1
|
Silver D, Bae JY, Macinko J. Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000-2022. PLoS One 2024; 19:e0299248. [PMID: 38451933 PMCID: PMC10919691 DOI: 10.1371/journal.pone.0299248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.
Collapse
Affiliation(s)
- Diana Silver
- New York University School of Global Public Health, New York, NY, United States of America
| | - Jin Yung Bae
- New York University School of Global Public Health, New York, NY, United States of America
| | - James Macinko
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
| |
Collapse
|
2
|
Silver D, Bae JY, Furuya E, Macinko J. An assessment of court fees, surcharges, and penalties for alcohol-impaired driving in five midwestern U.S. states: implications for exacerbating poverty and health inequalities. J Public Health Policy 2024; 45:58-73. [PMID: 38148380 DOI: 10.1057/s41271-023-00454-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/28/2023]
Abstract
Driving under the influence (DUI) remains an important threat to public health in the United States, and a substantial literature has evaluated the effectiveness of state-mandated penalties. Researchers have overlooked accelerated use of obscured fees and surcharges levied by local and state court systems added to penalties in the past 15 years. We present data regarding DUI penalties for offenders with a blood alcohol content (BAC of 0.08) and the fees and surcharges attached to them in Minnesota, Illinois, Wisconsin, Michigan, and Iowa, and variation in these within Wisconsin at four BAC levels. In all states, surcharges and fees exceed penalty fines substantially. Variation within Wisconsin is also meaningful. Our data suggest that opaque costs in state court systems add a substantial financial burden to DUI penalties, particularly for those with lower incomes. An appraisal of the deterrent role of these added costs is warranted.
Collapse
Affiliation(s)
- Diana Silver
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY, 10006, USA.
| | - Jin Yung Bae
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY, 10006, USA
| | - Elizabeth Furuya
- Department of Public Health Policy and Management, NYU School of Global Public Health, 708 Broadway, New York, NY, 10006, USA
| | - James Macinko
- Departments of Community Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
3
|
Silva AF, Dourado I, Lua I, Jesus GS, Guimarães NS, Morais GAS, Anderle RVR, Pescarini JM, Machado DB, Santos CAST, Ichihara MY, Barreto ML, Magno L, Souza LE, Macinko J, Rasella D. Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians. Nat Commun 2024; 15:1307. [PMID: 38346964 PMCID: PMC10861499 DOI: 10.1038/s41467-024-44975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024] Open
Abstract
Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 -0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030.
Collapse
Affiliation(s)
- Andréa F Silva
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Gabriela S Jesus
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Faculty of Medicine, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Nathalia S Guimarães
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Gabriel A S Morais
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Rodrigo V R Anderle
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Julia M Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Daiane B Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Carlos A S T Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Maria Y Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Mauricio L Barreto
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | - Luis E Souza
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain.
| |
Collapse
|
4
|
Anderle RV, de Oliveira RB, Rubio FA, Macinko J, Dourado I, Rasella D. Modelling HIV/AIDS epidemiological complexity: A scoping review of Agent-Based Models and their application. PLoS One 2024; 19:e0297247. [PMID: 38306355 PMCID: PMC10836677 DOI: 10.1371/journal.pone.0297247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVE To end the AIDS epidemic by 2030, despite the increasing poverty and inequalities, policies should be designed to deal with population heterogeneity and environmental changes. Bottom-up designs, such as the Agent-Based Model (ABM), can model these features, dealing with such complexity. HIV/AIDS has a complex dynamic of structural factors, risk behaviors, biomedical characteristics and interventions. All embedded in unequal, stigmatized and heterogeneous social structure. To understand how ABMs can model this complexity, we performed a scoping review of HIV applications, highlighting their potentialities. METHODS We searched on PubMed, Web of Science, and Scopus repositories following the PRISMA extension for scoping reviews. Our inclusion criteria were HIV/AIDS studies with an ABM application. We identified the main articles using a local co-citation analysis and categorized the overall literature aims, (sub)populations, regions, and if the papers declared the use of ODD protocol and limitations. RESULTS We found 154 articles. We identified eleven main papers, and discussed them using the overall category results. Most studies model Transmission Dynamics (37/154), about Men who have sex with Men (MSM) (41/154), or individuals living in the US or South Africa (84/154). Recent studies applied ABM to model PrEP interventions (17/154) and Racial Disparities (12/154). Only six papers declared the use of ODD Protocol (6/154), and 34/154 didn't mention the study limitations. CONCLUSIONS While ABM is among the most sophisticated techniques available to model HIV/AIDS complexity. Their applications are still restricted to some realities. However, researchers are challenged to think about social structure due model characteristics, the inclusion of these features is still restricted to case-specific. Data and computational power availability can enhance this feature providing insightful results.
Collapse
Affiliation(s)
| | | | - Felipe Alves Rubio
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Ines Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil
- ISGlobal, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Macinko J, Beltrán-Sánchez H, Mambrini JVDM, Lima-Costa MF. Socioeconomic, Disease Burden, Physical Functioning, Psychosocial, and Environmental Factors Associated With Mortality Among Older Adults: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil). J Aging Health 2024; 36:25-34. [PMID: 37078416 DOI: 10.1177/08982643231171184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
OBJECTIVES There is little nationally representative information about factors associated with longevity among older Brazilians. METHODS Baseline survey data from the Brazilian longitudinal Study of Aging (ELSI-Brazil) were linked to vital statistics systems. Mortality rates and life expectancy estimates were calculated and compared to official sources. Cox Proportional Hazards models and Population Attributable Fractions (PAFs) identified significant predictors of mortality. Results: Calculated mortality rates and life expectancy estimates were similar to official statistics for most ages with higher risk of death among older ages, as expected. High School completion, being partnered, and female sex were negatively associated with mortality, while being underweight, previous diagnosis of a chronic condition, having any functional limitations, poor self-rated health, low grip strength, and smoking were all associated with higher mortality risk. Discussion: The ELSI-Brazil study has potential to identify factors associated with longevity and to inform programs and policies designed to enhance healthy aging among older adults in Brazil.
