Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 32 Records) |
Query Trace: Dhingra S[original query] |
---|
Development of core competencies for field veterinary epidemiology training programs
Pinto J , Dissanayake RB , Dhand N , Rojo-Gimeno C , Falzon LC , Akwar H , Alambeji RB , Beltran-Alcrudo D , Castellan DM , Chanachai K , Guitian J , Hilmers A , Larfaoui F , Loth L , Motta P , Rasamoelina H , Salyer S , Shadomy S , Squarzoni C , Rwego I , Santos CV , Wongsathapornchai K , Lockhart C , Okuthe S , Kane Y , Gilbert J , Soumare B , Dhingra M , Sumption K , Tiensin T . Front Vet Sci 2023 10 1143375 A workforce with the adequate field epidemiology knowledge, skills and abilities is the foundation of a strong and effective animal health system. Field epidemiology training is conducted in several countries to meet the increased global demand for such a workforce. However, core competencies for field veterinary epidemiology have not been identified and agreed upon globally, leading to the development of different training curricula. Having a set of agreed core competencies can harmonize field veterinary epidemiology training. The Food and Agriculture Organization of the United Nations (FAO) initiated a collective, iterative, and participative process to achieve this and organized two expert consultative workshops in 2018 to develop core competencies for field veterinary epidemiology at the frontline and intermediate levels. Based on these expert discussions, 13 competencies were identified for the frontline and intermediate levels. These competencies were organized into three domains: epidemiological surveillance and studies; field investigation, preparedness and response; and One Health, communication, ethics and professionalism. These competencies can be used to facilitate the development of field epidemiology training curricula for veterinarians, adapted to country training needs, or customized for training other close disciplines. The competencies can also be useful for mentors and employers to monitor and evaluate the progress of their mentees, or to guide the selection process during the recruitment of new staff. |
Survival of children living with human immunodeficiency virus on antiretroviral therapy in Andhra Pradesh, India
Jha UM , Dhingra N , Raj Y , Rewari BB , Jeyaseelan L , Harvey P , Chavan L , Saggurti N , Reddy DCS . Indian Pediatr 2018 55 (4) 301-305 Objectives: To assess the survival probability and associated factors among children living with human immunodeficiency virus (CLHIV) receiving antiretroviral therapy (ART) in India. Methods: The data on 5874 children (55% boys) from one of the high HIV burden states of India from the cohort were analyzed. Data were extracted from the computerized management information system of the National AIDS Control Organization (NACO). Children were eligible for inclusion if they had started ART during 2007-2013, and had at least one potential follow-up. Kaplan Meier survival and Cox proportional hazards models were used to measure survival probability. Results: The baseline median (IQR) CD4 count at the start of antiretroviral therapy was 244 (153, 398). Overall, the mortality was 30 per 1000 child years; 39 in the <5 year age group and 25 in 5-9 year age group. Mortality was highest among infants (86 per 1000 child years). Those with CD4 count ≥200 were six times more likely to die (adjusted HR: 6.3, 95% CI 3.5, 11.4) as compared to those with a CD4 count of ≥350/mm3. Conclusion: Mortality rates among CLHIV is significantly higher among children less than five years when the CD4 count at the start of ART is above 200. Additionally, lower CD4 count, HIV clinical staging IV, and lack of functional status seems to be associated with high mortality in children who are on ART. |
Sustained progress, but no room for complacency: Results of 2015 HIV estimations in India
Pandey A , Dhingra N , Kumar P , Sahu D , Reddy DCS , Narayan P , Raj Y , Sangal B , Chandra N , Nair S , Singh J , Chavan L , Srivastava DJ , Jha UM , Verma V , Kant S , Bhattacharya M , Swain P , Haldar P , Singh L , Bakkali T , Stover J , Ammassari S . Indian J Med Res 2017 146 (1) 83-96 BACKGROUND & OBJECTIVES: Evidence-based planning has been the cornerstone of India's response to HIV/AIDS. Here we describe the process, method and tools used for generating the 2015 HIV estimates and provide a summary of the main results. METHODS: Spectrum software supported by the UNAIDS was used to produce HIV estimates for India as a whole and its States/Union Territories. This tool takes into consideration the size and HIV prevalence of defined population groups and programme data to estimate HIV prevalence, incidence and mortality over time as well as treatment needs. RESULTS: India's national adult prevalence of HIV was 0.26 per cent in 2015. Of the 2.1 million people living with HIV/AIDS, the largest numbers were in Andhra Pradesh, Maharashtra and Karnataka. New HIV infections were an estimated 86,000 in 2015, reflecting a decline by around 32 per cent from 2007. The declining trend in incidence was mirrored in most States, though an increasing trend was detected in Assam, Chandigarh, Chhattisgarh, Gujarat, Sikkim, Tripura and Uttar Pradesh. AIDS-related deaths were estimated to be 67,600 in 2015, reflecting a 54 per cent decline from 2007. There were variations in the rate and trend of decline across India for this indicator also. INTERPRETATION & CONCLUSIONS: While key indicators measured through Spectrum modelling confirm success of the National AIDS Control Programme, there is no room for complacency as rising incidence trends in some geographical areas and population pockets remain the cause of concern. Progress achieved so far in responding to HIV/AIDS needs to be sustained to end the HIV epidemic. |
Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014
Zhao G , Okoro CA , Dhingra SS , Xu F , Zack M . Public Health 2017 146 108-117 Objective To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18–64 years) in 50 states and the District of Columbia (DC). Study design Cross-sectional surveys. Methods We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18–64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993–2010 and 2011–2014 due to methodologic changes in the BRFSS. Results From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0–24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2–10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state. Conclusions The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18–64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population. |
