Gay and bisexual men infected with human immunodeficiency virus (HIV) comprise a sizable, medically vulnerable population. Depression is the most commonly experienced mental health disorder affecting this group of people, lending itself to a host of risks associated with depression. As screening of depression in this population can be challenging, it is vital that clinicians have the best available tools and guidelines to detect depressive symptomology. This focused, comprehensive review of the literature examined current data describing the clinical instruments used to detect depressive symptoms in HIV-infected gay and bisexual men. The aim of this analysis was to seek out which instruments were the most widely and successfully employed for this population. An initial search using EBSCOhost and associated databases CINAHL, MEDLINE, PsycINFO, and Health and Psychosocial Instruments alongside inclusion and exclusion criteria found 1,899 articles. Results were narrowed using additional inclusion and exclusion criteria and relevancy, yielding a total of 13 articles for review. The findings of this review suggest screening of depressive symptoms in HIV-infected gay and bisexual men was most successful using the CES-D, the BSI-18, and the BDI. Health care providers should have an understanding of the importance in assessing this population for depression and have access to the best possible tools to do so.

Background: Adolescence is a crucial point in life where choices, behaviors, and environmental influences can significantly shape future outcomes. This research investigates the increasing concerns surrounding adolescent substance use and examines its long-term effects on socioeconomic status (SES) in adulthood. Substance use during adolescence has been shown to have significant long-term physiological impacts, as the brain is still developing at this age. Additionally, many short- and long-term effects are associated with substance use, such as impacts on academics, physical and emotional well-being, and social life. Several studies have been conducted to explore the relationship between substance use and SES, however, there is little research that investigates how the initiation of substance use during adolescence will affect SES-related factors in adulthood while using a nationally representative sample and a comprehensive range of substances. Methods: Data from Wave I and Wave V of the nationally representative data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset was used to explore the relationship between early initiation of substance use and subsequent socioeconomic-related outcomes during adulthood. Substance use was defined through survey questions addressing the age of initial exposure to alcohol, marijuana, and other illicit drugs reported at Wave I (ages 1-21), while SES in adulthood was assessed through objective indicators (personal income, educational attainment, and poverty indicators such as being unable to pay utility bills) and the subjective MacArthur Scale of Subjective Social Status (SSS) reported at Wave V (ages 33-43). Logistic regression was used to estimate odds ratios and 95% confidence intervals for the association between age at first substance use for each substance [categorized as never used (referent), first use at age 1-11, age 12-17, or 18 or older] and each adulthood SES outcome accounting for the complex survey design. Results: Age of first alcohol use was not significantly associated with adulthood functional poverty indicators, educational attainment, or personal income relative to the federal poverty line. Compared to those who never used, early alcohol use initiation was found to be strongly associated with a decreased SSS (first use at age 1-11, OR = 1.66, 95% CI = 1.08, 2.55). Age of illicit drug use initiation was significantly associated with functional poverty indicators in adulthood (age 12-17, OR = 1.40, 95% CI = 1.02, 1.90) and lower perceived SSS (age 12-17, OR = 1.56, 95% CI = 1.12, 2.27). Lastly, the first age of marijuana use was statistically significant across all measured outcomes, with differences present across age categories. For example, marijuana use was significantly associated with functional poverty indicators in adulthood (first use at age 1-11, OR = 3.40, 95% CI = 1.55, 7.49; first use at age 12-17, OR = 1.56, 95% CI = 1.30, 1.94), a lowered educational attainment (chi-squared = 69.3804, p = 0.0000), reduced personal income relative to the federal poverty line (first use at age 1-11, OR = 2.28, 95% CI = 1.06, 4.93), and a lowered perceived SSS (first use at age 12-17, OR = 1.39, 95% CI = 1.12, 1.74). Conclusions: The insights from this analysis will be beneficial to the local community as they have the potential to benefit adolescents from a reduced socioeconomic status in the long term; it can inform intervention strategies, public health policies, and result in the formation of other initiatives to mitigate potential consequences of the initiation of substance use. Understanding the relationship between the initiation of substance use during adolescence and the resulting repercussions to socioeconomic status during adulthood is essential in crafting targeted and effective measures to support the well-being of adolescents and, by extension, the broader society.

