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Objective: To examine health behaviors associated with overweight/obesity by race/ethnicity at a diverse urban college. Participants: 270 undergraduates (77.0% female; 26.7% non-Hispanic white) and median body mass index (BMI) of 23.1 kg/m2. Methods: A questionnaire about health-related behaviors as part of the “Get Fruved” project was used to measure health behaviors (sugar sweetened beverage (SSB), fruit and vegetable consumption, physical activity, stress, and sleep) by race/ethnicity. Multivariable logistic regression was used to assess the adjusted odds of engaging in positive health-related behaviors. Results: Non-Hispanic black and Hispanic students were 64% and 59% less likely to consume lower amounts of SSB. Hispanic students were 83% and 81% less likely to meet vegetable and fruit recommendations. Non-Hispanic black and other (including biracial) had reduced odds of meeting vegetable recommendations (AOR = 0.18 and 0.28). Conclusions: Disparities in SSB, fruit, and vegetable consumption represent potential intervention targets to improve health behaviors among racial/ethnic minorities. © 2020 Taylor & Francis Group, LLC.

Hypotheses concerning possible correlates of sexual satisfaction in marriage were tested using the replies of 797 married women and men of diverse ages to a 70-item mailed questionnaire that contained seven Likert-type sub-scales measuring different sexual and non-sexual variables. Multiple regression analysis, using sexual satisfaction as the dependent variable, yielded a five-variable model that accounted for a significant portion of the variation in sexual satisfaction (Adjusted R Squared = .602). The variable 'overall satisfaction with marriage' had the highest correlation with sexual satisfaction (r = .622), followed by 'satisfaction with non-sexual aspects of the relationship' (r = .609), frequency of spouse/partner orgasm per sexual encounter (r = .529), frequency of sexual activity (r = .370), and 'sexual uninhibitedness' (r = .230). None of three measures of religiosity made a significant contribution to explaining the variation on self reported sexual satisfaction. Men and women did not differ in level of sexual satisfaction, and adding gender to the regression model did not increase the level of explained variation. The results indicate that sexual satisfaction in these married respondents could not be compartmentalized to their sexual interactions, but was strongly associated with non-sexual aspects of the overall marital relationship as well.

PURPOSE: African-, Hispanic-, and Native Americans are underrepresented in the field of epidemiology including degree programs. As part of the assessment component of its mandate, the American College of Epidemiology Committee on Minority Affairs conducted a survey of minority recruitment activities of U.S. epidemiology degree programs. METHODS: The survey, containing questions related to marketing activities, institutional infrastructure, financial support, academic offerings, and receptive/supportive environment, was mailed to all programs identified in Episource as offering epidemiology degrees. Separate responses were requested concerning activities at the department and school levels. RESULTS: Fifty- two completed questionnaires were received (response rate of 79%). All but two institutions had at least one activity conducted by either the department or the school. However, all activities were more common at the school- than at the department-level. Indeed, some activities [a written minority student recruitment plan (6% of departments and 52% of schools), personnel with minority recruitment responsibilities (4% of departments and 73% of schools] were almost exclusively school-sponsored. Although marketing-type activities were the most common minority recruitment tool used by departments, only 21% made visits to minority schools, 17% visited other colleges specifically to recruit minorities, and 12% produced materials targeted to ethnic/racial minorities. Six percent of the departments and 19% of the schools offered financial support (grants, fellowships, scholarships) to almost all underrepresented minority students. CONCLUSIONS: Even though individual epidemiology degree programs may not see a need for general recruitment activities in order to maintain the size of their applicant pool, minority- specific recruitment activities should be undertaken to enhance and diversify that pool. We recommend that epidemiology departments develop, adopt, and implement comprehensive written plans for the recruitment of underrepresented minority students into their programs.

Increasing emphasis on the need for medical student education about substance abuse has led to the development of a variety of training efforts through faculty development. The Yale University School of Medicine Faculty Development Program or CADRE (Clinical Alcohol and Drug Research and Education) was instituted in 1992 for the purpose of enhancing substance abuse teaching in the Yale medical student curriculum. CADRE faculty were identify in internal medicine, pediatrics, and psychiatry. Prior to the program, there was limited formal teaching about substance abuse in the Yale curriculum and no coordinated effort across disciplines. The enhancement of teaching activities occurred primarily within four required “core”; clinical clerkships for third‐and fourth‐year medical students. Student evaluations of this new teaching activity were positive. The CADRE program was successful at developing a multidisciplinary core faculty group with expertise in substance abuse teaching and resulted in the development of a coordinated, multidisciplinary substance abuse curriculum for Yale medical students.

