Faculty Bibliography

PURPOSE: Among young men who have sex with men (YMSM) few studies have examined the relationship between intimate partner violence (IPV) perpetration versus victimization and sexual behaviors. METHODS: Using data from n = 528 urban YMSM, multinomial logistic regression models were built to examine the distinct relationships between any IPV, victimization, and perpetration with condomless sex in the previous 30 days, controlling for key sociodemographic characteristics. RESULTS: In this sample of YMSM, lifetime experience of any IPV was associated with increased odds of recent condomless oral (adjusted odds ratio [AOR] = 1.81, 95% confidence interval [CI] = 1.21-2.72) and anal receptive sex (AOR= 2.29, 95% CI = 1.22-4.31). IPV victimization was associated with a greater likelihood of condomless receptive anal sex (AOR= 2.12, 95% CI = 1.15-3.93) whereas IPV perpetration was associated with increased odds of condomless receptive (AOR= 2.11, 95% CI = 1.14-3.91) and insertive (AOR= 2.21, 95% CI = 1.06-4.59) anal sex. CONCLUSIONS: Among YMSM, reports of both IPV perpetration and victimization were associated with increased odds of recent condomless sex. These findings indicate that the need for IPV prevention and intervention programs for this new generation of YMSM is highly warranted.

OBJECTIVE: Maternal depression affects 10% to 40% of mothers with young children and has negative consequences for children's health and development. The American Academy of Pediatrics (AAP) recommends that pediatricians identify women with maternal depression. The authors examined trends in inquiring about (asking informal questions) or screening for (using a standardized instrument) maternal depression by pediatricians in 2004 and 2013 and identified correlates of usually inquiring/screening to identify maternal depression. METHODS: Data were ascertained from 778 nontrainee pediatricians exclusively practicing general pediatrics who completed the 2004 (n = 457) and 2013 (n = 321) AAP Periodic Surveys. Pediatricians answered questions about physician and practice characteristics, training, attitudes, and inquiring/screening to identify maternal depression. Sample weights were used to reduce nonresponse bias. Weighted descriptive and logistic regression analyses were conducted. RESULTS: The prevalence of usually inquiring/screening to identify maternal depression increased from 33% to 44% (p < .01). In both years, pediatricians who usually inquired about child/adolescent depression had increased odds of usually inquiring/screening to identify maternal depression. Patient race/ethnicity and training in adult Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for depression were associated with inquiring/screening in 2004, and believing that family screening is within the scope of the pediatrician was associated with inquiring/screening in 2013. CONCLUSION: Although inquiring/screening about maternal depression has increased since 2004, less than half of pediatricians usually screen or inquire about maternal depression, representing a missed opportunity to identify depression and manage or refer women for treatment. Further training on the importance of mental and family health to children's health may increase identification of maternal depression in pediatric primary care.

OBJECTIVE: This study estimated the proportions of Hispanic and non-Hispanic white and black children ages three to 17 with a diagnosis of attention-deficit hyperactivity disorder (ADHD) receiving services from the New York State public mental health system (NYS PMHS) and their annual treated ADHD prevalence rates. Findings were compared with those of recent national studies of general population samples. METHODS: Data were from a 2011 survey of users of NYS PMHS nonresidential services. Adjusted odds ratios compared the probability of an ADHD diagnosis among the groups by age, gender, and insurance type. Prevalence rates were compared among groups by age and gender. RESULTS: An estimated 133,091 children used the NYS PMHS, of whom 31% had an ADHD diagnosis. The prevalence rate of ADHD among whites was significantly lower than that among Hispanics or blacks in all gender and age groups except Hispanic females ages 13 to 17. White children were significantly less likely than black children to receive an ADHD diagnosis. CONCLUSIONS: National studies have reported higher ADHD rates among white children. Compared with children in the NYS PMHS, those in national studies had multiple access points to care, including private psychiatrists and clinicians and primary care practitioners. The higher reported ADHD rates in national studies may reflect higher rates of private insurance among white children, which would increase the likelihood of their using private practitioners. Cultural factors that influence whether and where care is sought and whether practitioners appropriately diagnosis ADHD may also explain the difference in findings.

