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Ravandi B, Mehler P, Ispirova G, Barabási AL, Menichetti G. GroceryDB: Prevalence of Processed Food in Grocery Stores. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2022.04.23.22274217. [PMID: 38883708 PMCID: PMC11177926 DOI: 10.1101/2022.04.23.22274217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
The offering of grocery stores is a strong driver of consumer decisions, shaping their diet and long-term health. While highly processed food like packaged products, processed meat, and sweetened soft drinks have been increasingly associated with unhealthy diet, information on the degree of processing characterizing an item in a store is not straightforward to obtain, limiting the ability of individuals to make informed choices. Here we introduce GroceryDB, a database with over 50,000 food items sold by Walmart, Target, and Wholefoods, unveiling how big data can be harnessed to empower consumers and policymakers with systematic access to the degree of processing of the foods they select, and the potential alternatives in the surrounding food environment. The wealth of data collected on ingredient lists and nutrition facts allows a large scale analysis of ingredient patterns and degree of processing stratified by store, food category, and price range. We find that the nutritional choices of the consumers, translated as the degree of food processing, strongly depend on the food categories and grocery stores. Moreover, the data allows us to quantify the individual contribution of over 1,000 ingredients to ultra-processing. GroceryDB and the associated http://TrueFood.Tech/ website make this information accessible, guiding consumers toward less processed food choices while assisting policymakers in reforming the food supply.
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Affiliation(s)
- Babak Ravandi
- Network Science Institute and Department of Physics, Northeastern University, Boston, USA
| | - Peter Mehler
- Department of Computer Science, IT University of Copenhagen, Copenhagen, Denmark
| | - Gordana Ispirova
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Albert-László Barabási
- Network Science Institute and Department of Physics, Northeastern University, Boston, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Department of Network and Data Science, Central European University, Budapest, Hungary
| | - Giulia Menichetti
- Network Science Institute and Department of Physics, Northeastern University, Boston, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
- Harvard Data Science Initiative, Harvard University, Boston, USA
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Roy V, Hamilton D, Chokshi DA. Health and political economy: building a new common sense in the United States. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae041. [PMID: 38757005 PMCID: PMC11071682 DOI: 10.1093/haschl/qxae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/22/2024] [Accepted: 04/11/2024] [Indexed: 05/18/2024]
Abstract
The prevailing economic paradigm, characterized by free market thinking and individualistic cultural narratives, has deeply influenced contemporary society in recent decades, including health in the United States. This paradigm, far from being natural, is iteratively intertwined with politics, social group stratification, and norms, together shaping what is known as political economy. The consequences are starkly evident in health, with millions of lives prematurely lost annually in the United States. Drawing on economic re-thinking happening in fields like climate and law, we argue for a new "common sense" towards a health-focused political economy. Central to this proposed shift is action in 3 interconnected areas: capital, care, and culture. Re-orienting capital to prioritize longer-term investments, such as in public options for health care and baby bonds, can promote health and affirmatively include historically marginalized groups. Recognizing that caregiving is economically valuable and necessary for health, approaches like local cadres of community health workers across the United States would be part of building robust caregiving infrastructures. Advancing momentum in these directions, in turn, will require displacing dominant cultural narratives. As the health arena pursues change in the face of real obstacles, recent efforts reinvigorating industrial policy and addressing concentrated market power can serve as inspiration.
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Affiliation(s)
- Victor Roy
- National Clinician Scholars Program, Yale School of Medicine, New Haven, CT 06510-8088, United States
| | - Darrick Hamilton
- The Department of Economics, The Institute on Race, Power and Political Economy, The Public and Urban Policy Program, The New School, New York, NY 10011, United States
| | - Dave A Chokshi
- Colin Powell School for Civic and Global Leadership, The City College of New York, New York, NY 10031, United States
- Bellevue Hospital, New York, NY 10016, United States
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3
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Islami F, Baeker Bispo J, Lee H, Wiese D, Yabroff KR, Bandi P, Sloan K, Patel AV, Daniels EC, Kamal AH, Guerra CE, Dahut WL, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2023. CA Cancer J Clin 2024; 74:136-166. [PMID: 37962495 DOI: 10.3322/caac.21812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023] Open
Abstract
In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6-2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black-White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black-White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence-based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.
