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Ahmed N, Sun F, Teigland C, Kilgore KM, Mohammadi I, Chambers J, Dieyi C, Feng C, Osborn J, Fu C, Gergis U. Chimeric Antigen Receptor T-Cell Access in Patients with Relapsed/Refractory Large B-Cell Lymphoma: Association of Access with Social Determinants of Health and Travel Time to Treatment Centers. Transplant Cell Ther 2024; 30:714-725. [PMID: 38697294 DOI: 10.1016/j.jtct.2024.04.017] [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: 01/25/2024] [Revised: 03/27/2024] [Accepted: 04/24/2024] [Indexed: 05/04/2024]
Abstract
Large B-cell lymphoma (LBCL) is the most common type of non-Hodgkin lymphoma. Chimeric antigen receptor T-cell (CAR T) therapy represents a novel treatment with curative potential for relapsed or refractory (R/R) LBCL, but there are access barriers to this innovative therapy that are not well-studied. Study objectives were: (1) Assess the impact of geographic factors and social determinants of health (SDOH) on access to treatment with CAR T in a sample of patients with R/R LBCL and ≥2 prior lines of therapy (LOT). (2) Compare and contrast patient characteristics, SDOH, and travel time between patients with R/R LBCL who received CAR T and those who did not. An observational, nested case-control study of patients with R/R LBCL, ≥2 prior LOT, not in a clinical trial, identified using 100% Medicare Fee-For-Service and national multi-payer claims databases. Patients were linked to near-neighborhood SDOH using 9-digit ZIP-code address. Driving distance and time between residence and nearest CAR T treatment center (TC) was calculated. Patients were stratified based on treatments received upon third LOT initiation (Index Date) or later: (1) received CAR T and (2) did not receive CAR T. Multivariable logistic regression was used to evaluate factors associated with CAR T. 5011 patients met inclusion criteria, with 628 (12.5%) in the CAR T group. Regression models found the likelihood of receiving CAR T decreased with patient age (odds ratio [OR] = .96, P < .001), and males were 29% more likely to receive CAR T (OR = 1.29, P = .02). Likelihood of CAR T increased with Charlson Comorbidity Index (CCI; OR = 1.07, P < .001) indicating patients with more comorbidities were more likely to receive CAR T. Black patients were less than half as likely to receive CAR T than White patients (OR = .44, P = .01). Asian patients did not significantly differ from White patients (OR = 1.43, P = .24), and there was a trend for Hispanic patients to have a slightly lower likelihood of CAR T (OR = .50, P = .07). Higher household income was associated with receipt of CAR T, with the lowest income group more than 50% less likely to receive CAR T than the highest (OR = .44, P = .002), and the second lowest income group more than 30% less likely (OR = .68, P = .02). Finally, likelihood of CAR T therapy was reduced when the driving time to the nearest TC was 121 to 240 minutes (reference group: ≤30 minutes; OR = .64, P = .04). Travel times between 31 and 121 or greater than 240 minutes were not significantly different from ≤30 minutes. Payer type was collinear with age and could not be included in the regression analysis, but patients with commercial insurance were 1.5 to 3 times more likely to receive CAR T than other payers on an unadjusted basis. We identified significant disparities in access to CAR T related to demographics and SDOH. Patients who were older, female, low income, or Black were less likely to receive CAR T. The positive association of CCI with CAR T requires further research. Given the promising outcomes of CAR T, there is urgent need to address identified disparities and increase efforts to overcome access barriers.
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Affiliation(s)
- Nausheen Ahmed
- The University of Kansas Cancer Center, Kansas City, Kansas
| | - Fang Sun
- Kite, a Gilead Company, Santa Monica, California
| | | | | | | | | | | | | | | | - Christine Fu
- Kite, a Gilead Company, Santa Monica, California
| | - Usama Gergis
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
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Martin CL, Ghastine L, Wegienka G, Wise LA, Baird DD, Vines AI. Early Life Disadvantage and the Risk of Depressive Symptoms among Young Black Women. J Racial Ethn Health Disparities 2024; 11:1819-1828. [PMID: 37380937 DOI: 10.1007/s40615-023-01654-x] [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: 10/05/2022] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023]
Abstract
OVERVIEW We examined the association between early-life socioeconomic disadvantage and depressive symptoms in adulthood and assessed whether social factors in adulthood modify the association. METHODS The 11-item Center for Epidemiologic Studies-Depression Scale (CES-D) assessed adult depressive symptoms among 1612 Black women and other participants with a uterus (hereafter participants) in the Study of Environment, Lifestyle and Fibroids. Baseline self-reported childhood factors (i.e., parents in the household, mother's educational attainment, food insecurity, neighborhood safety, childhood income, and quiet bedroom for sleep) were included in a latent class analysis to derive an early life disadvantage construct. Multivariable log-binomial models estimated the association between early life disadvantage and adult depressive symptoms. Potential effect modifiers included adult educational attainment, social support, and financial difficulty. RESULTS Participants classified as having high early life disadvantage had 1.34 times (95% CI: 1.20, 1.49) the risk of high depressive symptoms than those in the low early life disadvantage class after adjusting for age, first born status, and childhood health. Adult educational attainment and social support modified the association. CONCLUSION Early life disadvantage increased the risk of depressive symptoms in adulthood. Participants with at least some college education and with high social support had greater risk than those with less than college education and low social support, respectively. Thus, the mental health of Black women and other participants with a uterus exposed to early life disadvantage do not necessarily benefit from higher education or from social support.
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Affiliation(s)
- Chantel L Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lea Ghastine
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Donna D Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Burton DC, Kelly A, Cardo D, Daskalakis D, Huang DT, Penman-Aguilar A, Raghunathan PL, Zhu BP, Bunnell R. Principles of Health Equity Science for Public Health Action. Public Health Rep 2024; 139:277-283. [PMID: 38044623 PMCID: PMC11037219 DOI: 10.1177/00333549231213162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Affiliation(s)
- Deron C. Burton
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service, Washington, DC, USA
| | - Angele Kelly
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Denise Cardo
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Demetre Daskalakis
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David T. Huang
- US Public Health Service, Washington, DC, USA
- National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ana Penman-Aguilar
- Office of Health Equity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Bao-Ping Zhu
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rebecca Bunnell
- Office of Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lin D, Tan R, Teigland C, Hernandez S, Kim S, Kilgore KM. Race/ethnicity and socioeconomic position in emergency department utilization in patients with hepatocellular carcinoma. Future Oncol 2024:1-13. [PMID: 38639552 DOI: 10.2217/fon-2023-0412] [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: 05/10/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024] Open
Abstract
Aim: Evaluate the association of race/ethnicity and socioeconomic position (SEP) on emergency department (ED) visits for patients with hepatocellular carcinoma (HCC), which may reflect access to and quality of cancer care. Materials & methods: Patients with HCC identified from a commercial multi-payer claims database between 2015 and 2018 were matched to near-neighborhood social determinants of health (SDOH) and stratified by race/ethnicity and SEP (proxied by annual household income). Analyses evaluated the effect of race/ethnicity and SEP on ED utilization, adjusting for SDOH, demographic and clinical characteristics using multivariable regression methods. Results: A total of 22,247 patients were included. Black and Hispanic patients had 43 and 18% higher ED utilization than White patients at higher-income levels (p < 0.01); these differences were nonsignificant at lower-income. Regardless of income level, Asian patients had lower ED utilization. Conclusion: Further research on the intersectionality between race/ethnicity, SEP and other SDOH may guide structural-level interventions to address health inequities.
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Affiliation(s)
- Daniel Lin
- Department of Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
| | - Ruoding Tan
- Public Affairs and Access, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Christie Teigland
- Research Science and Advanced Analytics, Inovalon, Inc. Bowie, MD 20716, USA
| | - Sairy Hernandez
- Public Affairs and Access, Genentech, Inc., South San Francisco, CA 94080, USA
| | - Seung Kim
- Research Science and Advanced Analytics, Inovalon, Inc. Bowie, MD 20716, USA
| | - Karl M Kilgore
- Research Science and Advanced Analytics, Inovalon, Inc. Bowie, MD 20716, USA
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Martz CD, Benner AD, Goosby BJ, Mitchell C, Gaydosh L. Structural racism in primary schools and changes in epigenetic age acceleration among Black and White youth. Soc Sci Med 2024; 347:116724. [PMID: 38458127 PMCID: PMC11134904 DOI: 10.1016/j.socscimed.2024.116724] [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: 08/24/2023] [Revised: 11/14/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
Structural racism generates racial inequities in U.S. primary education, including segregated schools, inequitable funding and resources, racial disparities in discipline and achievement, and hostile racial climates, which are risk factors for adverse youth health and development. Black youth are disproportionately exposed to adverse school contexts that may become biologically embedded via stress-mediated epigenetic pathways. This study examined whether childhood exposure to adverse school contexts is associated with changes in epigenetic aging during adolescent development. DNA methylation-based epigenetic clocks were calculated from saliva samples at ages 9 and 15 among Black (n = 774) and White (n = 287) youth in the Future of Families and Child Wellbeing Study (2009-2015). We performed latent class analyses to identify race-specific primary school contexts using administrative data on segregation, discipline, achievement, resources, economic disadvantage, and racial harassment. We then estimated change in epigenetic age acceleration from childhood to adolescence across school typologies using GrimAge, PhenoAge, and DunedinPACE epigenetic clocks. Three distinct school contexts were identified for Black youth: segregated and highly-disadvantaged (17.0%), segregated and moderately-disadvantaged (52.1%), and integrated and moderately-disadvantaged (30.8%). Two school contexts emerged for White youth: integrated and unequal (46.5%) and predominantly White & advantaged (53.5%). At age 15, Black youth who attended segregated and highly-disadvantaged primary schools experienced increases in their speed of epigenetic aging with GrimAge and DunedinPACE. Slowed epigenetic aging with GrimAge was observed for Black youth who attended integrated and moderately-disadvantaged schools. School contexts were not associated with changes in epigenetic age acceleration for White youth. Our findings suggest that manifestations of structural racism in primary school contexts are associated with early-life epigenetic age acceleration and may forecast future health inequities.
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Affiliation(s)
- Connor D Martz
- Population Research Center, The University of Texas at Austin, United States.
| | - Aprile D Benner
- Population Research Center, The University of Texas at Austin, United States; Department of Human Development and Family Sciences, The University of Texas at Austin, United States
| | - Bridget J Goosby
- Population Research Center, The University of Texas at Austin, United States; Department of Sociology, The University of Texas at Austin, United States
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, United States
| | - Lauren Gaydosh
- Population Research Center, The University of Texas at Austin, United States; Department of Sociology, The University of Texas at Austin, United States
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Kranz AM, Evans LA, Geissler KH. Changes in dental visits and oral health for children by race and ethnicity during the COVID-19 pandemic. J Am Dent Assoc 2024; 155:195-203.e4. [PMID: 38206256 DOI: 10.1016/j.adaj.2023.11.005] [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: 05/10/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND The COVID-19 pandemic created new barriers to oral health care, which may worsen oral health and exacerbate disparities. The authors quantified changes in children's dental care receipt and oral health outcomes during the pandemic and examined differences among racial and ethnic groups. METHODS Using the National Survey of Children's Health (163,948 child observations from 2017-2021), the authors used weighted modified Poisson models to examine caregiver-reported receipt of a dental visit (for any reason and for preventive care) and adverse oral health outcomes (teeth in fair or poor condition; difficulty with toothaches, cavities, or bleeding gums) from 2017 through 2019 (prepandemic) compared with 2020 and 2021. The authors examined outcomes within and across racial and ethnic groups. RESULTS Children from all racial and ethnic groups experienced declines in receipt of dental visits, but there were limited changes in adverse oral health outcomes during 2020 and 2021. Prepandemic disparities in receipt of dental visits persisted for Black children and Asian children compared with White children. Hispanic children experienced larger increases in risk of experiencing both adverse oral health outcomes compared with White children in 2020 and in having teeth in fair or poor condition in 2021. CONCLUSIONS The pandemic did not create new disparities in receipt of dental visits or oral health outcomes, but disparities in care persisted, and the oral health of Hispanic children was affected differentially. PRACTICAL IMPLICATIONS Continued monitoring of dental visits and adverse oral health outcomes by race and ethnicity is critical to ensuring all children have access to oral health care. This information can help develop targeted interventions to improve children's oral health, including for minoritized racial and ethnic groups.
