The Nurse’s Role in the Prevention of Cervical Cancer Among Underserved and Minority Populations

Since the implementation of the Papanicolaou test, there has been a significant decline in the incidence of cervical cancer over the last 50 years. Despite this reduction, each year there are approximately 11,000 women in the United States diagnosed with cervical cancer, the second most common type of cancer in women worldwide. Infection with oncogenic human papillomavirus (HPV) is necessary for the development of precancerous lesions and the progression to cervical cancer. For those diagnosed with an HPV infection or cervical cancer, a considerable personal and financial burden often results. Recent analyses estimate that the total direct costs associated with cervical dysplasia and cancer are extensive. Additionally, a patient’s quality of life (social, emotional, and sexual functioning) is adversely affected following a diagnosis with an HPV infection or cervical cancer. The data also show disparities in the incidence of cervical cancer and barriers that may contribute to these phenomena in underserved populations. National programs have been implemented and can help reduce the burden of disease, but vaccination against HPV remains the primary method of prevention. In the healthcare field, nurses play many roles, a prominent one being a patient educator. As a result, there is a need to educate nurses about the risks and impact of HPV and cervical cancer. Nurses can be instrumental in educating the public about vaccination and increasing awareness of HPV and cervical cancer among the underserved.     

Are Risk and Protective Factors for Substance Use Consistent Across Historical Time?: National Data From the High School Classes of 1976 Through 1997

Researchers have seldom examined whether risk and protective factors are consistently linked to substance use across historical time. Using nationally representative data collected from 22 consecutive cohorts of high school seniors (approximate N = 188,000) from the Monitoring the Future (MTF) project, we investigated whether correlates of substance use changed across historical time. We found a high degree of consistency across historical time in predictors of past month cigarette use, past month alcohol use, past year marijuana use, and past year cocaine use. Some predictors such as religiosity, political beliefs, truancy, and frequent evenings out were consistently linked to substance use. The consistency of other predictors such as region, parental education, and college plans was contingent in part upon historical time period, the particular substance, and its level of use.     

Testing the keepin’ it REAL Substance Use Prevention Curriculum Among Early Adolescents in Guatemala City

Prevention Science - This article describes a test in Guatemala City of Mantente REAL, a linguistically adapted version of the keepin’ it REAL universal substance use prevention curriculum...     

Surveillance of Tobacco Use Among South Asians in the US: Are We Underestimating Prevalence?

This study employed a randomized split sample survey to assess the accuracy of standard tobacco surveillance measures among South Asians living in the US. 219 South Asian adults completed a web-based survey of “standard” tobacco use questions, as they appear in national surveillance surveys, and half were randomly assigned to also receive questions about South Asian tobacco products. Prevalence of tobacco use was compared by experimental condition, assessed by only the standard questions for the control group (N = 116) and by both standard and South Asian questions for the experimental group (N = 103). Among the experimental group, sensitivity and negative predictive value (NPV) of the standard use definitions were calculated, considering the inclusive definitions as the “gold standard.” Prevalence of any tobacco product use was higher among the experimental group, as was prevalence of smokeless tobacco (SLT) use, relative to the control group (34.7 vs. 17.2 % and 21.2 vs. 4.3 %, respectively). 70.6 and 33.3 % of true tobacco users (any product) and SLT users were correctly classified by the respective standard product questions. A majority of gutka, paan with tobacco, and supari with tobacco users (69, 86, and 75 %, respectively) did not otherwise endorse the standard SLT questions. Current tobacco surveillance measures may underestimate the use of tobacco in the South Asian population residing in the US. These results indicate that careful consideration must be given to how tobacco-related questions are presented to minority populations.     