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Affiliation(s)
| | | | | | | | | | - Priti Bandi
- American Cancer Society, Atlanta, Georgia, USA
| | | | | | | | | | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Jiang Q, Huang X, Wang Z, Dai X, Li R, Cui D. Regional differences of physical fitness and overweight and obesity prevalence among college students before and after COVID-19 pandemic since the "double first-class" initiative in China. Front Public Health 2024; 11:1252270. [PMID: 38249415 PMCID: PMC10796554 DOI: 10.3389/fpubh.2023.1252270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/12/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Physical fitness has been widely recognized as a powerful marker of health in children and adolescents, and it negatively affected by the COVID-19 pandemic. The construction of world-class universities and first-class disciplines, known as the "Double First-Class" Initiative (DFC), is a major commitment made by the Chinese government to adapt to changes in the educational environment, both domestically and internationally, in order to promote the development and practice of international higher education. The aim of the study was to look deep into the regional differences of physical fitness and overweight and obesity prevalence among college students before and after the COVID-19 pandemic since the DFC. Methods The original physical fitness parameters of students from 10 DFC universities and colleges in Central South China were downloaded from the official website of Chinese National Student Physical Fitness Database (CNSPFD) and then divided into 3 groups based on the pandemic periods: pre-pandemic (2019), the first year after pandemic outbreak (2020), and the second year after pandemic outbreak (2021). All the data were stored in Excel 2010, analyzed by SPSS 17.0, and plotted with ArcGIS 10.4. Results The total "fail" percentage (from 9.19% in 2019 to 12.94% in 2021) and the prevalence of overweight and obesity in boys (from 22.53 to 29.25% in 2021) exhibited a continuous increase year by year, and among all the physical fitness indicators the score of strength in boys and endurance quality in all individuals were the lowest in overweight and obesity groups. Students with 'fail' rate developed from northern and northeastern province to southern areas from 2019 to 2021. For grade 2019th, overweight and obesity students who also failed the test had covered nationwide and the most affected areas including northeast, east, as well as central north in senior year. The distribution of overall fitness assessments in Hubei province was in accordance with the national data, and the overall scoring growths in both class of 2021st and 2022nd were measured with a negative increase (p < 0.01). Conclusion The government and related functional departments should take into consideration the student regional sources, especially in western and northeast regions of China, and school polices and physical education (PE) teachers should pay more attention to put training efforts on endurance for all adolescents and strength for boys and the group of overweight and obesity who also failed in the standard test, when designing specific interventions to promote physical health and counteract the negative effects of COVID-19 pandemic in college students.
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Affiliation(s)
- Qing Jiang
- School of Physical Education, Hunan University, Changsha, Hunan, China
- Hunan Students’ Physical Fitness Test Data Management Center, Changsha, Hunan, China
| | - Xin Huang
- School of Physical Education, Hunan University, Changsha, Hunan, China
- Hunan Students’ Physical Fitness Test Data Management Center, Changsha, Hunan, China
| | - Zuoliang Wang
- School of Physical Education, Hunan University, Changsha, Hunan, China
- Hunan Students’ Physical Fitness Test Data Management Center, Changsha, Hunan, China
| | - Xinghong Dai
- School of Physical Education, Hunan University, Changsha, Hunan, China
| | - Rongxuan Li
- School of Physical Education, Hunan University, Changsha, Hunan, China
| | - Di Cui
- School of Physical Education, Hunan University, Changsha, Hunan, China
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Heinold E, Funk M, Niehaus S, Rosen PH, Wischniewski S. OSH related risks and opportunities for industrial human-robot interaction: results from literature and practice. Front Robot AI 2023; 10:1277360. [PMID: 37965632 PMCID: PMC10642918 DOI: 10.3389/frobt.2023.1277360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Robotic systems are an integral component of today's work place automation, especially in industrial settings. Due to technological advancements, we see new forms of human-robot interaction emerge which are related to different OSH risks and benefits. We present a multifaceted analysis of risks and opportunities regarding robotic systems in the context of task automation in the industrial sector. This includes the scientific perspective through literature review as well as the workers' expectations in form of use case evaluations. Based on the results, with regards to human-centred workplace design and occupational safety and health (OSH), implications for the practical application are derived and presented. For the literature review a selected subset of papers from a systematic review was extracted. Five systematic reviews and meta-analysis (492 primary studies) focused on the topic of task automation via robotic systems and OSH. These were extracted and categorised into physical, psychosocial and organisational factors based on an OSH-factors framework for advanced robotics developed for the European Agency for Safety and Health at Work (EU-OSHA). To assess the workers' perspective, 27 workers from three European manufacturing companies were asked about their expectations regarding benefits and challenges of robotic systems at their workplace. The answers were translated and categorised in accordance with the framework as well. The statements, both from literature and the survey were then analysed according to the qualitative content analysis, to gain additional insight into the underlying structure and trends in them. As a result, new categories were formed deductively. The analysis showed that the framework is capable to help categorise both findings from literature and worker survey into basic categories with good interrater reliability. Regarding the proposed subcategories however, it failed to reflect the complexity of the workers' expectations. The results of the worker evaluation as well as literature findings both predominantly highlight the psychosocial impact these systems may have on workers. Organisational risks or changes are underrepresented in both groups. Workers' initial expectations lean towards a positive impact.
