Lynne C Messer

Portland State University, Portland, Oregon, United States

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Publications (79)192.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Racial and/or ethnic minorities carry the highest burden of many adverse health outcomes intergenerationally. We propose a paradigm in which developmental programming exacerbates the effects of racial patterning of adverse environmental conditions, thereby contributing to health disparity persistence. Evidence that developmental programming induces a heightened response to adverse exposures (“second hits”) encountered later in life is considered. We evaluated the evidence for the second hit phenomenon reported in animal and human studies from three domains (air, stress, nutrition). Original research including a gestational exposure and a childhood or adulthood second hit exposure was reviewed. Evidence from animal studies suggest that prenatal exposure to air pollutants is associated with an exaggerated reaction to postnatal air pollution exposure, which results in worse health outcomes. It also indicates offspring exposed to prenatal maternal stress produce an exaggerated response to subsequent stressors, including anxiety and hyper-responsiveness of the hypothalamic–pituitary–adrenal axis. Similarly, prenatal and postnatal Western-style diets induce synergistic effects on weight gain, metabolic dysfunction, and atherosclerotic risk. Cross-domain second hits (e.g., gestational air pollution followed by childhood stressor) were also considered. Suboptimal gestational environments induce exaggerated offspring responses to subsequent environmental and social exposures. These developmental programming effects may result in enhanced sensitivity of ongoing, racially patterned, adverse exposures in race/ethnic minorities, thereby exacerbating health disparities from one generation to the next. Empirical assessment of the hypothesized role of priming processes in the propagation of health disparities is needed. Future social epidemiology research must explicitly consider synergistic relationships among social environmental conditions to which gestating females are exposed and offspring exposures when assessing causes for persistent health disparities.
    01/2015; 2(1). DOI:10.1007/s40471-014-0033-1
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    ABSTRACT: The relationship between environmental conditions and human health varies by urbanicity. To estimate ambient environmental conditions, an Environmental Quality Index (EQI) for 2000-2005 was constructed by the Environmental Protection Agency using county-level data representing five environmental domains (air, water, land, built and sociodemographic) for each U.S. county (n=3141). Annual county-level, age-adjusted, cancer incidence rate data for 2006-2010 from Surveillance, Epidemiology, and End Results Program (SEER) was modeled with EQI quintiles. A random intercept multi-level linear regression clustered by state estimated fixed effects of EQI quintiles on all-site cancer incidence by sex, adjusted for percentage of population ever smoked (both sexes), and percentage to have had a mammogram and a pap smear (females). Results are reported as incidence rate difference (IRD) (95% confidence interval) comparing highest quintile/worst environmental quality to lowest/best environmental quality. All cause cancer was strongly positively associated with EQI in both sexes (males: 32.60 (16.28, 48.91), females: 30.34 (20.47, 40.21)). Models were also stratified by four rural-urban continuum codes (RUCC) ranging from metropolitan urbanized (RUCC1) to rural (RUCC4). We observed positive associations between all cause cancer and EQI for most strata for males (RUCC1: 27.01 (11.29, 42.74); RUCC2: 11.29 (-18.10, 40.67), RUCC3: 25.66 (3.85, 47.47), RUCC4: -12.12 (-50.65, 26.42)) and across all strata for females (RUCC1: 21.76 (8.26, 35.26); RUCC2: 2.34 (1.62, 3.06), RUCC3: 1.77 (1.19, 2.35), RUCC4: 2.06 (0.93, 3.19)). The strength of association varied by urbanization with the strongest observed in the most urbanized areas for both sexes. In addition, we assessed associations with the top three causes of cancer for both sexes. Cancer incidence is associated with ambient environmental quality and the strength of association varies by level of urbanization, which has implications for public health programs intervention planning in more or less urban areas. This abstract does not necessarily reflect EPA policy.