February 2021 highlights from AJPH

Date: Dec 22 2020

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations

American Journal of Public Health February issue research highlights:

  • Gay, lesbian, bisexual Americans face higher risk of violence
  • Lethal means counseling could help military addressing rising suicide
  • Public health intervention reaching underserved with opioid use treatment
  • People of color less likely to receive mental health care following jail

Gay, lesbian, bisexual Americans face higher risk of violence

Gay, lesbian and bisexual people in the U.S. experience much higher rates of violence than their heterosexual peers, according to a new study in the February issue of AJPH.

To conduct the study, researchers examined data from the 2017 and 2018 National Crime Victimization Survey. They found that total rates of violence were two to nine times higher among lesbian, gay and bisexual people, when compared to heterosexual people. More specifically, compared with heterosexual women, odds of experiencing a violent victimization in 2017 or 2018 were two times higher among lesbians and more than three times higher among bisexual women. Odds of serious violence were almost two-and-a-half times higher among gay men, compared to heterosexual men, and nearly four times higher among bisexual men.

Significant disparities were found between bisexual and heterosexual people regarding a number of forms of violence, including rape, sexual assault and violence that resulted in serious injuries. Overall, the dataset showed bisexual women experienced violence at the highest rates.

“What our findings most underscore is the urgent need for multisector violence prevention programs; victim services that are affirming, inclusive, and culturally tailored to various (lesbian, gay and bisexual) groups; and widespread social norms changes to eliminate discrimination, prejudice and violence on the basis of sexual orientation,” authors wrote.

[Author contact: Stephanie L. Sansom, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia. “Optimal Allocation of Societal HIV Prevention Resources to Reduce HIV Incidence in the United States”]

Lethal means counseling could help military address rising suicide

Lethal means counseling could be a promising way to help prevent suicide among service members, finds a study in the February issue of AJPH.

With guns accounting for the majority of U.S. suicides and the majority of military suicides, researchers designed a study to test the impact of lethal means counseling — which involves discussing ways to limit a person’s access to methods of suicide — and the provision of cable locks, which are devices that prevent a gun from being fired.

Researchers recruited about 230 gun-owning members of the Mississippi National Guard, randomly assigning them to one of four groups: one that received lethal means counseling; another that got lethal means

counseling, plus cable locks; the third received health and stress counseling; and the fourth group got health and stress counseling, plus cable locks. Follow-up interviews happened three and six months after baseline, and data was gathered from February 2018 to July 2020.

Overall, researchers found that lethal means counseling and provision of cable locks resulted in greater adoption of several safe gun storage methods over time. Service members who received lethal means counseling reported a larger increase in the practice of safe gun storage, such as using gun safes and locking devices, compared to those who received health and stress counseling. Those who were given cable locks were more likely to use them over time than those who did not.

“Given the frequency with which firearms are used in military suicides, promoting safe firearm storage may represent an invaluable tool for military suicide prevention,” the study stated.

[Author contact: Michael Anestis, School of Public Health, Rutgers University, Piscataway, New Jersey. “Lethal Means Counseling, Distribution of Cable Locks, and Safe Firearm Storage Practices Among the Mississippi National Guard: A Factorial Randomized Controlled Trial, 2018-2020”]

Public health intervention reaching underserved with opioid use treatment

Expanding access to buprenorphine treatment in safety net clinics can help reach underserved residents and narrow inequitable gaps in addiction care, according to a practice article published in February’s AJPH.

The article focused on the work of the Buprenorphine Nurse Care Manager Initiative, a local effort funded by the New York City Department of Health and Mental Hygiene, to train primary care providers working in safety net settings to offer buprenorphine, a safe and effective medication for opioid addiction. The authors noted that in New York City, buprenorphine prescription rates are inequitably concentrated in communities with the highest incomes and lowest percentage of Black and Hispanic residents.

As of January 2020, the Buprenorphine Nurse Care Manager Initiative had resulted in 116 new buprenorphine providers — such as nurse practitioners and family medicine physicians — prescribing the treatment across 27 clinics. In addition, more than 1,200 patients had been enrolled, most of them identifying as Latinx or Hispanic and most covered by Medicaid.

“The initiative is a public health funding priority, given the success in increasing the number of buprenorphine providers and delivering buprenorphine care to patients who are underserved,” authors wrote. “However, to support long-term expansion and sustainability, clinics must be able to bill third-party payers for substance use disorder care management delivered by nurses.”

[Author contact: Marissa Kaplan-Dobbs, New York City Department of Health and Mental Hygiene, New York City, New York. “Increasing Access to Buprenorphine in Safety-Net Primary Care Clinics: The New York City Buprenorphine Nurse Care Manager Initiative”]

People of color less likely to receive mental health care following jail

Compared to people of color, white people have greater odds of receiving community-based mental health and substance use treatment after being in jail, finds a new study in the February issue of AJPH.

To conduct the study, researchers recruited a group of more than 600 people who screened positive for mental health issues while being booked at eight jails in the U.S. Midwest in 2017. They followed the cohort through jail-based mental health treatment and then used Medicaid billing data to assess engagement in community-based treatment in the year following release from jail.

While they did not find any racial disparities in jail-based treatment, they did find that compared to people of color, white participants had nearly two times greater odds of receiving community-based mental health and substance use treatment and 4.5 times greater odds of receiving co-occurring disorder treatment.

“Barriers that individuals released from jail face adversely affect (people of color), resulting in reduced access to treatment,” researchers wrote. “Critical race theory can expose the assumptions and functions of systems of care and the possible reproduction of implicit bias in potential solutions.”

[Author contact: Bethany Joy Hedden, Wayne State University, Detroit, Michigan. “Racial Disparities in Access to and Utilization of Jail- and Community-Based Mental Health Treatment in Eight U.S. Midwestern Jails in 2017”]

Check out the full list of AJPH research papers that published online in our First Look area.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to APHA Media Relations. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single-issue access is $30, and online single-article access is $22 at AJPH.org. For direct customer service, call 202-777-2516, or email us.

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