Showing papers in "American Journal of Public Health in 2013"
TL;DR: This work provides illustrative evidence on the health consequences of stigma and presents a conceptual framework describing the psychological and structural pathways through which stigma influences health.
Abstract: Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
1,768 citations
TL;DR: The findings support the minority stress model and suggest that prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people and enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.
Abstract: Objectives. We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population.Methods. In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Guided by the minority stress model, we evaluated associations between stigma and mental health and tested whether indicators of resilience (family support, peer support, identity pride) moderated these associations.Results. Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. We found few differences by gender identity.Conclusions. Our findings support the minority stres...
1,141 citations
TL;DR: Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults and to assess subgroup differences within these communities.
Abstract: Objectives. We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older.Methods. We analyzed data from the 2003–2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions.Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men.Conclusions. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Res...
704 citations
TL;DR: Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing, and multilevel interventions are needed for transgender populations.
Abstract: Objectives. We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia.Methods. In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper).Results. Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed...
697 citations
TL;DR: It is provided a synthesis of use, summarized key issues in applying, and highlighted exemplary applications in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Abstract: We provided a synthesis of use, summarized key issues in applying, and highlighted exemplary applications in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. We articulated key RE-AIM criteria by reviewing the published literature from 1999 to 2010 in several databases to describe the application and reporting on various RE-AIM dimensions.After excluding nonempirical articles, case studies, and commentaries, 71 articles were identified. The most frequent publications were on physical activity, obesity, and disease management. Four articles reported solely on 1 dimension compared with 44 articles that reported on all 5 dimensions of the framework.RE-AIM was broadly applied, but several criteria were not reported consistently.
636 citations
TL;DR: The evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking is reviewed and it is suggested that such campaigns should be funded on a global basis.
Abstract: Globally, more than 70% of people with mental illness receive no treatment from health care staff. Evidence suggests that factors increasing the likelihood of treatment avoidance or delay before presenting for care include (1) lack of knowledge to identify features of mental illnesses, (2) ignorance about how to access treatment, (3) prejudice against people who have mental illness, and (4) expectation of discrimination against people diagnosed with mental illness. In this article, we reviewed the evidence on whether large-scale anti-stigma campaigns could lead to increased levels of help seeking.
540 citations
TL;DR: The strength of social isolation as a predictor of mortality is similar to that of well-documented clinical risk factors, and the results suggest the importance of assessing patients' level of social isolate.
Abstract: Objectives. We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors.Methods. We used data on 16 849 adults from the Third National Health and Nutrition Examination Survey and the National Death Index. Predictor variables were 4 social isolation factors and a composite index. Comparison predictors included smoking, obesity, elevated blood pressure, and high cholesterol. Unadjusted Kaplan–Meier tables and Cox proportional hazards regression models controlling for sociodemographic characteristics were used to predict mortality.Results. Socially isolated men and women had worse unadjusted survival curves than less socially isolated individuals. Cox models revealed that social isolation predicted mortality for both genders, as did smoking and high blood pressure. Among men, individual social predictors included being unmarried, participating infrequently in r...
452 citations
TL;DR: Findings provided strong evidence of a Hispanic mortality advantage, with implications for conceptualizing and addressing racial/ethnic health disparities.
Abstract: To investigate the possibility of a Hispanic mortality advantage, we conducted a systematic review and meta-analysis of the published longitudinal literature reporting Hispanic individuals’ mortality from any cause compared with any other race/ethnicity. We searched MEDLINE, PubMed, EMBASE, HealthSTAR, and PsycINFO for published literature from January 1990 to July 2010.Across 58 studies (4 615 747 participants), Hispanic populations had a 17.5% lower risk of mortality compared with other racial groups (odds ratio = 0.825; P < .001; 95% confidence interval = 0.75, 0.91). The difference in mortality risk was greater among older populations and varied by preexisting health conditions, with effects apparent for initially healthy samples and those with cardiovascular diseases. The results also differed by racial group: Hispanics had lower overall risk of mortality than did non-Hispanic Whites and non-Hispanic Blacks, but overall higher risk of mortality than did Asian Americans.These findings provided strong ...
325 citations
TL;DR: Soft drink consumption is significantly linked to overweight, obesity, and diabetes worldwide, including in low- and middle-income countries.