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Affiliation(s)
| | | | | | - Patricia H. Rosen
- Unit Human Factors and Ergonomics, Federal Institute for Occupational Safety and Health, Dortmund, Germany
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Schnake-Mahl AS, Jahn JL, Purtle J, Bilal U. Considering multiple governance levels in epidemiologic analysis of public policies. Soc Sci Med 2022; 314:115444. [PMID: 36274459 PMCID: PMC9896379 DOI: 10.1016/j.socscimed.2022.115444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/04/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
Epidemiology is increasingly asking questions about the use of policies to address structural inequities and intervene on health disparities and public health challenges. However, there has been limited explicit consideration of governance structures in the design of epidemiologic policy analysis. To advance empirical and theoretical inquiry in this space, we propose a model of governance analysis in which public health researchers consider at what level 1) decision-making authority for policy sits, 2) policy is implemented, 3) and accountability for policy effects appear. We follow with examples of how these considerations might improve the evaluation of the policy drivers of population health. Consideration and integration of multiple levels of governance, as well as interactions between levels, can help epidemiologists design studies including new opportunities for quasi-experimental designs and stronger counterfactuals, better quantify the policy drivers of inequities, and aid research evidence and policy development work in targeting multiple levels of governance, ultimately supporting evidence-based policy making.
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Affiliation(s)
- Alina S Schnake-Mahl
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Jaquelyn L Jahn
- The Ubuntu Center on Racism, Global Movements & Population Health Equity, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York University, New York, NY, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Finkelstein DM, Harding JF, Paulsell D, English B, Hijjawi GR, Ng'andu J. Economic Well-Being And Health: The Role Of Income Support Programs In Promoting Health And Advancing Health Equity. Health Aff (Millwood) 2022; 41:1700-1706. [PMID: 36469819 DOI: 10.1377/hlthaff.2022.00846] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
People with low incomes have poorer health outcomes, including greater risk for disease and shorter lifespans. This pattern has the least favorable outcomes for those living in poverty but is present at every level of the income ladder. Income support programs that provide a social safety net for families-including the Earned Income Tax Credit and Temporary Assistance for Needy Families-can influence health by meeting families' basic needs and supporting participation in economic development. However, families face inequitable access to income support programs. States vary in whether they offer the Earned Income Tax Credit, and this can lead to unequal access and participation across groups. Critical challenges for policy makers are identifying barriers to access to and participation in income supports as well as developing strategies to increase equitable access to income supports. This article synthesizes evidence on income and health and its relevance to income supports.
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Affiliation(s)
| | | | - Diane Paulsell
- Diane Paulsell, Abt Associates, Cambridge, Massachusetts
| | | | - Gina R Hijjawi
- Gina R. Hijjawi, Robert Wood Johnson Foundation, Princeton, New Jersey
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8
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Montez JK, Mehri N, Monnat SM, Beckfield J, Chapman D, Grumbach JM, Hayward MD, Woolf SH, Zajacova A. U.S. state policy contexts and mortality of working-age adults. PLoS One 2022; 17:e0275466. [PMID: 36288322 PMCID: PMC9604945 DOI: 10.1371/journal.pone.0275466] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/16/2022] [Indexed: 01/24/2023] Open
Abstract
The rise in working-age mortality rates in the United States in recent decades largely reflects stalled declines in cardiovascular disease (CVD) mortality alongside rising mortality from alcohol-induced causes, suicide, and drug poisoning; and it has been especially severe in some U.S. states. Building on recent work, this study examined whether U.S. state policy contexts may be a central explanation. We modeled the associations between working-age mortality rates and state policies during 1999 to 2019. We used annual data from the 1999-2019 National Vital Statistics System to calculate state-level age-adjusted mortality rates for deaths from all causes and from CVD, alcohol-induced causes, suicide, and drug poisoning among adults ages 25-64 years. We merged that data with annual state-level data on eight policy domains, such as labor and taxes, where each domain was scored on a 0-1 conservative-to-liberal continuum. Results show that the policy domains were associated with working-age mortality. More conservative marijuana policies and more liberal policies on the environment, gun safety, labor, economic taxes, and tobacco taxes in a state were associated with lower mortality in that state. Especially strong associations were observed between certain domains and specific causes of death: between the gun safety domain and suicide mortality among men, between the labor domain and alcohol-induced mortality, and between both the economic tax and tobacco tax domains and CVD mortality. Simulations indicate that changing all policy domains in all states to a fully liberal orientation might have saved 171,030 lives in 2019, while changing them to a fully conservative orientation might have cost 217,635 lives.
