Research and Publications - Department of Community Medicine and Population Health

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    Providers as Stakeholders in Addressing Implementation Barriers to Youth Mental Healthcare
    (Springer, 2022) Goodcase, Eric T.; Brewe, Alexis M.; White, Susan W.; Jones, Shane; University of Alabama Tuscaloosa
    Research has shown that youth with mental health disorders often do not receive adequate care. School- and community-based mental health organizations are integral to implementing evidence-based mental healthcare to the vast majority of youth. It is therefore important to understand the perspectives of this stakeholder group, to determine how to improve access to high-quality care. A series of three focus groups with community mental health providers and three school counselors and social workers focus groups were conducted to get their perspective on existing barriers that prevent youth who need mental health services from being treated. A grounded theory inductive qualitative analysis revealed six major themes (Lack of Services, Lack of Knowledge, Stigma, Logistics, Poor Past Experiences with Mental Health, and Poor Coordination of Services). Each of these themes are discussed and implications are framed within the context of implementation science.
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    Introduction to the special issue: Management Science in the Fight Against Covid-19
    (Springer, 2021) Morton, Alec; Bish, Ebru; Megiddo, Itamar; Zhuang, Weifen; Aringhieri, Roberto; Brailsford, Sally; Deo, Sarang; Geng, Na; Higle, Julie; Hutton, David; Janssen, Mart; Kaplan, Edward H.; Li, Jianbin; Oliveira, Monica D.; Prinja, Shankar; Rauner, Marion; Silal, Sheetal; Song, Jie; University of Alabama Tuscaloosa; Xiamen University; University of Turin; University of Southampton; Indian School of Business (ISB); Shanghai Jiao Tong University; University of Southern California; University of Michigan; Yale University; Huazhong University of Science & Technology; Universidade de Lisboa; Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh; University of Vienna; University of Cape Town; Peking University
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    Six-Month Utilization of Psychotherapy by Older Adults with Depressive Symptoms
    (Springer, 2014) Gum, Amber M.; Hirsch, Anne; Dautovich, Natalie D.; Ferrante, Stephen; Schonfeld, Lawrence; University of South Florida; University of Alabama Tuscaloosa; Florida Atlantic University
    We explored psychotherapy utilization patterns for community-dwelling older adults with depressive symptoms identified during a statewide initiative designed for identifying risk of substance misuse. Individuals screening negative for substance misuse, but positive for depressive symptoms, agreed to participate in monthly interviews conducted over 6 months (n = 144). Results showed that 39 (27 %) received psychotherapy, of which nearly two-thirds reported four or fewer visits. Mental health counselors were the most frequently reported service providers (50-62.5 %). Location of service varied considerably. This study documents low rates of psychotherapy use and few visits. Current efforts to increase psychotherapy access are discussed.
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    Geographic and Racial-Ethnic Differences in Satisfaction With and Perceived Benefits of Mental Health Services
    (American Psychiatric Publishing, 2014) Kim, Giyeon; Parton, Jason M.; Ford, Katy-Lauren; Bryant, Ami N.; Shim, Ruth S.; Parmelee, Patricia; University of Alabama Tuscaloosa; Morehouse School of Medicine
    Objective: This study examined whether racial-ethnic differences in satisfaction with and perceived benefits from mental health services vary by geographic region among U.S. adults. Methods: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES), selected samples consisted of 2,160 adults age 18 and older from diverse racial-ethnic groups (Asian, black, Hispanic/Latino, and white) who had used mental health services in the past 12 months. Generalized linear model analysis was conducted for the United States as a whole and separately by geographic region (Northeast, South, Midwest, and West) after adjustment for covariates. Results: In the national sample, no significant main effects of race-ethnicity and geographic region were found in either satisfaction with or perceived benefits from mental health services. In the stratified analyses for geographic regions, however, significant racial-ethnic differences were observed in the West; blacks in the West were significantly more likely to report higher satisfaction and perceived benefits, whereas Hispanics/Latinos in the West were significantly less likely to do so. Conclusions: The findings suggest that there are regional variations of racial-ethnic differences in satisfaction with and perceived benefits from mental health services among U.S. adults and that addressing needs of Hispanics/Latinos in the West may help reduce racial-ethnic disparities in mental health care. Clinical and policy implications are discussed.
