NAU publications by CHER
Faculty & staff publications
NAU faculty and staff have the opportunity to publish their findings and knowledge as authors. CHER has many researchers that have been cited multiple times in major publications for their great work. The Center for Health Equity Research has accumulated all faculty publications into one, easy to navigate database.
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Sahker, Ethan; Pro, George; Sakata, Masatsugu; Furukawa, Toshiaki A Substance use improvement depends on Race/Ethnicity: Outpatient treatment disparities observed in a large US national sample Journal Article Drug and Alcohol Dependence, 2020. @article{Sahker2020, title = {Substance use improvement depends on Race/Ethnicity: Outpatient treatment disparities observed in a large US national sample}, author = {Ethan Sahker and George Pro and Masatsugu Sakata and Toshiaki A. Furukawa }, doi = {10.1016/j.drugalcdep.2020.108087}, year = {2020}, date = {2020-05-24}, journal = {Drug and Alcohol Dependence}, abstract = {Racial/ethnic disparities exist at many levels of substance use disorder (SUD) treatment and recovery, reflecting biological and socioeconomic factors. However, racial/ethnic disparities in SUD treatment effectiveness have not been sufficiently investigated. Latinos demonstrated greater use improvement than Black and White clients. Socioeconomic characteristics moderated this general tendency. Culturally sensitive treatments can be enhanced by addressing culturally specific needs according to client age, employment, specific problem substance, and referral source. For example, Black clients referred from school improved more than Whites and Latinos. Increasing resources for school referrals may further improve Black client outcomes.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Racial/ethnic disparities exist at many levels of substance use disorder (SUD) treatment and recovery, reflecting biological and socioeconomic factors. However, racial/ethnic disparities in SUD treatment effectiveness have not been sufficiently investigated. Latinos demonstrated greater use improvement than Black and White clients. Socioeconomic characteristics moderated this general tendency. Culturally sensitive treatments can be enhanced by addressing culturally specific needs according to client age, employment, specific problem substance, and referral source. For example, Black clients referred from school improved more than Whites and Latinos. Increasing resources for school referrals may further improve Black client outcomes. |
Baldwin, Julie A; Lowe, John; Brooks, Jada; Charbonneau-Dahlen, Barbara K; Lawrence, Gary; Johnson-Jennings, Michelle; Padgett, Gary; Kelley, Melessa; Camplain, Carolyn Health Promotion Practice, 2020. @article{Baldwin2020, title = {Formative Research and Cultural Tailoring of a Substance Abuse Prevention Program for American Indian Youth: Findings from the Intertribal Talking Circle Intervention}, author = {Julie A. Baldwin and John Lowe and Jada Brooks and Barbara K. Charbonneau-Dahlen and Gary Lawrence and Michelle Johnson-Jennings and Gary Padgett and Melessa Kelley and Carolyn Camplain}, url = {https://doi.org/10.1177/1524839920918551}, doi = {10.1177/1524839920918551}, year = {2020}, date = {2020-05-14}, journal = {Health Promotion Practice}, abstract = {Substance use among American Indians (AIs) is a critical health issue and accounts for many health problems such as chronic liver disease, cirrhosis, behavioral health conditions, homicide, suicide, and motor vehicle accidents. In 2013, the highest rates of substance use and dependence were seen among AIs when compared to all other population groups, although these rates vary across different tribes. Among AI adolescents, high rates of substance use have been associated with environmental and historical factors, including poverty, historical trauma, bicultural stress, and changing tribal/familial roles. Our project, the Intertribal Talking Circle intervention, involved adapting, tailoring, implementing, and evaluating an existing intervention for AI youth of three tribal communities in the United States. Formative Results. Community partnership committees (CPCs) identified alcohol, marijuana, and prescription medications as high priority substances. CPC concerns focused on the increasing substance use in their communities and the corresponding negative impacts on families, stating a lack of coping skills, positive role models, and hope for the future as concerns for youth. Cultural Tailoring Process Results. Each site formed a CPC that culturally tailored the intervention for their tribal community. This included translating Keetoowah-Cherokee language, cultural practices, and symbolism into the local tribal customs for relevance. The CPCs were essential for incorporating local context and perceived concerns around AI adolescent substance use. These results may be helpful to other tribal communities developing/implementing substance use prevention interventions for AI youth. It is critical that Indigenous cultures and local context be factored into such programs.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Substance use among American Indians (AIs) is a critical health issue and accounts for many health problems such as chronic liver disease, cirrhosis, behavioral health conditions, homicide, suicide, and motor vehicle accidents. In 2013, the highest rates of substance use and dependence were seen among AIs when compared to all other population groups, although these rates vary across different tribes. Among AI adolescents, high rates of substance use have been associated with environmental and historical factors, including poverty, historical trauma, bicultural stress, and changing tribal/familial roles. Our project, the Intertribal Talking Circle intervention, involved adapting, tailoring, implementing, and evaluating an existing intervention for AI youth of three tribal communities in the United States. Formative Results. Community partnership committees (CPCs) identified alcohol, marijuana, and prescription medications as high priority substances. CPC concerns focused on the increasing substance use in their communities and the corresponding negative impacts on families, stating a lack of coping skills, positive role models, and hope for the future as concerns for youth. Cultural Tailoring Process Results. Each site formed a CPC that culturally tailored the intervention for their tribal community. This included translating Keetoowah-Cherokee language, cultural practices, and symbolism into the local tribal customs for relevance. The CPCs were essential for incorporating local context and perceived concerns around AI adolescent substance use. These results may be helpful to other tribal communities developing/implementing substance use prevention interventions for AI youth. It is critical that Indigenous cultures and local context be factored into such programs. |
