Showing papers in "American Journal of Public Health in 2009"

Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008

Abstract: Objectives. We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans.Methods. We determined the prevalence and predictors of mental health diagnoses among 289 328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data.Results. Of 289 328 Iraq and Afghanistan veterans, 106 726 (36.9%) received mental health diagnoses; 62 929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated w...

Racial/Ethnic Disparities in the Identification of Children With Autism Spectrum Disorders

Abstract: Objectives. We sought to examine racial and ethnic disparities in the recognition of autism spectrum disorders (ASDs).Methods. Within a multisite network, 2568 children aged 8 years were identified as meeting surveillance criteria for ASD through abstraction of evaluation records from multiple sources. Through logistic regression with random effects for site, we estimated the association between race/ethnicity and documented ASD, adjusting for gender, IQ, birthweight, and maternal education.Results. Fifty-eight percent of children had a documented autism spectrum disorder. In adjusted analyses, children who were Black (odds ratio [OR] = 0.79; 95% confidence interval [CI] = 0.64, 0.96), Hispanic (OR = 0.76; CI = 0.56, 0.99), or of other race/ethnicity (OR = 0.65; CI = 0.43, 0.97) were less likely than were White children to have a documented ASD. This disparity persisted for Black children, regardless of IQ, and was concentrated for children of other ethnicities when IQ was lower than 70.Conclusions. Signi...

The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy

Abstract: I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when they are overpromoted and highly prescribed. An in-depth analysis of the promotion and marketing of OxyContin illustrates some of the associated issues. Modifications of the promotion and marketing of controlled drugs by the pharmaceutical industry and an enhanced capacity of the Food and Drug Administration to regulate and monitor such promotion can have a positive impact on the public health.

The Health and Health Care of US Prisoners: Results of a Nationwide Survey

Abstract: Objectives. We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates.Methods. We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates.Results. Among inmates in federal prisons, state prisons, and local jails, 38.5% (SE = 2.2%), 42.8% (SE = 1.1%), and 38.7% (SE = 0.7%), respectively, suffered a chronic medical condition. Among inmates with a mental condition ever treated with a psychiatric medication, only 25.5% (SE = 7.5%) of federal, 29.6% (SE = 2.8%) of state, and 38.5% (SE = 1.5%) of local jail inmates were taking a psychiatric medication at the time of arrest, whereas 69.1% (SE = 4.8%), 68.6% (SE = 1.9%), and 45.5% (SE = 1.6%) were on a psychiatric medication after admission.Conclusions. Many inmates with a serious chronic physical illness fail to receive care while incarcerated. Among...

Understanding Evidence-Based Public Health Policy

Abstract: Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts). We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy. Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.

Proximity of Fast-Food Restaurants to Schools and Adolescent Obesity

Abstract: Geocoded data (obtained from the 2002ﾖ2005 California Healthy Kids Survey) on over 500 000 youths and multivariate regression models was used to estimate associations between adolescent obesity and proximity of fast-food restaurants to schools. Results showed that students with fast-food restaurants near (within one half mile of) their schools (1) consumed fewer servings of fruits and vegetables, (2) consumed more servings of soda, and (3) were more likely to be overweight (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02, 1.10) or obese (OR = 1.07; 95% CI = 1.02, 1.12) than were youths whose schools were not near fast-food restaurants, after controling for student- and school-level characteristics. The result was unique to eating at fast-food restaurants (compared with other nearby establishments) and was not observed for another risky behavior (smoking). The researchers concluded that exposure to poor-quality food environments has important effects on adolescent eating patterns and overweight. Policy interventions limiting the proximity of fast-food restaurants to schools could help reduce adolescent obesity.

State-Level Policies and Psychiatric Morbidity In Lesbian, Gay, and Bisexual Populations

Abstract: Objectives. We investigated the modifying effect of state-level policies on the association between lesbian, gay, or bisexual status and the prevalence of psychiatric disorders.Methods. Data were from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative study of noninstitutionalized US adults (N = 34 653). States were coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation.Results. Compared with living in states with policies extending protections, living in states without these policies predicted a significantly stronger association between lesbian, gay, or bisexual status and psychiatric disorders in the past 12 months, including generalized anxiety disorder (F = 3.87; df = 2; P = .02), post-traumatic stress disorder (F = 3.42; df = 2; P = .04), and dysthymia (F = 5.20; df = 2; P = .02). Living in states with policies that did not extend protections also predicted a stronger rela...

