Tuberculosis infection among young adults enlisting in the United States Navy

BACKGROUND: Tuberculosis (TB) is a re-emerging infectious disease threat worldwide. To protect the health and readiness of US military personnel, policies exist to screen for and treat latent TB infection at the time of service entrance. RESULTS: of this screening programme have not been recently described. METHODS: Multivariate regression techniques were used to evaluate demographic and medical data associated with TB infection among all young adults entering US Navy enlisted service between 1 October 1997 and 30 September 1998. Results A total of 44,128 adults (ages 17-35, 81% male) were screened for TB during this 12-month period. The prevalence of latent TB infection was 3.5%. Place of birth was very strongly associated with TB infection, with foreign-born recruits eight times more likely to have a reactive tuberculin skin test or history of infection. Those who reported their race as 'Asian/Pacific Island' had 3.8 times the odds of having evidence of TB infection compared with 'Caucasian' recruits, even after adjusting for place of birth. CONCLUSIONS: The prevalence of TB infection among Navy recruits was last reported as 2.5% nearly 10 years ago. The apparent increase to 3.5% in this large cohort is likely due to a concurrent increase in the number of foreign-born recruits, and it serves to underscore the importance of comprehensive screening and treatment of latent TB infections in this population.     

HIV testing among young adults in the United States: associations with financial resources and geography

We estimated prevalence and odds ratios for self-reported HIV testing among sexually experienced young adults using nationally representative data obtained from Wave III of the National Longitudinal Study of Adolescent Health (Add Health). The prevalence of testing in the past year was 18.8%.Young adults who had private or no health insurance were less likely to report testing than were young adults who had public health insurance, particularly in the South. Respondents with functional income were less likely to report testing than were those without functional income, particularly in the South and Northeast. Variable HIV testing based on finances and insurance should be addressed.     

Self-rated health among multiracial young adults in the United States: findings from the add health study

Objective: The multiracial adult population is one of the fastest growing segments of the U.S. population, yet much remains to be learned about multiracial health. Considerable research finds racial/ethnic disparities in self-rated health, however subgroups within the multiracial population have not been consistently described.

Design: We use data from the National Longitudinal Survey of Adolescent Health (Add Health) and multivariate logistic regression analyses to compare self-rated health of multiracial and monoracial young adults (n?=?7880).

Results: Overall, there were no significant differences in poor self-rated health status of multiracial adults as a single group odds ratio 0.84 (95% CI: 0.52–1.36) compared to monoracial White adults. Analyses further revealed important variations in health-status by specific subgroups and show that some multiracial subgroups may not fit existing patterns of health disparities. For instance, Asian-White multiracial adults do not fit documented patterns of health disparities and report better health than monoracial Asian and monoracial White adults.

Conclusion: This study illustrates that the inclusion of specific multiracial categories provides evidence to enhance understanding of the pathways that are linked to health outcomes and the implications for health disparities.     

HIV antibody testing among adults in the United States: data from 1988 NHIS.

Data collected from 21,168 adults using the 1988 AIDS supplement to the National Health Interview Survey were examined to determine awareness of and experience with HIV antibody testing in the United States. Three-fourths of adults knew of the blood test for HIV antibodies; awareness was lower among Blacks, Hispanics, older adults, and those less educated. Overall, 17 percent of adults had been tested; of these, 73 percent because of blood donation, 14 percent through other non-voluntary programs (such as military induction), and 16 percent sought testing voluntarily. While a smaller proportion of Black and Hispanic adults had been tested, they were more likely than their White non-Hispanic counterparts to have been tested voluntarily. Persons who reported belonging to groups with high-risk behaviors were also more likely to have been voluntarily tested. Most of those tested voluntarily received their test results, but only one-third also received prevention information. Three percent of adults plan to be tested voluntarily in the next year; about half will seek testing through their doctor or health maintenance organization.     