Collapse
Affiliation(s)
- James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Hiram Beltrán-Sánchez
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | | | - Maria Fernanda Lima-Costa
- Fundação Oswaldo Cruz, Instituto René Rachou. Belo Horizonte, MG, Brasil
- Programa de Pós Graduação Em Saúde Pública, Universidade Federal de Minas Gerais Belo Horizonte, MG, Brasil
| |
Collapse
|
6
|
Aryal A, Garcia FB, Scheitler AJ, Faraon EJA, Moncatar TJRT, Saniel OP, Lorenzo FME, Rosadia RAF, Shimkhada R, Macinko J, Ponce NA. Evolving academic and research partnerships in global health: a capacity-building partnership to assess primary healthcare in the Philippines. Glob Health Action 2023; 16:2216069. [PMID: 37249029 PMCID: PMC10231040 DOI: 10.1080/16549716.2023.2216069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
Building fair, equitable, and beneficial partnerships between institutions collaborating in research in low- and middle-income countries (LMIC) and high-income countries (HIC) has become an integral part of research capacity building in global health in recent years. In this paper, we offer an example of an academic collaboration between the University of California Los Angeles, Center for Health Policy and Research (UCLA CHPR) and the University of Philippines, Manila, College of Public Health (UPM CPH) that sought to build an equitable partnership between research institutions. The partnership was built on a project to build capacity for research and produce data for policy action for the prevention and care of non-communicable diseases (NCDs) through primary healthcare in the Philippines. The specific objectives of the project were to: (1) locally adapt the Primary Care Assessment Tool for the Philippines and use the adapted tool to measure facility-level primary care delivery, (2) conduct focus group discussions (FGDs) to gather qualitative observations regarding primary care readiness and capacity, and (3) conduct a comprehensive population-based health survey among adults on NCDs and prior healthcare experience. We describe here the progression of the partnership between these institutions to carry out the project and the elements that helped build a stronger connection between the institutions, such as mutual goal setting, cultural bridging, collaborative teams, and capacity building. This example, which can be used as a model depicting new directionality and opportunities for LMIC-HIC academic partnerships, was written based on the review of shared project documents, including study protocols, and written and oral communications with the project team members, including the primary investigators. The innovation of this partnership includes: LMIC-initiated project need identification, LMIC-based funding allocation, a capacity-building role of the HIC institution, and the expansion of scope through jointly offered courses on global health.
Collapse
Affiliation(s)
- Anu Aryal
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Fernando B. Garcia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - A. J. Scheitler
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Emerito Jose A. Faraon
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - T. J. Robinson T. Moncatar
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Ofelia P. Saniel
- Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Fely Marilyn E. Lorenzo
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Roberto Antonio F. Rosadia
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines
| | - Riti Shimkhada
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
| | - James Macinko
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Ninez A. Ponce
- Center for Health Policy and Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
7
|
Pinto PFPS, Macinko J, Silva AF, Lua I, Jesus G, Magno L, Santos CAST, Ichihara MY, Barreto ML, Moucheraud C, Souza LE, Dourado I, Rasella D. The effect of primary health care on AIDS incidence and mortality: a cohort study of 3.4 million Brazilians. medRxiv 2023:2023.10.02.23296417. [PMID: 37873240 PMCID: PMC10593023 DOI: 10.1101/2023.10.02.23296417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Primary Health Care (PHC) is essential for the health and wellbeing of people living with HIV/AIDS. This study evaluated the effects of one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. Methods A retrospective cohort study carried out in Brazil, from January 1 2007 to December 31 2015. We conducted a quasi-experimental effect evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the effect of FHS on AIDS incidence and mortality and comparing outcomes between residents of municipalities with no FHS coverage with those in municipalities with full FHS coverage. We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated FHS effect by sex and age, and performed a wide range of sensitivity and triangulation analyses. Findings FHS coverage was associated with lower AIDS incidence (rate ratio [RR]:0.76, 95%CI:0.68-0.84) and mortality (RR:0.68,95%CI:0.56-0.82). FHS effect was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR 0.62, 95%CI:0.53-0.72) and mortality (RR 0.56, 95%CI:0.43-0.72). Conclusions AIDS should be an avoidable outcome for most people living with HIV today, and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.
Collapse
Affiliation(s)
- Priscila FPS Pinto
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Andréa F Silva
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Gabriela Jesus
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil
| | - Carlos AS Teles Santos
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Maria Yury Ichihara
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Mauricio L Barreto
- The Centre for Data and Knowledge Integration for Health (CIDACS-Fiocruz), Salvador, Brazil
| | - Corrina Moucheraud
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California (UCLA), Los Angeles, California, The United States of America (USA)
| | - Luis E Souza
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (ISC/UFBA), Salvador, Brazil
- Instituto de Salud Global Barcelona (ISGlobal), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Macinko J, Silver D, Clark DA, Pomeranz JL. The Diffusion of Punitive Firearm Preemption Laws Across U.S. States. Am J Prev Med 2023; 65:649-656. [PMID: 37028569 DOI: 10.1016/j.amepre.2023.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Firearm violence is a public health crisis. Most states prohibit local firearm laws, but some states have laws that allow for lawsuits and other penalties against local governments and lawmakers who pass firearm laws deemed preempted. These punitive firearm preemptive laws may reduce firearm policy innovation, discussion, and adoption beyond preemption alone. Yet, it is unknown how these laws spread from state to state. METHODS In 2022, using an event history analysis framework with state dyads, logistic regression models estimate the factors associated with adoption and diffusion of firearm punitive preemption laws, including state-level demographic, economic, legal, political, population, and state-neighbor factors. RESULTS As of 2021, 15 states had punitive firearm preemption laws. Higher numbers of background checks (AOR=1.50; 95% CI=1.15, 2.04), more conservative government ideology (AOR=7.79; 95% CI=2.05, 35.02), lower per capita income (AOR=0.16; 95% CI=0.05, 0.44), a higher number of permissive state firearm laws (AOR=2.75; 95% CI=1.57, 5.30), and neighboring state passage of the law (AOR=3.97; 95% CI=1.52, 11.51) were associated with law adoption. CONCLUSIONS Both internal and external state factors predict the adoption of punitive firearm preemption. This study may provide insight into which states are susceptible to adoption in the future. Advocates, especially in neighboring states without such laws, may want to focus their firearm safety policy efforts on opposing the passage of punitive firearm preemption.