Background The administration of the COVID-19 vaccines has met with resistance and hesitance from different population groups including people living with HIV/AIDS (PLWHA). It is concerning to know that PLWHAs are showing a higher rate of COVID-19 vaccine hesitancy than the general population. The objective of this study is to synthesize the literature and determine the correlates and predictors of COVID-19 vaccine hesitancy among PLWHA using primary and secondary data. Methods A scoping review was conducted to identify and summarize studies on COVID-19 vaccine hesitancy among PLWHA using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Extension for scoping reviews. For the secondary data, the Tennessee Department of Health HIV surveillance and COVID-19 immunization dataset was retrieved from the TDH partners and a questionnaire was developed and administered to PLWHA accessing care at the Ryan White HIV Center of Excellence in Johnson City for the primary data analysis. Results There was a significant association between age group (p < 0.001), gender (p < 0.001), and region (p < 0.001) and uptake of COVID-19 vaccination. PLWHA between the ages 35-44, 45-54, and 55+ in Tennessee were 1.4, 1.8, and 2.8 times more likely more to take doses of COVID-19 vaccines respectively than those between the ages of 15-24 in the State. At the Ryan White clinic, regularity with HAART (p=0.039), uptake of at least one of the other essential vaccines for PLWHA (p=0.011), belief about the safety of the COVID-19 vaccine (p< 0.001), and interference between the COVID-19 vaccine and HAART (p< 0.001) were significantly associated with the uptake of COVID-19 vaccination. Conclusion Efforts and strategies to improve the COVID-19 vaccine behavior of young PLWHA with social media-based vaccine education is imperative. Furthermore, the association between the regularity of HAART and the perception of the safety of the vaccine for PLWHA on COVID-19 vaccine uptake has implications for policy and intervention strategies.

Diet quality during early childhood is a strong predictor of mental and physical outcomes, as well as future diet quality. Although many factors determine diet quality during childhood, food insecurity is a significant predictor of lower diet quality. On the other hand, participation in nutrition assistant programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a significant predictor of higher diet quality. In addition, specific feeding practices, including timing of complementary food and beverage (CFB) introduction, types of CFB introduced early, and diversity of dietary exposures (DD), in the first year may predict future diet quality, and all of these feeding practices may be affected by both food insecurity and WIC participation. A limited number of studies have explored associations between food insecurity, WIC participation, and early-life feeding practices with a focus on initiation of the complementary feeding and diversity of dietary exposures in the first year of life. The present study is a secondary analysis of the WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS 2) aimed at exploring associations between food insecurity, WIC participation, timing of CFB introduction, types of CFB introduced early, DD by 13 months, and diet quality at 2 years. The WIC ITFPS is a longitudinal, nationally representative study of mothers and children under 6 years old which examined feeding practices, associations between WIC services and feeding practices, and the health status of children participating in WIC. Data was collected via phone interviews and questionnaires. Logistic regression analysis was used to assess whether the presence of food insecurity predicted timing of CFB introduction and types of CFB introduced early. Multivariate linear regression analysis was used to assess whether the diversity of dietary exposures (DD) score at age 13 months and diet quality at 2 years was predicted by the combination of food insecurity, timing of CFB introduction, and WIC participation. The results showed that food insecurity was not significantly associated with timing of CFB introduction or types of CFB introduced before 4 months of age. Food insecurity was not a significant predictor of DD score at 13 months, but significant interactions between food insecurity and WIC participation were noted. Among families participating in WIC, infants in families with low or very low food security had significantly higher DD scores compared to families with high or marginal food security. Food insecurity was not associated with diet quality at 24 months, but higher diet quality scores were predicted by the combination of later introduction of CFB (after 4 months), higher DD scores at 13 months, and WIC participation at 24 months. The findings of this study point to the benefits of supporting parents in participating in WIC, introducing CFB on-time, and maximizing diversity of dietary exposures during infancy. Future research should aim to verify causality, include longitudinal studies, focus on exploring WIC recruitment and retention, and continue to add the limited research on the preceding relationships between the above mentioned factors, specifically during the first two years of life.