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Ranjit N, Badillo DJ, Hoelscher DM, Macias S, Gonzalez A, Wilkinson AV. Racial/Ethnic Differences in Physical Activity in a Low-Income Sample in Texas. J Phys Act Health 2024; 21:22-28. [PMID: 37917980 DOI: 10.1123/jpah.2022-0602] [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: 11/30/2022] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION National data reveal that the age-adjusted prevalence of leisure-time physical inactivity is higher among Blacks and Hispanics compared with Whites. However, these estimates do not consider nonleisure physical activity (PA). Also, race/ethnicity in these findings may by confounded by socioeconomic status disparities in PA. Here, we examine racial/ethnic differences in multiple measures of PA within a lower socioeconomic status sample. METHODS Participants in the current cross-sectional study (n = 1526 adults, aged ≥ 18 y) were recruited from Supplemental Nutrition Assistance Program-Education classes (nutrition education classes that target low-income people) in Texas. Self-report data were obtained using survey questionnaires in spring and fall 2018. PA outcomes of 4 different intensities were assessed: mean daily time spent walking, engaging in moderate and vigorous PA, and sitting. Additional PA-related measures included use and awareness of community PA resources. Linear regression models examined racial/ethnic differences in the 4 PA outcomes after adjusting for participant gender, age, household composition measures, and various socioeconomic status measures. RESULTS In this low-income sample, Hispanic and Black participants spent 6 to 9 more minutes per day walking and engaging in moderate and vigorous PA compared with White/other participants (P < .05 for each measure). Conversely, White/other participants reported spending 82 more minutes sitting per day than Black and Hispanic participants (P < .01). Overall, Black participants were most likely to utilize community PA resources and report ease of engaging in exercise. DISCUSSION Together, these results reveal greater engagement in PA by racial/ethnic minorities in low-income communities compared with Whites. Our results have implications for tailoring PA programming to these communities.
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Affiliation(s)
- Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health Austin, Austin, TX, USA
| | - David J Badillo
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health Austin, Austin, TX, USA
| | - Deanna M Hoelscher
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health Austin, Austin, TX, USA
| | - Sarah Macias
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health El Paso, El Paso, TX, USA
| | - Alejandra Gonzalez
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health Austin, Austin, TX, USA
| | - Anna V Wilkinson
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health Austin, Austin, TX, USA
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8
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Sun S. Racial/Ethnic Heterogeneity in Parental Wealth and Substance Use from Adolescence to Young Adulthood. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01893-y. [PMID: 38114858 DOI: 10.1007/s40615-023-01893-y] [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: 06/19/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Substance use has a negative impact on health outcomes, at the individual and population levels. Little consensus exists regarding the relationship between socioeconomic position and substance use across race/ethnicity. This study examines how race/ethnicity and socioeconomic factors, especially parental wealth, are associated with substance use across an 18-year span from adolescence to young adulthood. METHOD Data were drawn from the National Longitudinal Survey of Youth 1997. Substance use behaviors were measured by self-reported heavy episodic drinking, daily cigarette smoking, and use of cannabis. Parental wealth and parental education were measured at baseline. Other socioeconomic factors included education, employment status, and household income. Two-level logistic regression was performed. RESULTS White respondents were more likely to drink, smoke cigarettes, and use cannabis compared to other racial/ethnic groups. More parental wealth was associated with greater odds of heavy episodic drinking, but lower odds of cigarette and cannabis usage. Race/ethnicity modifies the relationships between parental wealth and substance use. Whereas Black respondents from wealthier families had lower odds of heavy episodic drinking, the direction was opposite among white respondents. Wealth functioned as a protective factor against smoking for all groups, although to a lesser extent among respondents of color than for white respondents. Finally, wealthier Hispanics were more likely to smoke daily and use cannabis compared to other racial/ethnic groups. CONCLUSION These findings highlight a nuanced patterning of racial/ethnic heterogeneity in the relationship between parental wealth and substance use behaviors. Implications for policy and programming are discussed.
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Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA.
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O'Hearn M, Reedy J, Robinson E, Economos C, Wong JB, Sacks G, Mozaffarian D. Landscape analysis of environmental, social and governance (ESG) investing metrics for consumer nutrition and health in the food and beverage sector. BMJ Nutr Prev Health 2023; 6:139-152. [PMID: 38264364 PMCID: PMC10800242 DOI: 10.1136/bmjnph-2022-000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/30/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction The private sector plays a critical role in influencing food choices and health outcomes of consumers. Among private sector actors, investors are a powerful yet underutilised stakeholder for driving scalable public health impact. There are systems to facilitate investors' involvement, notably environmental, social and governance (ESG) investing, which is well placed to include an assessment of business risks to social well-being. However, nutrition efforts within the ESG agenda (ESG-Nutrition) are nascent. We aimed to critically assess the strength of existing ESG-Nutrition metrics to advance the science of measuring business impacts on consumer nutrition and health. Methods ESG-Nutrition metrics were extracted from eight ESG frameworks and categorised across four domains: product portfolio healthfulness; product distribution and equity; product marketing and labelling; and nutrition-related governance. The strength of each metric was evaluated and scored 1-3 (best), independently by two researchers, based on six attributes: materiality, objectivity, alignment, activity, resolution and verifiability. The total score (range 6-18) and intercorrelation for each attribute was calculated. Results Across 529 metrics, most related to product marketing and labelling (n=230, 43.5%), followed by product healthfulness (n=126, 23.8%), nutrition-related governance (n=108, 20.4%) and product distribution and equity (n=65, 12.3%). Across all metrics, average total score was 10.94 (1.58), with average attribute scoring highest for verifiability (mean: 2.36 (SD: 0.57)), objectivity (2.11 (0.61)) and materiality (2.01 (0.68)) and lowest for activity (1.83 (0.74)), alignment (1.37 (0.67)) and resolution (1.26 (0.65)). Most intercorrelations were null, suggesting attributes were measuring distinct characteristics of each metric. Significant heterogeneity across domains and frameworks was also observed. Conclusions This research identifies a range of nutrition-related metrics used in ESG frameworks with respect to food companies, but with substantial heterogeneity in relevant nutrition domains covered and strength of each metric. Efforts are required to improve the quality of metrics across frameworks, establish standardised reporting and align these with investor priorities.
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Affiliation(s)
- Meghan O'Hearn
- Food Systems for the Future Institute, Chicago, Illinois, USA
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Julia Reedy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Ella Robinson
- Global Centre for Preventive Health and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Christina Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - John B Wong
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition, Deakin University, Burwood, Victoria, Australia
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Olstad DL, Nejatinamini S, Blanchet R, Moubarac JC, Polsky J, Vanderlee L, Livingstone KM, Hosseini Pozveh S. Protecting traditional cultural food practices: Trends in diet quality and intake of ultra-processed foods by Indigenous status and race/ethnicity among a nationally representative sample of adults in Canada. SSM Popul Health 2023; 24:101496. [PMID: 37701069 PMCID: PMC10493595 DOI: 10.1016/j.ssmph.2023.101496] [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: 06/20/2023] [Revised: 07/29/2023] [Accepted: 08/20/2023] [Indexed: 09/14/2023] Open
Abstract
Background The traditional cultural food practices of Indigenous people and adults from racial/ethnic minority groups may be eroded in the current food system where nutrient-poor and ultra-processed foods (UPF) are the most affordable and normative options, and where experiences of racism may promote unhealthy dietary patterns. We quantified absolute and relative gaps in diet quality and UPF intake of a nationally representative sample of adults in Canada by Indigenous status and race/ethnicity, and trends between 2004 and 2015. Methods Adults (≥18 years) in the Canadian Community Health Survey-Nutrition self-reported Indigenous status and race/ethnicity and completed a 24-h dietary recall in 2004 (n = 20,880) or 2015 (n = 13,970) to calculate Healthy Eating Index-2015 (HEI-2015) scores from 0 to 100 and proportion of energy from UPF. Absolute and relative dietary gaps were quantified for Indigenous people and six racial/ethnic minority groups relative to White adults and trends between 2004 and 2015. Results Adults from all six racial/ethnic minority groups had higher mean HEI-2015 scores (58.7-61.9) than White (56.3) and Indigenous adults (51.9), and lower mean UPF intake (31.0%-41.0%) than White (45.9%) and Indigenous adults (51.9%) in 2015. As a result, absolute gaps in diet quality were positive and gaps in UPF intake were negative among racial/ethnic minority groups-indicating more favourable intakes-while the reverse was found among Indigenous adults. Relative dietary gaps were small. Absolute and relative dietary gaps remained largely stable. Conclusions Adults from six racial/ethnic minority groups had higher diet quality and lower UPF intake, whereas Indigenous adults had poorer diet quality and higher UPF intake compared to White adults between 2004 and 2015. Absolute and relative dietary gaps remained largely stable. Findings suggest racial/ethnic minority groups may have retained some healthful aspects of their traditional cultural food practices while highlighting persistent dietary inequities that affect Canada's Indigenous people.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Rosanne Blanchet
- Département de Médecine Sociale et Préventive, École de Santé Publique, Université de Montréal, 7101 Avenue du Parc, 3e étage, Montréal, Québec, H3N 1X9, Canada
| | - Jean-Claude Moubarac
- Département de Nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, Montréal, Québec, H3T 1A8, Canada
| | - Jane Polsky
- Health Analysis Division, Statistics Canada, 150 Tunney's Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada
| | - Lana Vanderlee
- École de Nutrition, Université Laval, Québec, Québec, G1V 0A6, Canada
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap St, Geelong, Victoria, 3220, Australia
| | - Seyed Hosseini Pozveh
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
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Adynski H, Propper C, Beeber L, Gilmore JH, Zou B, Santos HP. The role of social adversity on emotional dysregulation during infancy and early childhood. J Pediatr Nurs 2023; 72:26-35. [PMID: 37037102 PMCID: PMC10560316 DOI: 10.1016/j.pedn.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood. DESIGN & METHODS A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis. RESULTS Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability. CONCLUSION & PRACTICAL IMPLICATIONS Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention.
