Medical Home Access Among American Indian and Alaska Native Children in 7 States: National Survey of Children’s Health

To describe the prevalence of medical home among American Indian and Alaska Native children (AIAN) compared to non-Hispanic white (NHW) children and identify areas for improvement in the provision of care within a medical home. Prevalence of medical home, defined as family-centered, comprehensive, coordinated, compassionate, culturally effective care, including a personal doctor or nurse and usual care location, was estimated using 2007 National Survey of Children’s Health data. Analyses included 1–17 year-olds in states reporting AIAN race as a distinct category (Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota, n = 9,764). Associations between medical home and demographic (child’s age, household education and income, and state) and health-related [child’s insurance status, special health care need status, and past year Indian Health Service (IHS) utilization] characteristics were assessed among AIAN children. Overall, the prevalence of medical home was 27 % lower among AIAN children (42.6, 95 % CI = 34.4–50.8) than NHW children (58.3, 95 % CI = 56.2–60.4). Child’s age (adjusted OR [aOR] = 2.7, 95 % CI = 1.3–5.6) was significantly associated with medical home. IHS utilization was associated with medical home among AIAN children with private insurance (aOR = 0.2, 95 % CI = 0.1–0.4), but not among uninsured or publicly insured children. Care coordination and family-centered care were noted areas for improvement among AIAN children. Less than half of AIAN children had a medical home. Future studies should further examine the intersection between insurance and IHS to determine if enhanced coordination is needed for this population, which is often served by multiple federally-funded health-related programs.     

Indigenous Adolescents’ Suicidal Behaviors and Risk Factors: Evidence from the National Youth Risk Behavior Survey

The study sought to examine indigenous adolescents’ suicidal behaviors and risk factors in a nationally representative sample and explore potential causes of disparities. The study analyzed the 1991–2013 Youth Risk Behavior Survey National Combined Datasets. Suicidal behavior outcomes included suicide consideration, planning, and attempts during the past 12 months. Logit regressions were used to estimate the effects of potential suicide risk factors on these suicidal behaviors. The results showed that a high percentage of indigenous adolescents exhibited suicidal behaviors (consideration: 24.6 %; planning: 20.7 %; attempts: 16.2 %). After adjusting for risk factors, indigenous adolescents were no more likely than other adolescents to consider or plan for suicide (consideration: OR 1.18, CI 0.96-1.45, p = 0.125; planning: OR 1.16, CI 0.95–1.42, p = 0.156); however, they remained significantly more likely to have made suicide attempts (OR 1.73, CI 1.32–2.26, p < 0.001). Disparities in adolescent suicidal behaviors could be explained by the heterogeneous prevalence of suicidal risk factors across different races/ethnicities.     

Latina Adolescents Health Risk Behaviors and Suicidal Ideation and Suicide Attempts: Results from the National Youth Risk Behavior Survey 2001–2013

Suicidal ideation and suicide attempts are more common in Latina adolescents than White or African–American adolescents. Several health risk behaviors have been identified as being associated with Latina adolescent suicides. However, to date, no study has identified the consistency and stability of these risk behaviors over time. This study utilized the national Youth Risk Behaviors Survey from 2001 to 2013 to estimate the prevalence of suicidal ideation, suicide attempts, and health risk behaviors associated with suicidal behaviors in Latina adolescents. Our analysis found the prevalence of suicidal ideation and suicide attempts varied significantly over the 13-year study span, decreasing from 2001 to 2009 and increased from 2011 to 2013. The analyses found 11 health risk behaviors that were significantly associated with both suicidal ideation and suicide attempts that did not vary over time. The stability of these 11 health risk behaviors associated with suicidal behaviors could be useful to school personnel to identify early at risk Latina adolescents who may benefit from school and community mental health resources.     

