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Tierney KI, Greil AL, Bell AV. Socioeconomic and Racial/Ethnic Inequalities in Infertility Prevalence, Help-Seeking, and Help Received Since 1995. Womens Health Issues 2024; 34:401-408. [PMID: 38692970 DOI: 10.1016/j.whi.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND In the United States, infertility and treatment for infertility are marked by racial/ethnic and socioeconomic inequalities. Simultaneously, biomedical advances and increased public health attention toward preventing and addressing infertility have grown. It is not known, however, whether the racial/ethnic and socioeconomic inequalities observed in infertility prevalence, help-seeking, or help received have changed over time. METHODS Using National Survey of Family Growth data (1995 through 2017-2019 cycles), this study applied multivariable logistic regression with interaction terms to investigate whether and how racial/ethnic and socioeconomic inequalities in 1) the prevalence of infertility, 2) ever seeking help to become pregnant, and 3) use of common types of medical help (advice, testing, medication for ovulation, surgery for blocked tubes, and artificial insemination) have changed over time. RESULTS The results showed persisting, rather than narrowing or increasing, inequalities in the prevalence of infertility and help-seeking overall. The results showed persisting racial/ethnic inequalities in testing, ovulation medication use, and surgery for blocked tubes. By contrast, the results showed widening socioeconomic inequalities in testing and narrowing inequalities in the use of ovulation medications. CONCLUSIONS There is little evidence to suggest policy interventions, biomedical advances, or increased public health awareness has narrowed inequalities in infertility prevalence, treatment seeking, or use of specific treatments.
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Affiliation(s)
| | - Arthur L Greil
- Division of Social Sciences, Alfred University, Alfred, New York
| | - Ann V Bell
- Department of Sociology and Criminal Justice, University of Delaware, Newark, Delaware
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Meredith WJ, Silvers JA. Experience-dependent neurodevelopment of self-regulation in adolescence. Dev Cogn Neurosci 2024; 66:101356. [PMID: 38364507 PMCID: PMC10878838 DOI: 10.1016/j.dcn.2024.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/18/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
Adolescence is a period of rapid biobehavioral change, characterized in part by increased neural maturation and sensitivity to one's environment. In this review, we aim to demonstrate that self-regulation skills are tuned by adolescents' social, cultural, and socioeconomic contexts. We discuss adjacent literatures that demonstrate the importance of experience-dependent learning for adolescent development: environmental contextual influences and training paradigms that aim to improve regulation skills. We first highlight changes in prominent limbic and cortical regions-like the amygdala and medial prefrontal cortex-as well as structural and functional connectivity between these areas that are associated with adolescents' regulation skills. Next, we consider how puberty, the hallmark developmental milestone in adolescence, helps instantiate these biobehavioral adaptations. We then survey the existing literature demonstrating the ways in which cultural, socioeconomic, and interpersonal contexts drive behavioral and neural adaptation for self-regulation. Finally, we highlight promising results from regulation training paradigms that suggest training may be especially efficacious for adolescent samples. In our conclusion, we highlight some exciting frontiers in human self-regulation research as well as recommendations for improving the methodological implementation of developmental neuroimaging studies and training paradigms.
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Affiliation(s)
- Wesley J Meredith
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, USA.
| | - Jennifer A Silvers
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, USA
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3
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Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Chen X, Liang J, Yang Q, Huang J, Li L, Deng K. Age affects the association between socioeconomic status and infertility: a cross-sectional study. BMC Womens Health 2023; 23:675. [PMID: 38115086 PMCID: PMC10729442 DOI: 10.1186/s12905-023-02680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Previous studies have shown the interaction between age and socioeconomic status (SES) on the risk of infertility in the UK, but the association is still unclear in the United States. Therefore, the present study investigated the effect of age on the relationship between SES and the risk of infertility in American women. METHODS The study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. The poverty income ratio (PIR) was used to represent the SES of the population. With participants stratified according to age category (< 35 years; ≥ 35 years), we further assessed differences in the relationship between PIR and infertility risk among participants of different age groups using multivariate logistic regression and interaction tests. RESULTS Approximately 3,273 participants were enrolled in the study. There were 399 cases of infertility and 2,874 cases without infertility. In women ≥ 35 years of age, PIR levels were significantly higher in infertile participants than in non-infertile participants, but no such difference was found in those < 35 years of age. The association of PIR with the risk of infertility appeared to differ between age < 35 years and age ≥ 35 years (OR: 0.99, 95%Cl: 0.86-1.13 vs. OR: 1.24, 95%Cl: 1.12-1.39) in a fully adjusted model. Furthermore, an interaction between age and PIR increased the risk of infertility (p-value for interaction < 0.001). CONCLUSION Our study found that age may influence the association between PIR and infertility. It is imperative to perform further studies to provide more evidence.