Tobacco Use Among Married Women in Nepal: The Role of Women’s Empowerment

This study documented the prevalence and correlates of tobacco use among women of reproductive age in Nepal using nationally representative data. We utilized the 2006 Nepal Demographic and Health Survey that interviewed 10,793 women and 4,397 men. We analyzed the couple’s data or households (N = 2,600) in which both husband and wife were interviewed. We examined the effects of women’s empowerment—measured by education, employment, intra-household decisions, and age—on their tobacco use controlling for other individual and household characteristics. Women’s empowerment had mixed effects on tobacco use. While women’s education was inversely associated with their tobacco use, their age, employment and ability to make intra-household mobility decisions were positively associated with smoking. Women with primary and beyond primary education were 48 and 92 % less likely to smoke compared to women with no education, respectively. Tobacco use among women increased dramatically with age from 8 % in teen years to 42 % in their forties. A 1 year increase in age increased the odds of tobacco use by 6 %. Women whose husbands smoked were twice as likely to smoke. Nepal should not only restrict tobacco use in public places by implementing its Tobacco Control and Regulatory Act of 2010 but also focus on encouraging smoke-free homes by increasing awareness about the health consequences of tobacco use and secondhand smoke among populations most likely to smoke that include nearly all men, employed women, women with low levels of education, women whose spouses smoke and those who are 30 and above in age. Additionally, a long term goal should be to ensure at least 5th grade of education for all girls.     

Urban–Rural Differences in Physical Activity in Belgian Adults and the Importance of Psychosocial Factors

Recent research in urban planning and public health has drawn attention to the associations between urban form and physical activity in adults. Because little is known on the urban–rural differences in physical activity, the main aims of the present study were to examine differences in physical activity between urban and rural adults and to investigate the moderating effects of the physical environment on the relationship between psychosocial factors and physical activity. In Flanders, Belgium, five rural and five urban neighborhoods were selected. A sample of 350 adults (20–65 years of age; 35 adults per neighborhood) participated in the study. Participants wore a pedometer for 7 days, and self-reported physical activity and psychosocial data were also collected. Results showed that urban adults took more steps/day and reported more walking and cycling for transport in the neighborhood, more recreational walking in the neighborhood, and more walking for transportation outside the neighborhood than rural adults. Rural adults reported more recreational cycling in the neighborhoods. The physical environment was a significant moderator of the associations between several psychosocial factors (modeling from family, self-efficacy, and perceived barriers) and physical activity. In rural participants, adults with psychosocial scores above average were more physically active, whereas there were no differences in physical activity according to psychosocial factors in urban participants. These results are promising and plead for the development of multidimensional interventions, targeting specific population subgroups. In rural environments, where changing the environment would be a very challenging task, interventions focusing on modifiable psychosocial constructs could possibly be effective.     

What does Access to Maternal Care Mean Among the Urban Poor? Factors Associated with Use of Appropriate Maternal Health Services in the Slum Settlements of Nairobi, Kenya

Objectives The study seeks to improve understanding of maternity health seeking behaviors in resource-deprived urban settings. The objective of this paper is to identify the factors which influence the choice of place of delivery among the urban poor, with a distinction between sub-standard and “appropriate” health facilities. Methods The data are from a maternal health project carried out in two slums of Nairobi, Kenya. A total of 1,927 women were interviewed, and 25 health facilities where they delivered, were assessed. Facilities were classified as either “inappropriate” or “appropriate”. Place of delivery is the dependent variable. Ordered logit models were used to quantify the effects of covariates on the choice of place of delivery, defined as a three-category ordinal variable. Results Although 70% of women reported that they delivered in a health facility, only 48% delivered in a facility with skilled attendant. Besides education and wealth, the main predictors of place of delivery included being advised during antenatal care to deliver at a health facility, pregnancy “wantedness”, and parity. The influence of health promotion (i.e., being advised during antenatal care visits) was significantly higher among the poorest women. Conclusion Interventions to improve the health of urban poor women should include improvements in the provision of, and access to, quality obstetric health services. Women should be encouraged to attend antenatal care where they can be given advice on delivery care and other pregnancy-related issues. Target groups should include poorest, less educated and higher parity women.     

Successful Outcomes in Stroke Following Forced Use: What Are the Contributing Factors?