Lack of health insurance among adults aged 18 to 64 years: Findings from the 2013 Behavioral Risk Factor Surveillance System
Okoro CA , Zhao G , Dhingra SS , Xu F . Prev Chronic Dis 2015 12 E231 INTRODUCTION: The objective of this study was to estimate the prevalence of lack of health insurance among adults aged 18 to 64 years for each state and the United States and to describe populations without insurance. METHODS: We used 2013 Behavioral Risk Factor Surveillance System data to categorize states into 3 groups on the basis of the prevalence of lack of health insurance in each state compared with the national average (21.5%; 95% confidence interval, 21.1%-21.8%): high-insured states (states with an estimated prevalence of lack of health insurance below the national average), average-insured states (states with an estimated prevalence of lack of health insurance equivalent to the national average), and low-insured states (states with an estimated prevalence of lack of health insurance higher than the national average). We used bivariate analyses to compare the sociodemographic characteristics of these 3 groups after age adjustment to the 2000 US standard population. We examined the distribution of Medicaid expansion among the 3 groups. RESULTS: Compared with the national age-adjusted prevalence of lack of health insurance, 24 states had lower rates of uninsured residents, 12 states had equivalent rates of uninsured, and 15 states had higher rates of uninsured. Compared with adults in the high-insured and average-insured state groups, adults in the low-insured state group were more likely to be non-Hispanic black or Hispanic, to have less than a high school education, to be previously married (divorced, widowed, or separated), and to have an annual household income at or below $35,000. Seventy-one percent of high-insured states were expanding Medicaid eligibility compared with 67% of average-insured states and 40% of low-insured states. CONCLUSION: Large variations exist among states in the estimated prevalence of health insurance. Many uninsured Americans reside in states that have opted out of Medicaid expansion. |
A new source of data for public health surveillance: Facebook likes
Gittelman S , Lange V , Gotway Crawford CA , Okoro CA , Lieb E , Dhingra SS , Trimarchi E . J Med Internet Res 2015 17 (4) e98 BACKGROUND: Investigation into personal health has become focused on conditions at an increasingly local level, while response rates have declined and complicated the process of collecting data at an individual level. Simultaneously, social media data have exploded in availability and have been shown to correlate with the prevalence of certain health conditions. OBJECTIVE: Facebook likes may be a source of digital data that can complement traditional public health surveillance systems and provide data at a local level. We explored the use of Facebook likes as potential predictors of health outcomes and their behavioral determinants. METHODS: We performed principal components and regression analyses to examine the predictive qualities of Facebook likes with regard to mortality, diseases, and lifestyle behaviors in 214 counties across the United States and 61 of 67 counties in Florida. These results were compared with those obtainable from a demographic model. Health data were obtained from both the 2010 and 2011 Behavioral Risk Factor Surveillance System (BRFSS) and mortality data were obtained from the National Vital Statistics System. RESULTS: Facebook likes added significant value in predicting most examined health outcomes and behaviors even when controlling for age, race, and socioeconomic status, with model fit improvements (adjusted R(2)) of an average of 58% across models for 13 different health-related metrics over basic sociodemographic models. Small area data were not available in sufficient abundance to test the accuracy of the model in estimating health conditions in less populated markets, but initial analysis using data from Florida showed a strong model fit for obesity data (adjusted R(2)=.77). CONCLUSIONS: Facebook likes provide estimates for examined health outcomes and health behaviors that are comparable to those obtained from the BRFSS. Online sources may provide more reliable, timely, and cost-effective county-level data than that obtainable from traditional public health surveillance systems as well as serve as an adjunct to those systems. |
Associations among county-level social determinants of health, child maltreatment, and emotional support on health-related quality of life in adulthood
Barile JP , Edwards VJ , Dhingra SS , Thompson WW . Psychol Violence 2015 5 (2) 183-191 Correction Notice: An Erratum for this article was reported in Vol 5(2) of Psychology of Violence (see record 2015-04307-001). Data in Table 2 were incorrectly reported in the "Obtain needed support" column for the country-level predictors unemployment rate and median income. No corrections to the text were needed. The correct data are presented in the erratum.] Objective: This study determined whether county-level social determinants of health and adverse childhood experiences (ACE) were associated with emotional support and health-related quality of life (HRQOL) in adulthood. This study represents the largest population-based investigation on ACE to include county-level indicators of the social ecology. Method: We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey (29,212 adults from 5 states) and the American Community Survey (2010; 304 counties). Multilevel structural equation models were employed to test direct and indirect associations between county-level social determinants of health, ACEs and indicators of adult HRQOL. Results: At the individual level, ACEs were associated with lower emotional support, and lower emotional support was associated with worse physical and mental HRQOL. Parental divorce was associated with better mental HRQOL for individuals who reported =2 forms of childhood maltreatment and/or negative household environments during childhood. At the county-level, low median income and high county-level unemployment were associated with low emotional support, and high median income and high unemployment were directly associated with poor physical and mental HRQOL. Conclusion: Findings from this study suggest that intervention efforts designed to promote positive emotional supports for adults who have experienced ACEs, particularly for those living in disadvantaged counties, may ameliorate potential health consequences during adulthood. |
