Inequalities in US Life Expectancy by Area Unemployment Level, 1990-2010

This study examined the association between unemployment and life expectancy in the United States during 1990-2010. 

Census-based unemployment rates were linked to US county-level mortality data. Life expectancies were calculated by age, sex, race, and unemployment level during 1990-2010. Differences in life expectancy were decomposed by age and cause of death. 

Life expectancy was consistently lower in areas with higher unemployment rates. In 2006-2010, those in areas with high unemployment rates (≥9%) had a life expectancy of 76.9 years, compared with 80.7 years for those in areas with low unemployment rates (<3%). The association between unemployment and life expectancy was stronger for men than for women. 

Life expectancy ranged from 69.9 years among black men in high unemployment areas to 90.0 years among Asian/Pacific Islander women in low unemployment areas. Disparities persisted over time. In 1990-1992, life expectancy was 4.7 years shorter in high unemployment than in low unemployment areas. In 2006-2010, the life expectancy difference between the lowest and highest unemployment areas decreased to 3.8 years. Heart disease, cancer, homicide, unintentional injuries, diabetes, HIV/AIDS, and liver cirrhosis contributed most to the lower life expectancy in high unemployment areas. High unemployment areas recorded larger gains in life expectancy than low unemployment areas, contributing to the narrowing gap during 1990-2010.

Below:  Life expectancy at birth by sex and area unemployment level, United States, 1990–2010

Below:  Survivorship by age, race, and unemployment level, United States, 1990–2010

Below:  Conditional probability of survival between ages of 25 and 64 years by unemployment level, United States, 1990–2010

Full article at:   http://goo.gl/FI27Gt

By:  Singh GK1, Siahpush M2.

• 1US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
• 2Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198-4365, USA.
• Scientifica (Cairo). 2016;2016:8290435. doi: 10.1155/2016/8290435. Epub 2016 Mar 17. 

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Understanding differences in HIV/HCV prevalence according to differentiated risk behaviors in a sample of PWID in rural Puerto Rico

BACKGROUND:

Blood contained in needles and injection equipment has been identified as a vector for HIV and HCV transmission among people who inject drugs (PWID). Yet, there is often a wide discrepancy in prevalence for both viruses. While microbiological differences between viruses influence prevalence, other variables associated with the way drugs are acquired and used, also play a role.

METHODS:

Respondent-driven sampling (RDS) methods recruited a sample of 315 current intravenous drug users in rural Puerto Rico. Information about type and frequency of use, HIV and HVC risk behaviors (sharing needles, cookers, cotton, and water), sexual behaviors, and alcohol use was collected. HIV and HCV statuses were assessed via rapid antibody tests. T tests compare means of participants who tested positive (reactive) to those who tested negative. Logistic regression analyses were used to validate the association of the risk factors involved.

RESULTS:

Tests showed a significant difference in HIV (6 %) and HCV (78.4 %) prevalence among a population of current PWID. The main riskbehaviors in HCV transmission are the sharing of injection "works", (e.g., cookers, cotton, and water). Sharing works occurred more than twice as often as the sharing of needles, and HCV+ and HCV- individuals reported the same needle sharing habits.

CONCLUSIONS:

Washing and rinsing injection works with water seems to prevent HIV transmission, but it is unable to prevent HCV infection. While education about the need to clean injection equipment with bleach might be beneficial, equipment sharing-and the subsequent risk of HVC-might be unavoidable in a context where participants are forced to pool resources to acquire and use intravenous drugs.

Descriptive statistics

	Mean/%	SD	N
% HIV positive (INSTI Rapid Test)	6.0 %		315
% HCV positive (OraQuick Rapid Test)	78.4 %		315
% Male	90.5 %		315
% Born in Puerto Rico	93.0 %		315
Age (years)	41.8	(10.07)	315
Annual per capita income	$4452	($3200)	311
% Unemployed	85.4 %		314
% Currently homeless	21.9 %		314
% Graduate high school (or higher)	52.4 %		315
% Married or living together as married	22.2 %		315
% Injected 4 or more times per day	39.7 %		315
% Injected 2–3 times per day	39.7 %		315

Full article at:   http://goo.gl/xAXsqk

By:  Abadie R1, Welch-Lazoritz M2, Gelpi-Acosta C3, Reyes JC4, Dombrowski K5.

• 1Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA. rabadie2@unl.edu.
• 2Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA. mwelch2@unl.edu.
• 3Social Science Department, LaGuardia Community College, 31-10 Thomson Ave., Long Island City, NY, 11101, USA. camilagelpi@gmail.com.
• 4Department of Biostatistics and Epidemiology, University of Puerto Rico, 365067, San Juan, PR, 00936, USA. juan.reyes5@upr.edu.
• 5Department of Sociology, University of Nebraska-Lincoln, 206 Benton Hall, Lincoln, NE, 68588, USA. kdombrowski2@unl.edu.
• Harm Reduct J. 2016 Mar 8;13(1):10. doi: 10.1186/s12954-016-0099-9. 