Effective health risk communication about pandemic influenza for vulnerable populations.

Abstract: The consequences of pandemic influenza for vulnerable populations will depend partly on the effectiveness of health risk communications. Strategic planning should fully consider how life circumstances, cultural values, and perspectives on risk influence behavior during a pandemic.We summarize recent scientific evidence on communication challenges and examine how sociocultural, economic, psychological, and health factors can jeopardize or facilitate public health interventions that require a cooperative public. If ignored, current communication gaps for vulnerable populations could result in unequal protection across society during an influenza pandemic.We offer insights on communication preparedness gleaned from scientific studies and the deliberations of public health experts at a meeting convened by the Centers for Disease Control and Prevention, May 1 and 2, 2008.

Health Insurance and Mortality in US Adults

Abstract: Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death.Results. Among all participants, 3.1% (95% confidence interval [CI] = 2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI = 1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio = 1.40; 95% CI = 1.06, 1.84) than those with insurance.Conclusions. Uninsurance is associated with mortality. The strengt...

Socioeconomic Inequality in Exposure to Bullying During Adolescence: A Comparative, Cross-Sectional, Multilevel Study in 35 Countries

Abstract: Objectives. We examined the socioeconomic distribution of adolescent exposure to bullying internationally and documented the contribution of the macroeconomic environment.Methods. We used an international survey of 162 305 students aged 11, 13, and 15 years from nationally representative samples of 5998 schools in 35 countries in Europe and North America for the 2001–2002 school year. The survey used standardized measures of exposure to bullying and socioeconomic affluence.Results. Adolescents from families of low affluence reported higher prevalence of being victims of bullying (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.10, 1.16). International differences in prevalence of exposure to bullying were not associated with the economic level of the country (as measured by gross national income) or the school, but wide disparities in affluence at a school and large economic inequality (as measured by the Gini coefficient) at the national level were associated with an increased prevalence of expo...

The Influence of the Physical Environment and Sociodemographic Characteristics on Children's Mode of Travel to and From School

Abstract: Objectives. We examined whether certain characteristics of the social and physical environment influence a child's mode of travel between home and school.Methods. Students aged 11 to 13 years from 21 schools throughout London, Ontario, answered questions from a travel behavior survey. A geographic information system linked survey responses for 614 students who lived within 1 mile of school to data on social and physical characteristics of environments around the home and school. Logistic regression analysis was used to test the influence of environmental factors on mode of travel (motorized vs “active”) to and from school.Results. Over 62% of students walked or biked to school, and 72% from school to home. The likelihood of walking or biking to school was positively associated with shorter trips, male gender, higher land use mix, and presence of street trees. Active travel from school to home was also associated with lower residential densities and lower neighborhood incomes.Conclusions. Our findings demo...

Trust in the Health Care System and the Use of Preventive Health Services by Older Black and White Adults

Abstract: OBJECTIVES: We sought to find racial differences in the effects of trust in the health care system on preventive health service use among older adults. METHODS: We conducted a telephone survey with 1681 Black and White older adults. Survey questions explored respondents' trust in physicians, medical research, and health information sources. We used logistic regression and controlled for covariates to assess effects of race and trust on the use of preventive health services. RESULTS: We identified 4 types of trust through factor analysis: trust in one's own personal physician, trust in the competence of physicians' care, and trust in formal and informal health information sources. Blacks had significantly less trust in their own physicians and greater trust in informal health information sources than did Whites. Greater trust in one's own physician was associated with utilization of routine checkups, prostate-specific antigen tests, and mammograms, but not with flu shots. Greater trust in informal information sources was associated with utilization of mammograms. CONCLUSIONS: Trust in one's own personal physician is associated with utilization of preventive health services. Blacks' relatively high distrust of their physicians likely contributes to health disparities by causing reduced utilization of preventive services. Health information disseminated to Blacks through informal means is likely to increase Blacks' utilization of preventive health services.

Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City

Abstract: Objectives. We investigated health care utilization, barriers to care, and hormone use among male-to-female transgender persons residing in New York City to determine whether current care is in accord with the World Professional Association for Transgender Health and the goals of Healthy People 2010.Methods. We conducted interviews with 101 male-to-female transgender persons from 3 community health centers in 2007.Results. Most participants reported having health insurance (77%; n = 78) and seeing a general practitioner in the past year (81%; n = 82). Over 25% of participants perceived the cost of medical care, access to specialists, and a paucity of transgender-friendly and transgender-knowledgeable providers as barriers to care. Being under a physician's care was associated with high-risk behavior reduction, including smoking cessation (P = .004) and obtaining needles from a licensed physician (P = .002). Male-to-female transgender persons under a physician's care were more likely to obtain hormone ther...

Concurrent Partnerships and HIV Prevalence Disparities by Race: Linking Science and Public Health Practice

Abstract: Concurrent sexual partnerships may help to explain the disproportionately high prevalence of HIV and other sexually transmitted infections among African Americans. The persistence of such disparities would also require strong assortative mixing by race. We examined descriptive evidence from 4 nationally representative US surveys and found consistent support for both elements of this hypothesis. Using a data-driven network simulation model, we found that the levels of concurrency and assortative mixing observed produced a 2.6-fold racial disparity in the epidemic potential among young African American adults.

Impact of the family health program on infant mortality in Brazilian municipalities

Abstract: Objectives. We evaluated the effects of the Family Health Program (FHP), a strategy for reorganization of primary health care at a nationwide level in Brazil, on infant mortality at a municipality level.Methods. We collected data on FHP coverage and infant mortality rates for 771 of 5561 Brazilian municipalities from 1996 to 2004. We performed a multivariable regression analysis for panel data with a negative binomial response by using fixed-effects models that controlled for demographic, social, and economic variables.Results. We observed a statistically significant negative association between FHP coverage and infant mortality rate. After we controlled for potential confounders, the reduction in the infant mortality rate was 13.0%, 16.0%, and 22.0%, respectively for the 3 levels of FHP coverage. The effect of the FHP was greater in municipalities with a higher infant mortality rate and lower human development index at the beginning of the study period.Conclusions. The FHP had an important effect on redu...

Influences of physical and social neighborhood environments on children's physical activity and obesity

Abstract: Data on 650 children and their primary caregivers was collected during phase 1 of Healthy Passages, a multisite, community-based, cross-sectional study of health risk behaviors and health outcomes in children. Independent systematic neighborhood observations were conducted to measure neighborhood physical characteristics, and we analyzed survey data on social processes. Children's physical activity and obesity status were modelled with structural equation models that included latent variables for the physical and social environments. After controlling for children's sociodemographic factors, it was found that a favorable social environment was positively associated with several measures of physical activity and that physical activity was negatively associated with obesity in these children. Physical environment was not significantly associated with physical activity. The findings suggest that neighborhood social factors as well as the physical environment should be considered in the development of health policy and interventions to reduce childhood obesity.

Structural and Environmental Barriers to Condom Use Negotiation With Clients Among Female Sex Workers: Implications for HIV-Prevention Strategies and Policy

Abstract: Objectives. We investigated the relationship between environmental–structural factors and condom-use negotiation with clients among female sex workers.Methods. We used baseline data from a 2006 Vancouver, British Columbia, community-based cohort of female sex workers, to map the clustering of “hot spots” for being pressured into unprotected sexual intercourse by a client and assess sexual HIV risk. We used multivariate logistic modeling to estimate the relationship between environmental–structural factors and being pressured by a client into unprotected sexual intercourse.Results. In multivariate analyses, being pressured into having unprotected sexual intercourse was independently associated with having an individual zoning restriction (odds ratio [OR] = 3.39; 95% confidence interval [CI] = 1.00, 9.36), working away from main streets because of policing (OR = 3.01; 95% CI = 1.39, 7.44), borrowing a used crack pipe (OR = 2.51; 95% CI = 1.06, 2.49), client-perpetrated violence (OR = 2.08; 95% CI = 1.06, 4....