Comparisons of service use and treatment outcomes for 145 black and 236 white homeless veterans with mental disorders showed few differences. A greater improvement in psychiatric symptoms and alcohol problems among white than black veterans did not hold true when black veterans had participated in the residential treatment component of the program. The implications of the findings for the successful treatment of homeless black veterans are discussed.

Objective: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. Methods: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. Results: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. Conclusion: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.

Objectives: This study examined the clinical significance of non-complexed (free) prostate-specific antigen (PSA) in the differential diagnosis of prostate cancer with an emphasis on patients with total PSA values between 4.0 and 10.0 ng/mL (the diagnostic gray zone). Methods: Serum samples were obtained from three specimen banks. Patient samples consisted of 55 untreated historically confirmed primary cancer, 62 men with untreated benign prostatic disease histologically confirmed by 6 negative sextant biopsies, and 64 asymptomatic healthy male controls with normal digital rectal examinations and PSA values less than 4.0 ng/mL. All patients were between the ages of 50 and 75 years. Total PSA levels were determined using the PA immunoassay performed on the TOSOH AIA-1200 automated immunoassay instrument. Free PSA levels were determined using a monoclonal-polyclonal antibody sandwich radioimmunoassay. The proportion of free to total PSA was calculated by dividing the patient's free PSA value by the total PSA value. Results: When all subjects were included, both total PSA and the proportion of free to total PSA significantly differentiated between patients with prostate cancer and patients with benign histologic conditions (P< 0.0001). However, in men with total PSA values between 4.0 and 10.0 ng/mL, the proportion of free to total PSA significantly differentiated between patients with benign and malignant histologic conditions (P = 0.0004), whereas the total PSA did not (P = 0.13). Among this subgroup of patients, the analysis of sensitivity and specificity showed that the proportion of free to total PSA had a clearly higher specificity compared with that of the total PSA at the same level of sensitivity. Conclusions: Measurement of the free PSA level in a patient's serum and calculation of the proportion of free to total PSA enhances the ability to distinguish benign histologic conditions from cancer while retaining high sensitivity for detecting cancer in men who present with total PSA levels between 4.0 and 10.0 ng/mL. A large-scale population-based study is currently in progress to confirm this preliminary finding. © 1995.

Objective: This study evaluated the impact of a Department of Veterans Affairs outreach and residential treatment program for homeless mentally ill veterans on utilization and cost of health care services provided by the VA. Methods: Veterans at nine program sites (N = 1,748) were assessed with a standard intake instrument. Services provided by the outreach program were documented in quarterly clinical reports and in residential treatment discharge summaries. Data on nonprogram VA health service utilization and health care costs were obtained from national VA data bases. Changes in use of services and cost of services from the year before initial contact with the program to the year after were analyzed by t test. Multivariate analyses were used to examine the relationship of these changes to indicators of Clinical need and to participation in the outreach program. Results: Although utilization of inpatient service did not increase after veterans' initial contact with the program, use of domiciliary and outpatient services increased substantially. Total annual costs to the VA also increased by 35 percent, from $6,414 to $8,699 per veteran per year. Both clinical need and participation in the program were associated with increased use of health services and increased cost. Veterans with concomitant psychiatric and substance abuse problems used fewer health care services than others. Conclusions: Specialized programs to improve the access of homeless mentally ill persons to health care services appear to be effective, but costly. Dually diagnosed persons seem especially difficult to engage in treatment.

Objectives: To engage a community to critically examine local health disparities. Design: Concept mapping is a tool used to rapidly assess the variations in thinking of large stakeholder groups' about a particular topic. Setting: Jackson, Mississippi. Participants: Community members. Methods: Dialog groups and community meetings were held, and participants were asked to respond to the statement, "A specific thing that causes African Americans to get sicker and die sooner is⋯" Aggregate responses were rated for importance and feasibility and then sorted into related groups. Aggregate sorts and ratings were then processed by using multidimensional scaling and hierarchical cluster analysis. Results: There were 132 (unduplicated) reported contributors to health disparities. These responses fell into eight general clusters: economic issues, government, contextual factors, cultural factors, HIV, stress, environment, and motivation. Factors respondents felt were the most important contributors to disparities (economic factors, contextual factors, stress) did not correlate with those that they thought were most likely to be changed in society (contextual factors, government, motivation). Conclusions: Concept mapping provided a mechanism for rapidly documenting community thinking about health disparities. This mechanism stimulated community dialog and was used as a first step toward the long-term goal of creating equal community, academic, and medical partnerships for addressing disparities. The concept mapping process stimulated critical thinking about contributors to health inequities and uncovered contextual factors previously unknown to researchers and public health planners. The process allowed for active engagement and exchange of knowledge between the community and researchers and allowed a mechanism for identifying and rectifying disconnects in knowledge within and between stakeholder groups.