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    Immunize the HPV Vaccine Rumors: Effects of Inoculation Messages and Tone of Voice on Parental Intention to Vaccinate Their Children
    (Springer, 2022) Park, EunHae; Kim, Seoyeon; Cameron, Glen T.; Ball State University; University of Alabama Tuscaloosa; University of Missouri Columbia
    The purpose of this study was to develop an effective health communication strategy to guide the decision-making process of parents considering getting their children HPV vaccines. Using inoculation theory and findings on tone of voice as theoretical frameworks, the present study conducted a 2 (message type: inoculation vs. supportive) x 2 (tone of voice: human voice vs. organizational voice) mixed experiment with a total of 231 U.S. parents (either mother or father of a child eligible for the HPV vaccine). The results revealed that HPV vaccination promotions based on the inoculation message were more likely to generate positive attitudes toward the vaccination, higher intention to vaccinate their children, and higher intention to spread positive word of mouth (WOM) about HPV vaccination. Also, HPV vaccination promotions in the human voice were likely to increase the WOM intention more than those in the organizational voice. In regard to an interaction effect, human voice turned out to be more effective than organizational voice to generate the WOM intention when it comes to supportive messages; inoculation-based messages were similarly effective across the human and the organizational voice condition.
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    Insomnia severity and depressive symptoms in people living with HIV and chronic pain: associations with opioid use
    (Routledge, 2022) Cody, Shameka L.; Hobson, Joanna M.; Gilstrap, Shannon R.; Gloston, Gabrielle F.; Riggs, Kevin R.; Justin Thomas, S.; Goodin, Burel R.; University of Alabama Tuscaloosa; University of Alabama Birmingham
    Chronic pain commonly occurs in people living with HIV (PLWH). Many PLWH in the United States obtain opioids for chronic pain management. Whether insomnia severity and depressive symptoms are exacerbated by chronic pain and opioid use in PLWH remains to be determined. This study examined insomnia severity and depressive symptoms in 85 PLWH with chronic pain and 35 PLWH without chronic pain. Among PLWH with chronic pain, reported opioid use was examined in relation to insomnia severity and depressive symptoms. PLWH with chronic pain reported significantly greater insomnia severity (p = .033) and depressive symptoms (p = .025) than PLWH without chronic pain. Among PLWH with chronic pain who reported opioid use (n = 36), insomnia severity was greater compared to those who denied opioid use (n = 49), even after controlling for pain severity and number of comorbidities (p = .026). Greater pain severity was significantly associated with greater insomnia severity (p < .001) and depressive symptoms (p = .048) among PLWH with chronic pain who reported opioid use. These associations were not significant among those PLWH with chronic pain who denied opioid use. Findings suggest that PLWH with chronic pain are likely to experience poor sleep and depressed mood. Furthermore, poor sleep was associated with opioid use among PLWH with chronic pain.
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    Relationship Between General Illness and Mental Health Service Use and Expenditures Among Racially-Ethnically Diverse Adults >= 65 Years
    (American Psychiatric Publishing, 2015) Jimenez, Daniel E.; Le Cook, Benjamin; Kim, Giyeon; Reynolds, Charles F., III; Alegria, Margarita; Coe-Odess, Sarah; Bartels, Stephen J.; University of Miami; Harvard University; University of Alabama Tuscaloosa; University of Pittsburgh; Cambridge Health Alliance; Swarthmore College; Dartmouth College
    Objectives: The association of general medical illness and mental health service use among older adults from racial-ethnic minority groups is an important area of study given the disparities in mental health and general medical services and the low use of mental health services in this population. The purpose of this report is to describe the impact of comorbid general medical illness on mental health service use and expenditures among older adults and to evaluate disparities in mental health service use and expenditures in a racially-ethnically diverse sample of older adults with and without comorbid general medical illness. Methods: Data were obtained from the Medical Expenditure Panel Survey (years 2004-2011). The sample included 1,563 whites, 519 African Americans, and 642 Latinos (N = 2,724) age >= 65 with probable mental illness. Two-part generalized linear models were used to estimate and compare mental health service use among adults with and without a comorbid general medical illness. Results: Mental health service use was more likely for older adults with comorbid general medical illness than for those without it. Once mental health services were accessed, no differences in mental health expenditures were found. Comorbid general medical illness increased the likelihood of mental health service use by older whites and Latinos. However, the presence of comorbidity did not affect racial-ethnic disparities in mental health service use. Conclusions: This study highlighted the important role of comorbid general medical illness as a potential contributor to using mental health services and suggests intervention strategies to enhance engagement in mental health services by older adults from racial-ethnic minority groups.