Perceived risk of chlamydial and gonococcal infection among sexually experienced young adults in the United States

CONTEXT: Understanding young adults' perceived risk of chlamydial and gonococcal infection can inform interventions to reduce the prevalence of these sexually transmitted diseases. METHODS: Bivariate and multivariate analyses, using data from Wave 3 of the National Longitudinal Study of Adolescent Health (2001-2002), were conducted to examine relationships between perceived risk and selected characteristics in two groups: a nationally representative sample of sexually experienced 18-26-year-olds and a subsample of those who tested positive for chlamydia or gonorrhea. The relationship between current infection and perceived risk was also evaluated. RESULTS: Only 14% of all respondents and 33% of infected participants reported some perceived risk of chlamydial or gonococcal infection. In the overall sample, the odds of perceiving risk were significantly elevated among blacks, Hispanics, unmarried respondents, inconsistent condom users and nonusers, respondents who reported multiple partners in the past year, those who had received a diagnosis of chlamydia or gonorrhea in the past year, and those reporting current symptoms (odds ratios, 1.5-3.3). Currently infected participants were significantly more likely than those who were not infected to perceive some risk of infection (2.4). Among infected respondents, the factors positively associated with perceived risk were being black or Hispanic, using condoms inconsistently or not using them, having exchanged money for sex, having been tested in the past year but with no diagnosis, having received a diagnosis, and reporting current symptoms (2.5-5.2). CONCLUSIONS: Interventions to increase the accuracy of young adults' risk perceptions may influence sexual and health care-seeking behaviors in a way that will reduce rates of chlamydia and gonorrhea.     

Assessment of recent HIV testing among older adults in the United States

Older adults are the fastest growing segment of people living with HIV, and unfortunately many are unaware of their HIV status. Many providers are reluctant to ask older adults about their sexual histories, evaluate their risk factors, and test for HIV, and older adults have low perception of HIV risk. Using data from the 2013 to 2014 National Health and Nutrition Examination Survey, this study assessed the prevalence of recent HIV testing among older adults in the United States (n = 1,056) and identified predictors and barriers to recent HIV testing. The prevalence of recent HIV testing was 28%. Recent HIV testing was associated positively with male gender, education level, having public insurance, having same sex sexual behavior, African, and Hispanic ethnicity, whereas age, income-to-poverty ratio, and Asian ethnicity were associated negatively with recent HIV testing. Public health social workers are advised that targeted HIV testing for Asian, economically disadvantaged, female older adults is needed to increase HIV awareness and detection and to decrease late diagnosis of HIV. Provided public insurance was identified as a predictor of recent HIV testing, facilitating economically disadvantaged older adults’ eligibility for public insurance that will likely improve access to HIV testing services and increase HIV testing rates.     

Public policy and smoking cessation among young adults in the United States

In the wake of significant budget shortfalls, numerous states have increased cigarette excise taxes to boost revenues. This study examines whether or not increasing the price of cigarettes, which will occur as a consequence of cigarette excise tax increases, and implementing stronger restrictions on smoking in private worksites and other public places have an impact on smoking cessation decisions of young adults, thereby influencing public health in the United States (US). This paper employs longitudinal data on young adults from the Monitoring the Future Surveys matched with information on site-specific prices and measures of clean indoor air restrictions. A Cox regression is employed to estimate the smoking cessation equations. The estimates clearly indicate that increasing the price of cigarettes increases the number of young adults who quit smoking. The average price elasticity of cessation is 0.35. In addition, stronger restrictions on smoking in private worksites and public places other than restaurants increase the probability of young adult smoking cessation. Given the well-documented benefits of smoking cessation, a significant increase in cigarette excises taxes may be one of the most effective means to reduce premature death and disease in the United States.     

