Associations Between Major Depression, Health-risk Behaviors, and Medication Adherence Among Hiv-positive Adults Receiving Medical Care in Georgia

Background: There are approximately 1.2 million people in the United States living with HIV, and 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression to substance use and medication adherence among HIV-positive adults receiving medical care for HIV in Georgia. Methods: Secondary data with a probability sample of 775 HIV-positive adults who took part in the 2009-2013 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analyses and multivariate logistic regressions were conducted to assess relationships between depression and current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design. Results: Among HIV-positive adults in Georgia, 8.5% met the criteria for major depression, including 13.7% of women and 6.5% of men. Heterosexual adults had a higher percentage of major depression (10.7%) compared to adults who identified as bisexual (7.4%) or homosexual (5.8%). Major depression was also higher among adults with a high school diploma or GED (12.7%) compared to adults with a higher level of education (5.2%). Major depression was associated with a greater odds of current cigarette smoking (AOR 2.7; 95% CI: 1.5, 5.2) and other non-injection drug use (2.5; 95% CI: 1.4, 4.4), after adjusting for sociodemographic variables. The three measures of medication adherence were not statistically significantly associated with major depression. Conclusions: As previously observed for the general population, we found, among HIV-positive adults, significant associations between depression and smoking and other non-injection drug use. Because HIVpositive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population

Trends in Awareness and Use of Electronic Cigarettes Among US Adults, 2010–2013

Introduction: Electronic cigarette (e-cigarette) marketing has increased considerably since the product entered the US market in 2007, thereby warranting additional surveillance to monitor recent trends in population-level awareness and utilization. We assessed the prevalence, characteristics, and trends in e-cigarette awareness and use among nationally representative samples of US adults during 2010–2013. Methods: Data came from the 2010–2013 HealthStyles survey, an annual consumer-based web survey of US adults aged ≥18 years. Sample sizes ranged from 2,505 (2010) to 4,170 (2012). Descriptive statistics were used to assess e-cigarette awareness, ever use, and current use (use within the past 30 days) overall and by sex, age, race/ethnicity, education, income, US region, and cigarette smoking status. Trends were assessed using logistic regression. Results: During 2010–2013, increases (p \u3c .05) were observed for e-cigarette awareness (40.9%– 79.7%), ever use (3.3%–8.5%), and current use (1.0%–2.6%). Awareness increased among all sociodemographic subpopulations during 2010–2013 (p \u3c .05); an increase in ever use of e-cigarettes occurred among all sociodemographic groups except those aged 18–24 years, Hispanics, and those living in the Midwest (p \u3c .05). During 2010–2013, ever use increased among current (9.8%–36.5%) and former (2.5%–9.6%) cigarette smokers (p \u3c .05), but it remained unchanged among never smokers (1.3%–1.2%). Conclusions: Awareness and use of e-cigarettes increased considerably among US adults during 2010–2013. In 2013, more than one-third of current cigarette smokers reported having ever used e-cigarettes. Given the uncertain public health impact of e-cigarettes, continued surveillance of emerging use patterns is critical for public health planning

Quality-adjusted life expectancy (QALE) loss due to smoking in the United States

Purpose: Estimate quality-adjusted life expectancy (QALE) loss due to smoking and examine trends and state differences in smoking-related QALE loss in the U.S. Methods: Population health-related quality of life (HRQOL) scores were estimated from the Behavioral Risk Factor Surveillance System. This study constructed life tables based on U.S. mortality files and the mortality linked National Health Interview Survey and calculated QALE for smokers, non-smokers, and the total population. Results: In 2009, an 18-year-old smoker was expected to have 43.5 (SE = 0.2) more years of QALE, and a non-smoker of the same age was expected to have 54.6 (SE = 0.2) more years of QALE. Therefore, smoking contributed 11.0 (SE = 0.2) years of QALE loss for smokers and 4.1 years (37%) of this loss resulted from reductions in HRQOL alone. At the population level, smoking was associated with 1.9 fewer years of QALE for U.S. adults throughout their lifetime, starting at age 18. Conclusions: This study demonstrates an application of a recently developed QALE estimation methodology. The analyses show good precision and relatively small bias in estimating QALE––especially at the individual level. Although smokers may live longer today than before, they still have a high disease burden due to morbidities associated with poor HRQOL

Cigar Smoking Among U.S. Students: Reported Use After Adding Brands to Survey Items

Background: Among U.S. youth overall, cigars are the most commonly used tobacco product after cigarettes. However, youth who identify their products by brand names, not general terms like “cigar,” may underreport use. Purpose: To examine changes in reported cigar (cigar, cigarillo, or little cigar) smoking among students following inclusion of cigar brand examples on the National Youth Tobacco Survey (NYTS). Methods: Data from the 2011 and 2012 NYTS and National Survey on Drug Use and Health (NSDUH) were analyzed in 2013 to estimate ever and current cigar smoking, overall and by race/ ethnicity. The 2012 NYTS included cigar brand examples (Black and Mild, Swisher Sweets, Dutch Masters, White Owl, Phillies Blunt) in the survey instructions and ever use question, but the 2011 NYTS and 2011 and 2012 NSDUH did not. Results: NYTS ever cigar smoking was higher in 2012 (27.8%) than 2011 (19.5%) among black students overall. Current cigar smoking was 60%–70% higher among black females and students agedZ17 years, in 2012 than 2011. For black females, current cigar smoking (11.5%) was two times greater than that of white females (4.3%) in 2012, whereas the prevalence among these subgroups was comparable in 2011. Similar changes were not observed among these subgroups in the 2011– 2012 NSDUH. Conclusions: This study highlights the high burden of cigar use among U.S. youth and suggests that NYTS ascertainment of cigar smoking may have improved by including brands. Disparities in cigar smoking need to be addressed to prevent and reduce all youth tobacco use. (Am J Prev Med 2014;47(2S1):S28–S35) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicin

