Faculty Bibliography

BACKGROUND:Medication for addiction treatment (MAT) has received much attention in recent years for treating individuals with opioid use disorders (OUD). However, these medications have been significantly underused among particular subgroups. In this paper, we describe the age distribution of treatment episodes for substance use disorder among Medicaid beneficiaries in New York and corresponding MAT use. METHODS:Using New York Medicaid claims, we identified individuals with OUD that received treatment for substance use disorder in 2015. The type of substance use treatment is the primary outcome measure, which includes methadone, buprenorphine, naltrexone or other non-medication treatment. RESULTS:A total of 88,637 individuals were diagnosed with OUD and received treatment for substance use disorder and 56,926 individuals received some type of MAT in 2015, with 40.2% receiving methadone, 21.9% receiving buprenorphine and 2.2% receiving naltrexone while 21.9% received non-medication based treatment. Young adults (ages 18-29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT. Relative to young adults, 30-39 year olds (adjusted odds ratio [AOR] = 1.62, 95% CI = 1.56-1.68), 40-49 year olds (AOR = 1.90, 95% CI = 1.82-1.99), 50-59 year olds (AOR = 2.65, 95% CI = 2.52-2.78), and 60-64 year olds (AOR = 5.03, 95% CI = 4.62-5.48) were more likely to receive MAT. CONCLUSIONS:These preliminary findings highlight high numbers of young adults in treatment for OUD and low rates of MAT, which is not consistent with treatment guidelines. Significant differences exist in the type of medication prescribed across age. More attention is needed to address the treatment needs among individuals of different age, notably young adults.

Physical child punishment is a critical public health problem that exhibits negative and long-lasting mental and physical health consequences. Yet, the predictors of physical punishment are understudied in developing countries, and disparities that exist between levels of economic status are not known well. The socioeconomic predictors of physical child punishment were investigated using three rounds of the Multiple Indicator Cluster Survey (MICS) results in a lower middle-income country, Viet Nam from 2006 to 2014. A total of 16,784 households that have answered the child punishment questionnaire from MICS data from 2006 to 2014 were included in the analysis. Descriptive statistics, univariate, and multivariate logistic regression analyses were conducted. A secular trend of disparity was investigated with and without the parents' normative values on physical punishment. Children in Viet Nam have been subject to some form of violent physical punishment by their parents or caregivers. About half of the children in the poorest households (44.7%) experienced physical child punishment while lesser percentage of children in the richer households experienced physical child punishment. Disparities existed across different wealth groups as the prevalence of physical child punishment decreased: the gap between the poorest and the richest group widened. Compared to the richest households, the poorest households were more likely to experience physical child punishment AOR 1.58 (95% CI 1.39-1.79). There is a decrease in the prevalence of physical punishment over the recent years in Viet Nam, socioeconomic disparities, in contrast, have increased, and the poorest children have a higher risk of experiencing physical child punishment. Such disparities should be considered in future research and intervention development.

Objective:We sought to assess how widowhood among older adults in India was associated with alcohol consumption, smoking, and use of chewing tobacco or other drugs. Method:Data were collected in 2011 from 9,852 adults aged 60 and older from seven regionally diverse states in India. Regression analyses provided estimates of the relationship between widowhood and having smoked cigarettes, consumed alcohol, or used chewed tobacco or other drugs in the past month among men, adjusting for demographic and socioeconomic factors. We also estimated the relationship between widowhood and past-month substance use among women. Results:Recently widowed men (within 0-4 years) were 1.76 times (95% confidence interval [CI] 1.01-3.09, p < .05) more likely to have consumed alcohol and 1.62 times (95% CI 1.01-2.59, p < .05) more likely to have used chewing tobacco or other drugs as compared with married men. Women widowed for any length of time were 1.37 times (95% CI 1.11-1.69, p < .01) more likely to have used chewing tobacco or other drugs. Discussion:Interventions aimed at reducing use of chewing tobacco or other drugs among older adults in India should consider focusing on recently widowed men and women widowed for any amount of time.