The Politics of Plastics: The Making and Unmaking of Bisphenol A “Safety”

Abstract: Bisphenol A (BPA), a synthetic chemical used in the production of plastics since the 1950s and a known endocrine disruptor, is a ubiquitous component of the material environment and human body. New research on very-low-dose exposure to BPA suggests an association with adverse health effects, including breast and prostate cancer, obesity, neurobehavioral problems, and reproductive abnormalities. These findings challenge the long-standing scientific and legal presumption of BPA's safety. The history of how BPA's safety was defined and defended provides critical insight into the questions now facing lawmakers and regulators: is BPA safe, and if not, what steps must be taken to protect the public's health? Answers to both questions involve reforms in chemical policy, with implications beyond BPA.

The health impacts of housing improvement: a systematic review of intervention studies from 1887 to 2007

Abstract: OBJECTIVES: We conducted a systematic review of the health impacts of housing improvement. METHODS: Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality. RESULTS: Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health. CONCLUSIONS: Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.

Implementing Evidence-Based Practice in Community Mental Health Agencies: A Multiple Stakeholder Analysis

Abstract: Objectives. We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies.Methods. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers.Results. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups.Conclusions. Implementation of EBP is a complex process. Cross-system–level approaches are needed to b...

Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children.

Abstract: Objectives. We examined the associations of intimate partner violence (IPV) and maternal risk factors with maternal child maltreatment risk within a diverse sample of mothers.Methods. We derived the study sample (N = 2508) from the Fragile Families and Child Well-Being Study. We conducted regression analyses to examine associations between IPV, parenting stress, major depression, key covariates, and 4 proxy variables for maternal child maltreatment.Results. Mothers reported an average of 25 acts of psychological aggression and 17 acts of physical aggression against their 3-year-old children in the year before the study, 11% reported some act of neglect toward their children during the same period, and 55% had spanked their children during the previous month. About 40% of mothers had experienced IPV by their current partner. IPV and maternal parenting stress were both consistent risk factors for all 4 maltreatment proxy variables. Although foreign-born mothers reported fewer incidents of child maltreatment...

Women's Preferences for Place of Delivery in Rural Tanzania: A Population-Based Discrete Choice Experiment

Abstract: Objectives. We fielded a population-based discrete choice experiment (DCE) in rural western Tanzania, where only one third of women deliver children in a health facility, to evaluate health-system factors that influence women's delivery decisions.Methods. Women were shown choice cards that described 2 hypothetical health centers by means of 6 attributes (distance, cost, type of provider, attitude of provider, drugs and equipment, free transport). The women were then asked to indicate which of the 2 facilities they would prefer to use for a future delivery. We used a hierarchical Bayes procedure to estimate individual and mean utility parameters.Results. A total of 1203 women completed the DCE. The model showed good predictive validity for actual facility choice. The most important facility attributes were a respectful provider attitude and availability of drugs and medical equipment. Policy simulations suggested that if these attributes were improved at existing facilities, the proportion of women preferr...

Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

Abstract: Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose.

Health Disadvantage in US Adults Aged 50 to 74 Years: A Comparison of the Health of Rich and Poor Americans With That of Europeans

Abstract: Objectives. We compared the health of older US, English, and other European adults, stratified by wealth.Methods. Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17 481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations.Results. American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. S...

Use of a Social and Character Development Program to Prevent Substance Use, Violent Behaviors, and Sexual Activity Among Elementary-School Students in Hawaii

Abstract: Objectives. We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students. Methods. We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N=1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N=1225) substance use and violence. Results. Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR]=0.41; 90% confidence interval [CI]=0.25, 0.66) and violence (RR=0.42; 90% CI=0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio=0.24; 90% CI=0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors. Conclusions. Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior. Language: en

Novice drivers' risky driving behavior, risk perception, and crash risk: findings from the DRIVE study