Marhefka, Stephanie L; Lockhart, Elizabeth; Turner, DeAnne; Wang, Wei; Dolcini, Margaret M; Baldwin, Julie A; Roig-Romero, Regina Maria; Lescano, Celia M; Glueckauf, Robert L AIDS Behav, 24 (5), pp. 1463-1475, 2020. @article{Marhefka2020, title = {Social Determinants of Potential eHealth Engagement Among People Living with HIV Receiving Ryan White Case Management: Health Equity Implications from Project TECH}, author = {Stephanie L Marhefka and Elizabeth Lockhart and DeAnne Turner and Wei Wang and M Margaret Dolcini and Julie A Baldwin and Regina Maria Roig-Romero and Celia M Lescano and Robert L Glueckauf}, doi = {10.1007/s10461-019-02723-1}, year = {2020}, date = {2020-05-01}, journal = {AIDS Behav}, volume = {24}, number = {5}, pages = {1463-1475}, abstract = {Evaluate the relationships between social characteristics of Floridian persons living with HIV (PLWH) and both use of digital technologies and willingness to use eHealth for HIV-related information. Ryan White case managers (N = 155) from 55 agencies in 47 Florida counties administered a survey to PLWH (N = 1268) from June 2016-April 2017. Multilevel logistic regression models were used to identify correlates of technology use and willingness. Use of mobile phones with text messaging was high (89%). Older (vs. younger) adults and non-Hispanic blacks (vs. whites) were less likely to use most technologies. These groups, along with Hispanics (vs. whites) were less likely to express willingness to use technologies for HIV-related information in models adjusting for use. Among PLWH in Florida, eHealth-related inequities exist. Willingness to engage in HIV-related eHealth is affected by social determinants, even when considering technology access. Although eHealth may reduce some healthcare inequities, it may exacerbate others.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Evaluate the relationships between social characteristics of Floridian persons living with HIV (PLWH) and both use of digital technologies and willingness to use eHealth for HIV-related information. Ryan White case managers (N = 155) from 55 agencies in 47 Florida counties administered a survey to PLWH (N = 1268) from June 2016-April 2017. Multilevel logistic regression models were used to identify correlates of technology use and willingness. Use of mobile phones with text messaging was high (89%). Older (vs. younger) adults and non-Hispanic blacks (vs. whites) were less likely to use most technologies. These groups, along with Hispanics (vs. whites) were less likely to express willingness to use technologies for HIV-related information in models adjusting for use. Among PLWH in Florida, eHealth-related inequities exist. Willingness to engage in HIV-related eHealth is affected by social determinants, even when considering technology access. Although eHealth may reduce some healthcare inequities, it may exacerbate others. |
Pro G Sahker E, Baldwin JA Incarceration as a Reason for US Alcohol and Drug Treatment Non-completion: a Multilevel Analysis of Racial/Ethnic and Sex Disparities Journal Article The Journal of Behavioral Health Services & Research, 2020. @article{Pro2020d, title = {Incarceration as a Reason for US Alcohol and Drug Treatment Non-completion: a Multilevel Analysis of Racial/Ethnic and Sex Disparities}, author = {Pro G, Sahker E, Baldwin JA}, url = {https://doi.org/10.1007/s11414-020-09703-7}, doi = {10.1007/s11414-020-09703-7 }, year = {2020}, date = {2020-04-29}, journal = {The Journal of Behavioral Health Services & Research}, abstract = {Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015–2016 Treatment Episode Dataset–Discharges. Among a sample restricted to treatment non-completers (n = 306,008), 5% terminated treatment because they became incarcerated (n = 13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [95% CI] = 0.26–0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR = 1.37, 95% CI = 1.29–1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015–2016 Treatment Episode Dataset–Discharges. Among a sample restricted to treatment non-completers (n = 306,008), 5% terminated treatment because they became incarcerated (n = 13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [95% CI] = 0.26–0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR = 1.37, 95% CI = 1.29–1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment. |
Pro, George; Sahker, Ethan; Baldwin, Julie Incarceration as a barrier to U.S. alcohol and drug treatment completion: A multilevel analysis of racial/ethnic and sex disparities Journal Article Journal of Behavioral Health Services & Research, 2020. @article{Pro2020e, title = {Incarceration as a barrier to U.S. alcohol and drug treatment completion: A multilevel analysis of racial/ethnic and sex disparities}, author = {George Pro and Ethan Sahker and Julie Baldwin}, url = {https://doi.org/10.1007/s11414-020-09703-7}, doi = {10.1007/s11414-020-09703-7}, year = {2020}, date = {2020-04-29}, journal = {Journal of Behavioral Health Services & Research}, abstract = {Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015–2016 Treatment Episode Dataset–Discharges. Among a sample restricted to treatment non-completers (n = 306,008), 5% terminated treatment because they became incarcerated (n = 13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [95% CI] = 0.26–0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR = 1.37, 95% CI = 1.29–1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Incarceration may be an overlooked reason for treatment non-completion experienced disproportionately by African Americans. This study utilized multilevel logistic regression to model treatment non-completion due to incarceration using the 2015–2016 Treatment Episode Dataset–Discharges. Among a sample restricted to treatment non-completers (n = 306,008), 5% terminated treatment because they became incarcerated (n = 13,082), which varied widely by demographics and by state. In Idaho, 46% of African Americans terminated treatment because they became incarcerated. Women had lower odds of treatment non-completion than men, and the effect of sex was strongest among African Americans (adjusted odds ratio [aOR] = 0.30, 95% confidence interval [95% CI] = 0.26–0.34). Among men, all racial/ethnic minority groups demonstrated significantly higher odds of treatment non-completion due to incarceration compared with Whites, and the strongest effect was among African Americans (aOR = 1.37, 95% CI = 1.29–1.44). Incarceration as a reason for treatment non-completion disproportionately affects African Americans and men and varies by state. Interventions targeting incarceration alternatives should be availed to racial/ethnic minorities already participating in treatment. |