Current depression among adult cancer survivors: findings from the 2010 Behavioral Risk Factor Surveillance System
Zhao G , Okoro CA , Li J , White A , Dhingra S , Li C . Cancer Epidemiol 2014 38 (6) 757-64 BACKGROUND: A cancer diagnosis and subsequent treatments constitute a significantly increased psychological burden among cancer patients. This study examined the prevalence of current depression and the risk factors associated with a high burden of depression among cancer survivors in the US. METHODS: We analyzed data from 3550 cancer survivors (aged ≥18 years) and 26,917 adults without cancer who participated in the 2010 Behavioral Risk Factor Surveillance System. Depressive symptoms were assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Participants with a total depression severity score of ≥10 were defined as having current depression. Prevalence and prevalence ratios were estimated by conducting log-linear regression analysis while controlling for potential confounders. RESULTS: Overall, 13.7% of cancer survivors (vs. 8.9% of adults without cancer, P<0.001) reported having current depression; the prevalence varied significantly by cancer category. Among cancer survivors, after multivariate adjustment for covariates, cancer diagnosis within a year, being in 'other' racial/ethnic group, divorced, separated, widowed, or never married, current or former smoker, or having histories of diabetes, disability, or depression were associated with significantly higher prevalence ratios for current depression; whereas being at an advanced age (≥60 years old), attaining educational levels of >high school graduate, or engaging in leisure-time physical activity were associated with significantly lower prevalence ratios for current depression. CONCLUSION: Our results indicate that cancer survivors are at increased risk of current depression. Targeting cancer survivors at high risk of depressive issues may be especially important for clinical support and interventions aimed at improving mental well-being. |
Severity of psychological distress among adults with and without disabilities
Okoro CA , Dhingra SS . Soc Work Public Health 2014 29 (7) 671-85 The aim of this study is to examine psychological distress and its individual symptoms between adults with and without disabilities, and among adults with disabilities, to examine whether an association exists between severity of distress and health-related factors. Cross-sectional data from the 2007 Behavioral Risk Factor Surveillance System were used for this study. Severity of psychological distress was assessed using the Kessler 6 scale of nonspecific psychological distress. Logistic regression analyses were performed to estimate predicted marginals and prevalence ratios. Nine percent of adults had mild to moderate psychological distress and 3.9% had serious psychological distress. The adjusted mean Kessler 6 total scores and individual item scores were higher for adults with disabilities, as was the average number of days that a mental health condition interfered with activities in the past 30 days. Among adults with disabilities, mild to moderate and serious psychological distress were particularly high among those who were unemployed or unable to work. Those who had either mild to moderate or serious psychological distress were significantly more likely than those with no psychological distress to be physically inactive, to smoke, and to report fair or poor health, life dissatisfaction, and inadequate social support. A dose-response relationship exists between categorical severity of psychological distress and examined health-related factors. These findings may inform the design of targeted public health strategies that aim to eliminate health disparities between people with and without disabilities. |
Childhood adversity and adult chronic disease: an update from ten states and the District of Columbia, 2010
Gilbert LK , Breiding MJ , Merrick MT , Thompson WW , Ford DC , Dhingra SS , Parks SE . Am J Prev Med 2014 48 (3) 345-9 BACKGROUND: Adverse childhood experiences (ACEs), including child abuse and family dysfunction, are linked to leading causes of adult morbidity and mortality. Most prior ACE studies were based on a nonrepresentative patient sample from one Southern California HMO. PURPOSE: To determine if ACE exposure increases the risk of chronic disease and disability using a larger, more representative sample of adults than prior studies. METHODS: Ten states and the District of Columbia included an optional ACE module in the 2010 Behavioral Risk Factor Surveillance Survey, a national cross-sectional, random-digit-dial telephone survey of adults. Analysis was conducted in November 2012. Respondents were asked about nine ACEs, including physical, sexual, and emotional abuse and household member mental illness, alcoholism, drug abuse, imprisonment, divorce, and intimate partner violence. An ACE score was calculated for each subject by summing the endorsed ACE items. After controlling for sociodemographic variables, weighted AORs were calculated for self-reported health conditions given exposure to zero, one to three, four to six, or seven to nine ACEs. RESULTS: Compared to those who reported no ACE exposure, the adjusted odds of reporting myocardial infarction, asthma, fair/poor health, frequent mental distress, and disability were higher for those reporting one to three, four to six, or seven to nine ACEs. Odds of reporting coronary heart disease and stroke were higher for those who reported four to six and seven to nine ACEs; odds of diabetes were higher for those reporting one to three and four to six ACEs. CONCLUSIONS: These findings underscore the importance of child maltreatment prevention as a means to mitigate adult morbidity and mortality. |
