Search

Objectives:Our two study objectives were: (1) to understand the relationship between the perception of a previous negative health-care experience and race/ethnicity, and how socio-demographic, access-to-health-care, and self-reported health variables modified this relationship; and (2) to assess how many behaviors participants reported changing as a result of experiencing a perceived negative health-care experience, which behaviors they changed, and if there were differences in patterns of change across racial/ethnic groups. Design:We conducted a cross-sectional survey of a convenience sample of 600 African-American, Mexican-Hispanic, and white adults in socioeconomically diverse neighborhoods in Chicago, IL. We used multivariable logistic regression to analyze the relationship between a perceived negative health-care experience in the last 5 years and race/ethnicity. We summed and then calculated the percentage of people who changed each of the 10 behaviors and evaluated whether or not there were differences in behavior change across racial/ethnic groups. Principal findings:More than 32% of participants reported a perceived negative health-care experience in the past 5 years. Participants who had a bachelor’s degree or above (OR: 2.95, 95%CI: 1.01–8.63), avoided needed care due to cost (OR: 1.84, 95%CI: 1.11–3.06), or who reported fair/poor health (OR: 3.58, 95%CI: 1.66–7.80) had significantly increased odds of reporting a negative health-care experience. Of these people, 88% reported ‘sometimes/always’ changing at least one health-seeking behavior. There were no racial/ethnic differences in reporting negative experiences or in patterns of behavior change. Conclusions:Race/ethnicity was not related to reporting a perceived negative health-care experience or reported patterns of behavior change in response to that experience. However, those who avoided care due to cost were more highly educated, or who indicated poorer health status reported having a negative experience more often. Our findings suggest that the perception of a previous negative experience may influence subsequent health-care-seeking behaviors. [ABSTRACT FROM AUTHOR]

Sexual minority identity (bisexual, lesbian) is a known risk factor for depression in women. This study examined a facet of minority stress prevalent among women-sexual identity mobility-as an identity-related contributor to higher levels of depressive symptoms. We used three waves of data from the Chicago Health and Life Experiences of Women study, a longitudinal study of sexual minority women (N = 306). Random effects OLS regression models were constructed to examine the effect of sexual identity changes on depressive symptoms. We found that 25.6 % of the sample reported a sexual identity change between Wave I and Wave II, and 24.9 % reported a sexual identity change between Waves II and III. Women who reported a change in sexual identity also reported more depressive symptoms subsequent to identity change. This effect was moderated by the number of years participants had reported their baseline identity and by whether the participant had initiated a romantic relationship with a male partner. [ABSTRACT FROM AUTHOR]

Incarcerated women are among the most vulnerable and perhaps the least studied populations in the US. Significant proportions of female inmates are substance users, and many living in unstable housing conditions or being homeless. Female inmates are often at high risk of engaging in sex exchange for drugs or housing needs. While a disproportionate number of incarcerated women have experienced childhood household adversities and maltreatments, the effects of these childhood experiences on psychosocial and behavioral outcomes of this population in later life. We apply a life course perspective to examine these pathways in a sample of incarcerated women in Cook County, Illinois. Findings demonstrated lasting, but differential, effects of household adversities and childhood abuse on subsequent life risks and opportunities among these women. [ABSTRACT FROM AUTHOR]

Understanding the relationship between nonresponse processes and key research variables is central to evaluating if and how nonresponse introduces bias into survey estimates. In most telephone surveys, however, little information is available with which to estimate these effects. We report a procedure for examining the potential effects of nonresponse via analyses that (1) investigate the linkages between community-level (zip code) variables and survey nonresponse and (2) examine the associations between these community-level variables and key survey measures. We demonstrate these procedures using hierarchical modeling to analyze data from a state-wide telephone survey in Illinois. One zip code-level indicator of concentrated disadvantage--the percentage of the population below poverty level--was found to be positively associated with nonresponse and, among respondents, with both current physical disability status and lack of health insurance coverage, suggesting that both may have been underestimated in this survey. This inexpensive approach has the potential of enabling researchers to routinely evaluate nonresponse effects in their survey data. [ABSTRACT FROM AUTHOR]