Collapse
Affiliation(s)
- James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California.
| | - Diana Silver
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| | - Duncan A Clark
- Department of Statistics, College of Physical Sciences, University of California, Los Angeles, Los Angeles, California
| | - Jennifer L Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York
| |
Collapse
|
9
|
La Charite J, Macinko J, Hedrick R, Santoro M, Dudovitz R. Extracurricular Activities, Child and Caregiver Mental Health, and Parental Aggravation-A National Cross-Sectional Study. Acad Pediatr 2023; 23:1394-1402. [PMID: 36634843 DOI: 10.1016/j.acap.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Expanding access to extracurricular activities (EA) may help address the growing mental health needs of children and caregivers. Evidence supports that EA may benefit child mental health, but few studies explore whether this association is influenced by child and EA factors. Further, the impact of EA on caregivers remains unknown. METHODS We conducted a secondary analysis of the 2019 National Survey of Children's Health (NSCH), a nationally representative sample of children and their caregivers. We used responses from caregivers of children aged 6 to 17. Weighted logistic regressions tested associations between EA and 1) child anxiety and/or depression diagnosis, 2) caregiver mental health, and 3) parental aggravation, controlling for child, family, and neighborhood-level covariates. Interaction terms tested whether associations were moderated by child age, sex, and presence of physical, developmental, or behavioral condition. Subanalyses explored whether results varied by EA number and type. RESULTS Weighted sample included 21,259 children. There were disparities in which children were engaged in EA. EA participation was associated with lower odds of a 1) child being diagnosed with anxiety and/or depression; 2) caregiver reporting "fair/poor" mental health, and 3) caregiver reporting "usually/always" experiencing parental aggravation. Child age, sex, EA number and type, but not health condition, influenced the relationship between EA and child anxiety and/or depression diagnosis. CONCLUSIONS Access to EA is associated with child mental health and family functioning. Further studies should assess causality and specific mechanisms of action.
Collapse
Affiliation(s)
- Jaime La Charite
- Department of General Internal Medicine, University of California (J La Charite), Los Angeles, Calif; Departments of Internal Medicine and Pediatrics, Cedars-Sinai Medical Center (J La Charite), Los Angeles, Calif.
| | - James Macinko
- Department of Community Health Sciences and Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health (J Macinko), Los Angeles, Calif
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center (R Hedrick), Los Angeles, Calif
| | - Mercedes Santoro
- County of Los Angeles Department of Parks and Recreation (M Santoro), Alhambra, Calif
| | - Rebecca Dudovitz
- Department of Pediatrics, University of California, Los Angeles (R Dudovitz), Los Angeles, Calif
| |
Collapse
|
10
|
Lua I, Silva AF, Guimarães NS, Magno L, Pescarini J, Anderle RV, Ichihara MY, Barreto ML, Teles Santos CA, Chenciner L, Souza LE, Macinko J, Dourado I, Rasella D. The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individuals. Lancet Reg Health Am 2023; 24:100554. [PMID: 37521440 PMCID: PMC10372893 DOI: 10.1016/j.lana.2023.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
Background Social determinants of health (SDH) include factors such as income, education, and race, that could significantly affect the human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS). Studies on the effects of SDH on HIV/AIDS are limited, and do not yet provide a systematic understanding of how the various SDH act on important indicators of HIV/AIDS progression. We aimed to evaluate the effects of SDH on AIDS morbidity and mortality. Methods A retrospective cohort of 28.3 million individuals was evaluated over a 9-year period (from 2007 to 2015). Multivariable Poisson regression, with a hierarchical approach, was used to estimate the effects of SDH-at the individual and familial level-on AIDS incidence, mortality, and case-fatality rates. Findings A total of 28,318,532 individuals, representing the low-income Brazilian population, were assessed, who had a mean age of 36.18 (SD: 16.96) years, 52.69% (14,920,049) were female, 57.52% (15,360,569) were pardos, 34.13% (9,113,222) were white/Asian, 7.77% (2,075,977) were black, and 0.58% (154,146) were indigenous. Specific socioeconomic, household, and geographic factors were significantly associated with AIDS-related outcomes. Less wealth was strongly associated with a higher AIDS incidence (rate ratios-RR: 1.55; 95% confidence interval-CI: 1.43-1.68) and mortality (RR: 1.99; 95% CI: 1.70-2.34). Lower educational attainment was also greatly associated with higher AIDS incidence (RR: 1.46; 95% CI: 1.26-1.68), mortality (RR: 2.76; 95% CI: 1.99-3.82) and case-fatality rates (RR: 2.30; 95% CI: 1.31-4.01). Being black was associated with a higher AIDS incidence (RR: 1.53; 95% CI: 1.45-1.61), mortality (RR: 1.69; 95% CI: 1.57-1.83) and case-fatality rates (RR: 1.16; 95% CI: 1.03-1.32). Overall, also considering the other SDH, individuals experiencing greater levels of socioeconomic deprivation were, by far, more likely to acquire AIDS, and to die from it. Interpretation In the population studied, SDH related to poverty and social vulnerability are strongly associated with a higher burden of HIV/AIDS, most notably less wealth, illiteracy, and being black. In the absence of relevant social protection policies, the current worldwide increase in poverty and inequalities-due to the consequences of the COVID-19 pandemic, and the effects of war in the Ukraine-could reverse progress made in the fight against HIV/AIDS in low- and middle-income countries (LMIC). Funding National Institute of Allergy and Infectious Diseases (NAIDS), National Institutes of Health (NIH), US Grant Number: 1R01AI152938.
Collapse
Affiliation(s)
- Iracema Lua
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Department of Health, State University of Feira de Santana (UEFS), Feira de Santana, Bahia, Brazil
| | - Andrea F. Silva
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Nathalia S. Guimarães
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Laio Magno
- Department of Life Sciences, State University of Bahia (UNEB), Salvador, Bahia, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rodrigo V.R. Anderle
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Maria Yury Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Mauricio L. Barreto
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Carlos A.S. Teles Santos
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Louisa Chenciner
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford, UK
- Oxford University Hospitals, Oxford, UK
- Department of Infection and Immunity, St George's University London, London, UK
| | - Luis Eugênio Souza
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Ines Dourado
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
11
|
Gonçalves PD, Bruzelius E, Levy NS, Segura LE, Livne O, Gutkind S, Boustead AE, Hasin DS, Mauro PM, Silver D, Macinko J, Martins SS. Recreational cannabis legislation and binge drinking in U.S. adolescents and adults. Int J Drug Policy 2023; 118:104085. [PMID: 37329666 PMCID: PMC10527765 DOI: 10.1016/j.drugpo.2023.104085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Recreational cannabis laws (RCLs) may have spillover effects on binge drinking. Our aims were to investigate binge drinking time trends and the association between RCLs and changes in binge drinking in the United States (U.S.). METHODS We used restricted National Survey on Drug Use and Health data (2008-2019). We examined trends in the prevalence of past-month binge drinking by age groups (12-20, 21-30, 31-40, 41-50, 51+). Then, we compared model-based prevalences of past-month binge drinking before and after RCL by age group, using multi-level logistic regression with state random intercepts, an RCL by age group interaction term, and controlling for state alcohol policies. RESULTS Binge drinking declined overall from 2008 to 2019 among people aged 12-20 (17.54% to 11.08%), and those aged 21-30 (43.66% to 40.22%). However, binge drinking increased among people aged 31+ (ages 31-40: 28.11% to 33.34%, ages 41-50: 25.48% to 28.32%, ages 51+: 13.28% to 16.75%). When investigating model-based prevalences after versus before RCL, binge drinking decreased among people aged 12-20 (prevalence difference=-4.8%; adjusted odds ratio (aOR)=0.77, [95% confidence interval (CI) 0.70-0.85]), and increased among participants aged 31-40 (+1.7%; 1.09[1.01-1.26]), 41-50 (+2.5; 1.15[1.05-1.26]) and 51+ (+1.8%; 1.17[1.06-1.30]). No RCL-related changes were noted in respondents ages 21-30. CONCLUSIONS Implementation of RCLs was associated with increased past-month binge drinking in adults aged 31+ and decreased past-month binge drinking in those aged < 21. As the cannabis legislative landscape continues to change in the U.S., efforts to minimize harms related to binge drinking are critical.
Collapse
Affiliation(s)
- Priscila Dib Gonçalves
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Emilie Bruzelius
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Luis E Segura
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Sarah Gutkind
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Anne E Boustead
- School of Government & Public Policy, University of Arizona, USA
| | - Deborah S Hasin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, USA
| | - James Macinko
- Departments of Community Health Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| |
Collapse
|
12
|
Guimarães NS, Magno L, de Paula AA, Silliman M, Anderle RVR, Rasella D, Macinko J, de Souza LE, Dourado I. The effects of cash transfer programmes on HIV/AIDS prevention and care outcomes: a systematic review and meta-analysis of intervention studies. Lancet HIV 2023; 10:e394-403. [PMID: 37270225 PMCID: PMC10329870 DOI: 10.1016/s2352-3018(22)00290-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 06/05/2023]
Abstract
BACKGROUND Poverty and social inequality are risk factors for poor health outcomes in patients with HIV/AIDS. In addition to eligibility, cash transfer programmes can be divided into two categories: those with specific requirements (conditional cash transfers [CCTs]) and those without specific requirements (unconditional cash transfers). Common CCT requirements include health care (eg, undergoing an HIV test) and education (eg, children attending school). Trials assessing the effect of cash transfer programmes on HIV/AIDS outcomes have yielded divergent findings. This review aimed to summarise evidence to evaluate the effects of cash transfer programmes on HIV/AIDS prevention and care outcomes. METHODS For this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane Library, LILACS, WHO IRIS, PAHO-IRIS, BDENF, Secretaria Estadual de Saúde SP, Localizador de Informação em Saúde, Coleciona SUS, BINACIS, IBECS, CUMED, SciELO, and Web of Science up to Nov 28, 2022. We included randomised controlled trials (RCTs) that evaluated the effects of cash transfer programmes on HIV incidence, HIV testing, retention in HIV care, and antiretroviral therapy adherence, and conducted risk of bias and quality of evidence assessments using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations approach. A random-effects meta-analysis model was used to combine studies and calculate risk ratios (RRs). Subgroup analyses were performed using conditionality types (ie, school attendance or health care). The protocol was registered with PROSPERO, CRD42021274452. FINDINGS 16 RCTs, which included 5241 individuals, fulfilled the inclusion criteria. Of these, 13 studies included conditionalities for receiving cash transfer programmes. The results showed that receiving a cash transfer was associated with lowered HIV incidence among individuals who had to meet health-care conditionalities (RR 0·74, 95% CI 0·56-0·98) and with increased retention in HIV care for pregnant women (1·14, 95% CI 1·03-1·27). No significant effect was observed for HIV testing (RR 0·45, 95% CI 0·18-1·12) or antiretroviral therapy adherence (1·13, 0·73-1·75). Lower risk of bias was observed for HIV incidence and having an HIV test. The strength of available evidence can be classified as moderate. INTERPRETATION Cash transfer programmes have a positive effect on mitigating HIV incidence for individuals who have to meet health-care conditionalities and on increasing retention in HIV care for pregnant women. These results show the potential of cash transfer programmes for HIV prevention and care, especially among people in extreme poverty, and highlight that cash transfer programmes must be considered when developing policies for HIV/AIDS control, as indicated by the UNAIDS 95-95-95 target of the HIV care continuum. FUNDING National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.