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Affiliation(s)
- Harry Adynski
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States.
| | - Cathi Propper
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - Linda Beeber
- School of Nursing, University of North Carolina at Chapel Hill, NC, United States
| | - John H Gilmore
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, United States
| | - Baiming Zou
- Department of Biostatistics, University of North Carolina at Chapel Hill, NC, United States
| | - Hudson P Santos
- The University of Miami School of Nursing and Health Studies, Florida, United States
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12
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Barnes JM, Johnson KJ, Osazuwa-Peters N, Yabroff KR, Chino F. Changes in cancer mortality after Medicaid expansion and the role of stage at diagnosis. J Natl Cancer Inst 2023; 115:962-970. [PMID: 37202350 PMCID: PMC10407703 DOI: 10.1093/jnci/djad094] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Medicaid expansion is associated with improved survival following cancer diagnosis. However, little research has assessed how changes in cancer stage may mediate improved cancer mortality or how expansion may have decreased population-level cancer mortality rates. METHODS Nationwide state-level cancer data from 2001 to 2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results National Program of Cancer Registries (incidence) and the National Center for Health Statistics (mortality) databases. We estimated changes in distant stage cancer incidence and cancer mortality rates from pre- to post-2014 in expansion vs nonexpansion states using generalized estimating equations with robust standard errors. Mediation analyses were used to assess whether distant stage cancer incidence mediated changes in cancer mortality. RESULTS There were 17 370 state-level observations. For all cancers combined, there were Medicaid expansion-associated decreases in distant stage cancer incidence (adjusted odds ratio = 0.967, 95% confidence interval = 0.943 to 0.992; P = .01) and cancer mortality (adjusted odds ratio = 0.965, 95% confidence interval = 0.936 to 0.995; P = .022). This translates to 2591 averted distant stage cancer diagnoses and 1616 averted cancer deaths in the Medicaid expansion states. Distant stage cancer incidence mediated 58.4% of expansion-associated changes in cancer mortality overall (P = .008). By cancer site subgroups, there were expansion-associated decreases in breast, cervix, and liver cancer mortality. CONCLUSIONS Medicaid expansion was associated with decreased distant stage cancer incidence and cancer mortality. Approximately 60% of the expansion-associated changes in cancer mortality overall were mediated by distant stage diagnoses.
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Affiliation(s)
- Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Duke University, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - K Robin Yabroff
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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13
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Lean RE, Gerstein ED, Smyser TA, Smyser CD, Rogers CE. Socioeconomic disadvantage and parental mood/affective problems links negative parenting and executive dysfunction in children born very preterm. Dev Psychopathol 2023; 35:1092-1107. [PMID: 34725016 PMCID: PMC9058043 DOI: 10.1017/s0954579421000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Poverty increases the risk of poorer executive function (EF) in children born full-term (FT). Stressors associated with poverty, including variability in parenting behavior, may explain links between poverty and poorer EF, but this remains unclear for children born very preterm (VPT). We examine socioeconomic and parental psychosocial adversity on parenting behavior, and whether these factors independently or jointly influence EF in children born VPT. At age five years, 154 children (VPT = 88, FT = 66) completed parent-child interaction and EF tasks. Parental sensitivity, intrusiveness, cognitive stimulation, and positive and negative regard were coded with the Parent-Child Interaction Rating Scale. Socioeconomic adversity spanned maternal demographic stressors, Income-to-Needs ratio, and Area Deprivation Index. Parents completed measures of depression, anxiety, inattention/hyperactivity, parenting stress, and social-communication interaction (SCI) problems. Parental SCI problems were associated with parenting behavior in parents of children born VPT, whereas socioeconomic adversity was significant in parents of FT children. Negative parenting behaviors, but not positive parenting behaviors, were related to child EF. This association was explained by parental depression/anxiety symptoms and socioeconomic adversity. Results persisted after adjustment for parent and child IQ. Findings may inform research on dyadic interventions that embed treatment for parental mood/affective symptoms and SCI problems to improve childhood EF.
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Affiliation(s)
- Rachel E Lean
- Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Emily D Gerstein
- Psychological Sciences, University Missouri-St. Louis, St. Louis, USA
| | - Tara A Smyser
- Psychiatry, Washington University School of Medicine, St. Louis, USA
| | - Christopher D Smyser
- Neurology, Washington University School of Medicine, St. Louis, USA
- Radiology, Washington University School of Medicine, St. Louis, USA
- Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Cynthia E Rogers
- Psychiatry, Washington University School of Medicine, St. Louis, USA
- Pediatrics, Washington University School of Medicine, St. Louis, USA
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14
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Hougen HY, Swami N, Dee EC, Alshalalfa M, Meiyappan K, Florez N, Penedo FJ, Nguyen PL, Punnen S, Mahal BA. Disparities in Diagnosis, Treatment Access, and Time to Treatment Among Hispanic Men With Metastatic Prostate Cancer. JCO Oncol Pract 2023; 19:645-653. [PMID: 37262399 PMCID: PMC10424902 DOI: 10.1200/op.23.00040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/26/2023] [Accepted: 03/08/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Reporting racial/ethnic disparities in aggregate obscures within-group heterogeneity. We sought to identify disparities in diagnosis and treatment in Hispanic subpopulations with metastatic prostate cancer (mPCa). METHODS We disaggregated men with prostate adenocarcinoma from the National Cancer Database from 2004 to 2017 by racial subgroup and Hispanic background. We assessed (1) presenting with mPCa, (2) receiving any treatment, and (3) receiving delayed treatment beyond 90 days. Logistic regression and adjusted odds ratios (aOR) were reported. RESULTS Hispanic men had greater odds of presenting with mPCa (aOR, 1.54; 95% CI, 1.50 to 1.58; P < .001) compared with non-Hispanic White (NHW) men. All Hispanic racial subgroups were more likely to present with mPCa, with the highest risk in Hispanic Black (HB) men (aOR, 1.68; 95% CI, 1.46 to 1.93; P < .01). Men from all Hispanic backgrounds had higher odds of presenting with mPCa, especially Mexican men (aOR, 1.99; 95% CI, 1.86 to 2.12; P < .01). Hispanic men were less likely to receive any treatment (aOR, 0.60; 95% CI, 0.53 to 0.67; P < .001), and this effect was particularly strong for Hispanic White patients (aOR, 0.58; 95% CI, 0.52 to 0.66; P < .001) and Dominican men (aOR, 0.52; 95% CI, 0.28 to 0.98; P = .044). Hispanic men were more likely to experience treatment delays compared with NHW men (aOR, 1.38; 95% CI, 1.26 to 1.52; P < .001) and in particular HB (aOR, 1.83; 95% CI, 1.22 to 2.75; P = .002) and South/Central American men (aOR, 1.48; 95% CI, 1.07 to 2.04; P = .018). CONCLUSION Differences exist in stage at presentation, treatment receipt, and delays in treatment on disaggregation by racial subgroup and Hispanic heritage. We need to study the potential mechanisms of the observed variations to help develop targeted interventions.
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Affiliation(s)
- Helen Y. Hougen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
| | - Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA
- Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | | | - Narjust Florez
- Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Frank J. Penedo
- Departments of Psychology and Medicine, University of Miami Miller School of Medicine and College of Arts and Sciences, Miami, FL
| | - Paul L. Nguyen
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miami, FL
- Sylvester Comprehensive Cancer Center, Miami, FL
| | - Brandon A. Mahal
- Sylvester Comprehensive Cancer Center, Miami, FL
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
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15
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McConnell KH, Hajat A, Sack C, Mooney SJ, Khosropour CM. Associations Between Insurance, Race and Ethnicity, and COVID-19 Hospitalization, Beyond Underlying Health Conditions: A Retrospective Cohort Study. AJPM FOCUS 2023; 2:100120. [PMID: 37362398 PMCID: PMC10260262 DOI: 10.1016/j.focus.2023.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction : People of lower socioeconomic position (SEP) and people of color (POC) experience higher risks of severe COVID-19, but understanding of these associations beyond the effect of underlying health conditions (UHCs) is limited. Moreover, few studies have focused on young adults, who have had the highest incidence of COVID-19 during much of the pandemic. Methods : We conducted a retrospective cohort study using electronic health record data from the University of Washington Medicine healthcare system. Our study population included individuals aged 18-39 years who tested positive for SARS-CoV-2 from February 2020 to March 2021. Using regression modeling, we estimated adjusted risk ratios (aRRs) and differences (aRDs) of COVID-19 hospitalization by SEP (using health insurance as a proxy) and race and ethnicity. We adjusted for any UHC to examine these associations beyond the effect of UHCs. Results: Among 3,101 individuals, the uninsured/publicly insured had a 1.9-fold higher risk of hospitalization (aRR [95% CI]=1.9 [1.0, 3.6]) and 9 additional hospitalizations per 1,000 SARS-CoV-2 positive persons (aRD [95% CI]=9 [-1, 20]) compared to the privately insured. Hispanic or Latine, non-Hispanic (NH) Asian, NH Black, and NH Native Hawaiian or Pacific Islander patients had a 1.5-, 2.7-, 1.4-, and 2.1-fold-higher risk of hospitalization (aRR [95% CI]=1.5 [0.7, 3.1]; 2.7 [1.1, 6.5]; 1.4 [0.6, 3.3]; 2.1 [0.5, 9.1]), respectively, compared to NH White patients. Conclusions: Though they should be interpreted with caution given low precision, our findings suggest the increased risk of COVID-19 hospitalization among young adults of lower SEP and young adults of color may be driven by forces other than UHCs, including social determinants of health.
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Affiliation(s)
- Kate H. McConnell
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Coralynn Sack
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
| | - Stephen J. Mooney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Christine M. Khosropour
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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16
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Josey KP, Delaney SW, Wu X, Nethery RC, DeSouza P, Braun D, Dominici F. Air Pollution and Mortality at the Intersection of Race and Social Class. N Engl J Med 2023; 388:1396-1404. [PMID: 36961127 PMCID: PMC10182569 DOI: 10.1056/nejmsa2300523] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Black Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM2.5]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM2.5 pollution than high-income Americans. Because information is lacking on exposure-response curves for PM2.5 exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM2.5 standards. METHODS We analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM2.5 exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible). RESULTS Lower PM2.5 exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM2.5 levels decreased. For example, the hazard ratio associated with decreasing PM2.5 from 12 μg per cubic meter to 8 μg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation. CONCLUSIONS Higher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM2.5 levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.).
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Affiliation(s)
- Kevin P Josey
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
| | - Scott W Delaney
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
| | - Xiao Wu
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
| | - Rachel C Nethery
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
| | - Priyanka DeSouza
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
| | - Danielle Braun
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
| | - Francesca Dominici
- From the Departments of Biostatistics (K.P.J., R.C.N., D.B., F.D.) and Environmental Health (S.W.D.), Harvard T.H. Chan School of Public Health, Boston; the Department of Biostatistics, Mailman School of Public Health, Columbia University, New York (X.W.); and the Department of Urban and Regional Planning, University of Colorado Denver, Denver (P.D.)
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17
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Holt SB, Vinopal K. Examining inequality in the time cost of waiting. Nat Hum Behav 2023; 7:545-555. [PMID: 36759586 DOI: 10.1038/s41562-023-01524-w] [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: 07/08/2021] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
Time spent waiting for services represents unproductive time lost while fulfilling needs. We use time diary data from the nationally representative American Time Use Survey to estimate the difference between high- and low-income people in time spent waiting for basic services. Relative to high-income people, low-income people are one percentage point more likely to wait on an average day, are three percentage points more likely to wait when using services, spend an additional minute waiting for services on a typical day and spend 12 more minutes waiting when waiting occurs. The unconditional gap in waiting time suggests low-income people spend at least six more hours per year waiting for services than high-income people. The income gap in waiting time cannot be explained by differences in family obligations, demographics, education, work time or travel time. Further, high-income Black people experience the same higher average wait times as low-income people regardless of race.