BACKGROUND:Understanding factors associated with domestic violence-supportive attitudes among Vietnamese women is important for designing effective policies to prevent this behavior. Previous studies have largely overlooked risk factors associated with domestic violence-supportive attitudes by women in Vietnam. OBJECTIVE:This paper explores and identifies socioeconomic factors that contribute to domestic violence-supportive attitudes among Vietnamese women using data from the Multiple Indicator Cluster Surveys (MICS). DESIGN/METHODS:Secondary data from two cross-sectional studies (MICS 3, 2006, and MICS 4, 2011) with representative samples (9,471 and 11,663 women, respectively) in Vietnam were analyzed. The prevalence of supportive attitudes toward domestic violence and associations with age, residence region, area, education level, household wealth index, ethnicity, and marital status were estimated using descriptive statistics and multivariate Poisson models, giving estimates of relative risk. RESULTS:Overall, the prevalence of acceptance of domestic violence declined between 2006 and 2011 in Vietnam (65.1% vs. 36.1%). Socioeconomic factors associated with women's condoning of domestic violence were age, wealth, education level, and living area. In particular, younger age and low educational attainment were key factors associated with violence-supportive attitudes, and these associations have become stronger over time. CONCLUSION/CONCLUSIONS:Higher educational attainment in women is an important predictor of women's attitudes toward domestic violence. To date, Doi Moi and the Vietnamese government's commitment to the Millennium Development Goals may have positively contributed to lowering the acceptance of domestic violence. Tailored interventions that focus on education will be important in further changing attitudes toward domestic violence.

INTRODUCTION/BACKGROUND:Under current HIV transmission mechanisms operating in Vietnam, women are seen as victims of their male partners. Having multiple sexual partners is one of the well-known risk factors for HIV infection. However, little is known about women's risky sexual behaviour and their vulnerability to HIV in Vietnam. This study aims to explore association between early sexual initiation and the number of lifetime sexual partners in Vietnamese women. Although the Vietnamese culture is socially conservative in this area, identifying women's risky sexual behaviour is important for the protection of women at risk of HIV and other sexually transmitted diseases. DESIGN/METHODS:A total of 8,791 women, who reported having had sexual intercourse, were included in this analysis of data from the 2011 Multiple Indicator Cluster Survey in Vietnam. Data were collected using two-stage strata sampling, first at the national level and second across six geographical regions (n=8,791). Multivariable logistic regressions describe association between early initiation of a sexual activity and lifetime multiple sexual partners. RESULTS:Early sexual intercourse was significantly associated with having lifetime multiple sexual partners. Women who were aged 19 or younger at first sexual intercourse were over five times more likely to have multiple sexual partners, compared with women whose first sexual intercourse was after marriage; aged 10-14 years (OR=5.9; 95% CI=1.9-18.8) at first intercourse; and aged 15-19 years (OR=5.4; 95% CI=4.0-7.2) at first intercourse. There was significant association with having multiple sexual partners for women of lower household wealth and urban residence, but the association with educational attainment was not strong. CONCLUSIONS:The study results call for health and education policies to encourage the postponement of early sexual activity in young Vietnamese women as protection against risky sexual behaviour later in life.

INTRODUCTION/BACKGROUND:Early birth registration, childhood care, and education are essential rights for children and are important for their development and education. This study investigates changes and socioeconomic inequalities in early birth registration and indicators of care and education in children aged under 5 years in Vietnam. DESIGN/METHODS:The analyses reported here used data from the Vietnam Multiple Indicator Cluster Surveys (MICS) in 2006 and 2011. The sample sizes in 2006 and 2011 were 2,680 and 3,678 for children under 5 years of age. Four indicators of childcare and preschool education were measured: birth registration, possession of books, preschool education attendance, and parental support for early childhood education. The concentration index (CI) was used to measure inequalities in gender, maternal education, geographical area, place of residence, ethnicity, and household wealth. RESULTS:There were some improvements in birth registration (86.4% in 2006; 93.8% in 2011), preschool education attendance (57.1% in 2006; 71.9% in 2011), and parental support for early childhood education (68.9 and 76.8%, respectively). However, the possession of books was lower (24.7% in 2006; 19.6% in 2011) and became more unequal over time (i.e. CI=0.370 in 2006; CI=0.443 in 2011 in wealth inequality). Inequalities in the care and education of children were still persistent. The largest inequalities were for household wealth and rural versus urban areas. CONCLUSION/CONCLUSIONS:Although there have been some improvements in this area, inequalities still exist. Policy efforts in Vietnam should be directed towards closing the gap between different socioeconomic groups for the care and education of children under 5 years old.