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Affiliation(s)
- Xiting Chen
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Jiemei Liang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Qian Yang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Jinfa Huang
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Lixin Li
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China
| | - Kaixian Deng
- Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), No.1 Jiazi Road, Lunjiao, Shunde District, Foshan City, 528308, Guangdong Province, China.
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Kheradmand M, Hamzehgardeshi Z, Shahhosseini Z, Mirjalili R, Moosazadeh M. The association between early menarche and higher-risk cardiometabolic profile: a dose-response analysis of the Tabari cohort at enrollment phase. Front Cardiovasc Med 2023; 10:1241179. [PMID: 37719973 PMCID: PMC10502719 DOI: 10.3389/fcvm.2023.1241179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
Objectives The association between age at menarche and higher-risk cardiometabolic factors is controversial and more strands of evidence are required. Therefore, in this study, we aimed to investigate the effect of early menarche on cardiometabolic profile in a large-scale cohort population. Study design Data collected in the enrollment phase of the Tabari cohort study were utilized for the present study. We analyzed data from 6,103 women aged 35-70 years. Logistic regression and dose-response (trend) analyses were used to investigate the effect of early menarche on prevalence of diabetes, dyslipidemia, obesity, high waist circumference (WC), high waist-to-hip ratio (WHR), and high waist-to-height ratio (WHtR). Results The results of the adjusted logistic regression analysis showed that women who experienced early menarche had significantly higher odds of obesity (odds ratio: 1.64, 95% CI: 1.36-1.99, P for trend <0.001), high WC (odds ratio: 1.34, 95% CI: 1.07-1.67, P for trend = 0.035), high WHR (odds ratio: 1.32, 95% CI: 1.05-1.66, P for trend = 0.057), and high WHtR (odds ratio: 1.83, 95% CI: 1.22-2.74, P for trend = 0.006) compared to those aged ≥14 at menarche. The prevalence of dyslipidemia was also higher among women who experienced early menarche than in women aged ≥14 at menarche (79.9% vs. 76.6%), but the difference was not statistically significant (P = 0.098). Additionally, each year of earlier menarche was significantly associated with an increase in the chance of diabetes (by 5%), obesity (10%), high WC (5%), and high WHtR (13%). Conclusion The present study showed that early menarche is a strong predictor for later development of obesity and diabetes, and for high WC, WHR, and WHtR. Among all factors examined, age at menarche had the greatest predictive power for WHtR. As an age-dependent anthropometric index for central obesity, WHtR is more suitable as an index for identification of individuals with increased cardiometabolic risk.
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Affiliation(s)
- Motahareh Kheradmand
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Professor, Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Shahhosseini
- Professor of Reproductive Health, Sexual and Reproductive Health Research Center, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Razie Mirjalili
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Science, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestitional Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Lazzari E, Tierney K. Parental sociodemographics of medically assisted reproduction births in the United States: a dyadic population-level study. F S Rep 2023; 4:292-299. [PMID: 37692190 PMCID: PMC7615071 DOI: 10.1016/j.xfre.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To study how men's and couples' sociodemographic characteristics predict the probability of having a birth conceived using medically assisted reproduction (MAR) in the United States. Design Population-based study. Setting Not applicable. Patients Men and women in the National Vital Statistics Birth certificate data from 2009 to 2019. Intervention None. Main Outcome Measures Proportion of MAR births out of total births by parental sociodemographic categories and probability of having a MAR birth. Results Between 2009 and 2019, the overall prevalence of MAR births among men was 1.81%. Fathers of children conceived using MAR tended to be older, higher educated, and white compared with fathers of naturally conceived children. During the period of 2009-2019, these sociodemographic profiles remained largely unchanged. Controlling for maternal age and birth order only partially reduced disparities by education and race. In 2019, highly educated fathers were 2.04 percentage points (95% confidence interval, 1.97-2.12) more likely to have a MAR-conceived birth than fathers with a low educational level, and black fathers were associated with a reduction in the probability of having an MAR-conceived child by - 1.07 percentage points (95% confidence interval, -1.11 to -1.04) compared with white fathers. The dyadic analysis using parents' education and race interactions revealed that partnering with someone of a higher educational level increases the likelihood of having a MAR birth, beyond what would be observed by considering only individual-level characteristics. Conclusions To comprehend the environment in which MAR-conceived children are born and raised, performing dyadic analyses that examine the characteristics of both partners is essential. The findings underscore the enduring presence of substantial social disparities in MAR use in the United States, with MAR-conceived children raised in environments of relative advantage, which may impact their future health and development.
