The association between reproductive rights and access to abortion services and mental health among US women

Background

This study examines whether living in US states with (1) restrictive reproductive rights and (2) restrictive abortion laws is associated with frequent mental health distress among women.

Methods

We operationalize reproductive rights using an overall state-level measure of reproductive rights as well as a state-level measure of restrictive abortion laws. We merged data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) with these state-level exposure variables and other state-level information. We used multilevel logistic regression to assess the relationship between these two measures and the likelihood of reporting 14 or more days of frequent mental health distress. We also tested whether associations differed across race, household income, education, and marital status.

Results

In the adjusted models, a standard deviation-unit increase in the reproductive rights score was significantly associated with decreased odds of reporting frequent mental health distress (OR = 0.95, 95% CI = 0.91, 0.99). Women in states with very hostile abortion restrictions had higher odds of frequent mental health distress. Associations between state-level abortion restrictions were larger among women 25-34 years old and women with a high school degree. For example, women aged 25-34 years residing in moderate (OR = 1.54, 95% CI = 1.14, 2.04), hostile (OR = 1.59, 95% CI = 1.15, 2.18), and very hostile (OR = 1.29, 95% CI = 1.02, 1.64) states were more likely to report frequent mental health distress than women living in states with less restrictive abortion policies.

Conclusion

We found the association between state-level restrictions on reproductive rights and abortion access and frequent mental health distress differed by age and socioeconomic status. These results suggest abortion rights restrictions may contribute to mental health inequities among women.

Voting restrictions associated with health inequities in teenage birth rates

OBJECTIVES

Since the Landmark Shelby V. Holder Supreme Court Ruling, the number of laws in the United States that make it difficult to vote has increased dramatically. This may lead to legislation that limits access to health care, including options for family planning services. We determine whether voting restrictions are associated with county-level teenage birth rates.

STUDY DESIGN

This is an ecological study.

METHODS

The Cost of Voting Index, a state-level measure of barriers to voting during US elections from 1996 to 2016, was used as a proxy for access to voting. County-level teenage birth rates were obtained from the County Health Rankings data. We used multilevel modeling to determine whether restrictive voting laws were associated with county-level teenage birth rates. We tested whether associations varied across racial and socio-economic groups.

RESULTS

When confounders were included, a significant association was observed between increasing voting restrictions and teenage birth rates (β = 1.72, 95% confidence interval: 0.54, 2.89). A Cost of Voting Index-median income interaction term was tested and was statistically significant (β = -1.00, 95% confidence interval: -1.36, -0.64), indicating that the observed relationship was particularly strong among lower-income counties. The number of reproductive health clinics per capita within each state is a potential mediator.

CONCLUSION

Restrictive voting laws were associated with higher teenage birth rates, particularly for low-income counties. Future work should use methods in which a causal relation can be identified.

High Fear of Discriminatory Violence among Racial, Gender, and Sexual Minority College Students and Its Association with Anxiety and Depression

Minority students experience more discrimination on college campuses, yet little is known about fear of discrimination. This paper (a) establishes a new measure, fear of discriminatory violence, (b) assesses sociodemographic correlates of fear of discriminatory violence, and (c) estimates the effect of fear of discriminatory violence on anxiety and depression. A cross-sectional study using online surveys was undertaken among college students. A zero-inflated negative binomial model estimated the association between sociodemographics and fear of discriminatory violence. Multiple logistic regression models estimated the association between fear of discriminatory violence and anxiety/depression. Fear of discriminatory violence was higher among Black (ME: 11.9, p < 0.0001), Hispanic (ME: 5.9, p < 0.0001), Middle Eastern (ME: 5.4, p = 0.03), Asian (ME: 4.9, p < 0.0001), and multiracial (ME: 2.9, p < 0.0001) students compared with White students; transgender/gender non-conforming (ME: 7.2, p = 0.01) and female (ME: 3.4, p < 0.0001) students compared with male students; and gay (ME: 10.7, p < 0.0001), lesbian (ME: 9.0, p = 0.01), and bisexual students (ME: 3.4, p = 0.001) as well as those with a sexual orientation not included (ME: 5.5, p = 0.001), compared with heterosexual students. Increasing fear of discriminatory violence was associated with increased odds of anxiety (AOR: 1.04; 95% CI: 1.02, 1.06) and depression (AOR: 1.03; 95% CI: 1.02, 1.05). This understudied public health issue should be addressed to prevent fear of discriminatory violence and the resulting mental health consequences among college populations.