Background: Breakfast is important in maintaining optimal diet quality and decreasing preventable diet-related disease later in life. Breakfast skipping is highly prevalent in the college population, potentially decreasing self-regulation and diet quality and increasing habits of overeating. However, specific eating styles and diet quality have yet to be studied in breakfast skippers. Objective: To explore and compare the characteristics of eating style, self-regulation, and diet quality among college students between a day when breakfast is skipped and a day when breakfast is consumed. Methodology: Undergraduate students (n=103) participating in this observational crossover study completed demographics, the Self-regulation of Eating Behavior Questionnaire (SREBQ), the Dutch Eating Behavior Questionnaire (DEBQ), and the Short Healthy Eating Index (sHEI) in session A (breakfast skipped) and repeated the measures in session B (breakfast consumed, n=61). Participants were predominantly female (65%), white (54%), health professions majors (31%), and the average age was 21 years old. Statistical Analysis: Descriptive statistics, bivariate correlations, multiple linear regressions, and paired t-tests were analyzed using SPSS V29.0. Results: Self-regulation scores were negatively associated with emotional eating and external eating in both sessions. External eating was shown to be positively correlated with total added sugars. Self-regulation levels significantly predicted diet quality and emotional and uncontrolled eating. Frequency of breakfast consumption positively predicted total diet quality in session B. From A to B, emotional eating significantly decreased, external eating marginally decreased, and restrained eating increased; seafood and plant, whole fruits, and total fruits diet quality increased; consumption of added sugars and saturated fat decreased while sodium increased. Conclusion: Our results add specific data within the irregular breakfast-skipping population between days when breakfast was consumed vs. skipped. Future studies should include irregular breakfast skippers as a distinct category. Universities should increase healthy food accessibility on campus to mitigate the risks of student malnutrition.

“We carry our histories in our bodies, how could we not?” – Nancy Krieger In the United States and abroad, socioeconomic status (income, education, and occupation) greatly impacts health outcomes for a given population. There is a strong and consistent socioeconomic gradient within health outcomes which has been documented as far back as in Ancient Egypt and China (Krieger, Willains, & Moss, 1997; Liberatos, Link, & Kelsey, 1988) The general trend shows that individuals with higher socioeconomic status generally enjoy lower rates of morbidity (disease) and disability, which can ultimately lead to higher mortality rates (House et al. (1992) and House et al. (1994); Williams & Collins, 1995). Most of the literature focuses on the impact of race or gender on socioeconomic status and therefore health status, but rarely is the intersectionality of both race and gender—a factor in the lives of all Afro-American women—the focus of this inquiry. This research views socioeconomic factors in light of historical and sociological conditions which shape present urban environments in which Black women lives and grow. The goal of this thesis is to analyze the ways in which socioeconomic (particularly educational attainment) inequities lead to decreased health status of Afro-American women living in urban slums who fail to graduate high school. This research investigates the long-term effects of a) residential and educational segregation (b) racism and sexism within the educational system (c) racism and sexism within the healthcare system and (d) implications for morbidity and mortality rates amongst Afro-American women with respect to differences in educational attainment and high school dropout status. More research on this topic is necessary to better understand the direct correlation between educational attainment and health status among minority groups in the United States.

Childhood obesity is a serious health problem in the United States. Numerous weight management programs attempt to address this issue. However, attrition poses significant treatment efficacy challenges. Understanding attendance and attrition from childhood obesity programs is crucial for effective and appropriate resource utilization. NOURISH+ is a community-based treatment program for parents of overweight and obese children (age 5–11 years, BMI ≥ 85th percentile). The current study investigated attrition from NOURISH+ to enhance understanding of pediatric obesity treatment retention factors. NOURISH+ participants (n=70) completed a questionnaire assessing barriers to adherence and general program feedback. Data were analyzed using frequencies, descriptive statistics, correlation, regression, and qualitative analyses. Practical barriers were commonly endorsed attendance impediments. This study highlights the significant barriers parents must overcome to partake meaningfully in a group parenting obesity intervention. Results could inform the delivery, acceptability, and feasibility of parent-focused interventions for overweight or obese children in urban environments.

