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Introduction: The proportion of Ohioans experiencing deafness or serious difficulty hearing is higher than national estimates and is increasing over time. Purpose: The purpose of this study is to describe the burden, risk factors, comorbidities, and financial implications of hearing loss in Ohio as well as discuss approaches to reduce the burden of hearing loss in Ohio applying the Social-Ecological Model Methods: A narrative review was completed to summarize peer-reviewed literature on hearing loss in Ohio. The Social-Ecological Model was applied to identify approaches to reduce the burden of hearing loss in Ohio. Results: The burden of hearing loss on health and economic well-being is substantial in Ohio. While initiatives have sought to reduce costs and increase access, barriers continue to persist impeding people’s ability to obtain needed services in Ohio. Approaches were identified on all levels of the Social-Ecological Model to address the burden of hearing loss in Ohio such as creating interventions for prevention, improving access to hearing tests and hearing aids, and changing policies that expand insurance coverage for hearing aids. Conclusion: There is a critical need for public health-initiated programs and policies that reduce barriers and increase access to hearing related services that can be implemented on all levels of the Social-Ecological Model.

Background Malaria during pregnancy is a major contributor to maternal and infant morbidity and mortality in Gambia. The World Health Organization recommends that women adhere to intermittent preventive treatment with sulfadoxine-pyrimethamine (SP-IPTp) provided through antenatal care (ANC) to prevent adverse outcomes. The aim of this study was to examine predictors of SP-IPTp adherence among women in Gambia. Methods Data analysis was conducted using the 2019–2020 Women's Health Survey from the Gambia Demographic and Health Survey dataset. χ2 tests and multivariate logistic regression were employed to assess the influence of ANC and sociodemographic characteristics on SP-IPTp adherence. Results Among 5381 women, less than half (47.3%) achieved adherence (three or more doses) to SP-IPTp. More than three-quarters (79.7%) attended four or more ANC visits. Women who attended four ANC visits were twice as likely to adhere to SP-IPTp than women who attended none to three ANC visits (adjusted odds ratio 2.042 [95% confidence interval 1.611 to 2.590]). Conclusions Attending four or more and earlier initiation of ANC visits may be related to improved SP-IPTp adherence. Additional research is needed to assess structural and healthcare system components that influence SP-IPTp adherence.

Evidence suggests women in sub-Saharan Africa may be more likely to experience intimate partner violence (IPV) than women anywhere else in the world. Data was obtained from women (n = 29,444) who completed the Demographic Health Survey's (DHS) domestic violence module in seven countries in sub-Saharan Africa countries between 2011 and 2015. Women who reported controlling behavior by a spouse/partner were more likely to have experienced less severe lifetime physical violence (adjusted odds ratio (AOR) 3.02, 95% confidence interval (CI) 2.63, 3.47) and severe violence (AOR 4.27, 95% CI 3.32, 5.49). Partner's controlling behavior may increase the likelihood of experiencing both less severe and severe lifetime physical violence.

To investigate the relationship between dimensions of religiosity and attitudes toward the professional treatment of mental health among African American church attendees. In 2018, surveys were administered to African American attendees of four churches in northeastern Pennsylvania and central New Jersey (n = 435). The independent variables assessed were three dimensions of religiosity: subjective (perceptions and attitudes), organizational (public displays), and non-organizational (private practices). The Multidimensional Measure of Religious Involvement for African Americans scale assessed each dimension of religiosity. The dependent variable was measured through the 20-item scale, Attitudes Toward Mental Health Treatment Scale. We conducted multivariate linear regression with robust standard errors to adjust for clustering effects by church. Covariates adjusted for in the analysis were age, sex, denomination, education, marital status, depressive symptoms, location, and support. Most participants were aged 50 and older (79.3%). They resided in urban (9.89%), rural (2.3%), or suburban (87.8%) settings. Participants who reported high subjective religiosity endorsed less positive attitudes toward professional mental health treatment in comparison with participants reporting low subjective religiosity (β = − 1.36, 95% confidence interval [− 2.35, − 0.39], p