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Characteristics of Clients Using a Community-Based Drug Treatment Service (‘CAPS-AD’) in Brazil: An Exploratory Study

Highlights

• ‘CAPS-AD’ is a novel vehicle of community-based treatment for alcohol and drugs in Brazil.
• We assessed a ‘snapshot sample’ of CAPS-AD clients in Brasilia (capital of Brazil).
• Most clients were male, middle-aged, unemployed, with alcohol or crack-cocaine problems.
• Half engaged in their first-ever treatment episode, suggesting effective reach by the CAPS-AD.
• Concerns about care structures, logistics and staff attitudes may compromise client retention.

Abstract

Background

Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) – providing community-based care – have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients.

Methods

N = 143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week ‘snapshot’ assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information.

Results

Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p < .05).

Conclusion

CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.

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By:  Andrea Donatti Gallassi, Eduardo Yoshio Nakano, Gabriela Arantes Wagner, Maria de Nazareth Rodrigues Malcher de Oliveira Silva, Benedikt Fischer

Affiliations

Center of Drugs and Associated Vulnerabilities, Faculty of Ceilândia, University of Brasilia, Brazil

Science and Health Technology Program, Faculty of Ceilândia, University of Brasilia, Brazil

Correspondence

Corresponding author at: Center of Drugs and Associated Vulnerabilities, University of Brasília (UNB), Faculty of Ceilândia, Centro Metropolitano 1, Conjunto A – Ceilândia Sul Zip 72220-900, Brasília DF, Brazil. Tel.: +55 6133770615.

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Prevalence of Auditory Verbal Hallucinations in a General Population: A Group Comparison Study

The present study was specifically designed to investigate the prevalence of auditory verbal hallucinations (AVH) in the general population, and sought to compare similarities and differences regarding socio‐demographics, mental health and severe life events between individuals who have never experienced AVH with those who had. The study also aimed to compare those who sought professional help for their experience of AVH with those who had not sought help. 

Through a postal questionnaire, 2,533 participants ages 18 and over from a national survey completed the Launay‐Slade Hallucinations Scale and other measures examining AVH characteristics and other areas related to AVH. In total, 7.3% of the sample reported a life‐time prevalence of AVH. 

Those with AVH were more likely to be single and unemployed, reported higher levels of depression and anxiety, and experienced a higher number of severe life events compared with those without AVH. Only 16% of those who experienced AVH in the general population sought professional help for these experiences. Compared to those who did not seek professional help, participants that had were more likely to experience AVH with a negative content, experience them on a daily basis, undergo negative reactions when experiencing AVH, and resist AVH. 

In conclusion, the prevalence of AVH was found to be relatively high. The results also revealed higher levels of reduced mental health for individuals who sought professional help, followed by those who did not, compared with those who had never experienced AVH.

BElow:  Gender distribution of voice‐hearers in different age groups

Full article at:   http://goo.gl/BtjrWP

By:  Bodil Kråkvik, 1 , 2 Frank Larøi, 3 , 4 Anne Martha Kalhovde, 5 Kenneth Hugdahl, 4 , 6 , 7 , 8 , 9 Kristiina Kompus, 4 Øyvind Salvesen, 10 Tore C Stiles, 2 and Einar Vedul‐Kjelsås 11 , 12

¹Nidaros District Psychiatric Center, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway

²Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway

³Department of Psychology: Cognition and Behaviour, University of Liège, Liège, Belgium

⁴Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway

⁵Jæren District Psychiatric Center, Bryne, Norway

⁶Division of Psychiatry, Haukeland University Hospital, Bergen, Norway

⁷Department of Radiology, Haukeland University Hospital, Bergen, Norway

⁸NORMENT Center of Excellence, University of Bergen, Bergen, Norway

⁹KG Jebsen Center of Neuropsychiatric Disorders, University of Bergen, Bergen, Norway

¹⁰Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

¹¹Department of Research and Development, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway

¹²Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Corresponding author.

^*Bodil Kråkvik, Nidaros District Psychiatric Center, Department of Research and Development, St. Olavs University Hospital, Postbox 1893 Lade,N‐7040 Trondheim, Norway. Tel: +4747359171; fax: +4772865401; e‐mail: on.valots@kivkark.lidob

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“There's Nothing Here”: Deindustrialization as Risk Environment for Overdose

Applying the “risk environment” approach proposed by ( Rhodes, 2002; Rhodes, 2009 ), this study considers the diverse contextual factors contributing to drug overdose in a deindustrialized region of the United States. 

