1
|
Willoughby M, Janca E, Kwon S, Johnston B, Collins T, Kinner SA, Johns D, Gallant D, Glover-Wright C, Borschmann R. Interventions to Prevent and Respond to Violence Against Justice-Involved Young Women: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:1036-1052. [PMID: 37170786 PMCID: PMC10913338 DOI: 10.1177/15248380231171183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Young women who have had contact with the criminal justice system (justice-involved young women) have an increased risk of being a victim of violence. However, no reviews have synthesized the evidence on interventions to prevent or respond to violence against justice-involved young women. We conducted a scoping review to identify interventions designed to prevent or respond to violence against justice-involved young women. We searched Medline, Criminal Justice Abstracts, Web of Science, and Google Scholar for peer-reviewed and gray literature published in English from January 1, 2000 until March 23, 2021. Consistent with the public health approach to violence, we included primary, secondary, and tertiary interventions. Excluding duplicates, our search returned 5,603 records, 14 of which met our inclusion criteria. We narratively synthesized the included studies, all of which were conducted in the United States. Most included studies examined a tertiary intervention (n = 10), and few examined a primary (n = 2) or secondary (n = 2) intervention. Across the Joanna Briggs Institute Critical Appraisal Tools, the percentage of items met ranged from 0% to 78%. There was some limited evidence that tertiary interventions that included cognitive behavioral therapy reduced the mental health impacts of violence victimization among justice-involved young women. There was little evidence on primary and secondary interventions. Effective and evidence-based interventions to prevent violence victimization and revictimization against justice-involved young women remains a critical gap in knowledge.
Collapse
Affiliation(s)
- Melissa Willoughby
- The University of Melbourne, Parkville, VIC, Australia
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
| | - Emilia Janca
- The University of Melbourne, Parkville, VIC, Australia
- Curtin University, Perth, WA, Australia
| | - Sohee Kwon
- The University of Melbourne, Parkville, VIC, Australia
| | | | - Tamlynn Collins
- The University of Melbourne, Parkville, VIC, Australia
- Youth Support and Advocacy Service, Fitzroy, VIC, Australia
| | - Stuart A. Kinner
- The University of Melbourne, Parkville, VIC, Australia
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- Curtin University, Perth, WA, Australia
- Griffith University, Mount Gravatt, QLD, Australia
| | - Diana Johns
- The University of Melbourne, Parkville, VIC, Australia
| | - David Gallant
- The University of Melbourne, Parkville, VIC, Australia
| | | | - Rohan Borschmann
- The University of Melbourne, Parkville, VIC, Australia
- Murdoch Children’s Research Institute, Parkville, VIC, Australia
- University of Oxford, UK
| |
Collapse
|
2
|
Woodward EN, Castillo AIM, True G, Willging C, Kirchner JE. Challenges and promising solutions to engaging patients in healthcare implementation in the United States: an environmental scan. BMC Health Serv Res 2024; 24:29. [PMID: 38178131 PMCID: PMC10768202 DOI: 10.1186/s12913-023-10315-y] [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: 03/08/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. METHODS We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. RESULTS We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. CONCLUSION We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.
Collapse
Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | - Andrea Isabel Melgar Castillo
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
- Graduate School, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA, 70119, USA
- Section on Community and Population Medicine, School of Medicine, Louisiana State University, 2400 Canal St (11F), New Orleans, LA, USA
| | - Cathleen Willging
- Pacific Institute for Research and Evaluation, 851 University Boulevard, Suite 101, Albuquerque, NM, 87106, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
| |
Collapse
|
3
|
Booth JM, Shaw D, Song H, Sintim D, Pearl D, Pollard J, Weaver E. Examination of the Relationship Between Daily Perceptions of Collective Efficacy and Marijuana Use Among Black Youth: Does the Location of the Perception Matters? YOUTH & SOCIETY 2023; 55:1475-1500. [PMID: 38187889 PMCID: PMC10769106 DOI: 10.1177/0044118x221114425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Neighborhood-level collective efficacy protects Black youth from substance use; however, neighborhood research does not account for the entirety of adolescents' exposure or their perceptions of space which may be critical to understanding the role of context in substance use. To address this limitation, the SPIN Project recruited 65 Black adolescents (M(SD) = 15.32(1.06)) to complete four brief surveys each day for a month describing their perceptions of spaces and marijuana use. Multilevel negative binomial models were estimated to test the relationship between an individual's perceptions of collective efficacy and the marijuana used during a day, and if the location of the observations moderated these relationships. Findings indicated that the perceptions of collective efficacy protected adolescents from marijuana use when occurring within their home neighborhood, but not outside of it; thereby suggesting important variations in adolescents' perceptions based on the location that matter for Black youth marijuana use.
Collapse
|
4
|
Tracy M, Gordis E, Strully K, Marshall BDL, Cerdá M. Applications of agent-based modeling in trauma research. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:939-950. [PMID: 36136775 PMCID: PMC10030380 DOI: 10.1037/tra0001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Trauma, violence, and their consequences for population health are shaped by complex, intersecting forces across the life span. We aimed to illustrate the strengths of agent-based modeling (ABM), a computational approach in which population-level patterns emerge from the behaviors and interactions of simulated individuals, for advancing trauma research; Method: We provide an overview of agent-based modeling for trauma research, including a discussion of the model development process, ABM as a complement to other causal inference and complex systems approaches in trauma research, and past ABM applications in the trauma literature; Results: We use existing ABM applications to illustrate the strengths of ABM for trauma research, including incorporating interactions between individuals, simulating processes across multiple scales, examining life-course effects, testing alternate theories, comparing intervention strategies in a virtual laboratory, and guiding decision making. We also discuss the challenges of applying ABM to trauma research and offer specific suggestions for incorporating ABM into future studies of trauma and violence; Conclusion: Agent-based modeling is a useful complement to other methodological advances in trauma research. We recommend a more widespread adoption of ABM, particularly for research into patterns and consequences of individual traumatic experiences across the life course and understanding the effects of interventions that may be influenced by social norms and social network structures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Elana Gordis
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI, 02912, United States
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016, United States
| |
Collapse
|
5
|
Montenegro Martínez G, Arias-Castro CE, Silva Sánchez DC, Cardona-Arango D, Segura-Cardona Á, Muñoz-Rodríguez DI, Gutiérrez Ossa J, Henao Villegas S. [Social inequalities related to road traffic mortality]. GACETA SANITARIA 2023; 37:102313. [PMID: 37352821 DOI: 10.1016/j.gaceta.2023.102313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To synthesize the social inequalities related to mortality from traffic accidents reported in scientific publications. METHOD A scoping review following the PRISMA-ScR guide was carried out. Using the MesH vocabulary, we systematically searched for articles in English, Portuguese and Spanish published in the EBSCO, Scielo, Scopus, Ovid, and PubMed databases. RESULTS We identified 47,790 records in the initial search, of which 35 articles met the selection criteria. Nine out ten publications are in high-income countries; there is a greater interest in analyzing mortality in occupants and drivers of vehicles and motorcyclists. Half of the publications use race-ethnicity and geolocation as socioeconomic position variables. The articles included in this review indicate that groups of people with low socioeconomic positions have higher mortality due to traffic accidents. CONCLUSIONS The highest mortality from traffic accidents occurs in people with low socioeconomic positions which suggests the development of road safety actions from a comprehensive, integrative perspective and linked to other political agendas to reduce their incidence by 2030. Although road traffic fatalities are higher in low and middle-income countries, few publications are available in these countries. It is necessary to strengthen the research capacities in these countries.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jahir Gutiérrez Ossa
- Facultad de Ciencias Administrativas y Económicas, Universidad CES, Medellín, Colombia
| | | |
Collapse
|
6
|
Jones A, Nnadi I, Centeno K, Molina G, Nasir R, Granger GG, Mercado NR, Ault-Brutus AA, Hackett M, Karaye IM. Investigating the Spatial Relationship between Social Vulnerability and Healthcare Facility Distribution in Nassau County, New York. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4353. [PMID: 36901363 PMCID: PMC10001444 DOI: 10.3390/ijerph20054353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
Health is a fundamental human right, yet healthcare facilities are not distributed equitably across all communities. This study aims to investigate the distribution of healthcare facilities in Nassau County, New York, and examine whether the distribution is equitable across different social vulnerability levels. An optimized hotspot analysis was conducted on a dataset of 1695 healthcare facilities-dental, dialysis, ophthalmic, and urgent care-in Nassau County, and social vulnerability was measured using the FPIS codes. The study found that healthcare facilities were disproportionately distributed in the county, with a higher concentration in areas of low social vulnerability compared to areas of high social vulnerability. The majority of healthcare facilities were found to be clustered in two ZIP codes-11020 and 11030-that rank among the top ten wealthiest in the county. The results of this study suggest that socially vulnerable residents in Nassau County are at a disadvantage when it comes to attaining equitable access to healthcare facilities. The distribution pattern highlights the need for interventions to improve access to care for marginalized communities and to address the underlying determinants of healthcare facility segregation in the county.