Correlates of Overweight and Obesity Among American Indian/Alaska Native and Non-Hispanic White Children and Adolescents: National Survey of Children’s Health, 2007

Risk factors for overweight and obesity may be different for American Indian and Alaska Native (AI/AN) children compared to children of other racial/ethnic backgrounds, as obesity prevalence among AI/AN children remains much higher. Using data from the 2007 National Survey of Children’s Health, behavioral (child’s sport team participation, vigorous physical activity, television viewing, and computer use), household (parental physical activity, frequency of family meals, rules limiting television viewing, and television in the child’s bedroom), neighborhood (neighborhood support, perceived community and school safety, and presence of parks, sidewalks, and recreation centers in the neighborhood), and sociodemographic (child’s age and sex, household structure, and poverty status) correlates of overweight/obesity (body mass index ≥85th percentile for age and sex) were assessed among 10–17 year-old non-Hispanic white (NHW) and AI/AN children residing in Alaska, Arizona, Montana, New Mexico, North Dakota, Oklahoma, and South Dakota (n = 5,372). Prevalence of overweight/obesity was 29.0 % among NHW children and 48.3 % among AI/AN children in this sample. Viewing more than 2 h of television per day (adjusted odds ratio [aOR] = 2.0; 95 % confidence interval [CI] = 1.5–2.8), a lack of neighborhood support (aOR = 1.9; 95 % CI = 1.1–3.5), and demographic characteristics were significantly associated with overweight/obesity in the pooled sample. Lack of sport team participation was significantly associated with overweight/obesity only among AI/AN children (aOR = 2.7; 95 % CI = 1.3–5.2). Culturally sensitive interventions targeting individual predictors, such as sports team participation and television viewing, in conjunction with neighborhood-level factors, may be effective in addressing childhood overweight/obesity among AI/AN children. Longitudinal studies are needed to confirm these findings.     

Immigration Measures and Reproductive Health Among Hispanic Youth: Findings from the National Longitudinal Survey of Youth, 1997–2003

PurposeTo explore relationships between immigration measures and risk of reproductive and sexual events among U.S. Hispanic adolescents.MethodsWe examined generation status, language in the home and country of origin in relation to sexual activity, contraception, and childbearing among 1614 Hispanic adolescents, using nationally representative 1997–2003 longitudinal data. Multivariable analyses controlled for potentially confounding variables. Tests for effect modification by gender and Mexican origin were conducted.ResultsFewer first generation adolescents transitioned to sexual intercourse before age 18 (odds ratio [OR] = .80, 95% confidence interval [CI] = .66–.98) and fewer first and second generation sexually active teens used contraceptives consistently at age 17 (OR = .32, 95% CI = .17–.60 and OR = .50, 95% CI = .31–.80, respectively) than third-generation teens. Language was similarly associated with the transition to sexual intercourse and contraceptive practices. Versus teens of Mexican origin, teens of Puerto Rican origin and origins other than Cuba and Central/South America had greater odds of becoming sexually active; youth of all origins except Central/South America had fewer multiple live births (OR = .14–.31). Gender modified the effects of generation on consistent use of contraceptives and condoms at age 17. Gender also modified the effect of country of origin on transitioning to sexual intercourse before age 18 years.ConclusionsResults expand on previous observations that generation, language, and country of origin are predictors of reproductive and sexual risks for Hispanic adolescents. These immigration measures may therefore be useful in targeting community and clinical preventive services.     

Trends in Recall and Appraisal of Anti-Smoking Advertising Among American Youth: National Survey Results, 1997–2001

Public health efforts to reduce the harms related to tobacco use currently include a significant emphasis on anti-smoking media campaigns. This paper provides (a) data on the overall extent of exposure to anti-smoking media among American youth from 1997 to 2001, (b) an appraisal of general youth reactions to such advertising, and (c) an examination of how exposure levels and reactions vary by socio-demographic characteristics. Data were obtained from the Monitoring the Future study, an ongoing nationwide study of youth. Data were collected each year from nationally representative separate and nonoverlapping school samples of 8th, 10th, and 12th grade students (N = 29,724; 24,639; and 12,138, respectively). Self-reported levels of recalled exposure to both electronic and print anti-smoking advertising were measured, as well as the judged impact and perceived exaggeration of such advertising. Data indicate that significant increases in overall exposure to anti-smoking advertising occurred over the study time period. These increases were associated with (a) increases in the self-reported likelihood that anti-smoking advertising diminished the probability of individual smoking behaviors, and (b) increases in the perceived level to which anti-smoking advertising exaggerates the risks associated with smoking. Further, these trends were significantly associated with various characteristics—most notably, ethnicity, smoking behaviors, and residence in a state with an ongoing tobacco-control program having a media component.     