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Affiliation(s)
- Stephen B Holt
- University at Albany, SUNY, Rockefeller College of Public Affairs and Policy, Albany, NY, USA.
| | - Katie Vinopal
- The Ohio State University, John Glenn College of Public Affairs, Columbus, OH, USA
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18
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Sun S, Lee H, Hudson DL. Racial/ethnic differences in the relationship between wealth and health across young adulthood. SSM Popul Health 2023; 21:101313. [PMID: 36589274 PMCID: PMC9798167 DOI: 10.1016/j.ssmph.2022.101313] [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: 10/13/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
•Wealth attenuated racial differences in self-rated health during young adulthood.•Wealth had consistent incremental effect on health among White & Hispanic Americans.•For Black Americans, wealth was protective of health in the highest wealth quartile.•Individual wealth, not parental wealth was associated with health among Hispanics.
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Affiliation(s)
- Sicong Sun
- School of Social Welfare, The University of Kansas, 1545 Lilac Lane, Lawrence, KS, 66045, USA
| | - Hedwig Lee
- Department of Sociology, Trinity College of Arts & Sciences, 417 Chapel Dr, Durham, NC, 27708, USA
| | - Darrell L. Hudson
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
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19
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Park HJ, Francisco SC, Pang MR, Peng L, Chi G. Exposure to anti-Black Lives Matter movement and obesity of the Black population. Soc Sci Med 2023; 316:114265. [PMID: 34366168 PMCID: PMC10120863 DOI: 10.1016/j.socscimed.2021.114265] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/08/2021] [Accepted: 07/22/2021] [Indexed: 01/11/2023]
Abstract
RATIONALE Black Lives Matter (BLM) is a social movement against systematic injustice and police violence toward Black people whose goal is to ensure their safety and the expression of their culture. As BLM gained momentum, counter-movements emerged, such as All Lives Matter (ALM), White Lives Matter (WLM), and Blue Lives Matter (BlueLM). Because they undermine support for Black people's safety and culture, exposure to stances against BLM can be a race-related stressor. Although the perception of racial discrimination has been associated with negative health outcomes in Black people, it is not clear whether exposure to negative stances on a race-related social issue is associated with worse health outcomes. OBJECTIVE We investigated whether living in areas of the United States with a high prevalence of negative stances on BLM is associated with worse health outcomes, such as higher body mass index (BMI) and prevalence of obesity. METHODS We scraped geo-coded tweets (N = 51,020) that contained #BLM, #ALM, #WLM, and #BlueLM from 2014 to 2016. We determined the stances of the tweets on BLM using machine learning algorithms and aggregated stances at the metropolitan or micropolitan statistical area (MMSA) levels. Participants' BMI and obesity status were derived from the 2017 BRFSS SMART data in 76 MMSAs, as compiled by the Centers for Disease Control and Prevention (N = 20,530). RESULTS After controlling for individual- and regional-level covariates, regional measures of racism and police brutality rate, and baseline BMI in 2014 aggregated on MMSA level, Black people had a higher BMI and prevalence of obesity in areas that showed higher negative stances on BLM. Stances against BLM were positively associated with implicit racism against Black people and can be an acute race-related stressor associated with negative downstream health outcomes. CONCLUSION Negative societal sentiments around race-related issues may be detrimental to the health outcomes of minority populations.
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Affiliation(s)
- Hyun Joon Park
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Sara Chari Francisco
- Department of Sociology, The Pennsylvania State University, University Park, PA, USA
| | - M Rosemary Pang
- Department of Political Science, The Pennsylvania State University, University Park, PA, USA
| | - Lulu Peng
- School of Journalism and Information Communication, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Guangqing Chi
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA, USA
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20
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Keohane LM, Nikpay S, Braun K, Cheng A, Stevenson D, Buntin MB, Yu D, Blot WJ, Lipworth L. Association of Race and Income with Incident Diagnosis of Alzheimer's Disease and Related Dementias among Black and White Older Adults. J Appl Gerontol 2022; 42:898-908. [PMID: 36469682 PMCID: PMC10081951 DOI: 10.1177/07334648221142851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To investigate how differences in income and education levels may contribute to disparities in incidence of Alzheimer's disease and related dementia (ADRD), we compared ADRD incidence in traditional Medicare claims for 11,132 Black and 7703 White participants aged 65 and over from a predominantly low-income cohort. We examined whether the relationship between ADRD incidence and race varied by income or education. Based on 2015 incident ADRD diagnoses, Black and White participants had unadjusted incidence rates of 26.5 and 23.2 cases per 1000 person-years, respectively (rate ratio 1.14, 95% CI 1.05-1.25). In multivariable Cox proportional hazard models, the relationship between race and incident ADRD diagnosis did not vary by education level (p-interaction = 0.748) but was modified by income level (p-interaction = 0.007), with higher ADRD incidence among Black participants observed only among higher income groups. These results highlight the importance of understanding how race and economic factors influence ADRD incidence and diagnosis rates.
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Affiliation(s)
- Laura M Keohane
- Department of Health Policy, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sayeh Nikpay
- 43353University of Minnesota School of Public Health, MN, USA
| | - Kyle Braun
- Department of Health Policy, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Audrey Cheng
- Department of Health Policy, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David Stevenson
- Department of Health Policy, 12327Vanderbilt University School of Medicine, Nashville, TN, USA.,The Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, USA
| | - Melinda B Buntin
- Department of Health Policy, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Danxia Yu
- Department of Medicine, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - William J Blot
- Department of Medicine, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Loren Lipworth
- Department of Medicine, 12327Vanderbilt University School of Medicine, Nashville, TN, USA
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21
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Swami N, Nguyen T, Dee EC, Franco I, Baez YA, Lapen K, Wang L, Goel N, Mahal BA, Fayanju OM, Duma N, Chino F. Disparities in Primary Breast Cancer Stage at Presentation Among Hispanic Subgroups. Ann Surg Oncol 2022; 29:7977-7987. [PMID: 35953743 DOI: 10.1245/s10434-022-12302-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the United States (US) Hispanic population consists of diverse communities, prior breast cancer studies often analyze this group in aggregate. Our aim was to identify differences in breast cancer stage at presentation in the US population, with a particular focus on Hispanic subgroups. METHODS Data from the National Cancer Database (NCDB) from 2004 to 2017 were used to select women with primary breast cancer; individuals were disaggregated by racial and ethnic subgroup and Hispanic country of origin. Ordinal logistic regression was used to create adjusted odds ratios (aORs) with 95% confidence intervals (CIs), with higher odds representing presentation at later-stage breast cancer. Subgroup analysis was conducted based on tumor receptor status. RESULTS Overall, among 2,282,691 women (5.2% Hispanic), Hispanic women were more likely to live in low-income and low-educational attainment neighborhoods, and were also more likely to be uninsured. Hispanic women were also more likely to present at later-stage primary breast cancer when compared with non-Hispanic White women (aOR 1.19, 95% CI 1.18-1.21; p < 0.01). Stage disparities were demonstrated when populations were disaggregated by country of origin, particularly for Mexican women (aOR 1.55, 95% CI 1.51-1.60; p < 0.01). Disparities worsened among both racial and country of origin subgroups in women with triple-negative disease. CONCLUSION Later breast cancer stage at presentation was observed among Hispanic populations when disaggregated by racial subgroup and country of origin. Socioeconomic disparities, as well as uncaptured disparities in access and/or differential care, may drive these observed differences. Future studies with disaggregated data are needed to characterize outcomes in Hispanic communities and develop targeted interventions.
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Affiliation(s)
- Nishwant Swami
- University of Massachusetts Chan Medical School, Worcester, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tiffany Nguyen
- University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Idalid Franco
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
| | - Yefri A Baez
- Department of Urology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kaitlyn Lapen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lora Wang
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Neha Goel
- Department of Surgical Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Oluwadamilola M Fayanju
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, USA.,Rena Rowan Breast Center, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA.,Penn Center for Cancer Care Innovation, The University of Pennsylvania, Philadelphia, PA, USA
| | - Narjust Duma
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Farmer HR, Slavish DC, Ruiz J, Dietch JR, Ruggero CJ, Messman BA, Kelly K, Kohut M, Taylor DJ. Racial/ethnic variations in inflammatory markers: exploring the role of sleep duration and sleep efficiency. J Behav Med 2022; 45:855-867. [PMID: 36029411 PMCID: PMC10062430 DOI: 10.1007/s10865-022-00357-8] [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: 03/25/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
Individuals from minoritized racial/ethnic groups have higher levels of circulating inflammatory markers. However, the mechanisms underlying these differences remain understudied. The objective of this study was to examine racial/ethnic variations in multiple markers of inflammation and whether impaired sleep contributes to these racial/ethnic differences. Nurses from two regional hospitals in Texas (n = 377; 71.62% White; 6.90% Black; 11.14% Hispanic, 10.34% Asian; mean age = 39.46; 91.78% female) completed seven days of sleep diaries and actigraphy to assess mean and variability in total sleep time (TST) and sleep efficiency (SE). On day 7, blood was drawn to assess 4 inflammatory markers: C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α). Results from regression models showed differences in inflammatory markers by race/ethnicity, adjusting for age and gender. The associations between sleep parameters and inflammatory markers also varied by race/ethnicity. Among White nurses, lower mean and greater variability in actigraphy-determined TST and greater variability in diary-determined TST were associated with higher levels of IL-6. Among Black nurses, lower mean diary-determined SE was associated with higher levels of IL-6 and IL-1β. Among Hispanic nurses, greater diary-determined mean TST was associated with higher CRP. Among Asian nurses, greater intraindividual variability in actigraphy-determined SE was associated with lower CRP. Among nurses, we did not find racial/ethnic disparities in levels of inflammation. However, analyses revealed differential relationships between sleep and inflammatory markers by race/ethnicity. Results highlight the importance of using a within-group approach to understand predictors of inflammatory markers.
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Affiliation(s)
- Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, 19716, USA.
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - John Ruiz
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Marian Kohut
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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23
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Hailu EM, Carmichael SL, Berkowitz RL, Snowden JM, Lyndon A, Main E, Mujahid MS. Racial/ethnic disparities in severe maternal morbidity: An intersectional lifecourse approach. Ann N Y Acad Sci 2022; 1518:239-248. [PMID: 36166238 PMCID: PMC11019852 DOI: 10.1111/nyas.14901] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite long-existing calls to address alarming racial/ethnic gaps in severe maternal morbidity (SMM), research that considers the impact of intersecting social inequities on SMM risk remains scarce. Invoking intersectionality theory, we sought to assess SMM risk at the nexus of racial/ethnic marginalization, weathering, and neighborhood/individual socioeconomic disadvantage. We used birth hospitalization records from California across 20 years (1997-2017, N = 9,806,406) on all live births ≥20 weeks gestation. We estimated adjusted average predicted probabilities of SMM at the combination of levels of race/ethnicity, age, and neighborhood deprivation or individual socioeconomic status (SES). The highest risk of SMM was observed among Black birthing people aged ≥35 years who either resided in the most deprived neighborhoods or had the lowest SES. Black birthing people conceptualized to be better off due to their social standing (aged 20-34 years and living in the least deprived neighborhoods or college graduates) had comparable and at times worse risk than White birthing people conceptualized to be worse off (aged ≥35 years and living in the most deprived neighborhoods or had a high-school degree or less). Our findings highlight the need to explicitly address structural racism as the driver of racial/ethnic health inequities and the imperative to incorporate intersectional approaches.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Suzan L Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, and Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, USA
| | - Rachel L Berkowitz
- Department of Public Health and Recreation, College of Health and Human Sciences, San Jose State University, San Jose, California, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Elliott Main
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
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24
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More, less, or the same: A scoping review of studies that compare depression between Black and White U.S. adult populations. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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25
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Delaney SW. Editorial: Are Neural Biomarkers Valid for All Children? J Am Acad Child Adolesc Psychiatry 2022; 61:1327-1328. [PMID: 36007817 DOI: 10.1016/j.jaac.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
Poverty-like all life experiences-can change the developing brain. Psychopathology can, too. But how? And when? And why? And what happens to brain development when children face both poverty and pathology at the same time? With 1 in 5 children growing up poor in the United States today-each at higher risk for developing depression-answering these questions remains among public mental health's most important imperatives. Yet doing so is wickedly challenging: investigators must decipher a wide array of interacting social and biological processes.