Collapse
Affiliation(s)
- Alea Jones
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Ijeoma Nnadi
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Kelly Centeno
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Giselle Molina
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Rida Nasir
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
| | - Gina G. Granger
- Pipeline Programs, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | - Nicholas R. Mercado
- Department of Health Humanities and Bioethics, University of Rochester Medical Center, Rochester, NY 14642, USA
| | | | - Martine Hackett
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
| | - Ibraheem M. Karaye
- Department of Population Health, Hofstra University, Hempstead, NY 11549, USA
| |
Collapse
|
7
|
Goldstick JE, Jay J. Agent-Based Modeling: an Underutilized Tool in Community Violence Research. CURR EPIDEMIOL REP 2022; 9:135-141. [PMID: 35821794 PMCID: PMC9263807 DOI: 10.1007/s40471-022-00292-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
Purpose of Review Recent Findings Summary
Collapse
Affiliation(s)
- Jason E. Goldstick
- Injury Prevention Center, University of Michigan, 2800 Plymouth Road, Suite B10-G080, Ann Arbor, MI 48109-2800 USA
- Department of Emergency Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109 USA
- Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48105 USA
| | - Jonathan Jay
- Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
| |
Collapse
|
8
|
Cerdá M, Hamilton AD, Tracy M, Branas C, Fink D, Keyes KM. Would restricting firearm purchases due to alcohol- and drug-related misdemeanor offenses reduce firearm homicide and suicide? An agent-based simulation. Inj Epidemiol 2022; 9:17. [PMID: 35681243 PMCID: PMC9185952 DOI: 10.1186/s40621-022-00381-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Substance-related interactions with the criminal justice system are a potential touchpoint to identify people at risk for firearm violence. We used an agent-based model to simulate the change in firearm violence after disqualifying people from owning a firearm given prior alcohol- and drug-related misdemeanors. METHODS We created a population of 800,000 agents reflecting a 15% sample of the adult New York City population. RESULTS Disqualification from purchasing firearms for 5 years after an alcohol-related misdemeanor conviction reduced population-level rates of firearm homicide by 1.0% [95% CI 0.4-1.6%] and suicide by 3.0% [95% CI 1.9-4.0%]. Disqualification based on a drug-related misdemeanor conviction reduced homicide by 1.6% [95% CI 1.1-2.2%] and suicide by 4.6% [95% CI 3.4-5.8%]. Reductions were generally 2 to 8 times larger for agents meeting the disqualification criteria. CONCLUSIONS Denying firearm access based on a history of drug and alcohol misdemeanors may reduce firearm violence among the high-risk group. Enactment of substance use-related firearms denial criteria needs to be balanced against concerns about introducing new sources of disenfranchisement among already vulnerable populations.
Collapse
Affiliation(s)
- Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY USA
- Department of Population Health, Grossman School of Medicine, NYU Langone Health, 180 Madison Avenue, Room 416, New York, NY 10016 USA
| | - Ava D. Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, NY USA
| | - Charles Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - David Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY USA
| |
Collapse
|
9
|
Keyes KM, Hamilton A, Tracy M, Kagawa RMC, Pear VA, Fink D, Branas CC, Cerdá M. Simulating the bounds of plausibility: Estimating the impact of high-risk versus population-based approaches to prevent firearm injury. PLoS One 2022; 17:e0269372. [PMID: 35653403 PMCID: PMC9162316 DOI: 10.1371/journal.pone.0269372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC). METHODS We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity. RESULTS In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43-6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified "high-risk" groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results. CONCLUSION A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an "either-or" question. When individual risk is variable and diffuse in the population, "high-risk approaches" to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.
Collapse
Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Ava Hamilton
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, New York, United States of America
| | - Rose M. C. Kagawa
- Department of Emergency Medicine, Violence Prevention Research Program, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - Veronica A. Pear
- Department of Emergency Medicine, Violence Prevention Research Program, School of Medicine, University of California, Davis, Sacramento, California, United States of America
| | - David Fink
- Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York, United States of America
| | - Charles C. Branas
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Magdalena Cerdá
- Department of Population Health, New York University Langone Health, New York, New York, United States of America
| |
Collapse
|
10
|
Yakubovich AR, Heron J, Barter C, Humphreys DK. Trajectories of Exposure to Neighborhood Deprivation and the Odds of Experiencing Intimate Partner Violence Among Women: Are There Sensitive Periods for Exposure? JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP5728-NP5746. [PMID: 32960156 PMCID: PMC8980452 DOI: 10.1177/0886260520959626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neighborhood disadvantage is commonly hypothesized to be positively associated with intimate partner violence (IPV) against women. However, longitudinal investigation of this association has been limited, with no studies on whether the timing of exposure matters. We used data from 2,115 women in the UK-based Avon Longitudinal Study of Parents and Children. Exposure to neighborhood-level deprivation was measured at 10-time points from baseline (gestation) until age 18. Family-level socioeconomic characteristics were measured at baseline. At age 21, participants self-reported whether they had experienced any IPV since age 18. We used a three-step bias-adjusted longitudinal latent class analysis to investigate how different patterns of neighborhood deprivation exposure were associated with the odds of experiencing IPV. A total of 32% of women experienced any IPV between ages 18 and 21. Women who consistently lived in deprived neighborhoods (chronic high deprivation) or spent their early childhoods in more deprived neighborhoods and later moved to less deprived neighborhoods (decreasing deprivation) had higher odds of experiencing IPV compared to those who consistently lived in non-deprived neighborhoods. The odds of experiencing IPV did not consistently differ between women who lived in non-deprived neighborhoods during early childhood and later moved to deprived neighborhoods (increasing deprivation) and those stably in non-deprived neighborhoods. Living in more deprived neighborhoods during early childhood, regardless of later exposure, was associated with higher odds of experiencing later IPV. This is congruent with prior research demonstrating the persistent effects of early neighborhood disadvantage on health and well-being. Replication, and underlying mechanisms, should be assessed across contexts.
Collapse
Affiliation(s)
- Alexa R. Yakubovich
- University of Oxford, Oxford, United Kingdom
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jon Heron
- University of Bristol, Bristol, United Kingdom
| | - Christine Barter
- University of Central Lancashire, Preston, Lancashire, United Kingdom
| | | |
Collapse
|
11
|
Mooney SJ, Shev AB, Keyes KM, Tracy M, Cerdá M. G-Computation and Agent-Based Modeling for Social Epidemiology: Can Population Interventions Prevent Posttraumatic Stress Disorder? Am J Epidemiol 2022; 191:188-197. [PMID: 34409437 PMCID: PMC8897987 DOI: 10.1093/aje/kwab219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/02/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Agent-based modeling and g-computation can both be used to estimate impacts of intervening on complex systems. We explored each modeling approach within an applied example: interventions to reduce posttraumatic stress disorder (PTSD). We used data from a cohort of 2,282 adults representative of the adult population of the New York City metropolitan area from 2002-2006, of whom 16.3% developed PTSD over their lifetimes. We built 4 models: g-computation, an agent-based model (ABM) with no between-agent interactions, an ABM with violent-interaction dynamics, and an ABM with neighborhood dynamics. Three interventions were tested: 1) reducing violent victimization by 37.2% (real-world reduction); 2) reducing violent victimization by100%; and 3) supplementing the income of 20% of lower-income participants. The g-computation model estimated population-level PTSD risk reductions of 0.12% (95% confidence interval (CI): -0.16, 0.29), 0.28% (95% CI: -0.30, 0.70), and 1.55% (95% CI: 0.40, 2.12), respectively. The ABM with no interactions replicated the findings from g-computation. Introduction of interaction dynamics modestly decreased estimated intervention effects (income-supplement risk reduction dropped to 1.47%), whereas introduction of neighborhood dynamics modestly increased effectiveness (income-supplement risk reduction increased to 1.58%). Compared with g-computation, agent-based modeling permitted deeper exploration of complex systems dynamics at the cost of further assumptions.
Collapse
Affiliation(s)
- Stephen J Mooney
- Correspondence to Dr. Stephen Mooney, 1959 NE Pacific Street, Health Sciences Building F-262, Box 357236, Seattle, WA 98195 (e-mail: )
| | | | | | | | | |
Collapse
|
12
|
Mannor KM, Malcoe LH. Uses of Theory in Racial Health Disparities Research: A Scoping Review and Application of Public Health Critical Race Praxis. Ann Epidemiol 2021; 66:56-64. [PMID: 34793963 DOI: 10.1016/j.annepidem.2021.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 11/19/2022]
Abstract
Given the persistence of racial health disparities, scholars have called for investigations into structural origins of health inequity and deeper engagement with theory. We systematically assessed uses of theory-including theory-informed conceptualizations of race and ethnicity, social structure, and racial hierarchy-in epidemiology and other quantitative population health literature on racial health disparities. We conducted a scoping review of systematically identified original research articles (n=650) that sought to explain racial health disparities; articles were published in 17 high-impact epidemiology, public health, and social science journals. Trained coders abstracted data from each article. We applied Public Health Critical Race Praxis and an iterative data-charting method to identify key themes. Only 63 (9.7%) of 650 racial health disparities articles explicitly used theory. Among studies that engaged theory, one third (n=21/63) clearly conceptualized race and/or ethnicity, and a minority theorized social structure (n=19/63; 30%) and/or racial hierarchy as a structural relation (n=4/63; 6%). There is a pressing need for racial health disparities researchers to unambiguously use theory to conceptualize race and ethnicity in social and historical contexts and explain relational aspects of racial hierarchy. These approaches can better elucidate and inform action on structural determinants of both racial inequity and racial health inequity.