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Physical inactivity has been associated with numerous adverse health outcomes including obesity, heart disease, and depression, and is considered a major contributor to all-cause mortality worldwide. Many studies have shown associations between specific environmental features (lack of sidewalks, safe surroundings, clean air) and physical inactivity. Yet, exposures affecting inactivity do not occur in isolation. Understanding the role of the overall ambient environment in population inactivity levels is essential. A novel county-level Environmental Quality Index (EQI) was developed by the Environmental Protection Agency (EPA) for all US counties from 2000-2005 representing 5 environmental domains: air, water, land, built, and sociodemographic. We linked the EQI to 2006 Behavioral Risk Factor Surveillance System county-level prevalence of age-adjusted physical inactivity in US counties (N=3,141). We used random intercept multi-level linear regression, clustering by state, to estimate fixed effects of EQI quintiles on physical inactivity prevalence. Analyses were stratified by 4 modified United States Department of Agriculture rural-urban continuum codes (RUCC) ranging from metropolitan urbanized (RUCC1) to rural (RUCC4). Results are reported as prevalence difference (PD) (95% confidence interval) comparing highest quintile/worst quality to lowest/best. For the overall EQI, negative quality environments were associated with reduced physical inactivity (RUCC1: -5.07(-5.65, -4.49); RUCC2: -3.36(-4.70, -2.01), RUCC3: -3.35(-4.00, -2.71); RUCC4: -2.55(-3.18, -1.92). However, in domain-specific EQI analyses, patterns of association (strength and direction) varied by RUCC: RUCC1, sociodemographic domain PD=4.56 (4.04, 5.08) and built PD=-4.07(-4.66, -3.48); RUCC2, air PD=1.96 (0.78, 3.13) and sociodemographic PD=-5.03, (-6.18, -3.89); RUCC3, air PD=1.24 (0.64, 1.84) and built PD=-1.23(-1.74, -0.71); RUCC4, sociodemographic PD=-3.00(-3.64, -2.37) and air PD=1.86 (0.98, 2.75). Physical inactivity was influenced by multiple domains of environmental quality depending on the extent of urbanization. These results provide useful information for environmental research and programs aimed at reducing county-level physical inactivity. This abstract does not necessarily reflect EPA policy.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Abstract The combined epidemics of substance abuse, violence, and HIV/AIDS, known as the SAVA syndemic, contribute to the disproportionate burden of disease among people of color in the U.S. To examine the association between HIV viral load suppression and SAVA syndemic variables, we used baseline data from 563 HIV+ women of color treated at nine HIV medical and ancillary care sites participating in HRSA's Special Project of National Significance Women of Color (WOC) Initiative. Just under half the women (n=260) were virally suppressed. Five psychosocial factors contributing to the SAVA syndemic were examined in this study: substance abuse, binge drinking, intimate partner violence, poor mental health, and sexual risk taking. Associations among the psychosocial factors were assessed and clustering confirmed. A SAVA score was created by summing the dichotomous (present/absent) psychosocial measures. Using generalized estimating equation (GEE) models to account for site-level clustering and individual-covariates, a higher SAVA score (0 to 5) was associated with reduced viral suppression; OR (adjusted)=0.81, 95% CI: 0.66, 0.99. The syndemic approach represents a viable framework for understanding viral suppression among HIV positive WOC, and suggests the need for comprehensive interventions that address the social/environmental contexts of patients' lives.
    AIDS PATIENT CARE and STDs 11/2014; 29(S1). DOI:10.1089/apc.2014.0278 · 3.58 Impact Factor
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    ABSTRACT: Irregular participation in HIV medical care hinders HIV RNA suppression and impacts health among people living with HIV. Cluster analysis of clinical data from 1,748 patients attending a large academic medical center yielded three HIV service usage patterns, namely: 'engaged in care', 'sporadic care', and 'frequent use'. Patients 'engaged in care' exhibited most consistent retention (on average, >88 % of each patient's observation years had ≥2 visits 90 days apart), annualized visit use (2.9 mean visits/year) and viral suppression (>73 % HIV RNA tests <400 c/mL). Patients in 'sporadic care' demonstrated lower retention (46-52 %), visit use (1.7 visits/year) and viral suppression (56 % <400 c/mL). Patients with 'frequent use' (5.2 visits/year) had more inpatient and emergency visits. Female, out-of-state residence, low attendance during the first observation year and detectable first-observed HIV RNA were early predictors of subsequent service usage. Patients 'engaged in care' were more likely to have HIV RNA <400 than those receiving sporadic care. Results confirm earlier findings that under-utilization of services predicts poorer viral suppression and health outcomes and support recommendations for 2-3 visits/year.