Abstract: Objectives. We estimated the relationship between soft drink consumption and obesity and diabetes worldwide.Methods. We used multivariate linear regression to estimate the association between soft drink consumption and overweight, obesity, and diabetes prevalence in 75 countries, controlling for other foods (cereals, meats, fruits and vegetables, oils, and total calories), income, urbanization, and aging. Data were obtained from the Euromonitor Global Market Information Database, the World Health Organization, and the International Diabetes Federation. Bottled water consumption, which increased with per-capita income in parallel to soft drink consumption, served as a natural control group.Results. Soft drink consumption increased globally from 9.5 gallons per person per year in 1997 to 11.4 gallons in 2010. A 1% rise in soft drink consumption was associated with an additional 4.8 overweight adults per 100 (adjusted B; 95% confidence interval [CI] = 3.1, 6.5), 2.3 obese adults per 100 (95% CI = 1.1, 3.5), ...
315 citations
TL;DR: The medical literature demonstrates that influenza B can pose a significant burden to the global population and additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment the understanding of the disease and assist in vaccine development.
Abstract: We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010.Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B–specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant.The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disea...
304 citations
TL;DR: A program that might diminish stigma's effect by helping some people to disclose to colleagues, neighbors, and others their experiences with mental illness, treatment, and recovery is assessed.
Abstract: Self-stigma has a pernicious effect on the lives of people with mental illness. Although a medical perspective might discourage patients from identifying with their illness, public disclosure may promote empowerment and reduce self-stigma.We reviewed the extensive research that supports this assertion and assessed a program that might diminish stigma’s effect by helping some people to disclose to colleagues, neighbors, and others their experiences with mental illness, treatment, and recovery.The program encompasses weighing the costs and benefits of disclosure in deciding whether to come out, considering different strategies for coming out, and obtaining peer support through the disclosure process. This type of program may also pose challenges for public health research.
TL;DR: It is argued that sibling comparison, offspring of twins or siblings, in vitro fertilization designs, and other genetically informed approaches play a unique role in bridging gaps between basic biological and social science research.
Abstract: Researchers have identified environmental risks that predict subsequent psychological and medical problems. Based on these correlational findings, researchers have developed and tested complex developmental models and have examined biological moderating factors (e.g., gene-environment interactions). In this context, we stress the critical need for researchers to use family-based, quasi-experimental designs when trying to integrate genetic and social science research involving environmental variables because these designs rigorously examine causal inferences by testing competing hypotheses. We argue that sibling comparison, offspring of twins or siblings, in vitro fertilization designs, and other genetically informed approaches play a unique role in bridging gaps between basic biological and social science research. We use studies on maternal smoking during pregnancy to exemplify these principles.
TL;DR: The scarcity of empirical evidence points to the need for more interventions with participatory and user-generated features to address health disparities, and interventions must consider accessibility for vulnerable populations.
Abstract: As Web 2.0 and social media make the communication landscape increasingly participatory, empirical evidence is needed regarding their impact on and utility for health promotion. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched 4 medical and social science databases for literature (2004–present) on the intersection of Web 2.0 and health.A total of 514 unique publications matched our criteria. We classified references as commentaries and reviews (n = 267), descriptive studies (n = 213), and pilot intervention studies (n = 34).The scarcity of empirical evidence points to the need for more interventions with participatory and user-generated features. Innovative study designs and measurement methods are needed to understand the communication landscape and to critically assess intervention effectiveness. To address health disparities, interventions must consider accessibility for vulnerable populations.
TL;DR: Obesity significantly shapes US mortality levels, placing it at the forefront of concern for public health action, and an increasing percentage of mortality attributable to obesity across birth cohorts.
Abstract: Objectives. To estimate the percentage of excess death for US Black and White men and women associated with high body mass, we examined the combined effects of age variation in the obesity–mortality relationship and cohort variation in age-specific obesity prevalence.Methods. We examined 19 National Health Interview Survey waves linked to individual National Death Index mortality records, 1986–2006, for age and cohort patterns in the population-level association between obesity and US adult mortality.Results. The estimated percentage of adult deaths between 1986 and 2006 associated with overweight and obesity was 5.0% and 15.6% for Black and White men, and 26.8% and 21.7% for Black and White women, respectively. We found a substantially stronger association than previous research between obesity and mortality risk at older ages, and an increasing percentage of mortality attributable to obesity across birth cohorts.Conclusions. Previous research has likely underestimated obesity’s impact on US mortality. M...