Examination of the factorial structure of adverse childhood experiences and recommendations for three subscale scores
Ford DC , Merrick MT , Parks SE , Breiding MJ , Gilbert LK , Edwards VJ , Dhingra SS , Barile JP , Thompson WW . Psychol Violence 2014 4 (4) 432-444 OBJECTIVE: The purpose of the current investigation is to assess and validate the factor structure of the Behavioral Risk Factor Surveillance System's (BRFSS) Adverse Childhood Experience (ACE) module. METHOD: ACE data available from the 2009 BRFSS survey were fit using exploratory factor analysis (EFA) to estimate an initial factorial structure. The exploratory solution was then validated using confirmatory factor analysis (CFA) with data from the 2010 BRFSS survey. Lastly, ACE factors were tested for measurement invariance using multiple group factor analysis. RESULTS: EFA results suggested that a 3-factor solution adequately fit the data. Examination of factor loadings and item content suggested the factors represented the following construct areas: Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse. Subsequent CFA results confirmed the 3-factor solution and provided preliminary support for estimation of an overall latent ACE score summarizing the responses to all available items. Measurement invariance was supported across both gender and age. CONCLUSIONS: Results of this study provides support for the use of the current ACE module scoring algorithm, which uses the sum of the number of items endorsed to estimate exposure. However, the results also suggest potential benefits to estimating 3 separate composite scores to estimate the specific effects of exposure to Household Dysfunction, Emotional/Physical Abuse, and Sexual Abuse. |
Progress toward prevention of transfusion-transmitted hepatitis B and hepatitis C infection - sub-Saharan Africa, 2000-2011
Apata IW , Averhoff F , Pitman J , Bjork A , Yu J , Amin NA , Dhingra N , Kolwaite A , Marfin A . MMWR Morb Mortal Wkly Rep 2014 63 (29) 613-9 Infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are major causes of morbidity and mortality globally, primarily because of sequelae of chronic liver disease including cirrhosis and hepatocellular carcinoma. The risks for HBV and HCV transmission via blood transfusions have been described previously and are believed to be higher in countries in sub-Saharan Africa. Reducing the risk for transfusion-transmitted human immunodeficiency virus (HIV), HBV, and HCV infection is a priority for international aid organizations, such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Combat HIV/AIDS, Malaria, and Tuberculosis, and the World Health Organization (WHO). Over the last decade, PEPFAR and the Global Fund have supported blood safety programs in many sub-Saharan African countries with heavy burdens of HIV and acquired immunodeficiency syndrome (AIDS), hepatitis, malaria, and maternal mortality. This report summarizes HBV- and HCV-related surveillance data reported by the blood transfusion services of WHO member states to WHO's Global Database on Blood Safety (GDBS) (4). It also evaluates the performance of blood safety programs in screening for HBV and HCV in 38 sub-Saharan Africa countries.* Selected GDBS indicators were compared for the years 2000 and 2004 (referred to as the 2000/2004 period) and 2010 and 2011 (referred to as the 2010/2011 period). From 2000/2004 to 2010/2011, the median of the annual number of units donated per country increased, the number of countries screening at least 95% of blood donations for HBV and HCV increased, and the median of the national prevalence of HBV and HCV marker-reactive blood donations decreased. These findings suggest that during the past decade, more blood has been donated and screened for HBV and HCV, resulting in a safer blood supply. Investments in blood safety should be continued to further increase the availability and safety of blood products in sub-Saharan Africa. |
A triple play: psychological distress, physical comorbidities, and access and use of health services among U.S. adults with disabilities
Okoro CA , Dhingra SS , Li C . J Health Care Poor Underserved 2014 25 (2) 814-36 PURPOSE: Among adults with disabilities, we examined whether increasing levels of psychological distress were associated with higher estimated prevalences of chronic conditions, obesity, health care access, and use of preventive services. METHODS: We analyzed data from the 2007 Behavioral Risk Factor Surveillance System. The Kessler-6 scale was used to assess psychological distress. RESULTS: Increasing levels of psychological distress were associated with an increased prevalence of chronic diseases and conditions, and decreased access to health care and utilization of preventive services in keeping with what has been established for non-disabled populations. Among adults with disabilities, aged 18-64 years and 65 years or older, increasing levels of distress were also associated with increased receipt of mental health treatment. However, compared to adults aged 18-64 years, larger proportions of older adults reported non-receipt of mental health treatment (mild to moderate psychological distress: 58.0% versus 70.6%; serious psychological distress: 40.5% versus 54.5%). CONCLUSIONS: While adults with disabilities who had increased levels of psychological distress were more likely to receive mental health services, they also had higher estimated prevalences of chronic conditions, barriers to health care, and non-receipt of preventive cancer screenings. |
Effects of Massachusetts health reform on the use of clinical preventive services