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Affiliation(s)
- Scott W Delaney
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
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26
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Bell CN, Robles B, Singleton CR, Thomas Tobin CS, Spears EC, Thorpe RJ. Association between Proximity to Food Sources and Dietary Behaviors in Black and White College Graduates. Am J Health Behav 2022; 46:515-527. [PMID: 36333832 DOI: 10.5993/ajhb.46.5.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Unequal access to healthy food environments is often implicated in racial inequities in health and behaviors that are largest among college graduates. The aim of this study was to determine associations between perceived proximity to food sources and dietary behaviors between black and white college graduates. METHODS In a cross-sectional online survey of dietary behaviors between black and white adults who have a ≥ 4-year bachelor's degree, respondents were asked how long it typically takes for them to get to grocery stores and fast-food restaurants from home. We used ordinal logit regression models to assess associations between perceived proximity to food sources and dietary behaviors. RESULTS Among black men, perceiving that a grocery store was ≥ 10 minutes from their home was associated with lower fruit consumption (beta=-0.94, SE=0.48). Perceiving that a grocery store was ≥ 10 minutes from their home was associated with more frequent fast-food consumption among black men (beta=1.21, SE=0.39), Black women (beta=0.98, SE=0.34), and white men (beta=0.74, SE=0.30). CONCLUSIONS The associations between perceived proximity to food sources and dietary behaviors differ by race and sex among college graduates with important implications for racial disparities in diet quality and obesity across SES.
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Affiliation(s)
- Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane University School of Public Health & Tropical Medicine, New Orleans, LA, United States
| | - Courtney S Thomas Tobin
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Erica C Spears
- Louisiana Public Health Institute, New Orleans, LA, United States
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, and Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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27
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Sims KD, Batty GD, Smit E, Hystad PW, McGregor JC, Odden MC. Discrimination, Mediating Psychosocial or Economic Factors, and Antihypertensive Treatment: A 4-Way Decomposition Analysis in the Health and Retirement Study. Am J Epidemiol 2022; 191:1710-1721. [PMID: 35689640 DOI: 10.1093/aje/kwac102] [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: 08/25/2021] [Revised: 04/20/2022] [Accepted: 06/07/2022] [Indexed: 01/29/2023] Open
Abstract
Untested psychosocial or economic factors mediate associations between perceived discrimination and suboptimal antihypertensive therapy. This study included 2 waves of data from Health and Retirement Study participants with self-reported hypertension (n = 8,557, 75% non-Hispanic White, 15% non-Hispanic Black, and 10% Hispanic/Latino) over 4 years (baselines of 2008 and 2010, United States). Our primary exposures were frequency of experiencing discrimination, in everyday life or across 7 lifetime circumstances. Candidate mediators were self-reported depressive symptoms, subjective social standing, and household wealth. We evaluated with causal mediation methods the interactive and mediating associations between each discrimination measure and reported antihypertensive use at the subsequent wave. In unmediated analyses, everyday (odds ratio (OR) = 0.86, 95% confidence interval (CI): 0.78, 0.95) and lifetime (OR = 0.91, 95% CI: 0.85, 0.98) discrimination were associated with a lower likelihood of antihypertensive use. Discrimination was associated with lower wealth, greater depressive symptoms, and decreased subjective social standing. Estimates for associations due to neither interaction nor mediation resembled unmediated associations for most discrimination-mediator combinations. Lifetime discrimination was indirectly associated with reduced antihypertensive use via depressive symptomatology (OR = 0.99, 95% CI: 0.98, 1.00). In conclusion, the impact of lifetime discrimination on the underuse of antihypertensive therapy appears partially mediated by depressive symptoms.
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28
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Webb EK, Cardenas-Iniguez C, Douglas R. Radically reframing studies on neurobiology and socioeconomic circumstances: A call for social justice-oriented neuroscience. Front Integr Neurosci 2022; 16:958545. [PMID: 36118113 PMCID: PMC9479322 DOI: 10.3389/fnint.2022.958545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 01/29/2023] Open
Abstract
Socioeconomic circumstances are associated with symptoms and diagnostic status of nearly all mental health conditions. Given these robust relationships, neuroscientists have attempted to elucidate how socioeconomic-based adversity "gets under the skin." Historically, this work emphasized individual proxies of socioeconomic position (e.g., income, education), ignoring the effects of broader socioeconomic contexts (e.g., neighborhood socioeconomic disadvantage) which may uniquely contribute to chronic stress. This omission represented a disconnect between neuroscience and other allied fields that have recognized health is undeniably linked to interactions between systems of power and individual characteristics. More recently, neuroscience work has considered how sociopolitical context affects brain structure and function; however, the products of this exciting line of research have lacked critical sociological and historical perspectives. While empirical evidence on this topic is burgeoning, the cultural, ethical, societal, and legal implications of this work have been elusive. Although the mechanisms by which socioeconomic circumstances impact brain structure and function may be similar across people, not everyone is exposed to these factors at similar rates. Individuals from ethnoracially minoritized groups are disproportionally exposed to neighborhood disadvantage. Thus, socioeconomic inequities examined in neuroscience research are undergirding with other forms of oppression, namely structural racism. We utilize a holistic, interdisciplinary approach to interpret findings from neuroscience research and interweave relevant theories from the fields of public health, social sciences, and Black feminist thought. In this perspective piece, we discuss the complex relationship that continues to exist between academic institutions and underserved surrounding communities, acknowledging the areas in which neuroscience research has historically harmed and/or excluded structurally disadvantaged communities. We conclude by envisioning how this work can be used; not just to inform policymakers, but also to engage and partner with communities and shape the future direction of human neuroscience research.
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Affiliation(s)
- E. Kate Webb
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, WI, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, United States
| | - Carlos Cardenas-Iniguez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Robyn Douglas
- Department of Psychological and Behavioral Sciences, Texas A&M University, College Station, TX, United States
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29
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Brown AD, Seligman H, Sliwa S, Barnidge E, Krupsky KL, Demissie Z, Liese AD. Food Insecurity and Suicidal Behaviors Among US High School Students. THE JOURNAL OF SCHOOL HEALTH 2022; 92:898-906. [PMID: 35610158 PMCID: PMC9378726 DOI: 10.1111/josh.13199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors. METHODS Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex-stratified prevalence ratios (PRs) from Poisson regression models. A single-question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors. RESULTS Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non-Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non-Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]). CONCLUSIONS FI is consistently associated with mental health and suicidal behaviors among different subgroups of students.
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Affiliation(s)
- Andrea D. Brown
- Department of Epidemiology and BiostatisticsArnold School of Public Health, University of South Carolina915 Greene Street, ColumbiaSC29208USA
| | - Hilary Seligman
- Departments of Medicine and of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Sarah Sliwa
- Division of Population HealthNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and PreventionAtlantaGAUSA
| | - Ellen Barnidge
- Saint Louis University College of Public Health and Social JusticeSaint LouisMOUSA
| | | | - Zewditu Demissie
- Division of Adolescent and School HealthNational Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service Commissioned CorpsRockvilleMDUSA
| | - Angela D. Liese
- Department of Epidemiology and BiostatisticsArnold School of Public Health, University of South Carolina915 Greene StreetColumbiaSC29208USA
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30
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Health Care Disparities Among Latina Patients Presenting With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2022; 28:608-615. [PMID: 35759777 DOI: 10.1097/spv.0000000000001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE This study identifies barriers, including language and insurance status, Latina patients may face in accessing urogynecology care. OBJECTIVE The aim of the study was to determine differences in objective prolapse severity at the time of presentation between Latina and non-Latina patients and the effect socioeconomic disparities may have on these differences. STUDY DESIGN This is a retrospective cohort study of patients visiting urogynecology clinics at 2 academic institutions (1 private, 1 public). Patients with symptomatic > stage II prolapse were included. Initial Pelvic Organ Prolapse Quantification examinations, leading edge of prolapse, and demographic data were extracted. We evaluated several socioeconomic factors for associations with prolapse severity in a multivariable analysis. RESULTS Three hundred forty-two patients were included (36% Latina). Twenty-eight percent were non-English speaking and 54% had public or no insurance. Using leading edge as the outcome, there was no objective difference in prolapse severity between the Latina and non-Latina patients. A higher proportion of patients with public insurance had more advanced prolapse compared with those with private insurance (odds ratio, 2.78; 95% confidence interval, 1.40-5.55; P < 0.01) and a higher proportion of non-English speaking had more advanced prolapse compared with English speakers (odds ratio, 2.44; 95% confidence interval, 1.12-5.34; P = 0.03). CONCLUSIONS Latina ethnicity was not a risk factor for more advanced prolapse at the time of initial evaluation in a urogynecology clinic. Rather, patients who were non-English speaking and had public insurance were more likely to present with more advanced prolapse. Our data suggest that language barriers and lower socioeconomic status are health care disparities for patients seeking care for prolapse.
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31
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Paccoud I, Nazroo J, Leist AK. Region of birth differences in healthcare navigation and optimisation: the interplay of racial discrimination and socioeconomic position. Int J Equity Health 2022; 21:106. [PMID: 35945565 PMCID: PMC9364564 DOI: 10.1186/s12939-022-01709-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background While a large body of research has documented socioeconomic and migrant inequities in the effective use of healthcare services, the reasons underlying such inequities are yet to be fully understood. This study assesses the interplay between racial discrimination and socioeconomic position, as conceptualised by Bourdieu, and their contributions to healthcare navigation and optimisation. Methods Using a cross-sectional survey in Luxembourg we collected data from individuals with wide-ranging migration and socioeconomic profiles. We fitted sequential multiple linear and logistic regressions to investigate the relationships between healthcare service navigation and optimisation with perceived racial discrimination and socioeconomic position measured by economic, cultural and social capital. We also investigated whether the ownership of these capitals moderates the experience of racial discrimination in healthcare settings. Results We observed important disparities in healthcare navigation among different migrant communities. These differences were explained by accounting for the experience of racial discrimination. Racial discrimination was also negatively related with the extent of healthcare services optimisation. However, the impact of discrimination on both health service navigation and optimisation was reduced after accounting for social capital. Higher volumes of economic and social capital were associated with better healthcare experience, and with a lower probability of perceived racial discrimination. Conclusions Racial discrimination plays a substantial role in accounting for inequality in healthcare service navigation by different migrant groups. This study highlights the need to consider the complex interplay between different forms of economic, cultural and social capital and racial discrimination when examining migrant, and racial/ethnic differences in healthcare. Healthcare inequalities arising from socioeconomic position and racism need to be addressed via multilevel policies and interventions that simultaneously tackle structural, interpersonal, and institutional dimensions of racism.
