RESUMEN
The objective of this analysis was to determine the prevalence of obesity and its association with selected medical conditions in a non-institutionalized elderly Mexican-American population. Data employed are from a representative sample of 3050 elderly Mexican Americans from the five Southwestern states: Texas, California, Colorado, New Mexico, and Arizona. Complete Body Mass Index (BMI) data were available for 2769 individuals. The in-home survey obtained socio-demographic data, anthropometric measurements, including height and weight, blood pressure readings, self-reported health conditions and depressive symptomatology. It was found that 23% of men and 35% of women were obese (BMI > or =30 kg/m2). Using a weighted logistic regression model, a BMI of > or =26 kg/m2 was associated with a significantly higher risk of diabetes; a BMI of > or =30 kg/m2 was significantly associated with arthritis and measured hypertension and a BMI<22 kg/m2 was associated with a higher likelihood of self-reported cancer. In addition, the prevalence of obesity was found to be much higher in this elderly Mexican-American population than in the general population.
Asunto(s)
Envejecimiento/fisiología , Americanos Mexicanos , Obesidad/etnología , Obesidad/epidemiología , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Femenino , Estado de Salud , Humanos , Masculino , Prevalencia , Clase Social , Sudoeste de Estados UnidosRESUMEN
OBJECTIVES: This study examines the effects of health, predisposing, and enabling factors on recognition of a mental health problem, use of formal mental health care, and contact with a specialized mental health provider. METHODS: Interviews were conducted with a probability sample of 3,435 adults. The variables examined include measures of mental health; social and demographic factors; and enabling factors relevant to the help-seeking process. RESULTS: Subjective and objective measures of mental health were associated with the recognition of a mental health problem. The objective assessment of definite need for services was relevant for the use of formal services. However, the subjects' perception of poor mental health was strongly related to receiving care from a mental health specialist. Although interaction with social networks is associated with use of formal services, low economic strain is related to receiving care from the specialty sector. CONCLUSIONS: The results support the importance of using multiple measures of mental health problems. The finding that individuals' perceived economic strain increases the likelihood of receiving specialized care suggests that studies of economic barriers to the use of mental health services might benefit from the adoption of measures that assess perceived economic circumstances.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Pobreza/psicología , Adolescente , Adulto , Anciano , Causalidad , Femenino , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud/normas , Humanos , Modelos Logísticos , Masculino , Servicios de Salud Mental/clasificación , Persona de Mediana Edad , Puerto Rico , Apoyo Social , Encuestas y CuestionariosRESUMEN
Needle sharing is one of the principal risk behaviors leading to HIV transmission among injection drug users (IDUs). Shooting galleries, a social context where IDUs rent, share, and borrow needles, are locations usually found near drug markets. This study, which interviewed 1,700 IDUs from May 1989 to June 1990, assesses sociodemographic characteristics and HIV risk behaviors among shooting gallery users in Puerto Rico. Multivariate analyses showed that shooting gallery use is associated with speedball (a concoction of heroin and cocaine) injection, income from illegal activities and previous drug treatment. Shooting gallery users were more likely to rent, share, and borrow needles, and less likely to always use bleach and water to clean needles. Strategies to reduce shooting gallery use among drug injectors are discussed.
Asunto(s)
Infecciones por VIH/etiología , Compartición de Agujas/efectos adversos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Femenino , Humanos , Control de Infecciones , Masculino , Análisis Multivariante , Puerto Rico , Factores de Riesgo , Asunción de Riesgos , Factores Socioeconómicos , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
Needle sharing is one of the principal risk behaviors leading to HIV transmission among injection drug users (IDUs). Shooting galleries, a social context where IDUs rent, share, and borrow needles, are locations usually found near drug markets. This study, which interviewed 1,700 IDUs from May 1989 to June 1990, assesses sociodemographic characteristics and HIV risk behaviors among shooting gallery users in Puerto Rico. Multivariate analyses showed that shooting gallery use is associated with speedball (a concoction of heroin and cocaine) injection, income from illegal activities and previous drug treatment. Shooting gallery users were more likely to rent, share, and borrow needles, and less likely to always use bleach and water to clean needles. Strategies to reduce shooting gallery use among drug injectors are discussed
Asunto(s)
Adulto , Femenino , Humanos , Infecciones por VIH/etiología , Compartición de Agujas/efectos adversos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Control de Infecciones , Análisis Multivariante , Puerto Rico , Factores de Riesgo , Asunción de Riesgos , Factores Socioeconómicos , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
The relationship between perceived risk of developing AIDS and subsequent behavioral risk status is estimated for 1740 Puerto Rican injection drug users (IDUs). Prospective behavioral effects were examined comparing data collected at two intervals approximately 6 months apart. We estimated the association between perceived risk at baseline and risky behaviors at follow-up with unadjusted odds ratios. We confirmed the results with adjusted odds ratios using logistic regressions which included baseline risk status as well as socio-demographic and health status covariates. The analyses showed that having a high HIV/AIDS risk perception was related to subsequent sharing of needles, injection of drugs in shooting galleries and sharing of cookers. None of the tests between risk perception and sex risk behaviors showed a significance association. Increasing IDUs' perceived vulnerability to HIV/AIDS might not be effective in helping reduce HIV risk behaviors. IDUs perceiving themselves to be at high risk of AIDS might believe there is little they can do to reverse the consequences of risky behavior.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/transmisión , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/psicología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/psicología , Adulto , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Compartición de Agujas/psicología , Compartición de Agujas/estadística & datos numéricos , Puerto Rico/epidemiología , Medio Social , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiologíaRESUMEN
This paper examines the association of depressive symptoms with human immunodeficiency virus (HIV) infection and risk behaviors among 127 sex workers. Data were obtained by a structured interview and blood specimens tested for HIV. Findings showed a high prevalence rate of depressive symptoms for all sex workers regardless of HIV infection status. Results of a logistic regression analysis indicated that the use of injected drugs and engaging in unprotected intercourse with clients were strongly associated with a high level of depressive symptoms.