Coulter K., Sabo Martínez Chisholm Gonzalez Bass Zavala Villalobos Garcia Levy Slack S D K K S E D T J A Study and Analysis of the Treatment of Mexican Unaccompanied Minors by Customs and Border Protection Journal Article Journal on Migration and Human Security, 2020. @article{Coulter2020, title = {A Study and Analysis of the Treatment of Mexican Unaccompanied Minors by Customs and Border Protection}, author = {Coulter, K., Sabo, S., Martínez, D., Chisholm, K., Gonzalez, K., Bass Zavala, S., Villalobos E., Garcia D. Levy, T., Slack, J.}, url = {https://journals.sagepub.com/doi/10.1177/2331502420915898}, doi = {10.1177/2331502420915898}, year = {2020}, date = {2020-04-22}, journal = {Journal on Migration and Human Security}, abstract = {The routine human rights abuses and due process violations of unaccompanied alien children (UAC) by US Customs and Border Protection (CBP) have contributed to a mounting humanitarian and legal crisis along the US–Mexico border. In the United States, the treatment of UAC is governed by laws, policies, and standards drawn from the Flores Settlement, the Trafficking Victims Protection Reauthorization Act (TVPRA), and CBP procedures and directives, which are intended to ensure UAC’s protection, well-being, and ability to pursue relief from removal, such as asylum. As nongovernmental organizations and human rights groups have documented, however, CBP has repeatedly violated these legal standards and policies, and subjected UAC to abuses and rights violations. This article draws from surveys of 97 recently deported Mexican UAC, which examine their experiences with US immigration authorities. The study finds that Mexican UAC are detained in subpar conditions, are routinely not screened for fear of return to their home countries or for human trafficking, and are not sufficiently informed about the deportation process. The article recommends that CBP should take immediate steps to improve the treatment of UAC, that CBP and other entities responsible for the care of UAC be monitored to ensure their compliance with US law and policy, and that Mexican UAC be afforded the same procedures and protection under the TVPRA as UAC from noncontiguous states.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The routine human rights abuses and due process violations of unaccompanied alien children (UAC) by US Customs and Border Protection (CBP) have contributed to a mounting humanitarian and legal crisis along the US–Mexico border. In the United States, the treatment of UAC is governed by laws, policies, and standards drawn from the Flores Settlement, the Trafficking Victims Protection Reauthorization Act (TVPRA), and CBP procedures and directives, which are intended to ensure UAC’s protection, well-being, and ability to pursue relief from removal, such as asylum. As nongovernmental organizations and human rights groups have documented, however, CBP has repeatedly violated these legal standards and policies, and subjected UAC to abuses and rights violations. This article draws from surveys of 97 recently deported Mexican UAC, which examine their experiences with US immigration authorities. The study finds that Mexican UAC are detained in subpar conditions, are routinely not screened for fear of return to their home countries or for human trafficking, and are not sufficiently informed about the deportation process. The article recommends that CBP should take immediate steps to improve the treatment of UAC, that CBP and other entities responsible for the care of UAC be monitored to ensure their compliance with US law and policy, and that Mexican UAC be afforded the same procedures and protection under the TVPRA as UAC from noncontiguous states. |
Williamson, Heather J; van Heumen, Lieke; Schwartz, Ariel E Photovoice with Individuals with Intellectual and/or Developmental Disabilities: Lessons Learned from Inclusive Research Efforts Journal Article Collaborations, 3 (1), 2020. @article{Williamson2020, title = {Photovoice with Individuals with Intellectual and/or Developmental Disabilities: Lessons Learned from Inclusive Research Efforts}, author = {Heather J. Williamson and Lieke van Heumen and Ariel E. Schwartz}, url = {http://doi.org/10.33596/coll.45}, doi = {http://doi.org/10.33596/coll.45}, year = {2020}, date = {2020-04-15}, journal = {Collaborations}, volume = {3}, number = {1}, abstract = {Inclusive research is an approach in which individuals with intellectual and/or developmental disabilities (IDD) are included as co-researchers throughout the research processes, and has demonstrated benefits for people with IDD. Because inclusive research is still not common within disability research, it is important for research teams to provide reflections and lessons learned to encourage future inclusive approaches. This paper provides case studies of two research projects completed in collaboration with adults with IDD using Photovoice as an approach that can increase access to the research process for co-researchers with IDD. Drawing upon previously defined inclusive research criteria, we reflect on lessons learned and challenges. Inclusive research requires time, flexibility, shared power, clear communication, and cultural humility. Across both studies, we discuss the importance of clear communication with Institutional Review Boards and collaboration with the extended support networks of individuals with IDD. We reflect on how the accessible nature of Photovoice supports inclusive research teams to combine the strengths of co-researchers with IDD and academically trained researchers, such that the knowledge production process is shifted to co-researchers with IDD.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Inclusive research is an approach in which individuals with intellectual and/or developmental disabilities (IDD) are included as co-researchers throughout the research processes, and has demonstrated benefits for people with IDD. Because inclusive research is still not common within disability research, it is important for research teams to provide reflections and lessons learned to encourage future inclusive approaches. This paper provides case studies of two research projects completed in collaboration with adults with IDD using Photovoice as an approach that can increase access to the research process for co-researchers with IDD. Drawing upon previously defined inclusive research criteria, we reflect on lessons learned and challenges. Inclusive research requires time, flexibility, shared power, clear communication, and cultural humility. Across both studies, we discuss the importance of clear communication with Institutional Review Boards and collaboration with the extended support networks of individuals with IDD. We reflect on how the accessible nature of Photovoice supports inclusive research teams to combine the strengths of co-researchers with IDD and academically trained researchers, such that the knowledge production process is shifted to co-researchers with IDD. |