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Affiliation(s)
- Ivana Paccoud
- University of Luxembourg, Institute for Research on Socio-Economic Inequality (IRSEI), Campus Belval, Maison des Sciences Humaines 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg.
| | - James Nazroo
- The University of Manchester, School of Social Sciences / Manchester Institute for Collaborative Research on Ageing, The Cathie Marsh Institute (CMI), Humanities Bridgeford Street, Oxford Road, Manchester, M13 9PL, UK
| | - Anja K Leist
- University of Luxembourg, Institute for Research on Socio-Economic Inequality (IRSEI), Campus Belval, Maison des Sciences Humaines 11, Porte des Sciences, L-4366, Esch-sur-Alzette, Luxembourg
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Zheng Z, Liu W, Lu Y, Sun N, Chu Y, Chen H. The influence mechanism of community-built environment on the health of older adults: from the perspective of low-income groups. BMC Geriatr 2022; 22:590. [PMID: 35842581 PMCID: PMC9288733 DOI: 10.1186/s12877-022-03278-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background With the rapid development of population ageing, the international community has been paying more attention to the health problems of older adults and the age-friendly community. But there has not been enough discussion about the internal mechanism of the community-built environment that influences the health of older adults. The aim of our study was to explore the complex relationships among community-built environment, social participation, outdoor exercise, and health of older adults, as well as the differences among older adults in different income groups, particular attention was paid to the situation of low-income group. Methods This study used descriptive statistical analysis and structural equation Modeling (SEM) to make a group comparison among older adults in different income groups. The data of this study came from a sample survey in Shanghai, China. Results The study found that health difference exists among older adults in China: the lower the income, the worse the community-built environment, the worse the health. The community-built environment had an important impact on the health of older adults, especially the low-income older adults. And the community-built environment influenced the health of older adults through the intermediary role of outdoor exercise and social participation. Furthermore, the lower the income level of older adults, the stronger the direct effect of the community-built environment on their health; the higher the income level of older adults, the stronger the mediating effect of outdoor exercise and social participation on the impact of the community-built environment on their health. Conclusion Governments should pay more attention to the health and living conditions of low-income older adults and take proactive steps to help them. Community design and construction should pay more attention to the demands of low-income older adult groups, which will help to improve the health inequality of older adults, consequently enhancing older adults’ overall health.
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Affiliation(s)
- Zhenhua Zheng
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Wanting Liu
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Yingchen Lu
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Ning Sun
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Yusu Chu
- College of Communication and Art Design, University of Shanghai for Science and Technology, Shanghai, China
| | - Hong Chen
- College of Architecture & Environment, Sichuan University, Chengdu, China.
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33
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O'Hearn M, Lauren BN, Wong JB, Kim DD, Mozaffarian D. Trends and Disparities in Cardiometabolic Health Among U.S. Adults, 1999-2018. J Am Coll Cardiol 2022; 80:138-151. [PMID: 35798448 PMCID: PMC10475326 DOI: 10.1016/j.jacc.2022.04.046] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few studies have assessed U.S. cardiometabolic health trends-optimal levels of multiple risk factors and absence of clinical cardiovascular disease (CVD)-or its impact on health disparities. OBJECTIVES The purpose of this study was to investigate U.S. trends in optimal cardiometabolic health from 1999 to 2018. METHODS We assessed proportions of adults with optimal cardiometabolic health, based on adiposity, blood glucose, blood lipids, blood pressure, and clinical CVD; and optimal, intermediate, and poor levels of each component among 55,081 U.S. adults in the National Health and Nutrition Examination Survey. RESULTS In 2017-2018, only 6.8% (95% CI: 5.4%-8.1%) of U.S. adults had optimal cardiometabolic health, declining from 1999-2000 (P trend = 0.02). Among components of cardiometabolic health, the largest declines were for adiposity (optimal levels: 33.8%-24.0%; poor levels: 47.7%-61.9%) and glucose (optimal levels: 59.4%-36.9%; poor levels: 8.6%-13.7%) (P trend <0.001 for each). Optimal levels of blood lipids increased from 29.9%-37.0%, whereas poor decreased from 28.3%-14.7% (P trend <0.001). Trends over time for blood pressure and CVD were smaller. Disparities by age, sex, education, and race/ethnicity were evident in all years, and generally worsened over time. By 2017-2018, prevalence of optimal cardiometabolic health was lower among Americans with lower (5.0% [95% CI: 2.8%-7.2%]) vs higher education (10.3% [95% CI: 7.6%-13.0%]); and among Mexican American (3.2% [95% CI: 1.4%-4.9%]) vs non-Hispanic White (8.4% [95% CI: 6.3%-10.4%]) adults. CONCLUSIONS Between 1999 and 2000 and 2017 and 2018, U.S. cardiometabolic health has been poor and worsening, with only 6.8% of adults having optimal cardiometabolic health, and disparities by age, sex, education, and race/ethnicity. These novel findings inform the need for nationwide clinical and public health interventions to improve cardiometabolic health and health equity.
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Affiliation(s)
- Meghan O'Hearn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
| | - Brianna N Lauren
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - John B Wong
- Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA; Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - David D Kim
- Tufts Medical Center, Institute for Clinical Research and Health Policy Studies, Boston, Massachusetts, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA; Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Berkowitz RL, Mujahid M, Pearl M, Poon V, Reid CK, Allen AM. Protective Places: the Relationship between Neighborhood Quality and Preterm Births to Black Women in Oakland, California (2007-2011). J Urban Health 2022; 99:492-505. [PMID: 35384585 PMCID: PMC9187821 DOI: 10.1007/s11524-022-00624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
Black women have the highest incidence of preterm birth (PTB). Upstream factors, including neighborhood context, may be key drivers of this increased risk. This study assessed the relationship between neighborhood quality, defined by the Healthy Places Index, and PTB among Black women who lived in Oakland, California, and gave birth between 2007 and 2011 (N = 5418 women, N = 107 census tracts). We found that, compared with those living in lower quality neighborhoods, women living in higher quality neighborhoods had 20-38% lower risk of PTB, independent of confounders. Findings have implications for place-based research and interventions to address racial inequities in PTB.
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Affiliation(s)
- Rachel L. Berkowitz
- Department of Public Health and Recreation, College of Health and Human Sciences, San José State University, One Washington Square, San Jose, CA 95192-0052 USA
| | - Mahasin Mujahid
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, CA 94720-7360 Berkeley, USA
| | - Michelle Pearl
- Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA 94804-6403 USA
| | - Victor Poon
- Environmental Health Investigations Branch, California Department of Public Health, 850 Marina Bay Parkway, Building P, 3rd Floor, Richmond, CA 94804-6403 USA
| | - Carolina K. Reid
- College of Environmental Design, University of California, 230 Bauer Wurster Hall #1820, Berkeley, CA 94720-1820 USA
| | - Amani M. Allen
- School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Room 5302, CA 94720-7360 Berkeley, USA
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Phuong J, Riches NO, Madlock‐Brown C, Duran D, Calzoni L, Espinoza JC, Datta G, Kavuluru R, Weiskopf NG, Ward‐Caviness CK, Lin AY. Social Determinants of Health Factors for Gene-Environment COVID-19 Research: Challenges and Opportunities. ADVANCED GENETICS (HOBOKEN, N.J.) 2022; 3:2100056. [PMID: 35574521 PMCID: PMC9087427 DOI: 10.1002/ggn2.202100056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Indexed: 01/25/2023]
Abstract
The characteristics of a person's health status are often guided by how they live, grow, learn, their genetics, as well as their access to health care. Yet, all too often, studies examining the relationship between social determinants of health (behavioral, sociocultural, and physical environmental factors), the role of demographics, and health outcomes poorly represent these relationships, leading to misinterpretations, limited study reproducibility, and datasets with limited representativeness and secondary research use capacity. This is a profound hurdle in what questions can or cannot be rigorously studied about COVID-19. In practice, gene-environment interactions studies have paved the way for including these factors into research. Similarly, our understanding of social determinants of health continues to expand with diverse data collection modalities as health systems, patients, and community health engagement aim to fill the knowledge gaps toward promoting health and wellness. Here, a conceptual framework is proposed, adapted from the population health framework, socioecological model, and causal modeling in gene-environment interaction studies to integrate the core constructs from each domain with practical considerations needed for multidisciplinary science.
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Affiliation(s)
- Jimmy Phuong
- Division of Biomedical and Health InformaticsUniversity of WashingtonSeattleWA98195USA
- Harborview Injury Prevention Research CenterUniversity of WashingtonSeattleWA98104USA
| | - Naomi O. Riches
- Department of Biomedical InformaticsUniversity of Utah School of MedicineSalt Lake CityUT84108‐3514USA
| | - Charisse Madlock‐Brown
- Health Informatics and Information ManagementUniversity of Tennessee Health Science CenterMemphisTN38163USA
| | - Deborah Duran
- National Institute on Minority Health and Health Disparities (NIMHD)National Institutes of HealthBethesdaMD20892‐5465USA
| | - Luca Calzoni
- National Institute on Minority Health and Health Disparities (NIMHD)National Institutes of HealthBethesdaMD20892‐5465USA
- Department of Biomedical InformaticsUniversity of PittsburghPittsburghPA15206USA
| | - Juan C. Espinoza
- Department of PediatricsChildren's Hospital Los AngelesLos AngelesCA90015USA
| | - Gora Datta
- Department of Civil and Environmental EngineeringUniversity of California at BerkeleyBerkeleyCA94720USA
| | - Ramakanth Kavuluru
- Division of Biomedical InformaticsDepartment of Internal MedicineUniversity of KentuckyLexingtonKY40506USA
| | - Nicole G. Weiskopf
- Department of Medical Informatics & Clinical EpidemiologyOregon Health & Science UniversityPortlandOR97239USA
| | - Cavin K. Ward‐Caviness
- Center for Public Health and Environmental AssessmentUS Environmental Protection AgencyChapel HillNC27514USA
| | - Asiyah Yu Lin
- National Human Genome Research Institute (NHGRI)National Institutes of HealthBethesdaMD20892‐2152USA
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Deardorff J, Tissue MM, Elliott P, Handler A, Vamos C, Bonilla Z, Turchi R, Obeng CS, Liu J, Grason H. The Critical Value of Maternal and Child Health (MCH) to Graduate Training in Public Health: A Framework to Guide Education, Research and Practice. Matern Child Health J 2022; 26:121-128. [PMID: 35524927 PMCID: PMC9077345 DOI: 10.1007/s10995-022-03401-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/10/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
Introduction In light of persistent health inequities, this commentary describes the critical role of maternal and child health (MCH) graduate training in schools and programs of public health (SPPH) and illustrates linkages between key components of MCH pedagogy and practice to 2021 CEPH competencies. Methods In 2018, a small working group of faculty from the HRSA/MCHB-funded Centers of Excellence (COEs) was convened to define the unique contributions of MCH to SPPH and to develop a framework using an iterative and consensus-driven process. The working group met 5 times and feedback was integrated from the broader faculty across the 13 COEs. The framework was further revised based on input from the MCHB/HRSA-funded MCH Public Health Catalyst Programs and was presented to senior MCHB leaders in October 2019. Results We developed a framework that underscores the critical value of MCH to graduate training in public health and the alignment of core MCH training components with CEPH competencies, which are required of all SPPH for accreditation. This framework illustrates MCH contributions in education, research and evaluation, and practice, and underscores their collective foundation in the life course approach. Conclusions This new framework aims to enhance training for the next generation of public health leaders. It is intended to guide new, emerging, and expanding SPPH that may currently offer little or no MCH content. The framework invites further iteration, adaptation and customization to the range of diverse and emerging public health programs across the nation.
