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Social Support and Symptoms of Depression in Late Life: Bidirectional Associations over Time

Turner, Shira T; Carmel, Sara; O'Rourke, Norm; Raveis, Victoria H; Tovel, Hava; Cohn-Schwartz, Ella
Social support functions as an effective buffer against depression, especially among older adults with limited social networks. For the current study, we examined longitudinal bidirectional associations between social support and depression among those 75+ years of age. We recruited and followed a sample of Israeli adults 75+ years of age (N = 824; M = 80.84; range 75-96 years). Structured interviews were conducted in the homes of participants at three annual points of measurement. Participants reported depressive symptoms and emotional and instrumental support received from friends and family. We examined a cross-lagged, longitudinal structural equation model (SEM) in which social support and depressive symptoms predict each other over time, covarying for previously reported social support and depressive symptoms. We found that both depressive symptoms and social support are largely consistent in late life. Depressive symptoms and social support reported at baseline predict levels reported 1 and 2 years thereafter. Cross-over effects emerged over time. Depressive symptoms predicted lower social support in future, and social support at baseline predicted depressive symptoms 2 years later. These findings suggest that associations between depressive symptoms and social support are bidirectional in late life. Further research is needed to replicate findings in other cultures and over longer periods, ideally until end of life.
PMID: 36498138
ISSN: 1660-4601
CID: 5378962

Disparities in colorectal cancer screening among South Asians in New York City: a cross-sectional study

Wyatt, Laura C; Patel, Shilpa; Kranick, Julie A; Raveis, Victoria H; Ravenell, Joseph E; Yi, Stella S; Kwon, Simona C; Islam, Nadia S
Despite improvements in colorectal cancer (CRC) screening in New York City (NYC) since the early 2000s, the degree to which disparities persist for specific Asian American subgroups has yet to be fully elucidated. The purpose of this study is to examine disparities in rates of timely colonoscopy screening among five racial/ethnic groups in NYC. We performed a retrospective cross-sectional analysis of combined 2014-2018 NYC Community Health Survey data. Prevalence estimates of timely colonoscopy screening (within the past 10 years) among individuals ≥ 50 years of age were calculated and presented overall (n = 24,288) and by socio-demographic variables. Racial/ethnic categories included White, Black, Hispanic, East Asian, and South Asian. Multivariable models examined socio-demographic and racial/ethnic predictors of timely colonoscopy screening. A trend analysis examined colonoscopy screening by race/ethnicity and year from 2012 to 2018 (n = 33,130). Age-adjusted prevalence of timely colonoscopy screening was lowest among Asian Americans (South Asian 61.1% and East Asian 65.9%) compared to Hispanics (71.3%), Blacks (70.2%), and Whites (68.6%). Adjustment by socio-demographics, including insurance status, further explained disparities for South Asians (adjusted risk ratio [RR] = 0.84, 95% CI = 0.73-0.97) compared to Hispanics; additionally, Whites (adjusted RR=0.88, 95% CI = 0.84-0.92) were less likely to have received a timely colonoscopy compared to Hispanics. Age, health insurance, poverty group, and education were significant predictors in adjusted regression. Results indicate that South Asians have not equally benefited from campaigns to increase colonoscopy screening in NYC. Our findings support the development of targeted, and linguistically and culturally adapted campaigns that facilitate access to health systems and leverage existing community assets and social support systems among South Asian populations.
PMID: 33723796
ISSN: 1543-0154
CID: 4817592

Associations between Spiritual Health Locus of Control, Perceived Discrimination and Breast and Cervical Cancer Screening for Muslim American Women in New York City

Azhar, Sameena; Wyatt, Laura C; Jokhakar, Vaidehi; Patel, Shilpa; Raveis, Victoria H; Kwon, Simona C; Islam, Nadia S
BACKGROUND:We sought to understand the impacts of religion-related factors, namely perceived discrimination and spiritual health locus of control, on breast and cervical cancer screening for Muslim American women. METHODS:A total of 421 Muslim American women were surveyed at baseline of a breast and cervical cancer screening intervention, measuring discrimination through the Perceived Ethnic Discrimination Questionnaire (PED-Q), a 17-item scale measuring perceived interpersonal racial/ethnic discrimination; and spiritual beliefs through the Spiritual Health Locus of Control Scale, a 13-item scale measuring the link between control over one's health with a connection to religious beliefs. Multivariable logistic regression models were used to determine factors associated with an up-to-date mammogram and Pap test. RESULTS:Most women preferred to receive medical care from a healthcare provider of their same gender (75.2%) and same race, ethnicity or religion (62.1%). The middle age group (50-59) and a lower God's Grace Spiritual Health Locus of Control subscale were associated with up-to-date mammogram. Younger age, lower education, higher Exclusion/Rejection subscale, and lower Spiritual Life/Faith Subscale were associated with an up-to-date Pap test. CONCLUSION/CONCLUSIONS:The spiritual beliefs of Muslim American women impact their likelihood of obtaining breast and cervical cancer screenings. Therefore, these services need to be better tailored to match these needs, for example, by ensuring that Muslim American women have access to healthcare providers of their same gender, race, ethnicity or religion.
PMID: 35078722
ISSN: 1938-0666
CID: 5147532

