No abstract

The current study tested the postdictive validity of the Vulnerability Index (VI), an instrument used to assess medical vulnerability among people who are homeless. It also examined the relationship between hospitalization records and self-reported health status. The VI is based on self-reports of hospital utilization and chronic health conditions. Data were collected over a one-year period from individuals receiving homeless services in a southwestern city (N = 97, 53.3% male, 57.7% African American). Vulnerability Index scores and three subcomponents of the measure (chronic health conditions, substance use, and mental health problems) were regressed on official reports of past-year hospitalizations, controlling for gender and race, using four separate regression models. Official hospitalization records significantly predicted overall VI scores, but they did not predict the subcomponents of the measure. Results show that, within the current sample, official hospital records are predictive of overall VI scores and are correlated with self-reported hospitalization. The lack of relationship between hospital records and subcomponents of the VI may indicate an underutilization of health care for those with serious health conditions.

Chronic diseases, like diabetes and heart disease, disproportionately impact women of color as compared to White women. Community-engaged and participatory approaches are proposed as a means to address chronic disease health disparities in minority communities, as they allow for tailoring and customization of strategies that align with community needs, interests, and priorities. While community-based participatory research (CBPR) is a framework that offers a clear set of principles to guide intervention design and development, the complexity and diversity of community contexts make it challenging to anticipate all of the possible pathways to implementation. This article describes the application of CBPR principles in the design and development of SHE Tribe (She’s Healthy and Empowered), a social network–based healthy lifestyle intervention intended to promote the adoption of sustainable health behaviors in underserved communities. Practical and specific strategies are described to aid practitioners, researchers, and community partners as they engage in community–academic partnerships. These strategies uncover some of the inner workings of this partnership to promote trust and collaboration and maximize partner strengths, with the aim to aid others with key elements and practical steps in the application of participatory methods.

African American women have higher prevalence (82%) of overweight (body mass index [BMI] 25–29) and obesity (BMI ≥30) than white women (63.2%) or Hispanic women (77.2%), and weight-loss programs yield minimal results in this population. We examine the concept of BMI as a measure of health for African American women and suggests a more holistic, multifaceted approach to preventing chronic disease.

The agreement between self-reported and toxicologically verified substance use provides important information about the validity of self-reported use. While some studies report aggregate agreement across follow-up points, only a few have examined the agreement at each time point separately. An overall rate of agreement across time may miss changes that occur as people progress through a research study. In this study, a sample of 644 adults (43.8% male, 32.6% White, 57.0% Black, 90.2% ages 36+) residing in subsidized housing was used to determine the agreement between self-reported use and saliva toxicological testing for marijuana, cocaine, PCP, amphetamine, and methamphetamine at three different time points. Agreement between saliva toxicological testing and self-report ranged between 84.2% and 94.3% for different substances over time. Higher rates of agreement were found for cocaine than had been reported by previous studies. Statistically significant differences in the odds ratios of concordance over time (baseline, 6-month, and 12-month follow-up) were found for marijuana and the combined category for PCP, amphetamine, and methamphetamine. Our findings suggest that oral fluid drug tests generally withstand community field assessments and result in relatively high levels of agreement for marijuana, cocaine, PCP, amphetamine, and methamphetamine use, when compared to self-report. Because of the ease of sample collection and low chance of adulteration, we conclude that saliva testing is a viable method for toxicological confirmation of substance use behavior in this setting.