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Boateng S, Ameyaw P, Gyabaah S, Adjepong Y, Njei B. Recipient functional status impacts on short and long-term intestinal transplant outcomes in United States adults. World J Transplant 2024; 14:93561. [PMID: 39295973 PMCID: PMC11317861 DOI: 10.5500/wjt.v14.i3.93561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/27/2024] [Accepted: 06/13/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Recipient functional status prior to transplantation has been found to impact post-transplant outcomes in heart, liver and kidney transplants. However, information on how functional status, before and after transplant impacts post-transplant survival outcomes is lacking. AIM To investigate the impact of recipient functional status on short and long term intestinal transplant outcomes in United States adults. METHODS We conducted a retrospective cohort study on 1254 adults who underwent first-time intestinal transplantation from 2005 to 2022. The primary outcome was mortality. Using the Karnofsky Performance Status, functional impairment was categorized as severe, moderate and normal. Analyses were conducted using Kaplan-Meier curves and multivariable Cox regression. RESULTS The median age was 41 years, majority (53.4%) were women. Severe impairment was present in 28.3% of recipients. The median survival time was 906.6 days. The median survival time was 1331 and 560 days for patients with normal and severe functional impairment respectively. Recipients with severe impairment had a 56% higher risk of mortality at one year [Hazard ratio (HR) = 1.56; 95%CI: 1.23-1.98; P < 0.001] and 58% at five years (HR = 1.58; 95%CI: 1.24-2.00; P < 0.001) compared to patients with no functional impairment. Recipients with worse functional status after transplant also had poor survival outcomes. CONCLUSION Pre- and post-transplant recipient functional status is an important prognostic indicator for short- and long-term intestinal transplant outcomes.
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Affiliation(s)
- Sarpong Boateng
- Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, United States
- Department of Epidemiology and Biostatistics, University of North Texas, Fort Worth, TX 76107, United States
| | - Prince Ameyaw
- Department of Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT 06610, United States
| | - Solomon Gyabaah
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi KS 1934, Ghana
| | - Yaw Adjepong
- Yale University School of Medicine, New Haven, CT 06520, United States
| | - Basile Njei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06520, United States
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Chang JC, Liu JP, Berbert LM, Chandler MT, Patel PN, Smitherman EA, Weller EA, Son MBF, Costenbader KH. Racial and Ethnic Composition of Populations Served by Freestanding Children's Hospitals and Disparities in Outcomes of Pediatric Lupus. Arthritis Care Res (Hoboken) 2024; 76:926-935. [PMID: 38374576 PMCID: PMC11209814 DOI: 10.1002/acr.25314] [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: 09/25/2023] [Revised: 01/16/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Health disparities may be driven by hospital-level factors. We assessed whether racial and ethnic composition of populations hospitals serve explain or modify disparities in hospital outcomes of children with systemic lupus erythematosus (SLE). METHODS In this retrospective cohort study of patients 5 to 26 years old with SLE at 47 children's hospitals in the Pediatric Health Information System (2006-2021), race and ethnicity were assessed at the patient level and hospital level (proportion of total admissions composed of Black or Hispanic patients, respectively). Outcomes included intensive care unit (ICU) admission or adverse renal outcome (end-stage renal disease, dialysis, or transplant) during follow-up. We estimated racial and ethnic disparities, adjusted or stratified by hospital racial or ethnic composition. RESULTS Of 8,125 patients with SLE, 2,293 (28%) required ICU admission, and 698 (9%) had an adverse renal outcome. Black and non-Hispanic White disparities in ICU admission were observed only at hospitals serving higher proportions of Black patients (odds ratio [OR] 1.29, 95% confidence interval [95% CI] 1.04-1.59 vs OR 1.07, 95% CI 0.83-1.38). Larger Black and non-Hispanic White disparities in adverse renal outcomes were observed at hospitals with higher Black racial composition (OR 2.0, 95% CI 1.4-2.8 vs OR 1.7, 95% CI 1.1-2.4). Conversely, Hispanic versus non-Hispanic disparities in renal outcomes persisted after adjustment for hospital-reported Hispanic ethnic composition but were observed only at hospitals with lower proportions of Hispanic patients. CONCLUSION Worse Black and White disparities in SLE outcomes are observed at children's hospitals serving more Black children, whereas distinct patterns are observed for Hispanic and non-Hispanic disparities. Reporting of hospital characteristics related to populations served is needed to identify modifiable drivers of hospital-level variation.
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Affiliation(s)
- Joyce C Chang
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica P Liu
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura M Berbert
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mia T Chandler
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pooja N Patel
- Lurie Children's Hospital and Northwestern University, Chicago, Illinois
| | | | - Edie A Weller
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mary Beth F Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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Soto-Vásquez AD, Gonzalez AA, Garza Garza E, Shi W, Garcia N. The Cultural Influence of Familismo in Prompting Vaccination Against COVID-19 Among U.S. Latina/o/x Border Residents. HEALTH COMMUNICATION 2024:1-11. [PMID: 38744433 DOI: 10.1080/10410236.2024.2353418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
This study centers on familismo as a relevant cultural construct that adds a U.S. Latina/o/x perspective to the Health Belief Model. Employing a qualitative lens, we use in-depth semi-structured focus groups and interviews with participants living, working, and attending school in a mid-size city on the U.S./Mexico border on the decision to take the COVID-19 vaccine. We find that, for many members of these communities, getting vaccinated is seen as a way to protect not only oneself but also one's family, especially those with chronic health conditions, reflecting an obligation to prioritize the collective over the individual. We highlight various approaches that families take to discuss COVID-19 vaccines, ranging from women coordinating vaccination to a non-confrontational approach to the unvaccinated. The borderlands as a place also showcase the diversity of the U.S. Latina/o/x experience during the pandemic, since the perceived disparities of vaccine access in Mexico also seemed to cue the decision to get vaccinated. We propose this helps explain the exceptionally high vaccination rate in the city under study and seen in several other border communities. By illuminating how familial ties impact health communication surrounding this important issue, this study adds an expanded Latina/o/x cultural context for aspects of the Health Belief Model such as perceived severity and susceptibility.
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Affiliation(s)
| | - Ariadne A Gonzalez
- Department of Psychology and Communication, Texas A&M International University
| | - Edith Garza Garza
- Department of Psychology and Communication, Texas A&M International University
| | - Wanzhu Shi
- Department of Political Science and Public Administration, University of North Florida
| | - Nilda Garcia
- Department of Social Sciences, Texas A&M International University
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Santaularia NJ, Hunt SL, Bonilla Z. Exploring the Links Between Immigration and Birth Outcomes Among Latine Birthing Persons in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01999-x. [PMID: 38713369 DOI: 10.1007/s40615-024-01999-x] [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: 10/10/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines-regardless of citizenship status and increasing rates of preterm birth and low birth weight infants. METHODS AND RESULTS We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy. CONCLUSION Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
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Affiliation(s)
- N Jeanie Santaularia
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Shanda Lee Hunt
- University Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Phillips-Bell GS, Mohamoud YA, Kirby RS, Parks SE, Cozier YC, Shapiro-Mendoza CK. Neighborhood Deprivation and Privilege: an Examination of Racialized-Economic Segregation and Preterm Birth, Florida 2019. J Racial Ethn Health Disparities 2024; 11:72-80. [PMID: 36652162 PMCID: PMC10352457 DOI: 10.1007/s40615-022-01498-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: 10/03/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023]
Abstract
The Black-White disparity in preterm birth persists and is not fully explained by individual-level social, behavioral, or clinical risk factors. Consequently, there is increasing emphasis on understanding the role of structural and area-level factors. Racialized-economic segregation measured as the index of concentration at the extremes (ICE) simultaneously captures extremes of deprivation and privilege. Our objective was to examine associations between preterm birth (PTB) and the index of concentration at the extremes (ICE). In this cross-sectional study, we analyzed 193,957 Florida birth records from 2019 linked to 2015-2019 census tract data from the American Community Survey. We assessed PTB (< 37 weeks gestation) by subtypes: (1) early (< 34 weeks) and late (34-36 weeks) and (2) spontaneous and indicated (i.e., provider-initiated) deliveries. We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for three ICE measures: (1) ICE_INC: income, (2) INC_INC + WB: income + race/ethnicity (non-Hispanic White vs. Black), and (3) INC_INC + WH: income + race/ethnicity (non-Hispanic White vs. Hispanic). Results. For ICE_INC and INC_INC + WB, aORs for residing in the worst-off vs. best-off areas were 1.25 (95% CI: 1.12, 1.46) and 1.21 (95% CI: 1.07, 1.37) for early PTB, respectively, and 1.16 (95% CI: 1.05, 1.28) to 1.22 (95% CI: 1.12, 1.34) for indicated PTB. In conclusion, deprivation captured by ICE was associated with increased odds of early or indicated PTB. Eliminating PTB disparities may require a multifaceted approach that includes addressing the interplay between income and race/ethnicity in residential areas.