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    A Prospective Study of the Associations Among Housing Status and Costs of Services in a Homeless Population
    (American Psychiatric Publishing, 2015) Fuehrlein, Brian S.; Cowell, Alexander J.; Pollio, David; Cupps, Lori; Balfour, Margaret E.; North, Carol S.; University of Texas Southwestern Medical Center Dallas; US Department of Veterans Affairs; Veterans Health Administration (VHA); VA North Texas Health Care System; Research Triangle Institute; University of Alabama Tuscaloosa; Washington University (WUSTL)
    Objective: The complex needs of homeless populations result in use of a wide range of services and high costs for housing programs and psychiatric and general medical care. Allocation of resources often is not congruent with assessed needs. A series of cost-congruence hypotheses was developed to test assumptions that needs are associated with resources provided for appropriate services in homeless populations. Methods: Individuals (N=255) who were homeless were followed for two years and were categorized by housing status over time (consistently housed, housed late, lost housing, or consistently homeless). Detailed information about the individuals was obtained at baseline, and follow-up data were collected one and two years later. Extensive data about the costs of services provided by type (medical, psychiatric, substance abuse, and homeless maintenance and amelioration) were derived from 23 agencies, and service use information was collected from the agencies and by self-report. Multiple regression models were used to test the hypotheses. Results: Medical, psychiatric, and homeless maintenance costs varied by housing status. Serious mental illness predicted costs for psychiatric services, as expected, but also costs for substance abuse services and acute behavioral health care and total costs. Alcohol use disorders predicted substance abuse service costs. Conclusions: This study followed a homeless cohort prospectively and provided estimates of costs of service use derived from a large number of agencies. This research increases the understanding of patterns of service use in a homeless population and informs the provision of services appropriate to the complex needs of this difficult-to-serve population.
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    Racial Anxiety among Medical Residents: Institutional Implications of Social Accountability
    (Johns Hopkins University Press, 2019) Bradley, Lilanta Joy; Clem, Jennifer; Godsil, Rachel; MacFarlane, Jessica; Foster, Pamela Payne; University of Alabama Tuscaloosa; Rutgers State University Newark
    As the U.S. population becomes more racially diverse, physicians need to have cultural skills for optimal health outcomes; however, the literature is sparse for cultural skill application of medical trainees. This paper focuses on Family Medicine residents' perceptions of racial anxiety and their preparedness to manage cross-racial interactions. Of the 24 respondents, the majority were female. The ethnicities of respondents were 16 non-Hispanic White, five African American, and three Native American. Most participants demonstrated good general knowledge and/or self-efficacy on racial anxiety, but produced lower scores in workplace skills and actions related to racial anxiety. Thus, physician training programs should incorporate more skill development around racial anxiety. More research is needed to examine how medical schools approach multicultural education as a method of disrupting health disparities to reflect trends of social accountability and social justice.
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    Misinformation, Gendered Perceptions, and Low Healthcare Provider Communication Around HPV and the HPV Vaccine Among Young Sexual Minority Men in New York City: The P18 Cohort Study
    (Springer, 2020) Jaiswal, Jessica; LoSchiavo, Caleb; Maiolatesi, Anthony; Kapadia, Farzana; Halkitis, Perry N.; University of Alabama Tuscaloosa; Rutgers State University Newark; Rutgers State University New Brunswick; Yale University; New York University
    Human papillomavirus (HPV) is the most common sexually transmitted infection among adults in the United States, and can cause several types of cancer. This is of particular concern for sexual minority men, as their increased risk of HIV acquisition increases risk for HPV and HPV-associated cancers, particularly when coupled with low rates of HPV vaccination. As part of a larger study of the syndemic of HIV, substance use, and mental health among young sexual minority men in New York City, we sought to explore what sexual minority men know about HPV and the HPV vaccine, along with their experiences have been communicating about the virus and vaccine. We interviewed 38 young sexual minority men with diverse sociodemographic characteristics and identified three main themes: low knowledge about HPV infection and vaccination, highly gendered misconceptions about HPV only affecting women, and lack of communication from healthcare providers about HPV. The prevalence of incorrect HPV knowledge, coupled with inadequate education and vaccination in healthcare settings, indicates a missed opportunity for HPV prevention in a high-risk and high-need population.