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Article Reference Troff document (with manpage macros)Better a Friend Nearby Than a Brother Far Away? The Health Implications of Foreign Domestic Workers’ Family and Friendship Networks
Migrant domestic workers provide essential services to the families they live with, but they are not considered a part of the family. As a group, they are not well-integrated into the society and often suffer from social isolation. In this article, we explore the potential health buffering effects of their personal network, in terms of family and friendship ties in both the local community and their home country. Existing literature provides inconsistent evidence on who and what matters more, with regard to the nature, strength, and geographic locations of individual personal networks. Using data from the Survey of Migrant domestic Workers in Hong Kong (2017), we find that family ties are extremely important. The presence of family members in Hong Kong as well as daily contact with family, regardless of location, are associated with better self-reported health. Only daily contact with friends in Hong Kong, not with friends in other countries, promotes better health. We also find evidence that the protective effects of family and friends networks depend on each other. Those foreign domestic workers with families in Hong Kong but also maintain daily contact with friends have the best self-reported health among all.
Located in MPRC People / Feinian Chen, Ph.D. / Feinian Chen Publications
Article Reference Troff document (with manpage macros)Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex
Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions and 44 in-depth interviews using semi-structured tools. Interviews were audio recorded, and transcribed verbatim. Data were analysed using a thematic analysis. While AGYW did not necessarily use the language of coercion, their narratives describe a number of coercive aspects in their relationships. First, coercion by force as a result of “de-toothing” a man (whereby they received money or resources but did not wish to provide sex as “obligated” under the implicit “terms” of the relationships). Second, they described the coercive role that receiving resources played in their decision to have sex in the face of men’s verbal insistence. Finally, they discussed having sex as a result of coercive economic circumstances including poverty, and because of peer pressure to uphold modern lifestyles. Support for income-generation activities, microfinance and social protection programmes may help reduce AGYW’s vulnerability to sexual coercion in transactional sex relationships. Targeting gender norms that contribute to unequal power dynamics and social expectations that obligate AGYW to provide sex in return for resources, critically assessing the meaning of consensual sex, and normative interventions building on parents’ efforts to ascertain the source of their daughters’ resources may also reduce AGYW’s vulnerability to coercion.
Located in MPRC People / Kirsten Stoebenau, Ph.D. / Kristen Stoebenau Publications
Article Reference Troff document (with manpage macros)Association of Childhood Asthma With Federal Rental Assistance
Importance   Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives   To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants   This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures   Participation in rental assistance provided by HUD. Main Outcomes and Measures   Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results   This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance   Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.
Located in MPRC People / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Association of Childhood Asthma With Federal Rental Assistance
Importance   Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives   To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants   This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures   Participation in rental assistance provided by HUD. Main Outcomes and Measures   Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results   This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance   Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.
Located in MPRC People / Michel Boudreaux, Ph.D. / Michel Boudreaux Publications
Article Reference Troff document (with manpage macros)Challenging Stereotypes: A Counter-Narrative of the Contraceptive Experiences of Low-Income Latinas
Purpose: Reproductive autonomy is associated with educational attainment, advanced employment, and wellbeing. While U.S. Latinas use contraception to control their own childbearing and have reported a desire to do so, they often use it inconsistently and have the lowest rates of contraceptive use of any group. Reasons previously cited for why Latinas do not use contraception compared with non-Latino white women include lack of access, lack of knowledge, language barriers, emphasis on large families, machismo, and religiosity. These reasons are often overly simplistic and can lead to widespread generalizations about Latinas. Methods: Using focus groups and semistructured interviews from November 2014 through June 2015, this study describes the family planning perspectives and experiences of 16 Latinas living in Baltimore and recruited from two federally qualified health centers. A social determinant of health framework was used to guide identification of important concepts and explain findings. Results: Results demonstrated that respondents reported contraceptive agency and claimed autonomy over their bodies; described a sense of responsibility and often expressed caution about having families too large to care for; expressed educational and career aspirations; and perceived contraception as critical for the postponement of childbearing to achieve their goals. Conclusion: The patient/provider encounter should include communication that recognizes all patient preferences and lived experiences to support vulnerable and/or marginalized Latinas in their desires to control their own childbearing and life choices.
Located in MPRC People / Ruth Zambrana, Ph.D. / Ruth Zambrana Publications
Article Reference Troff document (with manpage macros)Racial Non-equivalence of Socioeconomic Status and Self-rated Health among African Americans and Whites
Racial health inequities are not fully explained by socioeconomic status (SES) measures like education, income and wealth. The largest inequities are observed among African American and white college graduates suggesting that African Americans do not receive the same health benefits of education. African Americans do not receive the same income and wealth returns of college education as their white counterparts indicating a racial non-equivalence of SES that may affect health inequities. The aim of this study is to determine whether racial non-equivalence of SES mediates race inequities in self-rated health by education and sex. Using data from the 2007–2016 National Health and Nutrition Examination Survey in the United States, the mediation of the associations between race and self-rated health through household income ≥400% federal poverty line, homeownership, and investment income were assessed among college graduates and non-college graduates by sex. Indirect associations were observed among college graduate women (odds = 0.08, standard error (s.e.) = 0.03), and non-college graduate men (odds = 0.14, s.e. = 0.02) and women (odds = 0.06, s.e. = 0.02). Direct associations between race and self-rated health remained after accounting for household income and wealth indicators suggesting that race differences in income and wealth partially mediate racial inequities in self-rated health. This study demonstrates that the racial non-equivalence of SES has implications for health inequities, but the magnitude of indirect associations varied by sex. Other factors like discrimination, health pessimism and segregation should be considered in light of the racial non-equivalence of SES and racial inequities in self-rated health.