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Affiliation(s)
- Ghasi S Phillips-Bell
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA.
| | - Yousra A Mohamoud
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
| | - Russell S Kirby
- University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL, 33612, USA
| | - Sharyn E Parks
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
| | - Yvette C Cozier
- Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Carrie K Shapiro-Mendoza
- Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S-1072, Atlanta, GA, 30341, USA
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April-Sanders AK, Karaboyas A, Yunes M, Norris KC, Dominguez M, Kim RS, Isasi CR, Golestaneh L. Receiving hemodialysis in Hispanic ethnic dense communities is associated with better adherence and outcomes among young patients: a retrospective analysis of the Dialysis Outcomes and Practice Patterns Study. BMC Nephrol 2023; 24:263. [PMID: 37670225 PMCID: PMC10478353 DOI: 10.1186/s12882-023-03297-w] [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: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Hispanic ethnic density (HED) is a marker of better health outcomes among Hispanic patients with chronic disease. It is unclear whether community HED is associated with mortality risk among ethnically diverse patients receiving maintenance hemodialysis. METHODS A retrospective analysis of patients in the United States cohort of the Dialysis Outcomes and Practice Patterns Study (DOPPS) database (2011-2015) was conducted (n = 4226). DOPPS data was linked to the American Community Survey database by dialysis facility zip code to obtain % Hispanic residents (HED). One way ANOVA and Kruskal Wallis tests were used to estimate the association between tertiles of HED with individual demographic, clinical and adherence characteristics, and facility and community attributes. Multivariable Cox proportional hazards models were used to estimate the mortality hazard ratio (HR) and 95% CIs by tertile of HED, stratified by age; a sandwich estimator was used to account for facility clustering. RESULTS Patients dialyzing in facilities located in the highest HED tertile communities were younger (61.4 vs. 64.4 years), more commonly non-White (62.4% vs. 22.1%), had fewer comorbidities, longer dialysis vintage, and were more adherent to dialysis treatment, but had fewer minutes of dialysis prescribed than those in the lowest tertile. Dialyzing in the highest HED tertile was associated with lower hazard of mortality (HR, 0.86; 95% CI, 0.72-1.00), but this association attenuated with the addition of individual race/ethnicity (HR, 0.92; 95% CI, 0.78-1.09). In multivariable age-stratified analyses, those younger than 64 showed a lower hazard for mortality in the highest (vs. lowest) HED tertile (HR, 0.66; 95% CI, 0.49-0.90). Null associations were observed among patients ≥ 64 years. CONCLUSIONS Treating in communities with greater HED and racial/ethnic integration was associated with lower mortality among younger patients which points to neighborhood context and social cohesion as potential drivers of improved survival outcomes for patients receiving hemodialysis.
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Affiliation(s)
- Ayana K April-Sanders
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, 683 Hoes Lane West Piscataway, 08854, NJ, USA.
| | | | - Milagros Yunes
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Keith C Norris
- Division of General Internal Medicine and Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Mary Dominguez
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Ryung S Kim
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, 10461, Bronx, NY, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, 10461, Bronx, NY, USA
| | - Ladan Golestaneh
- Renal Division, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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Sullivan BA, Doshi A, Chernyavskiy P, Husain A, Binai A, Sahni R, Fairchild KD, Moorman JR, Travers CP, Vesoulis ZA. Neighborhood Deprivation and Association With Neonatal Intensive Care Unit Mortality and Morbidity for Extremely Premature Infants. JAMA Netw Open 2023; 6:e2311761. [PMID: 37166800 PMCID: PMC10176121 DOI: 10.1001/jamanetworkopen.2023.11761] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/20/2023] [Indexed: 05/12/2023] Open
Abstract
Importance Socioeconomic status affects pregnancy and neurodevelopment, but its association with hospital outcomes among premature infants is unknown. The Area Deprivation Index (ADI) is a validated measure of neighborhood disadvantage that uses US Census Bureau data on income, educational level, employment, and housing quality. Objective To determine whether ADI is associated with neonatal intensive care unit (NICU) mortality and morbidity in extremely premature infants. Design, Setting, and Participants This retrospective cohort study was performed at 4 level IV NICUs in the US Northeast, Mid-Atlantic, Midwest, and South regions. Non-Hispanic White and Black infants with gestational age of less than 29 weeks and born between January 1, 2012, and December 31, 2020, were included in the analysis. Addresses were converted to census blocks, identified by Federal Information Processing Series codes, to link residences to national ADI percentiles. Exposures ADI, race, birth weight, sex, and outborn status. Main Outcomes and Measures In the primary outcome, the association between ADI and NICU mortality was analyzed using bayesian logistic regression adjusted for race, birth weight, outborn status, and sex. Risk factors were considered significant if the 95% credible intervals excluded zero. In the secondary outcome, the association between ADI and NICU morbidities, including late-onset sepsis, necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (IVH), were also analyzed. Results A total of 2765 infants with a mean (SD) gestational age of 25.6 (1.7) weeks and mean (SD) birth weight of 805 (241) g were included in the analysis. Of these, 1391 (50.3%) were boys, 1325 (47.9%) reported Black maternal race, 498 (18.0%) died before NICU discharge, 692 (25.0%) developed sepsis or NEC, and 353 (12.8%) had severe IVH. In univariate analysis, higher median ADI was found among Black compared with White infants (77 [IQR, 45-93] vs 57 [IQR, 32-77]; P < .001), those who died before NICU discharge vs survived (71 [IQR, 45-89] vs 64 [IQR, 36-86]), those with late-onset sepsis or NEC vs those without (68 [IQR, 41-88] vs 64 [IQR, 35-86]), and those with severe IVH vs those without (69 [IQR, 44-90] vs 64 [IQR, 36-86]). In a multivariable bayesian logistic regression model, lower birth weight, higher ADI, and male sex were risk factors for mortality (95% credible intervals excluded zero), while Black race and outborn status were not. The ADI was also identified as a risk factor for sepsis or NEC and severe IVH. Conclusions and Relevance The findings of this cohort study of extremely preterm infants admitted to 4 NICUs in different US geographic regions suggest that ADI was a risk factor for mortality and morbidity after adjusting for multiple covariates.
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Affiliation(s)
- Brynne A. Sullivan
- Division of Neonatology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Ayush Doshi
- currently a medical student at University of Virginia School of Medicine, Charlottesville
| | - Pavel Chernyavskiy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | - Ameena Husain
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Alexandra Binai
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Rakesh Sahni
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Karen D. Fairchild
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - J. Randall Moorman
- Division of Cardiology, Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Colm P. Travers
- Division of Neonatology, Department of Pediatrics, University of Alabama at Birmingham
| | - Zachary A. Vesoulis
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
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Parchem JG, Rice MM, Grobman WA, Bailit JL, Wapner RJ, Debbink MP, Thorp JM, Caritis SN, Prasad M, Tita ATN, Saade GR, Sorokin Y, Rouse DJ, Tolosa JE. Racial and Ethnic Disparities in Adverse Perinatal Outcomes at Term. Am J Perinatol 2023; 40:557-566. [PMID: 34058765 PMCID: PMC8630098 DOI: 10.1055/s-0041-1730348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aimed to evaluate whether racial and ethnic disparities in adverse perinatal outcomes exist at term. STUDY DESIGN We performed a secondary analysis of a multicenter observational study of 115,502 pregnant patients and their neonates (2008-2011). Singleton, nonanomalous pregnancies delivered from 37 to 41 weeks were included. Race and ethnicity were abstracted from the medical record and categorized as non-Hispanic White (White; referent), non-Hispanic Black (Black), non-Hispanic Asian (Asian), or Hispanic. The primary outcome was an adverse perinatal composite defined as perinatal death, Apgar score < 4 at 5 minutes, ventilator support, hypoxic-ischemic encephalopathy, subgaleal hemorrhage, skeletal fracture, infant stay greater than maternal stay (by ≥ 3 days), brachial plexus palsy, or facial nerve palsy. RESULTS Of the 72,117 patients included, 48% were White, 20% Black, 5% Asian, and 26% Hispanic. The unadjusted risk of the primary outcome was highest for neonates of Black patients (3.1%, unadjusted relative risk [uRR] = 1.16, 95% confidence interval [CI]: 1.04-1.30), lowest for neonates of Hispanic patients (2.1%, uRR = 0.80, 95% CI: 0.71-0.89), and no different for neonates of Asian (2.6%), compared with those of White patients (2.7%). In the adjusted model including age, body mass index (BMI), smoking, obstetric history, and high-risk pregnancy, differences in risk for the primary outcome were no longer observed for neonates of Black (adjusted relative risk [aRR] = 1.06, 95% CI: 0.94-1.19) and Hispanic (aRR = 0.92, 95% CI: 0.81-1.04) patients. Adding insurance to the model lowered the risk for both groups (aRR = 0.85, 95% CI: 0.75-0.96 for Black; aRR = 0.68, 95% CI: 0.59-0.78 for Hispanic). CONCLUSION Although neonates of Black patients have the highest frequency of adverse perinatal outcomes at term, after adjustment for sociodemographic factors, this higher risk is no longer observed, suggesting the importance of developing strategies that address social determinants of health to lessen extant health disparities. KEY POINTS · Term neonates of Black patients have the highest crude frequency of adverse perinatal outcomes.. · After adjustment for confounders, higher risk for neonates of Black patients is no longer observed.. · Disparities in outcomes are strongly related to insurance status..