Jones, Marie; Credo, Jonathan; Ingram, Jani; Baldwin, Julie; Trotter, Robert; Propper, Catherine Arsenic Concentrations in Ground and Surface Waters across Arizona Including Native Land Journal Article Journal of Contemporary Water Research & Education, 169 , pp. 44-60, 2020. @article{Jones2020, title = {Arsenic Concentrations in Ground and Surface Waters across Arizona Including Native Land}, author = {Marie Jones and Jonathan Credo and Jani Ingram and Julie Baldwin and Robert Trotter and Catherine Propper}, url = {https://ucowr.org/wp-content/uploads/2020/04/169_MCJones_etal.pdf}, year = {2020}, date = {2020-04-01}, journal = {Journal of Contemporary Water Research & Education}, volume = {169}, pages = {44-60}, abstract = {Parts of the Southwestern United States report arsenic levels in water resources that are above the United States Environmental Protection Agency’s current drinking water limits. Prolonged exposure to arsenic through food and drinking water can contribute to significant health problems including cancer, developmental effects, cardiovascular disease, neurotoxicity, and diabetes. In order to understand exposure risks, water sampling and testing have been conducted throughout Arizona. This information is available to the public through often non-overlapping databases that are difficult to access and in impracticable formats. The current study utilized a systemic compilation of online databases to compile a spreadsheet containing over 33,000 water samples. The reported arsenic concentrations from these databases were collected from 1990-2017. Using ArcGIS software, these data were converted into a map shapefile and overlaid onto a map of Arizona. This visual representation shows that arsenic levels in surface and ground water exceed the United States Environmental Protection Agency’s drinking water limits for many sites in several counties in Arizona, and there is an underrepresentation of sampling in several tribal jurisdictions. This information is useful for water managers and private well owners throughout the State for determining safe drinking water sources and limiting exposure to arsenic.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Parts of the Southwestern United States report arsenic levels in water resources that are above the United States Environmental Protection Agency’s current drinking water limits. Prolonged exposure to arsenic through food and drinking water can contribute to significant health problems including cancer, developmental effects, cardiovascular disease, neurotoxicity, and diabetes. In order to understand exposure risks, water sampling and testing have been conducted throughout Arizona. This information is available to the public through often non-overlapping databases that are difficult to access and in impracticable formats. The current study utilized a systemic compilation of online databases to compile a spreadsheet containing over 33,000 water samples. The reported arsenic concentrations from these databases were collected from 1990-2017. Using ArcGIS software, these data were converted into a map shapefile and overlaid onto a map of Arizona. This visual representation shows that arsenic levels in surface and ground water exceed the United States Environmental Protection Agency’s drinking water limits for many sites in several counties in Arizona, and there is an underrepresentation of sampling in several tribal jurisdictions. This information is useful for water managers and private well owners throughout the State for determining safe drinking water sources and limiting exposure to arsenic. |
Pro, George; Utter, Jeff; Haberstroh, Shane; Baldwin, Julie A Drug and Alcohol Dependence, 209 (1), 2020. @article{Pro2020f, title = {Dual mental health diagnoses predict the receipt of medication-assisted opioid treatment: Associations moderated by state Medicaid expansion status, race/ethnicity and gender, and year}, author = {George Pro and Jeff Utter and Shane Haberstroh and Julie A Baldwin}, url = {https://pubmed.ncbi.nlm.nih.gov/32172130/}, doi = {10.1016/j.drugalcdep.2020.107952}, year = {2020}, date = {2020-03-07}, journal = {Drug and Alcohol Dependence}, volume = {209}, number = {1}, abstract = { Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Mental health diagnoses (MHD) are common among those with opioid use disorders (OUD). Methadone/buprenorphine are effective medication-assisted treatment (MAT) strategies; however, treatment receipt is low among those with dual MHDs. Medicaid expansions have broadly increased access to OUD and mental health services over time, but MAT uptake may vary depending on multiple factors, including MHD status, state Medicaid expansion decisions, and race/ethnicity and gender. Examining clinical and policy approaches to promoting MAT uptake may improve services among marginalized groups. |
Fisher, Kim W; Williamson, Heather; Guerra, Nichole Technology and Social Inclusion: Technology Training and Usage by Youth With IDD in the National Longitudinal Transition Study of 2012 Journal Article Inclusion, 8 (1), pp. 43–57, 2020. @article{Fisher2020, title = {Technology and Social Inclusion: Technology Training and Usage by Youth With IDD in the National Longitudinal Transition Study of 2012}, author = {Kim W. Fisher and Heather Williamson and Nichole Guerra}, url = {https://doi.org/10.1352/2326-6988-8.1.43}, doi = {10.1352/2326-6988-8.1.43}, year = {2020}, date = {2020-03-01}, journal = {Inclusion}, volume = {8}, number = {1}, pages = {43–57}, abstract = {Technology use is a key form of social inclusion and a means to engage in community participation. People with intellectual and developmental disabilities (IDD) experience a digital divide with less technology access as compared to their peers. We used data from the National Longitudinal Transition Study of 2012 to study technology use and access to instruction among adolescents with IDD compared to adolescents with other disabilities and adolescents without disabilities. Results indicate adolescents with IDD use technology less, receive less technology training, and engage in fewer social inclusion opportunities than their peers. Implications for future research, policy, and practice are provided, including promoting digital citizenship training during transition planning and the use of social capital theory. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Technology use is a key form of social inclusion and a means to engage in community participation. People with intellectual and developmental disabilities (IDD) experience a digital divide with less technology access as compared to their peers. We used data from the National Longitudinal Transition Study of 2012 to study technology use and access to instruction among adolescents with IDD compared to adolescents with other disabilities and adolescents without disabilities. Results indicate adolescents with IDD use technology less, receive less technology training, and engage in fewer social inclusion opportunities than their peers. Implications for future research, policy, and practice are provided, including promoting digital citizenship training during transition planning and the use of social capital theory. |