Associations between having been threatened or injured with a weapon and substance use and mental health among high school students in the United States

Being threatened or injured with a weapon is a serious form of physical bullying. Little is known about the effects of being threatened or injured with a weapon on substance use and mental health among adolescents. A secondary analysis of 2017 Youth Risk Behavior Survey data assessed the associations between having been threatened or injured with a weapon and substance use (binge drinking, marijuana, tobacco use, prescription medication misuse) and mental health (feeling sad or hopeless, considering suicide). Multiple logistic regression models with complex survey weights were used, controlling for potential confounders. Approximately 6.0% of students reported having been threatened/injured with a weapon. After adjusting for covariates, having been threatened/injured with a weapon was associated with binge drinking (AOR = 2.5; 95% CI: 1.9-3.4), marijuana (AOR = 2.1; 95% CI: 1.6-2.7), tobacco use (AOR = 2.6; 95% CI: 2.0-3.5), and misuse of prescription medication (AOR = 2.2; 95% CI: 1.6-3.0) compared with students who have not been threatened/injured. Having been threatened/injured with a weapon was associated with 1.6 times the odds (95% CI: 1.2-2.2) of feeling sad/hopeless and 1.7 times the odds (95% CI: 1.3-2.3) of considering suicide. Having been threatened or injured with a weapon is an important public health issue associated with negative mental health and substance use.

An Ounce of Prevention: Reducing Ageism Through the Lens of Public Health

Ageism is pervasive. The negative consequences of ageism are vast, and the literature on the effects of ageism on health and health care is extensive. The perpetrators of ageism are equally vast. While it may be tempting to believe that those who go into the fields of gerontology and geriatrics are free from these attitudes and behaviors, this is untrue. It is reasonable to suspect that future public health professionals, even those interested in gerontology, may also carry ageist ideas and practices into their professional careers. This research was developed to determine whether teaching about aging and ageism in a public health course could reduce ageism among students. Participants were students in a class on aging and public health. All students were graduate students in a Master of Public Health (MPH) program. Multiple assessments were used to assess ageism including the Framboni Scale of Ageism (FSA), a validated 29-question measure used to assess ageism, and the Succession, Identity, and Consumption (SIC) scale, another scale assessing ageism. Students were enrolled in an elective course on aging and public health, which was taught through the public health lens of disease prevention and health promotion. Health topics related to aging are discussed with an emphasis on prevention. The contributions older adults make, and the resulting improved health and well-being of self, others, and community are promoted. And the class participates in activities with a variety of community-dwelling older adults. Results show that ageism among students is reduced after the semester long course.

Financial Barriers to Mental Healthcare Services and Depressive Symptoms among Residents of Washington Heights, New York City

Objectives: In the United States, Hispanics are more likely to experience financial barriers to mental health care than non-Hispanics. We used a unique survey to study the effect of these financial barriers on the severity of depressive symptoms among Hispanics who had previously been diagnosed as having depression. Methods: This cross-sectional study used data from the 2015 Washington Heights Community Survey, administered to 2,489 households in Manhattan, New York City. Multiple regression models and propensity score matching were used to estimate the association between financial barriers to mental health care and depressive symptoms and the likelihood of being clinically depressed. Results: Among those diagnosed with depression, those with financial barriers to mental health services or counseling had significantly higher (β = 0.36, 95% CI = 0.03, 0.70) depressive symptoms. When propensity score matching was utilized, those with financial barriers to mental health services had significantly greater depressive symptoms (β = 0.63, 95% CI = 0.37, 0.89) and were significantly more likely to be currently depressed (OR = 2.38, 95% CI = 1.46, 3.89), in comparison to those who had access. Conclusions: Making mental health care more affordable and therefore more accessible to Hispanics is one step toward mitigating the burden on mental illness and decreasing health disparities.