To better understand the prevalence, correlates, risk factors and context of club drug use among US adults in the City of Chicago. An Audio Computer-Assisted Self Interview was administered to a household probability sample of adults, aged 18–40 years, from June 2001 to January 2002. Subjects were drawn from randomly selected households using a multi-stage area probability design. The data represent 627 randomly selected adult participants. Weighted prevalence estimates with design-effect adjusted confidence intervals of life-time, past 12 month and past 30 day use of any club drug and of specific club drugs; prevalence of rave attendance, other drug use, motivation for use among club drug users; χ2 tests of significance, logistic regression and adjusted odds ratios. Overall club drug prevalence rates were nearly twice those obtained for MDMA alone. Club drug users were more likely to use multiple illicit substances and to report having been in treatment for substance use. A majority of life-time club drug users never attended a rave although rave attendees were more likely to report frequent use of MDMA. Use was associated with gender, race and sexual orientation. Prevention research should be informed by further population-based research on club drug use. Research should not focus exclusively on rave attendees, as they are only a subset of club drug users. Research is needed on neurological and behavioral sequelae across different types of club drugs, gender differences in the impact of sexual orientation on club drug risk and on the effects of personality characteristics such as sensation seeking on club drug use behavior. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate whether substance abuse is a direct factor in the explanation of homelessness or one that operates indirectly through disaffiliation and human capital processes to place individuals at greater risk of the condition.METHODS: Analyses were conducted using data on substance abuse and homeless experiences from a random probability sample of 481 homeless persons and those at risk of homelessness in Cook County, Illinois. Covariance structure models were used to assess substance abuse, human capital, and disaffiliation as potential precursors of homelessness, with particular attention paid to the direct and indirect role of substance abuse in the loss of domicile.RESULTS: Analysis of several nested models of homelessness links substance abuse only indirectly to loss of domicile, primarily through its impact on social and institutional affiliations. Contrary to expectations, substance abuse did not impact homelessness indirectly by diminishing the accumulation of human capital.CONCLUSIONS: The role of disaffiliation as a proximate cause of homelessness was confirmed. This locates the phenomenon within the context of society itself, as a direct result of a breakdown in the social bonds necessary for human community. Substance abuse plays a critical role in this breakdown, negatively influencing social as well as institutional relationships. [Copyright &y& Elsevier]

Examines the effectiveness of the components of a smoking intervention program among female smokers with a high school education or less in Chicago, Illinois. Effects of several baseline measures and exposure to the intervention components on subsequent stage of change; Interaction between exposure to the manual and baseline stage.

Abstract: Objective: This study examines the relationship between self-reported symptoms of substance dependence and risky sexual behavior among 187 HIV-negative men who have sex with men. Method: In a supplement to a Chicago household survey, using random probability sampling, men who reported consensual sex with other men or who identified as gay or bisexual were selected for interviews. Participants reported on sexual behavior, substance use, and symptoms of substance dependence related to past year use of alcohol, marijuana, cocaine, and sedatives, tranquilizers or pain relievers. Risky sexual behavior was defined as unprotected insertive or receptive anal intercourse plus having multiple partners, casual partners, or a partner who was HIV positive or of unknown serostatus. Results: Risky sexual behavior in the past six months was significantly and positively associated with alcohol dependence symptoms, cocaine dependence symptoms (receptive only), and prescription drug dependence symptoms (insertive only). Confirmatory factor analyses revealed that dependence symptoms loaded on separate factors by substance, which in turn loaded on an overarching dependence symptoms factor. In structural equation models, individual substance factors were not significantly associated with sexual risk behavior, however the higher order dependence symptoms factor was significantly and positively associated with both receptive and insertive risk behavior. Conclusions: MSM with symptoms of multiple substance use dependencies are more likely to be engaged in sexual behavior that places them at risk for acquiring HIV and other sexually transmitted infections. Alcohol and drug abuse treatment providers should be aware of the need for HIV testing and counseling in this population. [Copyright &y& Elsevier]

Objective: Studies of alcohol use among lesbians have typically used convenience samples with uncertain generalizability or general population samples with small numbers of lesbians. Here we compare rates of high-risk and problem drinking in a large sample of Chicago-area lesbians and a national sample of age- and education- matched urban heterosexual women. Method: Data came from comparable face-to-face interviews with 405 self-identified Chicago-area lesbians and with 548 urban women from a U.S. national sample. Rates of hazardous drinking (heavy episodic drinking, intoxication, drinking- related problems, alcohol-dependence symptoms) were compared for exclusively heterosexual, mostly heterosexual, bisexual, mostly lesbian, and exclusively lesbian subgroups. Results: Exclusively heterosexual women had lower rates than did all other women on all measures of hazardous drinking. Exclusively heterosexual women also reported less childhood sexual abuse, early alcohol use, and depression. Bisexual women reported more hazardous drinking indicators and depression than did exclusively or mostly lesbian women. Conclusions: These results indicate that sexual minority women are likely to have elevated risks of hazardous drinking. The differences between lesbian and bisexual women suggest that more attention is needed to subgroup differences among sexual minority women. Health care providers need to know the sexual identity of their patients and how their sexual identity may affect their risks for hazardous drinking. Higher rates of childhood sexual abuse, early drinking, and depression among sexual minority women suggest that these experiences may be important in assessing and treating problems related to their drinking, and in developing prevention and early intervention strategies. [ABSTRACT FROM AUTHOR]

