Disparities in the prevalence and severity of periodontal disease are associated with socioeconomic factors, such as education and income, and have been recognized since the1960s. Epidemiologic reports have consistently shown that i) periodontal disease is inversely related to education and income after controlling for age and gender, and ii) differences in education and income explain mode if not all of the observed disparities in periodontal disease between blacks and whites. Although race/ethnicity has been the main focus of differences in periodontal diseases in the U.S., disparities in socioeconomic position (SEP) indicators (i.e., education, income, poverty-income ratio) have remained pervasive in the U.S. over the years. SEP indicators, as used in the epidemiologic literature, allocate assignment of socioeconomic measures as a proxy for one's place, position and power in society. Thus, understanding these disparities in periodontal health status may provide insight and context more generally into why racial/ethnic disparities persist. In this paper, we review recent prevalence estimates of periodontitis, according to SEP indicators, and critically assess the importance of SEP factors in periodontal epidemiolgy. The majority of the data available for review comes from the U.S. However, data from other countries is included where available. Specifically, we aim to identify the advantages and disadvantages of the most commonly used SEP indicators in studying periodontal disease; summarize existing evidence on the association between SEP indicators and periodontitis; discuss the analytical issues associated with SEP indicators; and finally, discuss and present, future and alternative research directions on examining the association between SEP indicators and periodontitis.

This study indicates that inequalities in periodontitis associated with race/ethnicity, education and income continue to be pervasive in the US over the years.

Purpose-To determine whether illicit drug users recruited through Respondent-Driven Sampling (RDS) and targeted street outreach (TSO) differ by comparing two samples recruited concurrently with respect to sample selection and potential recruitment biases.Methods-217 heroin, crack, and cocaine users aged 18-40 were recruited through TSO in New York City (2006)(2007)(2008)(2009). 46 RDS seeds were recruited similarly and concurrently yielding a © 2010 Elsevier Inc. All rights reserved.Correspondence: Abby Rudolph, Mailing Address: 3422 Keswick Rd, Baltimore MD 21211, Abby.Rudolph@gmail.com, Phone: 267-261-6395. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusion-These data suggest that RDS and TSO strategies reach different sub-groups of drug users. Understanding the differing capabilities of each recruitment strategy will enable researchers and public health practitioners to select an appropriate recruitment tool for future research and public health practice. KeywordsRespondent Driven Sampling; Targeted Street Outreach; HIV; illicit drug users; sampling biasGenerating a representative sample of illicit drug users for substance abuse and HIV research can be challenging because there is no sampling frame. While convenience, targeted, snowball and time-location sampling methods are used to recruit this population, volunteer and masking biases may result from the inability to sample randomly from the target population. Respondent-Driven Sampling (RDS) aims to reduce these biases with a modified form of chain-referral sampling that regulates peer recruitment and uses probability weights to offset nonrandom recruitment.RDS has recruited geographically(1-3) and demographically diverse samples of injection drug users (IDUs).(4-9) Like samples recruited with other strategies, respondent-driven samples include IDUs from both institutional settings and public venues. RDS also recruits those missed by traditional strategies: those only identified through social networking approaches or through their participation in activities that define the hidden population.(10)Studies comparing respondent-driven samples with chain referral(11), targeted(12,13), traditional outreach(1,2), snowball (14) and time-location samples(3,14,15) have reported differences in demographic characteristics (1,11,12,14), but not in HIV risk behaviors(11).Results from comparison studies should be interpreted with caution, because comparison samples were often recruited over different enrollment periods(14-16) and from different geographic locations.(17) For example, in a study comparing samples rec...

Background Little is known on the effect of stigma on the health and behavior of people who inject drugs (PWID). PWID may internalize these negative attitudes and experiences and stigmatize themselves (internalized stigma). With previous research suggesting a harmful effect of internalized stigma on health behaviors, we aimed to determine socio-demographic characteristics and injection risk behaviors associated with internalized PWID-related stigma in New York City (NYC). Methods Three NYC pharmacies assisted in recruiting PWID. Pharmacy-recruited PWID syringe customers received training in recruiting up to three of their peers. Participants completed a survey on injection behaviors and PWID-related stigma. Among HIV-negative PWID (n=132), multiple linear regression with GEE (to account for peer network clustering) was used to examine associations with internalized PWID-related stigma. Results Latinos were more likely to have higher internalized stigma, as were those with lower educational attainment. Those with higher internalized stigma were more likely to not use a syringe exchange program (SEP) recently, although no association was found with the recent use of pharmacies for syringes. Lastly, higher internalized stigma was related to less than 100% use of pharmacies or SEPs for syringe needs. Conclusions These data suggest that PWID with higher internalized stigma are less likely to consistently use sterile syringe sources in urban settings with multiple sterile syringe access points. These results support the need for individual-and structural-level interventions that address PWID-related stigma. Future research is needed to examine why PWID with higher internalized stigma have less consistent use of public syringe access venues.

There is growing awareness of the role of stigma and discrimination in HIV prevention, testing, and medical care. Yet, few studies have examined the stigma associated with using illicit drugs. In the present study, we examined the relationship between social network characteristics, drug user stigma, and depression. Study participants were comprised of 340 individuals who reported cocaine, crack, and/or heroin use in the prior 6 months and were involved in an HIV prevention study. They were recruited through street outreach, referrals, and word of mouth in inner-city Baltimore, MD, USA. The stigma scale was comprised of eight items, such as "how much do you feel ashamed of using drugs?" Depression was assessed with the Center for Epidemiological Studies Depression Scale, using cutoffs of 16 and 20 or greater. In the bivariate analyses, gender, homelessness in the past 6 months, drug user stigma, larger size of drug network, and current use of heroin, cocaine, and crack were all significantly associated with high levels of depression, whereas in the multivariate analyses, only drug user stigma remained significantly associated with depression. The results of this study suggest that drug treatment providers and other professionals who provide services to drug users should consider developing trainings to address drug user stigma. These programs should focus on the attitudes and behaviors of health and service providers toward drug users, among drug users themselves, and among family members and others who provide social support to drug users.

These data suggest that stress may be associated with periodontitis in the USA, with Mexican Americans exhibiting the strongest association. Furthermore, this group may lack appropriate coping responses to process chronic stressors that other groups may have historically been conditioned to handle. More research is needed to understand allostatic load in Mexican Americans and its influence on periodontitis.

New York State (NYS) passed legislation authorizing pharmacists to administer immunizations in 2008.

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