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Harsh times lead us to reflect on our values and seek inspiration from revered figures. Italian neurologist and senator-for-life Rita Levi Montalcini celebrated her 100th birthday on April 22, 2009. In 1986, she received the Nobel Prize for Medicine with Stanley Cohen of the United States for discoveries of mechanisms that regulate cell and organ growth. Word of her long life and well-being was refreshing to read at a time when most news reports concern the mortgage crisis and bleak economic outlook. While stories of profound hardship for people around the globe take a toll on all of us, I am personally affected by fears of what the future will hold for my young daughter. The term “new needy” has been coined to denote people who are unemployed for the first time in their lives and unable to pay their mortgages and other debts. They are seeking resources from churches, soup kitchens, and unemployment agencies that are traditionally only utilized by the chronically homeless. These meager safety net systems are quickly becoming overburdened or even bankrupt, and thus unable to provide emergency services for the swelling numbers of the new needy and their families.

There is no quick fix to the current economic crisis. Shared responsibility and collectivism are gaining in popularity as approaches going forward, but when so many of us are in perilous circumstances, making a difference through fulfilling our daily public health mandates seems impossible. Is it enough for programs to keep their doors open when the systems around them are falling apart?

The theme of this month’s issue is “Social Conditions and Health.” These two broad categories are intricately linked, and disentangling them is challenging. An overemphasis on disciplinary exactness forces attention on either social conditions or health, but rarely both. History and context are essential in unraveling the complex relationships of human interactions with their environments and the social conditions that are responsible for most of the health disparities witnessed worldwide. Just how the current financial crisis will affect public health in the long term is uncertain. Nonetheless, the short-term effects are already evident as families lose their homes, belongings, and each other. In some places around the globe, economic upheaval has affected entire neighborhoods, communities, and towns, for financial deprivation affects the health of not only people who lose their homes, but also those who remain behind. Some have opted to forgo payments for health insurance, essential health care, or prescriptions to pay for rent, food, and gas. The toll of these sacrifices will eventually become manifest on population health, as many lack the support and resources to engage in health-promoting behaviors such as eating nutritious foods and receiving preventive health care.

As Nancy Kass put it in her 2001 Journal piece, “The most important asset that public health can have is the public’s trust that work is being done on its own behalf. In such a context, public health professionals can and must advocate what they believe, on balance, are the ethically best approaches for furthering social justice and the public’s health” (Kass NE. An ethics framework for public health. Am J Public Health. 2001;91:1782). As her 100th birthday drew near, Montalcini recounted in a Huffington Post interview how the anti-Jewish laws of the 1930s under Mussolini’s Fascist regime forced her to quit school and do research in her bedroom. “Above all, don’t fear difficult moments,” she advised. “The best comes from them” (von Pfetten V. Rita Levi Montalcini, Nobel Prize-winning scientist turns 100, still works. Huffington Post. Available at: http://www.huffingtonpost.com/2009/04/ 20/rita=levi=montalcini=noble_n_188935. html. Accessed April 18, 2009.).

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Objectives. We analyzed the response of the Chicago Department of Public Health with respect to its effectiveness in providing health care to Hurricane Katrina evacuees arriving in the city.
Methods. Between September 12 and October 21, 2005, we conducted a real-time qualitative assessment of a medical unit in Chicago’s Hurricane Victim Welcome and Relief Center. A semistructured guide was used to interview 33 emergency responders in an effort to identify key operational successes and failures.
Results. The medical unit functioned at a relatively high level, primarily as a result of the flexibility, creativity, and dedication of its staff and the presence of strong leadership. Chronic health care services and prescription refills were the most commonly mentioned services provided, and collaboration with a national pharmacy proved instrumental in reconstructing medication histories. The lack of a comprehensive and well-communicated emergency response plan resulted in several preventable inefficiencies.
Conclusions. Our findings highlight the need for improved planning for care of evacuee populations after a major emergency event and the importance of ensuring continuity of care for the most vulnerable. We provide an emergency response preparedness checklist for local public health departments. (Am J Public Health. 2009;99:1496-1504. doi:10.2105/AJPH.2007.126680)

Hurricane Katrina made landfall near the Mississippi- Louisiana border on August 29, 2005, devastating the region and forcing more than 800000 Gulf Coast residents to evacuate, the largest displacement of a population in recent US history.1 Evacuation centers were initially established in the affected and neighboring states; in Texas, for example, an estimated 250000 evacuees were provided services (shelter and other emergency relief services).2 The response ultimately took on a national scope, with 45 states providing disaster relief services.3

By September 4, nearly 500 evacuees had been airlifted to Illinois,4 and over the following 2 weeks more than 6000 displaced individuals were estimated to have arrived on their own, most settling in the Chicago area.5 In response, the city of Chicago collaborated with the American Red Cross, the United Way, and the Salvation Army to provide housing and other social services to evacuees. On September 6, Chicago’s Joint Operations Center, which is part of the Office of Emergency Management and Communications, established 2 relief centers: one at O’Hare International Airport and one at the Fosco Park Community Center, a new Chicago Park District facility.6 The Fosco Park Hurricane Victim Welcome and Relief Center (hereafter “the center”)-the focus of our study-was used primarily by evacuees arriving on their own. The Chicago Department of Public Health (CDPH) was charged with providing medical and mental health care at the center.

We summarize findings from a real-time assessment of Chicago’s public health response and highlight lessons learned with respect to the center’s provision of medical care. Our assessment was based primarily on qualitative interviews conducted during the center’s operations; thus, it reflects staff members’ perceptions at or shortly after the time they provided services. Our goals were to evaluate key systemic strategies developed to provide health care to a recently displaced population, to identify gaps in the public health response, and to offer suggestions for improvements.

METHODS

At the request of CDPH, we designed a qualitative process assessment that included interviews with key staff members, direct observations, and reviews of records routinely collected by the center’s medical and mental health units. A separate team conducted a cross-sectional study intended to describe the types of medical conditions treated at the medical unit.7

Data Collection and Analysis

Our analysis was based primarily on the responses of key CDPH and non-CDPH staff and volunteers to formal, confidential interviews; a semistructured guide was used in conducting these interviews. Individuals involved in the response from the beginning or those who had worked at least 2 shifts were targeted for interviews to ensure a comprehensive knowledge and experience base. Between September 15 and October 21, 2005, 29 of the 82 individuals who were eligible for the study were contacted and interviewed. Four individuals in various leadership positions outside the health units also were interviewed. Most interviews (30 of 33) were completed before the center closed on September 23; 27 were audiotaped.