The purpose of this study was to examine the relationship between dimensions of religiosity (organizational, non-organizational, subjective) and depressive symptoms in the Black church. Surveys were administered to attendees of four churches in the northeastern U.S. The Multidimensional Measure of Religious Involvement for African Americans examined religiosity and the Patient Health Questionnaire-8 items assessed depressive symptoms. Logistic regression analysis was employed to examine the relationship between religiosity and depressive symptoms adjusting for potentially influential covariates. Participants reporting high organizational religiosity were significantly more likely to report non-significant depressive symptoms (adjusted odds ratio (AOR) = 1.80, 95% confidence interval (CI) = 1.05, 3.08) in comparison with those reporting low organizational religiosity, when controlling for potentially influential covariates. Our findings suggest that organizational religiosity may be protective against depression. These findings inform the development of initiatives seeking to reduce the burden of depression in the Black church.

Optimal management of Type 2 diabetes mellitus (Type 2 DM) is impeded by widespread nonadherence to efficacious medication regimens. Cardiovascular disease (CVD) is the most common cause of morbidity and mortality among persons with Type 2 DM. In this work we evaluated the relationship between CVD and medication adherence to antihypertensives, oral hypoglycemic agents, and antidepressants among patients with Type 2 DM. We also sought to understand how patients perceived barriers to and facilitators of adherence to medications. Adherence to medications was measured in 72 primary care patients from the West Philadelphia area using electronic monitoring (Medication Event Monitoring System caps) over 12 weeks. Standard questions assessed the presence of CVD. Participants answered open-ended questions about barriers to and facilitators of medication adherence. Participants who had CVD were significantly less likely to achieve ≥80% adherence to an antidepressant, oral hypoglycemic agent, and antihypertensive medications at 12 weeks. Participants identified four themes related to medication adherence: Interference from Psychosocial Demands, Need for Technological Innovation, Awareness of Disease Severity, and Integrating Community Linkages. Interventions to improve medication adherence among persons with Type 2 DM in underserved communities may aim to address social determinants of health, create community linkages, emphasize disease severity and utilize apps which are integrated with existing primary care services.

Intimate partner violence (IPV) is a serious public health issue that increases risk for sexually transmitted infections (STIs). Data was obtained from women (n = 32,409) who completed the Demographic Health Survey's (DHS) domestic violence module in 7 countries in sub-Saharan Africa between 2011 and 2015. DHS questions assessed lifetime physical, emotional and sexual IPV, cumulative exposure to IPV as well as the presence of a STI in the past 12 months. Multivariate logistic regression examined the association between IPV and STIs adjusting for potentially influential covariates. Data were weighted and analyzed using STATA Software (version 14.0). Women who had experienced physical, emotional sexual and cumulative IPV were significantly more likely to have had a STIs in the past 12 months. In order to reduce the burden of STIs, initiatives may need to address underlying mechanisms such as gender norms and power inequalities which perpetuate IPV.

Purpose Recruiting medical students into women’s health and gender-based medical research is important internationally. Medical student research training is critical for developing future women’s health leaders who are adept at conducting high-impact research. This paper aims to describe a six-month medical student research fellowship in women’s health in terms of fellowship recipients’ publications related to their research project and future academic careers. Design/methodology/approach Targeted searches of fellowship recipients and their fellowship mentors were conducted in PubMed and Scopus from 2001–2017. Prior student fellows were also e-mailed and called to assess whether they held academic positions. Findings Since 2001, funds have been secured to support a total of 83 students (69 women, 14 men) in a mentored research experience in women’s health and gender-based medicine. In total, 48 out of the 83 (57.8%) medical student fellowship recipients published at least one peer-reviewed research paper or scientific review related to their research project. Of the 50 prior recipients with a least five years of follow-up data (41 women, 9 men), 26 (52%) were in academic careers. Research limitations/implications Because this is an observational study and only medical students interested in women’s health applied to be a student fellow, there is an inability to infer causality. Practical implications Following completion of the medical student research training fellowship in women’s health, more than half of recipients published in peer-reviewed medical journals on their research project. Originality/value This study explores the association of an innovative medical student experience in women’s health research on subsequent fellowship-related publications and career outcomes, contributing to the body of knowledge on the influence of a mentored research leadership program for medical students on academic professional development.