Adult maladaptive behaviors including antisocial personality disorder (ASPD) and marijuana use are major public health concerns. At the present time, there is a dearth of research showing the interrelationships among the possible predictors of adult maladaptive behaviors (i.e., ASPD and marijuana use). Therefore, the current study examines the pathways from adverse family environments in late adolescence to these maladaptive behaviors in adulthood. There were 674 participants (52 % African Americans, 48 % Puerto Ricans). Sixty percent of the sample was female. Structural equation modeling in the current study included 4 waves of data collection (mean ages 19, 24, 29, and 36). An adverse family environment in late adolescence was related to greater externalizing personality in late adolescence, which in turn, was related to greater marijuana use in emerging adulthood. This in turn was positively associated with partner marijuana use in young adulthood, which in turn, was ultimately related to maladaptive behaviors in adulthood. An adverse family environment in late adolescence was also related to greater marijuana use in emerging adulthood, which in turn, was associated with an adverse relationship with one's partner in young adulthood. Such a negative partner relationship was related to maladaptive behaviors in adulthood. The findings suggest that family-focused interventions (Kumpfer and Alvarado in Am Psychol 58(6-7): 457-465, 2003) for dysfunctional families may be most helpful when they include the entire family.

The Prostate Health Index is a Food and Drug Administration-approved blood test combining total, free, and [-2]pro prostate-specific antigen with greater specificity than free and total prostate-specific antigen for clinically significant prostate cancer. This article reviews the evidence on the performance of the Prostate Health Index to predict prostate biopsy outcome, its incorporation into multivariable risk-assessment tools, and its ability to predict prognosis after conservative management or prostate cancer treatment.

BACKGROUND: Racial disparities in access to regular health care have been reported in the U.S., but little is known about the extent of disparities in societies with universal coverage. PURPOSE: To investigate the extent of racial disparities in access to care under conditions of universal coverage by observing the association between race and regular access to a doctor in Canada. METHODS: Racial disparities in access to a regular doctor were calculated using the largest available source of nationally representative data in Canada-the Canadian Community Health Survey. Surveys from 2000-2010 were analyzed in 2014. Multinomial regression analyses predicted odds of having a regular doctor for each racial group compared to whites. Analyses were stratified by immigrant status-Canadian-born versus shorter-term immigrant versus longer-term immigrants-and controlled for sociodemographics and self-rated health. RESULTS: Racial disparities in Canada, a country with universal coverage, were far more muted than those previously reported in the U.S. Only among longer-term Latin American immigrants (OR=1.90, 95% CI=1.45, 2.08) and Canadian-born Aboriginals (OR=1.34, 95% CI=1.22, 1.47) were significant disparities noted. Among shorter-term immigrants, all Asians were more likely than whites, and among longer-term immigrants, South Asians were more like than whites, to have a regular doctor. CONCLUSIONS: Universal coverage may have a major impact on reducing racial disparities in access to health care, although among some subgroups, other factors may also play a role above and beyond health insurance.

OBJECTIVE: Diffusion tensor imaging (DTI) can identify structural connectivity alterations in attention-deficit/hyperactivity disorder (ADHD). Most ADHD DTI studies have concentrated on regional differences in fractional anisotropy (FA) despite its limited sensitivity to complex white matter architecture and increasing evidence of global brain differences in ADHD. Here, we examine multiple DTI metrics in separate samples of children and adults with and without ADHD with a principal focus on global between-group differences. METHOD: Two samples: adults with ADHD (n = 42) and without (n = 65) and children with ADHD (n = 82) and without (n = 80) were separately group matched for age, sex, and head motion. Five DTI metrics (FA, axial diffusivity, radial diffusivity, mean diffusivity, and mode of anisotropy) were analyzed via tract-based spatial statistics. Group analyses tested for diagnostic differences at the global (averaged across the entire white matter skeleton) and regional level for each metric. RESULTS: Robust global group differences in diffusion indices were found in adults, with the largest effect size for mode of anisotropy (MA; Cohen's d = 1.45). Global MA also differed significantly between groups in the pediatric sample (d = 0.68). In both samples, global MA increased classification accuracy compared to the model with clinical Conners' ADHD ratings alone. Regional diagnostic differences did not survive familywise correction for multiple comparisons. CONCLUSION: Global DTI metrics, particularly the mode of anisotropy, which is sensitive to crossing fibers, capture connectivity abnormalities in ADHD across both pediatric and adult samples. These findings highlight potential diffuse white matter microarchitecture differences in ADHD.

This column discusses "cultural activation," defined as a consumer's recognition of the importance of providing cultural information to providers about cultural affiliations, challenges, views about, and attitudes toward behavioral health and general medical health care, as well as the consumer's confidence in his or her ability to provide this information. An aid to activation, "Cultural Activation Prompts," and a scale that measures a consumer's level of activation, the Cultural Activation Measurement Scale, are described. Suggestions are made about ways to introduce cultural activation as a component of usual care.