Prevalence of influenza-specific vaccination hesitancy among adults in the United States, 2018

BackgroundThe role of vaccine hesitancy on influenza vaccination is not clearly understood. Low influenza vaccination coverage in U.S. adults suggests that a multitude of factors may be responsible for under-vaccination or non-vaccination including vaccine hesitancy. Understanding the role of influenza vaccination hesitancy is important for targeted messaging and intervention to increase influenza vaccine confidence and uptake. The objective of this study was to quantify the prevalence of adult influenza vaccination hesitancy (IVH) and examine association of IVH beliefs with sociodemographic factors and early-season influenza vaccination.MethodsA four-question validated IVH module was included in the 2018 National Internet Flu Survey. Weighted proportions and multivariable logistic regression models were used to identify correlates of IVH beliefs.ResultsOverall, 36.9% of adults were hesitant to receive an influenza vaccination; 18.6% expressed concerns about vaccination side effects; 14.8% personally knew someone with serious side effects; and 35.6% reported that their healthcare provider was not the most trusted source of information about influenza vaccinations. Influenza vaccination ranged from 15.3 to 45.2 percentage points lower among adults self-reporting any of the four IVH beliefs. Being female, age 18–49 years, non-Hispanic Black, having high school or lower education, being employed, and not having primary care medical home were associated with hesitancy.ConclusionsAmong the four IVH beliefs studied, being hesitant to receiving influenza vaccination followed by mistrust of healthcare providers were identified as the most influential hesitancy beliefs. Two in five adults in the United States were hesitant to receive an influenza vaccination, and hesitancy was negatively associated with vaccination. This information may assist with targeted interventions, personalized to the individual, to reduce hesitancy and thus improve influenza vaccination acceptance.     

Recent trends in violent deaths among young adults in the United States.

Those Americans who feel that theirs has become an increasingly violent society have support for that belief in recent mortality statistics. Since 1960, death rates in the United States among young adults from motor vehicle accidents, homicide, and suicide have increased dramatically. As of 1973, homicide and suicide rates have shown no indication of leveling off. Death rates from nonviolent causes among young adults, however, are declining, particularly among nonwhite females.     

Missed conceptions or misconceptions: perceived infertility among unmarried young adults in the United States

CONTEXT: Perceived infertility is an individual’s belief that she or he is unable to conceive or impregnate, regardless of whether this belief is medically accurate. This perception may lead to contraceptive nonuse, which may, in turn, lead to unintended pregnancy. Little research has examined perceived infertility among young adults, including potential associations with contraceptive behaviors. METHODS: The frequency of perceived infertility among young adults was assessed using 2009 data from a nationally representative telephone survey of 1,800 unmarried men and women aged 18–29. Multinomial regression analyses assessed associations between respondents’ perceived infertility and selected background, reproductive knowledge, sexual experience and contraceptive use characteristics. RESULTS: Overall, 19% of women and 13% of men believed that they were very likely to be infertile. Hispanic women and women who had received public assistance in the past year had elevated odds of perceived infertility (odds ratios, 3.4 and 3.0, respectively), as did Hispanic men and men of other racial or ethnic minorities, except blacks (2.5 and 6.1, respectively). Men who had some college education, had received sex education or were not in a current relationship had decreased odds of thinking they were very likely to be infertile (0.3–0.4). Among men, perceived infertility was associated with the belief that they were likely to have sex without using a contraceptive in the next three months (2.6). CONCLUSIONS: A substantial proportion of young adults believe they are infertile. Improved provider counseling and sex education may be useful in helping them to better understand their actual probability of infertility, and this knowledge may lead to improved contraceptive use.     

Neighborhood social disorganization and the acquisition of trichomoniasis among young adults in the United States