Collapse
Affiliation(s)
- Kara M Mannor
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Milwaukee, WI, USA
| | - Lorraine Halinka Malcoe
- University of Wisconsin-Milwaukee, Joseph J. Zilber School of Public Health, Milwaukee, WI, USA.
| |
Collapse
|
13
|
Broomhead T, Ballas D, Baker SR. Neighbourhoods and oral health: Agent-based modelling of tooth decay. Health Place 2021; 71:102657. [PMID: 34543838 DOI: 10.1016/j.healthplace.2021.102657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022]
Abstract
This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models.
Collapse
Affiliation(s)
- T Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, S10 2TA, United Kingdom.
| | - D Ballas
- Department of Economic Geography, Faculty of Spatial Sciences, University of Groningen, Landleven 1, 9747 AD, Groningen, the Netherlands
| | - S R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, S10 2TA, United Kingdom
| |
Collapse
|
14
|
Montez JK, Hayward MD, Zajacova A. Trends in U.S. Population Health: The Central Role of Policies, Politics, and Profits. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:286-301. [PMID: 34528482 PMCID: PMC8454055 DOI: 10.1177/00221465211015411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Recent trends in U.S. health have been mixed, with improvements among some groups and geographic areas alongside declines among others. Medical sociologists have contributed to the understanding of those disparate trends, although important questions remain. In this article, we review trends since the 1980s in key indicators of U.S. health and weigh evidence from the last decade on their causes. To better understand contemporary trends in health, we propose that commonly used conceptual frameworks, such as social determinants of health, should be strengthened by prominently incorporating commercial, political-economic, and legal determinants. We illustrate how these structural determinants can provide new insights into health trends, using disparate health trajectories across U.S. states as an example. We conclude with suggestions for future research: focusing on structural causes of health trends and inequalities, expanding interdisciplinary perspectives, and integrating methods better equipped to handle the complexity of causal processes driving health trends and inequalities.
Collapse
|
15
|
Cruden G, Karmali R. Opioid misuse as a coping behavior for unmet mental health needs among U.S. adults. Drug Alcohol Depend 2021; 225:108805. [PMID: 34174774 DOI: 10.1016/j.drugalcdep.2021.108805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Self-medication theory posits that opioids may be misused to cope with mental or emotional distress, especially if distress is not treated. Opioid misuse may lead to opioid use disorder, overdose, and death. We estimated the risk of opioid misuse associated with unmet mental health treatment needs (UMHN). METHODS We used 2015-2018 data on U.S. adults from the National Survey of Drug Use and Health (n = 165,767). UMHN was the perceived need for mental health services in the past year without service receipt. The primary dependent variable was past year prescription opioid misuse (POM). Secondary analyses estimated POM and/or heroin misuse risk. Logistic regressions estimated the predicted probability for POM, controlling for demographics, social factors, a major depressive episode (MDE), and overall health. We also tested whether the association of UMHN on the predicted probability of POM varied by MDE. RESULTS UMHN was associated with a 4.6 percentage point higher predicted probability of POM (p < 0.001; 95 % CI 0.04-0.05) and a 4.9 percentage point higher predicted probability of POM and/or heroin (p < 0.001; 95 % CI 0.04-0.06) compared to adults who accessed mental health services. MDE was associated with a significantly greater risk of POM (p < 0.001). POM risk was greater for adults potentially experiencing social isolation. CONCLUSION Targeted mental health support strategies may reduce the likelihood of POM initiation and episodes. Future research should investigate the relationship between unmet mental health needs and initiation of POM episodes.
Collapse
Affiliation(s)
- Gracelyn Cruden
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401, United States.
| | - Ruchir Karmali
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States.
| |
Collapse
|
16
|
Psychiatric symptoms and behavioral adjustment during the COVID-19 pandemic: evidence from two population-representative cohorts. Transl Psychiatry 2021; 11:174. [PMID: 33731687 PMCID: PMC7967107 DOI: 10.1038/s41398-021-01279-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 11/06/2020] [Indexed: 01/03/2023] Open
Abstract
This study examined prevalences of anxiety and depression and their correlations with daily routines among Hong Kong Chinese during the COVID-19 pandemic. Random digit dialing recruited two population-representative samples of 6029 residents during a period of low infection and limited intervention (survey 1: n = 4021) and high incidence and intensive measures (survey 2: n = 2008). Prevalence of anxiety for survey 1 and survey 2 were 14.9% and 14% and depression were 19.6% and 15.3%, respectively. Increased odds of anxiety and depression were associated with disrupted routines and lower socioeconomic status in both surveys, whereas depression was inversely related to the novel preventive routine of avoiding going to crowded places in survey 1. The prevalences of anxiety and depression were higher than preceding public health/social crises. A heavier burden of psychiatric conditions was evidenced amongst people experiencing disrupted daily routines across different phases of the pandemic and without novel preventive routines in the early phase.
Collapse
|
17
|
Keyes KM, Hamilton A, Swanson J, Tracy M, Cerdá M. Simulating the Suicide Prevention Effects of Firearms Restrictions Based on Psychiatric Hospitalization and Treatment Records: Social Benefits and Unintended Adverse Consequences. Am J Public Health 2020; 109:S236-S243. [PMID: 31242005 DOI: 10.2105/ajph.2019.305041] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the number of lives saved from firearms suicide with expansions of gun restrictions based on mental health compared with the number who would be unnecessarily restricted. Methods. Agent-based models simulated effects on suicide mortality resulting from 5-year ownership disqualifications in New York City for individuals with any psychiatric hospitalization and, more broadly, anyone receiving psychiatric treatment. Results. Restrictions based on New York State Office of Mental Health-identified psychiatric hospitalizations reduced suicide among those hospitalized by 85.1% (95% credible interval = 36.5%, 100.0%). Disqualifications for anyone receiving psychiatric treatment reduced firearm suicide rates among those affected and in the population; however, 244 820 people were prohibited from firearm ownership who would not have died from firearm suicide even without the policy. Conclusions. In this simulation, denying firearm access to individuals in psychiatric treatment reduces firearm suicide among those groups but largely will not affect population rates. Broad and unfeasible disqualification criteria would needlessly restrict millions at low risk, with potential consequences for civil rights, increased stigma, and discouraged help seeking.
Collapse
Affiliation(s)
- Katherine M Keyes
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Ava Hamilton
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Jeffrey Swanson
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Melissa Tracy
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| | - Magdalena Cerdá
- Katherine M. Keyes and Ava Hamilton are with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY. Katherine M. Keyes is also with the Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile, and is a Guest Editor for this supplement issue. Jeffrey Swanson is with Psychiatry and Behavioral Sciences, Social and Community Psychiatry, School of Medicine, Duke University, Durham, NC. Melissa Tracy is with the Department of Epidemiology and Biostatistics, University at Albany School of Public Health, State University of New York, Rensselaer, NY. Magdalena Cerdá is with the Department of Emergency Medicine, University of California, Davis, Sacramento, and the Department of Population Health, New York University School of Medicine, New York
| |
Collapse
|
18
|
Heaton B, Cherng ST, Sohn W, Garcia RI, Galea S. Complex Systems Model of Dynamic Mechanisms of Early Childhood Caries Development. J Dent Res 2020; 99:537-543. [PMID: 32122213 DOI: 10.1177/0022034520909841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Early childhood caries (ECC) is a largely preventable condition that occurs when children develop caries in their primary teeth before the age of six. National trends of ECC indicate that prevalence is decreasing, but disparities between various sociodemographic groups may be increasing, despite intervention efforts. Dynamic mechanisms in caries development are hypothesized to be responsible for the observed population distributions of disease. Agent-based models (ABMs) have been utilized to explore similar hypotheses in many areas of health research. Therefore, we developed an ABM of ECC development mechanisms and examined population outcomes of hypothetical preventive intervention scenarios. We found that risk-based targeting had minimal impact on population averages or disparities and was largely due to the strength of the dynamic mechanisms among those considered to be at high caries risk. Universally increasing intervention access reduced population caries prevalence, but increased disparities between different groups of caries risk profiles. We show that population distributions of ECC can emerge as a result of dynamic mechanisms that have been shown to drive disease development. Understanding the effectiveness of a proposed intervention in relation to the hypothesized mechanism(s) that contributes to the outcome of interest is critical to future efforts to address population disparities in ECC.
Collapse
Affiliation(s)
- B Heaton
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - S T Cherng
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - W Sohn
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.,Discipline of Population Oral Health, School of Dentistry, University of Sydney, Westmead, New South Wales, Australia
| | - R I Garcia
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - S Galea
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| |
Collapse
|
19
|
Diderichsen F, Hallqvist J, Whitehead M. Differential vulnerability and susceptibility: how to make use of recent development in our understanding of mediation and interaction to tackle health inequalities. Int J Epidemiol 2020; 48:268-274. [PMID: 30085114 DOI: 10.1093/ije/dyy167] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2018] [Indexed: 12/25/2022] Open
Abstract
This paper discusses the concepts of vulnerability and susceptibility and their relevance for understanding and tackling health inequalities. Tackling socioeconomic inequalities in health is based on an understanding of how an individual's social position influences disease risk. Conceptually, there are two possible mechanisms (not mutually exclusive): there is either some cause(s) of disease that are unevenly distributed across socioeconomic groups (differential exposure) or the effect of some cause(s) of disease differs across groups (differential effect). Since differential vulnerability and susceptibility are often used to denote the latter, we discuss these concepts and their current use and suggest an epidemiologically relevant distinction. The effect of social position can thus be mediated by causes that are unevenly distributed across social groups and/or interact with social position. Recent improvements in the methodology to estimate mediation and interaction have made it possible to calculate measures of relevance for setting targets and priorities in policy for health equity which include both mechanisms, i.e. equalize exposure or equalize effects. We finally discuss the importance of differential susceptibility and vulnerability for the choice of preventive strategies, including approaches that target high-risk individuals, whole populations and vulnerable groups.