Okoro CA , Dhingra SS , Coates RJ , Zack M , Simoes EJ . J Gen Intern Med 2014 29 (9) 1287-95 BACKGROUND: Expansion of health insurance coverage, and hence clinical preventive services (CPS), provides an opportunity for improvements in the health of adults. The degree to which expansion of health insurance coverage affects the use of CPS is unknown. OBJECTIVE: To assess whether Massachusetts health reform was associated with changes in healthcare access and use of CPS. DESIGN: We used a difference-in-differences framework to examine change in healthcare access and use of CPS among working-aged adults pre-reform (2002-2005) and post-reform (2007-2010) in Massachusetts compared with change in other New England states (ONES). SETTING: Population-based, cross-sectional Behavioral Risk Factor Surveillance System surveys. PARTICIPANTS: A total of 208,831 survey participants aged 18 to 64 years. INTERVENTION: Massachusetts health reform enacted in 2006. MEASUREMENTS: Four healthcare access measures outcomes and five CPS. KEY RESULTS: The proportions of adults who had health insurance coverage, a healthcare provider, no cost barrier to healthcare, an annual routine checkup, and a colorectal cancer screening increased significantly more in Massachusetts than those in the ONES. In Massachusetts, the prevalence of cervical cancer screening in pre-reform and post-reform periods was about the same; however, the ONES had a decrease of -1.6 percentage points (95 % confidence interval [CI] -2.5, -0.7; p <0.001). As a result, the prevalence of cervical cancer screening in Massachusetts was increased relative to the ONES (1.7, 95 % CI 0.2, 3.2; p = 0.02). Cholesterol screening, influenza immunization, and breast cancer screening did not improve more in Massachusetts than in the ONES. LIMITATIONS: Data are self-reported. CONCLUSIONS: Health reform may increase healthcare access and improve use of CPS. However, the effects of health reform on CPS use may vary by type of service and by state. |
Predictors of blood trihalomethane concentrations in NHANES 1999-2006
Riederer AM , Dhingra R , Blount BC , Steenland K . Environ Health Perspect 2014 122 (7) 695-702 BACKGROUND: Trihalomethanes (THMs) are water disinfection by-products that have been associated with bladder cancer and adverse birth outcomes. Four (bromoform, chloroform, bromodichloromethane, dibromochloromethane) were measured in blood and tap water of U.S. adults in NHANES 1999-2006. THMs are metabolized to potentially toxic/mutagenic intermediates by cytochrome p450 (CYP) 2D6 and CYP2E1 enzymes. OBJECTIVES: We conducted exploratory analyses of blood THMs including factors affecting CYP2D6 and CYP2E1 activity. METHODS: We used weighted multivariable regression to evaluate associations between blood THMs and water concentrations, survey year, and other factors potentially affecting THM exposure or metabolism (e.g., prescription medications, cruciferous vegetables, diabetes, fasting, pregnancy, swimming). RESULTS: From 1999-2006, geometric mean blood and water THM levels dropped in parallel-32%-76% in blood and 38%-52% in water-likely resulting, in part, from the lowering of the total THM drinking water standard in 2002-2004. The strongest predictors of blood THM levels were survey year and water concentration (N=4,232 total THM; N=4,582 chloroform; N=4,080 bromoform; N=4,374 bromodichloromethane; N=4,464 dibromochloromethane). Statistically significant inverse associations were detected with diabetes and eating cruciferous vegetables in all but the bromoform model. Medications did not consistently predict blood levels. Afternoon/evening blood samples had lower THM concentrations than morning samples. In a sub-sample (n=230), air chloroform better predicted blood chloroform than water chloroform, suggesting showering/bathing was a more important source than drinking. CONCLUSIONS: We identified several factors associated with blood THMs which may be factors affecting their metabolism; potential health implications require further study. |
Change in health insurance coverage in Massachusetts and other New England states by perceived health status: potential impact of health reform
Dhingra SS , Zack MM , Strine TW , Druss BG , Simoes E . Am J Public Health 2013 103 (6) e107-14 OBJECTIVES: We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health. METHODS: We used 2003-2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform. RESULTS: The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P < .001). Groups with higher perceived health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states-from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs. CONCLUSIONS: On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e8. doi:10.2105/AJPH.2012.300997). |
Associations between overall and abdominal obesity and suicidal ideation among US adult women
Zhao G , Li C , Ford ES , Tsai J , Dhingra SS , Croft JB , McKnight-Eily LR , Balluz LS . J Obes 2012 2012 263142 Obesity is associated with increased risks for mental disorders. This study examined associations of obesity indicators including body mass index (BMI), waist circumference, and waist-height ratio with suicidal ideation among U.S. women. We analyzed data from 3,732 nonpregnant women aged ≥20 years who participated in the 2005-2008 National Health and Nutrition Examination Survey. We used anthropometric measures of weight, height, and waist circumference to calculate BMI and waist-height ratio. Suicidal ideation was assessed using the Item 9 of the Patient Health Questionnaire-9. Odds ratios with 95% conference intervals were estimated using logistic regression analyses after controlling for potential confounders. The age-adjusted prevalence of suicidal ideation was 3.0%; the prevalence increased linearly across quartiles of BMI, waist circumference, and waist-height ratio (P for linear trend <0.01 for all). The positive associations of waist circumference and waist-height ratio with suicidal ideation remained significant (P < 0.05) after adjustment for sociodemographics, lifestyle-related behavioral factors, and having either chronic conditions or current depression. However, these associations were attenuated after both chronic conditions and depression were entered into the models. Thus, the previously reported association between obesity and suicidal ideation appears to be confounded by coexistence of chronic conditions and current depression among women of the United States. |
The relationship of level of positive mental health with current mental disorders in predicting suicidal behavior and academic impairment in college students