Effect of fear of victimization on hazardous alcohol drinking, tobacco, and marijuana use among university students: A tale of two sexes

BACKGROUND

Fear of victimization has been associated with poorer physical and mental health, yet is understudied in public health. Few studies have examined sex differences in the effects of fear of victimization on substance use. We examined associations between fear of victimization and hazardous alcohol drinking, tobacco, and marijuana use among female and male university students.

METHODS

A cross-sectional study was conducted among university students in an urban location (n = 1415). Socio-demographics, substance use, and fear related to various crimes were measured using online surveys. All fear types were summed into a total fear score and categorized into quartiles: no/little fear, moderate fear, high fear, and very high fear. Chi-square tests and multiple logistic regression models were used to examine associations between fear of victimization, hazardous alcohol drinking, tobacco and marijuana use, by sex.

RESULTS

Females were more likely to report high and very high fear of victimization (26.6% and 33.1%) than male students (19.8% and 16.3%; p < 0.001). In multiple logistic regression models, associations differed by sex: moderate, high, and very high fear were all independently associated with hazardous drinking among females but not males. Female students with very high fear of victimization were more likely to report tobacco use. High and very high fear was also independently associated with marijuana use among female only.

CONCLUSIONS

Higher fear of victimization was associated with substance use among females but not male students. Public health and health care professionals should acknowledge fear of victimization as a potential risk factor for substance use, particularly among women.

Relation between neighborhood socio-economic characteristics and social cohesion, social control, and collective efficacy: Findings from the Boston Neighborhood Study

Little is known about the determinants of collective efficacy, a neighborhood social process comprised of social cohesion and social control, which has shown to be beneficially associated with health. Our goal was to identify determinants of collective efficacy, social cohesion and social control. We used data collected from the Boston Neighborhood Survey, a cross-sectional survey conducted in 38 Boston neighborhoods in 2010 (n = 1710). We used multi-level logistic regression analyses to identify the relationship between the neighborhood-level characteristics and collective efficacy, social cohesion, and social control. High social fragmentation was associated with a decreased likelihood of reporting high collective efficacy (OR = 0.71, 95% CI = 0.54,0.95). and high social cohesion (OR = 0.63, 95% CI = 0.46, 0.86). High social fragmentation (OR = 0.80, 95% CI = 0.64, 0.99), and moderate economic deprivation (OR = 0.64, 95% CI = 0.47, 0.88) were associated with a decreased likelihood of reporting high social control, while high trust in police was associated with an increased likelihood in reporting high social control (OR = 1.86, 95% CI = 1.16, 3.00). Further research should be undertaken to better understand the direction of effect of these associations and how interventions to promote social processes can utilize these findings to improve health.

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We tested the association between neighborhood characteristics and social processes.

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Social Fragmentation was associated with decreased odds for Social Cohesion.

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Trust in Police was associated with increased odds for Social Control.

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Social Fragmentation was associated with decreased odds for Collective Efficacy.

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Future work should be conducted to determine if these associations are causal.

TECHNOLOGICAL AND FINANCIAL PREDICTORS OF FEAR OF FINANCIAL ABUSE AMONG OLDER ADULTS

Much research has focused on elder abuse. Less research focuses on fear of abuse. This analysis examines the associations between feelings of technological competence and variables assessing financial confidence with fear of financial victimization. Data were collected among community dwelling older adults in Nevada (n=467). Questions were asked regarding technological competence, confidence in navigating the financial system, asset protection, trust in financial institutions, and previous financial abuse victimization. The outcome was assessed by asking how afraid the respondent was of becoming a victim of financial abuse. Multivariate logistic regression models were run controlling for confounding. Controlling for all covariates, those who reported feeling unconfident in their technological competence had 2.5 times the odds of being afraid of financial abuse compared with those who felt confident (p<0.02). Those who reported feeling like their assets were at risk had 4.12 times the odds of being afraid of financial abuse (p<0.0001). Older adults who reported feeling vulnerable to financial victimization had 9.4 times the odds of being afraid of financial abuse compared with those who felt invulnerable (p<0.0001). Those who were previously victims of financial abuse had 4.33 times odds of being afraid of financial abuse compared with those who had no history of financial abuse (p<0.0001). Feeling confident in the financial system, asset protection, fear of credit card use, and trust in financial institutions were not associated with fear of financial abuse. These data provide a better understanding of fear of financial abuse, which will allow for better prevention of this issue.