The interview guide was developed to gather information from interviewees on their position at the center, role changes over time, staff training, types of patients seen, successes and failures of the response, and recommendations. Prompts were used to encourage participants to elaborate on their responses. Interview data, which consisted of detailed notes taken during and immediately after each interview and written summaries of audiotapes systematically reviewed shortly after the completion of data collection, were converted to a standard summary format. Interview summaries were then coded and analyzed according to the evaluation objectives, the themes of the interview guide, and emerging themes.

All interview summaries were reviewed independently by at least 2 researchers, and the final coding structure was discussed by the authors to ensure the accuracy and reliability of the final data set. A master summary spreadsheet that incorporated dichotomous responses and coded answers to open-ended questions was created to guide assessments of key findings and formulation of conclusions and recommendations. In some instances, direct quotations were drawn to support specific findings and aid in describing the overall experience.

In addition to the interviews, direct observations and reviews of documents used in the health unit provided a valuable contextual framework for understanding and interpreting findings from the interviews. Qualitative observations were made on several days between September 12 and September 23 to assess the overall operation, and these observations were summarized in a narrative form according to the interview guide questions. Furthermore, copies of documents described by the interviewees, such as facility maps, lists of services, medical forms, and volunteer or staff application forms, were reviewed.

Table 1 summarizes the 33 interviews conducted; most of the interviews (n=24) involved CDPH employees. Interviewees represented a wide range of positions and responsibilities at the center: 22 were clinicians and 11 provided nonclinical support, including administration and emergency management. Given that most (22 of 33) of the interviews were conducted with medical staff, we focused on provision of medical services (as opposed to mental health services).

Setting

The center opened on September 6, 2005. It was open 24 hours a day until September16 and then operated under reduced hours until it closed on September 23. The center served 5373 Gulf Coast evacuees, including 919 in the medical unit and 241 in the mental health unit.

The center was designed as a “one-stop shop” for a variety of social and health services. Upon arrival, individuals were greeted by United Way volunteers and guided through the facility. After registering with the Red Cross, evacuees selected from services provided by an array of governmental and nonprofit agencies. Individuals in need of health care services were escorted to a medical or mental health unit, both operated by CDPH. The center also included child-care facilities, an interfaith spiritual center, a cafeteria, and rest areas. The Salvation Army established a warehouse near the center where evacuees were provided with free personal items such as clothing, toiletries, and toys.

RESULTS

Respondents agreed that the center was a place of compassion and that staff members had a strong sense of mission. However, because one of our goals was to formulate recommendations for future emergency planning, we focused on qualitative process assessments specifically relating to the operational successes and failures observed at the center. Here we summarize our findings in the form of 8 key issues, described in the sections to follow.

Planning

When asked about issues surrounding preparedness, the majority of respondents mentioned inadequate planning. Although CDPH had some elements of preparedness in place before Hurricane Katrina, the need to create key organizational systems during the center’s operations decreased efficiency. CDPH disaster response preparation prior to Hurricane Katrina consisted of an inventory of potential sites for emergency response centers, an incident command structure managed by the Joint Operations Center (a city agency distinct from the health department charged with coordinating large-scale emergency responses), and 2 internal CDPH emergency drills (described subsequently). Most of the respondents stated that documents pertaining to the site inventory and the incident command structure were not useful, lacked key components, or were inaccessible. Consequently, members of the medical staff were often compelled to improvise, particularly during the first week of operations. This situation resulted in 2 major difficulties.

First, the site initially selected involved serious shortcomings; for example, its size was inadequate and its accessibility by car was limited. The center was moved to Fosco Park the night before it opened, diverting staff time from other tasks such as stocking basic supplies (sterile gauze and over-the-counter analgesics were unavailable for the first 2 days). The move also meant that logistics staff went sleepless the night before the center opened. Furthermore, although the Fosco Park site was ultimately well suited for the size of the Katrina response, the space allocated for medical care had to be expanded during the unit’s operation.

Second, although Chicago’s distance from the site of the disaster provided additional time to establish the incident command structure and to prepare the response, several management systems were not initially in place or were inadequate, including systems associated with staffing, medical and prescription records, referrals, and patient follow-up (described subsequently). The Labor Day holiday prior to the center’s opening further complicated logistics, in that key individuals involved in the response were difficult to reach or unavailable.

Training

Despite 2 previous emergency response drills conducted by CDPH, some of the interviewees deemed the level of training inadequate. Although some CDPH staff members reported that the 2 CDPH bioterrorism preparedness drills conducted in 2005 helped them prepare for work at the center, 9 of the 24 individuals interviewed stated that they had no previous emergency response training (Table 1). Two staff members indicated that they did not feel prepared prior to arriving but felt prepared once they had begun working, and these individuals described the clinical director’s guidance as helpful. Only 4 of the 24 CDPH respondents had no knowledge of their duties before arriving.

Medical students who staffed the triage unit during the first week received training from the Red Cross specific to Hurricane Katrina immediately before they reported. At that time, the students were expecting to travel to Baton Rouge, LA, but they decided to volunteer at the center at the clinical director’s request. Overall, the students perceived that they were unprepared, although they found the experience valuable (e.g., they helped set up the triage area, provided triage care with little or no supervision, and assisted physicians in providing primary care services).

Primary Care Focus

The medical unit was originally designed as a triage and referral center but evolved into a primary care facility. Planning for the medical unit was informed by previous Chicago-based emergency preparedness exercises, which focused on mass prophylaxis and infectious disease outbreaks. These experiences resulted in medical services being tailored to provide acute and emergency care, mainly through triage and referral. However, at the center, most patients presented with health needs typically seen in a primary care setting; specifically, many needed prescription medications and care for chronic conditions such as diabetes and hypertension. The results of the investigation conducted in conjunction with this study showed that 48% of the patients seen required medication refills, 7 a percentage similar to those found in previous research focusing on floods and hurricanes. 8-10 A medical unit staff member summarized what most respondents suggested: “Many patients needed teeth [dentures], eyeglasses, hearing aids they had lost. Next time we should take care of that first.”

Staff members noted several factors that helped them adapt to the range of medical needs among the evacuees: the ability to expand the unit’s patient care areas, an ad hoc process for procurement of durable supplies, and frequent briefings for key medical staff. Because the medical staff briefings fostered efficient communication and facilitated implementation of changes, they became essential, and nonattendance caused by scheduling conflicts or unawareness of briefings led to confusion. Although, according to 1 respondent, “Procedures changed every 2 minutes,” many of the staff members believed that this situation did not cause extraordinary stress.