Keyes CL , Eisenberg D , Perry GS , Dube SR , Kroenke K , Dhingra SS . J Am Coll Health 2012 60 (2) 126-33 OBJECTIVE: To investigate whether level of positive mental health complements mental illness in predicting students at risk for suicidal behavior and impaired academic performance. PARTICPANTS: A sample of 5,689 college students participated in the 2007 Healthy Minds Study and completed an Internet survey that included the Mental Health Continuum-Short Form and the Patient Health Questionnaire screening scales for depression and anxiety disorders, questions about suicide ideation, plans, and attempts, and academic impairment. RESULTS: Just under half (49.3%) of students were flourishing and did not screen positive for a mental disorder. Among students who did, and those who did not, screen for a mental disorder, suicidal behavior and impaired academic performance were lowest in those with flourishing, higher among those with moderate, and highest in those with languishing mental health. CONCLUSIONS: Positive mental health complements mental disorder screening in mental health surveillance and prediction of suicidal behavior and impairment of academic performance. |
Associations between adverse childhood experiences, psychological distress, and adult alcohol problems
Strine TW , Dube SR , Edwards VJ , Prehn AW , Rasmussen S , Wagenfeld M , Dhingra S , Croft JB . Am J Health Behav 2012 36 (3) 408-23 OBJECTIVE: To examine the mediating role of psychological distress on the relationship between adverse childhood experiences and adult alcohol problems by gender. METHODS: Linear and logistic regression analyses were conducted on 7279 Kaiser-Permanente members, aged >18 years. RESULTS: Psychological distress mediated significant proportions of alcohol problems associated with childhood emotional abuse and neglect, physical abuse and neglect, mental illness in the household, parental separation or divorce, sexual abuse, and household drug use among women and mental illness in the household, emotional neglect, physical abuse, household drug use, and sexual abuse among men. CONCLUSION: It may be important to identify early childhood trauma and adult psychological distress in programs that focus on reducing alcohol abuse. |
Mental illness surveillance among adults in the United States
Reeves WC , Strine TW , Pratt LA , Thompson W , Ahluwalia I , Dhingra SS , McKnight-Eily LR , Harrison L , D'Angelo DV , Williams L , Morrow B , Gould D , Safran MA . MMWR Suppl 2011 60 (3) 1-29 Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity. |
State-level socioeconomic factors are associated with current depression among U.S. adults in 2006 and 2008
Fan AZ , Strasser S , Zhang XY , Dhingra S , McKnight-Eily L , Holt J , Balluz L . J Public Health Epidemiol 2011 3 (10) 462-470 This study investigated whether state-level socioeconomic deprivation and income inequality are associated with depression prevalence. Current depressive symptoms within a two-week timeframe were assessed using the patient health questionnaire-2 from the 2006 and 2008 behavioral risk factor surveillance system (BRFSS) administered in selected states. State socio-economic deprivation indexes (percent of people below poverty level; employment/population ratio for the population 16 to 64 years old; median household income) were obtained from the 2006 and 2008 American community survey (ACS). State Gini indexes (indicating income inequality) were obtained from 2000 U.S. Census. After controlling for age, sex, race/ethnicity, marital status, educational attainment, annual household income, and chronic physical health condition index, adults residing in states with median household income in the lowest quintile (OR (95% CI)=1.18 (1.16 to 1.20) vs. others), in states with population below poverty line greater than the fourth quintile (OR (95% CI)=1.22 (1.20 to 1.24), vs. others), in states with employment/population ratios in the lowest quintile (OR(95% CI)=1.31 (1.29 to 1.34), vs. others), and in states with higher income inequality (GINI index >0.452) (OR(95% CI)=1.22 (1.21-1.24), vs. others) had higher odds of current depression. The results suggest that state-level socioeconomic factors are associated with depression prevalence among U.S. adults beyond individual level socioeconomic characteristics. |
Uninsurance among nonelderly adults with and without frequent mental and physical distress in the United States
Strine TW , Zack M , Dhingra S , Druss B , Simoes E . Psychiatr Serv 2011 62 (10) 1131-7 OBJECTIVES: This research describes uninsurance rates over time among nonelderly adults in the United States with or without frequent physical and mental distress and provides estimates of uninsurance by frequent mental distress status and sociodemographic characteristics nationally and by state. METHODS: Data from the 1993 through 2009 Behavioral Risk Factor Surveillance System, a telephone survey that uses random-digit dialing, were used to examine the prevalence of uninsurance among nearly 3 million respondents by self-report of frequent physical and frequent mental distress and sociodemographic characteristics, response year, and state of residence. RESULTS: After adjustment for sociodemographic characteristics, uninsurance among adults aged 18 to 64 years was markedly higher among those with frequent mental distress only (22.6%) and those with both frequent mental and frequent physical distress (21.8%) than among those with frequent physical distress only (17.7%). The prevalence of uninsurance did not differ markedly between those with only frequent mental distress and those with both frequent mental distress and frequent physical distress. The prevalence of uninsurance among those with frequent mental distress only and those with neither frequent mental distress nor frequent physical distress increased significantly over time. CONCLUSIONS: Uninsurance rates among nonelderly adults with frequent mental distress were disproportionately high. The results of this analysis can be used as baseline data to assess whether implementation of the Affordable Care Act is accompanied by changes in health care access, utilization, and self-reported measures of health, particularly among those with mental illness. |
The association between depression and anxiety and use of oral health services and tooth loss