Nonadherence to antidepressants is widespread and poses a significant barrier to optimal management and treatment of depression in community settings. The objective of this study was to compare self-reported and electronic monitoring of adherence to antidepressants and to examine the relationship of these measures with depressive symptoms in a medically underserved community. Adherence to antidepressants was measured in 38 primary care patients from the West Philadelphia area using self-report and electronic monitoring (Medication Event Monitoring System caps). Self-report and electronic monitoring of antidepressant adherence showed fair agreement at baseline, slight agreement at 6 weeks, and slight agreement at 12 weeks. Adherence to antidepressants as assessed by electronic monitors was significantly associated with depression remission at 12 weeks [adjusted odds ratio 18.6, 95% confidence interval (1.05, 330.56)]. Compared with electronic monitoring, self-reported adherence tended to overestimate medication adherence to antidepressants. Adherence assessed by electronic monitoring was associated with depression remission.

Differential social and contextual environments may contribute to adolescent sleep disparities, yet most prior studies are limited to self-reported sleep data and have not been conducted at a national level, limiting the variation in neighborhood contexts. This study examined the association between neighborhood disadvantage and objective measures of adolescent sleep. A racially and geographically diverse sample of American adolescents (N = 682) wore wrist-worn accelerometers, “actigraphs,” for ≥ 5 nights. Neighborhood disadvantage was calculated using a standardized index of neighborhood characteristics (proportion of female-headed households, public assistance recipients, households in poverty, adults without high school degrees, and unemployed). Adolescents in more disadvantaged neighborhoods spent more time awake after falling asleep (4.0 min/night, p

Medication nonadherence in individuals with diabetes can lead to adverse health outcomes. Young and middle-aged adults are more likely to have low food security than other age groups. However, little research has focused on the relationship between food security and medication adherence in this population. The objective of this study was to examine the relationship between food security and medication adherence among young and middle-aged adults with diabetes. This study used 2019 National Health Interview Survey data. Persons were included if they were aged less than 50 and had a diabetes diagnosis. Individuals were categorized as nonadherent to medication if they answered "yes" to one question indicating nonadherence. Food security status was categorized as food secure, low food security, and very low food security. Among adults under age 50 with diabetes, nearly a fifth were categorized as having low or very low food security. Approximately a quarter of the participants were not adherent. Respondents with low food security and very low food security were significantly more likely to be nonadherent to medication than those who were food secure. People with diabetes under the age of 50 who have low or very low food security are at an increased risk for nonadherence to medication.

Objective To examine the association between activity limitation stages and patient satisfaction and perceived quality of medical care among younger Medicare beneficiaries. Design Cross-sectional study. Setting Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011. Participants A population-based sample (N=9323) of Medicare beneficiaries Interventions Not applicable. Main Outcome Measures MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physician (PCP), interpersonal skills of PCP, and quality of information provided by PCP. Persons were classified into an activity limitation stage (0-IV) which was derived from self-reported difficulty performing activities of daily living (ADL) and instrumental activities of daily living (IADL). Results Compared to beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (95% confidence intervals) for stage I (mild) to stage IV (complete) for satisfaction with access barriers ranged from 0.62 (0.53-0.72) at stage I to a minimum of 0.31 (0.22-0.43) at stage IV. Similarly, compared to beneficiaries at IADL stage 0, satisfaction with access barriers ranged from 0.66 (0.55-0.79) at stage I to a minimum of 0.36 (0.26-0.51) at stage IV. Satisfaction with care coordination and quality and perceived quality of medical care were not associated with activity limitation stages. Conclusions Younger Medicare beneficiaries with disabilities reported decreased satisfaction with access to medical care, highlighting the need to improve access to health care and human services and to enhance workforce capacity to meet the needs of this patient population.