TL;DR: Provider recommendations were strongly associated with HPV vaccination, and racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation.
Abstract: Objectives. Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination.Methods. We used the 2009 National Immunization Survey–Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine.Results. More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccinati...
TL;DR: The goal is to make a clear distinction between multivariate and multivariable analyses and to identify the nuances that make these types of analyses so distinct from one another.
Abstract: The terms multivariate and multivariable are often used interchangeably in the public health literature. However, these terms actually represent 2 very distinct types of analyses. We define the 2 types of analysis and assess the prevalence of use of the statistical term multivariate in a 1-year span of articles published in the American Journal of Public Health. Our goal is to make a clear distinction and to identify the nuances that make these types of analyses so distinct from one another.
TL;DR: Implementing policies that support evidence-based medication treatment of opiate dependence may decrease heroin overdose deaths, as increased access to opioid agonist treatment was associated with a reduction in heroin overdoses.
Abstract: Objectives. We examined the association between the expansion of methadone and buprenorphine treatment and the prevalence of heroin overdose deaths in Baltimore, Maryland from 1995 to 2009.Methods. We conducted a longitudinal time series analysis of archival data using linear regression with the Newey–West method to correct SEs for heteroscedasticity and autocorrelation, adjusting for average heroin purity.Results. Overdose deaths attributed to heroin ranged from a high of 312 in 1999 to a low of 106 in 2008. While mean heroin purity rose sharply (1995–1999), the increasing number of patients treated with methadone was not associated with a change in the number of overdose deaths, but starting in 2000 expansion of opioid agonist treatment was associated with a decline in overdose deaths. Adjusting for heroin purity and the number of methadone patients, there was a statistically significant inverse relationship between heroin overdose deaths and patients treated with buprenorphine (P = .002).Conclusions. I...
TL;DR: Efforts should prioritize inclusion, integration, and competences for the reduction of cultural barriers to recognition, response, and recovery in order to improve population mental health.
Abstract: Objectives We used the Stigma in Global Context–Mental Health Study to assess the core sentiments that represent consistent, salient public health intervention targetsMethods Data from 16 countries employed a nationally representative sampling strategy, international collaboration for instrument development, and case vignettes with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition depression and schizophrenia criteria We measured knowledge and prejudice with existing questions and scales, and employed exploratory data analysis to examine the public response to 43 itemsResults Across countries, levels of recognition, acceptance of neurobiological attributions, and treatment endorsement were high However, a core of 5 prejudice items was consistently high, even in countries with low overall stigma levels The levels were generally lower for depression than schizophrenia, and exclusionary sentiments for more intimate venues and in authority-based roles showed the greatest stigma Ne
TL;DR: Policy and practice changes are needed to reduce the risk that youths in foster care will become homeless after aging out and a discrete time hazard model was estimated that predicted first reported episode of homelessness.
Abstract: Objectives. We estimated the incidence of homelessness during the transition to adulthood and identified the risk and protective factors that predict homelessness during this transition.Methods. Using data from the Midwest Evaluation of the Adult Functioning of Former Foster Youth, a longitudinal study of youths aging out of foster care in 3 Midwestern states, and a bounds approach, we estimated the cumulative percentage of youths who become homeless during the transition to adulthood. We also estimated a discrete time hazard model that predicted first reported episode of homelessness.Results. Youths aging out of foster care are at high risk for becoming homeless during the transition to adulthood. Between 31% and 46% of our study participants had been homeless at least once by age 26 years. Running away while in foster care, greater placement instability, being male, having a history of physical abuse, engaging in more delinquent behaviors, and having symptoms of a mental health disorder were associated ...
TL;DR: Alternative tobacco products are attractive to smokers who want to quit smoking, but these data did not indicate that alternative tobacco products promote cessation.