Objectives. We examined relationships between neighborhood social disorganization and trichomoniasis among young US adults.Methods. We employed multilevel logistic regression modeling with secondary data from wave III of the National Longitudinal Study of Adolescent Health (2001–2002). The dependent variable—trichomoniasis—was measured via urine testing. The measures for neighborhood social disorganization were derived from the 2000 US Census—racial and ethnic composition, concentrated poverty, and residential instability. The sample comprised 11 370 individuals across 4912 neighborhoods.Results. Trichomoniasis was more likely in neighborhoods with higher concentrations of Black residents (adjusted odds ratio [AOR] = 1.16; 95% confidence interval [CI] = 1.03, 1.30). However, this association was mediated by neighborhood concentrated poverty. Furthermore, young adults who lived in neighborhoods with higher concentrations of poverty were significantly more likely to have trichomoniasis (AOR = 1.25; 95% CI = 1.07, 1.46). Neither immigrant concentration nor residential instability was significantly associated with trichomoniasis.Conclusions. These findings strengthen the evidence that neighborhood structural conditions are associated with individual sexually transmitted infection (STI) acquisition. Research is needed to explore the mechanisms through which these conditions influence STI. In addition, STI-prevention programs that include structural interventions targeting neighborhood disadvantage are needed.Adolescents and young adults are at increased risk for sexually transmitted infections (STIs) because of a complex interplay of biological, behavioral, and developmental factors.¹ Nearly half of all STIs diagnosed in the United States annually are among adolescents and young adults^1,2 despite national priority goals aimed at reducing infection rates.³ Trichomoniasis, a common and easily curable STI,¹ is of increasing concern because the infection facilitates HIV acquisition and transmission through mucosal inflammation of the genital tract and alterations in the innate immune response. ^4-7 The infection is caused by the protozoa, Trichomonas vaginalis, and is typically transmitted via penis-to-vagina or vulva-to-vulva contact.¹ Infected persons are often asymptomatic or experience only mild symptoms,¹ which can hinder early detection and treatment and increase the risk of STIs and HIV.In the United States, the prevalence of trichomoniasis is difficult to ascertain because routine screening currently is not recommended nor is the reporting of positive results required.^1,4 According to urine assay data from the National Longitudinal Study of Adolescent Health (Add Health), the prevalence of trichomoniasis among the young adult population in 2001–2002 was approximately 2.3%.⁷ The study also found that women were at greater risk than were men (2.8% vs 1.7%) as were non-Hispanic Black (6.9%) and Latino (2.1%) youths compared with their non-Hispanic White peers (1.2%).⁷ In other studies of adult women, individual risk factors for trichomoniasis included poverty, lower education, douching, non-Hispanic Black race/ethnicity, and greater numbers of lifetime sexual partners.^8,9 Among clinic samples of adolescent women, research found trichomoniasis to be associated with older male sexual partners, casual sexual activity, marijuana use, and delinquency.¹⁰However, to date, no studies have examined the role of the broader structural context in shaping trichomoniasis risk, despite theory and previous STI research suggesting that the neighborhood environment may play a role. According to social disorganization theory,^11–14 key indicators of neighborhood structural disadvantage (i.e., racial/ethnic composition, concentrated poverty, and residential instability) influence health outcomes by weakening social ties, reducing access to institutional resources, and limiting exposure to positive role models, conventional social norms, and collective efficacy. Findings from previous research examining other STIs support the hypothesis that neighborhood contexts influence STI prevalence. For example, with respect to racial and ethnic composition, studies have found that gonorrhea rates were higher in cities and neighborhoods with greater proportions of Black residents.^15,16 Furthermore, in an analysis of Chicago neighborhoods, the incidence rates of gonorrhea and chlamydia were higher for neighborhoods in which more than 60% of the residents were Black compared with those in which more than 60% of residents were Hispanic, which suggests that segregated Hispanic ethnic enclaves may be protective of STI compared with segregated Black communities.¹⁷ Researchers hypothesize that the residential segregation of Black communities has contributed to the pervasive Black-White disparities in STI through discrimination processes, which in turn has led to greater concentration of poverty, lower male-to-female gender ratios due to the disproportionate incarceration and mortality of Black men, and closed, racially segregated sexual networks that facilitate the transmission of infection.^18–20In addition, the role of community poverty in shaping STI risk has been examined extensively and found to be positively associated with rates of chlamydia, gonorrhea, syphilis, and HIV in cross-sectional^{15,17,21–23} and longitudinal analyses.¹⁶ Other socioeconomic factors, such as unemployment^17,24 and lower educational attainment,^16,17 have also been linked to higher rates of chlamydia and gonorrhea. Research on the effects of residential instability on STI is limited, but the single study that examined these relationships found greater residential instability was associated with fewer self-reported STIs among a national sample of adolescents.²⁴ Depending on the context, perhaps residential instability could increase STI risk by disrupting social support ties and informal social control measures or reduce STI risk by dispersing closed sexual networks that facilitate infection transmission.Although the aforementioned studies have illustrated links between neighborhood social disorganization and a variety of STIs, limitations exist. First, the majority have been ecological studies, in which the outcomes were measured as community STI rates and no adjustment was made for potential confounding relationships with individual-level data.^{15–17,21–23} Consequently, inferences can be made only about the community, and individual variation in the outcome cannot be ascertained.²⁵ Second, although 1 study examined individual STI, the measure was based on self-report,²⁴ which potentially increases bias because of underreporting as well as unrecognized or undiagnosed infection. In addition, the study only focused on STI in general, which could limit our understanding of unique relationships with specific infectious organisms. Third, data sources of previous research tend to be at local or state levels,^{15–17,21–23} which limits external validity of the findings. Therefore, the purpose of our research was to examine relationships between neighborhood social disorganization and trichomoniasis among young adults in the United States. Our research builds on previous studies in 3 significant ways: (1) we examined multiple levels of analysis, which enabled us to simultaneously examine the independent relationships between individual and neighborhood variables and individual acquisition of trichomoniasis, (2) we examined a more refined measure of STI through the use of urine screening, and (3) we examined data from a large national data set—Add Health.     

