Little is known about incorporating community data into clinical care. This study sought to understand the clinical associations of cold spots (census tracts with worse income, education, and composite deprivation). Living in cold spots is associated with worse chronic conditions and quality for some screening tests. Practices can use neighborhood data to allocate resources and identify those at risk for poor outcomes.

Cognitive impairment, particularly coupled with advanced age, is becoming an increasing concern for both clinicians and caregivers. Nonadherence is a common problem in individuals with cognitive impairment, leading to concerns regarding patient autonomy. The development and use of innovative strategies to overcome nonadherence is important to increase the likelihood of engagement in healthy lifestyle behaviors.

Recently, much scholarly work has been conducted examining the effect of rising income inequality on health outcomes. However, this work is somewhat inconclusive. Chiefly, the mechanisms which could produce such an association are still being sorted out. Further, much of this work is focused on mortality outcomes with little attention to how this process operates for actual health conditions, including chronic health problems, which are arguably now the main public health concerns of the developed world. In this study, in a series of multilevel binary logistic regression models using data from the 2005 and 2007 Behavioral Risk Factor Surveillance System (BRFSS), we examine the association between state-level income inequality, poverty, and social welfare measures on spending and policy to examine the association between these factors for three chronic health outcomes: diabetes, hypertension, and coronary heart disease. We find that income inequality is only conditionally positively related to the diagnosis of two of the three outcomes, diabetes and hypertension, and only in 2007. However, absolute poverty is related to the outcome across all three dependent variables. Additionally, certain social welfare measures attenuate the effects of both income inequality and absolute poverty, suggesting that certain welfare policies reduce this association.

Youth who exhibit externalizing problems during childhood and adolescence are at an increased risk for a wide range of detrimental life outcomes. Despite the profound consequences of externalizing problems for children, their families, and their communities, we know less about the precise trajectory of externalizing symptoms across late childhood and adolescence, because of the paucity of fine-grained longitudinal research. The present study examined the development of externalizing symptoms in a large sample (N = 674) of Mexican-origin youth, assessed annually from age 10 to 17. Specifically, we conducted analyses to better understand the trajectories of attention-deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms (and their codevelopment), as well as how gender and cultural factors influence symptom trajectories. On average, ADHD symptoms slowly declined from age 10 to 17; ODD symptoms increased until age 13 and then declined thereafter; and, CD symptoms slowly increased until age 15 and then leveled off. ADHD, ODD, and CD symptoms predicted change in each other, indicating youth may accumulate multiple forms of externalizing problems over time. Boys reported fewer externalizing problems than girls, contrary to expectations. Consistent with the Immigrant Paradox, we found that 2nd + generation youth, youth who endorsed fewer traditional Mexican cultural values (traditional gender roles, traditional family values, and religiosity), and youth who engaged in less Spanish/more English language use were at increased risk for exhibiting ADHD, ODD, and CD symptoms from childhood through adolescence. We discuss the theoretical and practical implications of these developmental patterns among Mexican-origin youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)

Scientific evidence implicates anxiety sensitivity (AS) as a risk factor for poor smoking cessation outcomes. Integrated smoking cessation programs that target AS may lead to improved smoking cessation outcomes, potentially through AS reduction. Yet, little work has evaluated the efficacy of integrated smoking cessation treatment on smoking abstinence. The present study prospectively examined treatment effects of a novel AS reduction-smoking cessation intervention relative to a standard smoking cessation intervention on smoking abstinence. Findings provide evidence for the efficacy of a novel, integrated anxiety and smoking cessation treatment to reduce AS. Moreover, the meditation pathway from STAMP to early abstinence through reductions in AS suggest that AS is a clinically important mechanism of change for smoking cessation treatment and research.

Lesbian and gay (LG) couples face a particular stress that is unique from their heterosexual counterparts: minority stress, the increased stress experienced as a result of living in an environment that is stigmatizing of their sexual orientation and identity. Research demonstrates that minority stress has far-reaching health implications for LG individuals. However, the literature examining the effects of minority stress on health at the couple level is limited. This study examined the impact of minority stress on emotional intimacy, relationship satisfaction, and psychological and physical health outcomes, as well as the moderating role of gender and marital status. A total of 181 LG-identified adults in same-sex relationships completed an online self-report survey. Results indicated that internalized homonegativity and sexual orientation concealment were negatively related to emotional intimacy and that emotional intimacy was positively related to relationship satisfaction. Emotional intimacy mediated the link between internalized homonegativity and relationship satisfaction for married—but not unmarried—individuals. Sexual orientation concealment mediated the link between sexual orientation concealment and relationship satisfaction for married men but not for any other group. Findings from the current study highlight the importance of emotional intimacy among individuals in LG couples. Areas for future research are explored, and implications for research, clinical practice, and policy are explicated.