Prenatal Cigarette Smoking and Smokeless Tobacco Use Among Alaska Native and White Women in Alaska, 1996–2003

Objective To examine trends in prenatal cigarette smoking and smokeless tobacco use among Alaska Native (AN) and white women in Alaska. Methods Using 1996–2003 data from the population-based Pregnancy Risk Assessment Monitoring System, we determined trends in self-reported prenatal tobacco use among AN and white women and used chi-square tests and multiple variable logistic regression analysis to identify maternal factors associated with prenatal tobacco use. Results Over the study period, prevalence of any tobacco use during pregnancy declined by 27% among AN women (from 55.8 to 40.9%) (P < 0.0001) and by 17% among white women (from 18.8 to 15.6%) (P < 0.0001). In 2003, among AN women the prevalence of self-reported smokeless tobacco use was 16.9%, cigarette smoking was 25.7%, and any tobacco use was 40.9%; corresponding values for white women were 0.4, 15.0, and 15.6%, respectively. Western Alaska had the highest prevalence of tobacco use. Conclusion The prevalence of tobacco use decreased between 1996 and 2003, but remained higher among AN women than white women, especially for smokeless tobacco. Support for cessation interventions targeting pregnant women should be made a public health priority in Alaska. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Violent Behaviors in Early Adolescent Minority Youth: Results from a “Middle School Youth Risk Behavior Survey”

Objectives: To describe the prevalence and characteristics of violence and violence-related behaviors among six populations of U.S. minority adolescents in grades 6–8. Methods: Six thousand four hundred non-White adolescents were recruited from six sites that were part of a collaborative project. Surveys were administered either during the school day or at community facilities. All students at each site were asked 10 questions about recent violence-related behaviors (including use of threats, fighting, weapon carrying, and weapon use). Prevalence of each violence-related behavior was reported within and across sites, and stratified by race/ethnicity, gender, age, and other characteristics expected to influence the behaviors. Results: Sixty-six percent (66%) of the middle school students sampled reported being involved in some type of recent fighting and/or weapon-related behaviors. Sixty-one percent (61%) indicated some form of fighting behavior in the past 3 months (threatening to beat someone up, physical fighting, and/or being hurt in a fight). Thirty percent (30%) of participating youth reported one or more weapon-related behaviors (threatening to use a weapon, carrying a weapon, using a weapon, and/or being cut, stabbed or shot at). Reported gun carrying among males varied depending upon site, but was as high as 20%. Grade in school was positively associated with reported violent behaviors. Adolescents who reported living full-time with a parent or parent figure, and those who reported religious observance or beliefs, were less likely to report violence involvement. All violence-related behaviors were more common among male than female adolescents. Conclusions: Violence prevention efforts should begin in elementary school and continue throughout adolescence. Programs should be prepared to provide services or referrals to victims of violence, implement programs tailored toward females as well as males, and build partnerships with churches and other community organizations in which youth are involved.     

Vaccine-preventable,hospitalizations among American Indian/Alaska Native children using the 2012 Kid’s Inpatient Database

Our aim was to assess the odds of hospitalization for a vaccine-preventable, infectious disease (VP-ID) in American Indian/Alaska Native (AI/AN) children compared to other racial and ethnic groups using the 2012 Kid’s Inpatient Database (KID) The KID is a nationally representative sample, which allows for evaluation of VP-ID in a non-federal, non-Indian Health Service setting. In a cross-sectional analysis, we evaluated the association of race/ethnicity and a composite outcome of hospitalization due to vaccine-preventable infection using multivariate logistic regression. AI/AN children were more likely (OR = 1.81, 95% CI = 1.34, 2.45) to be admitted to the hospital in 2012 for a VP-ID compared to Non-Hispanic white children after adjusting for age, sex, chronic disease status, metropolitan location, and median household income. This disparity highlights the necessity for a more comprehensive understanding of immunization and infectious disease exposure among American Indian children, especially those not covered or evaluated by Indian Health Service.     