Abstract: Objectives. We explored the risky driving behaviors and risk perceptions of a cohort of young novice drivers and sought to determine their associations with crash risk. Methods. Provisional drivers aged 17 to 24 (n = 20 822) completed a detailed questionnaire that included measures of risk perception and behaviors; 2 years following recruitment, survey data were linked to licensing and police-reported crash data. Poisson regression models that adjusted for multiple confounders were created to explore crash risk. Results. High scores on questionnaire items for risky driving were associated with a 50% increased crash risk (adjusted relative risk = 1.51; 95% confidence interval = 1.25, 1.81). High scores for risk perception (poorer perceptions of safety) were also associated with increased crash risk in univariate and multivariate models; however, significance was not sustained after adjustment for risky driving. Conclusions. The overrepresentation of youths in crashes involving casualties is a significant public health issue. Risky driving behavior is strongly linked to crash risk among young drivers and overrides the importance of risk perceptions. Systemwide intervention, including licensing reform, is warranted.

Effects of different types of antismoking ads on reducing disparities in smoking cessation among socioeconomic subgroups.

Abstract: Objectives. We assessed which types of mass media messages might reduce disparities in smoking prevalence among disadvantaged population subgroups.Methods. We followed 1491 adult smokers over 24 months and related quitting status at follow-up to exposure to antismoking ads in the 2 years prior to the baseline assessment.Results. On average, smokers were exposed to more than 200 antismoking ads during the 2-year period, as estimated by televised gross ratings points (GRPs). The odds of having quit at follow-up increased by 11% with each 10 additional potential ad exposures (per 1000 points, odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.00, 1.23; P < .05). Greater exposure to ads that contained highly emotional elements or personal stories drove this effect (OR = 1.14; 95% CI 1.02, 1.29; P < .05), which was greater among respondents with low and mid-socioeconomic status than among high–socioeconomic status groups.Conclusions. Emotionally evocative ads and ads that contain personalized stories abo...

Pathways to and from homelessness and associated psychosocial outcomes among adolescents leaving the foster care system

Abstract: Objectives. We evaluated the prevalence and nature of housing problems among adolescents leaving foster care because of their age to provide evidence that can inform public and programmatic policies designed to prevent homelessness.Methods. Housing and psychosocial outcomes in a sample of 265 adolescents who left the foster care system in 2002 and 2003 in a large midwestern metropolitan area were evaluated over a 2-year follow-up period. Analyses focused on identifying latent housing trajectory categories across the first 2 years after participants' exit from foster care.Results. Findings revealed 4 latent housing classifications. Most participants (57%) had experienced stable housing situations since their exit from foster care. Those in the remaining 3 categories endured housing problems, and 20% were chronically homeless during the follow-up period. Housing instability was related to emotional and behavioral problems, physical and sexual victimization, criminal conviction, and high school dropout.Concl...

Pathways and correlates connecting Latinos' mental health with exposure to the United States.

Abstract: Objectives. We examined potential pathways by which time in the United States may relate to differences in the predicted probability of past-year psychiatric disorder among Latino immigrants as compared with US-born Latinos.Methods. We estimated predicted probabilities of psychiatric disorder for US-born and immigrant groups with varying time in the United States, adjusting for different combinations of covariates. We examined 6 pathways by which time in the United States could be associated with psychiatric disorders.Results. Increased time in the United States is associated with higher risk of psychiatric disorders among Latino immigrants. After adjustment for covariates, differences in psychiatric disorder rates between US-born and immigrant Latinos disappear. Discrimination and family cultural conflict appear to play a significant role in the association between time in the United States and the likelihood of developing psychiatric disorders.Conclusions. Increased perceived discrimination and family c...

A rights-based approach to food insecurity in the United States

Abstract: Food insecurity is a serious public health problem associated with poor cognitive and emotional development in children and with depression and poor health in adults. Despite sizable continued investments in federal food assistance, food insecurity still affects 11.1% of US households--almost the same rate as in 1995, when annual measurement began. As a fresh approach to solving the problem of food insecurity, we suggest adoption of a human rights framework. This approach could actively engage those affected and would ensure that food security monitoring would be compared to benchmarks in national action plans. We describe key elements of a right-to-food approach, review challenges to implementing it, and suggest actions to foster its adoption.