Promoting Healthy Aging in the Dental Setting

Hays, Rosemary DeRosa; Raveis, Victoria H
ISSN: 1542-7838
CID: 5347792

A Culturally Adapted Breast and Cervical Cancer Screening Intervention Among Muslim Women in New York City: Results from the MARHABA Trial

Wyatt, Laura C; Chebli, Perla; Patel, Shilpa; Alam, Gulnahar; Naeem, Areeg; Maxwell, Annette E; Raveis, Victoria H; Ravenell, Joseph; Kwon, Simona C; Islam, Nadia S
We examine the efficacy of MARHABA, a social marketing-informed, lay health worker (LHW) intervention with patient navigation (PN), to increase breast and cervical cancer screening among Muslim women in New York City. Muslim women were eligible if they were overdue for a mammogram and/or a Pap test. All participants attended a 1-h educational seminar with distribution of small media health education materials, after which randomization occurred. Women in the Education + Media + PN arm received planned follow-ups from a LHW. Women in the Education + Media arm received no further contact. A total of 428 women were randomized into the intervention (214 into each arm). Between baseline and 4-month follow-up, mammogram screening increased from 16.0 to 49.0% in the Education + Media + PN arm (p < 0.001), and from 14.7 to 44.6% in the Education + Media arm (p < 0.001). Pap test screening increased from 16.9 to 42.3% in the Education + Media + PN arm (p < 0.001) and from 17.3 to 37.1% in the Education + Media arm (p < 0.001). Cancer screening knowledge increased in both groups. Between group differences were not statistically significant for screening and knowledge outcomes. A longer follow-up period may have resulted in a greater proportion of up-to-date screenings, given that many women had not yet received their scheduled screenings. Findings suggest that the educational session and small media materials were perhaps sufficient to increase breast and cervical cancer screening among Muslim American women. NCT03081507.
PMID: 35585475
ISSN: 1543-0154
CID: 5249272

Young Same-Gender-Loving Men (SGLM) Living with HIV Continue to Experience Symptoms that May Impair Their Retention in Care

Bortner, Adam C; Lee, Mei Ching; Karus, Daniel G; Lockman, Kashelle; Brotemarkle, Rebecca; Carrero-Tagle, Monique; Hossain, Mian Bazle; Henley, Yvonne; Raveis, Victoria H; Alexander, Carla S
Over half of HIV infections in the U.S. are among young gay, bisexual, and other same-gender-loving men (SGLM). Symptoms affecting these individuals must be clarified in order to be detected and addressed by health care providers. This report describes the symptom prevalence in young SGLM living with HIV. Study participants in an urban context experienced high symptom burden with a median of 6.2 symptoms despite antiretroviral treatment with viral suppression. Most common symptoms included fatigue (57%), depression (54%), insomnia (53%), anxiety (44%), dizziness (33%), and headache (33%). This study showed that young SGLM with HIV experience a high number of symptoms given their age. Health care providers should work to alleviate this symptom burden that affects patients' quality of life and may influence engagement in care.
PMID: 35153228
ISSN: 1548-6869
CID: 5208172

A Population Health Equity Approach Reveals Persisting Disparities in Colorectal Cancer Screening in New York City South Asian Communities

Patel, Shilpa; Kranick, Julie; Manne, Sharon; Shah, Krina; Raveis, Victoria; Ravenell, Joseph; Yi, Stella; Kwon, Simona; Islam, Nadia
To assess colorectal cancer (CRC) screening among South Asians (SAs) and explore the challenges and facilitators to CRC screening among SA subgroups in New York City (NYC). Fifty-one semi-structured in-depth interviews and surveys were conducted among SA immigrants in NYC. Qualitative results suggested challenges to CRC screening were related to socio-cultural factors, such as a lack of knowledge on CRC and CRC screening, and structural factors, such as cost and language. A physician referral was the most cited facilitator to CRC screening. Participants reported culturally and linguistically adapted education and information on CRC and CRC screening would help to overcome noted challenges. Our findings support the development of targeted, linguistically and culturally adapted campaigns for this population that facilitate access to health systems and leverage natural community assets and social support systems.
PMID: 32060860
ISSN: 1543-0154
CID: 4304702