Sean D. Rundell and, Linda Resnik ; Heagerty, Patrick J; Kumar, Amit; Jarvik, Jeffrey G Journal of Orthopaedic & Sports Physical Therapy, 50 (3), pp. 143-148, 2020. @article{Rundell2019c, title = {Comparing Performance of Comorbidity Indices in Predicting Functional Status, Health-Related Quality of Life, and Total Health Care Use in Older Adults with Back Pain}, author = {Sean D. Rundell, and, Linda Resnik and Patrick J. Heagerty and Amit Kumar and Jeffrey G. Jarvik}, url = {https://www.jospt.org/doi/10.2519/jospt.2020.8764}, doi = {10.2519/jospt.2020.8764}, year = {2020}, date = {2020-02-29}, journal = {Journal of Orthopaedic & Sports Physical Therapy}, volume = {50}, number = {3}, pages = {143-148}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Armstrong-Heimsoth, Amy; Hahn-Floyd, Molly; Williamson, Heather J; Kurka, Jonathan M; Yoo, Wonsuk; Jesús, Sue Rodríguez De A Former Foster System Youth: Perspectives on Transitional Supports and Programs Journal Article The Journal of Behavioral Health Services and Research, 2020. @article{Armstrong-Heimsoth2020, title = {Former Foster System Youth: Perspectives on Transitional Supports and Programs}, author = {Amy Armstrong-Heimsoth and Molly Hahn-Floyd and Heather J. Williamson and Jonathan M. Kurka and Wonsuk Yoo and Sue A. Rodríguez De Jesús}, url = {https://doi.org/10.1007/s11414-020-09693-6}, doi = {10.1007/s11414-020-09693-6}, year = {2020}, date = {2020-02-24}, journal = {The Journal of Behavioral Health Services and Research}, abstract = {Youth aging out of the foster care system have well-documented challenges when transitioning to adulthood. Multiple transition services provide support in the transition process; however, limited research is available regarding youth’s perceptions of programming. In this pilot study, sixteen youth between ages 18 and 20 participated in semi-structured interviews, support mapping, an resiliency measurements to gather the experiences of the transition from foster care. Comparisons between those who chose initial transition supports and those who did not receive or delayed receiving transition supports were initially explored. Common themes emerged in participants’ needs and perceived resiliency regardless of transition support services. All youth reported relationship, trust, and concern for well-being as highly important characteristics in transition team members. A need for earlier transition programming, decision-making opportunities, and life skills courses were important themes in transition programming needs. Implications for policy, research, and practice are presented based upon findings.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Youth aging out of the foster care system have well-documented challenges when transitioning to adulthood. Multiple transition services provide support in the transition process; however, limited research is available regarding youth’s perceptions of programming. In this pilot study, sixteen youth between ages 18 and 20 participated in semi-structured interviews, support mapping, an resiliency measurements to gather the experiences of the transition from foster care. Comparisons between those who chose initial transition supports and those who did not receive or delayed receiving transition supports were initially explored. Common themes emerged in participants’ needs and perceived resiliency regardless of transition support services. All youth reported relationship, trust, and concern for well-being as highly important characteristics in transition team members. A need for earlier transition programming, decision-making opportunities, and life skills courses were important themes in transition programming needs. Implications for policy, research, and practice are presented based upon findings. |
Eaves, Emery R; Williamson, Heather J; Sanderson, Katharine C; Elwell, Kristan; II, Robert Trotter T; Baldwin, Julie A Integrating Behavioral and Primary Health Care in Rural Clinics: What Does Culture Have to Do with It? Journal Article Journal of Health Care for the Poor and Underserved, 31 (1), pp. 201-217, 2020. @article{Eaves2020, title = {Integrating Behavioral and Primary Health Care in Rural Clinics: What Does Culture Have to Do with It?}, author = {Emery R Eaves and Heather J Williamson and Katharine C Sanderson and Kristan Elwell and Robert T Trotter II and Julie A Baldwin }, url = {https://muse.jhu.edu/article/747784}, doi = {10.1353/hpu.2020.0018}, year = {2020}, date = {2020-02-07}, journal = {Journal of Health Care for the Poor and Underserved}, volume = {31}, number = {1}, pages = {201-217}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Pro, George; Zaller, Nick PLOS One, 15 (2), 2020. @article{Pro2020c, title = {Interaction Effects in the Association Between Methadone Maintenance Therapy and Experiences of Racial Discrimination in U.S. Healthcare Settings}, author = {George Pro and Nick Zaller}, url = {https://doi.org/10.1371/journal.pone.0228755}, doi = {10.1371/journal.pone.0228755}, year = {2020}, date = {2020-02-06}, journal = {PLOS One}, volume = {15}, number = {2}, abstract = { Background Disparities in methadone maintenance therapy (MMT) outcomes have received limited attention, but there are important negative outcomes associated with MMT that warrant investigation. Racial discrimination is common in healthcare settings and affects opioid use disorder (OUD) treatment and comorbidities. However, race/ethnicity alone may not fully explain experiences of discrimination. MMT remains highly stigmatized and may compound the effect of race/ethnicity on discrimination in healthcare settings. We sought to quantify differential associations between MMT and experiences of racial discrimination between racial/ethnic groups in a U.S. national sample. Methods We used the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012–2013) to identify a subset of individuals with a lifetime OUD who had ever used MMT (survey n = 766; weighted population n = 5,276,507). We used multivariable logistic regression to model past-year experience of racial discrimination in a healthcare setting. We included an interaction term between race/ethnicity and MMT status to identify the odds of discrimination (MMT vs. no MMT [referent]) within racial/ethnic groups. We used survey procedures with weights to account for the parent study’s complex survey design. Findings Twenty-two percent of our sample experienced racial discrimination in a healthcare setting in the past year. Discrimination was more common among those who had ever used MMT (x2 = 10.00, p = 0.001) and racial/ethnic minorities (x2 = 23.15, p<0.001). The interaction effect was much stronger than the main effects of race/ethnicity and MMT status. MMT status (versus no MMT) was positively associated with discrimination among Blacks (aOR = 3.93, 95% CI = 3.87–3.98, p<0.001), Whites (aOR = 2.25, 95% CI = 2.23–2.27, p<0.001), and Latino/Latinas (aOR = 1.59, 95% CI = 1.55–1.62, p<0.001). Among American Indian/Alaska Natives (AI/AN), those who had used MMT had over thirty times the odds of racial discrimination, compared to their non-MMT counterparts (aOR = 32.78, 95% CI = 31.16–34.48, p<0.001). Conclusion Race/ethnicity alone did not sufficiently account for racial discrimination in healthcare settings among those with a lifetime OUD. MMT status was strongly associated with racial discrimination among AI/AN. Our strong interaction effect is indicative of an additional barrier to health services utilization among AI/AN, which has important implications for OUD treatment outcomes and comorbidities. Health promotion programs aimed at increased adoption of MMT are promising, but should be considered in the context of racial/ethnic disparities, drug use and MMT stigma, and implicit biases in clinical settings. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Background Disparities in methadone maintenance therapy (MMT) outcomes have received limited attention, but there are important negative outcomes associated with MMT that warrant investigation. Racial discrimination is common in healthcare settings and affects opioid use disorder (OUD) treatment and comorbidities. However, race/ethnicity alone may not fully explain experiences of discrimination. MMT remains highly stigmatized and may compound the effect of race/ethnicity on discrimination in healthcare settings. We sought to quantify differential associations between MMT and experiences of racial discrimination between racial/ethnic groups in a U.S. national sample. Methods We used the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012–2013) to identify a subset of individuals with a lifetime OUD who had ever used MMT (survey n = 766; weighted population n = 5,276,507). We used multivariable logistic regression to model past-year experience of racial discrimination in a healthcare setting. We included an interaction term between race/ethnicity and MMT status to identify the odds of discrimination (MMT vs. no MMT [referent]) within racial/ethnic groups. We used survey procedures with weights to account for the parent study’s complex survey design. Findings Twenty-two percent of our sample experienced racial discrimination in a healthcare setting in the past year. Discrimination was more common among those who had ever used MMT (x2 = 10.00, p = 0.001) and racial/ethnic minorities (x2 = 23.15, p<0.001). The interaction effect was much stronger than the main effects of race/ethnicity and MMT status. MMT status (versus no MMT) was positively associated with discrimination among Blacks (aOR = 3.93, 95% CI = 3.87–3.98, p<0.001), Whites (aOR = 2.25, 95% CI = 2.23–2.27, p<0.001), and Latino/Latinas (aOR = 1.59, 95% CI = 1.55–1.62, p<0.001). Among American Indian/Alaska Natives (AI/AN), those who had used MMT had over thirty times the odds of racial discrimination, compared to their non-MMT counterparts (aOR = 32.78, 95% CI = 31.16–34.48, p<0.001). Conclusion Race/ethnicity alone did not sufficiently account for racial discrimination in healthcare settings among those with a lifetime OUD. MMT status was strongly associated with racial discrimination among AI/AN. Our strong interaction effect is indicative of an additional barrier to health services utilization among AI/AN, which has important implications for OUD treatment outcomes and comorbidities. Health promotion programs aimed at increased adoption of MMT are promising, but should be considered in the context of racial/ethnic disparities, drug use and MMT stigma, and implicit biases in clinical settings. |
Pro, George; Utter, Jeff; Cram, Jessica; Baldwin, Julie A Journal of Psychoactive Drugs, 2020. @article{Pro2020, title = {Racial/Ethnic and Gender Differences in Associations of Medication-Assisted Therapy and Reduced Opioid Use between Outpatient Treatment Admission and Discharge}, author = {George Pro and Jeff Utter and Jessica Cram and Julie A Baldwin}, doi = {10.1080/02791072.2020.1717685}, year = {2020}, date = {2020-01-31}, journal = {Journal of Psychoactive Drugs}, abstract = {Medication-assisted therapy (MAT) for opioid use disorders is an effective treatment strategy. Racial/ethnic and gender disparities in MAT utilization have been documented, but less is known about disparities in MAT outcomes. We used the Treatment Episodes Dataset–Discharges (TEDS-D; 2015– 2017) to identify outpatient treatment episodes with heroin or illicit opioids indicated at admission (n = 232,547). We used multivariate logistic regression to model the association between MAT and a reduction in opioid use between treatment admission and discharge. We explored moderation by race/ethnicity and gender by including an interaction term. We identified a strong moderating effect of race/ethnicity and gender. American Indian/Alaska Native (AI/AN) women demonstrated the strongest association between MAT (versus no MAT) and a reduction in opioid use (aOR = 6.05, 95% CI = 4.81– 7.61), while White men demonstrated the weakest association (aOR = 2.78, CI = 2.70– 2.87). Our findings could inform changes in clinical MAT settings that are based on harm reduction and the incremental transition from illicit opioids to medication-assistance among a diverse opioid use disorder population.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Medication-assisted therapy (MAT) for opioid use disorders is an effective treatment strategy. Racial/ethnic and gender disparities in MAT utilization have been documented, but less is known about disparities in MAT outcomes. We used the Treatment Episodes Dataset–Discharges (TEDS-D; 2015– 2017) to identify outpatient treatment episodes with heroin or illicit opioids indicated at admission (n = 232,547). We used multivariate logistic regression to model the association between MAT and a reduction in opioid use between treatment admission and discharge. We explored moderation by race/ethnicity and gender by including an interaction term. We identified a strong moderating effect of race/ethnicity and gender. American Indian/Alaska Native (AI/AN) women demonstrated the strongest association between MAT (versus no MAT) and a reduction in opioid use (aOR = 6.05, 95% CI = 4.81– 7.61), while White men demonstrated the weakest association (aOR = 2.78, CI = 2.70– 2.87). Our findings could inform changes in clinical MAT settings that are based on harm reduction and the incremental transition from illicit opioids to medication-assistance among a diverse opioid use disorder population. |