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Affiliation(s)
- Jennifer Karas Montez
- Department of Sociology, Syracuse University, Syracuse, NY, United States of America
- * E-mail:
| | - Nader Mehri
- Aging Studies Institute, Syracuse University, Syracuse, NY, United States of America
| | - Shannon M. Monnat
- Department of Sociology, Syracuse University, Syracuse, NY, United States of America
| | - Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, MA, United States of America
| | - Derek Chapman
- Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Jacob M. Grumbach
- Department of Political Science, University of Washington, Seattle, WA, United States of America
| | - Mark D. Hayward
- Department of Sociology, University of Texas at Austin, Austin, TX, United States of America
| | - Steven H. Woolf
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Anna Zajacova
- Department of Sociology, University of Western Ontario, Ontario, CA, United States of America
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9
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Chatterjee P, Lin Y, Venkataramani AS. Changes in economic outcomes before and after rural hospital closures in the United States: A difference-in-differences study. Health Serv Res 2022; 57:1020-1028. [PMID: 35426125 PMCID: PMC9441283 DOI: 10.1111/1475-6773.13988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The objective of this study is to assess changes in local economic outcomes before and after rural hospital closures. DATA SOURCES Rural hospital closures from January 1, 2005, to December 31, 2018, were obtained from the Sheps Center for Health Services Research. Economic outcomes from this same period were obtained from the Bureau of Labor Statistics, Bureau of Economic Analysis, Quarterly Workforce Indicators, U.S. Federal Reserve Economic Data, RAND Corporation state statistics database, U.S. Social Security Administration, and U.S. Census Bureau. DESIGN Difference-in-differences study of 2094 rural counties. DATA COLLECTION/EXTRACTION The primary exposure was county-level rural hospital closures. The primary outcomes were county-level unemployment rates; employment-population ratios; labor force participation-population ratios; per capita income; total jobs; health care sector jobs; disability program participation-population ratios; percent of the population with subprime credit scores; total filings for bankruptcies per 1000 population; and population size. PRINCIPAL FINDINGS A total of 104 rural counties experienced a hospital closure, compared to 1990 rural counties that did not. Rural hospital closures were associated with significant reductions in health care sector employment (-13.8%; 95% CI: -22%, -5.6%; p < 0.001), but not with changes in any other economic measure. For unemployment rates, employment-population ratios, per capita income, disability program participation-population ratios, and total jobs, we found evidence of adverse trends preceding hospital closures. Findings were robust to adjusting for county-specific time trends, specifying exposure at the commuting zone-level, and using alternate definitions of rurality to define sample counties. CONCLUSION With the exception of a decline in jobs within the health care sector, there was no association between rural hospital closures and county-level economic outcomes. Instead, economic conditions were already declining in counties experiencing closures compared to those that did not.
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Affiliation(s)
- Paula Chatterjee
- Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Yuqing Lin
- Department of Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Atheendar S. Venkataramani
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Ethics & Health Policy, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Li P, Ma L, Liu J, Zhang L. Surveillance of Noncommunicable Diseases: Opportunities in the Era of Big Data. HEALTH DATA SCIENCE 2022; 2022:9893703. [PMID: 38487489 PMCID: PMC10878401 DOI: 10.34133/2022/9893703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/12/2022] [Indexed: 03/17/2024]
Affiliation(s)
- Pengfei Li
- Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
- National Institute of Health Data Science, Peking University, Beijing 100191, China
| | - Lin Ma
- Peking University Health Science Center, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Luxia Zhang
- Advanced Institute of Information Technology, Peking University, Hangzhou 311215, China
- National Institute of Health Data Science, Peking University, Beijing 100191, China
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11
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Destri K, Alves J, Gregório MJ, Dias SS, Henriques AR, Mendonça N, Canhão H, Rodrigues AM. Obesity- attributable costs of absenteeism among working adults in Portugal. BMC Public Health 2022; 22:978. [PMID: 35568836 PMCID: PMC9107744 DOI: 10.1186/s12889-022-13337-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/25/2022] [Indexed: 12/23/2022] Open
Abstract
Background Obesity leads to poor health outcomes and may adversely affect work productivity. This study, aimed to investigate the obesity- attributable costs of absenteeism among working adults in Portugal. Methods The study population included individuals actively working at baseline from the Epidemiology of Chronic Diseases Cohort (EpiDoC), a large Portuguese population-based prospective study. Body mass index was measured at baseline and in two follow-up interviews. Absenteeism in each wave of the EpiDoC was assessed by the question “Did you have a sick leave in the previous 12 months? yes/no”, followed by “How many days did you miss work due to sickness in the previous twelve months?”. Body mass index (BMI) was classified into underweight, normal weight, overweight, and obese, based on the standard World Health Organization definition. Association between obesity and absenteeism was estimated with the negative binomial regression model adjusted for BMI, chronic diseases, and lifestyle. Obesity- attributable costs were calculated using lost gross income during the time absent from work, through the human-capital approach. Results The EpiDoC included 4338 working adults at baseline. Of these, 15.2% were obese at the beginning of the study and 22.7% of the population had been absent from work in the last 12 months. Participants with obesity missed 66% more days at work (IRR: 1.66; CI 95%:1.13–2.44; (p = 0.009.) than those with normal weight. The odds of having been absent from work were 1.4 times higher in obese compared to non-obese individuals (CI 95%: 1.18–1.67; p < 0.01) adjusted to sex and type of work. Obese individuals missed 3.8 more days per year than those with normal weight (95%CI: 3.1–4.5). Extrapolating to the entire Portuguese working population, absenteeism due to obesity incurred an additional cost of €238 million per year. Conclusion Obesity imposes a financial burden due to absenteeism in Portugal. Employers and national health regulators should seek effective ways to reduce these costs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13337-z.