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Affiliation(s)
- Julianna Deardorff
- School of Public Health, University of California, Berkeley, CA, USA.
- Community Health Sciences Division, School of Public Health, University of California, 2121 Berkeley Way West, 94720-7360, Berkeley, CA, USA.
| | - Michelle Menser Tissue
- Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
| | | | - Arden Handler
- School of Public Health, University of Illinois, Chicago, IL, USA
| | - Cheryl Vamos
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Zobeida Bonilla
- School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Renee Turchi
- School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Jihong Liu
- School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Holly Grason
- School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Knighton JS, Dogan J, Crowell C, Stevens-Watkins D. Superwoman Schema: a context for understanding psychological distress among middle-class African American women who perceive racial microaggressions. ETHNICITY & HEALTH 2022; 27:946-962. [PMID: 32931323 PMCID: PMC7956919 DOI: 10.1080/13557858.2020.1818695] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/30/2020] [Indexed: 05/29/2023]
Abstract
Objective: Current racial mental health disparities among African American women have been attributed to chronic experiences of race-related stressors. Increased exposure to racism in predominately White spaces may increase reliance on culturally normative coping mechanisms. The objective of this study was to investigate the relationship between psychological distress, perceived racial microaggressions, and an obligation to show strength/suppress emotions among educated, middle-class African American women.Design: A sample of 243 African American women aged 19-72 years (M = 39.49 years) participated in an online study. Participants completed self-report measures of psychological distress (PHQ-8 and GAD-7), racial microaggressions (IMABI), and modified items from the Stereotypical Roles for Black Women (SRBWS) to assess an obligation to show strength/suppress emotions. Factor analyses were conducted to assess the reliability of the obligation to show strength/suppress emotions subscale in our sample. Descriptive statistics, multiple linear regression, and mediation analyses were also conducted to examine variable associations.Results: Statistical analyses revealed educated, middle-class African American women who endorse an obligation to show strength/suppress emotions with perceived racial microaggressions experienced increased psychological distress.Conclusion: Obligation to show strength/suppress emotion may increase risk for psychological distress among African American women who perceive racial microaggressions. Future research and clinical implications are discussed.
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Affiliation(s)
- Joi-Sheree’ Knighton
- Michigan Department of Health and Human Services (MDHHS), Center for Forensic Psychiatry
| | - Jardin Dogan
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 36 Dickey Hall, Lexington, Kentucky 40506
| | - Candice Crowell
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 36 Dickey Hall, Lexington, Kentucky 40506
| | - Danelle Stevens-Watkins
- Department of Educational, School, and Counseling Psychology, University of Kentucky, 36 Dickey Hall, Lexington, Kentucky 40506
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Jiang Y, Yang Y. Environmental Justice in Greater Los Angeles: Impacts of Spatial and Ethnic Factors on Residents' Socioeconomic and Health Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095311. [PMID: 35564705 PMCID: PMC9105631 DOI: 10.3390/ijerph19095311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/17/2022] [Accepted: 04/25/2022] [Indexed: 02/04/2023]
Abstract
Environmental justice advocates that all people are protected from disproportionate impacts of environmental hazards. Despite this ideal aspiration, social and environmental inequalities exist throughout greater Los Angeles. Previous research has identified and mapped pollutant levels, demographic information, and the population’s socioeconomic status and health issues. Nevertheless, the complex interrelationships between these factors remain unclear. To close this knowledge gap, we first measured the spatial centrality using sDNA software. These data were then integrated with other socioeconomic and health data collected from CalEnvironScreen, with census tract as the unit of analysis. Finally, structural equation modeling (SEM) was executed to explore direct, indirect, and total effects among variables. The results show that the White population tends to reside in the more segregated areas and lives closer to green space, contributing to higher housing stability, financial security, and more education attainment. In contrast, people of color, especially Latinx, experience the opposite of the environmental benefits. Spatial centrality exhibits a significant indirect effect on environmental justice by influencing ethnicity composition and pollution levels. Moreover, green space accessibility significantly influences environmental justice via pollution. These findings can assist decision-makers to create a more inclusive society and curtail social segregation for all individuals.
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Affiliation(s)
- Yuliang Jiang
- Landscape Justice Initiative, School of Architecture, University of Southern California, Los Angeles, CA 90089, USA;
- Stillwater Sciences, Los Angeles, CA 90013, USA
| | - Yufeng Yang
- Space Syntax Laboratory, The Bartlett School of Architecture, University College London, London WC1H 0AY, UK
- Correspondence:
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Localized prostate cancer disparities in risk group at presentation and access to treatment for Hispanic men. Prostate Cancer Prostatic Dis 2022:10.1038/s41391-022-00526-5. [DOI: 10.1038/s41391-022-00526-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/04/2022] [Accepted: 03/02/2022] [Indexed: 12/22/2022]
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Tavares CD, Bell CN, Zare H, Hudson D, Thorpe RJ. Allostatic Load, Income, and Race Among Black and White Men in the United States. Am J Mens Health 2022; 16:15579883221092290. [PMID: 35466781 PMCID: PMC9036348 DOI: 10.1177/15579883221092290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Research indicates that income is significantly associated with allostatic load (AL) and that this association may differ between White and Black Americans. Most existing income–AL link work focuses on women and less is known about this association among men. Using data from the National Health and Nutrition Examination Survey (NHANES), we examined whether race moderates the association between income and AL among Black and White men in the United States (n = 5,685). We find that, regardless of income levels, Black men have significantly higher prevalence of being in the high-AL group compared with high-income White men. Our findings suggest that Black men do not receive the same health benefits for increased income relative to their White counterparts.
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Affiliation(s)
- Carlos D Tavares
- Department of Anthropology and Sociology, Lafayette College, Easton, PA, USA
| | - Caryn N Bell
- Department of Social, Behavioral, and Population Sciences, Tulane University, New Orleans, LA, USA
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Global Health Services and Administration, University of Maryland Global Campus, Baltimore, MD, USA
| | - Darrell Hudson
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Roland J Thorpe
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ganson B, He TL, Henisz WJ. “Us” and “them”: Corporate strategic activism, horizontal inequalities, and society's capacity to address its grand challenges. GLOBAL STRATEGY JOURNAL 2022. [DOI: 10.1002/gsj.1430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Brian Ganson
- Africa Centre for Dispute Settlement Stellenbosch University Business School Cape Town South Africa
| | - Tony L. He
- Department of Management and Global Business Rutgers Business School—Newark and New Brunswick Newark New Jersey USA
| | - Witold J. Henisz
- The Wharton School University of Pennsylvania Philadelphia Pennsylvania USA
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Miao Q, Dunn S, Wen SW, Lougheed J, Maxwell C, Reszel J, Hafizi K, Walker M. Association of maternal socioeconomic status and race with risk of congenital heart disease: a population-based retrospective cohort study in Ontario, Canada. BMJ Open 2022; 12:e051020. [PMID: 35105571 PMCID: PMC8808396 DOI: 10.1136/bmjopen-2021-051020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the interrelationships between maternal socioeconomic status (SES), race and congenital heart diseases (CHD) among infants. DESIGN Retrospective cohort study. STUDY SETTING Ontario, Canada. STUDY POPULATION All singleton stillbirths and live births born in hospitals between 1 April 2012 and 31 March 2018 in Ontario, Canada (n=804 292). OUTCOME CHD. ANALYSIS Multivariable logistic regression models were performed to assess associations between maternal neighbourhood household income, education level, race and CHD while adjusting for maternal age at birth, assisted reproductive technology, obesity, pre-existing health conditions, substance use during pregnancy, maternal rural residence and infant's sex. RESULTS Compared with infants whose mothers lived in the highest median household income neighbourhoods, infants whose mothers lived in the lowest median income neighbourhoods had a higher likelihood of having CHD (adjusted OR 1.15, 95% CI 1.06 to 1.24). Compared with infants whose mothers lived in neighbourhoods with more people with a university or higher degree, those infants whose mothers lived in neighbourhoods with less people with a university or higher degree had a higher chance of developing CHD (adjusted OR 1.26, 95% CI 1.16 to 1.36). Compared with white mothers, black mothers had a higher odds of giving birth to a child with CHD (adjusted OR 1.40, 95% CI 1.27 to 1.54). No association was detected between White and Asian mothers and CHD among infants. CONCLUSIONS Our study indicates that there are inequities in CHD burden by maternal SES and race in Ontario, Canada. Further investigation is needed to examine racial variation in CHD using more detailed ethnic data.
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Affiliation(s)
- Qun Miao
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Sandra Dunn
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jane Lougheed
- Department of Pediatrics, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cynthia Maxwell
- Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Ontario, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Reszel
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kaamel Hafizi
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Mark Walker
- Better Outcomes Registry & Network (BORN) Ontario, Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- OMNI Research Group, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Jain S, Walkey AJ, Law AC, Ferrante LE, Lindenauer PK, Krumholz HM. Association between Residential Segregation and Long-Term Acute Care Hospital Performance on Improvement in Function among Ventilated Patients. Ann Am Thorac Soc 2022; 19:147-150. [PMID: 34644244 PMCID: PMC8787797 DOI: 10.1513/annalsats.202107-796rl] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
| | | | - Anica C. Law
- Beth Israel Deaconess Medical CenterBoston, Massachusetts
| | | | - Peter K. Lindenauer
- University of Massachusetts Medical School-BaystateSpringfield, Massachusetts
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Salminen LE, Tubi MA, Bright J, Thomopoulos SI, Wieand A, Thompson PM. Sex is a defining feature of neuroimaging phenotypes in major brain disorders. Hum Brain Mapp 2022; 43:500-542. [PMID: 33949018 PMCID: PMC8805690 DOI: 10.1002/hbm.25438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/12/2022] Open
Abstract
Sex is a biological variable that contributes to individual variability in brain structure and behavior. Neuroimaging studies of population-based samples have identified normative differences in brain structure between males and females, many of which are exacerbated in psychiatric and neurological conditions. Still, sex differences in MRI outcomes are understudied, particularly in clinical samples with known sex differences in disease risk, prevalence, and expression of clinical symptoms. Here we review the existing literature on sex differences in adult brain structure in normative samples and in 14 distinct psychiatric and neurological disorders. We discuss commonalities and sources of variance in study designs, analysis procedures, disease subtype effects, and the impact of these factors on MRI interpretation. Lastly, we identify key problems in the neuroimaging literature on sex differences and offer potential recommendations to address current barriers and optimize rigor and reproducibility. In particular, we emphasize the importance of large-scale neuroimaging initiatives such as the Enhancing NeuroImaging Genetics through Meta-Analyses consortium, the UK Biobank, Human Connectome Project, and others to provide unprecedented power to evaluate sex-specific phenotypes in major brain diseases.
