This study examines the association between frequency of seeing people walk within sight of home and neighborhood social cohesion among adults, and whether this association varies by race/ethnicity. People seeing others walk every day and every 2-3 days were significantly more likely to report medium levels of neighborhood social cohesion, relative to seeing others with low frequency. The association between seeing people walk and neighborhood social cohesion varied by race/ethnicity. Higher frequency of seeing others walk may contribute to higher levels of neighborhood social cohesion.

Food insecurity is associated with mental health outcomes among adults experiencing homelessness. Different mechanistic explanations have emerged to account for the inequality of health outcomes among vulnerable populations. The neomaterial theoretical perspective suggests that nutritional deficiencies from experiencing food insecurity are related to negative health outcomes. Whereas, the psychosocial theoretical perspective indicates that perceived disadvantages or inability to cope emotionally (i.e. lower distress tolerance) from food insecurity leads to adverse health outcomes. Building on the these theoretical perspectives, the purpose of the study was to examine nutrition and emotional distress tolerance as potential links between food insecurity and poor physical and mental health among adults experiencing homelessness. Adults were recruited from six area shelters in Oklahoma City (N = 566) during July–August 2016. Self-rated poor health, depression, and post-traumatic stress disorder (PTSD) were regressed on food insecurity using logistic regressions. Indirect effects of nutrition and distress tolerance were assessed using bootstrapping methods outlined by Preacher and Hayes. In covariate-adjusted models, distress tolerance, but not nutrition, partially mediated the association between food insecurity and poor health (β = 0.28, [0.14, 0.44]), depression (β = 0.56, [0.33, 0.88]), and PTSD (β = 0.39, [0.22, 0.60]). Results suggest that experiencing food insecurity may lower the ability to withstand emotional distress and consequently contributes to negative health outcomes. Accessible fruit bowls and a 24-h pantry stocked with snacks and ready-to-go meals may assist in reducing the stress associated with receiving food in shelters.

OBJECTIVE:

This article describes a CDI outbreak in a long-term care (LTC) facility that used molecular typing techniques and whole-genome sequencing to identify widespread dissemination of the clonal strain in the environment which was successfully removed after terminal cleaning.

SETTING:

This study was conducted in a long-term care facility in Texas.

METHODS:

A recently hospitalized LTC patient was diagnosed with CDI followed shortly thereafter by 7 subsequent CDI cases. A stool specimen was obtained from each patient for culturing and typing. An environmental point-prevalence study of the facility was conducted before and after terminal cleaning of the facility to assess environmental contamination. Cultured isolates were typed using ribotyping, multilocus variant analysis, and whole-genome sequencing.

RESULTS:

Stool samples were available for 5 of 8 patients; of these specimens, 4 grew toxigenic C. difficile ribotype 027. Of 50 environmental swab samples collected throughout the facility prior to the facility-wide terminal cleaning, 19 (38%) grew toxigenic C. difficile (most commonly ribotype 027, 79%). The terminal cleaning was effective at reducing C. difficile spores in the environment and at eradicating the ribotype 027 strain (P<.001). Using multilocus variance analysis and whole-genome sequencing, clinical and environmental strains were highly related and, in some cases, were identical.

CONCLUSION:

Using molecular typing techniques, we demonstrated reduced environmental contamination with toxigenic C. difficile and the eradication of a ribotype 027 clone. These techniques may help direct infection control efforts and decrease the burden of CDI in the healthcare system.

Discrimination is a pervasive stressor among African-American adults. Social support is an important protective factor for psychological distress, especially among minority populations. Although a number of studies have examined social support in relation to discrimination, little research has examined how social support may serve as an important protective factor against both physical and psychological symptoms related to overall psychological distress within this group. The current study examined social support as a moderator of the relationship between discrimination and overall psychological distress as measured by the Brief Symptom Inventory among a community sample of 122 African-American church-going adults. Results indicated that social support buffered the associations of discrimination and overall psychological distress (p < 0.0001) in expected directions. Findings highlight the importance of cultivating strong social relationships to attenuate the effects of this social determinant on mental health disparities among this group.

Diseases induced by metabolic disorders, eg, Type 2 diabetes, has recently been linked to both sensory and motor deficit in the absence of a formal clinical diagnosis of peripheral neuropathy. Studies have demonstrated mild cognitive impairment in diabetic patients, which also plays a role in one's loss of ability to successfully perform basic motor activities. This project focused on evaluating cognitive function while maintaining balance. We hypothesized that simultaneous cognitive and motor deficit would occur among adults with Type 2 diabetes versus healthy age- and sex-matched control during a balance task.

This purpose of this study if to examine the association of perceived risk of prediabetes and diabetes with leisure-time physical activity (LTPA) and weight loss, and to determine whether the association of risk perception with LTPA and weight loss varies by race/ethnicity. Findings highlight the role of perceived risk for prediabetes and diabetes in LTPA and weight loss, with findings varying by race/ethnicity. Awareness of prediabetes and diabetes risk could contribute to efforts aimed at improving LTPA and weight loss.