Rio, Carlos Del; Baldwin, Julie; Chapman, Edwin; Cooper, Hannah; Gustafson, David; Hagan, Holly; Newhouse, Robin; Rich, Josiah; Springer, Sandra; Thomas, David Opportunities to improve opioid use disorder and infectious disease services: Integrating responses to a dual epidemic Journal Article A Consensus Study Report of the National Academies of Sciences, Engineering and Medicine, 2020. @article{Rio2020, title = {Opportunities to improve opioid use disorder and infectious disease services: Integrating responses to a dual epidemic}, author = {Carlos Del Rio and Julie Baldwin and Edwin Chapman and Hannah Cooper and David Gustafson and Holly Hagan and Robin Newhouse and Josiah Rich and Sandra Springer and David Thomas}, url = {https://doi.org/10.17226/25626}, doi = {10.17226/25626}, year = {2020}, date = {2020-01-23}, journal = {A Consensus Study Report of the National Academies of Sciences, Engineering and Medicine}, abstract = {Opioid use and infectious diseases are intertwined epidemics. Despite the fact that the United States is more than two decades into the opioid crisis—the cause of tens of thousands of deaths every year on its own—the health system has not sufficiently addressed the morbidity and mortality of drug use coupled with infectious diseases. This is at least in part due to traditional models of substance use disorder care wherein substance use disorder treatment is delivered independently of other medical care, thereby inhibiting the delivery of comprehensive care. As a result, the United States is experiencing a drastic increase in infectious diseases that spread with drug use.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Opioid use and infectious diseases are intertwined epidemics. Despite the fact that the United States is more than two decades into the opioid crisis—the cause of tens of thousands of deaths every year on its own—the health system has not sufficiently addressed the morbidity and mortality of drug use coupled with infectious diseases. This is at least in part due to traditional models of substance use disorder care wherein substance use disorder treatment is delivered independently of other medical care, thereby inhibiting the delivery of comprehensive care. As a result, the United States is experiencing a drastic increase in infectious diseases that spread with drug use. |
Camplain, Ricky; Camplain, Carolyn; II, Robert Trotter T; Pro, George; Sabo, Samantha; Eaves, Emery; Peoples, Marie; Baldwin, Julie A Racial/Ethnic Differences in Drug- and Alcohol-Related Arrest Outcomes in a Southwest County From 2009 to 2018 Journal Article American Journal of Public Health, 110 (51), pp. 585-592, 2020. @article{Camplain2020c, title = {Racial/Ethnic Differences in Drug- and Alcohol-Related Arrest Outcomes in a Southwest County From 2009 to 2018}, author = {Ricky Camplain and Carolyn Camplain and Robert T. Trotter II and George Pro and Samantha Sabo and Emery Eaves and Marie Peoples and Julie A. Baldwin}, url = {https://doi.org/10.2105/AJPH.2019.305409}, doi = {10.2105/AJPH.2019.305409}, year = {2020}, date = {2020-01-22}, journal = {American Journal of Public Health}, volume = {110}, number = {51}, pages = {585-592}, abstract = {More than 60% of criminal justice–involved individuals are racial/ethnic minorities, even though these groups make up just 30% of the US population. Black, Latino, and American Indian/Alaska Native (AI/AN) persons are more likely to be incarcerated compared with White persons, 1–3 and police interactions among racial/ethnic minorities are more likely to result in arrest, even after accounting for arrest decision-making by police. Although it is clear that racial/ethnic minorities are overrepresented in the criminal justice system, it is less clear how outcomes at different points of interactions with the criminal justice system, including entry into the system, prosecution and pretrial services, adjudication, sentencing and sanctions, and corrections,14 differ by race/ethnicity, specifically for drug- and alcohol-related offenses. Thus, we aimed to estimate the association between race/ethnicity and arrest outcomes among individuals arrested for drug- or alcohol-related reasons in a rural Southwest US county (the county) from 2009 to 2018.}, keywords = {}, pubstate = {published}, tppubtype = {article} } More than 60% of criminal justice–involved individuals are racial/ethnic minorities, even though these groups make up just 30% of the US population. Black, Latino, and American Indian/Alaska Native (AI/AN) persons are more likely to be incarcerated compared with White persons, 1–3 and police interactions among racial/ethnic minorities are more likely to result in arrest, even after accounting for arrest decision-making by police. Although it is clear that racial/ethnic minorities are overrepresented in the criminal justice system, it is less clear how outcomes at different points of interactions with the criminal justice system, including entry into the system, prosecution and pretrial services, adjudication, sentencing and sanctions, and corrections,14 differ by race/ethnicity, specifically for drug- and alcohol-related offenses. Thus, we aimed to estimate the association between race/ethnicity and arrest outcomes among individuals arrested for drug- or alcohol-related reasons in a rural Southwest US county (the county) from 2009 to 2018. |
Barger, Steven D; Broom, Timothy W; Esposito, Michael V; Lane, Taylor S BMJ Open, 10 (1), 2020. @article{Barger2020, title = {Is subjective well-being independently associated with mortality? A 14-year prospective cohort study in a representative sample of 25 139 US men and women}, author = {Steven D Barger and Timothy W Broom and Michael V Esposito and Taylor S Lane}, url = {http://dx.doi.org/10.1136/bmjopen-2019-031776}, doi = {10.1136/bmjopen-2019-031776}, year = {2020}, date = {2020-01-14}, journal = {BMJ Open}, volume = {10}, number = {1}, abstract = {Design A population-based prospective cohort study based on an in-person interview. Cox regression was used to examine mortality hazards for happiness alone and for a standardised summary well-being measure that included happiness, life satisfaction and negative emotions. Using prespecified analyses, we first adjusted for age and then additionally adjusted for self-rated health and then race/ethnicity, marital status, smoking and socioeconomic status.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Design A population-based prospective cohort study based on an in-person interview. Cox regression was used to examine mortality hazards for happiness alone and for a standardised summary well-being measure that included happiness, life satisfaction and negative emotions. Using prespecified analyses, we first adjusted for age and then additionally adjusted for self-rated health and then race/ethnicity, marital status, smoking and socioeconomic status. |