BackgroundMedication restricting behaviours are common among persons with diabetes increasing risk for poor health outcomes. Persons with diabetes are more likely to experience food insecurity than persons without diabetes.AimThis study aimed to assess the relationship between food insecurity and medication restricting behaviour among persons with diabetes in the United States.MethodsData from the 2019 National Health Interview Survey (NHIS) data conducted in the United States was used for this analysis. Medication restricting behaviour was assessed by questions asking whether four restricting behaviours were present (skipped medication, took less medication, delayed filling a prescription and/or took less medication due to cost). Food insecurity status was obtained through a 10-item scale and participants were categorized as either food secure, low food security, or very low food security. Poisson regression evaluated the relationship between medication restricting behaviour and food insecurity controlling for confounders.ResultsParticipants with very low food security had a significantly higher mean number of medication restricting behaviours than participants who were food secure (adjusted mean ratio (AMR) = 4.01; 95% confidence interval (CI) = (3.09, 5.21)). Similarly, participants with low food security had a significantly higher mean ratio than participants who were food secure (AMR = 3.76; 95% CI = (2.86. 4.94).ConclusionPersons with diabetes who have low or very low food security are at an increased risk for engaging in medication restricting behaviours.

One in four American adults has a disability. Individuals with disabilities are more likely to have mental health issues and use substances and are less likely to attend substance use rehabilitation compared to individuals without disabilities. However, most research about substance use and substance use rehabilitation does not focus specifically on sensory disabilities.The purpose was to test the association between vision and/or hearing loss, lifetime drug use, and lifetime drug rehabilitation.Data files from National Health and Nutrition Examination Survey cycles (2013-2014, 2015-2016, 2017-2018) were combined. Ordinal logistic regression was used to test the association between vision and hearing loss and lifetime drug use and binary logistic regression to test the association with lifetime rehabilitation among those who had used drugs, adjusting for multiple testing and the complex survey design.There was a significant association between vision and hearing loss status and lifetime drug use (p = .018), but not with lifetime rehabilitation (p = .972). Post-hoc comparisons were not statistically significant. However, individuals with vision loss only and hearing loss only had 36% and 37% greater odds, respectively, of drug use than those without a disability, and those with both vision and hearing loss had 18% greater odds of drug use than those with either alone.Persons with disability were more likely to have used drugs but were not more likely to have gone to drug rehabilitation.

Intimate partner violence (IPV) is a serious public health issue that increases risk for sexually transmitted infections (STIs). Data was obtained from women (n = 32,409) who completed the Demographic Health Survey's (DHS) domestic violence module in 7 countries in sub-Saharan Africa between 2011 and 2015. DHS questions assessed lifetime physical, emotional and sexual IPV, cumulative exposure to IPV as well as the presence of a STI in the past 12 months. Multivariate logistic regression examined the association between IPV and STIs adjusting for potentially influential covariates. Data were weighted and analyzed using STATA Software (version 14.0). Women who had experienced physical, emotional sexual and cumulative IPV were significantly more likely to have had a STIs in the past 12 months. In order to reduce the burden of STIs, initiatives may need to address underlying mechanisms such as gender norms and power inequalities which perpetuate IPV.