Communication Structure

As a result of the staff’s flexibility, long work hours, and personal contacts, the medical unit functioned reasonably well. However, communication gaps and the lack of a clear organizational structure hampered the unit’s efficiency.

The primary factors facilitating communication flow were daily briefings conducted by the unit’s clinical director, low staff turnover, and the presence of a single “go-to” person (the clinical director) for all questions and concerns. Most staff members reported that the medical unit “worked,” especially after communication elements were added during the first week, including clearly posted policy descriptions and staff schedules.

Although the organizational structure was simple and direct because a single person managed the operation, this arrangement would have been inadequate for a larger or more prolonged incident. The approach required that the director be present 20 or more hours each day for the first week, be aware of every emerging need, and instruct staff members individually regarding their responsibilities for a particular work shift. Furthermore, the structure replaced the command system developed before the incident, contributing to confusion among some staff members about the identity of their ultimate supervisor.

Gaps existed in interagency communication both within and outside the center. The building’s telephone lines were not functional during the first week of operations, and some staff members had to resort to personal cell phones; the use of 2-way radios was helpful. Furthermore, access to the Internet was inadequate, limiting communication with CDPH headquarters and restricting resource searches. These findings are consistent with the results from a recent report published by the US Department of Homeland Security, which concluded that Chicago lags in terms of unified communications, specifically between the city and Cook County agencies.11

On the whole, staff members believed that their peers and supervisors supported them. For example, according to one respondent, “[The center] feels like one big family.” However, many interviewees reported that the on-site presence of CDPH managementwas inadequate, particularly after the first week of operations.

Staffing Procedures

The process of staffing the emergency response team was inefficient and required lengthy security clearances. Three possible recruitment sources for medical staff were identified: CDPH (including clinicians), the Red Cross, and the Medical Reserve Corps, a national network of local volunteer medical and public health professionals. All staff and volunteers had to complete an 18-page application form and await approval from the CDPH legal office. This situation created a bottleneck of applications, complicating staffing and work schedules and even discouraging some volunteers from participating. In addition, several interviewees reported long waits before receiving assignments, and in some cases staff members were recalled after being informed that their services were no longer needed.

CDPH employees provided 24-hour medical coverage during the first week. Most CDPH staff (15 of 24 interviewed) commenced working within 24 hours of being contacted (Table 1). The utility of the Medical Reserve Corps system was hindered because the database had not been updated recently (and thus preapproved volunteers on the list may not have been available for emergencies, or their credentials or contact information may not have been up to date), and the person responsible for approving volunteers was on vacation with no backup assigned. Consequently, few non- CDPH volunteers were initially deployed.

CDPH respondents commonly described a lack of private physicians, nurses, mental health professionals, and clerical support. No dentists, optometrists, nutritionists, or hearing aid specialists were available. Pediatricians were present during limited hours in the first week, and the demand for female clinicians was not met. Other staffing issues stemmed from confusion over compensation and overtime pay. Several CDPH staff members reported that they were unsure whether they were classified as “paid” or “volunteer,” indicating inadequate communication during recruitment. This issue continued through the second week of operations and caused concern, debate, and stress until it was resolved after cessation of operations.

Medical Information Systems

Medical information systems had to be developed during the emergency response. The initial medical forms were inappropriate; the narrative form was lengthy and lacking key information. It was difficult to locate medical records for the few patients who returned for additional care. The situation improved over time, and many of the interviewees believed that these disruptions did not affect patient care.

The lack of an adequate system for referral to services within and outside the center was a barrier to providing expedited care. Staff often relied on personal contacts, and in one instance a commercial telephone book was used as a referral source. Some interviewees reported that the process of referring patients to the mental health unit, also operated by CDPH, was confusing and inefficient. Referral difficulties were most commonly reported for dental care, oncology, obstetrics and gynecology, and eye and ear care. Furthermore, outside referrals were made to the already overburdened public health clinics in the city and county, with few private practice referrals available. Because no previous agreements with local hospitals had been established, referrals to emergency departments were difficult. Eventually a working referral system, described by 1 interviewee as “better than nothing,” was created.

Reconstruction of Medication Regimens

Collaboration with a national pharmacy chain aided in reconstructing medication regimens. Prescription refills and replacement of lost medication were the most frequently cited patient needs. During the initial days of the response, a CDPH provider initiated collaboration with a local pharmacist that resulted in the involvement of a national pharmacy chain; this chain offered access to databases from the hurricane-affected areas, provided free medications for 30 days, and donated diabetes, asthma, contraception, and personal hygiene supplies.

This arrangement resulted in prompt reconstruction of prescription histories for patients who were customers of the national pharmacy; also, it allowed patients to access needed supplies. However, providers experienced difficulties in reconstructing medication regimens for patients who were not customers of the pharmacy and in instances in which pharmacists were unavailable.

Patient Follow-Up

The lack of a patient follow-up system severely limited continuity of care. A patient follow-up protocol was not integrated into the emergency response. As described earlier, the medical unit was initially intended to function as a triage and referral center but later evolved into a primary care facility. Several patients required ongoing, follow-up care, and some even returned to the center for second visits. Many clinicians expressed great concern with respect to continuity of care. The study conducted in conjunction with our investigation identified 63 patients who needed urgent follow-up,7 and a list of these patients was provided to the health department; however, attempts to establish a follow-up protocol did not materialize.

Finally, we identified a serious problem related to staff members’ inability to provide ongoing care to undocumented immigrants. Although these individuals received initial care at the center, provision of follow-up care was difficult as a result of eligibility issues (e.g., undocumented immigrants were not eligible for Medicaid cards).

DISCUSSION

Several important lessons emerged from Chicago’s public health response to Hurricane Katrina. In fact, many of the staff members we interviewed believed that the city’s response should be viewed, in part, as a test for future emergency events. Specifically, this response should inform future emergency response protocols for providing health care to an unexpected, mass influx of individuals after a natural or human-made disaster occurring some distance away. Although Chicago quickly mobilized and sent resources to the affected regions, the city’s distance from the Gulf Coast initially did not indicate a need for a local incident command response. However, Chicago’s strong historical ties to the South12 resulted in the city being a destination for many displaced families seeking shelter and assistance from relatives.