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Affiliation(s)
- Ester Lazzari
- Department of Demography, University of Vienna (Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna)), Vienna, Austria
| | - Katherine Tierney
- Department of Sociology, Western Michigan University, Kalamazoo, Michigan
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Brinson AK, da Silva SG, Hesketh KR, Evenson KR. Impact of Physical Activity and Sedentary Behavior on Spontaneous Female and Male Fertility: A Systematic Review. J Phys Act Health 2023; 20:600-615. [PMID: 37146984 PMCID: PMC7614776 DOI: 10.1123/jpah.2022-0487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/10/2023] [Accepted: 02/28/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility. METHOD PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men. RESULTS Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case-control studies, 5 randomized controlled trials, and one case-cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association. CONCLUSIONS The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored.
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Affiliation(s)
| | - Shana G. da Silva
- Federal University of Fronteira Sul, Passo Fundo, RS, Brazil University of North Carolina—Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn R. Hesketh
- University of North Carolina—Chapel Hill, Chapel Hill, NC, USA UCL Great Ormond Street Institute of Child Health, London, UK MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Moody SN, Phan JM, Shirtcliff EA, Wang W, Drury S, Theall K. Transgenerational effect of Mothers' experiences of discrimination on Black youths' hormone coupling in response to laboratory stress. RESEARCH IN HUMAN DEVELOPMENT 2023; 20:25-47. [PMID: 37484485 PMCID: PMC10358998 DOI: 10.1080/15427609.2023.2215130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Exposure to pervasive racial discrimination of Black Americans is transgenerational in that mothers' experiences of discriminatory violence impacts their children. This study explored whether stress-related biomarkers reflect transgenerational racial stress by implementing a "dual activation" framework to probe how adrenal and gonadal hormones underlying adolescent development are co-regulated during a laboratory stressor. Data were collected from 120 Black families in the United States. Children completed the Trier Social Stress Task (TSST-C) and provided 4 saliva samples across 2 days that were assayed for cortisol (C), dehydroepiandrosterone (DHEA), and testosterone (T). Mothers reported their experiences of total discrimination and racial discrimination related to skin color/race. Thirty four percent reported experiences of discrimination and on average 46.7% reported experiences of discrimination due to their race or skin tone. Mothers' experiences of racial discrimination were associated with their child's hormonal reactivity to and recovery from the TSST-C. Youth showed stronger positive hormone coupling between C-T if their mother experienced greater discrimination. Mothers' experiences of racial discrimination influenced both C-T coupling and youths' cortisol recovery from the TSST-C. For youths with high testosterone, cortisol recovery was blunted. Results suggest that associations between racism and hormonal stress response may be transgenerational. Mothers' experiences of discrimination had a profound impact on their children's hormonal co-regulation.
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Affiliation(s)
- Shannin N. Moody
- Department of Neurology, Louisiana State University Health Sciences Center, New Orleans (LA), USA
- Department of Human Development and Family Studies, Iowa State University, Ames, (IA), USA
| | - Jenny M. Phan
- Center for Autism Spectrum Disorders, Children’s National Hospital, Washington (D.C.) USA
| | - Elizabeth A. Shirtcliff
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Wen Wang
- Center for Translational Neuroscience, Department of Psychology, University of Oregon, Eugene (OR), USA
| | - Stacy Drury
- Department of Pediatrics, Tulane University, New Orleans, (LA), USA
| | - Katherine Theall
- Departments of Social, Behavioral, and Population Sciences and Epidemiology, Tulane University, New Orleans, (LA), USA
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Barreto SG, Ben-Aharon I. Young-Onset Cancers-Early Steps in the Right Direction. Cancers (Basel) 2023; 15:cancers15092599. [PMID: 37174065 PMCID: PMC10177185 DOI: 10.3390/cancers15092599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
The global incidence of young-onset (YO) cancer is on the rise [...].