Pro, George; Camplain, Ricky; de Heer, Brooke; Chief, Carmenlita; Teufel-Shone, Nicolette I Journal of Racial and Ethnic Health Disparities, 2020. @article{Pro2020bb, title = {A National Epidemiologic Profile of Physical Intimate Partner Violence, Adverse Childhood Experiences, and Supportive Childhood Relationships: Group Differences in Predicted Trends and Associations}, author = {George Pro and Ricky Camplain and Brooke de Heer and Carmenlita Chief and Nicolette I. Teufel-Shone}, url = {https://doi.org/10.1007/s40615-019-00696-4}, doi = {10.1007/s40615-019-00696-4}, year = {2020}, date = {2020-01-07}, journal = {Journal of Racial and Ethnic Health Disparities}, abstract = {Adverse childhood experiences (ACEs) are common in the USA and associated with multiple health sequelae. Physical intimate partner violence (IPV) is a type of revictimization that some adults with ACEs may be more prone to. Positive and supportive childhood environments may buffer the effects of ACEs, but little is known about the differential associations between physical IPV and ACEs and supportive childhood environments. We sought to illustrate racial/ethnic and gender differences in the adjusted predicted probability of physical IPV across multiple ACE and supportive childhood scores.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Adverse childhood experiences (ACEs) are common in the USA and associated with multiple health sequelae. Physical intimate partner violence (IPV) is a type of revictimization that some adults with ACEs may be more prone to. Positive and supportive childhood environments may buffer the effects of ACEs, but little is known about the differential associations between physical IPV and ACEs and supportive childhood environments. We sought to illustrate racial/ethnic and gender differences in the adjusted predicted probability of physical IPV across multiple ACE and supportive childhood scores. |
Camplain, Ricky; Sotres-Alvarez, Daniela; Alvarez, Carolina; Wilson, Rebbecca; Perreira, Krista M; Castañeda, Sheila F; Merchant, Gina; Gellman, Marc D; Chambers, Earle C; Gallo, Linda C; Evenson, Kelly R ScienceDirect, 17 , 2020. @article{Camplain2020b, title = {The association of acculturation with accelerometer-assessed and self-reported physical activity and sedentary behavior: The Hispanic Community Health Study/Study of Latinos}, author = {Ricky Camplain and Daniela Sotres-Alvarez and Carolina Alvarez and Rebbecca Wilson and Krista M. Perreira and Sheila F. Castañeda and Gina Merchant and Marc D. Gellman and Earle C. Chambers and Linda C. Gallo and Kelly R. Evenson }, url = {https://doi.org/10.1016/j.pmedr.2020.101050}, doi = {10.1016/j.ypmed.2017.07.024}, year = {2020}, date = {2020-01-06}, journal = {ScienceDirect}, volume = {17}, abstract = {The adoption of US culture among immigrants has been associated with higher leisure-time physical activity and sedentary behavior. However, most research to date assesses this association using single measures of acculturation and physical activity. Our objective was to describe the cross-sectional association between acculturation and both physical activity and sedentary behavior among US Hispanic/Latino adults. Participants included Hispanic/Latinos 18–74 years living in four US locations enrolled in the Hispanic Community Health Study/Study of Latinos from 2008 to 2011. Acculturation was measured using acculturation scales (language and social), years in the US, language preference, and age at immigration. Physical activity and sedentary behavior were measured using the Global Physical Activity Questionnaire (N = 15,355) and Actical accelerometer (N = 11,954). Poisson, logistic, and linear regression were used, accounting for complex design and sampling weights. English-language preference was positively associated with self-reported leisure-time and transportation physical activity and accelerometer-assessed moderate-to-vigorous physical activity (MVPA). Social acculturation was positively associated with self-reported leisure-time and transportation physical activity and MVPA. Years in the US and age at immigration were positively associated with accelerometer-assessed MVPA. Language acculturation, years in the US, and age at immigration were associated with occupational physical activity among those who reported employment. Most acculturation measures were associated with self-reported sitting but not with accelerometer-assessed sedentary behavior. Different measures of acculturation, capturing various domains acculturation, were associated with physical activity and sedentary behavior. However, the direction of the association was dependent on the measures of acculturation physical activity/sedentary behavior, highlighting the complexity of these relationships.}, keywords = {}, pubstate = {published}, tppubtype = {article} } The adoption of US culture among immigrants has been associated with higher leisure-time physical activity and sedentary behavior. However, most research to date assesses this association using single measures of acculturation and physical activity. Our objective was to describe the cross-sectional association between acculturation and both physical activity and sedentary behavior among US Hispanic/Latino adults. Participants included Hispanic/Latinos 18–74 years living in four US locations enrolled in the Hispanic Community Health Study/Study of Latinos from 2008 to 2011. Acculturation was measured using acculturation scales (language and social), years in the US, language preference, and age at immigration. Physical activity and sedentary behavior were measured using the Global Physical Activity Questionnaire (N = 15,355) and Actical accelerometer (N = 11,954). Poisson, logistic, and linear regression were used, accounting for complex design and sampling weights. English-language preference was positively associated with self-reported leisure-time and transportation physical activity and accelerometer-assessed moderate-to-vigorous physical activity (MVPA). Social acculturation was positively associated with self-reported leisure-time and transportation physical activity and MVPA. Years in the US and age at immigration were positively associated with accelerometer-assessed MVPA. Language acculturation, years in the US, and age at immigration were associated with occupational physical activity among those who reported employment. Most acculturation measures were associated with self-reported sitting but not with accelerometer-assessed sedentary behavior. Different measures of acculturation, capturing various domains acculturation, were associated with physical activity and sedentary behavior. However, the direction of the association was dependent on the measures of acculturation physical activity/sedentary behavior, highlighting the complexity of these relationships. |
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