Collapse
Affiliation(s)
- Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Saúde Coletiva, Fundacao Oswaldo Cruz, Recife, PE, Brazil
| | - Johan Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| |
Collapse
|
20
|
Galea S, Vaughan R. A Public Health of Consequence: Review of the March 2017 Issue of AJPH. Am J Public Health 2019; 107:363-364. [PMID: 28177809 DOI: 10.2105/ajph.2016.303638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sandro Galea
- Sandro Galea is Dean and Professor, School of Public Health, Boston University, Boston, MA. Roger Vaughan is an AJPH editor, and is also the Vice Dean and Professor of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Roger Vaughan
- Sandro Galea is Dean and Professor, School of Public Health, Boston University, Boston, MA. Roger Vaughan is an AJPH editor, and is also the Vice Dean and Professor of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
21
|
Affiliation(s)
- Magdalena Cerdá
- Magdalena Cerdá is with the Violence Prevention Research Program and the Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento
| |
Collapse
|
22
|
Gansky SA, Shafik S. At the crossroads of oral health inequities and precision public health. J Public Health Dent 2019; 80 Suppl 1:S14-S22. [PMID: 31063590 DOI: 10.1111/jphd.12316] [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] [Received: 09/16/2018] [Revised: 01/06/2019] [Accepted: 03/14/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This paper reviews the precision public health literature pertaining to oral health, identifies possible threats that could inadvertently increase health inequities, and proposes potential opportunities that precision public health could utilize to reduce oral health inequities. METHODS The health sciences literature was reviewed and supplemented with new data to identify important issues relating to precision medicine, precision oral health, precision public health, and health equity. RESULTS Examples from general health and oral health were provided to illustrate salient concepts. CONCLUSIONS Future precision public health should utilize multifactorial, multi-level conceptual frameworks and conceptual causal models with upstream social determinants and downstream health effects, as well as a proportionate universalism perspective; and proper analytic methods, including sufficient sample sizes, appropriate statistical competitors, health disparity indices, causal modeling, and internal and external validation.
Collapse
Affiliation(s)
- Stuart A Gansky
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health, University of California, San Francisco, CA, USA
| | - Sarah Shafik
- Division of Oral Epidemiology and Dental Public Health, Center to Address Disparities in Children's Oral Health, University of California, San Francisco, CA, USA
| |
Collapse
|
23
|
Cerdá M, Keyes KM. Systems Modeling to Advance the Promise of Data Science in Epidemiology. Am J Epidemiol 2019; 188:862-865. [PMID: 30877289 DOI: 10.1093/aje/kwy262] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/18/2022] Open
Abstract
Systems science models use computer-based algorithms to model dynamic interactions between study units within and across levels and are characterized by nonlinear and feedback processes. They are particularly valuable approaches that complement the traditional epidemiologic toolbox in cases in which real data are not available and in cases in which traditional epidemiologic methods are limited by issues such as interference, spatial dependence, and dynamic feedback processes. In this commentary, we propose 2 key contributions that systems models can make to epidemiology: 1) the ability to test assumptions about underlying mechanisms that give rise to population distributions of disease; and 2) help in identifying the types of interventions that have the greatest potential to reduce population rates of disease in the future or in new sites where they have not yet been implemented. We discuss central challenges in the application of systems science approaches in epidemiology, propose potential solutions, and predict future developments in the role that systems science can play in epidemiology.
Collapse
Affiliation(s)
- Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| |
Collapse
|
24
|
Castillo-Carniglia A, Pear VA, Tracy M, Keyes KM, Cerdá M. Limiting Alcohol Outlet Density to Prevent Alcohol Use and Violence: Estimating Policy Interventions Through Agent-Based Modeling. Am J Epidemiol 2019; 188:694-702. [PMID: 30608509 DOI: 10.1093/aje/kwy289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/27/2022] Open
Abstract
Increasing alcohol outlet density is well-documented to be associated with increased alcohol use and problems, leading to the policy recommendation that limiting outlet density will decrease alcohol problems. Yet few studies of decreasing problematic outlets and outlet density have been conducted. We estimated the association between closing alcohol outlets and alcohol use and alcohol-related violence, using an agent-based model of the adult population in New York City. The model was calibrated according to the empirical distribution of the parameters across the city's population, including the density of on- and off-premise alcohol outlets. Interventions capped the alcohol outlet distribution at the 90th to the 50th percentiles of the New York City density, and closed 5% to 25% of outlets with the highest levels of violence. Capping density led to a lower population of light drinkers (42.2% at baseline vs. 38.1% at the 50th percentile), while heavy drinking increased slightly (12.0% at baseline vs. 12.5% at the 50th percentile). Alcohol-related homicides and nonfatal violence remained unchanged. Closing the most violent outlets was not associated with changes in alcohol use or related problems. Results suggest that focusing solely on closing alcohol outlets might not be an effective strategy to reduce alcohol-related problems.
Collapse
Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Chile, Santiago, Chile
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - Veronica A Pear
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, State University of New York at Albany, Albany, New York
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, University of California, Davis, Sacramento, California
- Department of Population Health, New York University School of Medicine, New York, New York
| |
Collapse
|
25
|
Woodward EN, Matthieu MM, Uchendu US, Rogal S, Kirchner JE. The health equity implementation framework: proposal and preliminary study of hepatitis C virus treatment. Implement Sci 2019; 14:26. [PMID: 30866982 PMCID: PMC6417278 DOI: 10.1186/s13012-019-0861-y] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 01/25/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Researchers could benefit from methodological advancements to advance uptake of new treatments while also reducing healthcare disparities. A comprehensive determinants framework for healthcare disparity implementation challenges is essential to accurately understand an implementation problem and select implementation strategies. METHODS We integrated and modified two conceptual frameworks-one from implementation science and one from healthcare disparities research to develop the Health Equity Implementation Framework. We applied the Health Equity Implementation Framework to a historical healthcare disparity challenge-hepatitis C virus (HCV) and its treatment among Black patients seeking care in the US Department of Veterans Affairs (VA). A specific implementation assessment at the patient level was needed to understand any barriers to increasing uptake of HCV treatment, independent of cost. We conducted a preliminary study to assess how feasible it was for researchers to use the Health Equity Implementation Framework. We applied the framework to design the qualitative interview guide and interpret results. Using quantitative data to screen potential participants, this preliminary study consisted of semi-structured interviews with a purposively selected sample of Black, rural-dwelling, older adult VA patients (N = 12), living with HCV, from VA medical clinics in the Southern part of the USA. RESULTS The Health Equity Implementation Framework was feasible for implementation researchers. Barriers and facilitators were identified at all levels including the patient, provider (recipients), patient-provider interaction (clinical encounter), characteristics of treatment (innovation), and healthcare system (inner and outer context). Some barriers reflected general implementation issues (e.g., poor care coordination after testing positive for HCV). Other barriers were related to healthcare disparities and likely unique to racial minority patients (e.g., testimonials from Black peers about racial discrimination at VA). We identified several facilitators, including patient enthusiasm to obtain treatment because of its high cure rates, and VA clinics that offset HCV stigma by protecting patient confidentiality. CONCLUSION The Health Equity Implementation Framework showcases one way to modify an implementation framework to better assess health equity determinants as well. Researchers may be able to optimize the scientific yield of research inquiries by identifying and addressing factors that promote or impede implementation of novel treatments in addition to eliminating healthcare disparities.
Collapse
Affiliation(s)
- Eva N. Woodward
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs, 2200 Fort Roots Drive, 152 NLR, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
| | - Monica M. Matthieu
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs, 2200 Fort Roots Drive, 152 NLR, North Little Rock, AR 72114 USA
- College for Public Health and Social Justice, School of Social Work, Saint Louis University, St. Louis, MO USA
| | | | - Shari Rogal
- VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA USA
| | - JoAnn E. Kirchner
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, U.S. Department of Veterans Affairs, 2200 Fort Roots Drive, 152 NLR, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR USA
- VA Team-Based Behavioral Health QUERI, U.S. Department of Veterans Affairs, North Little Rock, AR USA
| |
Collapse
|
26
|
Keyes KM, Shev A, Tracy M, Cerdá M. Assessing the impact of alcohol taxation on rates of violent victimization in a large urban area: an agent-based modeling approach. Addiction 2019; 114:236-247. [PMID: 30315599 PMCID: PMC6314891 DOI: 10.1111/add.14470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 05/22/2018] [Accepted: 10/05/2018] [Indexed: 02/03/2023]
Abstract
AIMS To use simulation to estimate the impact of alcohol taxation on drinking, non-fatal violent victimization and homicide in New York City (NYC). We simulate the heterogeneous effects of alcohol price elasticities by income, level of consumption and beverage preferences, and examine whether taxation can reduce income inequalities in alcohol-related violence. DESIGN Agent-based modeling simulation. SETTING NYC, USA. PARTICIPANTS Adult population aged 18-64 years in the year 2000 in the 59 community districts of NYC. The population of 256 500 agents approximates a 5% sample of the NYC population. MEASUREMENTS Agents were parameterized through a series of rules that governed alcohol consumption and engagement in violence. Six taxation interventions were implemented based on extensive reviews and meta-analyses, increasing universal alcohol tax by 1, 5 and 10%, and beer tax by 1, 5 and 10%. FINDINGS Under no tax increase, approximately 12.2% [95% credible interval (prediction interval, PI) = 12.1-12.3%] were heavy drinkers. Taxation decreased the proportion of heavy drinkers; a 10% tax decreased heavy drinking to 9.6% (95% PI = 9.4-9.8). Beer taxes had the strongest effect on population consumption. Taxation influenced those in the lowest income groups more than the highest income groups. Alcohol-related homicide decreased from 3.22 per 100 000 (95% PI = 2.50-3.73) to 2.40 per 100 000 under a 10% universal tax (95% PI = 1.92-2.94). This translates into an anticipated benefit of ~1200 lives/year. CONCLUSION Reductions in alcohol consumption in a large urban environment such as New York City can be sustained with modest increases in universal taxation. Alcohol tax increases also have a modest effect on alcohol-related violent victimization. Taxation policies reduce income inequalities in alcohol-related violence.