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Affiliation(s)
- Jacqueline G Parchem
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, and Children's Memorial Hermann Hospital, Houston, Texas
| | | | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
| | - Jennifer L Bailit
- Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio
| | - Ronald J Wapner
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Michelle P Debbink
- Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John M Thorp
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steve N Caritis
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mona Prasad
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Alan T N Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - George R Saade
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
| | - Yoram Sorokin
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
| | - Dwight J Rouse
- Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island
| | - Jorge E Tolosa
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
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Maldonado LE, Farzan SF, Toledo-Corral CM, Dunton GF, Habre R, Eckel SP, Johnson M, Yang T, Grubbs BH, Lerner D, Chavez T, Breton CV, Bastain TM. A Vegetable, Oil, and Fruit Dietary Pattern in Late Pregnancy is Linked to Reduced Risks of Adverse Birth Outcomes in a Predominantly Low-Income Hispanic and Latina Pregnancy Cohort. J Nutr 2023; 152:2837-2846. [PMID: 36055799 PMCID: PMC9840002 DOI: 10.1093/jn/nxac209] [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] [Received: 05/11/2022] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies examining diet and its links to birth outcomes among socioeconomically disadvantaged populations in the United States are scarce. OBJECTIVES We aimed to identify prenatal dietary patterns, examine their relationships with birth outcomes, and evaluate the variation of these associations by maternal diabetes status [no diabetes, gestational diabetes mellitus (GDM), preexisting diabetes]. METHODS Women in the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) study (n = 465)-an ongoing, prospective pregnancy cohort of predominantly low-income Hispanic/Latina women in Los Angeles-completed up to two 24-hour dietary recalls in the third trimester of pregnancy. We identified prenatal dietary patterns via factor analysis and evaluated their associations with infant birth weight and gestational age at birth (GA) z-scores, separately, using linear regression, as well as the associations of the dietary patterns with premature births, having an infant that was small for gestational age (SGA), and having an infant that was large for gestational age, using logistic regression and adjusting for relevant covariates. We additionally tested interaction terms between prenatal dietary patterns and maternal diabetes status in separate models. We adjusted for multiple comparisons using the false discovery rate. RESULTS We identified 2 dietary patterns: 1) a dietary pattern of solid fats, refined grains, and cheese (SRC); and 2) a dietary pattern of vegetables, oils, and fruit (VOF). Comparing the highest to lowest quartiles, the VOF was significantly associated with a greater infant birth weight (β = 0.40; 95% CIs: 0.10, 0.70; Ptrend = 0.011), a greater GA (β = 0.32; 95% CIs: 0.03, 0.61; Ptrend = 0.036), lower odds of a premature birth (OR = 0.31; 95% CIs: 0.10, 0.95; Ptrend = 0.049), and lower odds of having an infant that was SGA (OR = 0.18; 95% CIs: 0.06, 0.58; Ptrend = 0.028). Only among women with GDM, a 1-SD score increase in the prenatal SRC was significantly associated with a lower infant birth weight (β = -0.20; 95% CIs -0.39, -0.02; Pinteraction = 0.040). CONCLUSIONS Among low-income Hispanic/Latina pregnant women, greater adherence to the prenatal VOF may lower the risk of a premature birth and having an infant that is SGA. Greater adherence to the SRC, however, may adversely affect newborn birth weight among mothers with GDM, but future research is needed to verify our findings.
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Affiliation(s)
- Luis E Maldonado
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shohreh F Farzan
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Claudia M Toledo-Corral
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Health Sciences, California State University, Northridge, Northridge, CA, USA
| | - Genevieve F Dunton
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Rima Habre
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mark Johnson
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tingyu Yang
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brendan H Grubbs
- Department of Obstetrics and Gynecology, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Thomas Chavez
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Carrie V Breton
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Theresa M Bastain
- Department of Population & Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Borrell LN, Bolúmar F, Rodriguez-Alvarez E, Nieves CI. Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox. Soc Sci Med 2022; 315:115527. [PMID: 36442315 DOI: 10.1016/j.socscimed.2022.115527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/09/2022] [Accepted: 11/09/2022] [Indexed: 11/13/2022]
Abstract
In the United States, African American or non-Hispanic Black infants experienced worst birth outcomes whereas Hispanic and Asian infants have intermediate or similar outcomes compared with non-Hispanic white infants. The findings of better birth outcomes for Hispanic women have been coined the "Hispanic Paradox" given their low education, income, and access to care. New York City (NYC) has a great racial/ethnic diversity with implications for neighborhood racial/ethnic composition on birth outcomes by protecting women from psychosocial stress via social support that may buffer against racial/ethnic discrimination and/or racism. Data from 2012 to 2018 were used to examine the association of NYC women's race/ethnicity and neighborhood racial/ethnic minority composition with adverse birth outcomes (low birthweight [LBW], small for gestational age [SGA], preterm birth and infant mortality); and whether the association between mother's race/ethnicity and each birth outcome differed by neighborhood racial/ethnic composition. Multilevel logistic regression was used to control for the clustering of outcomes within neighborhoods. Black, Asian, and American Indian women have poorer birth outcomes than white women. Infants of Mexican American, Central American, and South American women were less likely to be of LBW whereas the opposite was true for infants of Cuban and other Hispanic women compared with infants of white women. When compared with white women, Mexican American, and South American women were less likely to have an SGA infant whereas Puerto Rican and other Hispanic women were more likely to have an SGA infant. All Hispanic women were more likely to have a preterm birth than white women whereas for infant mortality, greater odds of dying were observed for infants of Puerto Rican, Dominican, and other Hispanic women. Higher neighborhood racial/ethnic minority composition was associated with greater odds of having an adverse outcome. Finally, we observed heterogeneity of the associations between mother's race/ethnicity and birth outcomes by neighborhood racial/ethnic minority composition.
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Affiliation(s)
- Luisa N Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA; OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Bizkaia, Spain; Department of Surgery, Medical and Social Science. University of Alcalá, Madrid, Spain.
| | - Francisco Bolúmar
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA; Department of Surgery, Medical and Social Science. University of Alcalá, Madrid, Spain.
| | - Elena Rodriguez-Alvarez
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU), Bizkaia, Spain; Department of Nursing I, University of the Basque Country (UPV/EHU), Bizkaia, Spain.
| | - Christina I Nieves
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, USA.
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11
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Rauscher E, Burns A. Unequal Opportunity Spreaders: Higher COVID-19 Deaths with Later School Closure in the United States. SOCIOLOGICAL PERSPECTIVES : SP : OFFICIAL PUBLICATION OF THE PACIFIC SOCIOLOGICAL ASSOCIATION 2021; 64:831-856. [PMID: 37332490 PMCID: PMC10275350 DOI: 10.1177/07311214211005486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Mixed evidence on the relationship between school closure and COVID-19 prevalence could reflect focus on large-scale levels of geography, limited ability to address endogeneity, and demographic variation. Using county-level Centers for Disease Control and Prevention (CDC) COVID-19 data through June 15, 2020, two matching strategies address potential heterogeneity: nearest geographic neighbor and propensity scores. Within nearest neighboring pairs in different states with different school closure timing, each additional day from a county's first case until state-ordered school closure is related to 1.5 to 2.4 percent higher cumulative COVID-19 deaths per capita (1,227-1,972 deaths for a county with median population and deaths/capita). Results are consistent using propensity score matching, COVID-19 data from two alternative sources, and additional sensitivity analyses. School closure is more strongly related to COVID-19 deaths in counties with a high concentration of Black or poor residents, suggesting schools play an unequal role in transmission and earlier school closure is related to fewer lives lost in disadvantaged counties.
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Samuels-Kalow ME, Dorner S, Cash RE, Dutta S, White B, Ciccolo GE, Brown DF, Camargo CA. Neighborhood Disadvantage Measures and COVID-19 Cases in Boston, 2020. Public Health Rep 2021; 136:368-374. [PMID: 33729070 PMCID: PMC8580391 DOI: 10.1177/00333549211002837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Understanding the pattern of population risk for coronavirus disease 2019 (COVID-19) is critically important for health systems and policy makers. The objective of this study was to describe the association between neighborhood factors and number of COVID-19 cases. We hypothesized an association between disadvantaged neighborhoods and clusters of COVID-19 cases. METHODS We analyzed data on patients presenting to a large health care system in Boston during February 5-May 4, 2020. We used a bivariate local join-count procedure to determine colocation between census tracts with high rates of neighborhood demographic characteristics (eg, Hispanic race/ethnicity) and measures of disadvantage (eg, health insurance status) and COVID-19 cases. We used negative binomial models to assess independent associations between neighborhood factors and the incidence of COVID-19. RESULTS A total of 9898 COVID-19 patients were in the cohort. The overall crude incidence in the study area was 32 cases per 10 000 population, and the adjusted incidence per census tract ranged from 2 to 405 per 10 000 population. We found significant colocation of several neighborhood factors and the top quintile of cases: percentage of population that was Hispanic, non-Hispanic Black, without health insurance, receiving Supplemental Nutrition Assistance Program benefits, and living in poverty. Factors associated with increased incidence of COVID-19 included percentage of population that is Hispanic (incidence rate ratio [IRR] = 1.25; 95% CI, 1.23-1.28) and percentage of households living in poverty (IRR = 1.25; 95% CI, 1.19-1.32). CONCLUSIONS We found a significant association between neighborhoods with high rates of disadvantage and COVID-19. Policy makers need to consider these health inequities when responding to the pandemic and planning for subsequent health needs.