First, our findings confirm the importance of a clear, comprehensive, and well-communicated emergency response plan that can be tailored to disasters of various types, sizes, and proximities. In the case of Chicago, a comprehensive emergency preparedness plan would have prevented or mitigated the challenges described here. Similar issues related to inadequate planning have been reported elsewhere, including issues associated with communication, 13-16 organization structure,13,14 medical records,13 referrals for chronic and mental health care,13,17 acquisition of supplies,13,14,16 availability of well-trained health care providers and volunteers, 13,14,16 and medication history reconstruction. 13,14

Second, medical personnel must be prepared to treat chronic and mental health conditions (including first-time diagnoses) in addition to infectious diseases and injuries, and they must meet other primary health care needs, such as medication refills. Health needs in Chicago were similar to those reported at other Hurricane Katrina response centers, irrespective of their distance from the affected regions or the mode of evacuation in question.13,15,18-24 Also, morbidity surveillance activities conducted by the Centers for Disease Control and Prevention in Arkansas, Louisiana, Mississippi, and Texas during the 3 weeks after Hurricane Katrina revealed that primary health care services and medication refills were the most commonly reported needs.25

Third, the ability to reconstruct prescription histories quickly is key to meeting patients’ needs and maintaining clinic flows. Cooperation with a national pharmacy chain, although entirely improvised, was highly effective in Chicago’s response, and such efforts should be expanded in future responses. Municipal health departments should collaborate with other national and local pharmacies to establish protocols for retrieving patient medication histories as part of preparedness planning. This should be done in coordination with the Red Cross, the United Way, and appropriate federal agencies.

It is beyond the scope of this article to describe the overall process that will lead to a comprehensive response plan, given that the structure of such a plan depends on local contexts. However, on the basis of our interview data, we recommend that the following components be included in any emergency or disaster plan (detailed component descriptions are presented in Table 2): (1) emergency and disaster training and exercises, (2) health record collection and retrieval systems, (3) referral systems and coordinated protocols for patient follow-up, (4) multiagency partnership agreements, (5) evaluation procedures and organizational flexibility during a response, (6) a clear chain of command and concise communication systems, and (7) procedures for staffing a response to quickly meet specific and emerging needs.

Finally, we recommend the inclusion of a protocol for ensuring clinical follow-up for individuals with health problems requiring urgent, ongoing attention after the emergency response. Moreover, although we did not collect data on the health of center personnel after the response, we recommend physical and psychological health follow-ups for emergency responders so that health conditions related to their work can be better understood, monitored, and treated.26,27

Limitations

Our findings need to be interpreted in light of several limitations. First, we primarily relied on self-reported information, which is subject to incomplete recall and social desirability bias. However, given that data were collected during rather than after the actual Katrina response, these forms of bias may have been reduced. Second, to avoid disruption of services, we did not implement formal selection procedures to recruit interviewees. Therefore, our data were based on a convenience sample and may not be generalizable. However, a standardized guide was used in interviewing a high proportion of the respondents, and all of the information gathered was thoroughly analyzed. Therefore, we believe that our findings accurately reflect the views of the individuals we interviewed.

Third, as a result of logistical considerations, we did not interview individuals receiving services at the center. Fourth, although mental health services represented an important part of the CDPH response, we lacked sufficient data to fully describe provision of these services. Finally, CDPH operates within a wellestablished clinic structure, and thus our findings may not directly apply to jurisdictions without a similar infrastructure.

Conclusions

The CDPH response to Hurricane Katrina highlights the need for a comprehensive emergency plan that includes strategies for emergencies of various types, sizes, proximities, and types of medical needs. Systems that effectively locate well-trained public health responders and quickly establish management structures, clear communication flows, collection of health data, patient referrals, and follow-up are essential if emergency responses are to be effective. It is imperative that all of these steps be continually evaluated and that they be sufficiently flexible to allow appropriate modifications.

It must be emphasized that a certain amount of improvisation will always be necessary during an emergency response; such improvisation can occur only through periodic training and familiarity among the core response staff. The lessons learned from Hurricane Katrina were complex in Chicago and elsewhere, but they offer an opportunity to reevaluate current procedures and continue to improve strategies to ensure the public’s well-being.

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Objectives. We assessed how different patterns of housing instability affect incarceration and whether correlates of incarceration are gender specific.
Methods. We used multivariate logistic regression to assess associations between patterns of housing instability and recent jail stays among a reproducible sample of 1175 marginally housed adults in San Francisco, California.
Results. Over the previous year, 71% of men and 21% of women in the sample reported jail stays. Among women, long-term single-room occupancy hotel stays (>90 days) were protective for incarceration. Stays in the street were associated with incarceration among both genders, but among men, short-term (i.e., ?90 days) street stays were associated with the highest odds of incarceration, and among women, long-term street stays were most correlated with incarceration. Sex trade increased the odds of incarceration among men only; recent drug use was associated with incarceration among both genders.
Conclusions. Correlates of incarceration differed by gender, and patterns of housing instability differentially affected incarceration for men and women. Policies to improve housing options and drug treatment for the urban poor are critical to breaking the cycle of incarceration and homelessness and improving health outcomes. (Am J Public Health. 2009;99:1459-1463. doi:10.2105/AJPH. 2008.141655)

Incarceration rates in the United States have more than quadrupled over the past 3 decades and have increased more rapidly among women than among men.1-3 Urban poor individuals are at especially high risk for incarceration. A strong body of literature shows bidirectional associations between homelessness and both jail and prison stays in that homelessness is a catalyst for incarceration and incarceration precipitates homelessness by disrupting social networks and employment opportunities.4-13

Incarceration has public health consequences other than decreased housing and employment options; individuals who have been incarcerated in jails or prisons have higher rates of substance abuse, victimization, mental illness, chronic diseases, tuberculosis, HCV, HIV, and other sexually transmitted diseases (STDs) when compared with other lowincome individuals.7,13-26 Among people with HIV, incarceration is associated with worse antiretroviral adherence and worse HIV clinical outcomes than among nonincarcerated individuals. 27,28 Prison and jail stays are also associated with increased risk of needle sharing, unsafe sexual behavior, and drug overdose, which compounds the negative health consequences associated with incarceration.29-32 Finally, incarceration is associated with high mortality rates compared with the general population, particularly within the first 2 weeks after release.32

In view of the many adverse public health effects of incarceration, it is critical to better understand its correlates. Although we have previously reported that correlates of homelessness differ between men and women,33 few data indicate whether correlates of incarceration vary by biological sex. This is particularly important because the reasons people are incarcerated in the first place seem to be gender specific (i.e., men are arrested more frequently for nearly every offense category other than prostitution, running away from home, and embezzlement) 34 and also because women and men living on the street may experience different vulnerabilities and may have different survival strategies.

Another important gap in the literature is that although links between homelessness and incarceration are well established, little is known about whether specific patterns of housing instability are differentially associated with incarceration. We therefore set out to assess gender-specific associations between patterns of homelessness and jail stays among low-income men and women in San Francisco, California.