Okoro CA , Strine TW , Eke PI , Dhingra SS , Balluz LS . Community Dent Oral Epidemiol 2011 40 (2) 134-44 OBJECTIVE: The purpose of this study is to examine the associations among depression, anxiety, use of oral health services, and tooth loss. MEYHODS: Data were analysed for 80 486 noninstitutionalized adults in 16 states who participated in the 2008 Behavioral Risk Factor Surveillance System. Binomial and multinomial logistic regression analyses were used to estimate predicted marginals, adjusted prevalence ratios, adjusted odds ratios (AOR) and their 95% confidence intervals (CI). RESULTS: The unadjusted prevalence for use of oral health services in the past year was 73.1% [standard error (SE), 0.3%]. The unadjusted prevalence by level of tooth loss was 56.1% (SE, 0.4%) for no tooth loss, 29.6% (SE, 0.3%) for 1-5 missing teeth, 9.7% (SE, 0.2%) for 6-31 missing teeth and 4.6% (SE, 0.1%) for total tooth loss. Adults with current depression had a significantly higher prevalence of nonuse of oral health services in the past year than those without this disorder (P < 0.001), after adjustment for age, sex, race/ethnicity, education, marital status, employment status, adverse health behaviours, chronic conditions, body mass index, assistive technology use and perceived social support. In logistic regression analyses employing tooth loss as a dichotomous outcome (0 versus ≥1) and as a nominal outcome (0 versus 1-5, 6-31, or all), adults with depression and anxiety were more likely to have tooth loss. Adults with current depression, lifetime diagnosed depression and lifetime diagnosed anxiety were significantly more likely to have had at least one tooth removed than those without each of these disorders (P < 0.001 for all), after fully adjusting for evaluated confounders (including use of oral health services). The adjusted odds of being in the 1-5 teeth removed, 6-31 teeth removed, or all teeth removed categories versus 0 teeth removed category were increased for adults with current depression versus those without (AOR = 1.35; 95% CI = 1.14-1.59; AOR = 1.83; 95% CI = 1.51-2.22; and AOR = 1.44; 95% CI = 1.11-1.86, respectively). The adjusted odds of being in the 1-5 teeth removed and 6-31 teeth removed categories versus 0 teeth removed category were also increased for adults with lifetime diagnosed depression or anxiety versus those without each of these disorders. CONCLUSIONS: Use of oral health services and tooth loss was associated with depression and anxiety after controlling for multiple confounders. |
Psychological distress severity of adults reporting receipt of treatment for mental health problems in the BRFSS
Dhingra SS , Zack MM , Strine TW , Druss BG , Berry JT , Balluz LS . Psychiatr Serv 2011 62 (4) 396-403 OBJECTIVE: Although effective mental health treatments exist, few population data are available on treatment receipt by persons with psychological distress. This study aimed to understand the association between symptoms and treatment receipt with data from the U.S Behavioral Risk Factor Surveillance System (BRFSS) survey. METHODS: In the 2007 survey, psychological distress was assessed with the Kessler-6 scale, and respondents were asked about receipt of mental health treatment. Data from 197,914 respondents were analyzed. RESULTS: In the overall population 87.5% of respondents reported no psychological distress, 8.5% mild to moderate psychological distress, and 3.9% serious psychological distress. Those with serious distress were nearly ten times as likely to receive treatment (adjusted odds ratio=9.58, 95% confidence interval=8.53-10.75) as those with no distress. One in ten persons (10.7%) in the study population reported receiving treatment. CONCLUSIONS: Distinct U.S. subpopulations exist by treatment and symptom status. Better understanding of all these groups is essential for improving population-based mental health care. (Psychiatric Services 62:396-403, 2011). |
Addressing mental health promotion in chronic disease prevention and health promotion
Perry GS , Presley-Cantrell LR , Dhingra SS . Am J Public Health 2010 100 (12) 2337-9 The World Health Organization (WHO) defines mental health as “not just the absence of mental disorder” but “as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”1(p2) Mental illness, on the other hand, is the “term that refers collectively to all diagnosable mental disorders” that are “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”2(p5) | Further, WHO has long defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease, or infirmity.”3(p100) Given these definitions, it should be clear that there is no health without mental health. |
Determining prevalence and correlates of psychiatric treatment with Andersen's behavioral model of health services use
Dhingra SS , Zack M , Strine T , Pearson WS , Balluz L . Psychiatr Serv 2010 61 (5) 524-8 OBJECTIVE: This study examined the prevalence and correlates of use of health professional services for the treatment of mental or emotional problems by using Andersen's Behavioral Model of Health Services Use. METHODS: In the 2007 Behavioral Risk Factor Surveillance System 169,546 community-dwelling respondents from 35 states, the District of Columbia, and Puerto Rico answered questions about their sociodemographic characteristics; perceived need; nonspecific psychological distress, as measured with the Kessler-6 scale; and use of professional treatment of mental or emotional problems. RESULTS: Evaluated need (psychological distress) was significantly associated with receipt of treatment for mental or emotional problems, as were predisposing factors (age, gender, race or ethnicity, marital status, and education), enabling and impeding factors (income, health insurance, and emotional support), and perceived need (number of mentally and physically unhealthy days and self-rated health). CONCLUSION: Constituents in the public mental health system should seriously consider that health services utilization is socially patterned and not just an individual behavior. |
Geographic and sociodemographic variation in self-reported seat belt use in the United States