Collapse
Affiliation(s)
- Nathalia Sernizon Guimarães
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Postgraduate Health Science, Medical Sciences College of Minas Gerais, Belo Horizonte, Brazil.
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Department of Life Sciences, State University of Bahia, Salvador, Brazil
| | | | - Miriam Silliman
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Barcelona Institute for Global Health, Barcelona, Spain
| | - James Macinko
- Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
13
|
Seixas BV, Macinko J. Distinct domains of childhood disadvantage and cognitive performance among older Brazilians: Evidence from ELSI-Brazil. SSM Popul Health 2023; 22:101416. [PMID: 37215155 PMCID: PMC10193012 DOI: 10.1016/j.ssmph.2023.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Objective To investigate the relationship between of distinct domains of childhood disadvantage and cognitive performance among older adults within the context of a middle-income country. Methods This study used baseline data (2015/2016) from the Brazilian Longitudinal Study of Aging (ELSI), a nationally representative cohort of 9412 adults aged 50 and over. Nine childhood exposure variables were grouped into three domains (family SES, childhood health, and cultural capital), for which scores were created. Survey-weighted Ordinary Least Squares (OLS) regressions estimated the association childhood disadvantage with cognitive performance as measured by immediate memory, late memory and semantic verbal fluency. Mediation analysis assessed whether adulthood socioeconomic status (SES) mediated this relationship of interest. Results Important disparities in cognitive performance were observed, particularly in terms of age, education, income, occupational status. Before controlling for adulthood SES in the multivariable analysis, all domains of childhood disadvantage were found to be associated with lower cognitive performance across all three measures. After inclusion of adulthood SES variables, the observed associations only remained for semantic verbal fluency. Formal mediation analysis indicated that adulthood SES mediates 47.9% (95% CI: 34.3%-78.6%) of the association between later-life verbal fluency and poor childhood health, and 49.9% (95% CI: 43.6%-57.8%) of the association between later-life verbal fluency and low childhood cultural capital. Conclusions We found that childhood disadvantage is associated with low performance in memory tests and semantic verbal fluency tests among older Brazilians. Adulthood SES fully mediated the association between all domains of childhood disadvantage and memory performance and only partially mediated its association with verbal fluency. Our findings support policy efforts to enhance early childhood development and improve adulthood SES, and guide additional research to better the mechanisms driving these relationships.
Collapse
Affiliation(s)
- Brayan V. Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| |
Collapse
|
14
|
Silva SLA, Macinko J, Lima-Costa MF, Torres JL. Effective primary care attenuates the association between frailty and hospital admission in old age: the ELSI-Brazil. Fam Pract 2023; 40:47-54. [PMID: 35639880 DOI: 10.1093/fampra/cmac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission. METHODS This cross-sectional study included data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, conducted in 2019-2021. Self-reported hospital admission in the past 12 months was the outcome. Frailty included the 5 phenotypic criteria: weight loss, exhaustion, low physical activity, weakness, and slowness. The effective primary care index included 12 attributes indicators, continuously. Statistical analyzes comprised logistic regression. RESULTS Among the 7,436 study participants, frailty (odds ratio [OR] 2.17; 95% confidence intervals [95% CI] 1.31-3.62) and effective primary care index (OR 1.10; 95% CI 1.03-1.16) were positively associated with higher hospitalization. Interaction revealed that while effective primary care was positively associated with hospitalization, this association was different among frail older adults (OR 0.80; 95% CI 0.65-0.99). After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. The predicted probability of hospitalization tended to decrease along with higher primary care index values among frail older adults and became similar to prefrail/nonfrail at the highest end of the scale. CONCLUSIONS Effective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.