Women are often faced with the primary role of providing care for individuals with Alzheimer's disease (AD). This study explored women caregiver's perceptions of caregiving through the use of Cognitive Mapping (CM), a qualitative research method. Volunteers were recruited from caregiver support groups to construct maps of their experience of "caregiving for someone with AD." Maps were analyzed for commonly identified concepts and relationships. Twelve participants identified 280 concepts, 206 of which were unduplicated. Concepts were collapsed into 17 categories; the largest concepts being "friends and family," "sad," "frustration," and "time." The maps produced by the sample in this study were unique, providing evidence that the experience of AD caregiving varies significantly among caregivers. CM appears to be effective for identifying caregiver stressors and needed support services.

Surveys estimate that 3-6% of the patients seen by physicians are gay or lesbian. There are unique health risks of gays and lesbians that are important to the clinician in determining an accurate diagnosis, providing patient education, and arriving at an appropriate treatment plan. One of the most significant medical risks of these populations includes avoidance of routine health care and dissatisfaction with healthcare. Many of these healthcare risks are not addressed because of lack of communication based on a number of common assumptions including the assumption that the patient is heterosexual. This article includes a summary of the medical literature through computerized searches to March 2002 in MEDLINE, PsychInfo, HEALTHSTAR, and bibliographies in articles on health care with gay and lesbian patients. The search strategy included health care of gays and lesbians and clinician-patient communication, partner and family issues. Secondly, it will examine common communication barriers and provide strategies for enhancing communication with patients in a gender-neutral, non-judgmental manner including suggestions for enlisting the inclusion of patients' families. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.

Understanding the barriers to antiretroviral adherence is a critical step in improving the effectiveness of HIV treatment and saving lives. We sought to assess, qualitatively, the experiences of HIV-positive persons taking antiretroviral therapy (ART) in North Carolina. Twenty-four people participated in one of six focus groups. A structured interview script included three questions (two open-ended) and eight probes. Each discussion was taped, transcribed, and content-analyzed. Three distinct themes emerged. First, many participants believed that taking ART was lifesaving but missed doses because they feared that taking them in public would reveal their HIV status. Second, as a result, participants often found it difficult to integrate their regimens into the most basic daily activities. Finally, participants stressed the importance of having open, ongoing dialogues about their treatment plans and privacy needs with a wide range of health care workers. Multidimensional, tailored interventions may help persons living with HIV overcome the stigma and other complex barriers they face in taking antiretroviral therapy.

OBJECTIVE: The purpose of the study was to determine if sexual behaviors, orgasm, tampon use, and douching during menstruation modify the risk of endometriosis., METHODS: A case-control study was conducted. Subjects (n = 2,012) consisted of members of the Endometriosis Association and friends not affiliated with the organization who completed mailed surveys. Data were analyzed using chi(2), Fisher's exact test, t test, and regression analyses., RESULTS: There was no difference between study groups concerning douching practices. However, cases were less likely than controls to report sometimes or often engaging in sexual behaviors during menstruation (p = 0.002, OR = 1.5), and sexual behaviors during menstruation that included orgasm (p = 0.001, OR = 1.5). Cases were also less likely than controls to report using only tampons (p < 0.0001, OR = 2.6)., CONCLUSION: Sexual activity, orgasm, and tampon use during menstruation may confer protection against endometriosis. Copyright 2002 S. Karger AG, Basel

The Enhancing Data Utilization Skills through Information Technology (EDUSIT) project trained Maternal and Child Health professionals to collect, analyze and interpret data via a year-long web-based course. The overall goal of the project was to strengthen the technology and analytic skills of the public health workforce. This article describes and analyzes a web-based module for training public health professionals to use qualitative research and evaluation methods that was one of six offered within the EDUSIT project. The qualitative module consisted of six units: overview of qualitative methods, planning qualitative studies, conducting field observations, qualitative interviewing, analyzing qualitative data and presenting qualitative findings. Evaluation results found no statistically significant changes in specific knowledge or beliefs about qualitative methods. However, the change in participants' self-efficacy was statistically significant. Participants' self-reports also showed significant changes in perceived skill levels in `collecting qualitative data through an interview' and `analyzing and interpreting qualitative data'. Most participants rated each lesson within the qualitative methods module as valuable, and most found the teaching methods used satisfactory, emphasizing the value of both the didactic teaching and the practical exercises and team project. The most common difficulty reported was finding the time to complete the module requirements while also working full-time. Implications of these findings for web-based teaching of public health professionals are discussed.