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Affiliation(s)
- Kelli Destri
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal. .,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Joana Alves
- Comprehensive Health Research Center (CHRC), NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria João Gregório
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,Programa Nacional Para a Promoção da Alimentação Saudável, Direção-Geral da Saúde, Lisbon, Portugal.,Faculdade de Ciências da Nutrição E Alimentação, Universidade Do Porto, Porto, Portugal
| | - Sara Simões Dias
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,Center for Innovative Care and Health Technology, CiTechCare, Instituto Politécnico de Leiria/Escola Superior de Saúde, Leiria, Portugal
| | - Ana Rita Henriques
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Nuno Mendonça
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,National School of Public Health, UNL, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, 1169-056, Lisboa, Portugal.,EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Hospital Dos Lusíadas, Lisboa, Portugal
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12
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Tucker JS, Davis JP, Perez LG, Klein DJ, D’Amico EJ. Late Adolescent Predictors of Homelessness and Food Insecurity During Emerging Adulthood. J Adolesc Health 2022; 70:736-742. [PMID: 34903427 PMCID: PMC9038616 DOI: 10.1016/j.jadohealth.2021.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/06/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Economic instability is a significant and growing problem among emerging adults in the U.S. This study identifies adolescent factors across multiple levels of influence that predict homelessness and food insecurity 5 years later. METHODS The analytic sample (n = 2,110) completed a survey in 2015-2016 (mean age 17) that assessed a range of demographic, behavioral health, family, peer, academic, and neighborhood factors, and a follow-up survey in 2019-2020 (mean age 23) that assessed past-year homelessness and food insecurity. Logistic regression analyses were conducted for the full sample, and by race/ethnicity. RESULTS At follow-up, 7.5% of participants reported homelessness, and 29.3% reported food insecurity. Multivariate analyses indicated that only adverse childhood experiences and weaker academic orientation predicted both outcomes. Future homelessness was additionally predicted by greater exposure to substance using peers during adolescence. Identifying as Hispanic, lower maternal education, and greater neighborhood disorganization were risk factors for future food insecurity, and living with both biological parents and better mental health were protective factors. Race/ethnicity stratified models showed variations in multilevel predictors of both outcomes, except for adverse childhood experiences, which were significant across all subgroups. CONCLUSIONS Adverse childhood experiences and weaker academic orientation emerged as the most robust predictors of economic instability in emerging adulthood. However, a range of other modifiable multilevel predictors in adolescence were identified that were unique to homelessness or food insecurity and that varied by race/ethnicity. Results suggest the need for multilevel approaches early in life to reduce risk of economic instability during emerging adulthood.
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Affiliation(s)
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute for Addiction Science, University of Southern California
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13
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Ortiz R, Joseph JJ, Branas CC, MacDonald JM, Nguemeni Tiako MJ, Oyekanmi K, South EC. Advancing health equity through integrated biology and population health research: A community-based sample cortisol feasibility and exploratory study. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100145. [PMID: 35757172 PMCID: PMC9228000 DOI: 10.1016/j.cpnec.2022.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 12/21/2022] Open
Abstract
Background Community-based research inclusive of self-assessment and objective environmental metrics can be enhanced by the collection of biomarker data in unity toward assessing the health impacts of the totality of environmental stress driven by structural racism. Cortisol dynamic range (CDR), a measure of chronic stress burden, may underpin place-based connections to health, but a gap remains in elucidating community-based CDR methodology. Purpose To 1) assess the feasibility of cortisol collection and CDR measurement in a community-based study with home-based, participant-directed specimen collection, and 2) explore the association between CDR and other individual and environmental measures in a sample of predominantly Black participants. Methods: In this cross-sectional, observational study in predominantly Black urban neighborhoods, participants (n = 73) completed health assessments and in-home, self-collected salivary cortisol. For feasibility, CDR (peak-nadir) was compared to cortisol awakening response (CAR) slope over time. Comparisons of CDR quartile by person and place variables were explored (ANOVA). Results The cohort (77% Black, 39.7% <$15 k/year income, high perceived stress) completed 98.6% of cortisol collection timepoints. CDR was calculated in all participants without interruptions to sleep-wake cycle as seen with CAR collection. Participants in the lowest quartile of CDR were the oldest (p = 0.03) with lowest reported mental health (p = 0.048) with no associations seen for CAR. Conclusion Participant-collected 10.13039/501100011622CDR is more feasible than cortisol measures dependent on slopes over time in a community-based, predominately Black cohort with exploratory findings supporting relevance to outcomes of interest to future work. Future community-based studies should integrate CDR with environment and psychosocial measures. Biological and social metrics can enhance community studies of structural racism. Cortisol dynamic range (CDR) may reflect the burden of chronic stress in a community. In-home, participant-collected salivary cortisol is feasible with in-field guidance. CDR may be more feasible in community-based study than measures dependent on time. Greatest CDR is seen with youngest age and best self-reported mental health.