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Affiliation(s)
- Margaret E. Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen Dorner
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca E. Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sayon Dutta
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Benjamin White
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gia E. Ciccolo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David F.M. Brown
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Stafford IA, Turrentine MA, Ostovar-Kermani T, Moustafa ASZ, Berra A, Sangi-Haghpeykar H. Disparities between US Hispanic and non-Hispanic women in obesity-related perinatal outcomes: a prospective cohort study. J Matern Fetal Neonatal Med 2021; 35:6172-6179. [PMID: 33843401 DOI: 10.1080/14767058.2021.1909559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mortality figures and national health surveillance data have demonstrated that Hispanics have a 24% lower risk of all-cause mortality compared to their non-Hispanic counterparts despite increased rates of obesity and related illnesses. OBJECTIVE The aim of this study is to evaluate if this paradox exists for obesity-related perinatal outcomes in otherwise low-risk Hispanic women. MATERIALS AND METHODS A prospective cohort study of low-risk women across all BMI classes with a singleton, non-anomalous term pregnancy admitted in active labor or undergoing induction of labor between May 2014 and April 2017. All demographic, obstetric, and neonatal outcomes were recorded, and the body mass index (BMI) closest to delivery was used for analysis. Data including composites of adverse maternal and neonatal outcomes were compared across BMI classes and between individuals of Hispanic and non-Hispanic ethnicity. Women with antenatal complications, prior cesarean delivery, and cesarean for non-reassuring fetal status were excluded. RESULTS Of the 11,369 women who met inclusion criteria, 6303 (55%) were Hispanic. Eight percent of Hispanic women were normal weight (BMI: 18.5-24.9), 34% were overweight (BMI: 25-29.9), and 58% were obese (BMI > 30). Fourteen percent of non-Hispanic women were normal weight, 42% were overweight, and 44% were obese. The majority (65%) of women were multiparous. Rate of induction and birthweight increased across BMI for Hispanic and non-Hispanic groups, however the route of delivery was not significantly different (p = .22, 0.16, respectively). Although the association between BMI and composite perinatal complications did not differ by BMI class and ethnicity, the newborns of non-Hispanic women were more likely to be admitted to the neonatal intensive care unit with increasing maternal weight class (<0.001), even after adjusting for age, parity, marital status, prenatal visits, current tobacco use, type of labor, mode of delivery, and birthweight. CONCLUSION There were no demonstrable differences in composite adverse maternal or neonatal outcomes between Hispanic and non-Hispanic obese women. However, newborns of non-Hispanic obese women were more likely to be transferred to the neonatal intensive care unit with increasing maternal BMI.
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Affiliation(s)
- Irene A Stafford
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center/McGovern Medical School, Houston, TX, USA
| | - Mark A Turrentine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | | | - Ahmed S Z Moustafa
- Department of Obstetrics and Gynecology, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Alexandra Berra
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
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Flores M, Ruiz JM, Butler EA, Sbarra DA. Hispanic Ethnic Density May Be Protective for Older Black/African American and Non-Hispanic White Populations for Some Health Conditions: An Exploration of Support and Neighborhood Mechanisms. Ann Behav Med 2021; 56:21-34. [PMID: 33821886 DOI: 10.1093/abm/kaab014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Hispanic ethnic density (HED) is associated with salubrious health outcomes for Hispanics, yet recent research suggests it may also be protective for other groups. The purpose of this study was to test whether HED was protective for other racial-ethnic groups. We tested whether social support or neighborhood social integration mediated the association between high HED and depressive symptoms (CES-D) and physical morbidity 5 years later. Lastly, we tested whether race-ethnicity moderated both main and indirect effects. METHODS We used Waves 1 (2005-2006), and 2 (2010-2011) from The National Social Life, Health, and Aging Project, a national study of older U.S. adults. Our sample was restricted to Wave 1 adults who returned at Wave 2, did not move from their residence between waves, and self-identified as Hispanic, non-Hispanic White (NHW), or non-Hispanic Black (NHB; n = 1,635). We geo-coded respondents' addresses to a census-tract and overlaid racial-ethnic population data. Moderated-mediation models using multiple imputation (to handle missingness) and bootstrapping were used to estimate indirect effects for all racial-ethnic categories. RESULTS Depressive symptoms were lower amongst racial-ethnic minorities in ethnically (Hispanic) dense neighborhoods; this effect was not stronger in Hispanics. HED was not associated with physical morbidity. Sensitivity analyses revealed that HED was protective for cardiovascular events in all racial-ethnic groups, but not arthritis, or respiratory disease. Social support and neighborhood social integration were not mediators for the association between HED and outcomes, nor were indirect effects moderated by race-ethnicity. CONCLUSIONS This study offers some evidence that HED may be protective for some conditions in older adults; however, the phenomena underlying these effects remains a question for future work.
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Affiliation(s)
- Melissa Flores
- Center for Border Health Disparities, Health Sciences, University of Arizona, Tucson, AZ, USA.,The Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA
| | - John M Ruiz
- The Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA
| | - Emily A Butler
- Norton School of Family and Consumer Sciences, College of Agricultural Life Sciences, University of Arizona, Tucson, AZ, USA
| | - David A Sbarra
- The Department of Psychology, College of Science, University of Arizona, Tucson, AZ, USA
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Rauscher E, Rangel DE. Rising inequality of infant health in the U.S. SSM Popul Health 2020; 12:100698. [PMID: 33299927 PMCID: PMC7702186 DOI: 10.1016/j.ssmph.2020.100698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/13/2020] [Accepted: 11/15/2020] [Indexed: 11/12/2022] Open
Abstract
Has infant health inequality narrowed or grown in recent decades? Inequality may have narrowed due to expanded medical insurance coverage and greater knowledge about fetal health. However, greater income inequality may have reduced health for births to the most economically disadvantaged mothers, leading to growing infant health inequality. We use administrative birth certificate data for over 22 million births to examine trends in inequality of infant health from 1989 to 2018 in the U.S. This period allows us to consider how contextual factors – such as passage of the Affordable Care Act, changing demographics, the Great Recession, or delayed impacts of rising income inequality – may have altered infant health inequality. We assess gaps in infant health by maternal race, marital status, and education. Following previous research, we also examine gaps between the most economically advantaged mothers – married, white mothers with a college degree – and the most economically disadvantaged mothers – single, Black mothers without a high school degree. Results reveal that inequality of infant health has increased since 2010.
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Affiliation(s)
- Emily Rauscher
- Department of Sociology, Brown University, Box 1916, Providence, RI, 02912, USA
| | - David E Rangel
- Department of Education, Brown University, Box 1938, Providence, RI, 02912, USA
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16
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Fryer KE, Vines AI, Stuebe AM. A Multisite Examination of Everyday Discrimination and the Prevalence of Spontaneous Preterm Birth in African American and Latina Women in the United States. Am J Perinatol 2020; 37:1340-1350. [PMID: 31365929 DOI: 10.1055/s-0039-1693696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE African American women have a higher risk of spontaneous preterm birth than White and Latina women. Although Latina women are exposed to similar social determinants of health, they have lower rates of spontaneous preterm birth. One theory for this difference is the maternal stress biological pathway, whereby lifetime stressors, such as racial discrimination, lead to a premature activation of parturition. We investigated the prevalence of self-reported discrimination and its association with the prevalence of spontaneous preterm birth. STUDY DESIGN Using data from the Community Child Health Research Network Study, a multisite cohort study from 2008 to 2012, we conducted a cross-sectional analysis of 1,154 African American women and 578 Latina women. RESULTS Adjusting for multiple risk factors, African American and Latina women who experienced the highest tertile of discrimination had a higher prevalence of preterm birth compared with those who experienced discrimination less than once per year, adjusted hazard ratio (aHR) = 1.5 (0.7-3.1) and 3.6 (0.9-14.4), respectively. CONCLUSION In our cohort, we found a statistically significant association only in the medium discrimination group in Latina women, but we did not find a statistically significant association in African American women. Reduction in experienced discrimination may be an important intervention for reducing adverse pregnancy outcomes.
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Affiliation(s)
- Kimberly E Fryer
- Department of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology, University of South Florida, Tampa, Florida
| | - Anissa I Vines
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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17
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Samuels‐Kalow ME, Ciccolo GE, Lin MP, Schoenfeld EM, Camargo CA. The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need. J Am Coll Emerg Physicians Open 2020; 1:852-856. [PMID: 33145531 PMCID: PMC7593464 DOI: 10.1002/emp2.12191] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
Emergency medicine has increasingly focused on addressing social determinants of health (SDoH) in emergency medicine. However, efforts to standardize and evaluate measurement tools and compare results across studies have been limited by the plethora of terms (eg, SDoH, health-related social needs, social risk) and a lack of consensus regarding definitions. Specifically, the social risks of an individual may not align with the social needs of an individual, and this has ramifications for policy, research, risk stratification, and payment and for the measurement of health care quality. With the rise of social emergency medicine (SEM) as a field, there is a need for a simplified and consistent set of definitions. These definitions are important for clinicians screening in the emergency department, for health systems to understand service needs, for epidemiological tracking, and for research data sharing and harmonization. In this article, we propose a conceptual model for considering SDoH measurement and provide clear, actionable, definitions of key terms to increase consistency among clinicians, researchers, and policy makers.
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Affiliation(s)
- Margaret E. Samuels‐Kalow
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Gia E. Ciccolo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Michelle P. Lin
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elizabeth M. Schoenfeld
- Department of Emergency Medicine and Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School – BaystateSpringfieldMassachusettsUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
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18
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Bornstein E, Eliner Y, Chervenak FA, Grünebaum A. Racial Disparity in Pregnancy Risks and Complications in the US: Temporal Changes during 2007-2018. J Clin Med 2020; 9:E1414. [PMID: 32397663 PMCID: PMC7290488 DOI: 10.3390/jcm9051414] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022] Open
Abstract
Maternal race and ethnicity have been associated with differences in pregnancy related morbidity and mortality. We aimed to evaluate the trends of several pregnancy risk factors/complications among different maternal racial/ethnic groups in the US between 2007 and 2018. Specifically, we used the Center for Disease Control and Prevention (CDC) natality files for these years to assess the trends of hypertensive disorders of pregnancy (HDP), chronic hypertension (CH), diabetes mellitus (DM), advanced maternal age (AMA) and grand multiparity (GM) among non-Hispanic Whites, non-Hispanic Blacks and Hispanics. We find that the prevalence of all of these risk factors/complications increased significantly across all racial/ethnic groups from 2007 to 2018. In particular, Hispanic women exhibited the highest increase, followed by non-Hispanic Black women, in the prevalence of HDP, CH, DM and AMA. However, throughout the entire period, the overall prevalence remained highest among non-Hispanic Blacks for HDP, CH and GM, among Hispanics for DM, and among non-Hispanic Whites for AMA. Our results point to significant racial/ethnic differences in the overall prevalence, as well as the temporal changes in the prevalence, of these pregnancy risk factors/complications during the 2007-2018 period. These findings could potentially contribute to our understanding of the observed racial/ethnic differences in maternal morbidity and mortality.