Strine TW , Beck LF , Bolen J , Okoro C , Dhingra S , Balluz L . Accid Anal Prev 2010 42 (4) 1066-71 BACKGROUND: With new data available, we sought to update existing literature on the prevalence of self-reported seat belt use by state, region, and rural/urban status and to estimate the strength of the association between seat belt use and rural/urban status adjusted for type of seat belt law and several other factors. METHODS: We examined data on self-reported use of seat belts from 50 states, the District of Columbia, and three territories using the 2008 Behavioral Risk Factor Surveillance System, a state-based random-digit-dialed telephone survey (n=406,552). Reported seat belt use was assessed by state, U.S. Census regions, and U.S. Department of Agriculture (USDA) rural/urban continuum codes. RESULTS: Overall, 85% of adults in the United States reported they always used seat belts. Regionally, the West had the highest prevalence of persons who reported that they always wear seat belts (89.6%) and the Midwest had the lowest (80.4%). States with primary seat belt laws had the highest prevalence of reported seat belt use, compared with states with secondary or no laws. After adjusting for various sociodemographic characteristics, body mass index, and type of seat belt law, persons in the most densely populated metropolitan areas were significantly more likely to report always wearing seat belts than those in most sparsely populated rural areas (adjusted odds ratio=2.9). CONCLUSION: Our findings reinforce the evidence that primary enforcement seat belt laws are effective for increasing seat belt use, and suggest that upgrading to primary enforcement laws will be an important strategy for reducing crash-related fatalities in rural areas. |
Psychological distress and mental health treatment among persons with and without active duty military experience, Behavioral Risk Factor Surveillance System, United States, 2007
Safran MA , Strine TW , Dhingra SS , Berry JT , Manderscheid R , Mokdad AH . Int J Public Health 2009 54 61-7 OBJECTIVES: To examine self-reported psychological distress (K-6 scale) and mental health treatment among persons with and without active duty U.S. military experience (ADME) currently residing in private residences in the U.S. METHODS: Analysis of 2007 Behavioral Risk Factor Surveillance System data from 35 states, District of Columbia, and Puerto Rico (n = 202,029 for those answering all K-6 questions, the treatment question, and the ADME question) RESULTS: Adjusting for age, sex, race/ethnicity, and education, overall mean K-6 scores of those with and without ADME were similar (p = 0.3223); however, more of those with, vs. without, ADME reported current mental health treatment (11.7 % vs. 9.6 %, p = 0.0001). Those with ADME receiving such treatment had a higher mean K-6 score (7.7) than those without ADME receiving such treatment (6.9) (p = 0.0032). CONCLUSIONS: Community-dwelling persons with ADME have similar demographically-adjusted mean K-6 psychological distress scores, but greater likelihood of recent mental health treatment, compared to those without ADME. |
Relationships between serious psychological distress and the use of health services in the United States: findings from the Behavioral Risk Factor Surveillance System
Pearson WS , Dhingra SS , Strine TW , Liang YW , Berry JT , Mokdad AH . Int J Public Health 2009 54 23-9 OBJECTIVE: To determine rates of access to and use of health services among adults with Serious Psychological Distress (SPD). METHODS: Adults > or = 18 years in the 2007 BRFSS were stratified based on the presence of SPD, assessed by scores > or = 13 using the Kessler-6 tool (N = 199,209). Access to and use of general and mental health services were compared for those with scores < 13 and those > or = 13 using Chi-square analyses and logistic regression models. RESULTS: Less than half of all adults with SPD indicated receiving mental health treatment. Persons < 65 years and having SPD were significantly less likely to have access to any type of health insurance (0.59 O.R., 0.51-0.68 95% C.I.) compared to persons <65 years without SPD. CONCLUSIONS: These results present a situation which could potentially lead to increased use of emergency departments for possible non-emergent services. Less than half of adults with SPD were receiving mental health treatment and most, regardless of their SPD score, were receiving routine health checkups; presenting an opportunity to identify and treat many mental health issues in the primary care setting. |
Serious psychological distress among adults with and without disabilities
Okoro CA , Strine TW , Balluz LS , Crews JE , Dhingra S , Berry JT , Mokdad AH . Int J Public Health 2009 54 52-60 OBJECTIVES: Our objective was to examine the extent to which serious psychological distress (SPD) is associated with behavioral and social correlates among US adults with self-reported disabilities. METHODS: Self-reported data on disability, SPD, and behavioral and social correlates were collected from 202,383 participants (aged > or = 18 years) of the 2007 Behavioral Risk Factor Surveillance System. Adults with self-reported disabilities were identified using two standardized questions--one relating to activity limitation, the other to special equipment. RESULTS: The age-adjusted prevalence of SPD among adults with disabilities was nearly seven times higher than among adults without disabilities (14.1 % vs. 1.8 %, respectively). Adults with disabilities who have both activity limitations and who use assistive technology, and those with activity limitations only consistently experienced a higher prevalence of SPD than those who used assistive technology only (age-adjusted prevalence: 21.0 % and 12.7 % vs. 4.9 %). After adjusting for age, sex, race/ethnicity, educational attainment, marital status, and employment status, in the past 30 days SPD was more common among Hispanic persons, and was significantly associated with younger age, lower educational attainment, marital history, and employment status. Adults with SPD and disabilities experienced increased levels of risk behaviors, life dissatisfaction, and inadequate social support. Most importantly, just over half of adults with disabilities and SPD (51.6 % [95 % CI = 48.6-54.6]) were receiving medical care for a mental health condition compared to 20.6 % (95 % CI = 19.9-21.3) without SPD. CONCLUSIONS: Given that SPD is strongly associated with both the behavioral and psychosocial determinants of health, this work underscores the need for evidence-based interventions that may reduce its prevalence among people living with disabilities. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 06, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure