Cigarette Smoking and Lesbian and Bisexual Women in the Bronx

This study investigated the prevalence of cigarette smoking, smoking patterns, and smoking cessation efforts of Black and Hispanic lesbian and bisexual women from a poor, urban community. One-on-one interviews were conducted with a convenience sample of 130 self-identified Black and Hispanic lesbian and bisexual women from the Bronx, NY. Bivariate statistics were used to determine differences between Black and Hispanic respondents in smoking prevalence, frequency, desire to quit, and impact on family unit. Fifty-five percent of Black respondents and sixty-two percent of Hispanic respondents were current smokers. Hispanics were more likely than Blacks to have a partner (p < 0.04), 2 or more children (p < 0.05), and an asthmatic in their household (p < 0.02). Hispanics were less likely than Blacks to have ever attempted to quit (p < 0.04) and to have made a serious attempt to quit in the past year (p < 0.02). Culturally sensitive interventions are needed to help Hispanic lesbian and bisexual women move from the pre-contemplative to action stage of quitting. The large proportion of current smokers requires greater access to effective smoking cessation tools.     

Evidence-based medicine grows up

By strategically addressing the challenges and user requirements of EBM, healthcare organizations can implement EBM systems that leverage their existing clinical investments and garner fast clinician adoption.     

Medical staff literature grows

Every now and then it pays to review the more thoughtful literature to make sure that what you learned on the job or in school is still current. Here are some recent books that provide important insights you won't get from reading magazines and newsletters or attending medical staff planning meetings.     

Accessing Primary Care: HIV+ Caribbean Immigrants in the Bronx

This article describes an ecology of health seeking behavior among Bronx residing HIV+ Caribbean immigrants participating in an arm of a U.S. government-funded multi-site evaluation of peer services in the utilization of HIV primary care. Standardized repeat measures were administered at baseline and three four-month intervals. Clinical markers were obtained through medical chart review. Additionally, local data included ethnographic interviews, focus groups, and progress notes. Clinical outcomes were positive for the 55 subjects, 23 of whom were undocumented. Alienation from family, women’s vulnerability to family violence, and difficulties with disclosure, employment, and health care were compounded by undocumented immigration status. Retention was encouraged by the community based site, high levels of peer interaction, and supportive services. Without consideration of broader contexts, peer driven interventions are potentially limited and the realities of immigrant health care are misunderstood through lack of recognition of competing needs.     

Comorbidity-Related Treatment Outcomes among HIV-Infected Adults in the Bronx,NY

Aging, HIV infection, and antiretroviral therapy have been associated with increasing rates of chronic comorbidities in patients with HIV. Urban minority populations in particular are affected by both the HIV/AIDS and chronic disease epidemics. Our objectives were to estimate the prevalence of and risk factors for hypertension, dyslipidemia, and diabetes among HIV-infected adults in the Bronx and describe comorbidity-related treatment outcomes. This was a cross-sectional study of 854 HIV-positive adults receiving care at 11 clinics which provide HIV primary care services; clinics were affiliated with a large urban academic medical center. Data on blood pressure (BP), cholesterol, and glycemic control were collected through standardized chart review of outpatient medical records. We found prevalence rates of 26%, 48%, and 13% for hypertension, dyslipidemia, and diabetes, respectively. Older age, obesity, family history, and current protease inhibitor use were consistently associated with comorbidity. Diabetes treatment goals were achieved less often than BP and lipid goals, and concurrent diabetes was a significant predictor for BP and lipid control. In conclusion, major cardiovascular-related comorbidities are prevalent among HIV-positive adults in the Bronx, especially older and obese individuals. Differences exist in comorbidity-related treatment outcomes, especially for patients with concurrent diabetes. Because cardiovascular risk is modifiable, effective treatment of related comorbidities may improve morbidity and mortality in HIV-infected patients.