Asunto(s)
Depresión/complicaciones , Infecciones por VIH/epidemiología , Trabajo Sexual , Adolescente , Adulto , Condones , Depresión/epidemiología , Femenino , Infecciones por VIH/complicaciones , Humanos , Persona de Mediana Edad , Puerto Rico/epidemiología , Análisis de Regresión , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
This paper assesses the factors related to self perception of developing AIDS among a group of 1,568 Puerto Rican injection drug users (IDUs). Incarceration history, years of drug injection, sharing needles, renting and borrowing needles, sharing rinse water or cooker, and having an IDU sex partner yielded a moderate association with HIV/AIDS risk perception. Use of sterile needles, shooting drugs alone, having had previous treatment episodes, and all the variables related to health status were also moderately associated with HIV/AIDS risk perception. A logistic regression model based on backwards elimination procedure, which included statistically significant variables in the bivariate analyses, yielded the variables living with children, sex with an IDU partner, shooting drugs alone, perception of health, having had a sexually transmitted disease, and results of HIV testing as statistically significant (p < 0.05).
Asunto(s)
Infecciones por VIH/etiología , Asunción de Riesgos , Autoimagen , Abuso de Sustancias por Vía Intravenosa/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/etiología , Adulto , Femenino , Infecciones por VIH/epidemiología , Seropositividad para VIH/epidemiología , Humanos , Modelos Logísticos , Masculino , Puerto Rico/epidemiología , Factores de Riesgo , Factores SocioeconómicosRESUMEN
This paper assesses the factors related to self perception of developing AIDS among a group of 1,568 Puerto Rican injection drug users (IDUs). Incarceration history, years of drug injection, sharing needles, renting and borrowing needles, sharing rinse water or cooker, and having an IDU sex partner yielded a moderate association with HIV/AIDS risk perception. Use of sterile needles, shooting drugs alone, having had previous treatment episodes, and all the variables related to health status were also moderately associated with HIV/AIDS risk perception. A logistic regression model based on backwards elimination procedure, which included statistically significant variables in the bivariate analyses, yielded the variables living with children, sex with an IDU partner, shooting drugs alone, perception of health, having had a sexually transmitted disease, and results of HIV testing as statistically significant (p < 0.05)
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Abuso de Sustancias por Vía Intravenosa/complicaciones , Infecciones por VIH/etiología , Asunción de Riesgos , Autoimagen , Seropositividad para VIH/epidemiología , Infecciones por VIH/epidemiología , Modelos Logísticos , Puerto Rico/epidemiología , Factores de Riesgo , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/etiología , Factores SocioeconómicosRESUMEN
This study compares the prevalence of human immunodeficiency virus (HIV) infection and HIV risk behaviors among 1,702 injection drug users (IDUs) recruited within four catchment areas in metropolitan San Juan (79.9% male and 20.1% female). To assess the impact of different antecedent variables on intercommunity risk differences, we constructed separate logistic regression models for each one of the catchment areas in the analysis. Old San Juan/Santurce has the highest rate of HIV seropositivity. Furthermore, Old San Juan/Santurce IDUs were more likely to have had incarceration experience, to report using drugs only by injection, and to have been injecting drugs for 16 years or more. Also, this group was more likely to report practicing prostitution and to have been diagnosed with sexually transmitted diseases (STDs) than their peers from the other sites. The need of preventive programs in specific communities within metropolitan urban areas is discussed.
Asunto(s)
Infecciones por VIH/epidemiología , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Áreas de Influencia de Salud , Femenino , Infecciones por VIH/complicaciones , Humanos , Modelos Logísticos , Masculino , Prevalencia , Puerto Rico/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Salud UrbanaRESUMEN
This study assesses factors associated with incarceration history and HIV seropositivity among 1,700 out-of-treatment drug injectors recruited in Puerto Rico between 1989-1990 from health care centers, emergency rooms, copping areas, shooting galleries, bars, billiard rooms and street corners. Analysis links incarceration history with criminal involvement and chronic drug use. After controlling for sociodemographics and previously reported correlates of HIV status, regression analysis shows incarceration history significantly relates to HIV status. The only predictor of incarceration history not related to HIV status was illegal activity as a major source of income. Analysis emphasizes HIV prevention programs within the penal system.