Objectives: Research on sexual minority health lack examinations of how sexual orientation intersects with other identities, including racial/ethnic identity, to shape health outcomes among U.S. adults. This study examines how health status and health behavior varies for gay, lesbian, and bisexual men and women who identify as non-Hispanic white, non-Hispanic black, Latino, Asian/Pacific Islander, and American Indian/Alaskan Native. By examining health and health behaviors within and across sexual minority subgroups, our study reports on race/ethnic, gender, and sexual orientation specific health risks.

Methods: We respond to shortcomings in current data by utilizing aggregated data from fourteen states from the Behavioral Risk Factor Surveillance System (BRFSS) collected between 2005 and 2010 (n = 557,773). We investigated the odds of reporting poorer health, current cigarette smoking, and obesity by sexual orientation within race/ethnic and gender subgroups; all statistical analyses were performed in 2016.

Results: Results suggest persistent health and behavior disadvantages for lesbian and bisexual women of all racial and ethnic identities, relative to heterosexuals. Some of the heightened odds are extreme. Asian/Pacific Islander lesbian (OR = 3.92) and bisexual (OR = 4.61) women, for example, have 4.0 times higher odds of smoking than heterosexual A/PI women. Results for men are more variable. To illustrate, the odds of obesity for White and A/PI men are indistinguishable between bisexuals and heterosexuals, and Black and American Indian/Alaskan Native bisexuals have lower odds of obesity than their heterosexual counterparts.

Conclusion: These findings highlight the need for policy efforts aimed at improving health and health behaviors among lesbian and bisexual women across groups, and more targeted efforts among sexual minority men.

Hispanics are disparately affected by diabetes. Treating socioeconomically disadvantaged Hispanics is challenging due to economic and cultural barriers. Health care providers must understand that cultural beliefs about medicine and disease may have an impact on how diabetes treatment is viewed. Concepts such as susto (fright), coraje (anger), and fatalismo (fatalism) are common cultural beliefs. If these beliefs are not well understood by the health care provider, recommendations for treatment are likely to be discarded. To dismantle cultural barriers between the patient and the health care provider, there are several strategies that a health care provider can implement. For instance, a health care provider must develop trust with the patient. The health care provider could also engage a family member or promotora or promotor (community health worker) in the conversation. Furthermore, if the cultural barriers are significant, the patient may be best served by receiving treatment from someone with a better understanding of his or her background. Thus, a referral may be appropriate.

Government health programs and private payors have adopted various reforms that fundamentally transform the physician-patient relationship. Public reporting on how well physicians perform on various quality and cost metrics, as well as payment reforms that link physicians’ reimbursements to their performance on these metrics, incentivize physicians to improve the quality and efficiency of care they provide to patients. Less appreciated, however, is that these reforms also create strong incentives for physicians to reject patients who do not abide by their physician’s medical opinion, including recommendations that the patient adopt healthier behaviors. These noncompliant patients increasingly will find themselves rejected by physicians, as current legal and ethical standards generally grant physicians full autonomy in deciding which patients to treat. This Article evaluates whether the law and standards of professional conduct should afford physicians broad discretion in deciding whether to treat noncompliant patients. It concludes that they should not and calls upon lawmakers and professional associations to place legal and ethical restraints on physicians’ ability to reject noncompliant patients.

The current study examined the role of bisexual-specific distal stressors (i.e. anti-bisexual discrimination from heterosexuals and from lesbians and gay men) and proximal stressors (i.e. internalized binegativity and anticipated discrimination) in sexual compulsivity among bisexual men. Sexual compulsivity disproportionately affects gay and bisexual men and confers risk of sexually transmitted infections, including HIV. A total of 942 bisexual male adults, recruited primarily from three large cities in the United States and Canada, completed online self-report surveys. Results revealed that discrimination from lesbians and gay men (but not from heterosexuals) was associated with both internalized binegativity and anticipated discrimination. Internalized binegativity and anticipated discrimination, in turn, were associated with increased sexual compulsivity. Moreover, there was a significant indirect effect of discrimination from heterosexuals and from lesbians and gay men on sexual compulsivity through anticipated discrimination. There was also a significant indirect effect of discrimination from lesbians and gay men on sexual compulsivity through internalized binegativity. Results suggest that these bisexual-specific distal and proximal minority stressors are important risk factors for sexual compulsivity. As such, treatment providers are encouraged to address these underlying risk factors in treating sexual compulsivity among bisexual men.