METHODS

A mobile outreach team of 3 men and 4 women recruited a reproducible sample of homeless and marginally housed adults living in San Francisco from August 2003 to April 2004. Recruitment sites included all large homeless shelters (n=8), free-food programs providing meals to more than 100 people per day (n=8), and a random sample of low-income hotels in 3 neighborhoods of the city (n=16) selected with a probability proportional to size. Individuals were recruited through the use of a systematic sampling design at each site. All individuals visiting recruitment sites were invited to participate in the study. A unique identifier was used to distinguish each participant and prevent duplicate responses.

Eight trained interviewers administered a standardized questionnaire that assessed demographics, incarceration history, drug and alcohol use, sexual behaviors, and health services utilization. Participants also were tested for HIV and reimbursed $15 for their participation.

The outcome of this study was recent incarceration. Given that prison stays are often initiated from jail, including both may have had the potential to capture the same legal process twice; only including prison would have failed to capture less serious crimes and would potentially underestimate the effect of study factors. We therefore defined incarceration as spending 1 or more nights in jail during the previous 12 months.

Covariates for this study were either binary variables or categorized by natural breaks in the data distribution. Long-term stays for living on the street, in a homeless shelter, or in a single-room occupancy hotel were defined as longer than 90 days (not necessarily consecutive), whereas short-term stays in the same location were defined as 1 to 90 days (not necessarily consecutive). Additional covariates included age (above the median vs at or below it), race (White vs non-White), education (less than high school vs a high school diploma or more), monthly income (above the median vs at or below it), living with any minor children, HIV status, exchanging sex for money or drugs during the previous 12 months, use of mental health services in the previous 12 months, use of stimulants (i.e., powder cocaine, crack cocaine, or methamphetamines) during the previous 30 days, heroin injection during the previous 30 days, and heavy drinking during the previous 30 days defined in accordance with the National Institute on Alcohol Abuse and Alcoholism’s definition of risky drinking (more than 2 drinks per day for men or 1 drink per day for women).35

Odds ratios (ORs) and confidence intervals (CIs) quantified associations between recent jail time and covariates. As recommended by Hosmer and Lemeshow,36 variables considered for adjusted analysis were those with a P value of .25 or less in bivariate analysis; those retained in the final model had an adjusted P value of .05 or less. To consider potential differential effects by sex, analyses were restricted by sex. Because of small sample sizes in some analyses, penalized likelihood estimation was used.37,38 Data were analyzed with SAS version 9.1 (SAS Institute Inc, Cary, NC).

RESULTS

Among 1614 individuals available at the selected venues at the time of recruitment, 1213 participants completed a baseline questionnaire (75%). Thirty-eight transgender individuals were excluded from the current analysis. Among the remaining 1175 participants, 514 were recruited from single-room occupancy hotels, 324 from free-meal programs, and 337 from homeless shelters. Seventy-eight percent (n=919) were biological males, and 22% were biological females (n=256). The median age was 44.6 years for women and 46.3 years for men. Seventy-three percent of the women and 67% of the men were non-White, and 70% of the women and 73% of the men had graduated high school (Table 1). Recent drug use was reported by 38% of the women and 46% of the men. With regard to housing stability, 90% of the participants reported sleeping on the street or in a homeless shelter during the past year. Longterm shelter stays were reported by 24% of both men and women, long-term street stays were reported by 11% of the women and 19% of the men, and long-term single-room occupancy hotel stays were reported by 41% of the women and 45% of the men. Of the men, 71% had spent 1 or more nights in jail in the past year, and 21% of the women were similarly incarcerated. Fifteen percent of the women and 12% of the men reported exchanging sex for money during the previous 12 months.

Compared with persons with no street stays, the unadjusted odds of recent incarceration were more than 2 times higher for both women and men reporting short-term street stays, 2 times higher for men reporting long-term street stays, and 5 times higher for women reporting long-term street stays (Table 2). The unadjusted odds of incarceration were higher among women who reported short-term, single-room occupancy hotel stays and lower among both men and women who reported long-term, single-room occupancy hotel stays. Stimulant, heroin, and heavy alcohol use increased the odds of incarceration among both men and women, whereas associations between incarceration and recent mental health treatment were strongest among men. Recent sex trade increased the odds of incarceration at least 3-fold among both men and women, and HIV status was not associated with incarceration for men or women. Living with minor children was protective for women, and no association was seen between living with minor children and incarceration among men.

Noteworthy differences between men and women remained in adjusted analyses. First, single-room occupancy hotel stays (long-term and short-term) had no significant associations with incarceration for men. Conversely, among women, long-term, single-room occupancy hotel stays were negatively associated with incarceration (adjusted OR=0.3; 95% CI=0.1, 0.6), and there was a trend toward a significant positive association with short-term singleroom occupancy hotel stays (adjusted OR=2.1; 95% CI=0.9, 5.1). Second, the high odds of incarceration among men reporting street stays were strongest among those reporting shortterm street stays (adjusted OR=2.1; 95% CI=1.3, 3.4). This pattern was reversed for women (adjusted OR for long-term street stays=3.1; 95% CI=1.2, 7.9), and there was a trend toward a protective effect for short-term street stays after we adjusted for single-room occupancy hotel stays. In addition, recent mental health treatment was positively associated with incarceration among men but not women (adjusted OR for men=1.6; 95% CI=1.1, 2.2). Recent sex trade also was associated with incarceration for men only (adjusted OR=2.2; 95% CI=1.3, 3.6). Finally, recent stimulant use and heroin use was associated with incarceration among both men and women, and this effect was stronger among women.

DISCUSSION

Consistent with previous literature, we found a very high prevalence of incarceration most notable among men, with 71% of the men and 21% of the women reporting at least 1 night in jail during the previous year. Moreover, we found that patterns of homelessness differentially influenced the odds of jail stays among women and men. Among women, longer-term street stays were associated with higher odds of incarceration, and longer-term single-room occupancy hotel stays were protective for incarceration. By contrast, among men, single-room occupancy hotel stays were not associated with incarceration, and short-term street stays were more strongly associated with incarceration than were long-term street stays.

Cycling on and off the streets may be part of a pattern of instability that places homeless men at greater risk for sex work, drug abuse, and subsequent incarceration. These findings also imply that being on the street and staying in single-room occupancy hotels may pose different risks for men and women, depending on the length of stay, and should be considered in the design of more-effective housing options for the urban poor. For instance, efforts to keep women off the streets for a longer time by making single-room occupancy hotel rooms available for longer stays may help reduce their risk of incarceration.