Patterns of Cigarette and Smokeless Tobacco Use Before, During, and After Pregnancy Among Alaska Native and White Women in Alaska, 2000–2003

Objective To examine patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska Native (AN) and white women living in Alaska. Methods We used data from the 2000–2003 population-based Pregnancy Risk Assessment Monitoring System to describe patterns of self-reported prenatal tobacco use among AN and white women. We used multiple variable logistic regression analysis to identify maternal factors associated with quitting and relapse. The final sample included 5,458 women. Results During 2000–2003, the prevalence of any tobacco use before pregnancy was twofold higher among AN women than among white women (60.0 vs. 27.5%), and the prevalence of any tobacco use during pregnancy and after pregnancy were each nearly threefold higher. Of the 25.8% (SE 0.9) of white women who smoked before pregnancy, 49.0% (SE 2.1) reported that they quit during pregnancy and of those, 41.1% (SE 2.9) relapsed postpartum. Of the 38.5% (SE 0.9) of AN women who smoked before pregnancy, 35.7% (SE 1.4) quit, and of those 57.0% (SE 2.4) relapsed. Of the 14.2% of AN women who chewed tobacco before pregnancy, 15.7% (SE 1.7) quit, and of those, 52.9% (SE 5.9) relapsed. Conclusion During 2000–2003, the prevalence of tobacco use was two to three times higher among AN women than among white women before, during, and after pregnancy. In addition, AN women had lower quit rates and higher relapse rates than white women. Comprehensive, culturally appropriate tobacco control approaches targeting AN women are needed to increase cessation during pregnancy and to decrease relapse.     

Assessing Disparities in the Rates of HCV Diagnoses Within American Indian or Alaska Native Populations Served by the U.S. Indian Health Service, 2005–2015

Hepatitis C virus (HCV) disproportionately affects American Indians/Alaska Natives (AI/AN). The Indian Health Service (IHS), via federal and tribal health facilities provides medical services to an estimated 2.2 million AI/AN people in the United States. HCV diagnoses, defined by International Classification of Diseases 9th Revision, Clinical Modification (ICD-9-CM) codes, were analyzed from 2005 to 2015. Results showed 29,803 patients with an HCV diagnosis; 53.4% were among persons born 1945–1965 and overall HCV burden was higher among males than females. These data will help inform local, regional, and national efforts to address, plan for and carry out a national strategy to provide treatment for HCV infected patients and programs to prevent new HCV infections.     

All-Cause and Cause-Specific Mortality among US Youth: Socioeconomic and Rural–Urban Disparities and International Patterns

We analyzed international patterns and socioeconomic and rural–urban disparities in all-cause mortality and mortality from homicide, suicide, unintentional injuries, and HIV/AIDS among US youth aged 15–24 years. A county-level socioeconomic deprivation index and rural–urban continuum measure were linked to the 1999–2007 US mortality data. Mortality rates were calculated for each socioeconomic and rural–urban group. Poisson regression was used to derive adjusted relative risks of youth mortality by deprivation level and rural–urban residence. The USA has the highest youth homicide rate and 6th highest overall youth mortality rate in the industrialized world. Substantial socioeconomic and rural–urban gradients in youth mortality were observed within the USA. Compared to their most affluent counterparts, youth in the most deprived group had 1.9 times higher all-cause mortality, 8.0 times higher homicide mortality, 1.5 times higher unintentional-injury mortality, and 8.8 times higher HIV/AIDS mortality. Youth in rural areas had significantly higher mortality rates than their urban counterparts regardless of deprivation levels, with suicide and unintentional-injury mortality risks being 1.8 and 2.3 times larger in rural than in urban areas. However, youth in the most urbanized areas had at least 5.6 times higher risks of homicide and HIV/AIDS mortality than their rural counterparts. Disparities in mortality differed by race and sex. Socioeconomic deprivation and rural–urban continuum were independently related to disparities in youth mortality among all sex and racial/ethnic groups, although the impact of deprivation was considerably greater. The USA ranks poorly in all-cause mortality, youth homicide, and unintentional-injury mortality rates when compared with other industrialized countries.     