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Affiliation(s)
- Savio George Barreto
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
- Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, SA 5042, Australia
- Department of Surgery, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia
| | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Center, Haifa 3109601, Israel
- Rappaport Faculty of Medicine, Technion, Haifa 3200003, Israel
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Acker J, Mujahid M, Aghaee S, Gomez S, Shariff-Marco S, Chu B, Deardorff J, Kubo A. Neighborhood Racial and Economic Privilege and Timing of Pubertal Onset in Girls. J Adolesc Health 2023; 72:419-427. [PMID: 36528517 PMCID: PMC10505041 DOI: 10.1016/j.jadohealth.2022.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Early puberty is associated with adverse health outcomes over the life course, and Black and Hispanic girls experience puberty earlier than girls of other racial/ethnic backgrounds. Neighborhood racial and economic privilege may contribute to these disparities by conferring differential exposure to mechanisms (e.g., stress, obesity, endocrine disruptors) underlying early puberty. We examined associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE), and age at pubic hair onset (pubarche) and breast development onset (thelarche) in a large multiethnic cohort. METHODS A cohort of 46,299 girls born 2005-2011 at Kaiser Permanente Northern California medical facilities were followed until 2021. Pubertal development was assessed routinely by pediatricians using the Sexual Maturity Rating scale. ICE quintiles for race/ethnicity, income, and income + race/ethnicity were calculated using American Community Survey 2010 5-year estimates and linked to census tract at birth. We fit multilevel Weibull regression models accommodating left, right, and interval censoring for all analyses. RESULTS ICE measures were monotonically associated with pubertal onset, with the strongest associations observed for ICE-race/ethnicity. Adjusting for maternal education, age at delivery, and parity, girls from the least versus most privileged ICE-race/ethnicity quintiles were at increased risk for earlier pubarche (hazard ratio: 1.30, 95% confidence interval: 1.21, 1.38) and thelarche (hazard ratio: 1.45, 95% confidence interval: 1.36, 1.54). These associations remained significant after adjusting for girls' race/ethnicity and childhood body mass index. Additionally, adjustment for ICE partially attenuated Black-White and Hispanic-White disparities in pubertal onset. DISCUSSION Neighborhood privilege may contribute to pubertal timing and related disparities.
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Affiliation(s)
- Julia Acker
- School of Public Health, University of California, Berkeley, Berkeley, California.
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Sara Aghaee
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Scarlett Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Brandon Chu
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Julianna Deardorff
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Ai Kubo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Tierney KI. Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis. J Assist Reprod Genet 2022; 39:2505-2519. [PMID: 36103005 PMCID: PMC9723016 DOI: 10.1007/s10815-022-02607-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics. METHODS Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information. RESULTS At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.063, SE = 0.018, p < .001), the tract median household income (aOR = 0.990, SE = 0.002, p < 0.001), and the percentages of the population who were Hispanic (aOR = 0.975, SE = 0.007, p < 0.001), women over 25 with a bachelor's degree or higher (aOR: 1.052, SE = 0.004, p < 0.001), and foreign-born (aOR: 1.037, SE = 0.009, p < .001). At the county-level, significant associations were found with the county median household income (aOR: 1.016, SE = 0.006, p < .01) and the percentage of the population that identified as Black (aOR = 1.013, SE = 0.006, p < .05) and Hispanic (aOR = 1.028, SE = 0.009, p < .05). Multivariate models showed no associations between tract clinic counts and state infertility policy. CONCLUSION There is mixed evidence that clinic concentration is associated with expected sociodemographics. In particular, physical proximity may not principally drive racial disparities in ART access. Furthermore, insurance mandates are not associated with the presence of an ART clinics in a tract, suggesting alternative policy levers may be needed to address differential access and utilization of ART services.
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Affiliation(s)
- Katherine I Tierney
- Department of Sociology, Western Michigan University, 1903 W. Michigan Ave, Kalamazoo, MI, 49008-5257, USA.
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Tierney K, Urban A. ‘I just think it’s weird’: the nature of ethical and substantive non-ethical concerns about infertility treatments among Black and White women in U.S. graduate programmes. HUM FERTIL 2022:1-13. [DOI: 10.1080/14647273.2022.2136014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Katherine Tierney
- Department of Sociology, Western Michigan University, Kalamazoo, MI, USA
| | - Amber Urban
- Department of Sociology, Western Michigan University, Kalamazoo, MI, USA
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