Because the study was cross-sectional, another possible interpretation of our findings is that housing options differ for men and women after release from jail. Even brief jail stays have been reported to result in homelessness for women because of diminished opportunities for employment following release from jail.6 The limited availability of affordable longterm housing and employment options for both men and women likely contributes to the ongoing bidirectional associations between unstable housing and incarceration.5,8,11,39,40

In addition to the fact that length of time on the street or in single-room occupancy hotels influenced the odds of incarceration for both genders, it was noteworthy that the alternative category for each variable (i.e., short-term compared with long-term stays) had associations that showed a trend in the opposite direction among women. This suggests that studies that collapse housing status into a binary variable (e.g., slept on the street vs did not sleep on the street) may not find significant results because of this nonlinear association. It is also striking that the association for short-term street stays changed direction only after the analysis was adjusted for single-room occupancy hotel stays. Taken together, these findings illustrate the importance of recognizing housing status as a multifaceted, dynamic phenomenon among indigent women. Finally, note that associations between incarceration and homeless shelter stays did not reach a level of significance in our study. This may be a function of a more homogeneously poor study population or may imply that links between the 2 reported in previous studies were confounded by the influence of sleeping on the street.

Other important differences in the correlates of incarceration were found among men and women. As has been previously reported,5,14,15,18 we found stimulant use and heroin use to be strongly associated with incarceration, but this effect was stronger among women, with use of either drug increasing the odds of incarceration by at least 4-fold. Lo et al.41 similarly reported that female arrestees were more likely than were male arrestees to show cocaine dependence. Our findings and those of others highlight the importance of providing drug treatment to inmates with histories of drug abuse.

Risk for incarceration stems from many sources and reflects a complex process with overlapping and sometimes interacting layers. For example, lack of economic opportunities may set the stage for sex work and homelessness. These conditions in turn may drive women and men to self-medicate through illicit substance use. Habit-forming substances may place an even greater economic burden on individuals and place them at greater risk for incarceration. Integrated services that address the interplay between homelessness, drug and alcohol addictions, and lack of economic opportunities for both men and women are necessary to manage the multiple vulnerabilities faced by men and women living on the street.

Another important gender difference was that history of mental health treatment was associated with increased odds of incarceration among men but not among women. Kushel et al.5 previously reported that history of psychiatric hospitalizations was independently associated with prison stays among the urban poor in San Francisco. Others have found that mental illness is a risk factor for both homelessness and incarceration7,14,23 and that mental illness worsens the chances of securing stable housing after incarceration.40 Our findings extend this previous research by suggesting that associations between incarceration and mental illness may be most pronounced for men. Again, because of the cross-sectional study design, another possible interpretation of this finding is that women are less able to access mental health treatment services following jail release. Larger longitudinal studies can help elucidate the complex interconnections and causal direction of associations among homelessness, incarceration, drug abuse, and mental illness and how they differ among men and women.

We have previously reported that greater length of homelessness was associated with sex exchange among women,42 and other studies have reported strong links between sex exchange and incarceration.43 In our study, we found that sex trade had strong positive associations with incarceration among both men and women in unadjusted analyses, but the effect remained in adjusted analyses for men only. This was an unexpected finding that may be explained by the ability of women to secure more consistent sexual clients, a need formen to bemore overt in soliciting sex work, the smaller sample size for women compared with men, or another unmeasured factor. These associations warrant further investigation within indigent populations.

Findings of this study should be interpreted within the study’s limitations: this study was cross-sectional, and the study sample had more than 3 times as many men as women. In summary, we found that correlates of incarceration are gender specific and that specific patterns of housing instability have different associations with incarceration according to gender. Our findings highlight the complex and multifaceted links between housing status, gender, and incarceration and the fact that treating housing status as a binary variable (homeless vs not homeless) does not adequately capture this complexity. Public policies designed to secure long-term housing options, drug treatment, and mental health care for the urban poor will be a critical step not only toward breaking the cycle of incarceration and homelessness but also toward improving health outcomes.

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( NewsRx.com) — Cavit Sciences, Inc (OTC BB: CVIT) and its officers and directors have agreed to launch a new project or subsidiary company to profit from the growing need for electronic health records. The new division is to be called “My Healthy Lifestyle HRA.” The company has already made significant progress on the new company website (see link below) which will provide secure access for all internet users to something which resembles a high-tech online health assessment— a.k.a. Health Risk Assessment [HRA] and a secure Personal Health Record [PHR/EHR] complete with a Family Tree for gathering and storing important family health histories (see also Cavit Sciences, Inc.).

The whole project is the first of its type to take advantage of the GoogleHealth online system, with the ability to import health information directly from GoogleHealth, Google’s on-line health compendium. The results may be accessed by user’s approved medical health professionals or kept completely private.

One consultant who viewed the project commented, “The future of health care reform is going to be about electronic security and information assessment. The days of seeing Beaver and Wally go to the little town doctor for cheap health care are long gone. Health care reform is going to happen, and it will happen with technology. Cavit has the technology that could be the key part for the future of healthcare reform, to help bring affordable health care to everyone. Self screening can be used to help detect and prevent problems early… this is here to stay and it’s only a matter of time before the industry embraces the new technology.”

Health Risk Assessments [HRA's] are the standard evaluation tool used in every wellness program to both identify any current health issues and are used to gauge progress for individuals while participating in a wellness plan. An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. EHRs are the inevitable next step in the continued progress of health care that can strengthen the relationship between patients and clinicians. The data, and the timeliness and availability of it, will enable providers to make better decisions and provide better care. According to an article published by William Ventres, MD, MA, Sarah Kooienga, FNP, and Ryan Marlin, MD, MPH, all members of the American Academy of Family Physicians [AAFP], “Electronic Health Records are clearly part of family medicine’s future.”

Elizabeth Gannon commented, “Mark my words, HRA is here to stay and it’s only going to become more and more popular. We are leading the way with our integrative website, and intend to stay in this position as web technology and medical practice continue to grow together.” About Cavit Sciences, Inc. Cavit Sciences, Inc. (“Cavit”) is a biotechnology company engaged in developing treatments and prevention for cancer, viral infections and related diseases along with natural supplements for a healthy lifestyle. Additional information regarding Cavit can be obtained on the company’s website, which is listed below along with subsidiary websites. Within weeks of a shareholder takeover resulting in an ousted former CEO, the shareholders have brought in new leadership, Elizabeth Gannon. Gannon has already brought in one new subsidiary and the announcement is the second aggressive move in the period of a week. About My Healthy Lifestyle(R) My Healthy Lifestyle(R) is the health care industry trusted trademark for the ultimate all-inclusive discount buying club for Health & Lifestyle and e-Health & Wellness portal. My Healthy Lifestyle(R) provides modestly priced custom turn key Wellness Solutions for Employers which can be easily be populated with their choice of services and content, and integrated into a custom branded website. We deliver portal access and functionality that is simple to implement, centrally administered and professionally managed. Like all of the new Cavit projects, the new web site will provide access to the consumer e-health portal at MyHealthyLifestyle.com where users gain access to valuable wellness information, tools, forums, community, and even savings through a buying club.