Sexual Orientation and Suicide Ideation,Plans, Attempts,and Medically Serious Attempts: Evidence From Local Youth Risk Behavior Surveys, 2001–2009

Objectives. We examined the associations between 2 measures of sexual orientation and 4 suicide risk outcomes (SROs) from pooled local Youth Risk Behavior Surveys.Methods. We aggregated data from 5 local Youth Risk Behavior Surveys from 2001 to 2009. We defined sexual minority youths (SMYs) by sexual identity (lesbian, gay, bisexual) and sex of sexual contacts (same- or both-sex contacts). Survey logistic regression analyses controlled for a wide range of suicide risk factors and sample design effects.Results. Compared with non-SMYs, all SMYs had increased odds of suicide ideation; bisexual youths, gay males, and both-sex contact females had greater odds of suicide planning; all SMYs, except same-sex contact males, had increased odds of suicide attempts; and lesbians, bisexuals, and both-sex contact youths had increased odds of medically serious attempts. Unsure males had increased odds of suicide ideation compared with heterosexual males. Not having sexual contact was protective of most SROs among females and of medically serious attempts among males.Conclusions. Regardless of sexual orientation measure used, most SMY subgroups had increased odds of all SROs. However, many factors are associated with SROs.Suicide is the 10th leading cause of death overall and the 3rd leading cause of death among youths aged 10 to 24 years. In 2010, more than 157 000 people in this age group visited US emergency departments because of attempted suicide or other self-harm injuries.1 Media reports convey the message that sexual minority youths (SMYs) have much greater rates of suicide (i.e., self-inflicted death) than do non-SMYs; however, the unavailability of sexual orientation information on death certificates makes this impossible to confirm or refute using archival data. What is known is that studies document large disparities in key indicators of suicide risk among SMYs, including suicidal ideation (i.e., considering suicide) and suicide attempts (i.e., nonfatal self-directed potentially injurious behavior with the intent to die).2–5 In early studies, often using small convenience samples without comparison groups, 20% to 40% of SMYs reported suicidal ideation and attempts.6–8 Later population-based surveys confirmed these reports and found odds of suicidal ideation and attempts up to 5 to 6 times greater among SMYs than among non-SMYs.9–16 Researchers understand this increased risk for suicide ideation and attempts in the context of minority stress,17,18 whereby a hostile social environment characterized by stigma, prejudice, and discrimination may be associated with increases in individual risk factors for suicide, including depression, substance abuse, social isolation, peer conflict, and victimization4,5,11,19–32 and decreases in protective factors such as supportive relationships with peers and family.33–35We sought to expand what is known about the risk of suicide among SMYs by addressing gaps in the research related to the measurement of both sexual orientation and suicide risk outcomes (SROs). That is, most studies on the topic measure only suicide ideation or attempts.11–15,36,37 Less is known about the full range of suicidal behaviors, including suicide planning and medically serious attempts (MSAs). These outcomes are important, as they indicate sustained injury and may indicate increased risk for future suicide, suicide attempt, or repeat attempts.38–41 Indeed, some research suggests that SMYs not only make more medically serious attempts but also have greater intent to die.10,42,43 Other research contests these findings.44 The Youth Risk Behavior Survey (YRBS) is a population-based study of high school students administered nationally, statewide, and locally that measures ideation, plans, attempts, and MSAs. Four state or local sites have published studies examining sexual orientation and SROs.9,16,37,45–48 All studies examined suicide attempts, 3 measured ideation,37,46,47 4 measured plans,37,45–47 4 measured MSAs,16,37,46,47 and 1 measured all.37 In this last study, the sample size precluded conducting adjusted analyses. A recent Centers for Disease Control and Prevention study reported prevalence rates of all SROs by sexual orientation for each of the selected state and local sites that collected sexual orientation information.49 We aggregated data across local sites providing adequate power to test the associations between sexual orientation and SROs while accounting for a range of risk factors and demographic variables. The use of data across local sites that are also urban areas adds a unique aspect to this study, as little is known about the associations between sexual orientation and SROs among urban populations.In addition to expanded measurement of SROs and a unique sample, we have provided multiple measures of sexual orientation. Most studies measure a single dimension of sexual orientation, typically sexual identity (e.g., lesbian, gay, bisexual [LGB]) or sexual behavior (sexual contact with opposite, same, or both sexes).29,32,50 This assumes that dimensions of sexual orientation are interchangeable and that 1 measure correctly identifies all SMYs. Sexual orientation, however, is multidimensional and dimensions may not overlap.9,49,51 For example, SMYs of color may engage in sexual contact with same-sex partners but not identify as sexual minorities because of social stigma.52 We have added to the research base and examined the associations between sexual orientation and SROs using 2 of 3 recommended dimensions of sexual orientation—sexual identity and sexual behavior53—with sexual attraction being the third and currently unavailable recommended measure. Finally, to avoid obscuring important within-group differences imposed by dichotomous measures of sexual orientation (e.g., LGB vs heterosexual),9,10,12,15,16,45,54 we analyzed subgroups of males and females on the basis of sexual identity and sex of sexual contacts, including the less studied population of youths who are unsure of their sexual identity.15,42 Using data from a unique urban sample and with expanded measures of sexual orientation and SROs, we asked the following questions:

