Suchergebnisse

Purpose. The population of military veterans attending college is rapidly growing as veterans return from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). We sought to describe patterns of student veterans' health-related behaviors and how they might differ from their nonveteran peers. Design. We analyzed data from the 2008 Boynton College Student Health Survey (CSHS). Setting. CSHS participants completed an anonymous online survey. Subjects. The CSHS sampled students (n = 8651) attending public, private, 2-year, and 4-year postsecondary educational institutions in Minnesota. Measures. The CSHS included items on substance use (including alcohol and tobacco), safety, nutrition, and physical activity. Analysis. We described demographics of OEF/OIF veteran, non-OEF/OIF veteran, and nonveteran students and used Poisson regression to compute adjusted relative risks (ARBs) with 95% confidence intervals (CIs) to characterize associations between veteran status and health behaviors. Results. After controlling for demographics, veteran students reported more safety-, tobacco-, and alcohol-related risk behaviors compared to nonveteran students. For instance, compared to the nonveteran reference group, the ARR for past year smokeless tobacco use and physical fighting among for OEF/OIF veterans was 1.76 (95% CI = 1.31–2.35) and 1.48 (95% CI = 1.22–1.79) respectively. Veteran and nonveteran students display similar weight-related behaviors, though OEF/OIF veteran students were more likely to engage in strengthening exercises. Conclusions. There are specific health risk behaviors that are particularly relevant for veterans attending postsecondary institutions. As veterans enroll in postsecondary education, there is a unique window of opportunity for health promotion in this population.

Purpose.To examine ethnic variations in the use of nicotine replacement therapy (NRT) in an equal access health care system.Design.Cross-sectional survey.Setting.Eighteen Veterans Affairs medical and ambulatory care centers.Subjects.A cohort of male current smokers (n = 1606).Measures.Use of NRT (nicotine patch or nicotine gum), ethnicity, sociodemographics, health status, smoking-related history, and facility prescribing policy.Results.Overall, only 34% of African-American and 26% of Hispanic smokers have ever used NRT as a cessation aid compared with 50% of white smokers. In the past year, African-American smokers were most likely to have attempted quitting. During a serious past-year quit attempt, however, African-American and Hispanic smokers reported lower rates of NRT use than white smokers (20% vs. 22% vs. 34%, respectively, p = .001). In multivariate analyses, ethnicity was independently associated with NRT use during a past-year quit attempt. Compared with white smokers, African-American (adjusted odds ratio, .53; 95% confidence interval, .34–.83) and Hispanic (adjusted odds ratio, .55; 95% confidence interval, .28–1.08) smokers were less likely to use NRT.Conclusions.Assessment of variations in use of NRT demonstrates that African-American and Hispanic smokers are less likely to use NRT during quit attempts. Future research is needed on the relative contributions of patient, physician, and system features to gaps in guideline implementation to provide treatment for ethnic minority smokers.

AbstractOver the past two decades, thousands of studies have demonstrated that Blacks receive lower quality medical care than Whites, independent of disease status, setting, insurance, and other clinically relevant factors. Despite this, there has been little progress towards eradicating these inequities. Almost a decade ago we proposed a conceptual model identifying mechanisms through which clinicians' behavior, cognition, and decision making might be influenced by implicit racial biases and explicit racial stereotypes, and thereby contribute to racial inequities in care. Empirical evidence has supported many of these hypothesized mechanisms, demonstrating that White medical care clinicians: (1) hold negative implicit racial biases and explicit racial stereotypes, (2) have implicit racial biases that persist independently of and in contrast to their explicit (conscious) racial attitudes, and (3) can be influenced by racial bias in their clinical decision making and behavior during encounters with Black patients. This paper applies evidence from several disciplines to further specify our original model and elaborate on the ways racism can interact with cognitive biases to affect clinicians' behavior and decisions and in turn, patient behavior and decisions. We then highlight avenues for intervention and make specific recommendations to medical care and grant-making organizations.