    AIDS and Behavior 09/2014; DOI:10.1007/s10461-014-0907-8 · 3.49 Impact Factor
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    ABSTRACT: Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004-2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
    Health & Place 09/2014; 30C:98-106. DOI:10.1016/j.healthplace.2014.08.010 · 2.44 Impact Factor
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    ABSTRACT: With more than 2 million children living in group homes, or "institutions", worldwide, the extent to which institution-based caregiving negatively affects development and wellbeing is a central question for international policymakers.
    PLoS ONE 08/2014; 9(8):e104872. DOI:10.1371/journal.pone.0104872 · 3.53 Impact Factor
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    ABSTRACT: Background: Although routine HIV testing programs aim to identify persons earlier in the course of their HIV infection, the results of extant HIV testing programs are inconclusive. The objective of this study was to estimate the impact of a routine, opt-out HIV testing program in North Carolina sexually transmitted disease (STD) clinics on the risk of progression to AIDS after HIV diagnosis. Methods: North Carolina residents aged 18-64 identified as new HIV-infected cases in North Carolina STD clinics from July 1, 2005 through June 30, 2011 were included. Exposure status was dichotomized on the date of intervention implementation on November 1, 2007. Risk of progression to AIDS within 12 months of initial HIV diagnosis was analyzed using county-specific random-intercept multilevel binomial regression models to calculate risk ratios (RRs) and 95% confidence intervals (95% CIs). Results: Of the 1203 persons newly diagnosed with HIV infection, 12% and 13% were diagnosed with AIDS within 12 months of their initial HIV diagnosis in the pre- and post-intervention periods, respectively. Overall, we did not observe an association between the introduction of the expanded HIV testing program and the risk of progression to AIDS (RR=1.04, 95% CI: 0.77-1.43). The intervention was associated with an increased risk of progression to AIDS among women (RR=2.32, 95% CI: 1.06-4.83) and persons who had previously been tested for HIV (RR=1.42, 95% CI: 0.92-2.19). Conclusions: Overall, the routine, opt-out HIV testing program was not associated with a decreased risk of progression to AIDS. Among some subpopulations, the increased risk of progression to AIDS post-intervention was likely due to identification of persons who had been infected for many years but were not previously targeted for risk-based testing. If undiagnosed HIV-infected persons do not seek interactions with the healthcare system, they cannot benefit from routine HIV testing programs in clinical settings.
    National STD Prevention Conference 2014 Centers for Disease Control and Prevention; 06/2014
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    ABSTRACT: The impact of routine, opt-out HIV testing programs in clinical settings is inconclusive. The objective of this study was to estimate the impact of an expanded, routine HIV testing program in North Carolina sexually transmitted disease (STD) clinics on HIV testing and case detection. Adults aged 18 to 64 years who received an HIV test in a North Carolina STD clinic from July 1, 2005, through June 30, 2011, were included in this analysis, dichotomized at the date of implementation on November 1, 2007. HIV testing and case detection counts and rates were analyzed using interrupted time series analysis and Poisson and multilevel logistic regression. Preintervention, 426 new HIV-infected cases were identified from 128,029 tests (0.33%), whereas 816 new HIV-infected cases were found from 274,745 tests postintervention (0.30%). Preintervention, HIV testing increased by 55 tests per month (95% confidence interval [CI], 41-72), but only 34 tests per month (95% CI, 26-42) postintervention. Increases in HIV testing rates were most pronounced in women and non-Hispanic whites. A slight preintervention decline in case detection was mitigated by the intervention (mean difference, 0.01; 95% CI, -0.02 to 0.05). Increases in case detection rates were observed among women and non-Hispanic blacks. The impact of a routine HIV screening in North Carolina STD clinics was marginal, with the greatest benefit among persons not traditionally targeted for HIV testing. The use of a preintervention comparison period identified important temporal trends that otherwise would have been ignored.
    Sexually transmitted diseases 06/2014; 41(6):395-402. DOI:10.1097/OLQ.0000000000000141 · 2.58 Impact Factor
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    ABSTRACT: Particulate matter < 2.5 micrometers in aerodynamic diameter (PM2.5) has been variably associated with preterm birth (PTB).