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Affiliation(s)
- Eran Bornstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USA; (F.A.C.); (A.G.)
| | - Yael Eliner
- School of Public Health, Boston University, Boston, MA 02118, USA;
| | - Frank A. Chervenak
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USA; (F.A.C.); (A.G.)
| | - Amos Grünebaum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lenox Hill Hospital—Northwell Health/Zucker School of Medicine, New York, NY 10075, USA; (F.A.C.); (A.G.)
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Adverse Infant and Maternal Outcomes Among Low-Risk Term Pregnancies Stratified by Race and Ethnicity. Obstet Gynecol 2020; 135:925-934. [DOI: 10.1097/aog.0000000000003730] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Mercado A, Venta A, Henderson C, Pimentel N. Trauma and cultural values in the health of recently immigrated families. J Health Psychol 2019; 26:728-740. [DOI: 10.1177/1359105319842935] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.
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21
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Yang I, Hall L. Factors related to prenatal smoking among socioeconomically disadvantaged women. Women Health 2019; 59:1026-1074. [PMID: 30835645 DOI: 10.1080/03630242.2019.1584145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Socioeconomically disadvantaged pregnant women are especially at risk for smoking. To understand better this health behavior disparity, this systematic, integrative, comprehensive review aimed to identify factors related to prenatal smoking among socioeconomically disadvantaged women in the United States. A comprehensive literature search yielded 67 articles published between 2008 and 2016. Associated factors included any study variable related to persistent prenatal smoking. The Social Ecological Model (SEM), a multidimensional ecological framework, was used to organize the findings. Thirty-eight factors were explored in the reviewed studies and categorized according to SEM dimensions: individual, interpersonal, organizational, community, public policies and laws. At the individual level, most studies identified the socioeconomically disadvantaged prenatal smoker as older, US-born, White, unmarried, and multiparous. Other individual-level factors included alcohol abuse, nicotine dependence, and psychosocial factors such as stress and depressive symptoms. For broader levels of the SEM, associated factors included abuse/trauma, secondhand smoke exposure, lack of prenatal care, smoking cessation interventions, neighborhood risk, and state level initiatives such as cigarette taxes. The results of this review suggested multiple directions for future research to move science toward effective, scalable, and sustainable approaches that effectively address prenatal smoking among socioeconomically disadvantaged women.
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Affiliation(s)
- Irene Yang
- Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta , GA , USA
| | - Lynne Hall
- School of Nursing, University of Louisville , Louisville , KY , USA
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Fishman SH, Morgan SP, Hummer RA. Smoking and Variation in the Hispanic Paradox: A Comparison of Low Birthweight Across 33 US States. POPULATION RESEARCH AND POLICY REVIEW 2018; 37:795-824. [PMID: 30906091 PMCID: PMC6424129 DOI: 10.1007/s11113-018-9487-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 08/14/2018] [Indexed: 12/19/2022]
Abstract
The Hispanic Paradox in birth outcomes is well documented for the US as a whole, but little work has considered geographic variation underlying the national pattern. This inquiry is important given the rapid growth of the Hispanic population and its geographic dispersion. Using birth records data from 2014 through 2016, we document state variation in birthweight differentials between US-born white women and the three Hispanic populations with the largest numbers of births: US-born Mexican women, foreign-born Mexican women, and foreign-born Central and South American women. Our analyses reveal substantial geographic variation in Hispanic immigrant-white low birthweight disparities. For example, Hispanic immigrants in Southeastern states and in some states from other regions have reduced risk of low birthweight relative to whites, consistent with a "Hispanic Paradox." A significant portion of Hispanic immigrants' birthweight advantage in these states is explained by lower rates of smoking relative to whites. However, Hispanic immigrants have higher rates of low birthweight in California and several other Western states. The different state patterns are largely driven by geographic variation in smoking among whites, rather than geographic differences in Hispanic immigrants' birthweights. In contrast, US-born Mexicans generally have similar or slightly higher odds of low birthweight than whites across the US. Overall, we show that the Hispanic Paradox in birthweight varies quite dramatically by state, driven by geographic variation in low birthweight among whites associated with white smoking disparities across states.
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Affiliation(s)
- Samuel H Fishman
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W. Franklin St., Chapel Hill, NC 27516, USA
| | - S Philip Morgan
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W. Franklin St., Chapel Hill, NC 27516, USA
| | - Robert A Hummer
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, Chapel Hill, NC 27599, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W. Franklin St., Chapel Hill, NC 27516, USA
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Ruiz JM, Sbarra D, Steffen PR. Hispanic ethnicity, stress psychophysiology and paradoxical health outcomes: A review with conceptual considerations and a call for research. Int J Psychophysiol 2018; 131:24-29. [DOI: 10.1016/j.ijpsycho.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/15/2022]
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Oliveira KAD, Araújo EMD, Oliveira KAD, Casotti CA, Silva CALD, Santos DBD. Association between race/skin color and premature birth: a systematic review with meta-analysis. Rev Saude Publica 2018; 52:26. [PMID: 29641651 PMCID: PMC5893270 DOI: 10.11606/s1518-8787.2018052000406] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/10/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To analyze the association between race/skin color and the occurrence of prematurity. METHODS Meta-analysis with observational studies, selected by a systematic review in the bibliographic databases Medline and Biblioteca Virtual da Saúde with the descriptors: “Race or ethnic group” and “ethnicity and health” associated with the words “infant premature” and “obstetric labor premature”. Articles published in the period from 2010 to 2014, of the observational epidemiological type, in Portuguese, English and Spanish, were included. Articles that did not have abstracts or that were review articles, theses, dissertations, and editorials were excluded. We adopted the relative risk and their respective confidence intervals (95%CI) as measures of effect, obtained through the random effect model and represented by the forest plot type graph. The Egger test and the Newcastle-Ottawa scale, respectively, were used to analyze possible publication biases and the quality of the studies. RESULTS Of the 926 articles identified, 17 were eligible for the study. Of the 17 full texts published, seven were retrospective cohort studies, nine were cross-sectional studies, and one was a case-control study. Except for one study, the others reported a positive association between race/color of skin and prematurity. Compared with full-term newborns, the relative risk of the combined effect in those born preterm was 1.51 (95%CI 1.39-1.69). The funnel chart suggested publication bias. CONCLUSIONS The present meta-analysis indicated a positive association for the risk of prematurity according to race/skin color.
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Affiliation(s)
- Kelly Albuquerque de Oliveira
- Universidade Estadual de Feira de Santana. Programa de Pós-Graduação em Saúde Coletiva. Feira de Santana, BA, Brasil
| | - Edna Maria de Araújo
- Universidade Estadual de Feira de Santana. Departamento de Saúde. Feira de Santana, BA, Brasil
| | | | - Cesar Augusto Casotti
- Universidade Estadual do Sudoeste da Bahia. Departamento de Saúde. Jequié, BA, Brasil
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Controversies and evidence for cardiovascular disease in the diverse Hispanic population. J Vasc Surg 2017; 67:960-969. [PMID: 28951154 DOI: 10.1016/j.jvs.2017.06.111] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/23/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Hispanics account for approximately 17% of the U.S. POPULATION They are one of the fastest growing racial/ethnic groups, second only to Asians. This heterogeneous population has diverse socioeconomic conditions, making the prevention, diagnosis, and management of vascular disease difficult. This paper discusses the cultural, racial, and social aspects of the Hispanic community in the United States and assesses how they affect vascular disease within this population. Furthermore, it explores risk factors, medical and surgical treatments, and outcomes of vascular disease in the Hispanic population; generational evolution of these conditions; and the phenomenon called the Hispanic paradox. METHODS A systematic search of the literature was performed to identify all English-language publications from 1991 to 2014 using PubMed, which draws from the National Institutes of Health and U.S. National Library of Medicine, with the words "cardiovascular disease," "prevalence," "vascular," and "Hispanic." An additional search was performed using "cardiovascular disease and Mexico," "cardiovascular disease and Cuba," "cardiovascular disease and Puerto Rico," and "cardiovascular disease and Latin America" as well as for complications, management, outcomes, surgery, vascular disease, and Hispanic paradox. The resulting publications were queried for generational data (spanning multiple well-defined age groups) regarding cardiovascular disease, and cross-references were obtained from their bibliographies. Results are segmented by country of origin. RESULTS Compared with non-Hispanic whites, Hispanics face higher risks of cardiovascular diseases because of a high prevalence of high blood pressure, obesity, diabetes mellitus, and ischemic stroke. However, the incidence of peripheral arterial disease and carotid disease appears to be significantly lower than in whites. The Hispanic paradox (lower mortality in spite of higher cardiovascular risk factors) may relate to challenges in ascribing life expectancy and cause of death in this diverse population. Low socioeconomic status and high prevalence of concomitant diseases negatively influence the outcomes of all patients, independent of being Hispanic. CONCLUSIONS Understanding the cultural diversity in Hispanics is important in terms of targeting preventive measures to modify cardiovascular risk factors, which affect development and outcomes of vascular disease. The available literature regarding vascular disease in the Hispanic population is limited, and further longitudinal study is warranted to improve health care delivery and outcomes in this group.
