits and challenges of implementing smoke-free rules were also examined. Overall, one-third of owners prohibited smoking in individual units. Among owners, nearly one-third owned or managed buildings with designated certified low-income units. Owners with low-income units were less likely than those without to have a smoke-free unit policy (26 vs. 36 %, p < 0.01) or be aware that owners can legally adopt smoke-free building policies (60 vs. 70 %, p < 0.01). In the final model, owners who believed that owners could legally adopt smoke-free policies were more likely to have a smoke-free unit policy, while current smokers and owners of larger buildings were less likely to have a policy. Nearly three quarters of owners without smoke-free units were interested in prohibiting smoking in all of their building/units (73 %). Among owners, correlates of interest in prohibiting smoking included awareness that secondhand smoke is a health issue and knowledge of their legal rights to prohibit smoking in their buildings. Current smokers were less likely to be interested in future smoke-free policies. Educational programs promoting awareness of owners' legal right to adopt smoke-free policies in residential buildings may improve the availability of smoke-free multiunit housing.

Disparities in teen pregnancy rates are explained by different rates of sexual activity and contraceptive use. Identifying other components of risk such as race/ethnicity and neighborhood can inform strategies for teen pregnancy prevention. Data from the 2005 and 2007 New York City Youth Risk Behavior Surveys were used to model demographic differences in odds of recent sexual activity and birth control use among black, white, and Hispanic public high school girls. Overall pregnancy risk was calculated using pregnancy risk index (PRI) methodology, which estimates probability of pregnancy based on current sexual activity and birth control method at last intercourse. Factors of race/ethnicity, grade level, age, borough, and school neighborhood were assessed. Whites reported lower rates of current sexual activity (23.4%) than blacks (35.4%) or Hispanics (32.7%), and had lower predicted pregnancy risk (PRI = 5.4% vs. 9.0% and 10.5%, respectively). Among sexually active females, hormonal contraception use rates were low in all groups (11.6% among whites, 7.8% among blacks, and 7.5% among Hispanics). Compared to white teens, much of the difference in PRI was attributable to poorer contraceptive use (19% among blacks and 50% among Hispanics). Significant differences in contraceptive use were also observed by school neighborhood after adjusting for age group and race/ethnicity. Interventions to reduce teen pregnancy among diverse populations should include messages promoting delayed sexual activity, condom use and use of highly effective birth control methods. Access to long-acting contraceptive methods must be expanded for all sexually active high school students.