1. On average, do youths who report their sexual identity as LGB or unsure have increased odds of suicide ideation, plans, suicide attempts, and medically serious attempts compared with heterosexual youths, controlling for a range of individual-level risk factors and demographic variables?
2. On average, do youths who report same- or both-sex sexual contact have increased odds of suicide ideation, plans, suicide attempts, and medically serious attempts compared with youths who have sexual contact with opposite-sex partners only, controlling for all other factors?

     

Suicide Risk in Nursing Homes and Assisted Living Facilities: 2003–2011

Objectives. We investigated the epidemiology of suicide among adults aged 50 years and older in nursing homes and assisted living facilities and whether anticipating transitioning into long-term care (LTC) is a risk factor for suicide.Methods. Data come from the Virginia Violent Death Reporting System (2003–2011). We matched locations of suicides (n = 3453) against publicly available resource registries of nursing homes (n = 285) and assisted living facilities (n = 548). We examined individual and organizational correlates of suicide by logistic regression. We identified decedents anticipating entry into LTC through qualitative text analysis.Results. Incidence of suicide was 14.16 per 100 000 in nursing homes and 15.66 in the community. Better performance on Nursing Home Compare quality metrics was associated with higher odds of suicide in nursing homes (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.21, 3.14). Larger facility size was associated with higher suicide risk in assisted living facilities (OR = 1.01; 95% CI = 1.00, 1.01). Text narratives identified 38 decedents anticipating transitioning into LTC and 16 whose loved one recently transitioned or resided in LTC.Conclusions. LTC may be an important point of engagement in suicide prevention.Approximately 40% of adults aged 65 years and older will need skilled residential nursing care at some point in their lifetime.1 Older adults have among the highest suicide risks in the United States2; the rate of suicide among men aged 65 years and older is 30 per 100 000; by contrast, it is 7 per 100 000 for men younger than 25 years.3 A key element of suicide prevention is the identification of points of engagement to interact with potential victims.4 Risk factors for suicide, such as social isolation, depression, and functional impairment, are common among long-term care (LTC) residents,5–7 and these facilities may therefore be important locations for preventing suicide among older adults. Indeed, the 1987 Nursing Home Reform Act mandated screening of LTC admissions to facilitate appropriate placement and increased psychiatric services,8 and the Minimum Data Set 3.0 includes a mandatory screener for depressive symptoms and suicidal ideation.9 Nearly 1.5 million adults reside in nursing homes,10,11 and another 1 million reside in assisted living facilities.12Little is known regarding risk and protective factors for suicide in LTC.13 In 2011 the Substance Abuse and Mental Health Services Administration released a tool kit on preventing suicide in senior-living communities, which notes,