Collapse
Affiliation(s)
- Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Aaron Shev
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, NY
| | - Magdalena Cerdá
- Department of Emergency Medicine, School of Medicine, University of California at Davis, Sacramento, CA
| |
Collapse
|
27
|
Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health 2019; 109:S16-S20. [PMID: 30699025 PMCID: PMC6356129 DOI: 10.2105/ajph.2018.304883] [Citation(s) in RCA: 364] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 11/04/2022]
Abstract
We introduce the National Institute on Minority Health and Health Disparities (NIMHD) research framework, a product that emerged from the NIMHD science visioning process. The NIMHD research framework is a multilevel, multidomain model that depicts a wide array of health determinants relevant to understanding and addressing minority health and health disparities and promoting health equity. We describe the conceptual underpinnings of the framework and define its components. We also describe how the framework can be used to assess minority health and health disparities research as well as priorities for the future. Finally, we describe how fiscal year 2015 research project grants funded by NIMHD map onto the framework, and we identify gaps and opportunities for future minority health and health disparities research.
Collapse
Affiliation(s)
- Jennifer Alvidrez
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Dorothy Castille
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Maryline Laude-Sharp
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Adelaida Rosario
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Derrick Tabor
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| |
Collapse
|
28
|
Broomhead T, Ballas D, Baker SR. Application of geographic information systems and simulation modelling to dental public health: Where next? Community Dent Oral Epidemiol 2018; 47:1-11. [DOI: 10.1111/cdoe.12437] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Tom Broomhead
- Unit of Oral Health Dentistry and Society School of Clinical Dentistry University of Sheffield Sheffield UK
| | - Dimitris Ballas
- Department of Economic Geography Faculty of Spatial Sciences University of Groningen Groningen The Netherlands
| | - Sarah R. Baker
- Unit of Oral Health Dentistry and Society School of Clinical Dentistry University of Sheffield Sheffield UK
| |
Collapse
|
29
|
DeSalvo KB, Wang YC. Public Health 3.0: Supporting Local Public Health in Addressing Behavioral Health. Am J Public Health 2018; 108:1279-1280. [DOI: 10.2105/ajph.2018.304626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Karen B. DeSalvo
- Karen B. DeSalvo was formerly acting assistant secretary for health at the US Department of Health and Human Services, Washington, DC, and is currently professor of medicine and population health at the University of Texas at Austin Dell Medical School, Austin. Claire Wang is associate professor of health policy and management at Columbia University, Mailman School of Public Health, New York, NY
| | - Y. Claire Wang
- Karen B. DeSalvo was formerly acting assistant secretary for health at the US Department of Health and Human Services, Washington, DC, and is currently professor of medicine and population health at the University of Texas at Austin Dell Medical School, Austin. Claire Wang is associate professor of health policy and management at Columbia University, Mailman School of Public Health, New York, NY
| |
Collapse
|
30
|
Syndemics: A theory in search of data or data in search of a theory? Soc Sci Med 2018; 206:117-122. [PMID: 29628175 DOI: 10.1016/j.socscimed.2018.03.040] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 03/27/2018] [Indexed: 12/14/2022]
Abstract
The concept of a syndemic was proposed more than two decades ago to explain how large-scale social forces might give rise to co-occurring epidemics that synergistically interact to undermine health in vulnerable populations. This conceptual instrument has the potential to help policymakers and program implementers in their endeavors to improve population health. Accordingly, it has become an increasingly popular heuristic for advocacy, most notably in the field of HIV treatment and prevention. However, most empirical studies purporting to validate the theory of syndemics actually do no such thing. Tomori et al. (2018) provide a novel case study from India illustrating how the dominant empirical approach fails to promote deeper understanding about how hazardous alcohol use, illicit drug use, depression, childhood sexual abuse, and intimate partner violence interact to worsen HIV risk among men who have sex with men. In this commentary, I relate the theory of syndemics to other established social science and public health theories of disease distribution, identify possible sources of conceptual and empirical confusion, and provide concrete suggestions for how to validate the theory using a mixed-methods approach. The hope is that more evidence can be mobilized -- whether informed by the theory of syndemics or not -- to improve health and psychosocial wellbeing among vulnerable populations worldwide.
Collapse
|
31
|
Abstract
While neighborhood conditions have been linked to alcohol misuse, less is known about the long-term consequences of exposure to adverse neighborhood conditions early in the life course. Using data from the National Longitudinal Survey of Adolescent to Adult Health, we examined how trajectories of alcohol behaviors from ages 12 to 32 varied according to neighborhood disorder, disadvantage, and advantage. Early exposure to adverse neighborhood conditions placed individuals at greater risk of being a current drinker and alcohol misuse, though these individuals never reached the same levels as those in more stable, advantaged neighborhoods. Early exposure appears to place individuals at risk for alcohol misuse across the early life course.
Collapse
Affiliation(s)
- Peter B Barr
- Department of Psychology, Virginia Commonwealth University, 817 W. Franklin St., Suite B-16, Office B-30, Richmond, VA 23284, United States.
| |
Collapse
|
32
|
Abstract
Agent-based modeling is a computational approach in which agents with a specified set of characteristics interact with each other and with their environment according to predefined rules. We review key areas in public health where agent-based modeling has been adopted, including both communicable and noncommunicable disease, health behaviors, and social epidemiology. We also describe the main strengths and limitations of this approach for questions with public health relevance. Finally, we describe both methodologic and substantive future directions that we believe will enhance the value of agent-based modeling for public health. In particular, advances in model validation, comparisons with other causal modeling procedures, and the expansion of the models to consider comorbidity and joint influences more systematically will improve the utility of this approach to inform public health research, practice, and policy.
Collapse
Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York 12144, USA;
| | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, Sacramento, California 95616, USA;
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
| |
Collapse
|
33
|
Cerdá M, Tracy M, Keyes KM. Reducing Urban Violence: A Contrast of Public Health and Criminal Justice Approaches. Epidemiology 2018; 29:142-150. [PMID: 28926374 PMCID: PMC5718925 DOI: 10.1097/ede.0000000000000756] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cities are investing millions in Cure Violence, a public health approach to reduce urban violence by targeting at-risk youth and redirecting conflict to nonviolent responses. The impact of such a program compared with criminal justice responses is unknown because experiments directly comparing criminal justice and public health approaches to violence prevention are infeasible with observational data. We simulated experiments to test the influence of two interventions on violence: (1) Cure Violence and (2) directed police patrol in violence hot spots. METHODS We used an agent-based model to simulate a 5% sample of the New York City (NYC) adult population, with agents placed on a grid representing the land area of NYC, with neighborhood size and population density proportional to land area and population density in each community district. Agent behaviors were governed by parameters drawn from city data sources and published estimates. RESULTS Under no intervention, 3.87% (95% CI, 3.84, 3.90) of agents were victimized per year. Implementing the violence interrupter intervention for 10 years decreased victimization by 13% (to 3.35% [3.32, 3.39]). Implementing hot-spots policing and doubling the police force for 10 years reduced annual victimization by about 11% (to 3.46% [3.42, 3.49]). Increasing the police force by 40% combined with implementing the violence interrupter intervention for 10 years decreased violence by 19% (to 3.13% [3.09, 3.16]). CONCLUSIONS Combined investment in a public health, community-based approach to violence prevention and a criminal justice approach focused on deterrence can achieve more to reduce population-level rates of urban violence than either can in isolation. See video abstract at, http://links.lww.com/EDE/B298.