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Encouraging parents to get their young children in for regular “well child” visits is the goal of a new program announced by the Ohio Association of Health Plans (OAHP) and its seven Medicaid Care Coordination Plans. The Medicaid plans serve families and dependent children, a group that includes 50% of all Ohio children between birth and age 6 (see also <http://www.newsrx.com/library/topics/Medicare-and-Medicaid.html> Medicare and Medicaid).

Keep Up with Checkups will run throughout the summer, and will be supported by a major public education campaign being conducted by OAHP and the Care Coordination Plans in conjunction with the Ohio Benefit Bank.

Regular checkups by a primary care doctor improve the chance of catching and treating physical, developmental and behavioral problems that can affect their health and long-term success in school. Those problems often show up well after infancy. But many parents stop regular checkups for their kids after age 3.

The Keep Up with Checkups campaign is part of a larger effort by OAHP and the Care Coordination Plans to educate Medicaid consumers on the value their Medicaid plan’s “Health Care Home” can provide such as coordinating services from multiple providers and access to extra services like a 24-hour nurse hotline, transportation to appointments, and outreach to social services that can help them overcome problems that affect their health, such as hunger.

“There is no question that regular care from a trusted doctor can help people stay healthier and manage illness better. And that leads to lower health care costs such as fewer visits to the emergency room, fewer avoidable illnesses and better, faster outcomes for medical needs. Prevention and wellness make the system more efficient while actually providing a higher level of care,” said Kelly McGivern, President and CEO of the Ohio Association of Health Plans.

To communicate health-related messages like “Keep Up with Check-Ups,” Health Care Home works with the Ohio Benefit Bank, a partnership of the Ohio Association of Second Harvest Foodbanks, the Governor’s Office of Faith Based and Community Initiatives and community organizations statewide to link Ohioans with state programs like Medicaid and food stamps.

“Encouraging Ohioans to access the regular medical care available to them fits in directly with our mission,” said Lisa Hamler-Fugitt, Executive Director of the Ohio Association of Second Harvest Foodbanks.

The first phase of the campaign includes the distribution of Keep Up with Checkups cards and posters statewide, at summer fairs and other events, as well as hundreds of social service agency and Benefit Bank locations. Information is also available at www.ohiohealthcarehome.com.

Keywords: Medicare and Medicaid, Behavior, Health Policy, Medicaid, Pediatrics, Ohio Association of Health Plans.

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To suggest a feasible economic strategy for second primary colorectal cancer screening of cancer survivors in Korea, A research group constructed a decision-analytic model, compared cost-effectiveness results of cancer screening in male cancer survivors. All non-dominant strategies were those using colonoscopy in both cancer survivors and the general population, and more strict and frequent recommendation of colonoscopy, colonoscopy every 5 years and every 3 years, could be considered as economic strategies for male cancer survivors.

The recent improvement in cancer survival due to early diagnosis and advances in treatment has raised the issue of second primary cancers in cancer survivors after their primary treatment. The age-standardized incidence rate was about 4 times higher for second primary colorectal cancer (CRC) than for first primary CRC in Korea. However, until now, there have been few recommendations and economic evaluations of CRC screening for cancer survivors.

A research article to be published in the World Journal of Gastroenterology on July 7,2009 addresses this question To suggest a feasible economic strategy of second CRC screening for cancer survivors in Korea, authors constructed a decision-analytic model, and compared the cost-effectiveness results of cancer screening in male cancer survivors.

All non-dominated strategies were those using colonoscopy in both cancer survivors and the general population, and more strict and frequent recommendation of colonoscopy such as COL5 (screening every 5 years) and COL3 (screening every 3 years) could be considered as economic strategies for male cancer survivors.

The major barrier to promoting colonoscopy as a primary CRC screening tool is the lack of manpower to deliver colonoscopy to the public in Korea. In these human-resource limited settings, it is important to identify the most vulnerable population who has the most potential to receive the benefits. In younger cancer survivors aged 40 years old, COL5 might be economically feasible, while COL10 is usually recommended for the Korean general population aged 50 years old. Therefore, at least for cancer survivors, CRC screening should be covered by the Korean national health insurance scheme and screening methods using colonoscopy should be recommended as a primary screening strategy for CRC in this population.

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New research published in the July issue of the Journal of the American College of Surgeons reveals that African Americans with gastrointestinal stromal tumors (GIST), a rare cancer that begins in the wall of the gastrointestinal tract, now have survival rates equivalent to those of Caucasians. Prior to 2000, African Americans were more likely to develop GIST and less likely to undergo surgical treatment for this type of cancer.

Racial disparities in survival rates have been demonstrated for a number of cancers, typically due to unequal access to care. Through the National Institutes of Health and Healthy People 2010, a national health promotion and disease prevention initiative, the federal government has set forth goals to explore, account for and minimize these disparities.

“Over the last decade, racial gaps in the treatment of GIST appeared to have closed,” said Michael Cheung, MD, DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine. “Both perioperative and long-term survival have improved among African Americans.”

“Our study suggests that better diagnosis and increased use of surgery – which still provides the best chance for cure – have contributed to improvements in care for African Americans,” said Leonidas G. Koniaris, MD, FACS, associate professor of surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, and surgical oncologist at Sylvester Comprehensive Cancer Center at UM. “In addition, increased access to new targeted therapies through medication assistance programs may be helping to eliminate racial disparities in cancer treatment.”

A statistical analysis was performed using the Surveillance, Epidemiology and End Results (SEER) database that identified 3,795 patients diagnosed with GIST and other intestinal mesenchymal tumors between1992 to 2005. Patient demographics showed 72.2 percent Caucasians, 15.6 percent African Americans, and 9.1 percent Hispanics. Survival was calculated from the time of initial diagnosis to the date of last contact or death.

Both perioperative and long-term survival had improved among African Americans since 2000. In patients diagnosed before the year 2000, 30-day surgical mortality was higher in African Americans (0.56 percent versus 0.76 percent Caucasians, p=0.012). After 2000, 30-day surgical mortality was equivalent between races (0.46 percent versus 0.35 percent for Caucasians, p=0.517).

