Objectives. To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources. Methods. A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record–generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health. Results. At 3 months, there was no difference between groups in mental (–1.03; 95% confidence interval [CI] = −3.02, 0.96) or physical HRQOL (0.59; 95% CI = −0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others. Conclusions. CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion. Trial Registration. ClinicalTrials.gov Identifier: NCT02435511.
In a real-world controlled trial of 374 adults, intervention recipients improved knowledge (AOR = 2.15; 95% CI, 1.29-3.58) and beliefs (AOR = 1.68; 95% CI, 1.07-2.64) about common resources in the community to manage health, specifically gaining knowledge about smoking cessation (AOR = 2.76; 95% CI, 1.07-7.12) and weight loss resources (AOR = 2.26; 95% CI 1.05-4.84). Positive changes in both knowledge and beliefs about community resources were associated with higher resource use (P = 0.02). CONCLUSIONS: In a middle-age and older population with high morbidity, a low-intensity health IT intervention to deliver resource referrals promoted behavior change by increasing knowledge and positive beliefs about community resources for self-management of health.
Background: During a pandemic, women may be especially vulnerable to secondary health problems driven by its social and economic effects. We examined the relationship between changes in health-related socioeconomic risks (HRSRs) and mental health. Materials and Methods: A cross-sectional survey of 3,200 women aged 18-90 years was conducted in April 2020 using a quota-based sample from a national panel (88% cooperation rate). Patterns of change in HRSRs (food insecurity, housing instability, interpersonal violence, and difficulties with utilities and transportation) were described. Weighted, multivariate logistic regression was used to model the odds of depression, anxiety, and traumatic stress symptoms among those with and without incident or worsening HRSRs. Results: More than 40% of women had one or more prepandemic HRSRs. In the early pandemic phase, 49% of all women, including 29% with no prepandemic HRSRs, had experienced incident or worsening HRSRs. By April 2020, the rates of depression and anxiety were twice that of prepandemic benchmarks (29%); 17% of women had symptoms of traumatic stress. The odds of depression, anxiety, and posttraumatic stress symptoms were two to three times higher among women who reported at least one incident or worsening HRSR; this finding was similar for women with and without prepandemic HRSRs. Conclusions: Increased health-related socioeconomic vulnerability among U.S. women early in the coronavirus disease 2019 (COVID-19) pandemic was prevalent and associated with alarmingly high rates of mental health problems. Pandemic-related mental health needs are likely to be much greater than currently available resources, especially for vulnerable women.
An evolutionary model of sexual behavior was used to generate predictions about sex differences in sexual arousal. Survey instruments were used to test these predictions with 388 adolescents, aged 12-18, from varying socioeconomic strata and geographic regions. Boys reported that their first arousal occurred at the start of puberty or before, usually in response to a visual stimulus, whereas girls generally reported first arousal as occurring 2-3 or more years after puberty, within a social/romantic context. The modal boy reported sexual arousal as occurring several times daily, the modal girl once or twice a week. Boys reported their arousal to be more discriminable, of greater intensity, and more distracting than the girls'. The sexes differed in attitudes related to sexual behavior. However, when reporting emotions and feelings coterminous with sexual arousal, the sexes did not differ. Retrospective college samples of 262 students from West Coast colleges replicated the adolescent data. A survey of 280 East Coast college students found that women's sexual arousal was significantly more partner-dependent than men's. Results were interpreted as supporting evolutionary models of sex differences in sexuality.
BackgroundThe purpose of this study was to examine associations between several types of police‐recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex.Methods and ResultsWe analyzed cross‐sectional data (N=14 799 patients) from 3 primary care clinics at an academic medical center in Chicago, IL. Patient‐level health data were obtained from the electronic health record (June 1, 2014–May 31, 2015), including body mass index and BP, and linked to the City of Chicago Police Data Portal. Geocoded crime counts were aggregated to census tract and calculated as the annual crime rate per 1000 population. Generalized linear mixed models were used to assess obesity and BP status as a function of crime rate quartile, controlling for patient, clinic, and neighborhood characteristics. Median violent crime rates in each quartile ranged from 15 to 84 per 1000 population. Median age was 56 years (interquartile range, 38–72 years); 42% of patients were obese and 33% had elevated BP. Compared with patients living in the lowest quartile, patients living in the highest quartile for violent crime had 53% higher adjusted odds of obesity (95% confidence interval, 1.15–2.03) and 25% higher adjusted odds of elevated BP (95% confidence interval, 1.01–1.56). In subanalyses examining homicide, a relatively rare event, exposure was not associated with obesity and was inconsistently associated with elevated BP.ConclusionsIn a densely populated, high‐poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
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