The purpose of this study was to examine the relationship between dimensions of religiosity (organizational, non-organizational, subjective) and depressive symptoms in the Black church. Surveys were administered to attendees of four churches in the northeastern U.S. The Multidimensional Measure of Religious Involvement for African Americans examined religiosity and the Patient Health Questionnaire-8 items assessed depressive symptoms. Logistic regression analysis was employed to examine the relationship between religiosity and depressive symptoms adjusting for potentially influential covariates. Participants reporting high organizational religiosity were significantly more likely to report non-significant depressive symptoms (adjusted odds ratio (AOR) = 1.80, 95% confidence interval (CI) = 1.05, 3.08) in comparison with those reporting low organizational religiosity, when controlling for potentially influential covariates. Our findings suggest that organizational religiosity may be protective against depression. These findings inform the development of initiatives seeking to reduce the burden of depression in the Black church.

OBJECTIVE: We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes. DESIGN: Cohort study with 21,257 community-dwelling Medicare beneficiaries aged 65 years and older who participated in the 2001–2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β-coefficients which were utilized to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality over two years of follow-up. RESULTS: A total of 18 factors were identified for functional deterioration (p

Background Significant disparities in health care access and quality persist between persons with disabilities (PWD) and persons without disabilities (PWOD). Little research has examined recommendations of patients and providers to improve health care for PWD. Objective We sought to explore patient and health care provider recommendations to improve health care access and quality for PWD through focus groups in the physical world in a community center and in the virtual world in an online community. Methods In all, 17 PWD, 4 PWOD, and 6 health care providers participated in 1 of 5 focus groups. Focus groups were conducted in the virtual world in Second Life® with Virtual Ability, an online community, and in the physical world at Agape Community Center in Milwaukee, WI. Focus group data were analyzed using a grounded theory methodology. Results Themes that emerged in focus groups among PWD and PWOD as well as health care providers to improve health care access and quality for PWD were: promoting advocacy, increasing awareness and knowledge, improving communication, addressing assumptions, as well as modifying and creating policy. Many participants discussed political empowerment and engagement as central to health care reform. Conclusions Both PWD and PWOD as well as health care providers identified common themes potentially important for improving health care for PWD. Patient and health care provider recommendations highlight a need for modification of current paradigms, practices, and approaches to improve the quality of health care provision for PWD. Participants emphasized the need for greater advocacy and political engagement.

The aim of this study was to examine whether activity limitation stages were associated with patient-reported trouble getting needed health care among Medicare beneficiaries.This was a population-based study (n = 35,912) of Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey for years 2001-2010. Beneficiaries were classified into an activity limitation stage from 0 (no limitation) to IV (complete) derived from self-reported or proxy-reported difficulty performing activities of daily living and instrumental activities of daily living. Beneficiaries reported whether they had trouble getting health care in the subsequent year. A multivariable logistic regression model examined the association between activity limitation stages and trouble getting needed care.Compared with beneficiaries with no limitations (activities of daily living stage 0), the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for stage I (mild) to stage IV (complete) for trouble getting needed health care ranged from OR = 1.53 (95% CI, 1.32-1.76) to OR = 2.86 (95% CI, 1.97-4.14). High costs (31.7%), not having enough money (31.2%), and supplies/services not covered (24.2%) were the most common reasons for reporting trouble getting needed health care.Medicare beneficiaries at higher stages of activity limitations reported trouble getting needed health care, which was commonly attributed to financial barriers.

The objective of this study was to carry out a randomized controlled pilot trial to test the effectiveness of an integrated intervention for hypertension and depression incorporating patients' social determinants of health (enhanced intervention) versus an integrated intervention alone (basic intervention). In all, 54 patients were randomized. An electronic monitor was used to measure blood pressure, and the nine-item Patient Health Questionnaire (PHQ-9) assessed depressive symptoms. Patients in the enhanced intervention had a significantly improved PHQ-9 mean change from baseline in comparison with patients in the basic intervention group at 12 weeks (p = 0.024). Patients in the enhanced intervention had a significantly improved systolic and diastolic blood pressure mean change from baseline in comparison with patients in the basic intervention group at 12 weeks (p = 0.003 and p = 0.019, respectively). Our pilot trial results indicate integrated care management that addresses the social determinants of health for patients with hypertension and depression may be effective.