Before the year 2000, three-year disease specific survival was better in Caucasians than African Americans (79.3 percent versus 75.1 percent, p=0.025). There was no racial difference in tumor stage (p=0.446) or grade (p=0.495), and African Americans underwent surgical procedures less frequently than Caucasians (p=0.003). Multivariate analysis correcting for patient demographics, socioeconomic status and clinical data demonstrated African American race and failure to undergo surgical treatment were independent predictors of poor prognosis. In patients diagnosed after 2000, three-year disease specific survival was nearly equivalent between Caucasians and African Americans (82.1 percent versus 80.7 percent, p=0.680) and African Americans underwent surgical procedures just as often as Caucasians (p=0.153) did. Multivariate analysis for patients diagnosed after 2000 demonstrated no difference in survival by race (p=0.126).

Keywords: Advertising, Federal Government, Government, Health Promotion, PoliticsCancer, Digestive System Neoplasm, Gastroenterology, Gastrointestinal Stromal Tumor, Gastrointestinal Stromal Tumors, Oncology, Surgery, Therapy, Treatment, Weber Shandwick Worldwide.

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A study by a bi-national team of global health researchers at the University of California, San Diego School of Medicine, examining HIV infection among male clients of female sex workers in Tijuana, has found that over half of male clients had recently had unprotected sex. They also reported a high prevalence of drug use.

“Targeted intervention among male clients is necessary to prevent the spread of HIV and other sexually transmitted infections – intervention that doesn’t solely place the onus on female sex workers,” said lead author Thomas L. Patterson, of UC San Diego’s Department of Psychiatry and the Veterans Administration Health Care System, San Diego.

Tijuana, located in Baja California, directly across the border with San Diego, has a thriving sex industry and is a popular destination for U.S. and foreign sex tourists. While the city’s health service does license female sex workers, on condition that they are regularly tested for HIV and other sexually transmitted diseases (STIs), only about half of them are indeed licensed. In addition, Baja California has the second highest cumulative AIDS incidence of any Mexican state and, in 2006, the HIV prevalence among female sex workers in Tijuana was six percent. It has been estimated that as many as one in 112 persons aged 15-49 living in Tijuana is HIV-infected.

“Male clients of female sex workers in the San Diego-Tijuana border region act as a bridge that can potentially transmit HIV and other STIs to sex partners, including their wives,” said co-author Manual Gallardo, M.D, Patronato Pro-COMUSIDA in Tijuana. “However, given that only 59% of clients reported regularly using condoms with a female sex worker, there appears to be some level of complacency that urgently needs to be addressed.”

The study, published in the current on-line issue of the journal AIDS, looked at 400 clients – about half residents of San Diego and the remainder from Tijuana. Their average age was 36.6 years, with the majority Mexican or Hispanic (about 80%) and single, never married or divorced (57.5%). During the past year, clients had sex with an female sex worker an average of more than 25 times and over half of them reported having unprotected sex during the past four months.

While only half of clients reported having been tested for HIV, 14.2% tested positive for at least one STI (Chlamydia, gonorrhea, syphilis or HIV). The prevalence of HIV infection among clients was similar to that of female sex workers in Tijuana. The risk of contracting HIV was highest for those who lived in Mexico, used methamphetamines or had tested positive for syphilis.

“Of those we interviewed, nearly nine out of 10 reported having used illicit drugs during their lifetime,” said Patterson. Many were binge drinkers, and one-third said they were frequently high on drugs when with a female sex worker. This profile of substance abuse – especially methamphetamine use – likely contributes to high-risk sexual behavior.”

Earlier reports by UCSD researchers suggested that interactions with clients can be a critical barrier to the adaptation of safe sex practices among female sex workers, who reported that some clients are willing to pay double for unprotected sex.

“Our new data suggests an urgent need to develop behavioral interventions to improve the clients’ knowledge of the risk of HIV,” said co-author Steffanie Strathdee, PhD, associate dean for Global Health Sciences at UC San Diego. “Intensified efforts to ‘test and treat’ should reach out to this high-risk group in ways that are culturally sensitive, recognizing that some men fail to realize that sexual health is a shared responsibility.”

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Current study results from the report, ‘Acculturation and colorectal cancer screening among older Latino adults: differential associations by national origin,’ have been published (see also <http://www.newsrx.com/library/topics/Colon-Cancer.html> Colon Cancer). According to recent research from the United States, “Although modest improvements in colorectal cancer (CRC) screening utilization have occurred, rates remain low among Latinos. It is unclear whether acculturation plays a role in the utilization of CRC screening.”

“This study aimed to examine the relationships between acculturation and CRC screening among older Mexican, Puerto-Rican and Cuban adults. Cross-sectional observational study. Latinos 50 years and older, never diagnosed with CRC, and who were surveyed in the 2000, 2003 and 2005 National Health Interview Survey (NHIS). We measured acculturation with US nativity and language of interview, and examined three different CRC screening outcomes: fecal occult blood test (FOBT) in the past year, up-to-date endoscopy and any up-to-date CRC screening. Logistic regression models were adjusted for predisposing, enabling and health-care need factors consistent with the behavioral model of health-care utilization. In adjusted analyses, US nativity was positively associated with up-to-date endoscopy among Mexicans (OR: 1.5; 95% CI: 1.1, 2.2), but negatively associated with FOBT in the past year among Puerto Ricans (OR: 0.3; 95% CI: 0.2, 0.7). In contrast to this latter finding among Puerto Ricans, English language interview was positively associated with FOBT in the past year (OR: 2.5; 95% CI: 1.1, 5.4). Results underscore the importance of stratification by national origin in studies of acculturation and cancer screening and of targeting less acculturated adults to promote CRC screening,” wrote A. Afable-Munsuz and colleagues, University of California, Department of Medicine.

The researchers concluded: “Clinicians, however, should consider the complexity of acculturation and treat US nativity and language preference as independent dimensions among their Latino patients.”

Afable-Munsuz and colleagues published their study in the Journal of General Internal Medicine (Acculturation and colorectal cancer screening among older Latino adults: differential associations by national origin. Journal of General Internal Medicine, 2009;24(8):963-70).

For additional information, contact A. Afable-Munsuz, University of California, University of California, Dept. of Medicine, 3333 California Street, Box 0856, San Francisco, CA 94143 USA..

Publisher contact information for the Journal of General Internal Medicine is: Springer, 233 Spring Street, New York, NY 10013, USA.

Keywords: United States, Box, Colon Cancer, Colon Carcinoma, Colorectal, Endoscopy, Gastroenterology, Internal Medicine, Oncology, Surgery.