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Affiliation(s)
- Robin Ortiz
- Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
- Institute for Excellence in Health Equity, New York University Langone Health, New York, Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, 1300 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Corresponding author. Departments of Pediatrics and Population Health, New York University, Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA
| | - Joshua J. Joseph
- The Ohio State University, Wexner Medical Center, Division of Endocrinology, Diabetes and Metabolism, 579 McCampbell Hall, Columbus, OH, 43210, USA
| | - Charlie C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm 1508, New York, NY, 10032, USA
| | - John M. MacDonald
- Department of Criminology, School of Arts and Sciences, University of Pennsylvania, 558 McNeil Building, Locus Walk, Philadelphia, PA, 19104, USA
| | | | - Kehinde Oyekanmi
- Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Urban Health Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Eugenia C. South
- Department of Emergency Medicine, University of Pennsylvania, Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Urban Health Lab, University of Pennsylvania, Philadelphia, PA, 19104, USA
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14
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Brand-Correa L, Brook A, Büchs M, Meier P, Naik Y, O'Neill DW. Economics for people and planet-moving beyond the neoclassical paradigm. Lancet Planet Health 2022; 6:e371-e379. [PMID: 35397225 PMCID: PMC9226380 DOI: 10.1016/s2542-5196(22)00063-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 05/26/2023]
Abstract
Despite substantial attention within the fields of public and planetary health on developing an economic system that benefits both people's health and the environment, heterodox economic schools of thought have received little attention within these fields. Ecological economics is a school of thought with particular relevance to public and planetary health. In this article, we discuss implications of key ecological economics ideas for public and planetary health, especially those related to critiques of gross domestic product as a measure of progress and economic growth as the dominant goal for economic and policy decision making. We suggest that ecological economics aligns well with public health goals, including concern for equality and redistribution. Ecological economics offers an opportunity to make the transition to an economic system that is designed to promote human and planetary health from the outset, rather than one where social and environmental externalities must be constantly corrected after the fact. Important ideas from ecological economics include the use of a multidimensional framework to evaluate economic and social performance, the prioritisation of wellbeing and environmental goals in decision making, policy design and evaluation that take complex relationships into account, and the role of provisioning systems (the physical and social systems that link resource use and social outcomes). We discuss possible interventions at the national scale that could promote public health and that align with the prioritisation of social and ecological objectives, including universal basic income or services and sovereign money creation. Overall, we lay the foundations for additional integration of ecological economics principles and pluralist economic thinking into public and planetary health scholarship and practice.
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Affiliation(s)
- Lina Brand-Correa
- Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada; Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
| | - Anna Brook
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Milena Büchs
- Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Yannish Naik
- School of Health and Related Research, University of Sheffield, Sheffield, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel W O'Neill
- Sustainability Research Institute, School of Earth and Environment, University of Leeds, Leeds, UK
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15
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Kilbourne AM, Garrido MM, Brown A. Translating Research into Policy and Action. Health Serv Res 2022; 57 Suppl 1:5-8. [PMID: 35362119 PMCID: PMC9108221 DOI: 10.1111/1475-6773.13980] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Amy M Kilbourne
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs.,Department of Learning Health Sciences, University of Michigan
| | - Melissa M Garrido
- Partnered Evidence-based Policy Resource Center, VA Boston Healthcare System.,Department of Health Law, Policy and Management, Boston University School of Public Health
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, UCLA School of Medicine.,Olive View-UCLA Medical Center
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16
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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17
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O'Brien R, Bair EF, Venkataramani AS. Death by Robots? Automation and Working-Age Mortality in the United States. Demography 2022; 59:607-628. [PMID: 35195250 DOI: 10.1215/00703370-9774819] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to "deaths of despair." Increasing automation-the use of industrial robots to perform tasks previously done by human workers-is one structural force driving the decline of manufacturing jobs and wages. In this study, we examine the impact of automation on age- and sex-specific mortality. Using exogenous variation in automation to support causal inference, we find that increases in automation over the period 1993-2007 led to substantive increases in all-cause mortality for both men and women aged 45-54. Disaggregating by cause, we find evidence that automation is associated with increases in drug overdose deaths, suicide, homicide, and cardiovascular mortality, although patterns differ by age and sex. We further examine heterogeneity in effects by safety net program generosity, labor market policies, and the supply of prescription opioids.