Collapse
|
34
|
Do DP, Frank R, Zheng C, Iceland J. Hispanic Segregation and Poor Health: It's Not Just Black and White. Am J Epidemiol 2017; 186:990-999. [PMID: 28541384 DOI: 10.1093/aje/kwx172] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/21/2016] [Indexed: 12/30/2022] Open
Abstract
Despite the importance of understanding the fundamental determinants of Hispanic health, few studies have investigated how metropolitan segregation shapes the health of the fastest-growing population in the United States. Using 2006-2013 data from the National Health Interview Survey, we 1) examined the relationship between Hispanic metropolitan segregation and respondent-rated health for US-born and foreign-born Hispanics and 2) assessed whether neighborhood poverty mediated this relationship. Results indicated that segregation has a consistent, detrimental effect on the health of US-born Hispanics, comparable to findings for blacks and black-white segregation. In contrast, segregation was salutary (though not always significant) for foreign-born Hispanics. We also found that neighborhood poverty mediates some, but not all, of the associations between segregation and poor health. Our finding of divergent associations between health and segregation by nativity points to the wide range of experiences within the diverse Hispanic population and suggests that socioeconomic status and structural factors, such as residential segregation, come into play in determining Hispanic health for the US-born in a way that does not occur among the foreign-born.
Collapse
|
35
|
Myaskovsky L, Gao S, Hausmann LRM, Bornemann KR, Burkitt KH, Switzer GE, Fine MJ, Phillips SL, Gater D, Spungen AM, Boninger ML. How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury? Arch Phys Med Rehabil 2017; 98:1812-1820.e3. [PMID: 28130083 PMCID: PMC6159211 DOI: 10.1016/j.apmr.2016.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To understand the role of cultural and psychosocial factors in the outcomes of veteran wheelchair users with spinal cord injury (SCI) to help clinicians identify unique factors faced by their patients and help researchers identify target variables for interventions to reduce disparities in outcomes. DESIGN Cross-sectional cohort study. SETTING Three urban Veterans Affairs medical centers affiliated with academic medical centers. PARTICIPANTS Of the patients (N=516) who were eligible to participate, 482 completed the interview and 439 had SCI. Because of small numbers in other race groups, analyses were restricted to white and African American participants, resulting in a final sample of 422. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Quality of life (QOL, Veterans RAND 12-Item Health Survey); satisfaction (Client Satisfaction Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique Short Form). RESULTS African American Veterans reported poorer physical QOL but better mental QOL than did white Veterans. No other significant race differences were found in unadjusted analyses. Multivariable analyses showed that psychosocial factors were predominantly associated with patients' QOL outcomes and satisfaction with service, but demographic and medical factors were predominantly associated with participation outcomes. Interaction analyses showed that there was a stronger negative association between anxiety and mental QOL for African Americans than for whites, and a positive association between higher self-esteem and social integration for whites but not African Americans. CONCLUSIONS Findings suggest that attempts to improve the outcomes of Veterans with SCI should focus on a tailored approach that emphasizes patients' demographic, medical, and psychosocial assets (eg, building their sense of self-esteem or increasing their feelings of mastery), while providing services targeted to their specific limitations (eg, reducing depression and anxiety).
Collapse
Affiliation(s)
- Larissa Myaskovsky
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
| | - Shasha Gao
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Kellee R Bornemann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Kelly H Burkitt
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Galen E Switzer
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | - David Gater
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Pennsylvania State University Medical Center, Hershey, PA
| | - Ann M Spungen
- National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Departments of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| |
Collapse
|
36
|
"Look at the Whole Me": A Mixed-Methods Examination of Black Infant Mortality in the US through Women's Lived Experiences and Community Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070727. [PMID: 28678200 PMCID: PMC5551165 DOI: 10.3390/ijerph14070727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/20/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022]
Abstract
In the US, the non-Hispanic Black infant mortality rate exceeds the rate among non-Hispanic Whites by more than two-fold. To explore factors underlying this persistent disparity, we employed a mixed methods approach with concurrent quantitative and qualitative data collection and analysis. Eighteen women participated in interviews about their experience of infant loss. Several common themes emerged across interviews, grouped by domain: individual experiences (trauma, grieving and counseling; criminalization); negative interactions with healthcare providers and the healthcare system; and broader contextual factors. Concurrently, we estimated the Black infant mortality rate (deaths per 1000 live births) using linked live birth-infant death records from 2010 to 2013 in every metropolitan statistical area in the US. Poisson regression examined how contextual indicators of population health, socioeconomic conditions of the Black population, and features of the communities in which they live were associated with Black infant mortality and inequity in Black–White infant mortality rates across 100 metropolitan statistical areas with the highest Black infant mortality rates. We used principal components analysis to create a Birth Equity Index in order to examine the collective impact of contextual indicators on Black infant mortality and racial inequity in mortality rates. The association between the Index and Black infant mortality was stronger than any single indicator alone: in metropolitan areas with the worst social, economic, and environmental conditions, Black infant mortality rates were on average 1.24 times higher than rates in areas where conditions were better (95% CI = 1.16, 1.32). The experiences of Black women in their homes, neighborhoods, and health care centers and the contexts in which they live may individually and collectively contribute to persistent racial inequity in infant mortality.
Collapse
|
37
|
Breslau J, Han B, Stein BD, Burns RM, Yu H. Did the Affordable Care Act's Dependent Coverage Expansion Affect Race/Ethnic Disparities in Health Insurance Coverage? Health Serv Res 2017; 53:1286-1298. [PMID: 28593643 DOI: 10.1111/1475-6773.12728] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To test the impact of the dependent coverage expansion (DCE) on insurance disparities across race/ethnic groups. DATA SOURCES/STUDY SETTING Survey data from the National Survey of Drug Use and Health (NSDUH). STUDY DESIGN Triple-difference (DDD) models were applied to repeated cross-sectional surveys of the U.S. adult population. DATA COLLECTION/EXTRACTION METHODS Data from 6 years (2008-2013) of the NSDUH were combined. PRINCIPAL FINDINGS Following the DCE, the relative odds of insurance increased 1.5 times (95 percent CI 1.1, 1.9) among whites compared to blacks and 1.4 times (95 percent CI 1.1, 1.8) among whites compared to Hispanics. CONCLUSIONS Health reform efforts, such as the DCE, can have negative effects on race/ethnic disparities, despite positive impacts in the general population.
Collapse
Affiliation(s)
| | - Bing Han
- RAND Corporation, Santa Monica, CA
| | | | | | - Hao Yu
- RAND Corporation, Pittsburgh , PA
| |
Collapse
|
38
|
Hermosilla SC, Kujawski SA, Richards CA, Muennig PA, Galea S, El-Sayed AM. An Ounce of Prevention: Deaths Averted From Primary Prevention Interventions. Am J Prev Med 2017; 52:778-787. [PMID: 28363409 PMCID: PMC5512568 DOI: 10.1016/j.amepre.2017.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 11/17/2016] [Accepted: 01/05/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The U.S. lags in the nationwide implementation of primary prevention interventions that have been shown to be efficacious. However, the potential population health benefit of widespread implementation of these primary prevention interventions remains unclear. METHODS The meta-analytic literature from October 2013 to March 2014 of primary prevention interventions published between January 2000 and March 2014 was reviewed. The authors then estimated the number of deaths that could have been averted in the U.S. in 2010 if all rigorously studied, efficacious primary prevention interventions for which population attributable risk proportions could be estimated were implemented nationwide. RESULTS A total of 372,054 (15.1%) of all U.S. deaths in 2010 would have been averted if all rigorously studied, efficacious primary prevention interventions were implemented. Two in three averted deaths would have been from cardiovascular disease or malignancy. CONCLUSIONS A substantial proportion of deaths in the U.S. in 2010 could have been averted if efficacious primary prevention interventions were implemented nationwide. Further investment in the implementation of efficacious interventions is warranted to maximize population health in the U.S.
Collapse
Affiliation(s)
- Sabrina C Hermosilla
- Department of Health Policy and Planning, Columbia University Mailman School of Public Health, New York, New York
| | - Stephanie A Kujawski
- Department of Health Policy and Planning, Columbia University Mailman School of Public Health, New York, New York
| | - Catherine A Richards
- Department of Health Policy and Planning, Columbia University Mailman School of Public Health, New York, New York
| | - Peter A Muennig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Sandro Galea
- Department of Health Policy and Planning, Columbia University Mailman School of Public Health, New York, New York
| | - Abdulrahman M El-Sayed
- Department of Health Policy and Planning, Columbia University Mailman School of Public Health, New York, New York.
| |
Collapse
|
39
|
Myaskovsky L, Gao S, Hausmann LRM, Bornemann KR, Burkitt KH, Switzer GE, Fine MJ, Phillips SL, Gater D, Spungen AM, Worobey L, Boninger ML. Quality and Equity in Wheelchairs Used by Veterans. Arch Phys Med Rehabil 2017; 98:442-449. [PMID: 27713075 PMCID: PMC6141307 DOI: 10.1016/j.apmr.2016.09.116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess in Veterans with spinal cord injury (SCI) or amputated limb (AL) the following: (1) patient demographics, medical factors, cultural and psychosocial characteristic by race; (2) wheelchair quality by race; and (3) the independent associations of patient race and the other factors with wheelchair quality. DESIGN Cross-sectional cohort study. SETTING Three Department of Veterans Affairs (VA) medical centers affiliated with academic medical centers. PARTICIPANTS Eligible participants were Veterans with SCI or ALs (N=516); 482 of them completed the interview. Analyses were restricted to white and African American participants. Because there was no variation in wheelchair quality among AL patients (n=42), they were excluded from all but descriptive analyses, leading to a final sample size of 421. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Wheelchair quality as defined by the Medicare Healthcare Common Procedure Coding System. RESULTS We found race differences in many of our variables, but not in quality for manual (odds ratio [OR]=.67; 95% confidence interval [CI], .33-1.36) or power (OR=.82; 95% CI, .51-1.34) wheelchairs. Several factors including age (OR=.96; 95% CI, .93-.99) and income (OR=3.78; 95% CI, 1.43-9.97) were associated with wheelchair quality. There were no significant associations of cultural or psychosocial factors with wheelchair quality. CONCLUSIONS Although there were no racial differences in wheelchair quality, we found a significant association of older age and lower income with poorer wheelchair quality among Veterans. Efforts are needed to raise awareness of such disparities among VA wheelchair providers and to take steps to eliminate these disparities in prescription practice across VA sites.