From October 2013 to July 2016, over 156,000 children traveling without their guardians were apprehended at the US-Mexico border. Although these unaccompanied youth have received substantial media attention, little is known about their health and well-being. The current study implemented a concurrent, parallel mixed methods research design, whereby quantitative (survey) and qualitative (focus groups) data were collected simultaneously to explore: (a) the frequency of posttraumatic stress disorder, depression, suicidal ideation, and substance use, (b) trauma exposure at pre-migration, migration, and post-migration, and (c) how youth may cope with these adversities. Thirty unaccompanied migrant youth were recruited from middle and high schools. An equal proportion of female and male participants from Honduras (n = 10), Guatemala (n = 8), México (n = 6), and El Salvador (n = 6) completed survey and focus group protocols. Over one-half of the sample met the criteria for posttraumatic stress disorder (56.7%), 30% met the criteria for major depressive disorder, and 30% reported suicidal ideation in the past year.

 While most youth reported no or infrequent substance use, they indicated having easy access to nearly all substances. Qualitative data revealed that youth faced persistent trauma exposure, including family separation, family and community violence, a lack of institutional protection, and pervasive poverty. Coping strategies related to mental health and substance use outcomes. Social withdrawal and avoidant coping were related to posttraumatic stress disorder, higher depressive symptoms and suicidal ideation, while adaptive coping strategies were protective against substance use. Unaccompanied youth flee their counties of origin to escape extreme violence and reunite with family. In the U.S., they report unresolved trauma and grief. If left untreated, these can be risk factors for mental illness and disability in adulthood. Reinforcing healthy coping may be an area where school and community providers can intervene to improve these youths' well-being.

27-hydroxycholesterol (27HC) is an abundant cholesterol metabolite in human circulation and promotes breast cancer cell proliferation. Although lung is one of the organs that contain high levels of 27HC, the role of 27HC in lung is unknown. In this study, we found that 27HC promotes lung cancer cell proliferation in an estrogen receptor β (ERβ)-dependent manner. The expression of 27HC-generating enzyme CYP27A1 is higher in lung cancer cells than in normal lung cells. Treatment with 27HC increased cell proliferation in ERβ-positive lung cancer cells, but not in ERα-positive or ER-negative cells. The effect on cell proliferation is specific to 27HC and another oxysterol, 25-hydroxycholesterol that has a similar oxysterol structure with 27HC. Moreover, among ligands for nuclear receptors tested, only estrogen had the proliferative effect, and the effect by 27HC and estrogen was inhibited by ERβ-specific, but not ERα-specific, inhibitors. In addition, the effect by 27HC was not affected by membrane-bound estrogen receptor GPR30. Interestingly, despite the high expression of CYP27A1, endogenously produced 27HC was not the major contributor of the 27HC-induced cell proliferation. Using kinase inhibitors, we found that the effect by 27HC was mediated by the PI3K-Akt signaling pathway. These results suggest that 27HC promotes lung cancer cell proliferation via ERβ and PI3K-Akt signaling. Thus, lowering 27HC levels may lead to a novel approach for the treatment of lung cancer.

Previous research has demonstrated the impacts of racial/ethnic residential segregation on access to health care, but little work has been conducted to tease out the mechanisms at play. I posit that the distribution of health care facilities may contribute to poor access to health care. In a study of the Houston area, I examine the association between residential segregation, the distribution of physician’s offices, and two health care access outcomes of having a personal physician, as well as the travel time to their office location. Using the 2010 Health of Houston Survey combined with several census products, I test these relationships in a series of spatial and multilevel models. I find that Black segregation is related to a lower density of physician’s offices. However, I find that this distribution is not related to having a personal physician, but is related to travel times, with a greater number of facilities leading to shorter travel times to the doctor. I also find that Black segregation is positively associated with travel times, and that the distribution of physician’s offices partially mediates this relationship. In sum, these findings suggest that a more equitable provision of health care resources across urban neighborhoods would mitigate some of the negative effects of segregation.

Despite the health benefits of tobacco control and cessation initiatives, tobacco users with behavioral health disorders (BHDs) have less access to evidence-based tobacco dependence treatment. Academic-community partnerships can help guide the translation of tobacco-related research findings and evidence-based guidelines into real-world applications. Through a comprehensive, evidence-based, multilevel, and multicomponent program, Taking Texas Tobacco Free (TTTF) facilitated the implementation of tobacco-free workplaces at 18 local mental health authorities in Texas, comprising over 250 individual community behavioral health centers. Compared with preprogram implementation, key accomplishments postimplementation include: (1) educated over 5,000 employees (nonclinical staff and providers) on the hazards of tobacco use and benefits of quitting, particularly among people with BHD; providers were additionally trained on the use of evidence based practices (EBPs; i.e. 5A’s model, use of pharmacotherapy) to identify and treat tobacco use among people with BHD; (2) providers’ significant increase in conducting tobacco-use assessments and using EBPs; (3) significant decrease in nonclinical staff tobacco use; (4) increase in quit attempts among consumers as evidenced by the demand for nicotine replacement therapy; and (5) reach to over 115,000 community members through outreach and education about the benefits of quitting tobacco use and maintaining a healthy lifestyle. TTTF demonstrated that the implementation of a comprehensive tobacco-free workplace program in behavioral health settings is feasible and beneficial, facilitating the capacity building of healthcare professionals and enhancing their resulting engagement in EBPs, and promoting healthier lifestyles among employees, consumers, and community members as a whole.