Collapse
Affiliation(s)
- Silvia L A Silva
- Departmento de Saúde Coletiva, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | | | - Juliana L Torres
- Departmento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
15
|
Silver D, Bae JY, McNeill E, Macinko J. Do alcohol policies affect everyone equally? An assessment of the effects of state policies on education-related patterns of alcohol use, 2011-2019. Drug Alcohol Depend 2022; 239:109591. [PMID: 35947919 DOI: 10.1016/j.drugalcdep.2022.109591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Public policies are a powerful tool to change behaviors that may harm population health, but little is known about how state alcohol policies affect different population groups. This study assesses the effects of a comprehensive measure of the state alcohol regulatory environment (the State Alcohol Policy Score or SAPS) on heavy drinking-a risk factor for premature death-on different population groups, defined by levels of educational attainment, then by race/ethnicity, and sex. METHODS We pool each state's Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 and use robust Poisson regression analyses that control for individual-level factors, state-level factors (1 year lagged SAPS score for each state, state fixed effects), and year fixed effects to assess the relationship between SAPS and heavy drinking behaviors by education group. Interaction terms test whether education moderates the relationship by race/ethnicity and gender. RESULTS SAPS scores increased 2010-2018, but substantial gaps persist between states. A 10 % increase in a state's alcohol policy score is associated with a 2 % lower prevalence in current drinking (APR=0.97, 95 % CI=0.97-0.97, p < 0.0011) although not for those with a high school education or less. A 10 % increase in the SAPS was associated with a 3 % lower prevalence of heavy drinking; interaction terms in models reveal that a 10 % increase in the SAPS was associated with a lower prevalence of heavy drinking among those with less than a college education. CONCLUSION Narrowing gaps in alcohol policies between states may reduce heavy drinking among those with lower educational attainment.
Collapse
Affiliation(s)
- Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA.
| | - Jin Yung Bae
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA
| | - James Macinko
- Departments of Community Health Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
| |
Collapse
|
16
|
de Sampaio Morais GA, Magno L, Silva AF, Guimarães NS, Ordoñez JA, Souza LE, Macinko J, Dourado I, Rasella D. Effect of a conditional cash transfer programme on AIDS incidence, hospitalisations, and mortality in Brazil: a longitudinal ecological study. Lancet HIV 2022; 9:e690-e699. [PMID: 36179752 PMCID: PMC9577474 DOI: 10.1016/s2352-3018(22)00221-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND One of the biggest challenges of the response to the AIDS epidemic is to reach the poorest people. In 2004, Brazil implemented one of the world's largest conditional cash transfer programmes, the Bolsa Família Programme (BFP). We aimed to evaluate the effect of BFP coverage on AIDS incidence, hospitalisations, and mortality in Brazil. METHODS In this longitudinal ecological study, we developed a conceptual framework linking key mechanisms of BFP effects on AIDS indicators and used ecological panel data from 5507 Brazilian municipalities over the period of 2004-18. We used government sources to calculate municipal-level AIDS incidence, hospitalisation, and mortality rates, and used multivariable regressions analyses of panel data with fixed-effects negative binomial models to estimate the effect of BFP coverage, which was classified as low (0-29%), intermediate (30-69%), and high (≥70%), on AIDS indicators, while adjusting for all relevant demographic, socioeconomic, and health-care covariates at the municipal level. FINDINGS Between 2004 and 2018, in the municipalities under study, 601 977 new cases of AIDS were notified, of which 376 772 (62·6%) were in males older than 14 years, 212 465 (35·3%) were in females older than 14 years, and 12 740 (2·1%) were in children aged 14 years or younger. 533 624 HIV/AIDS-related hospitalisations, and 176 868 AIDS-related deaths had been notified. High BFP coverage was associated with reductions in incidence rate ratios of 5·1% (95% CI 0·9-9·1) for AIDS incidence, 14·3% (7·7-20·5) for HIV/AIDS hospitalisations, and 12·0% (5·2-18·4) for AIDS mortality. The effect of the BFP on AIDS indicators was more pronounced in municipalities with higher AIDS endemicity levels, with reductions in incidence rate ratios of 12·7% (95% CI 5·4-19·4) for AIDS incidence, 21·1% (10·7-30·2) for HIV/AIDS hospitalisations, and 14·7% (3·2-24·9) for AIDS-related mortality, and reductions in AIDS incidence of 14·6% (5·9-22·5) in females older than 14 years, 9·7% (1·4-17·3) in males older than 14 years, and 24·5% (0·5-42·7) in children aged 14 years or younger. INTERPRETATION The effect of BFP coverage on AIDS indicators in Brazil could be explained by the reduction of households' poverty and by BFP health-related conditionalities. The protection of the most vulnerable populations through conditional cash transfers could contribute to the reduction of AIDS burden in low-income and middle-income countries. FUNDING US National Institute of Allergy and Infectious Diseases, National Institutes of Health. TRANSLATION For the Portugese translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
| | - Laio Magno
- Life Science Department, University of the State of Bahia, Salvador, Brazil
| | - Andrea F Silva
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | | | | | - Luís Eugênio Souza
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - James Macinko
- UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Inês Dourado
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Davide Rasella
- Collective Health Institute, Federal University of Bahia, Salvador, Brazil; ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
17
|
Hone T, Macinko J, Trajman A, Palladino R, Coeli CM, Saraceni V, Rasella D, Durovni B, Millett C. Expansion of primary healthcare and emergency hospital admissions among the urban poor in Rio de Janeiro Brazil: A cohort analysis. Lancet Reg Health Am 2022; 15:100363. [PMID: 36778075 PMCID: PMC9904151 DOI: 10.1016/j.lana.2022.100363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Robust evidence on the relationship between primary care and emergency admissions is lacking in low- and middle-income countries. This study evaluates how the phased roll out of the family health strategy (FHS) to the urban poor in Rio de Janeiro Brazil affected emergency hospital admissions and readmissions from ambulatory-care sensitives conditions (ACSCs). Methods A cohort of 1.2 million adults in Rio de Janeiro city were followed for five years (Jan 2012 to Dec 2016). The association between FHS use and the likelihood of emergency hospital admissions and 30-day readmissions were evaluated using multi-level Poisson regression models with inverse probability treatment weighting and regression adjustment (IPTW-RA) for socioeconomic and household characteristics. Inequalities in associations were examined across groups of causes and by key socioeconomic groups. Results Records from 2,551,934 primary care consultations and 15,627 admissions were analysed. In IPTW-RA analyses, each additional FHS consultation was associated with a 3% lower rate of ACSC admission (RR: 0.97; 95%CI: 0.95, 0.98), a 63% lower rate of 30-day readmissions from any non-birth cause (RR: 0.37; 95%CI: 0.30, 0.46), and an 57% lower rate of 30-day readmissions from ACSCs (RR: 0.43; 95%CI: 0.33, 0.55). Individuals who were older, had the lowest educational attainment, were unemployed, and had higher incomes had larger reductions in ACSC admissions associated with FHS use. Interpretation Investment in primary care is important for reducing emergency hospital admissions and their associated costs in LMICs. Funding DFID/MRC/Wellcome Trust/ESRC.
