Faculty Bibliography

Worldwide increases in diabetes prevalence in the face of limited medical resources have prompted international interest in innovative healthcare delivery models. Project ECHO (Extension for Community Healthcare Outcomes) is a "telementoring" program which has been shown to increase capacity for complex disease management in medically underserved regions. In contrast to a traditional telemedicine model which might connect a specialist with one patient, the ECHO model allows for multiple patients to benefit simultaneously by building new expertise. We recently applied the ECHO model to improve health outcomes of patients with complex diabetes (Endo ECHO) living in rural New Mexico. We describe the design of the Endo ECHO intervention and a 4-year, prospective program evaluation assessing health outcomes, utilization patterns, and cost-effectiveness. The Endo ECHO evaluation will demonstrate whether and to what extent this intervention improves outcomes for patients with complex diabetes living in rural New Mexico, and will serve as proof-of-concept for academic medical centers wishing to replicate the model in underserved regions around the world.

PURPOSE: Young sexual minority men smoke at higher rates relative to heterosexual peers. The purpose of this study was to examine correlates of smoking in a sample of young gay, bisexual, and other men who have sex with men (MSM) who might differ from more general and age-diverse samples of sexual minority individuals and, thus, inform tailored approaches to addressing tobacco use within this population. METHODS: Data on smoking status were examined in relation to demographics, mental health, substance use behavior, and psychosocial factors. Using multinomial logistic regression, factors were identified that differentiate current and former smokers from never smokers. RESULTS: In bivariate analysis, smoking status was related to demographic, mental health, substance use, and psychosocial factors. Most significantly, smoking status was associated with school enrollment status, current alcohol and marijuana use, and symptoms of depression. Multivariate modeling revealed that, compared to being a never smoker, the odds of current or former smoking were highest among those currently using either alcohol or marijuana. The odds of both current and former smoking were also higher among those reporting greater levels of gay community affinity. Finally, the odds of being a former smoker were higher for those reporting internalized antihomosexual prejudice. CONCLUSION: This study identifies several factors related to smoking status in a diverse sample of young sexual minority males. These findings should encourage investigations of smoking disparities among younger MSM to look beyond common smoking risk factors in an attempt to understand etiologies that may be unique to this group. Such findings may indicate multiple points of potential intervention aimed at decreasing cigarette smoking within this vulnerable population.

We administered a battery of neurocognitive tests to 100 HIV-positive men and women ages 50 to 70 seeking care at a large Northeastern urban HIV care clinic. Performance on neurocognitive assessments varied by demographic states. Across all assessments, approximately 28% of participants reached the threshold for borderline performance while 13% reached the threshold for impairment. When tests were grouped by domain of neurocognitive functioning, 12% of the sample met the threshold for impairment on executive functioning and 19% for processing speed. The findings demonstrate that neurocognitive declines may vary by domains of functioning, that disparities may exist across subpopulations of the seropositive aging population, and that these challenges may exist even in those actively engaged in HIV care.

The acceptability and clinical impact of a web-based intervention among patients entering addiction treatment who lack recent internet access are unclear. This secondary analysis of a national multisite treatment study (NIDA Clinical Trials Network-0044) assessed for acceptability and clinical impact of a web-based psychosocial intervention among participants enrolling in community-based, outpatient addiction treatment programs. Participants were randomly assigned to 12 weeks of a web-based therapeutic education system (TES) based on the community reinforcement approach plus contingency management versus treatment as usual (TAU). Demographic and clinical characteristics, and treatment outcomes were compared among participants with recent internet access in the 90 days preceding enrollment (N = 374) and without internet access (N = 133). Primary outcome variables included (1) acceptability of TES (i.e., module completion; acceptability of web-based intervention) and (2) clinical impact (i.e., self-reported abstinence confirmed by urine drug/breath alcohol tests; retention measured as time to dropout). Internet use was common (74 %) and was more likely among younger (18-49 years old) participants and those who completed high school (p < .001). Participants randomized to TES (n = 255) without baseline internet access rated the acceptability of TES modules significantly higher than those with internet access (t = 2.49, df = 218, p = .01). There was a near significant interaction between treatment, baseline abstinence, and internet access on time to dropout (chi 2(1) = 3.8089, p = .051). TES was associated with better retention among participants not abstinent at baseline who had internet access (X 2(1) = 6.69, p = .01). These findings demonstrate high acceptability of this web-based intervention among participants that lacked recent internet access.