    Environmental Health Perspectives 05/2014; DOI:10.1289/ehp.1307456 · 7.03 Impact Factor
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    ABSTRACT: A more comprehensive estimate of environmental quality would improve our understanding of the relationship between environmental conditions and human health. An environmental quality index (EQI) for all counties in the U.S. was developed.
    Environmental Health 05/2014; 13(1):39. DOI:10.1186/1476-069X-13-39 · 2.71 Impact Factor
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    ABSTRACT: A range of health effects, including adverse pregnancy outcomes, have been associated with exposure to ambient concentrations of particulate matter (PM) and ozone (O3). The objective of this study was to determine whether maternal exposure to fine particulate matter (PM2.5) and O3 during pregnancy is associated with the risk of term low birthweight and small for gestational age infants in both single and co-pollutant models. Term low birthweight and small for gestational age were determined using all birth certificates from North Carolina from 2003 to 2005. Ambient air concentrations of PM2.5 and O3 were predicted using a hierarchical Bayesian model of air pollution that combined modeled air pollution estimates from the EPA׳s Community Multi-Scale Air Quality (CMAQ) model with air monitor data measured by the EPA׳s Air Quality System. Binomial regression, adjusted for multiple potential confounders, was performed. In adjusted single-pollutant models for the third trimester, O3 concentration was positively associated with small for gestational age and term low birthweight births [risk ratios for an interquartile range increase in O3: 1.16 (95% CI 1.11, 1.22) for small for gestational age and 2.03 (95% CI 1.80, 2.30) for term low birthweight]; however, inverse or null associations were observed for PM2.5 [risk ratios for an interquartile range increase in PM2.5: 0.97 (95% CI 0.95, 0.99) for small for gestational age and 1.01 (95% CI 0.97, 1.06) for term low birthweight]. Findings were similar in co-pollutant models and linear models of birthweight. These results suggest that O3 concentrations in both urban and rural areas may be associated with an increased risk of term low birthweight and small for gestational age births.
    Environmental Research 04/2014; 132C:132-139. DOI:10.1016/j.envres.2014.03.040 · 3.24 Impact Factor
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    ABSTRACT: Racial residential segregation has been associated with preterm birth. Few studies have examined mediating pathways, in part because, with binary outcomes, indirect effects estimated from multiplicative models generally lack causal interpretation. We develop a method to estimate additive-scale natural direct and indirect effects from logistic regression. We then evaluate whether segregation operates through poor-quality built environment to affect preterm birth. To estimate natural direct and indirect effects, we derive risk differences from logistic regression coefficients. Birth records (2000-2008) for Durham, North Carolina, were linked to neighborhood-level measures of racial isolation and a composite construct of poor-quality built environment. We decomposed the total effect of racial isolation on preterm birth into direct and indirect effects. The adjusted total effect of an interquartile increase in racial isolation on preterm birth was an extra 27 preterm events per 1000 births (risk difference = 0.027 [95% confidence interval = 0.007 to 0.047]). With poor-quality built environment held at the level it would take under isolation at the 25th percentile, the direct effect of an interquartile increase in isolation was 0.022 (-0.001 to 0.042). Poor-quality built environment accounted for 35% (11% to 65%) of the total effect. Our methodology facilitates the estimation of additive-scale natural effects with binary outcomes. In this study, the total effect of racial segregation on preterm birth was partially mediated by poor-quality built environment.
    Epidemiology (Cambridge, Mass.) 03/2014; DOI:10.1097/EDE.0000000000000079 · 6.18 Impact Factor
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    ABSTRACT: Neighborhood deprivation is consistently associated with greater risk of low birthweight. However, large birth size is increasingly relevant but overlooked in neighborhood health research, and proximity within which neighborhood deprivation may affect birth outcomes is unknown. We estimated race/ethnic-specific effects of neighborhood deprivation index (NDI) within 1, 3, 5, and 8 km buffers around Oregon Pregnancy Risk Assessment Monitoring System (n=3716; 2004–2007) respondents׳ homes on small and large for gestational age (SGA, LGA). NDI was positively associated with LGA and SGA in most race/ethnic groups. The results varied little across the four buffer sizes.