Collapse
Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom,Corresponding author at: Public Health Policy Evaluation Unit, Imperial College London, Third Floor, Reynold's Building, Charing Cross Hospital, St Dunstan's Road, London W6 8RP, United Kingdom.
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, United States
| | | | - Raffaele Palladino
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom,Department of Public Health, University “Federico II” of Naples, Italy
| | - Claudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain,Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, United Kingdom,Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil,Comprehensive Health Research Center and Public Health Research Centre, NOVA National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| |
Collapse
|
18
|
Macinko J, Seixas BV, Woolley NO, Lima-Costa MF. Healthcare utilization among older Brazilians during the COVID-19 pandemic: The Brazilian Longitudinal Study of Ageing-COVID-19 initiative. Int J Health Plann Manage 2022; 37:2198-2210. [PMID: 35306679 DOI: 10.1002/hpm.3461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/15/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND As the COVID-19 pandemic progresses, understanding its sustained impact on healthcare access and utilization represents a vital task for decision-makers and health systems. This study investigates how three aspects of health care utilization (i.e., consultations for COVID-19 related symptoms, cancelation of previously scheduled care and hospitalisation in the past 30 days) relate to individual and municipal factors in a nationally-representative sample of Brazilians aged 50 and over. METHODS Data were obtained for 6584 participants from the second wave of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil in Portuguese) who were administered supplemental telephone interviews between September and October 2020. Descriptive statistics, bivariate analysis and multivariate analysis using survey-weighted Poisson regression were applied to evaluate all three outcomes of interest (consultation, care cancelation, and hospitalisation). Predicted probabilities were also calculated to understand the overall effect of relevant covariates. RESULTS Women were 76% less likely to seek care for COVID-19 symptoms (Odds Ratio [OR] = 0.24, 95% Confidence Interval [CI] = 0.10, 0.53) and 82% more likely to have healthcare cancelled due to the pandemic (OR = 1.82, 95% CI = 1.43, 2.33) than men. Those who live in municipalities with low coverage (<40%) of community-based primary care (the Family Health Strategy) were more likely (OR = 1.80, 95% CI = 1.00, 3.22) to be hospitalised for any reason in the past 30 days and more likely to experience healthcare cancelation (OR = 1.43, 95% CI = 1.01, 2.02). Living in the Southeast and Midwest regions was associated with 62% and 78%, respectively, lower odds of previously scheduled care being cancelled due to the pandemic, in comparison to the North region (OR = 0.38, 95% CI = 0.21, 0.67, and OR = 0.22, 95% CI = 0.14, 0.36). Living in the Southeast region was associated with over 7.61 higher odds of having sought care for COVID-19-related symptoms, relative to those living in the North (OR = 7.61, 95% CI = 2.16, 26.85). CONCLUSION Results highlight the uneven impact of the COVID-19 pandemic on health care utilization between males and females, and across Brazilian municipalities and regions.
Collapse
Affiliation(s)
- James Macinko
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Brayan V Seixas
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | - Maria Fernanda Lima-Costa
- Fundação Oswaldo Cruz, Instituto de Pesquisas René Rachou, Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo Horizonte, Brazil
| |
Collapse
|
19
|
Lima-Costa MF, de Melo Mambrini JV, Bof de Andrade F, de Souza PRB, de Vasconcellos MTL, Neri AL, Castro-Costa E, Macinko J, de Oliveira C. Cohort Profile: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil). Int J Epidemiol 2022; 52:e57-e65. [PMID: 35748356 PMCID: PMC9908056 DOI: 10.1093/ije/dyac132] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/07/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria Fernanda Lima-Costa
- Corresponding author. Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Av. Augusto de Lima 1715, 6º andar, sala 614, Belo Horizonte, 30190-003, Brasil. E-mail:
| | | | | | - Paulo Roberto Borges de Souza
- Instituto de Comunicação e Informação Científica e Tecnológica e Tecnologia em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Erico Castro-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
| |
Collapse
|
20
|
Macinko J, Mullachery PH. Primary care experiences among Brazilian adults: Cross-sectional evidence from the 2019 National Health Survey. PLoS One 2022; 17:e0269686. [PMID: 35671302 PMCID: PMC9173631 DOI: 10.1371/journal.pone.0269686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives
The Brazilian Family Health Strategy (FHS) is strongly associated with better health system performance, but there are no nationally-representative data examining individual-level primary care experiences in the country. Here, we examine reports of primary care experiences among adults with different forms of healthcare coverage (FHS, “traditional” public health posts, and private health plans).
Methods
Data are from the 2019 National Health Survey that included a shortened version of the Primary Care Assessment Tool (PCAT). PCAT questions were administered to a subsample of randomly-selected adults who had a doctor visit within the past 6 months and sought care in a primary care setting (9677 respondents). We used linear regression to examine the association between type of healthcare coverage and PCAT scores adjusted for sex, age, socioeconomic status, health status, geographic region and state of residence.
Results
Primary care experiences in the sample of Brazilians who had a doctor visit 6 months prior to the survey averaged a modest PCAT score of 57 out of 100. Regression models show that users of the FHS had superior primary care experiences, but with large variations across Brazilian regions and states. Individuals selected to respond to the PCAT questions were more likely to be female, older, and poorer, and to be in worse health than the general population.