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Affiliation(s)
- Rourke O'Brien
- Department of Sociology and Institution for Social and Policy Studies, Yale University, New Haven, CT, USA
| | - Elizabeth F Bair
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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18
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Spencer RA, Lemon ED, Komro KA, Livingston MD, Woods-Jaeger B. Women's Lived Experiences with Temporary Assistance for Needy Families (TANF): How TANF Can Better Support Women's Wellbeing and Reduce Intimate Partner Violence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1170. [PMID: 35162193 PMCID: PMC8834626 DOI: 10.3390/ijerph19031170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 02/04/2023]
Abstract
Women experiencing poverty are more likely to face intimate partner violence (IPV), poor health, and stigma. IPV survivors are overrepresented among those who receive Temporary Assistance for Needy Families (TANF), a conditional cash program serving families experiencing poverty. More generous TANF policies may be protective against IPV, but a greater insight into TANF's effect could be gleaned through a contemporaneous study that examines intersecting determinants of wellbeing and engages community interpretation of findings. Using an adapted Family Stress Model framework and analyzing data through an intersectional and community-based lens, we explore the impact of TANF on women's wellbeing through in-depth, semi-structured interviews during the COVID-19 pandemic with 13 women who had TANF experience in three U.S. states. Data were analyzed using thematic analysis in MAXQDA and researchers facilitated three member-checking events to enhance validity of result interpretation. Four themes emerged: (1) Low cash and conditional benefits provided limited short-term "relief" but contributed to poverty and hard choices; (2) TANF benefit levels and conditions increased women's dependence on others, straining relationships; (3) Women undertook extraordinary measures to access TANF, largely to fulfill their roles as mothers; and (4) TANF stigma creates psychological stress, differentially experienced by African Americans. Increasing TANF cash benefits and other cash transfers for those experiencing poverty, adopting solely state funded TANF programs, increasing funding for TANF administration, addressing TANF stigma and racialized narratives, and allowing optional child support participation or a larger "pass-through" of child support are important steps toward making TANF more protective against IPV.
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Affiliation(s)
- Rachael A. Spencer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA
| | - Emily D. Lemon
- Department of Behavioral, Social, & Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA; (E.D.L.); (K.A.K.); (M.D.L.); (B.W.-J.)
| | - Kelli A. Komro
- Department of Behavioral, Social, & Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA; (E.D.L.); (K.A.K.); (M.D.L.); (B.W.-J.)
| | - Melvin D. Livingston
- Department of Behavioral, Social, & Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA; (E.D.L.); (K.A.K.); (M.D.L.); (B.W.-J.)
| | - Briana Woods-Jaeger
- Department of Behavioral, Social, & Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA 30329, USA; (E.D.L.); (K.A.K.); (M.D.L.); (B.W.-J.)
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19
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Hiam L, Minton J, McKee M. What can lifespan variation reveal that life expectancy hides? Comparison of five high-income countries. J R Soc Med 2021; 114:389-399. [PMID: 33955790 PMCID: PMC8358556 DOI: 10.1177/01410768211011742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/04/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In most countries, life expectancy at birth (e0) has improved for many decades. Recently, however, progress has stalled in the UK and Canada, and reversed in the USA. Lifespan variation, a complementary measure of mortality, increased a few years before the reversal in the USA. To assess whether this measure offers additional meaningful insights, we examine what happened in four other high-income countries with differing life expectancy trends. DESIGN We calculated life disparity (a specific measure of lifespan variation) in five countries -- USA, UK, France, Japan and Canada -- using sex- and age specific mortality rates from the Human Mortality Database from 1975 to 2017 for ages 0--100 years. We then examined trends in age-specific mortality to identify the age groups contributing to these changes. SETTING USA, UK, France, Japan and Canada. PARTICIPANTS aggregate population data of the above nations. MAIN OUTCOME MEASURES Life expectancy at birth, life disparity and age-specific mortality. RESULTS The stalls and falls in life expectancy, for both males and females, seen in the UK, USA and Canada coincided with rising life disparity. These changes may be driven by worsening mortality in middle-age (such as at age 40). France and Japan, in contrast, continue on previous trajectories. CONCLUSIONS Life disparity is an additional summary measure of population health providing information beyond that signalled by life expectancy at birth alone.