    Health & Place 01/2014; 30:98–106. · 2.44 Impact Factor
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    ABSTRACT: A range of health effects, including adverse pregnancy outcomes, have been associated with exposure to ambient concentrations of particulate matter (PM) and ozone (O3). The objective of this study was to determine whether maternal exposure to fine particulate matter (PM2.5) and O3 during pregnancy is associated with the risk of term low birthweight and small for gestational age infants in both single and co-pollutant models. Term low birthweight and small for gestational age were determined using all birth certificates from North Carolina from 2003 to 2005. Ambient air concentrations of PM2.5 and O3 were predicted using a hierarchical Bayesian model of air pollution that combined modeled air pollution estimates from the EPA׳s Community Multi-Scale Air Quality (CMAQ) model with air monitor data measured by the EPA׳s Air Quality System. Binomial regression, adjusted for multiple potential confounders, was performed. In adjusted single-pollutant models for the third trimester, O3 concentration was positively associated with small for gestational age and term low birthweight births [risk ratios for an interquartile range increase in O3: 1.16 (95% CI 1.11, 1.22) for small for gestational age and 2.03 (95% CI 1.80, 2.30) for term low birthweight]; however, inverse or null associations were observed for PM2.5 [risk ratios for an interquartile range increase in PM2.5: 0.97 (95% CI 0.95, 0.99) for small for gestational age and 1.01 (95% CI 0.97, 1.06) for term low birthweight]. Findings were similar in co-pollutant models and linear models of birthweight. These results suggest that O3 concentrations in both urban and rural areas may be associated with an increased risk of term low birthweight and small for gestational age births.
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    ABSTRACT: Background: Research suggests the interacting epidemics of substance abuse, violence, HIV/AIDS and related health and psychosocial factors create an excess burden in marginalized communities (the SAVA syndemic). This study examines the relationships between SAVA syndemic-related factors and viral suppression among HIV-positive women of color (WoC) who have received recent HIV care. Methods: Data are from the cross-site evaluation of the HRSA-funded SPNS initiative designed to engage and retain WoC in HIV care. A standardized multi-site baseline survey was employed and matched with chart abstraction data. Women were included if they had a viral load test within 90 days of the baseline survey (implying the receipt of some level of HIV care). GEEs were utilized to test the predictive value of the psychosocial/health variables on viral suppression (y/n) while accounting for the clustering of women by site. Models included the dichotomous predictor variables frequent mental distress (≥14 days of symptoms/month), substance abuse, alcohol use, history of STD(s), and intimate partner violence, controlling for demographic variables. Results: Data for 268 HIV+ WoC were analyzed; 49% (N=132) were virally suppressed. Frequent mental distress and a history of STDs decreased the odds of viral suppression (95% CI, .518,.960,α=.026, and .378,.851,α=.006, respectively). No interactive or additive effects of the SAVA-related variables were found. Conclusions: While two SAVA syndemic-related factors were found to negatively effect viral suppression, the absence of interactive or additive effects of the variables suggest that the syndemic approach may not be a viable framework for predicting HIV clinical outcomes among this population.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Background. Social support provided by social network members is critical to the well-being of HIV+ women of color. However, network members may be unaware of HIV status due to HIV disclosure avoidance. Objective. Using data from the Guide to Healing project, we estimate both direct and indirect effects to evaluate how disclosure avoidance mediates the relationship between social networks and reported social support. Methods. Data were collected from ~150 HIV-positive women of color patients at the University of North Carolina's Infectious Disease clinic (July-December, 2011). General Social Survey questions were modified to elicit egocentric network membership and member characteristics. Interviewers also asked validated questions related to social support, disclosure avoidance and demographics. Measures of network exposure, size, support-provision and disclosure avoidance were constructed. We derived risk differences (RDs) from standard linear regression models, which generated beta coefficients and 95% confidence intervals for the direct and indirect effects related to disclosure avoidance. Results. Women were equally distributed across education categories (less than high school (HS), HS, more than HS) and 65% were <50 years old. About 10% were in non-permanent housing and the majority (72%) was unemployed. In models adjusted for age, education, insurance and employment, both more network ties and having ties who know one's HIV status were associated with higher values of treatment-specific social support. Disclosure avoidance was associated with lower social support. Conclusion. Social networks are understood to be an important source of social support for HIV+ women, but perceived social support is mediated through HIV disclosure.