Abstract: Objectives. We investigated the frequency of alternative tobacco product use (loose leaf, moist snuff, snus, dissolvables, electronic cigarettes [e-cigarettes]) among smokers and the association with quit attempts and intentions.Methods. A nationally representative probability-based cross-sectional survey of 1836 current or recently former adult smokers was completed in November 2011. Multivariate logistic regressions evaluated associations between alternative tobacco product use and smoking cessation behaviors.Results. Of the smokers, 38% had tried an alternative tobacco product, most frequently e-cigarettes. Alternative tobacco product use was associated with having made a quit attempt, and those intending to quit were significantly more likely to have tried and to currently use the products than were smokers with no intentions to quit. Use was not associated with successful quit attempts. Interest in future use of alternative tobacco products was low, except for e-cigarettes.Conclusions. Alternative to...
TL;DR: A cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research suggests considerable room for improvement in designing for dissemination.
Abstract: Objectives. We have described the practice of designing for dissemination among researchers in the United States with the intent of identifying gaps and areas for improvement.Methods. In 2012, we conducted a cross-sectional study of 266 researchers using a search of the top 12 public health journals in PubMed and lists available from government-sponsored research. The sample involved scientists at universities, the National Institutes of Health, and the Centers for Disease Control and Prevention in the United States.Results. In the pooled sample, 73% of respondents estimated they spent less than 10% of their time on dissemination. About half of respondents (53%) had a person or team in their unit dedicated to dissemination. Seventeen percent of all respondents used a framework or theory to plan their dissemination activities. One third of respondents (34%) always or usually involved stakeholders in the research process.Conclusions. The current data and the existing literature suggest considerable room for...
TL;DR: A growing focus on menstrual hygiene management from nongovernmental organizations, the United Nations Children's Fund (UNICEF), and other international agencies now highlights the profound impact of this problem on school-aged girls and provides the basis for a much needed research, programming, and policy agenda as discussed by the authors.
Abstract: INADEQUATE WATER AND sanitation facilities pose a major impediment to school-going girls during menstruation, compromising their ability to maintain proper hygiene and privacy. A growing focus on menstrual hygiene management (MHM) from nongovernmental organizations, the United Nations Children’s Fund (UNICEF), and other international agencies now highlights the profound impact of this problem on school-aged girls and provides the basis for a much needed research, programming, and policy agenda.
TL;DR: Scaling up and sustaining CHW programs in LMICs requires effective program design and management, including adequate training, supervision, motivation, and funding; acceptability of the program to the communities served; and securing support for the program from political leaders and other health care providers.
Abstract: Objectives. We sought to provide a systematic review of the determinants of success in scaling up and sustaining community health worker (CHW) programs in low- and middle-income countries (LMICs).Methods. We searched 11 electronic databases for academic literature published through December 2010 (n = 603 articles). Two independent reviewers applied exclusion criteria to identify articles that provided empirical evidence about the scale-up or sustainability of CHW programs in LMICs, then extracted data from each article by using a standardized form. We analyzed the resulting data for determinants and themes through iterated categorization.Results. The final sample of articles (n = 19) present data on CHW programs in 16 countries. We identified 23 enabling factors and 15 barriers to scale-up and sustainability, which were grouped into 3 thematic categories: program design and management, community fit, and integration with the broader environment.Conclusions. Scaling up and sustaining CHW programs in LMICs ...
TL;DR: In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks.
Abstract: The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population's well-being. Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health's total expenditures fell by 23.7% between 2009 and 2011. In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks.
TL;DR: Health communication interventions to provide correct information about e-cigarettes and regulation of e-cigarette marketing may be effective in reducing young adults' experimentation with e- cigarettes.
Abstract: Objectives. We assessed the characteristics associated with the awareness, perceptions, and use of electronic nicotine delivery systems (e-cigarettes) among young adults.Methods. We collected data in 2010–2011 from a cohort of 2624 US Midwestern adults aged 20 to 28 years. We assessed awareness and use of e-cigarettes, perceptions of them as a smoking cessation aid, and beliefs about their harmfulness and addictiveness relative to cigarettes and estimated their associations with demographic characteristics, smoking status, and peer smoking.Results. Overall, 69.9% of respondents were aware of e-cigarettes, 7.0% had ever used e-cigarettes, and 1.2% had used e-cigarettes in the past 30 days. Men, current and former smokers, and participants who had at least 1 close friend who smoked were more likely to be aware of and to have used e-cigarettes. Among those who were aware of e-cigarettes, 44.5% agreed e-cigarettes can help people quit smoking, 52.8% agreed e-cigarettes are less harmful than cigarettes, and 26...