We do not know how many residents of senior living communities attempt suicide or die by suicide. But, we do know that a suicide in a facility . . . profoundly impacts the lives of everyone concerned—residents, families, and staff.^14(p4)

Suicidal ideation is common among LTC residents, with between 5% and 33% reporting ideation (active or passive) within the past month.15 As a result, suicide risk may be substantial in these facilities despite countervailing factors such as regular monitoring by staff and limited access to lethal means. The handful of studies that have compared incidence of completed suicide in LTC to the general community are mixed, with 1 reporting higher16 and another reporting lower17 risk in these settings.Suicidal behavior in LTC likely reflects a combination of factors shared with community cases (e.g., presence of a psychiatric disorder), as well as factors that are unique to LTC (e.g., facility characteristics). For example, bed size (number of beds) and high staff turnover have been associated with higher risk of suicidal behaviors among residents.18,19 However, these studies were conducted in the 1980s, prior to the growth of assisted living,20 which reduces their applicability to modern facilities. Finally, it is unknown whether the transition to LTC, or the process of having a loved one transition, is a risk factor for suicide.21 These transitions often involve a complex interplay of social and psychological factors, including feelings of autonomy, social connectedness, and identity,22,23 and can produce feelings of anxiety, loneliness, and hopelessness because they affect a people’s sense of being at home, which is not simply their physical residence.24 Such transitions have potential implications for the psychological well-being of caregivers of the person moving into LTC as well.25To identify whether LTC settings are important points of engagement for reducing suicide risk among older adults,4,26 we analyzed data from the 2003 to 2011 Virginia Violent Death Reporting System (VVDRS). We aimed to (1) describe the epidemiology of completed suicide in nursing homes and assisted living facilities, (2) examine whether facility characteristics were related to suicide risk, and (3) assess whether the process of transitioning into an LTC facility was associated with suicide.     

Assessment of Sexual Behavior,Sexual Attitudes,and Sexual Risk in Sweden (1989–2003)

To assess changes in sexual behavior, sexual attitudes, and sexual risk related to HIV, we conducted mailed questionnaire surveys in random samples of the Swedish general population in 1989, 1994, 1997, 2000, and 2003 (total N = 13,762). Each sample consisted of 4,000–6,000 subjects aged 16–44 years, stratified by age: 16–17, 18–19, 20–24, 25–34, and 35–44 years. The overall participation rate was 63.8% (for men, 55.9%; for women, 71.9%). The prevalence of three or more sexual partners and casual sexual contacts without the use of a condom was comparatively high for men, for persons aged 16–24 years, single persons with and without a regular partner, and persons living in towns and urban areas. The prevalence of multiple sexual partners and casual sexual contacts increased significantly over time. There was a significant decrease in the proportion of participants who agreed with the statement Sexual intercourse should only take place in a stable relationship. Personal risk assessments related to HIV did not change significantly over time. The study shows that risky sexual behavior related to HIV/AIDS increased in the Swedish population between 1989 and 2003, and that attitudes concerning casual sexual relations became more permissive.     

Acculturation and Metabolic Syndrome Risk Factors in Young Mexican and Mexican–American Women

Little is known about effects of acculturation on disease risk in young Mexican and Mexican–American women living in a border community. The purpose of this study was to examine relationships between acculturation and features of metabolic syndrome (MetS) in Mexican and Mexican–American women (n = 60) living in the largest US-Mexico border community. Acculturation was measured by the short acculturation scale for Hispanics and birthplace. Body composition was measured by Bod Pod and daily physical activity was measured by questionnaire and accelerometer. Increased acculturation was related to individual features of MetS and increased risk of MetS. These relationships were mediated by fat mass rather than inactivity. Fat mass mediates the relationships between acculturation and individual features of MetS in young Mexican and Mexican–American women. These findings suggest that fat mass, rather than inactivity, is an important contributor to disease risk in young Mexican and Mexican–American women living in a large US/Mexico border community.