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Clowse MEB, Grotegut C. Racial and Ethnic Disparities in the Pregnancies of Women With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016; 68:1567-72. [PMID: 26815791 DOI: 10.1002/acr.22847] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 12/10/2015] [Accepted: 01/19/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Both systemic lupus erythematosus (SLE; lupus) and pregnancy individually have significant racial disparities, with black women experiencing higher rates of complications, yet no large studies have focused on the impact of race/ethnicity on pregnancy outcomes among women with lupus. METHODS Using the Nationwide Inpatient Sample (NIS) for 2008-2010, pregnancy delivery discharges were identified and pregnancy outcomes were compared for women with lupus by maternal race/ethnicity. Adjusted odds ratios were used to compare pregnancy outcomes between black and white or Hispanic and white women with lupus. RESULTS In this period, the NIS included 13,553 deliveries with lupus and 12,510,565 deliveries without lupus. Compared to white women with lupus, black and Hispanic women had higher rates of chronic hypertension, chronic renal failure, pneumonia, and acute renal failure. There was a high degree of pregnancy complication in all women with lupus, but especially in black and Hispanic women, with more than 40% cesarean-section delivery; preterm labor in 14.3% of white, 24.7% of black (odds ratio [OR] 1.97), and 20.6% of Hispanic (OR 1.56) deliveries; and preeclampsia and gestational hypertension in almost 20% of black and Hispanic pregnancies. After adjustment for predictors of pregnancy outcomes and racial differences in nonlupus pregnancy, black and Hispanic women with lupus had higher than expected rates of preeclampsia, preterm labor, and fetal growth restriction. CONCLUSION Black and Hispanic women with lupus have disproportionately poor pregnancy outcomes. This study suggests that identifying the key causes of these differences and targeting interventions to the women of greatest need is an essential next step.
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Lee JJH, Guilamo-Ramos V, Muñoz-Laboy M, Lotz K, Bornheimer L. Mechanisms of Familial Influence on Reentry among Formerly Incarcerated Latino Men. SOCIAL WORK 2016; 61:199-207. [PMID: 27501637 DOI: 10.1093/sw/sww023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the United States more than 10,000 people are released from state and federal prisons every week and often reenter the communities in which they were arrested. Formerly incarcerated individuals face considerable challenges to securing employment and housing. Subsequently, approximately two-thirds of former prisoners are rearrested within three years of their release. Latino men represent the fastest growing ethnic group of prisoners in the United States with unique cultural and social needs during the reentry process. The present study examined the role of the family in the reentry process through in-depth interviews (N = 16) with formerly incarcerated Latino men (FILM). The authors sought to identify familial processes specific to Latino men with potential to affect engagement and participation in reentry programs. Findings suggest that family mechanisms of social control and social support influence FILM's reentry. Social work practitioners who work with this growing population can engage familial processes to prevent recidivism and promote desistance.
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Ruiz JM, Hamann HA, Mehl MR, O’Connor MF. The Hispanic health paradox: From epidemiological phenomenon to contribution opportunities for psychological science. GROUP PROCESSES & INTERGROUP RELATIONS 2016. [DOI: 10.1177/1368430216638540] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Similar to non-Hispanic Blacks, Hispanics/Latinos experience a range of psychosocial and physical health challenges, including high rates of poverty, neighborhood segregation, discrimination, poor healthcare access, and high rates of obesity, diabetes, and undiagnosed and late-stage diagnosed diseases. Despite such risks, Hispanics generally experience better physical health and lower mortality than non-Hispanic Whites, an epidemiological phenomenon commonly referred to as the Hispanic or Latino health paradox. With the basic phenomenon increasingly well-established, attention now turns to the sources of such resilience. The current aims are to briefly examine the epidemiological paradox and highlight potential sociocultural resilience factors that may contribute to the paradoxical effects. We conclude with presentation of a framework for modeling sociocultural resilience and discuss future directions for psychological contributions.
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Giuntella O. The Hispanic health paradox: New evidence from longitudinal data on second and third-generation birth outcomes. SSM Popul Health 2016; 2:84-89. [PMID: 29349130 PMCID: PMC5757955 DOI: 10.1016/j.ssmph.2016.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/15/2016] [Accepted: 02/17/2016] [Indexed: 10/27/2022] Open
Abstract
This study examines the birth weight of second and third-generation Hispanics born in California and Florida, two of the major immigrant destination states in the US. I exploit a unique dataset of linked birth records for two generations of children born in California and Florida (1970-2009) and linear probability models to investigate the generational decline in the birth outcomes of Hispanics in the US. The data allow using an extensive set of socio-demographic controls and breaking down the results by country of origin. Second-generation children of Mexican and Cuban origin have better birth outcomes than children of US-born white women. Children of Puerto Rican origin have instead worse birth outcomes. The advantage observed among second-generation Hispanics erodes substantially in the third generation but third-generation Mexicans retain some of it.
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Washio Y, Cassey H. Systematic Review of Interventions for Racial/Ethnic-Minority Pregnant Smokers. J Smok Cessat 2016; 11:12-27. [PMID: 26925170 PMCID: PMC4764131 DOI: 10.1017/jsc.2014.12] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Large disparities exist in smoking rates during pregnancy by racial/ethnic status. AIMS The current review examined controlled studies that predominantly included racial/ethnic-minority pregnant smokers for providing smoking cessation treatment. METHODS Two authors independently conducted the literature searches in the standard databases using a combination of the keywords with minority, pregnancy, smoking, and cessation identifiers. RESULTS The searches identified nine articles that met the inclusion criteria. Only two studies exclusively targeted specific minority groups. Most of them provided some form of brief smoking cessation counseling, with two combining with incentives and one combining with pharmacotherapy. Two studies provided intensive cognitive interventions. Pregnant smokers of American Indian or Alaska Native, Hispanic subgroups, and Asian or Pacific Islander are under-studied. CONCLUSIONS Future studies to treat minority pregnant smokers could target under-studied minority groups and may need to directly and intensely target smoking behavior, address cultural and psychosocial issues in an individualized and comprehensive manner, and analyze cost-benefit of an intervention.
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Affiliation(s)
- Yukiko Washio
- Treatment Research Institute, Philadelphia PA, 19106, U.S.A
| | - Heather Cassey
- Temple University, Department of Psychological, Organizational, and Leadership Studies, Philadelphia PA, 19122, U.S.A
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Chesnokova A, French B, Weibe D, Camenga DR, Yun K. Association Between Neighborhood-Level Smoking and Individual Smoking Risk: Maternal Smoking Among Latina Women in Pennsylvania. Public Health Rep 2016; 130:672-83. [PMID: 26556939 DOI: 10.1177/003335491513000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined whether or not high maternal smoking rates at the neighborhood level increase the likelihood of individual smoking by Latina women in the three months prior to and during pregnancy, independent of other individual and neighborhood factors. METHODS This study was observational in nature, using linked vital statistics records for 24,443 Latina women in Pennsylvania (2009-2010) and U.S. Census data for 2,398 census tracts. We used multilevel logistic regression models to determine the individual odds of self-reported maternal smoking given different census tract-level rates of maternal smoking in the previous three years (2006-2008), adjusting for maternal and census-tract characteristics, including ethnic density, population density, and poverty. RESULTS Higher levels of maternal smoking at the census-tract level were associated with increased individual odds of smoking among Latina mothers. In the fully adjusted model, a 10% increase in the neighborhood smoking rate was associated with a 1.28 (95% confidence interval 1.22, 1.34) increase in the individual odds of smoking. CONCLUSION Latina women living in census tracts where more women have smoked during or immediately prior to pregnancy are themselves at higher risk of smoking during this period.
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Affiliation(s)
- Arina Chesnokova
- The Children's Hospital of Philadelphia PolicyLab, Division of General Pediatrics, Philadelphia, PA ; Current affiliation: Baylor College of Medicine, Houston, TX
| | - Benjamin French
- University of Pennsylvania Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA
| | - Douglas Weibe
- University of Pennsylvania Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA
| | - Deepa R Camenga
- Yale School of Medicine, Department of Pediatrics, New Haven, CT
| | - Katherine Yun
- The Children's Hospital of Philadelphia PolicyLab, Division of General Pediatrics, Philadelphia, PA ; University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA
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Where there's smoke: Cigarette use, social acceptability, and spatial approaches to multilevel modeling. Soc Sci Med 2015; 140:18-26. [PMID: 26188587 DOI: 10.1016/j.socscimed.2015.06.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 05/12/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
Abstract
I contribute to understandings of how context is related to individual outcomes by assessing the added value of combining multilevel and spatial modeling techniques. This methodological approach leads to substantive contributions to the smoking literature, including improved clarity on the central contextual factors and the examination of one manifestation of the social acceptability hypothesis. For this analysis I use restricted-use natality data from the Vital Statistics, and county-level data from the 2005-9 ACS. Critically, the results suggest that spatial considerations are still relevant in a multilevel framework. In addition, I argue that spatial processes help explain the relationships linking racial/ethnic minority concentration to lower overall odds of smoking.