TL;DR: Alcohol remains a major contributor to cancer mortality and YPLL and there is no safe threshold for alcohol and cancer risk.
Abstract: Objectives. Our goal was to provide current estimates of alcohol-attributable cancer mortality and years of potential life lost (YPLL) in the United States.Methods. We used 2 methods to calculate population-attributable fractions. We based relative risks on meta-analyses published since 2000, and adult alcohol consumption on data from the 2009 Alcohol Epidemiologic Data System, 2009 Behavioral Risk Factor Surveillance System, and 2009–2010 National Alcohol Survey.Results. Alcohol consumption resulted in an estimated 18 200 to 21 300 cancer deaths, or 3.2% to 3.7% of all US cancer deaths. The majority of alcohol-attributable female cancer deaths were from breast cancer (56% to 66%), whereas upper airway and esophageal cancer deaths were more common among men (53% to 71%). Alcohol-attributable cancers resulted in 17.0 to 19.1 YPLL for each death. Daily consumption of up to 20 grams of alcohol (≤ 1.5 drinks) accounted for 26% to 35% of alcohol-attributable cancer deaths.Conclusions. Alcohol remains a major c...
TL;DR: A case study of an intervention research project is presented to exemplify a clash between Western research methodologies and Indigenous methods and how it attempted reconciliation.
Abstract: Indigenous communities have long experienced exploitation by researchers and increasingly require participatory and decolonizing research processes. We present a case study of an intervention research project to exemplify a clash between Western research methodologies and Indigenous methodologies and how we attempted reconciliation. We then provide implications for future research based on lessons learned from Native American community partners who voiced concern over methods of Western deductive qualitative analysis. Decolonizing research requires constant reflective attention and action, and there is an absence of published guidance for this process. Continued exploration is needed for implementing Indigenous methods alone or in conjunction with appropriate Western methods when conducting research in Indigenous communities. Currently, examples of Indigenous methods and theories are not widely available in academic texts or published articles, and are often not perceived as valid.
TL;DR: The prevalence and incidence of gender identity disorder diagnoses among veterans in the Veterans Health Administration (VHA) health care system and suicide risk among veterans with a GID diagnosis were estimated and examined.
Abstract: Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis.Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk.Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population.Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years...
TL;DR: This study conducted a comprehensive thematic literature review and summarized empirically grounded discussions of ethics in CBPR, with a focus on the value of the Belmont principles and additional essential components of ethical CBPR.
Abstract: Health research has relied on ethical principles, such as those of the Belmont Report, to protect the rights and well-being of research participants. Community-based participatory research (CBPR), however, must also consider the rights and well-being of communities. This requires additional ethical considerations that have been extensively discussed but not synthesized in the CBPR literature. We conducted a comprehensive thematic literature review and summarized empirically grounded discussions of ethics in CBPR, with a focus on the value of the Belmont principles in CBPR, additional essential components of ethical CBPR, the ethical challenges CBPR practitioners face, and strategies to ensure that CBPR meets ethical standards. Our study provides a foundation for developing a working definition and a conceptual model of ethical CBPR.
TL;DR: The results suggest that, in the states assessed here, MMLs have not measurably affected adolescent marijuana use in the first few years after their enactment, and longer-term results, after M MLs are more fully implemented, might be different.
Abstract: Objectives. Medical marijuana laws (MMLs) have been suggested as a possible cause of increases in marijuana use among adolescents in the United States. We evaluated the effects of MMLs on adolescent marijuana use from 2003 through 2011.Methods. We used data from the Youth Risk Behavior Survey and a difference-in-differences design to evaluate the effects of passage of state MMLs on adolescent marijuana use. The states examined (Montana, Rhode Island, Michigan, and Delaware) had passed MMLs at different times over a period of 8 years, ensuring that contemporaneous history was not a design confound.Results. In 40 planned comparisons of adolescents exposed and not exposed to MMLs across states and over time, only 2 significant effects were found, an outcome expected according to chance alone. Further examination of the (nonsignificant) estimates revealed no discernible pattern suggesting an effect on either self-reported prevalence or frequency of marijuana use.Conclusions. Our results suggest that, in the s...