We evaluated how regulatory support services provided by University of Illinois at Chicago's Center for Clinical and Translational Science may reduce Institutional Review Board (IRB) turnaround times. IRB applications were categorized by receipt of any regulatory support and amount of support received. Turnaround time included total turnaround time, time for IRB review, and time for investigators to modify protocols. There were no differences in any turnaround times for supported versus nonsupported applications. However, for supported applications, those receiving more intensive support had total turnaround times 16.0 days ( SE 7.62, p < .05) faster than those receiving less intensive support. Receiving higher regulatory support may be associated with faster approval of IRB submissions.

Purpose: Higher pathologic grade, suboptimal debulking surgery, and late-stage are markers of more aggressive and advanced ovarian cancer. Neighborhood socioeconomic status (SES) has been associated with more aggressive and advanced tumors for other cancer sites, and this may also be true for ovarian cancer., Methods: We examined the association between neighborhood SES and ovarian cancer tumor characteristics using data on 581 women diagnosed with epithelial ovarian cancer in Cook County, Illinois. Two complementary measures (concentrated disadvantage and concentrated affluence) were used to estimate neighborhood SES. Prevalence differences and 95 % confidence intervals were estimated in logistic regression models adjusted for age and race., Results: Greater disadvantage was associated with higher grade tumors (p = 0.03) and suboptimal debulking (p = 0.05) and marginally associated with later tumor stage (p = 0.20). Greater affluence was inversely associated with stage at diagnosis (p = 0.004) and suboptimal debulking (p = 0.03) and (marginally) with tumor grade (p = 0.21)., Conclusion: Our findings suggest that lower SES, estimated by neighborhood SES, is associated with ovarian cancer tumor characteristics indicative of more advanced and aggressive disease.

Immigrant women are at greater risk for late stage breast cancer diagnosis. The rapid increase in the US foreign-born population and new immigration patterns lead us to investigate the association between changes in immigrant population and the likelihood of distant metastasis stage at diagnosis of breast cancer among women in Cook County, Illinois. Analyses employed Illinois State Cancer Registry data for 42,714 breast cancer cases diagnosed between 1994 and 2003 in conjunction with 1990 and 2000 Census tract data. We find that concentration of and increases in immigrant populations within neighborhoods contributed to the risk of late stage breast cancer diagnosis. These findings suggest that, although some health indicators for immigrant populations have improved in recent years, important health disparities in breast cancer diagnosis still remain at the neighborhood level. They further suggest that cancer screening and follow-up resources should be directed to areas experiencing rapid increases in immigrant populations.

Research shows that African Americans tend to have poorer and less informative patient-physician communication than Whites. We analyzed survey data from 248 African American and 244 White cancer patients to examine whether this disadvantage could be explained by race variability on several other variables commonly reported to affect communication. These variables were organized into background, enabling, and predisposing factors, based on the Precede-Proceed Model. Multivariate regressions were used to test whether race differences in communication and information variables persisted after successively controlling for background, enabling, and predisposing factors. African American patients had higher interpersonal communication barriers than Whites, but this difference did not persist after controlling for background factors. African Americans also had higher unmet information needs and were less likely to receive the name of a cancer expert. These differences persisted after controlling for all other factors. Future research should focus on the informational disadvantages of African American patients and how such disadvantages may affect cancer treatment decisions.

Relatively little is known about the substance abuse treatment need patterns and experiences of youth incarcerated in the United States juvenile justice system. To address this issue, four analytic questions concerned with understanding the predictors of treatment need and utilization patterns among adolescents entering the juvenile corrections system are examined. Data analyzed were collected as part of a face-to-face survey of 401 youth who entered the Illinois juvenile correctional system in mid-2000. Overall, need for treatment and treatment utilization each were predicted by sets of social environmental and personal characteristics, in addition to several sociodemographic variables. Less than half of youth with an identified need for treatment reported receiving treatment. Considerable variability in the effects of demographic and social environmental indicators on treatment need and utilization across race groups also was observed. These findings underscore the need for the continual development of the cultural competence of treatment providers and the expansion of on-site provision of substance abuse treatment services to incarcerated juveniles.