The psychosocial impact on frontline nurses of caring for patients with COVID-19 during the first wave of the pandemic in New York City

Kovner, Christine; Raveis, Victoria H; Van Devanter, Nancy; Yu, Gary; Glassman, Kimberly; Ridge, Laura Jean
BACKGROUND:Infectious disease pandemics, such as COVID-19, have dramatically increased in the last several decades. PURPOSE/OBJECTIVE:To investigate the personal and contextual factors associated with the psychological functioning of nurses responding to COVID in the New York City area. METHOD/METHODS:Cross sectional data collected via a 95-item internet-based survey sent to an email list of the 7,219 nurses employed at four hospitals. FINDINGS/RESULTS:2,495 nurses responded (RR 35%). The more that nurses cared for COVID patients as well as experienced home-work conflict and work-home conflict the higher the nurses' depression and anxiety. When asked what has helped the nurses to carry out their care of patients the most common responses were support from and to co-workers, training in proper PPE, and support from family/friends. DISCUSSION/CONCLUSIONS:Understanding the potential triggers and vulnerability factors can inform the development of institutional resources that would help minimize their impact, reducing the risk of psychological morbidity.
PMID: 33894986
ISSN: 1528-3968
CID: 4852842

Psychosocial resilience: Challenges and facilitators for nurses from four New York City hospitals responding to the first wave of COVID-19, spring 2020: Qualitative findings from a mixed-methods study

Devanter, Nancy Van; Raveis, Victoria H.; Kovner, Christine; Glassman, Kimberly; Yu, Gary; Ridge, Laura Jean
Frontline workers are at great risk of significant mental health challenges as a result of responding to large-scale disasters. We conducted a mixed-methods study to identify the challenges experienced and the resources nurses drew upon during this first phase of the COVID-19 pandemic in the spring of 2020 in New York City (NYC). The qualitative data presented here are on 591 nurse participants in the qualitative arm of the study. Responses to qualitative questions were reviewed by one of the investigators to identify emerging themes. Two qualitative researchers used both deductive (guided by the Resilience Theory) and inductive approaches to analysis. Challenges identi fied by nurses included concerns about well-being and health risk; mental health symptoms such as depres sion, anxiety, and difficulty sleeping; fears about the ability to care for patients with severe life-threatening symptoms; and home-work challenges such as risk to family and friends; and lack of availability of institutional resources, particularly, personal protec tive equipment (PPE). Facilitators of resilience were institutional resources and support available; social support from coworkers, friends, and family; and positive professional identity. Recommendations for promoting resilience in future disaster/pandemic responses included clarification of disaster-related professional responsibilities, integration of disaster preparedness into professional education, and engage ment of nurses/frontline workers in preparation plan ning for disasters.
ISSN: 1543-5865
CID: 5056342

Early Use of the Palliative Approach to Improve Patient Outcomes in HIV Disease: Insights and Findings From the Care and Support Access (CASA) Study 2013-2019

Alexander, Carla S; Raveis, Victoria H; Karus, Daniel; Carrero-Tagle, Monique; Lee, Mei Ching; Pappas, Gregory; Lockman, Kashelle; Brotemarkle, Rebecca; Memiah, Peter; Mulasi, Ila; Hossain, Basile Mian; Welsh, Christopher; Henley, Yvonne; Piet, Leslie; N'Diaye, Sabrina; Murray, Renard; Haltiwanger, David; Smith, Carlton Ray; Flynn, Colin; Redfield, Robert; Silva, Caroline L; Amoroso, Anthony; Selwyn, Peter
Young men of color who have sex with men (yMSM) living with human immunodeficiency virus (HIV) in syndemic environments have been difficult-to-retain in care resulting in their being at-risk for poor health outcomes despite availability of effective once-daily antiretroviral treatment (ART). Multiple methods have been implemented to improve outcomes for this cohort; none with sustainable results. Outpatient HIV staff themselves may be a contributing factor. We introduced multidisciplinary staff to the concept of using a palliative approach early (ePA) in outpatient HIV care management to enable them to consider the patient-level complexity of these young men. Young MSM (18-35 years of age) enrolled in and cared for at the intervention site of the Care and Support Access Study (CASA), completed serial surveys over 18 months. Patients' Global and Summary quality of life (QoL) increased during the study at the intervention site (IS) where staff learned about ePA, compared with patients attending the control site (CS) (p=.021 and p=.018, respectively). Using serial surveys of staff members, we found that in the era of HIV disease control, outpatient staff are stressed more by environmental factors than by patients' disease status seen historically in the HIV epidemic. A Community Advisory Panel of HIV stakeholders contributed to all phases of this study and altered language used in educational activities with staff members to describe the patient cohort.
PMID: 32851870
ISSN: 1938-2715
CID: 4575792