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Uphoff EP, Pickett KE, Crouch S, Small N, Wright J. Is ethnic density associated with health in a context of social disadvantage? Findings from the Born in Bradford cohort. ETHNICITY & HEALTH 2015; 21:196-213. [PMID: 26169185 DOI: 10.1080/13557858.2015.1047742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES In this study we aimed to test the associations between area-level ethnic density and health for Pakistani and White British residents of Bradford, England. DESIGN The sample consisted of 8610 mothers and infant taking part in the Born in Bradford cohort. Ethnic density was measured as the percentage of Pakistani, White British or South Asian residents living in a Lower Super Output Area. Health outcomes included birth weight, preterm birth and smoking during pregnancy. Associations between ethnic density and health were tested in multilevel regression models, adjusted for individual covariates and area deprivation. RESULTS In the Pakistani sample, higher own ethnic density was associated with lower birth weight (β = -0.82, 95% CI: -1.63, -0.02), and higher South Asian density was associated with a lower probability of smoking during pregnancy (OR = 0.99, 95% CI: 0.98, 1.00). Pakistani women in areas with 50-70% South Asian residents were less likely to smoke than those living in areas with less than 10% South Asian residents (OR = 0.39, 95% CI: 0.16, 0.97). In the White British sample, neither birth weight nor preterm birth was associated with own ethnic density. The probability of smoking during pregnancy was lower in areas with 10-29.99% compared to <10% South Asian density (OR = 0.79, 95% CI: 0.64, 0.98). CONCLUSION In this sample, ethnic density was associated with lower odds of smoking during pregnancy but not with higher birth weight or lower odds of preterm birth. Possibly, high levels of social disadvantage inhibit positive effects of ethnic density on health.
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Affiliation(s)
| | - Kate E Pickett
- a Department of Health Sciences , University of York , York , UK
| | - Simon Crouch
- a Department of Health Sciences , University of York , York , UK
| | - Neil Small
- b Bradford Institute for Health Research (BIHR) , Bradford Royal Infirmary , Bradford , UK
| | - John Wright
- b Bradford Institute for Health Research (BIHR) , Bradford Royal Infirmary , Bradford , UK
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DeCamp LR, Choi H, Fuentes-Afflick E, Sastry N. Immigrant Latino neighborhoods and mortality among infants born to Mexican-origin Latina women. Matern Child Health J 2015; 19:1354-63. [PMID: 25430802 PMCID: PMC4447583 DOI: 10.1007/s10995-014-1640-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To compare the association between neighborhood Latino immigrant concentration and infant mortality by maternal nativity among singleton births to Mexican-origin women in Los Angeles County. Information about births, infant deaths, and infant and maternal characteristics were obtained from geocoded Los Angeles County vital statistics records (2002-2005). Linked data on neighborhood characteristics (census tracts) were obtained from the 2000 census. Logistic regression models were used to predict infant mortality while accounting for spatial clustering by census tract. Two-thirds of births to Mexican-origin mothers were to foreign-born women. Foreign-born mothers were older, had less education, and were more likely to have delivery costs paid by Medicaid than US-born mothers. Infants born to foreign-born women had a lower infant mortality rates than infants born to US-born women (3.8/1,000 live births vs. 4.6, p = .002). Among infants of foreign-born mothers, the odds of infant mortality increased with increasing immigrant concentration (OR 1.29; 95 % CI 1.01-1.66). There was a similar pattern of association between immigrant concentration and mortality for infants of US-born mothers (OR 1.29; 95 % CI 0.99-1.67). In Los Angeles County, the odds of infant mortality among foreign-born Mexican-origin Latina were higher in higher-density immigrant neighborhoods, with a similar trend among US-born mothers. Thus, living in immigrant enclaves likely does not help to explain the lower than expected infant mortality rate among infants born to Latina women. Instead, higher neighborhood Latino immigrant concentration may indicate a neighborhood with characteristics that negatively impact maternal and infant health for Latinos.
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Affiliation(s)
- Lisa Ross DeCamp
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD, USA,
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Miyazaki Y, Hayashi K, Imazeki S. Smoking cessation in pregnancy: psychosocial interventions and patient-focused perspectives. Int J Womens Health 2015; 7:415-27. [PMID: 25960677 PMCID: PMC4411022 DOI: 10.2147/ijwh.s54599] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Smoking during pregnancy causes obstetric and fetal complications, and smoking cessation may have great benefits for the mother and the child. However, some pregnant women continue smoking even in pregnancy. OBJECTIVE To review the literature addressing the prevalence of smoking during pregnancy, explore psychosocial factors associated with smoking, and review the evidence of psychosocial interventions for smoking cessation during pregnancy in recent years. LITERATURE REVIEW Computerized Internet search results in PubMed for the years spanning from 2004 to 2014, as well as references cited in articles, were reviewed. A search for the keywords "smoking cessation pregnancy" and "intervention" and "clinical trials" yielded 52 citations. Thirty-five citations were identified as useful to this review for the evidence of psychosocial interventions for smoking cessation during pregnancy. RESULTS The prevalence of smoking during pregnancy differs by country, reflecting the countries' social, cultural, and ethnic backgrounds. Women who had socioeconomic disadvantages, problems in their interpersonal relationships, higher stress, depression, less social support, and who engaged in health-risk behaviors were more prone to smoking during pregnancy. Psychosocial interventions, such as counseling, are effective methods for increasing smoking cessation. CONCLUSION Smokers may have various psychosocial problems in addition to health problems. It is important to understand each individual's social situation or psychosocial characteristics, and a psychosocial intervention focused on the characteristics of the individual is required.
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Affiliation(s)
- Yukiko Miyazaki
- Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
| | - Kunihiko Hayashi
- School of Health Sciences, Faculty of Medicine, Gunma University, Maebashi, Japan
| | - Setsuko Imazeki
- Faculty of Health Care, Takasaki University of Health and Welfare, Takasaki, Japan
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Kearns A, Mason P. Regeneration, relocation and health behaviours in deprived communities. Health Place 2015; 32:43-58. [PMID: 25618564 DOI: 10.1016/j.healthplace.2014.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 12/10/2014] [Accepted: 12/22/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Ade Kearns
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow G12 8RS, UK.
| | - Phil Mason
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25-29 Bute Gardens, Glasgow G12 8RS, UK.
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Keet CA, McCormack MC, Pollack CE, Peng RD, McGowan E, Matsui EC. Neighborhood poverty, urban residence, race/ethnicity, and asthma: Rethinking the inner-city asthma epidemic. J Allergy Clin Immunol 2015; 135:655-62. [PMID: 25617226 PMCID: PMC4391373 DOI: 10.1016/j.jaci.2014.11.022] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/09/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although it is thought that inner-city areas have a high burden of asthma, the prevalence of asthma in inner cities across the United States is not known. OBJECTIVE We sought to estimate the prevalence of current asthma in US children living in inner-city and non-inner-city areas and to examine whether urban residence, poverty, or race/ethnicity are the main drivers of asthma disparities. METHODS The National Health Interview Survey 2009-2011 was linked by census tract to data from the US Census and the National Center for Health Statistics. Multivariate logistic regression models adjusted for sex; age; race/ethnicity; residence in an urban, suburban, medium metro, or small metro/rural area; poverty; and birth outside the United States, with current asthma and asthma morbidity as outcome variables. Inner-city areas were defined as urban areas with 20% or more of households at below the poverty line. RESULTS We included 23,065 children living in 5,853 census tracts. The prevalence of current asthma was 12.9% in inner-city and 10.6% in non-inner-city areas, but this difference was not significant after adjusting for race/ethnicity, region, age, and sex. In fully adjusted models black race, Puerto Rican ethnicity, and lower household income but not residence in poor or urban areas were independent risk factors for current asthma. Household poverty increased the risk of asthma among non-Hispanics and Puerto Ricans but not among other Hispanics. Associations with asthma morbidity were very similar to those with prevalent asthma. CONCLUSIONS Although the prevalence of asthma is high in some inner-city areas, this is largely explained by demographic factors and not by living in an urban neighborhood.
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Affiliation(s)
- Corinne A. Keet
- Johns Hopkins University School of Medicine, Division of Pediatric Allergy and Immunology
| | - Meredith C. McCormack
- Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, Baltimore, MD
| | - Craig E. Pollack
- Johns Hopkins University School of Medicine, Division of General Internal Medicine, Baltimore, MD
| | - Roger D. Peng
- Johns Hopkins Bloomberg School of Public Health, Department of Biostatistics, Baltimore, MD
| | - Emily McGowan
- Johns Hopkins University School of Medicine, Division of Allergy and Clinical Immunology, and Graduate Student, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elizabeth C. Matsui
- Johns Hopkins University 24 School of Medicine, Division of Pediatric Allergy and Immunology, Baltimore, MD
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Abstract
A growing body of research has examined whether racial/ethnic residential segregation contributes to health disparities, but recent findings in the literature, particularly with respect to cardiovascular disease (CVD) risk, have not been summarized. This review provides an overview of findings from studies of racial/ethnic residential segregation of non-Hispanic blacks and Hispanics with CVD risk published between January 2011 and July 2014. The majority of studies of black segregation showed higher segregation was related to higher CVD risk, although relationships were less clear for certain outcomes. Relationships among Hispanics were more mixed and appeared to vary widely by factors such as gender, country of origin, racial identity, and acculturation. Implications for research on racial/ethnic disparities in CVD and lingering gaps in the literature are discussed as well.