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Affiliation(s)
- Lauren E. Salminen
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Meral A. Tubi
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Joanna Bright
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Sophia I. Thomopoulos
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Alyssa Wieand
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - Paul M. Thompson
- Imaging Genetics CenterMark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
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Spikes TA, Isiadinso I, Mehta PK, Dunbar SB, Lundberg GP. Socioeconomic characteristics of African American women attending community blood pressure screenings. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100123. [PMID: 35441153 PMCID: PMC9014812 DOI: 10.1016/j.ahjo.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 12/03/2022]
Abstract
Study objective To examine the associations of education and income and blood pressure (BP) in a socioeconomically diverse cohort of African-American (AA) women attending community BP screenings. Design setting and participants This cross-sectional analysis used data from AA women (n = 972) 53 ± 14 years, enrolled between 2015 and 2019 in the 10,000-women hypertension community screening project in the metropolitan Atlanta area. OLS linear regression were used to examine the associations between SES (education and income) and BP after adjusting for age, body mass index (BMI), smoking, and lipids. Main outcomes and measures Outcomes were systolic and diastolic BP (SBP, DBP). Measures of SES included education [high school ≤(HS), some college, and ≥college] and income-[<$24,000, $24,000-<$48,000, $48,000-$96,000, and ≥$96,000]. Sociodemographics, health history, anthropometrics and point of care non-fasting lipids were obtained. Results Compared to women earning <$24,000, an income of ≥$96,000 (β = -5.7 mmHg, 95% CI: -9.9, -1.5, p = .01) was associated with a lower SBP in the minimally adjusted model. Subsequent adjustment for cardiovascular risk factors attenuated the association and was no longer significant. College and above versus ≤HS education was associated with a higher DBP in the minimally (ß = 2.7 mmHg, 95% CI: 0.2, 5.2, p = .03) and fully adjusted models (ß = 3.4 mmHg, 95% CI: 0.2, 6.5, p = .04). Conclusion Income of ≥$96,000 was associated with a lower SBP while a college and above education was associated with a higher DBP. Findings underscore the need for increased cardiovascular risk awareness and education targeting higher SES AA women attending community BP screenings.
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Affiliation(s)
- Telisa A. Spikes
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, NE, Atlanta, GA 30322, United States of America
- Emory University Rollins School of Public Health, Department of Epidemiology, 1522 Clifton Rd., Atlanta, GA 30322, United States of America
| | - Ijeoma Isiadinso
- Emory University School of Medicine, Center for Heart Disease Prevention, 1605 Chantilly Dr. NE, Atlanta, GA 30324, United States of America
| | - Puja K. Mehta
- Emory University School of Medicine, Division of Cardiology, 1462 Clifton Rd. NE Suite 505, Atlanta, GA 30322, United States of America
| | - Sandra B. Dunbar
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, NE, Atlanta, GA 30322, United States of America
| | - Gina P. Lundberg
- Emory University School of Medicine, Division of Cardiology, 137 Johnson Ferry Rd. Ste. 1200, Marietta, GA 30068, United States of America
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Powers BD, Fulp W, Dhahri A, DePeralta DK, Ogami T, Rothermel L, Permuth JB, Vadaparampil ST, Kim JK, Pimiento J, Hodul PJ, Malafa MP, Anaya DA, Fleming JB. The Impact of Socioeconomic Deprivation on Clinical Outcomes for Pancreatic Adenocarcinoma at a High-volume Cancer Center: A Retrospective Cohort Analysis. Ann Surg 2021; 274:e564-e573. [PMID: 31851004 PMCID: PMC7272283 DOI: 10.1097/sla.0000000000003706] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To assess the impact of a granular measure of SED on pancreatic surgical and cancer-related outcomes at a high-volume cancer center that employs a standardized clinic pathway. SUMMARY OF BACKGROUND DATA Prior research has shown that low socioeconomic status leads to less treatment and worse outcomes for PDAC. However, these studies employed inconsistent definitions and categorizations of socioeconomic status, aggregated individual socioeconomic data using large geographic areas, and lacked detailed clinicopathologic variables. METHODS We conducted a retrospective cohort study of 1552 PDAC patients between 2008 and 2015. Patients were stratified using the area deprivation index, a validated dataset that ranks census block groups based on SED. Multivariable models were used in the curative surgery cohort to predict the impact of SED on (1) grade 3/4 Clavien-Dindo complications, (2) initiation of adjuvant therapy, (3) completion of adjuvant therapy, and (4) overall survival. RESULTS Patients from high SED neighborhoods constituted 29.9% of the cohort. Median overall survival was 28 months. The rate of Clavien-Dindo grade 3/4 complications was 14.2% and completion of adjuvant therapy was 65.6%. There was no evidence that SED impacted surgical evaluation, receipt of curative-intent surgery, postoperative complications, receipt of adjuvant therapy or overall survival. CONCLUSIONS Although nearly one-quarter of curative-intent surgery patients were from high SED neighborhoods, this factor was not associated with measures of treatment quality or survival. These observations suggest that treatment at a high-volume cancer center employing a standardized clinical pathway may in part address socioeconomic disparities in pancreatic cancer.
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Affiliation(s)
- Benjamin D. Powers
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - William Fulp
- Department of Biometrics and Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - Amina Dhahri
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | | | - Luke Rothermel
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jennifer B. Permuth
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | | | | | - Jose Pimiento
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Pamela J. Hodul
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Mokenge P. Malafa
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Daniel A. Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Jason B. Fleming
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, Florida
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Mannor KM, Malcoe LH. Uses of Theory in Racial Health Disparities Research: A Scoping Review and Application of Public Health Critical Race Praxis. Ann Epidemiol 2021; 66:56-64. [PMID: 34793963 DOI: 10.1016/j.annepidem.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022]
Abstract
Given the persistence of racial health disparities, scholars have called for investigations into structural origins of health inequity and deeper engagement with theory. We systematically assessed uses of theory-including theory-informed conceptualizations of race and ethnicity, social structure, and racial hierarchy-in epidemiology and other quantitative population health literature on racial health disparities. We conducted a scoping review of systematically identified original research articles (n=650) that sought to explain racial health disparities; articles were published in 17 high-impact epidemiology, public health, and social science journals. Trained coders abstracted data from each article. We applied Public Health Critical Race Praxis and an iterative data-charting method to identify key themes. Only 63 (9.7%) of 650 racial health disparities articles explicitly used theory. Among studies that engaged theory, one third (n=21/63) clearly conceptualized race and/or ethnicity, and a minority theorized social structure (n=19/63; 30%) and/or racial hierarchy as a structural relation (n=4/63; 6%). There is a pressing need for racial health disparities researchers to unambiguously use theory to conceptualize race and ethnicity in social and historical contexts and explain relational aspects of racial hierarchy. These approaches can better elucidate and inform action on structural determinants of both racial inequity and racial health inequity.
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Affiliation(s)
- Kara M Mannor
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Milwaukee, WI, USA
| | - Lorraine Halinka Malcoe
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Milwaukee, WI, USA.
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Protudjer JLP, Greenhawt M, Abrams EM. Race and Ethnicity and Food Allergy: Remaining Challenges. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3859-3861. [PMID: 34749943 DOI: 10.1016/j.jaip.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/31/2021] [Accepted: 07/07/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada
| | - Matthew Greenhawt
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Man, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Man, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada.
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49
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Tolchin B, Oladele C, Galusha D, Kashyap N, Showstark M, Bonito J, Salazar MC, Herbst JL, Martino S, Kim N, Nash KA, Nguemeni Tiako MJ, Roy S, Vergara Greeno R, Jubanyik K. Racial disparities in the SOFA score among patients hospitalized with COVID-19. PLoS One 2021; 16:e0257608. [PMID: 34535009 PMCID: PMC8448580 DOI: 10.1371/journal.pone.0257608] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/04/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sequential Organ Failure Assessment (SOFA) score predicts probability of in-hospital mortality. Many crisis standards of care suggest the use of SOFA scores to allocate medical resources during the COVID-19 pandemic. RESEARCH QUESTION Are SOFA scores elevated among Non-Hispanic Black and Hispanic patients hospitalized with COVID-19, compared to Non-Hispanic White patients? STUDY DESIGN AND METHODS Retrospective cohort study conducted in Yale New Haven Health System, including 5 hospitals with total of 2681 beds. Study population drawn from consecutive patients aged ≥18 admitted with COVID-19 from March 29th to August 1st, 2020. Patients excluded from the analysis if not their first admission with COVID-19, if they did not have SOFA score recorded within 24 hours of admission, if race and ethnicity data were not Non-Hispanic Black, Non-Hispanic White, or Hispanic, or if they had other missing data. The primary outcome was SOFA score, with peak score within 24 hours of admission dichotomized as <6 or ≥6. RESULTS Of 2982 patients admitted with COVID-19, 2320 met inclusion criteria and were analyzed, of whom 1058 (45.6%) were Non-Hispanic White, 645 (27.8%) were Hispanic, and 617 (26.6%) were Non-Hispanic Black. Median age was 65.0 and 1226 (52.8%) were female. In univariate logistic screen and in full multivariate model, Non-Hispanic Black patients but not Hispanic patients had greater odds of an elevated SOFA score ≥6 when compared to Non-Hispanic White patients (OR 1.49, 95%CI 1.11-1.99). INTERPRETATION Given current unequal patterns in social determinants of health, US crisis standards of care utilizing the SOFA score to allocate medical resources would be more likely to deny these resources to Non-Hispanic Black patients.
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Affiliation(s)
- Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Carol Oladele
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Nitu Kashyap
- Information Technology, Yale New Haven Health, New Haven, Connecticut, United States of America
| | - Mary Showstark
- Yale School of Medicine Physician Assistant Online Program, New Haven, Connecticut, United States of America
| | - Jennifer Bonito
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Michelle C. Salazar
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jennifer L. Herbst
- Quinnipiac University School of Law, North Haven, Connecticut, United States of America
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Nancy Kim
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Katherine A. Nash
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Max Jordan Nguemeni Tiako
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shireen Roy
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Rebeca Vergara Greeno
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Karen Jubanyik
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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50
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Fedock G, Cummings C, Kubiak S, Bybee D, Campbell R, Darcy K. Incarcerated Women's Experiences of Staff-Perpetrated Rape: Racial Disparities and Justice Gaps in Institutional Responses. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8668-8692. [PMID: 31148502 DOI: 10.1177/0886260519850531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Within correctional settings, incarcerated women have disproportionately high rates of experiencing staff-perpetrated sexual victimization. In addition, only a small proportion of incarcerated women formally report their victimization experiences to correctional staff and even fewer reports are fully investigated by internal investigators and found to be substantiated. Given the multiple steps in this process, incarcerated women face several possible justice gaps in receiving preventive and intervention-focused responses from correctional staff. Racial differences among incarcerated women's experiences of these steps have not been explored. This study used a structural intersectional framework to examine racial differences in these areas: incarcerated women's experiences of staff-perpetrated rape, reporting decisions, and correctional staff's investigation decisions. With a sample of 180 incarcerated women, this study included analysis of archival data (i.e., settlement claim forms and internal investigation files) from a class action lawsuit involving incarcerated women who had experienced staff sexual misconduct. Black women represented over half of the incarcerated women who experienced staff-perpetrated rape. There were no statistical differences between Black and White women with regard to the characteristics of their victimization experiences, and they had similar rates of reporting their victimization to institutional staff. However, significant differences were found between women with regard to prison staff's responses to their reports; Black women were less likely to have their reports investigated by staff and were more likely to have their investigated reports found to be unsubstantiated. A detailed analysis of 100 specific incidents showed similar findings. Thus, while justice gaps existed for all women, gaps in institutional responses were exacerbated for Black women. Centering incarcerated Black women's experiences is pivotal for guiding efforts to transform correctional settings, to prevent and address staff-perpetrated sexual victimization, and to build safety for incarcerated women.
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