Forced use is an experimental treatment designed to overcome nonuse of a hemiparetic upper extremity. It has demonstrated significant and long-lasting effects in regaining functional use of the affected arm with select chronic hemiparetic subjects. Occupational therapists, who frequently treat post-acute hemiparetic patients, may benefit from knowing this technique. Since a search of the OT literature uncovered no information on forced use, studies outside the standard OT resources were used. In particular, this review analyzes forced use in an attempt to determine the factors that contribute to its success. Although many factors such as subject criteria, psychological and motor learning factors, time, and use appeared likely to affect the success of forced use, they could not be confirmed through the existing experiments. Future controlled research on the clinical relevance of forced use is suggested.     

Correction to: Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

The Journal of Behavioral Health Services & Research - The professional degree of co-author Kevin Campbell is incorrect. It should be “DrPH” and not “PhD”.     

Correlates of the Sex Trade among African–American Youth Living in Urban Public Housing: Assessing the Role of Parental Incarceration and Parental Substance Use

African–American youth are disproportionately affected by parental incarceration and the consequences of parental substance use. Many adapt to the loss of their parents to prison or drug addiction by engaging in sex-risk behavior, particularly the sex trade. These youth may engage in this risky behavior for a number of reasons. Although previous research has examined this issue, most of these studies have focused on runaway or street youth or youth in international settings. Empirical evidence on correlates of trading sex for money among urban African–American youth is practically missing. Using a sample of 192 African–American youth living in urban public housing, this paper attempts to rectify this gap in knowledge by assessing how individual and parental factors are related to the likelihood of a youth trading sex for money. The sample for this study reported a mean age of 19; 28 % reported having traded sex for money; 30 % had a father currently in prison; and 7 % reported having a mother currently in prison. Maternal incarceration and paternal substance use were associated with a higher likelihood of trading sex for money. Given the potential health risks associated with trading sex for money, understanding correlates of this behavior has important implications for the health of this vulnerable population of youth and urban health in general.     

Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

This study focused on (1) whether disparities in timely receipt of substance use services can be explained in part by the characteristics of the community in which the clients reside and (2) whether the effect of community characteristics on timely receipt of services was similar across racial/ethnic groups. The sample was composed of adults receiving publicly funded outpatient treatment in Washington State. Treatment data were linked to data from the US census. The outcome studied was “Initiation and Engagement” in treatment (IET), a measure noting timely receipt of services at the beginning of treatment. Community characteristics studied included community level economic disadvantage and concentration of American Indian, Latino, and Black residents in the community. Black and American Indian clients were less likely to initiate or engage in treatment compared to non-Latino white clients, and American Indian clients living in economically disadvantaged communities were at even greater risk of not initiating treatment. Community economic disadvantage and racial/ethnic makeup of the community were associated with treatment initiation, but not engagement, although they did not entirely explain the disparities found in IET.     

Vending Machines in Australian Hospitals: Are They Meeting the Needs of the Consumer?

The current report explores how well vending machines are meeting the needs of health care organizations and their staff and visitors in Australia. Hospital vending machines often provide the only source of food through the night to staff and visitors and traditionally offer less-healthy options. Findings presented in this report suggest that vending machines are not meeting current statewide policies and guidelines for healthier food environments in health care. This is despite widespread support for healthier refreshments in hospitals by staff, visitors, and patients. Alternatives to traditional vending and opportunities for nutrition educators and researchers are discussed.     

Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices,Opioid Treatment Programs,and Substance Abuse Treatment Facilities in Urban and Rural Counties

Context

Opioid use disorders are a significant public health problem. In 2002, the FDA approved buprenorphine as an opioid use disorder treatment when prescribed by waivered physicians who were limited to treating 30 patients at a time. In 2006, federal legislation raised this number to 100 patients. Although federal legislators are considering increasing these limits further and expanding prescribing privileges to nonphysicians, little information is available regarding the impact of such changes on buprenorphine use. We therefore examined the impact of the 2006 legislation—as well as the association between urban and rural waivered physicians, opioid treatment programs, and substance abuse treatment facilities—on buprenorphine distributed per capita over the past decade.