Using the General Social Survey - National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA

OBJECTIVES

Fear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death.

SETTING AND PARTICIPANTS

Data from the 1978-2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297).

METHODS

GSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex.

RESULTS

Among those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14).

CONCLUSIONS

Research has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully.

Violent death rates in the US compared to those of the other high-income countries, 2015

Violence is a serious public health issue in the U.S. This research compares the US and other high-income countries in terms of violent death. We used data from the World Health Organization for populous, high-income countries. Data from CDC's WISQARS and WONDER systems were used to assess mortality data among US white and non-white populations and in low-, medium-, and high-gun states in 2015. Death rates per 100,000 populations were calculated overall, by age, and by sex. Poisson and negative binomial regression were used to test for significance. The homicide rate in the US was 7.5 times higher than the homicide rate in the other high-income countries combined, which was largely attributable to a firearm homicide rate that was 24.9 times higher. The overall firearm death rate was 11.4 times higher in the US than in other high-income countries. In this dataset, 83.7% of all firearm deaths, 91.6% of women killed by guns, and 96.7% of all children aged 0-4 years killed by guns were from the US. Firearm homicide rates were 36 times higher in high-gun US states and 13.5 times higher in low-gun US states than the firearm homicide rate in other high-income countries combined. The firearm homicide rate among the US white population was 12 times higher than the firearm homicide rate in other high-income countries. The US firearm death rate increased between 2003 and 2015 and decreased in other high-income countries. The US continues to be an outlier among high-income countries with respect to firearm deaths.

The Association Between Electronic Bullying and School Absenteeism Among High School Students in the United States

BACKGROUND

We examined the relationship between exposure to electronic bullying and absenteeism as a result of being afraid.

METHODS

This multivariate, multinomial regression analysis of the 2013 Youth Risk Behavior Survey data assessed the association between experiencing electronic bullying in the past year and how often students were absent in the last month due to feeling unsafe at/in transit to school. The model controlled for other predictors of school absence including demographics, physical/behavioral health, and risk factors. Missing data were multiply imputed.

RESULTS

Electronic bullying was significantly associated with absences. Controlling for model covariates, the relative risk of missing 1 day of school was 1.77 times higher, the relative risk of missing 2 to 3 days of school per month increased by a factor of 2.08, and the relative risk of missing 4 or more days of school per month increased by a factor of 1.77 for those who experienced electronic bullying in the past year compared with those who were not electronically bullied.

CONCLUSIONS

Electronic bullying's association with absenteeism places it among already recognized negative influences such as depression and binge drinking, necessitating schools to implement policies to mediate the resulting harmful effects.

Violent Death Rates: The US Compared with Other High-income OECD Countries, 2010

BACKGROUND

Violent death is a serious problem in the United States. Previous research showing US rates of violent death compared with other high-income countries used data that are more than a decade old.

METHODS

We examined 2010 mortality data obtained from the World Health Organization for populous, high-income countries (n = 23). Death rates per 100,000 population were calculated for each country and for the aggregation of all non-US countries overall and by age and sex. Tests of significance were performed using Poisson and negative binomial regressions.

RESULTS

US homicide rates were 7.0 times higher than in other high-income countries, driven by a gun homicide rate that was 25.2 times higher. For 15- to 24-year-olds, the gun homicide rate in the United States was 49.0 times higher. Firearm-related suicide rates were 8.0 times higher in the United States, but the overall suicide rates were average. Unintentional firearm deaths were 6.2 times higher in the United States. The overall firearm death rate in the United States from all causes was 10.0 times higher. Ninety percent of women, 91% of children aged 0 to 14 years, 92% of youth aged 15 to 24 years, and 82% of all people killed by firearms were from the United States.

CONCLUSIONS

The United States has an enormous firearm problem compared with other high-income countries, with higher rates of homicide and firearm-related suicide. Compared with 2003 estimates, the US firearm death rate remains unchanged while firearm death rates in other countries decreased. Thus, the already high relative rates of firearm homicide, firearm suicide, and unintentional firearm death in the United States compared with other high-income countries increased between 2003 and 2010.