The Monongahela Valley of Pennsylvania, once a global center of steel production, has suffered a mass exodus of jobs, residents, and businesses since a national manufacturing crisis erupted in the early 1980s; more recently, it has seen a dramatic uptick in accidental drug poisoning deaths. 

Where recent local and national media attention to overdose has focused on suburban areas and middle class victims, this study concentrates instead on the deteriorating mill city of McKeesport, Pennsylvania. Eighteen clients of the city's sole drug treatment facility participated in in-depth interviews concerning their direct experience with accidental overdose. Specifically, participants were asked to describe their own most recent overdose event and/or the last overdose they had personally witnessed. They were also asked to speculate upon the roots of the local overdose epidemic, while venturing possible remedies. 

In relating their overdose experiences, participants characterized a micro-level risk environment that was hidden behind closed doors, and populated by unprepared, ambivalent overdose “assistants.” Tasked with explaining a geographic concentration of overdose in and around McKeesport, interviewees referenced the hopelessness of the area and its lack of opportunity as driving the use of heroin, with many explicitly suggesting the need for jobs and community reinvestment to reduce fatalities. 

While state and county efforts to ameliorate overdose mortality have focused upon creating an open market in naloxone, this study suggests the need for interventions that address the poverty and social isolation of opiate users in the post-industrial periphery.

Purchase full article at:   http://goo.gl/N6yTvy

By:  Katherine McLean

The Pennsylvania State University - Greater Allegheny, 4000 University Drive, McKeesport, PA, 15131, United States

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Discrepancies Between Physician's Perception of Depression in HIV Patients and Self-Reported CES-D-20 Assessment: The DHIVA study

Depression in HIV/AIDS patients affects adherence and disease progression and often goes unnoticed. DHIVA is a cross-sectional epidemiologic survey, investigating the prevalence of depression in people living with HIV through use of a validated self-administered scale (CES-D-20), as well and the degree of concordance between the physician's perception and patients' reports. 

A total of 690 HIV-infected patients attending 24 centers across Italy were enrolled. Concordance was calculated by K statistics. Association between depression and subject characteristics were evaluated through univariate and multivariate logistic models (OR and 95%CI). 

The prevalence of depressive symptoms was 48.8% from patient's questionnaires and 49.5% from physicians' reports, with a low/fair concordance (K = .38, p < .001). CES-D-20 found severe depression in 22.5% of the patients vs 4% identified by physicians. 135/155 (87%) of the severely depressed patients (according to CES-D-20) were considered as non or mildly/moderately depressed by physicians. Risk of severe depression was associated with unemployment (p < .001), previous depression (p < .001), treatment failure (p = .001), and former smoking status (p = .018). 

Depression is frequent in HIV-infected patients in the HAART era, with significant discrepancy between physician perception and the self-reported CES-D-20 results. Screening should be mandatory in all HIV patients.

Purchase full article at:  http://goo.gl/3vZ5S7

By:  Marando F1, Gualberti G1, Costanzo AM1, di Luzio Paparatti U1, Franzetti M2, Ammassari A3, Antinori A3, Galli M2.

• 1 Abbvie s.r.l. , Campoverde, LT , Italy.
• 2 Infectious Diseases Unit , University of Milan , L. Sacco Hospital, Milan , Italy.
• 3 Istituto Nazionale Malattie Infettive L. Spallanzani , Rome , Italy. 

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Willingness of Housing First Participants to Consider Supported-Employment Services

OBJECTIVE:

People who had a recent history of homelessness and had mental illness were studied to determine how many wished to be employed and were willing to accept supported-employment services and the factors associated with a decision to decline services.

METHODS:

People (N=194) with mental illness receiving Housing First were assessed at three-month intervals over 24 months. Analyses determined variables that were associated with accepting or declining randomization to supported-employment services. A regression model was used to determine the odds of obtaining employment.

RESULTS:

Of the 133 (69%) participants who wanted work, 75 (56%) accepted and 58 (44%) declined randomization to services. Those who declined had lower odds of obtaining employment (OR=.42, p=.022), less education, and fewer arrests and had spent less time homeless.

CONCLUSIONS:

People with a recent history of homelessness who have a mental illness want work. People who declined randomization to supported-employment services had fewer barriers to employment but had reduced odds of obtaining employment.

Purchase full article at:   http://goo.gl/dE7ypP

By:   Poremski D1, Hwang SW1.

• 1The authors are with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada (e-mail: daniel.poremski@mail.mcgill.ca ). Dr. Poremski is also with the Department of Psychiatry, Douglas Mental Health University Institute, Montreal, Quebec, Canada. Dr. Hwang is also with the Department of Medicine, University of Toronto, Toronto, Ontario. 
• Psychiatr Serv. 2016 Jan 4:appips201500140

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Correlates of PrEP Indication in a Multi-Site Cohort of Young HIV-Uninfected Transgender Women

Transgender women are at high risk of HIV infection, with younger transgender women (YTW) particularly vulnerable. Pre-Exposure Prophylaxis (PrEP) has shown efficacy in reducing HIV acquisition, but little is known about PrEP indication or initiation among YTW. 