Located in Retired Persons / Caryn Bell, Ph.D. / Caryn Bell Publications
Article Reference Troff document (with manpage macros)Seizing opportunities for intervention: Changing HIV-related knowledge among men who have sex with men and transgender women attending trusted community centers in Nigeria
Background Knowledge of HIV risk factors and reduction strategies is essential for prevention in key populations such as men who have sex with men (MSM) and transgender women (TGW). We evaluated factors associated with HIV-related knowledge among MSM and TGW and the impact of engagement in care at trusted community health centers in Nigeria. Methods The TRUST/RV368 cohort recruited MSM and TGW in Lagos and Abuja, Nigeria via respondent driven sampling. During study visits every three months, participants underwent structured interviews to collect behavioral data, received HIV education, and were provided free condoms and condom compatible lubricants. Five HIV-related knowledge questions were asked at enrollment and repeated after 9 and 15 months. The mean number of correct responses was calculated for each visit with 95% confidence intervals (CIs). Multivariable Poisson regression was used to calculate adjusted risk ratios and CIs for factors associated with answering more knowledge questions correctly. Results From March 2013 to April 2018, 2122 persons assigned male sex at birth were enrolled, including 234 TGW (11.2%). The mean number of correct responses at enrollment was 2.36 (95% CI: 2.31–2.41) and increased to 2.95 (95% CI: 2.86–3.04) and 3.06 (95% CI: 2.97–3.16) after 9 and 15 months in the study, respectively. Among 534 participants who completed all three HIV-related knowledge assessments, mean number of correct responses rose from 2.70 (95% CI: 2.60–2.80) to 3.02 (95% CI: 2.93–3.13) and then 3.06 (95% CI: 2.96–3.16). Factors associated with increased overall HIV-related knowledge included longer duration of study participation, HIV seropositivity, higher education level, and more frequent internet use. Conclusions There was suboptimal HIV-related knowledge among Nigerian MSM and TGW at that improved modestly with engagement in care. These data demonstrate unmet HIV education needs among Nigerian MSM and TGW and provide insights into modalities that could be used to address these needs.
Located in MPRC People / Hongjie Liu, Ph.D. / Hongjie Liu Publications
Article Reference Troff document (with manpage macros)Social Determinants of Cardiovascular Health: Early Life Adversity as a Contributor to Disparities in Cardiovascular Diseases
Social determinants of health (SDoH), factors related to the conditions in which people are born, live, work, play, age, and the systems that shape the conditions of daily life, have emerged as key drivers of health and health disparities. 1 , 2  A strong body of research supports that SDoH are associated with cardiovascular risk factors and outcomes, independently or in conjunction with more traditionally recognized risk factors. As a result, efforts to improve cardiovascular health are predicated on improved understanding of the impact of SDoH on cardiovascular disease (CVD) over the life course.
Located in MPRC People / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)Correlates of Health Promotion in a Community Sample of African American Churches
Though many African American churches offer health promotion activities to their members, less is known about organizational factors that predict the availability of this programming. This study examines organizational capacity as a predictor of the amount and type of health programming offered by a convenience sample of 119 African American churches. Leaders completed a survey of health promotion activities provided in the previous 12 months and a measure of organizational capacity. Churches offered an average of 6.08 (SD = 2.15) different health programs targeting 4.66 (SD = 3.63) topics. Allocation of space and having a health ministry were positively associated with both the number of health programs and health topics addressed. When seeking to initiate health programming in an African American church setting, it is recommended that stakeholders partner with churches that have existing structures to support health promotion such as a health ministry, or help them build this capacity.  
Located in MPRC People / Craig Fryer, Dr.P.H. / Craig Fryer Publications
Article Reference Troff document (with manpage macros)A Credible Messenger: The Role of the Violence Intervention Specialist in the Lives of Young Black Male Survivors of Violence
For hospital-based violence intervention programs (HVIPs), gun violence intervention and the treatment of firearm-related injuries for male survivors require a  sui generis  network of team members that includes physicians, caseworkers, mental health care providers, and violence intervention specialists (VIS). The VIS can play a vital part in the success of HVIPs, but there is no published literature about the roles, functions, and best practices of this position. A case study conducted at the Capital Region Violence Intervention Program, an emerging HVIP at the University of Maryland Prince George's Hospital Center, demonstrates the importance of the VIS fostering deep levels of interpersonal connection with survivors of violent injury. The VIS actively seeks to increase the rate of psychosocial services usage. Due to cultural competence, street experience, and a willingness to share lived experiences as a survivor of violent injury, the VIS has credibility when discussing mental health symptomatology and usage of services for young Black male survivors of violence. The relationship between the VIS and male survivors of violent injury markedly enhanced the provision of trauma-informed care, peer support, and mentoring. This case study demonstrates the importance of marshalling the shared lived experiences of the VIS to increase trust and perceived credibility by young Black male survivors of gun violence as a means to decrease trauma recidivism.
Located in MPRC People / Joseph Richardson, Ph.D. / Joseph Richardson Publications