We sought to develop and evaluate a health literacy measure in a multi-national study and to examine demographic characteristics associated with health literacy. Data were obtained from Demographic Health Surveys conducted between 2006–15 in 14 countries in Sub-Saharan Africa. Surveys were the same in all countries but translated to local languages as appropriate. We identified eight questions that corresponded to the National Academy of Medicine (NAM) definition of health literacy. Factor analysis was used to extract one measure of health literacy. Logistic regression was employed to examine the relationship between demographic characteristics and health literacy. A total of 224 751 individuals between the ages of 15 and 49 years were included. The derived health literacy measure demonstrated good internal consistency (Cronbach’s α = 0.72) and good content validity. The prevalence of high health literacy overall was 35.77%; females 34.08% and males 39.17%; less than or equal to primary education 8.93%, some secondary education 69.40% and ≥complete secondary 84.35%. High health literacy varied across nations, from 8.51% in Niger to 63.89% in Namibia. This is the first known study to evaluate a measure of health literacy relying on the NAM definition utilizing a large sample from 14 countries in Sub-Saharan Africa. Our study derived a robust indicator of NAM-defined health literacy. This indicator could be used to examine determinants and outcomes of health literacy in additional countries.

Intimate partner violence (IPV), commonly accompanied by controlling behavior, is a serious public health concern in sub-Saharan Africa. Data from women ( n = 37,115) aged 15 to 49 years who completed the Demographic Health Survey’s (DHS) domestic violence module in eight countries in sub-Saharan Africa (Cameroon, Democratic Republic of the Congo [DRC], Côte d’Ivoire, Namibia, Rwanda, Sierra Leone, Togo, and Zambia) between 2011 and 2015 were obtained. DHS questions assessed lifetime physical, emotional, and sexual violence (ever vs. never). Controlling behavior was measured by a revised Conflict Tactics Scale. Multivariate logistic regression examined the association between controlling behavior and IPV adjusting for all covariates, including age, education, marital status, wealth, urban/rural setting, and occupation. An interaction term was included to evaluate the consistency of effect estimates across countries. In all, 45.60% of women reported experiencing one or more forms of IPV (physical, sexual, or emotional violence) in their lifetime, ranging from 31.16% in Côte d’Ivoire to 57.37% in Cameroon. Women who reported controlling behavior by a spouse/partner were more likely to have experienced lifetime physical (adjusted odds ratio [AOR] = 3.57, 95% confidence interval [CI] = [3.31, 3.85], sexual (AOR = 3.98, CI = [3.47, 4.57]) or emotional (AOR = 3.52, CI = [3.22, 3.85]) violence than women who did not report controlling behavior. Women who reported controlling behavior were also more likely to have experienced one (AOR = 2.57, CI = [2.36, 2.81]) or two/three types (AOR = 5.34, CI = [4.80, 5.94]) of violence. AORs did not significantly differ across countries. Further research is needed to evaluate whether policies, programs, and education aimed at preventing or modifying controlling behavior may reduce IPV.

Background Blood pressure control remains a challenge despite the availability of effective antihypertensive agents. Objective This pilot study explored the feasibility of a simple, low-resource intervention to improve blood pressure control. Methods A convenience sample was drawn of 56 patients with hypertension from a primary care clinic. A preintervention-postintervention delivered by medical assistants involved prompts to providers to address blood pressure control with a visual aid indicating patients' current and target blood pressure in the context of a traffic light. Results Patients showed a significant reduction in mean systolic blood pressure (preintervention, 141.5 mm Hg, vs postintervention, 133.0 mm Hg; P = .002) and mean diastolic blood pressure (preintervention, 83.4 mm Hg, vs postintervention, 80.4 mm Hg; P = .049). Conclusion In this pilot study, we established the feasibility of a brief, simple intervention to improve blood pressure control implemented by existing primary care practice clinical support staff, and preliminary data show that it can be effective in improving blood pressure control.