Collapse
Affiliation(s)
- Larissa Myaskovsky
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
| | - Shasha Gao
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Kellee R Bornemann
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Kelly H Burkitt
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Galen E Switzer
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA
| | | | - David Gater
- Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA; Pennsylvania State University Medical Center, Hershey, PA
| | - Ann M Spungen
- National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Departments of Medicine and Rehabilitation Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lynn Worobey
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - Michael L Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Human Engineering and Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| |
Collapse
|
40
|
Cherng ST, Tam J, Christine P, Meza R. Modeling the Effects of E-cigarettes on Smoking Behavior: Implications for Future Adult Smoking Prevalence. Epidemiology 2016; 27:819-26. [PMID: 27093020 PMCID: PMC5039081 DOI: 10.1097/ede.0000000000000497] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use has increased rapidly in recent years. Given the unknown effects of e-cigarette use on cigarette smoking behaviors, e-cigarette regulation has become the subject of considerable controversy. In the absence of longitudinal data documenting the long-term effects of e-cigarette use on smoking behavior and population smoking outcomes, computational models can guide future empirical research and provide insights into the possible effects of e-cigarette use on smoking prevalence over time. METHODS Agent-based model examining hypothetical scenarios of e-cigarette use by smoking status and e-cigarette effects on smoking initiation and smoking cessation. RESULTS If e-cigarettes increase individual-level smoking cessation probabilities by 20%, the model estimates a 6% reduction in smoking prevalence by 2060 compared with baseline model (no effects) outcomes. In contrast, e-cigarette use prevalence among never smokers would have to rise dramatically from current estimates, with e-cigarettes increasing smoking initiation by more than 200% relative to baseline model estimates to achieve a corresponding 6% increase in smoking prevalence by 2060. CONCLUSIONS Based on current knowledge of the patterns of e-cigarette use by smoking status and the heavy concentration of e-cigarette use among current smokers, the simulated effects of e-cigarettes on smoking cessation generate substantially larger changes to smoking prevalence compared with their effects on smoking initiation.
Collapse
Affiliation(s)
- Sarah T. Cherng
- Department of Epidemiology, University of Michigan School of Public Health
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health
| | - Jamie Tam
- Department of Health Management and Policy, University of Michigan School of Public Health
| | - Paul Christine
- Department of Epidemiology, University of Michigan School of Public Health
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health
| |
Collapse
|
41
|
Diez Roux AV. Health in cities: is a systems approach needed? CAD SAUDE PUBLICA 2016; 31 Suppl 1:9-13. [PMID: 26648353 DOI: 10.1590/0102-311xde01s115] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/19/2014] [Indexed: 11/22/2022] Open
Abstract
This paper reviews the potential utility of using the concepts and tools of systems to understand and act on health in cities. The basic elements of systems approaches and the links between cities as systems and population health as emerging from the functioning of a system are reviewed. The paper also discusses implications of systems thinking for urban health including the development of dynamic conceptual models, the use of new tools, the integration of data in new ways and the identification of data gaps, and the formulation of different kinds of questions and identification of new policies. The paper concludes with a review of caveats and challenges.
Collapse
Affiliation(s)
- Ana V Diez Roux
- School of Public Health, Drexel University, Philadelphia, U.S.A
| |
Collapse
|
42
|
Sorhaindo A, Bonell C, Fletcher A, Jessiman P, Keogh P, Mitchell K. Being targeted: Young women's experience of being identified for a teenage pregnancy prevention programme. J Adolesc 2016; 49:181-90. [PMID: 27088658 DOI: 10.1016/j.adolescence.2016.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 03/24/2016] [Accepted: 03/26/2016] [Indexed: 10/21/2022]
Abstract
Research on the unintended consequences of targeting 'high-risk' young people for health interventions is limited. Using qualitative data from an evaluation of the Teens & Toddlers Pregnancy Prevention programme, we explored how young women experienced being identified as at risk for teenage pregnancy to understand the processes via which unintended consequences may occur. Schools' lack of transparency regarding the targeting strategy and criteria led to feelings of confusion and mistrust among some young women. Black and minority ethnic young women perceived that the assessment of their risk was based on stereotyping. Others felt their outgoing character was misinterpreted as signifying risk. To manage these imposed labels, stigma and reputational risks, young women responded to being targeted by adopting strategies, such as distancing, silence and refusal. To limit harmful consequences, programmes could involve prospective participants in determining their need for intervention or introduce programmes for young people at all levels of risk.
Collapse
Affiliation(s)
- Annik Sorhaindo
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Chris Bonell
- Department of Childhood, Families and Health, UCL Institute of Education, University College London, 20 Bedford Way, London WC1H 0AL, UK.
| | - Adam Fletcher
- School of Social Sciences, Cardiff University, Cardiff CF10 3XQ, UK.
| | - Patricia Jessiman
- School for Policy Studies, University of Bristol, Priory Road, Bristol BS8 1TZ, UK.
| | - Peter Keogh
- The Open University, Room 014, Horlock Building, Walton Hall, Milton Keynes MK7 6AA, UK.
| | - Kirstin Mitchell
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| |
Collapse
|
43
|
Lee JP, Kirkpatrick S, Rojas-Cheatham A, Sin T, Moore RS, Tan S, Godoy S, Ercia A. Improving the Health of Cambodian Americans: Grassroots Approaches and Root Causes. Prog Community Health Partnersh 2016; 10:113-21. [PMID: 27018360 DOI: 10.1353/cpr.2016.0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cambodian Americans experience great disparities in health compared to other Americans, yet may be underserved by conventional healthcare systems. Community-based participatory research (CBPR) is a means to engage underserved communities in health research and programming. We describe results of our efforts to engage the Cambodian grassroots members as well as formal leaders in Oakland, California. OBJECTIVES In addition to a community advisory group, we convened a Community Work Group (CWG), composed of 10 grassroots community women of varying ages and backgrounds. The project aimed to leverage the lived experiences of these women and their understandings of health and wellness in identifying specific health issues and developing culturally resonant strategies. METHODS The CWG met weekly with staff facilitators using methods for collective analysis including theater, body mapping, and other expressive arts. RESULTS The approach proved logistically challenging, but resulted in novel analyses and strategies. The group identified trauma, along with poor access to education, unemployment and underemployment, social isolation, and generation gap, together with community violence, as root causes of key behavioral health issues, namely, alcohol abuse, gambling, prescription drug misuse, and domestic violence. Strategies proposed and implemented by the group and project staff were a community garden, Cambodian New Year's celebrations, and a museum exhibit on the Cambodian refugee experiences. CONCLUSIONS Grassroots community engagement can support projects in identifying social determinants of health and developing the capacities of community members to conduct research and actions to improve health.
Collapse
|
44
|
Fink DS, Keyes KM, Cerdá M. Social Determinants of Population Health: A Systems Sciences Approach. CURR EPIDEMIOL REP 2016; 3:98-105. [PMID: 27642548 DOI: 10.1007/s40471-016-0066-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Population distributions of health emerge from the complex interplay of health-related factors at multiple levels, from the biological to the societal level. Individuals are aggregated within social networks, affected by their locations, and influenced differently across time. From aggregations of individuals, group properties can emerge, including some exposures that are ubiquitous within populations but variant across populations. By combining a focus on social determinants of health with a conceptual framework for understanding how genetics, biology, behavior, psychology, society, and environment interact, a systems science approach can inform our understanding of the underlying causes of the unequal distribution of health across generations and populations, and can help us identify promising approaches to reduce such inequalities. In this paper, we discuss how systems science approaches have already made several substantive and methodological contributions to the study of population health from a social epidemiology perspective.
Collapse
Affiliation(s)
- David S Fink
- Department of Epidemiology, Columbia University, New York, NY
| | | | - Magdalena Cerdá
- Department of Emergency Medicine, University of California, Davis, California, CA
| |
Collapse
|
45
|
Clouston SAP, Yukich J, Anglewicz P. Social inequalities in malaria knowledge, prevention and prevalence among children under 5 years old and women aged 15-49 in Madagascar. Malar J 2015; 13 Suppl 1:499. [PMID: 26651615 PMCID: PMC4676822 DOI: 10.1186/s12936-015-1010-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 11/24/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Approximately 15 % of all deaths in Africa among children under five years old are due to malaria, a preventable and treatable disease. A prevailing sociological theory holds that resources (including knowledge, money, power, prestige, or beneficial social connections) are particularly relevant when diseases are susceptible to effective prevention. This study examines the role of socioeconomic inequalities by broadly predicting malaria knowledge and use of preventive technology among women aged 15-49, and malaria among children aged 6-59 months in Madagascar. METHODS Data came from women aged 15-49 years (N = 8279) interviewed by Madagascar's 2011/2013 Malaria Indicator Studies, and their children aged under five years (N = 7644). Because geographic location may be associated with socioeconomic factors and exposure to malaria, multilevel models were used to account for unobserved geographic and administrative variation. Models also account for observed social, economic, demographic, and seasonal factors. RESULTS Prevalence among children four years old and younger was 7.8 %. Results showed that both mother's education and household wealth strongly influence knowledge about and efforts to prevent and treat malaria. Analyses also revealed that the prevalence of malaria among children aged 6-59 months was determined by household wealth (richest vs poorest: OR = 0.25, 95 % CI [0.10, 0.64]) and maternal education (secondary vs none: OR = 0.51, 95 % CI [0.28, 0.95]). CONCLUSIONS Malaria may be subject to socio-economic forces arising from a broad set of behavioural and geographic determinants, even after adjusting for geographic risk factors and seasonality. Nearly 21 % of the sample lacked primary schooling. To improve malaria reduction efforts, broad-based interventions may need to attack inequalities to ensure that knowledge, prevention and treatment are improved among those who are most vulnerable.