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Background. Cognitive impairment is associated with aging and may be especially pronounced among the HIV+ population, in whom HIV infection has documented neurological effects. Objective. We explored the prevalence, correlates, and associations with health outcomes of cognitive impairment among HIV+ women of color (WOC). Methods. Fifty WOC consented to cognitive testing (CogState) and completed a brief psycho-social survey at UNC's Infectious Disease clinic (summer 2012). Following a 30-minute testing battery (resulting in 6 standardized scores), interviewers asked about depression and anxiety, substance use and documented learning disabilities or neurological deficits. Multilogit logistic models resulted in risk ratios and 95% confidence intervals for the 3-level impairment variable (none, mild or equivocal, moderate or severe). Results. Participants generally had low education (88% <=ighschool), were not married (78%) and had been living with HIV for over six years (87%). One-half the sample reported at least one bout of serious depression but most were not on depression / anxiety medication (70%). While most women reported historical substance use (54%), few reported currently using (6%). Only 28% of women had no cognitive impairment while 38% had moderate or severe impairment; 28% of women were between 40-49 and 36% were between 50-59 years of age. Only historic substance use was associated with cognitive impairment in this sample Conclusions. Cognitive impairment is prevalent among HIV+ women of color. As this population ages and the neurological effects of HIV become manifest, the cognitive health of the HIV+ population will become increasingly important for research, practice, and policy.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixed-effects models were used to assess county-level associations between percent impaired waters and hospitalization rates adjusted for population density, a proxy for person-to-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses.
    Water Quality Exposure and Health 11/2013; 5(3). DOI:10.1007/s12403-013-0095-1
  • Matthew Toth, Lynne C Messer, E Byrd Quinlivan
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    ABSTRACT: Abstract HIV-infected women of color (WOC) face particular barriers to accessing HIV medical care. To understand the impact of physical symptoms, social support, and self-determination on barriers to care, we interviewed HIV-infected women of color. HIV-infected WOC (N=141), attending an academic infectious disease clinic for HIV care in North Carolina, completed the Barriers to Care scale and were categorized as reporting a history of low (less than four of eleven barriers) or high (five or more) barriers to care. Binomial regression was used to estimate prevalence ratios and risk differences of reported barriers to care and its correlates such as depression, anxiety, illness-severity, psychological abuse, social support, treatment-specific social support, and self-determination (autonomy, relatedness, competency). A lower risk of reporting five or more barriers to care was associated with higher levels of autonomy (PR=0.93, 95% CI: 0.89, 0.96), relatedness (PR=0.92, 95% CI: 0.89, 0.94), competency (PR=0.93, 95% CI: 0.87, 0.98), and social support (PR=0.24, 95% CI: 0.81, 0.81). Depression, illness severity, and psychological abuse were associated with a greater risk of having five or more barriers to care. There are multiple social and psychological factors that contribute to perceived barriers to HIV care among WOC in the southeastern USA. Interventions that promote social support and increase individual self-determination have the potential to improve access to HIV care for WOC.
    AIDS patient care and STDs 10/2013; DOI:10.1089/apc.2013.0030 · 2.68 Impact Factor

Publication Stats

991 Citations
192.82 Total Impact Points

Institutions

  • 2012–2015
    • Portland State University
      • School of Community Health
      Portland, Oregon, United States
  • 2008–2014
    • Duke University
      • Center for Health Policy & Inequalities Research
      Durham, North Carolina, United States
  • 2011
    • United States Environmental Protection Agency
      • Office of Research and Development
      Washington, D. C., DC, United States
  • 2010
    • Institute for Health Policy Solutions
      Washington, Washington, D.C., United States
  • 2009
    • University of Minnesota Duluth
      Duluth, Minnesota, United States
  • 2006–2007
    • University of North Carolina at Chapel Hill
      • Department of Environmental Sciences and Engineering
      North Carolina, United States