Context: Literature suggests that prenatal care and prenatal supplement use improves pregnancy outcomes. However, we do not know the factors associated with prenatal care and supplement use in Honduras.Objective: To identify characteristics of Honduran women who are the least and most likely to use prenatal care and supplements.Methods: Data from a 2001 Honduras cross-sectional survey of women was used to assess their use of prenatal care and supplements. All data was weighted, resulting in a sample size of n = 5647 women who had a live birth since January 1996. Bivariate and multivariate analyses were used to examine factors associated with prenatal care and supplement use.Results: Current education level was highly positively related to prenatal care and supplement use. Women who were 35 years or older at the time of their most recent birth, currently unmarried, of non-Catholic religious affiliation, and of low SES were significantly less likely to have used prenatal care and supplements. Women who reported the intentionality of their most recent birth as unwanted also were significantly less likely to have used prenatal care and supplements. Prenatal care was the most significant determinant of prenatal supplement use.Conclusion: There are significant differences between Honduran women who use prenatal care and supplements and women who do not. Efforts to increase prenatal health services among underserved women, especially women who are older, unmarried, with no formal education, of low SES, of a non-Catholic religious affiliation, and at risk for an unwanted pregnancy, may significantly improve pregnancy outcomes in Honduras.

Background: Studies of gingival bleeding and the effects of antioxidants on extracellular matrix and immunologic and inflammatory responses provide a rationale for hypothesizing that antioxidants reduce the risk for gingival bleeding.Methods: This study evaluated the role of antioxidants as contributing risk factors for gingival bleeding utilizing the Third National Health and Nutrition Examination Survey (NAHNES III). A sample of 18,825 adults (20 to ≥ 90 years of age), with dental measurement and assessment of serum levels of antioxidants were included in the study. Gingival bleeding was defined as those who had more than 30 percent of gingival bleeding in 28 sites examined. SPSS version 11.0 software and Epi-info 2000 were used to perform the statistical analysis.Results: Using multiple logistic regression in five separate antioxidants, the study showed an association between increased plasma levels of vitamin C (ascorbic acid) and decreased risk for gingival bleeding (OR= 0.33; 95% CI 0.15 to 0.72). An inverse relationship was also found between gingival bleeding and serum levels of beta carotene (OR=1.93; 95% CI 1.05 to 3.54). However, negative association was found between gingival bleeding and vitamin A (OR=2.60; 95% CI 1.04 to 6.50). No statistically significant association was observed between gingival bleeding and serum levels in vitamin E (alpha tocopherol) and selenium.Conclusion: Antioxidants, vitamin C, vitamin A, and beta carotene, were significant risk factors for gingival bleeding. This should be emphasized for improving the oral health of the U.S. adult population.

This dissertation examines sociodemographic determinants and preventive health behaviors among women 40-64 years of age who participated in the Virginia Department of Health’s Every Woman’s Life breast cancer screening program. Utilizing secondary data, this research sought to explore patterns of breast cancer incidence, mammography screening utilization and sources of health information among low-income women. The Virginia Department of Health provided a large sample size (N=34,942) on which to perform binary logistic regression analyses. Sociodemographic determinants and preventive health behaviors were analyzed as potential influencing factors in the diagnosis of breast cancer, the stage at the time of diagnosis and source of health information. Additionally, frequencies across all variables were explored and compared to state and national statistics, where appropriate. In this study, cancer and preventive health disparities reported in the literature persist within this sample of low income women. The binary regression analyses demonstrated that there are marginally worse outcomes for each level of decreasing income. Those with the most “wealth” were less likely to be diagnosed with invasive breast cancer and were more likely to obtain health information from a health provider. Additionally, it was determined that those without a prior mammogram were more likely to be diagnosed with breast cancer and the cancer was more likely to be invasive. The aims of the Every Woman’s Life program align with Affordable Care Act (2010) to strengthen health care and eliminate cancer disparities. Highlighting program characteristics and presenting these analyses allows policymakers, program officials and practitioners an opportunity to tailor health promotion activities while considering all tiers of influence.