Prevalence of body dissatisfaction among United States adults: Review and recommendations for future research

As the evidence supporting the role of body dissatisfaction (BD) in chronic disease risk factors and health behaviors increases, documenting the prevalence of BD is an essential first step in determining to what degree BD is a public health problem. Therefore, the primary purpose of this study is to critically evaluate research examining the population prevalence of BD among U.S. adults. Seven studies were located and provided estimates of prevalence of BD among U.S. adults that were extremely varied (11%–72% for women, and 8%–61% for men). While some of the variation may be due to increases in BD over time, the literature is also clouded by a lack of randomly selected samples, lack of consistency in measurement tools, lack of consistency in operational definitions of BD, and lack of standardized cut-off points for BD. Recommendations for improving BD prevalence research to enable public health research are provided.     

Health care seeking for HIV/AIDS among South Asians in the United States

Health-related behavior is a function of the sociocultural and environmental contexts in which it occurs. With South Asian immigrants, a comprehensive approach that focuses on community and individual factors may be more effective than an individualistic one. This article explores the factors that may influence HIV/AIDS-related health care seeking by South Asian immigrants to the United States. It focuses on South Asians from Bangladesh, India, and Pakistan. The need to involve the community in any intervention process is discussed. An understanding of the determinants of HIV-related health care seeking and behavioral change factors can help social work practitioners develop effective interventions for and with South Asian immigrants.     

Hepatitis A virus infection in the United States: serologic results from the Third National Health and Nutrition Examination Survey

To determine the prevalence of hepatitis A virus (HAV) infection in the general U.S. population, sera from participants in the Third National Health and Nutrition Examination Survey (NHANES III) conducted in 1988–1994 were tested for antibody to HAV (anti-HAV). Among 21,260 participants aged ≥6 years tested, the overall prevalence of infection was 31.3%, and increased markedly with age. The age-adjusted prevalence was significantly higher among foreign- compared to U.S.-born participants, and was highest among Mexican-Americans and lowest among non-Hispanic whites. Among U.S.-born children, only Mexican-American ethnicity and income below the poverty level were associated with HAV infection in a multivariate model. During this period before hepatitis A vaccination, age, ethnicity and birthplace were the most important determinants of HAV infection in the United States.