Collapse
Affiliation(s)
- Sean A P Clouston
- Program in Public Health and Department of Preventive, Population and Family Medicine, Stony Brook University, 101 Nichols Rd., Health Sciences Center #3-071, Stony Brook, NY, 11794, USA.
| | - Josh Yukich
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Ste. 2301, New Orleans, LA, 70112, USA.
| | - Phil Anglewicz
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St., Ste. 2210, New Orleans, LA, 70112, USA.
| |
Collapse
|
46
|
Rogawski ET, Meshnick SR, Becker-Dreps S, Adair LS, Sandler RS, Sarkar R, Kattula D, Ward HD, Kang G, Westreich DJ. Reduction in diarrhoeal rates through interventions that prevent unnecessary antibiotic exposure early in life in an observational birth cohort. J Epidemiol Community Health 2015; 70:500-5. [PMID: 26621194 DOI: 10.1136/jech-2015-206635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/09/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Antibiotic treatment early in life is often not needed and has been associated with increased rates of subsequent diarrhoea. We estimated the impact of realistic interventions, which would prevent unnecessary antibiotic exposures before 6 months of age, on reducing childhood diarrhoeal rates. METHODS In data from a prospective observational cohort study conducted in Vellore, India, we used the parametric g-formula to model diarrhoeal incidence rate differences contrasting the observed incidence of diarrhoea to the incidence expected under hypothetical interventions. The interventions prevented unnecessary antibiotic treatments for non-bloody diarrhoea, vomiting and upper respiratory infections before 6 months of age. We also modelled targeted interventions, in which unnecessary antibiotic use was prevented only among children who had already stopped exclusive breast feeding. RESULTS More than half of all antibiotic exposures before 6 months (58.9%) were likely unnecessary. The incidence rate difference associated with removing unnecessary antibiotic use before 6 months of age was -0.28 (95% CI -0.46 to -0.08) episodes per 30 child-months. This implies that preventing unnecessary antibiotic exposures in just 4 children would reduce the incidence of diarrhoea by 1 from 6 months to 3 years of age. CONCLUSIONS Interventions to reduce unnecessary antibiotic use among young children could result in an important reduction in diarrhoeal rates. This work provides an example application of statistical methods which can further the aim of presenting epidemiological findings that are relevant to public health practice.
Collapse
Affiliation(s)
| | - Steven R Meshnick
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sylvia Becker-Dreps
- Department of Family Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linda S Adair
- Department of Nutrition, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert S Sandler
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA Department of Medicine, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Deepthi Kattula
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Honorine D Ward
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Daniel J Westreich
- Department of Epidemiology, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
47
|
Lambert KG, Nelson RJ, Jovanovic T, Cerdá M. Brains in the city: Neurobiological effects of urbanization. Neurosci Biobehav Rev 2015; 58:107-22. [PMID: 25936504 PMCID: PMC4774049 DOI: 10.1016/j.neubiorev.2015.04.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 12/11/2022]
Abstract
With a majority of humans now living in cities, strategic research is necessary to elucidate the impact of this evolutionarily unfamiliar habitat on neural functions and well-being. In this review, both rodent and human models are considered in the evaluation of the changing physical and social landscapes associated with urban dwellings. Animal models assessing increased exposure to artificial physical elements characteristic of urban settings, as well as exposure to unnatural sources of light for extended durations, are reviewed. In both cases, increased biomarkers of mental illnesses such as major depression have been observed. Additionally, applied human research emphasizing the emotional impact of environmental threats associated with urban habitats is considered. Subjects evaluated in an inner-city hospital reveal the impact of combined specific genetic vulnerabilities and heightened stress responses in the expression of posttraumatic stress disorder. Finally, algorithm-based models of cities have been developed utilizing population-level analyses to identify risk factors for psychiatric illness. Although complex, the use of multiple research approaches, as described herein, results in an enhanced understanding of urbanization and its far-reaching effects--confirming the importance of continued research directed toward the identification of putative risk factors associated with psychiatric illness in urban settings.
Collapse
Affiliation(s)
- Kelly G Lambert
- Department of Psychology, Randolph-Macon College, Ashland, VA 23005, USA.
| | - Randy J Nelson
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Tanja Jovanovic
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30303, USA
| | - Magdalena Cerdá
- Department of Epidemiology, Columbia University, New York, NY 10032, USA
| |
Collapse
|
48
|
Wintemute GJ, Kass PH, Stewart SL, Cerdá M, Gruenewald PJ. Alcohol, drug and other prior crimes and risk of arrest in handgun purchasers: protocol for a controlled observational study. Inj Prev 2015; 22:302-7. [PMID: 26498316 DOI: 10.1136/injuryprev-2015-041856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/07/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Alcohol abuse is common in the USA and is a well-established risk factor for violence. Other drug use and criminal activity are risk factors as well and frequently occur together with alcohol abuse. Firearm ownership is also common; there are >50 million firearm owners in the USA. This study assesses the relationships between alcohol and drug abuse and future violence among firearm owners, which no prior research has done. DESIGN AND STUDY POPULATION This records-based retrospective cohort study will involve all persons who legally purchased handguns in California in 2001-approximately 116 000 individuals-with follow-up through the end of 2013. METHODS The principal exposures include prior convictions for alcohol-related and drug-related offenses. The primary outcome measure is an arrest following handgun purchase for a violent Crime Index offense: homicide, rape, robbery or aggravated assault. Subjects will be considered at risk for outcome events for only as long as their residence in California can be established independently of outcome events. Covariates include individual characteristics (eg, age, sex, criminal history, firearm purchase history) and community characteristics (eg, demographics, socioeconomic measures, firearm ownership and alcohol outlet density). We will employ survival analytic methods, expressing effects as HRs. DISCUSSION The results of this large-scale study are likely to be generalisable and to have important implications for violence prevention policies and programmes.
Collapse
Affiliation(s)
- Garen J Wintemute
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Philip H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Susan L Stewart
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Magdalena Cerdá
- Violence Prevention Research Program, Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, California, USA
| | - Paul J Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California, USA
| |
Collapse
|
49
|
Cerdá M, Tracy M, Keyes KM, Galea S. To Treat or to Prevent?: Reducing the Population Burden of Violence-related Post-traumatic Stress Disorder. Epidemiology 2015; 26:681-9. [PMID: 26237744 PMCID: PMC4827920 DOI: 10.1097/ede.0000000000000350] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Violence-related post-traumatic stress disorder (PTSD) remains a prevalent and disabling psychiatric disorder in urban areas. However, the most effective allocation of resources into prevention and treatment to reduce this problem is unknown. We contrasted the impact of two interventions on violence-related PTSD: (1) a population-level intervention intended to prevent violence (i.e., hot-spot policing), and (2) an individual-level intervention intended to shorten PTSD duration (i.e., cognitive-behavioral therapy-CBT). METHODS We used agent-based modeling to simulate violence and PTSD in New York City under four scenarios: (1) no intervention, (2) targeted policing to hot spots of violence, (3) increased access to CBT for people who suffered from violence-related PTSD, and (4) a combination of the two interventions. RESULTS Combined prevention and treatment produced the largest decrease in violence-related PTSD prevalence: hot-spot policing plus a 50% increase in CBT for 5 years reduced the annual prevalence of violence-related PTSD from 3.6% (95% confidence interval = 3.5%, 3.6%) to 3.4% (3.3%, 3.5%). It would have been necessary to implement hot-spot policing or to increase CBT by 200% for 10 years for either intervention to achieve the same reduction in isolation. CONCLUSIONS This study provides an empirically informed demonstration that investment in combined strategies that target social determinants of mental illness and provide evidence-based treatment to those affected by psychiatric disorders can produce larger reductions in the population burden from violence-related PTSD than either preventive or treatment interventions alone. However, neither hot-spot policing nor CBT, alone or combined, will produce large shifts in the population prevalence of violence-related PTSD.
Collapse
Affiliation(s)
- Magdalena Cerdá
- Violence Prevention Research Program, University of California, Davis, Sacramento, CA
- Department of Emergency Medicine, School of Medicine, University of California, Davis, Sacramento, CA
| | - Melissa Tracy
- Department of Epidemiology, University at Albany School of Public Health, Rensselaer, NY
| | - Katherine M. Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA
| |
Collapse
|
50
|
|