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Affiliation(s)
- Lucinda Hiam
- School of Geography and the Environment, University of Oxford, Oxford OX1 3QY, UK
| | - Jon Minton
- Public Health Scotland, Edinburgh, Scotland
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
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20
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Data Sources for Understanding the Social Determinants of Health: Examples from Two Middle-Income Countries: the 3-D Commission. J Urban Health 2021; 98:31-40. [PMID: 34472014 PMCID: PMC8409472 DOI: 10.1007/s11524-021-00558-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 01/05/2023]
Abstract
The expansion in the scope, scale, and sources of data on the wider social determinants of health (SDH) in the last decades could bridge gaps in information available for decision-making. However, challenges remain in making data widely available, accessible, and useful towards improving population health. While traditional, government-supported data sources and comparable data are most often used to characterize social determinants, there are still capacity and management constraints on data availability and use. Conversely, privately held data may not be shared. This study reviews and discusses the nature, sources, and uses of data on SDH, with illustrations from two middle-income countries: Kenya and the Philippines. The review highlights opportunities presented by new data sources, including the use of big data technologies, to capture data on social determinants that can be useful to inform population health. We conducted a search between October 2010 and September 2020 for grey and scientific publications on social determinants using a search strategy in PubMed and a manual snowball search. We assessed data sources and the data environment in both Kenya and the Philippines. We found limited evidence of the use of new sources of data to study the wider SDH, as most of the studies available used traditional sources. There was also no evidence of qualitative big data being used. Kenya has more publications using new data sources, except on the labor determinant, than the Philippines. The Philippines has a more consistent distribution of the use of new data sources across the HEALTHY determinants than Kenya, where there is greater variation of the number of publications across determinants. The results suggest that both countries use limited SDH data from new data sources. This limited use could be due to a number of factors including the absence of standardized indicators of SDH, inadequate trust and acceptability of data collection methods, and limited infrastructure to pool, analyze, and translate data.
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21
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Islami F, Fedewa SA, Thomson B, Nogueira L, Yabroff KR, Jemal A. Association between disparities in intergenerational economic mobility and cause-specific mortality among Black and White persons in the United States. Cancer Epidemiol 2021; 74:101998. [PMID: 34364819 DOI: 10.1016/j.canep.2021.101998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence about the association between structural racism and mortality in the United States is limited. We examined the association between ongoing structural racism, measured as inequalities in adulthood income between White and Black children with similar parental household income (economic mobility gap) in a recent birth cohort, and Black-White disparities in death rates (mortality gap) overall and for major causes. METHODS Sex-, race/ethnicity-, and county-specific data were used to examine sex-specific associations between economic mobility and mortality gaps for all causes combined, heart diseases, cerebrovascular diseases, chronic obstructive pulmonary disease (COPD), injury/violence, all malignant cancers, and 14 cancer types. Economic mobility data for 1978-1983 birth cohorts and death rates during 2011-2018 were obtained from the Opportunity Atlas and National Center for Health Statistics, respectively. Data from 471 counties were included in analyses of all-cause mortality at ages 30-39 years during 2011-2018 (corresponding to partially overlapping 1978-1983 birth cohorts); and from 1,572 and 1,248 counties in analyses of all-cause and cause-specific mortality in all ages combined, respectively. RESULTS In ages 30-39 years, a one percentile increase in the economic mobility gap was associated with a 6.8 % (95 % confidence interval 1.8 %-11.8 %) increase in the Black-White mortality gap among males and a 13.5 % (8.9 %-18.1 %) increase among females, based on data from 471 counties. In all ages combined, the corresponding percentages based on data from 1,572 counties were 10.2 % (7.2 %-13.2 %) among males and 14.8 % (11.4 %-18.2 %) among females, equivalent to an increase of 18.4 and 14.0 deaths per 100,000 in the mortality gap, respectively. Similarly, strong associations between economic mobility gap and mortality gap in all ages were found for major causes of death, notably for potentially preventable conditions, including COPD, injury/violence, and cancers of the lung, liver, and cervix. CONCLUSIONS Economic mobility gap conditional on parental income in a recent birth cohort as a marker of ongoing structural racism is strongly associated with Black-White disparities in all-cause mortality and mortality from several causes.
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Affiliation(s)
- Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States.
| | - Stacey A Fedewa
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - Blake Thomson
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - Leticia Nogueira
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - K Robin Yabroff
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, United States
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22
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Venkataramani AS, O'Brien R, Tsai AC. Declining Life Expectancy in the United States: The Need for Social Policy as Health Policy. JAMA 2021; 325:621-622. [PMID: 33591352 DOI: 10.1001/jama.2020.26339] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Rourke O'Brien
- Department of Sociology, Yale University, New Haven, Connecticut
- Institution for Social and Policy Studies, Yale University, New Haven, Connecticut
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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23
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Tsai AC, Venkataramani AS. US elections: treating the acute-on-chronic decompensation. LANCET PUBLIC HEALTH 2020; 5:e519-e520. [PMID: 33007207 PMCID: PMC7524534 DOI: 10.1016/s2468-2667(20)30212-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA.
| | - Atheendar S Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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