BACKGROUND:Although Vietnam has taken great efforts to reduce child mortality in recent years, a large number of children still die at early age. Only a few studies have been conducted to identify at-risk groups in order to provide baseline information for effective interventions. OBJECTIVE:The study estimated the overall trends in infant mortality rate (IMR) and under-five mortality rate (U5MR) during 1986-2011 and identified demographic and socioeconomic determinants of child mortality. DESIGN/METHODS:Data from the Vietnam Multiple Indicator Cluster Surveys (MICSs) in 2000 (MICS2), 2006 (MICS3) and 2011 (MICS4) were analysed. The IMR and U5MR were calculated using the indirect method developed by William Brass. Unadjusted and adjusted odds ratios were estimated to assess the association between child death and demographic and socioeconomic variables. Region-stratified stepwise logistic regression was conducted to test the sensitivity of the results. RESULTS:The IMR and U5MR significantly decreased for both male and female children between 1986 and 2010. Male children had higher IMR and U5MR compared with females in all 3 years. Women who were living in the Northern Midlands and Mountain areas were more likely to experience child deaths compared with women who were living in the Red River Delta. Women who were from minor ethnic groups, had low education, living in urban areas, and had multiple children were more likely to have experienced child deaths. CONCLUSION/CONCLUSIONS:Baby boys require more healthcare attention during the first year of their life. Comprehensive strategies are necessary for tackling child mortality problems in Vietnam. This study shows that child mortality is not just a problem of poverty but involves many other factors. Further studies are needed to investigate pathways underlying associations between demographic and socioeconomic conditions and childhood mortality.

BACKGROUND:Despite significant achievements in health indicators during previous decades, Vietnam lags behind other developing countries in reducing common early childhood illnesses, such as diarrhea and respiratory infections. To date, there has been little research into factors that contribute to the prevalence and treatment of childhood morbidity in Vietnam. OBJECTIVE:This study examines the determinants of diarrhea and 'illness with a cough' and treatments for each of the conditions among young children in Vietnam, and describes trends over time. DESIGN/METHODS:Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. Multivariable logistic regressions were undertaken to investigate factors associated with these childhood illnesses and proper treatment patterns. RESULTS:Between 2000 and 2011, the prevalence of diarrhea among children under the age of five declined from 11 to 7%, while having illness with a cough increased to 40% in 2011 after falling from 69 to 28% between 2000 and 2006. During the same period, the prevalence of oral rehydration therapy (ORT) for treating diarrhea increased from 13 to 46%, whereas the rate of seeking formal treatment for illnesses with a cough fell from 24 to 7%. Multivariable models indicated that children who were older than 2 years (odds ration [OR]: 0.44, 95% confidence interval [CI]: 0.37-0.53, p<0.001), male (OR: 1.21, 95% CI: 0.64-2.37, p<0.05), living in rural areas (OR: 1.28, 95% CI: 1.00-1.64, p<0.05), or of Kinh ethnicity (OR: 0.70, 95% CI: 0.56-0.87, p<0.01) were more likely to suffer from diarrhea. Ethnic differences and higher household wealth were factors significantly associated with having illness with a cough. In particular, the effect of level of wealth on illness with a cough varied in each wave. Mothers with higher levels of education had higher odds of seeking ORT compared with mothers with the lowest level of education. Seeking formal treatment for children who have illness with a cough was associated with being in a household in the richest wealth quintile (OR: 0.56, 95% CI: 0.34-0.91, p<0.05). CONCLUSIONS:This study demonstrates the importance of identifying different risk factors for these two illnesses and also factors associated with healthcare-seeking behaviors in order to reduce the burden of childhood morbidity in Vietnam. Policies aimed at tackling childhood morbidities should include comprehensive strategies that impact on socioeconomic and environmental factors.

BACKGROUND:Within the last decade, the use of amphetamine type stimulants (ATS) has swelled in Myanmar. Regionally, female sex workers have reported turning to ATS for occupational reasons. In doing so, drug-using female sex workers (FSW) face compounded risks for HIV and other sexually transmitted infections (STI). Here, we examine the factors that impact FSW drug use in Muse, a town along the China-Myanmar border. METHODS:In 2012, 101 FSW were recruited from entertainment venues and brothels along the Myanmar-Chinese border. Participants participated in a self-administered behavioral survey covering demographics, drug use, sex work, and risk behaviors. Bivariate and regression analyses were conducted in SPSS. RESULTS:Thirty four percent of respondents indicated current drug use. ATS derivatives were the most commonly used drugs (87.5%) with injection drug use being nearly non-existent in the sample. Drug using FSWs were older, had engaged in sex work longer, had more Chinese clients, and were more likely to have a previous boyfriend who had used drugs. They were also 3.5 times more likely to report a STI. Client condom use, HIV testing rates, and familiarity with public health resources did not statistically differ by drug use status. CONCLUSION/CONCLUSIONS:More research is needed to examine how romantic and professional sexual relationships push-and-pull FSW into using drugs. Our results suggest that diverse safer sex strategies, beyond client condom use, should be promoted with drug using FSWs, including strategies that acknowledge the impact of ATS use.