Baseline data from 180 YTW age 18-29 years enrolled in Project LifeSkills, an on-going HIV prevention intervention for YTW, were analyzed to examine factors associated with PrEP indication. The sample (mean age = 23.4, SD = 3.2) was comprised largely of women of color (69 %) and of low socioeconomic status (71 % unemployed). 

Overall, 62 % met criteria for PrEP indication, but only 5 % reported ever taking PrEP. Factors associated with increased odds of PrEP indication were: PrEP interest (aOR 3.24; 95 % CI 1.44, 7.33), number of recent anal sex partners (aOR 1.23; 95 % CI 1.04, 1.46), and lower collective self-esteem scores (aOR 0.67; 95 % CI 0.47, 0.94). 

Despite high levels of PrEP indication, there remain low levels of PrEP awareness and uptake among YTW.

Purchase full article at:  http://goo.gl/cyIR0N

By:  Kuhns LM1, Reisner SL, Mimiaga MJ, Gayles T, Shelendich M, Garofalo R.

• 1Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA, lkuhns@luriechildrens.org. 

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Pattern of Drug Use and Associated Behaviors among Female Injecting Drug Users from Northeast India: A Multi-Centric, Cross-Sectional, Comparative Study

Studies from developed countries document the presence of injecting drug use among females and significantly higher vulnerabilities and risks as compared with male injecting drug users (IDUs). Studies comparing vulnerabilities and drug use patterns between female and male IDUs are not available for developing countries.

The aim of the study was to assess the drug use pattern and related HIV vulnerabilities among female IDUs and compare these findings with those from male IDUs from four states of Northeast India.

The study used data collected as part of a nationwide study of drug use pattern and related HIV vulnerabilities among IDUs. Ninety-eight female and 202 male IDUs accessing services from harm reduction sites across the four states of Northeast region of India were chosen through random sampling methodology. Drug use pattern, injecting practices, and knowledge of HIV were assessed using a structured questionnaire.

Significantly higher proportion of female IDUs was uneducated, unemployed, reported their occupation as sex workers, and switched to injecting drug use faster as compared with male IDUs. Female IDUs practicing sex work differed significantly from those who did not with respect to frequency of daily injections, choice of drugs injected, and concomitant use of non-injecting drugs. More than half of female IDUs initiated sharing within the first month of injecting.

The study demonstrates that female IDUs differ from male IDUs in their drug use pattern, initiation into injection as well as injecting behavior, which would be an important consideration during designing of female-specific interventions.

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By: Ambekar A1, Rao R1, Agrawal A1, Goyal S1, Mishra A1, Kishore K2, Mukherjee D2, Albertin C2.

• 1a National Drug Dependence Treatment Centre, Department of Psychiatry, All India Institute of Medical Sciences , Ansari Nagar , New Delhi , India.
• 2b United Nations Office on Drugs and Crime , Chanakyapuri , New Delhi , India. 

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Risk Factors for Concurrent Use of Benzodiazepines & Opioids among Individuals Under Community Corrections Supervision

The use of heroin and prescription opioids has increased over the past decade. The concurrent use of opioids with other depressants such as benzodiazepines increases the risk of overdose death compared with use of either drug alone. This study examined factors associated with concurrent use of opioids and benzodiazepines in a criminal justice sample in the state of Alabama.

• Concurrent use was detected in 11.5% of the sample. 
• Concurrent use of opioids and benzodiazepines or use of either drug alone was associated with being White, female, married, prescribed psychiatric medications, having seen a physician in the past two years, cannabis use, and having a drug-related offense. 
• Concurrent users were more likely to be unemployed or disabled and have received counseling, and less likely to have completed college, live with relatives or friends, have a history of hallucinations, or have an offense against a person relative to nonusers.

While significant overlap of risk factors exists between individuals with concurrent use versus sole use of opioids or benzodiazepines, individuals with concurrent use generally have more social dysfunction than individ

Via:  http://ht.ly/SgBi6

By: Cropsey KL1, Stevens EN2, Valera P3, Brendan Clark C2, Bulls HW4, Nair P2, Lane PS2.

• 1University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, 1720 7th Ave S., Birmingham, AL 35294-0017, United States
• 2University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, 1720 7th Ave S., Birmingham, AL 35294-0017, United States.
• 3Columbia University, Mailman School of Public Health, 722 W. 168th St., New York, N.Y. 10032, United States.
• 4University of Alabama at Birmingham, Department of Psychology, 1720 2nd Ave S., Birmingham AL 35233, United States.
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