Original Research Associations between major depression, health-risk behaviors, and medication adherence among HIV-positive adults receiving medical care in Georgia

ABSTRACT Background: There are approximately 1.2 million people in the United States living with HIV, and 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression to substance use and medication adherence among HIV-positive adults receiving medical care for HIV in Georgia. Methods: Secondary data with a probability sample of 775 HIV-positive adults who took part in the 2009-2013 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analyses and multivariate logistic regressions were conducted to assess relationships between depression and current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design. Results: Among HIV-positive adults in Georgia, 8.5% met the criteria for major depression, including 13.7% of women and 6.5% of men. Heterosexual adults had a higher percentage of major depression (10.7%) compared to adults who identified as bisexual (7.4%) or homosexual (5.8%). Major depression was also higher among adults with a high school diploma or GED (12.7%) compared to adults with a higher level of education (5.2%). Major depression was associated with a greater odds of current cigarette smoking (AOR 2.7; 95% CI: 1.5, 5.2) and other non-injection drug use (2.5; 95% CI: 1.4, 4.4), after adjusting for sociodemographic variables. The three measures of medication adherence were not statistically significantly associated with major depression. Conclusions: As previously observed for the general population, we found, among HIV-positive adults, significant associations between depression and smoking and other non-injection drug use. Because HIVpositive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population

Intentions to Smoke Cigarettes Among Never-Smoking US Middle and High School Electronic Cigarette Users: National Youth Tobacco Survey, 2011–2013

Introduction: Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. Methods: We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6–12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. Results: Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24–2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. Conclusion: In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes

Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients

<p>Abstract</p> <p>Background</p> <p>Prescription drugs account for approximately 11% of national health expenditures. Prior research on adverse childhood experiences (ACEs), which include common forms of child maltreatment and related traumatic stressors, has linked them to numerous health problems. However, data about the relationship of these experiences to prescription drug use are scarce.</p> <p>Method</p> <p>We used the ACE Score (an integer count of 8 different categories of ACEs) as a measure of cumulative exposure to traumatic stress during childhood. We prospectively assessed the relationship of the Score to prescription drug use in a cohort of 15,033 adult HMO patients (mean follow-up: 6.1 years) and assessed mediation of this relationship by documented ACE-related health and social problems.</p> <p>Results</p> <p>Nearly 1.2 million prescriptions were recorded; prescriptions rates increased in a graded fashion as the ACE Score increased (p for trend < 0.0001). Compared to persons with an ACE Score of 0, persons with a Score ≥ 5 had rates increased by 40%; graded relationships were seen for all age groups (18–44, 45–64, and 65–89 years) (p for trend < 0.01). Graded relationships were observed for the risk of being in the upper decile of number of classes of drugs used; persons with scores of ≥ 5 had this risk increased 2-fold. Adjustment for ACE-related health problems reduced the strength of the associations by more than 60%.</p> <p>Conclusion</p> <p>ACEs substantially increase the number of prescriptions and classes of drugs used for as long as 7 or 8 decades after their occurrence. The increases in prescription drug use were largely mediated by documented ACE-related health and social problems.</p

An analysis of Georgia mothers who gave birth in 2015 and 2016 without receiving prenatal care

Background: The present study characterizes the population of women residing in the state of Georgia who did not receive prenatal care before giving birth to a live infant. The association between mother’s place of residence (rural/non-rural) and preterm delivery was also examined. Methods: This study examined data obtained from the Georgia Department of Public Health which includes data for 7,062 mothers who did not receive prenatal care before giving birth to a live infant in Georgia in the years 2015 and 2016. Data on the resulting births was also studied. Descriptive analyses of the following variables were used to characterize mothers not receiving prenatal care: mother’s age, race/ethnicity, education level, and county of residence in Georgia. Multivariable logistic regression examined the association between rural and non-rural residence in Georgia and the outcome of preterm birth, controlling for age, race, and education level. Results: From 2015 to 2016 there were a total of 261,273 live births in Georgia, of which 2.91% of births were from mothers who received no prenatal care. Of these infants, 21.53% were born preterm, 12.12% were born low birth weight and 5.34% were born very low birth weight. There was no statistically significant difference observed for preterm births between rural and non-rural mothers who did not receive prenatal care (p= 0.0873). Conclusions: Continued monitoring of Georgia women not receiving prenatal care is needed. The findings from this study can assist the state of Georgia in tailoring healthcare outreach efforts and in formulating population-specific intervention strategies that aim to improve access and allocation of prenatal care resources throughout the state of Georgia