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Fulda KG, Kurian AK, Balyakina E, Moerbe MM. Paternal race/ethnicity and very low birth weight. BMC Pregnancy Childbirth 2014; 14:385. [PMID: 25406725 PMCID: PMC4245806 DOI: 10.1186/s12884-014-0385-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 10/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose was to examine the association between paternal race/ethnicity and very low birth weight stratified by maternal race/ethnicity. METHODS Birth data for Tarrant County, Texas 2006-2010 were analyzed. Very low birth weight was dichotomized as yes (<1,500 g) and no (≥1,500 g). Paternal race/ethnicity was categorized as Caucasian, African American, Hispanic, other, and missing. Missing observations (14.7%) were included and served as a proxy for fathers absent during pregnancy. Potential confounders included maternal age, education, and marital status, plurality, previous preterm birth, sexually transmitted disease during pregnancy, smoking during pregnancy, and Kotelchuck Index of prenatal care. Logistic regressions were stratified by maternal race/ethnicity. Odds ratios and 95% confidence intervals were calculated. RESULTS Of 145,054 births, 60,156 (41.5%) were Caucasian, 22,306 (15.4%) African American, 54,553 (37.6%) Hispanic, and 8,039 (5.5%) other mothers. There were 2,154 (1.5%) very low birth weights total, with 3.1% for African American mothers and 1.2% for all other race/ethnicities. Among Caucasian mothers, African American paternal race was associated with increased odds of very low birth weight (OR = 1.52; 95% CI:1.08-2.14). Among Hispanic mothers, African American paternal race (OR = 1.66; 95% CI:1.01-2.74) and missing paternal race/ethnicity (OR = 1.65; 95% CI:1.15-2.36) were associated with increased odds of very low birth weight. CONCLUSIONS Paternal race/ethnicity is an important predictor of very low birth weight among Caucasian and Hispanic mothers. Future research should consider paternal race/ethnicity and further explore the association between paternal characteristics and very low birth weight.
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Affiliation(s)
- Kimberly G Fulda
- />Department of Family Medicine, North Texas Primary Care Practice Based Research Network (NorTex), Texas Prevention Institute, University of North Texas Health Science Center, 855 Montgomery, Fort Worth, TX 76107 USA
| | | | - Elizabeth Balyakina
- />Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas USA
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Bjornstrom EE, Kuhl DC. A different look at the epidemiological paradox: Self-rated health, perceived social cohesion, and neighborhood immigrant context. Soc Sci Med 2014; 120:118-25. [DOI: 10.1016/j.socscimed.2014.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/05/2014] [Accepted: 09/08/2014] [Indexed: 12/29/2022]
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Wilson FA, Wang Y, Stimpson JP, Kessler AS, Do DV, Britigan DH. Disparities in visual impairment by immigrant status in the United States. Am J Ophthalmol 2014; 158:800-807.e5. [PMID: 25034114 DOI: 10.1016/j.ajo.2014.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine differences in visual impairment between immigrants and natives in the United States (US). DESIGN This is a cross-sectional study of clinical vision examination data from the 2003-2008 National Health and Nutrition Examination Survey. METHODS Analyses compare myopia, hyperopia, astigmatism, and visual acuity between noncitizens, naturalized citizens, and US natives. Visual acuity variables included having 20/40 or better corrected vision. Differences in 20/20 vision and legal blindness (20/200 or worse) were also examined. Respondents born in the United States were defined as US natives. Foreign-born respondents were categorized as either naturalized US citizens or noncitizen residents. Multivariate logistic regression of outcomes adjusted for sex, age, race/ethnicity, poverty, insurance, diabetes, and surgical correction for eyesight. RESULTS A smaller percentage of noncitizens than US natives had myopia (18.8% vs 30.7%) or astigmatism (22.0% vs 30.9%). However, noncitizens using corrective lenses had an adjusted odds ratio (AOR) of 0.65 of having 20/20 vision compared to US natives (95% confidence interval [CI] 0.48-0.88). Differences in visual acuity for 20/40 and better vision were not statistically significant for corrective lens users. Among nonusers of corrective lenses, noncitizens were significantly less likely than US natives to have 20/40 or better vision (AOR = 0.54; 95% CI 0.39-0.74). Noncitizens also had up to 3.5 times the odds of being legally blind relative to US natives after adjusting for confounding factors (95% CI 1.52-7.83). CONCLUSIONS Significant differences in visual acuity exist between immigrants and US natives. More research is necessary to identify underlying factors that may explain these disparities in visual impairment.
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Kucik JE, Nembhard WN, Donohue P, Devine O, Wang Y, Minkovitz CS, Burke T. Community socioeconomic disadvantage and the survival of infants with congenital heart defects. Am J Public Health 2014; 104:e150-7. [PMID: 25211743 DOI: 10.2105/ajph.2014.302099] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between survival of infants with severe congenital heart defects (CHDs) and community-level indicators of socioeconomic status. METHODS We identified infants born to residents of Arizona, New Jersey, New York, and Texas between 1999 and 2007 with selected CHDs from 4 population-based, statewide birth defect surveillance programs. We linked data to the 2000 US Census to obtain 11 census tract-level socioeconomic indicators. We estimated survival probabilities and hazard ratios adjusted for individual characteristics. RESULTS We observed differences in infant survival for 8 community socioeconomic indicators (P < .05). The greatest mortality risk was associated with residing in communities in the most disadvantaged deciles for poverty (adjusted hazard ratio [AHR] = 1.49; 95% confidence interval [CI] = 1.11, 1.99), education (AHR = 1.51; 95% CI = 1.16, 1.96), and operator or laborer occupations (AHR = 1.54; 95% CI = 1.16, 1.96). Survival decreased with increasing numbers of indicators that were in the most disadvantaged decile. Community-level mortality risk persisted when we adjusted for individual-level characteristics. CONCLUSIONS The increased mortality risk among infants with CHDs living in socioeconomically deprived communities might indicate barriers to quality and timely care at which public health interventions might be targeted.
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Affiliation(s)
- James E Kucik
- James E. Kucik and Owen Devine are with the Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA. Wendy N. Nembhard is with the Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa. Pamela Donohue is with the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD. Ying Wang is with the Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, NY. Cynthia S. Minkovitz is with the Department of Population, Family and Reproductive Health, and Thomas Burke is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Vilchez G, Chelliah A, Bratley E, Bahado-Singh R, Sokol R. Decreased risk of prematurity after elective repeat cesarean delivery in Hispanics. J Matern Fetal Neonatal Med 2014; 28:141-5. [DOI: 10.3109/14767058.2014.907781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Denton EG, Green P, Newman J, Siqin Y, Davidson KW, Schwartz J. The benefits of neighborhood racial diversity: neighborhood factors and its association with increased physical activity in ACS patients. Int J Cardiol 2014; 173:517-8. [PMID: 24704399 DOI: 10.1016/j.ijcard.2014.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/09/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Ellen-ge Denton
- Department of Psychology, City University of New York College of Staten Island, United States.
| | - Philip Green
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Jonathan Newman
- Department of Medicine, New York University Langone Medical Center, United States
| | - Ye Siqin
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Karina W Davidson
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Joseph Schwartz
- Department of Medicine, Columbia University Medical Center, New York, NY, United States
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Culture in Prenatal Development: Parental Attitudes, Availability of Care, Expectations, Values, and Nutrition. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9251-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flink IJE, Prins RG, Mackenbach JJP, Jaddoe VW, Hofman A, Verhulst FC, Tiemeier H, Raat H. Neighborhood ethnic diversity and behavioral and emotional problems in 3 year olds: results from the Generation R Study. PLoS One 2013; 8:e70070. [PMID: 23967068 PMCID: PMC3743872 DOI: 10.1371/journal.pone.0070070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 06/16/2013] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Studies suggest that neighborhood ethnic diversity may be important when it comes to understanding ethnic inequalities in mental health. The primary aim of this study was to investigate whether neighborhood ethnic diversity moderated the association between the ethnic minority status and child behavioral and emotional problems. METHODS We included 3076 preschoolers participating in the Generation R Study, a birth cohort study in Rotterdam, the Netherlands. At child age 3-years, parents completed the Child Behavior Checklist (CBCL/1,5-5). Individual-level data, assessed with questionnaires, was combined with neighborhood-level data. Multi-level logistic regression models predicted the Odds Ratios for the CBCL total problems score as a function of maternal ethnic background and neighborhood ethnic diversity, computed with the Racial Diversity Index and categorized into tertiles. Interaction on the additive scale was assessed using Relative Access Risk due to Interaction. RESULTS Being from an ethnic minority was associated with child behavioral and emotional problems in unadjusted (OR 2.76, 95% CI 1.88-4.04) and adjusted models (OR 2.64, 95% CI 1.79-3.92). Residing in a high diversity neighborhood was associated with child behavioral and emotional problems in unadjusted (OR 2.03, 95% CI 1.13-3.64) but not in adjusted models (OR 0.89, 95% CI 0.51-1.57). When stratifying by the three levels of neighborhood ethnic diversity, ethnic inequalities in behavioral and emotional problems were greatest in low diversity neighborhoods (OR 5.24, 95%CI 2.47-11.14), smaller in high diversity neighborhoods (OR 3.15, 95% CI 1.66-5.99) and smallest in medium diversity neighborhoods (OR 1.59, 95% CI 0.90-2.82). Tests for interaction (when comparing medium to low diversity neighborhoods) trended towards negative on both the additive and multiplicative scale for the maternal-report (RERI: -3.22, 95% CI -0.70-0.59; Ratio of ORs: 0.30, 95% CI 0.12-0.76). CONCLUSION This study suggests that ethnic inequalities in child behavioral and emotional problems may be greatest in ethnically homogeneous neighborhoods.
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Affiliation(s)
- Ilse J E Flink
- The Generation R Study Group, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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