Asunto(s)
Seropositividad para VIH/epidemiología , Prisioneros , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Femenino , Seropositividad para VIH/complicaciones , Humanos , Modelos Logísticos , Masculino , Puerto Rico/epidemiología , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
Although injection drug use (IDU) is the major risk category for HIV infection in Puerto Rico and injection drug users start their drug injection careers very young, there is little information related to drug injection patterns of young IDUs. In this paper we report on factors found to be associated with HIV seropositivity among 255 young IDUs (16-24 years old). Overall, 23.5% subjects were HIV seropositive. Being 22 to 24 years old, having dropped out of school, having a history of incarceration, and having been diagnosed with STDs, and initiating drug use injection before 17 years of age were the factors significantly related to HIV seropositivity. Findings suggest that prevention programs should begin early in the development of youngsters. Special HIV and STD preventive programs for youngsters at risk of leaving school before completing high school should be a priority.
Asunto(s)
Seropositividad para VIH/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Femenino , Seropositividad para VIH/complicaciones , Humanos , Modelos Logísticos , Masculino , Puerto Rico/epidemiología , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
OBJECTIVES: Based on an epidemiologic field survey of community households in Puerto Rico, this study estimates the frequency of illicit drug use and clinically defined drug abuse and/or dependence syndromes. Results are compared with those from surveys on the United States mainland. Suspected risk factors are studied as well, with a special focus on childhood misbehavior. METHODS: Trained lay interviewers administered a Spanish Diagnostic Interview Schedule to 912 respondents aged 17 to 68 years who were selected by multistage probability sampling of island households. RESULTS: An estimated 8.2% of the population had a history of illicit drug use and 1.2% qualified for a standardized lifetime diagnosis of drug abuse, dependence, or both. An estimated 18.4% of the male drug users and 7.7% of the female drug users met criteria for drug abuse and/or dependence. A history of drug use was related to the diagnoses of alcohol abuse and/or dependence and antisocial personality, but few persons who had used illicit drugs at least once in their lifetime reported a history of receiving treatment for alcohol, drug, or mental health problems. CONCLUSIONS: The data were consistent with a suspected association between level of childhood misbehavior and occurrence of illicit drug use, even after statistical control for potentially confounding variables.
Asunto(s)
Drogas Ilícitas , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Anciano , Niño , Trastornos de la Conducta Infantil/complicaciones , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Persona de Mediana Edad , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Trastornos Relacionados con Sustancias/etiología , Trastornos Relacionados con Sustancias/terapiaRESUMEN
In this study, the contribution of four distinct domains of the Help Seeking-Decision Making model to predicting the use of mental health services is examined. Using a proposed methodology the authors assess the relevance of this model and its domains to mental services planning. The methodology combines logistic regression analysis and receiver operating characteristic (ROC) curves. Logistic regression analysis allows us to examine the individual variables of the model and generate predictions about use. ROC curves allow us to compare and interpret the relative contribution of a predisposing domain, a physical and mental health domain, an enabling-restrictive domain, and an organizational domain in correctly classifying users and nonusers of mental health services. The physical and mental health domain yielded a Somer's D-statistic of 0.7, which corresponds to an 85% correct classification of randomly selected pairs of users and nonusers. The study findings suggest that comparing ROC curves helps to describe and interpret the domains of the model that are relevant for making predictions about who will or will not use mental health services during a 1-year period.
Asunto(s)
Servicios de Salud Mental/estadística & datos numéricos , Modelos Psicológicos , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza , Curva ROC , Adolescente , Adulto , Causalidad , Características Culturales , Toma de Decisiones , Femenino , Predicción , Investigación sobre Servicios de Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Morbilidad , Puerto Rico/epidemiología , Factores SocioeconómicosRESUMEN
BACKGROUND: This paper describes utilization of mental health services by poor Puerto Ricans living on the island. It examines the utilization rates, within health sectors, and settings for the provision of mental health services. METHODS: Data are based on an islandwide probability sample of 18- to 64-year-old respondents living in low socioeconomic areas. We assessed need with the Psychiatric Symptom and Dysfunction Scales. RESULTS: Approximately one-third of our study population (31.5%) met criteria for need. Of these, only 32% had received any mental health care in the past year. Need was significantly associated with use of physical or mental health services for mental health problems. We found those who needed services to be five times more likely than those who did not need services to have used one or both sectors of care at least once in the past year. Among the first group 21.8% used the physical health sector to deal with mental health problems in contrast with 17.9% who sought care in the mental health sector. In the physical health sector, subjects used the public and private settings equally. In the mental health sector, 70% of subjects used the public setting. CONCLUSIONS: This suggests the nonpsychiatric physician as a main provider for mental health treatment.