BACKGROUND AND OBJECTIVES: The excessive consumption of alcohol is a major issue in the United States and elsewhere. It is associated with a number of adverse health consequences, as well as difficulty in relationships and employment. Therefore, the present longitudinal study investigates the direct and indirect adolescent predictors of alcohol use in adulthood. METHODS: Among the 674 participants (53% African Americans, 47% Puerto Ricans), 60% were females (n = 405). Mplus software was used to perform structural equation modeling. RESULTS: Parental problems with alcohol use in the participants' late adolescence were related to low parent-child attachment in late adolescence, which in turn, was related to self delinquency in late adolescence. This was related to peer delinquency in emerging adulthood, which in turn, was associated with alcohol use in emerging adulthood and in adulthood. Low parent-child attachment in late adolescence was also related to low satisfaction with school in late adolescence, which in turn, was related to self delinquency in late adolescence. This was associated with alcohol use in emerging adulthood, which in turn, was associated with alcohol use in adulthood. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: One of the key implications of this study is that an impaired low parent-child attachment relationship is a determinant of children's engagement in delinquent behavior and ultimately the use of alcohol in adult life. Implications for social interventions from the findings of the current study were also discussed. (Am J Addict 2016;XX:1-8).

Suicide is a leading cause of premature mortality. Aspects of the social environment such as incidents of violence in the community may induce psychological distress and affect suicidality, but these determinants are not well understood. We conducted an ecological study using California vital statistics records, geocoded to address of the decedent, to examine whether proximity to homicide was associated with the occurrence of suicide in urban census tracts. For each urban tract (N = 7194) and each month in 2012, we assessed homicides in the tract or within buffer zones around the tract with a 1-month lag. We estimated two risk difference parameters that capture how suicide risk is related to differences in homicide exposure. Proximity to homicides was negatively associated with suicide occurrence after controlling for demographic factors, seasonality, and other confounders. Estimates suggest that the absence of homicides would be associated with a 4.2 % higher number of tract-months with one or more suicides (95 % confidence interval 2.2-6.0). This relationship was stronger in tracts that were wealthier, older, and less civically engaged. Results were robust to a wide variety of sensitivity tests. Contrary to expectations, we identified a consistent negative association of proximity to homicide with suicide occurrence. It may be that a homicide deters or distracts from suicidality or that aggression or hopelessness may be expressed as inward or outward directed violence in different settings. Further investigation is needed to identify the drivers of this association.

The present 2 studies describe the development and initial psychometric evaluation of a new instrument, the Measure of Atheist Discrimination Experiences (MADE), which may be used to examine the minority stress experiences of atheist people. Items were created from prior literature, revised by a panel of expert researchers, and assessed psychometrically. In Study 1 (N = 1,341 atheist-identified people), an exploratory factor analysis with 665 participants suggested the presence of 5 related dimensions of perceived discrimination. However, bifactor modeling via confirmatory factor analysis and model-based reliability estimates with data from the remaining 676 participants affirmed the presence of a strong "general" factor of discrimination and mixed to poor support for substantive subdimensions. In Study 2 (N = 1,057 atheist-identified people), another confirmatory factor analysis and model-based reliability estimates strongly supported the bifactor model from Study 1 (i.e., 1 strong "general" discrimination factor) and poor support for subdimensions. Across both studies, the MADE general factor score demonstrated evidence of good reliability (i.e., Cronbach's alphas of .94 and .95; omega hierarchical coefficients of .90 and .92), convergent validity (i.e., with stigma consciousness, beta = .56; with awareness of public devaluation, beta = .37), and preliminary evidence for concurrent validity (i.e., with loneliness beta = .18; with psychological distress beta = .27). Reliability and validity evidence for the MADE subscale scores was not sufficient to warrant future use of the subscales. Limitations and implications for future research and clinical work with atheist individuals are discussed. (PsycINFO Database Record

In this article we review the existing fertility preservation options for women diagnosed with Turner syndrome and provide practical guidelines for the practitioner. Turner syndrome is the most common sex chromosome abnormality in women, occurring in approximately 1 in 2500 live births. Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency and infertility. Although approximately 70%-80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder might possess a small residual of ovarian follicles at birth or early childhood. The present challenge is to identify these women as early in life as is possible, to allow them to benefit from a variety of existing fertility preservation options. To maximize the benefits of fertility preservation, all women with Turner syndrome should be evaluated by an expert as soon as possible in childhood because the vast majority will have their ovarian reserve depleted before adulthood. Cryopreservation of mature oocytes and embryos is a proven fertility preservation approach, and cryopreservation of ovarian tissue is a promising technique with a growing number of live births, but remains investigational. Oocyte cryopreservation has been performed in children with Turner syndrome as young as 13 years of age and ovarian tissue cryopreservation in affected prepubertal children. However, current efficacy of these approaches is unknown in this cohort. For those who have already lost their ovarian reserve, oocyte or embryo donation and adoption are strategies that allow fulfillment of the desire for parenting. For those with Turner syndrome-related cardiac contraindications to pregnancy, use of gestational surrogacy allows the possibility of biological parenting using their own oocytes. Alternatively, gestational surrogacy can serve to carry pregnancy resulting from the use of donor oocytes or embryos, if needed.