Methods

Using 2004-2011 state-level data on buprenorphine dispensed and county-level data on the number of buprenorphine-waivered physicians and substance abuse treatment facilities using buprenorphine, we estimated a multivariate ordinary least squares regression model with state fixed effects of a state’s annual total buprenorphine dispensed per capita as a function of the state’s number of buprenorphine providers.

Findings

The amount of buprenorphine dispensed has been increasing at a greater rate than the number of buprenorphine providers. The number of physicians waivered to treat 100 patients with buprenorphine in both rural and urban settings was significantly associated with increased amounts of buprenorphine dispensed per capita. There was no significant association in the growth of buprenorphine distributed and the number of physicians with 30-patient waivers.

Conclusions

The greater amounts of buprenorphine dispensed are consistent with the potentially greater use of opioid agonists for opioid use disorder treatment, though they also make their misuse more likely. The changes after the 2006 legislation suggest that policies focused on increasing the number of patients that a single waivered physician could safely and effectively treat could be more effective in increasing buprenorphine use than would alternatives such as opening new substance abuse treatment facilities or raising the overall number of waivered physicians.     

Binational Cultural Adaptation of the keepin’ it REAL Substance Use Prevention Program for Adolescents in Mexico

Prevention Science - Sharp increases in substance use rates among youth and the lack of evidence-based prevention interventions in Mexico are a major concern. A team of investigators from Mexico...     

Occupational Therapy and Substance Use Disorders: Are Practitioners Addressing These Disorders in Practice?

Occupational therapy practitioners across all practice settings were surveyed in order to determine whether practitioners were assessing substance use disorders, and what interventions were used with clients who have or were suspected to have substance use disorders. Reasons practitioners did not address a clients' substance use disorder were explored. The perceptions of practitioners regarding their competence to assess and treat substance use disorders were also examined. The results of this study indicated that the majority of occupational therapy practitioners sampled outside the mental health setting did not routinely assess or treat substance use disorders. The findings of this study suggest that practitioners need to incorporate assessment and treatment of substance use disorders and their subsequent occupational performance deficits into daily practice regardless of practice area to assure holistic and comprehensive treatment.     

The Language of Substance Use and Recovery: Novel Use of the Go/No–Go Association Task to Measure Implicit Bias

ABSTRACT

Previous research has found initial evidence that word choice impacts the perception and treatment of those with behavioral health disorders through explicit bias (i.e., stigma). A more robust picture of behavioral health disorder stigma should incorporate both explicit and implicit bias, rather than relying on only one form.

The current study uses the Go/No–Go Association Task to calculate a d′ (sensitivity) indexed score of automatic attitudes (i.e., implicit associations) to two terms, “addict” and “person with substance use disorder.”

Participants have significantly more negative automatic attitudes (i.e., implicit bias) toward the term “addict” in isolation as well as when compared to “person with a substance use disorder.”

Consistent with previous research on explicit bias, implicit bias does exist for terms commonly used in the behavioral health field. “Addict” should not be used in professional or lay settings. Additionally, these results constitute the second pilot study employed the Go/No–Go Association Task in this manner, suggesting it is a viable option for continued linguistic stigma related research.     

The Role of Mass Media in Adolescents’ Sexual Behaviors: Exploring the Explanatory Value of the Three-Step Self-Objectification Process

Archives of Sexual Behavior - This longitudinal study (N = 730) explored whether the three-step process of self-objectification (internalization of appearance ideals, valuing...     

The Urban Health Transition Hypothesis: Empirical Evidence of an Avian Influenza Kuznets Curve in Vietnam?

The literature on development has focused on the concept of transition in understanding the emergent challenges facing poor but rapidly developing countries. Scholars have focused extensively on the health and urban transitions associated with this change and, in particular, its use for understanding emerging infectious diseases. However, few have developed explicit empirical measures to quantify the extent to which a transitions focus is useful for theory, policy, and practice. Using open source data on avian influenza in 2004 and 2005 and the Vietnam Census of Population and Housing, this paper introduces the Kuznets curve as a tool for empirically estimating transition and disease. Findings suggest that the Kuznets curve is a viable tool for empirically assessing the role of transitional dynamics in the emergence of new infectious diseases.