Conclusions
Brazil’s FHS is associated with modest, but higher-reported primary care experiences than both traditional public health posts and those who have a private health plan. Future iterations of the PCAT module could enhance generalizability by including individuals who had a doctor visit in the past 12 (instead of 6) months.
Collapse
Affiliation(s)
- James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California, United States of America
- * E-mail:
| | - Pricila H. Mullachery
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States of America
| |
Collapse
|
21
|
Macinko J, Mullachery PH. Education-related health inequities in noncommunicable diseases: an analysis of the Brazilian National Health Survey, 2013 and 2019. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00137721. [PMID: 35544920 DOI: 10.1590/0102-311x00137721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/03/2021] [Indexed: 01/22/2023] Open
Abstract
This study assesses changes in the prevalence and distribution of noncommunicable diseases (NCDs) and related risk factors among Brazilian adults from the 2013 and 2019 Brazilian National Health Surveys (PNS). It is based on the hypothesis that deteriorating socioeconomic conditions over this period would lead to increased NCDs among the least advantaged populations. We estimated adjusted prevalence ratios by education category and three inequality measures - the slope index of inequality (SII), the relative index of inequality (RII), and population attributable fraction (PAF) - for obesity, hypertension, arthritis, asthma, cancer, depression, diabetes, heart disease, having any chronic condition, and multimorbidity by survey year. We also estimated the 27 Brazilian Federative Units RII and prevalence rates for diabetes and multimorbidity per year and plotted the RII against prevalence by year. Results showed that all NCDs increased over the period observed, ranging from an 8% increase in the adjusted prevalence of arthritis to a 24% increase in the adjusted prevalence of obesity. Measures of inequality showed that most conditions exhibited significant educational inequities in both 2013 and 2019. However, on average, education-based inequities did not significantly change between the two periods. Considering the deterioration of the socioeconomic conditions of most Brazilians, the erosion of social protections, and the continuing economic, political, and health crises occurring in the nation, we observed an urgent need for discussion about the best way to adopt equity-promoting health policies and programs and action to reduce socioeconomic and geographic inequalities in NCDs throughout the country.
Collapse
|
22
|
Mullachery PH, Macinko J. The authors reply. CAD SAUDE PUBLICA 2022; 38Suppl 1:e00010422. [PMID: 35544914 DOI: 10.1590/0102-311x00010422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
|
23
|
Rasella D, Morais GADS, Anderle RV, da Silva AF, Lua I, Coelho R, Rubio FA, Magno L, Machado D, Pescarini J, Souza LE, Macinko J, Dourado I. Evaluating the impact of social determinants, conditional cash transfers and primary health care on HIV/AIDS: Study protocol of a retrospective and forecasting approach based on the data integration with a cohort of 100 million Brazilians. PLoS One 2022; 17:e0265253. [PMID: 35316304 PMCID: PMC8939793 DOI: 10.1371/journal.pone.0265253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/19/2022] Open
Abstract
Background Despite the great progress made over the last decades, stronger structural interventions are needed to end the HIV/AIDS pandemic in Low and Middle-Income Countries (LMIC). Brazil is one of the largest and data-richest LMIC, with rapidly changing socioeconomic characteristics and an important HIV/AIDS burden. Over the last two decades Brazil has also implemented the world’s largest Conditional Cash Transfer programs, the Bolsa Familia Program (BFP), and one of the most consolidated Primary Health Care (PHC) interventions, the Family Health Strategy (FHS). Objective We will evaluate the effects of socioeconomic determinants, BFP exposure and FHS coverage on HIV/AIDS incidence, treatment adherence, hospitalizations, case fatality, and mortality using unprecedently large aggregate and individual-level longitudinal data. Moreover, we will integrate the retrospective datasets and estimated parameters with comprehensive forecasting models to project HIV/AIDS incidence, prevalence and mortality scenarios up to 2030 according to future socioeconomic conditions and alternative policy implementations. Methods and analysis We will combine individual-level data from all national HIV/AIDS registries with large-scale databases, including the “100 Million Brazilian Cohort”, over a 19-year period (2000–2018). Several approaches will be used for the retrospective quasi-experimental impact evaluations, such as Regression Discontinuity Design (RDD), Random Administrative Delays (RAD) and Propensity Score Matching (PSM), combined with multivariable Poisson regressions for cohort analyses. Moreover, we will explore in depth lagged and long-term effects of changes in living conditions and in exposures to BFP and FHS. We will also investigate the effects of the interventions in a wide range of subpopulations. Finally, we will integrate such retrospective analyses with microsimulation, compartmental and agent-based models to forecast future HIV/AIDS scenarios. Conclusion The unprecedented datasets, analyzed through state-of-the-art quasi-experimental methods and innovative mathematical models will provide essential evidences to the understanding and control of HIV/AIDS epidemic in LMICs such as Brazil.
Collapse
Affiliation(s)
- Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
- * E-mail:
| | | | | | | | - Iracema Lua
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Ronaldo Coelho
- Department of Chronic Conditions and Sexually Transmitted Infections/Department of Health Surveillance/Ministry of Health (DCCI/SVS/MS), Brasília, Brazil
| | - Felipe Alves Rubio
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Life Science Department, University of the State of Bahia, Salvador, Brazil
| | - Daiane Machado
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil
| | - Luis Eugênio Souza
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - James Macinko
- UCLA Fielding School of Public Health, University of California at Los Angeles (UCLA), Los Angeles, California, United States of America
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
24
|
Yue D, Chen X, Zhu Y, Macinko J, Meng Q. Reductions in under-5 mortality and public health improvements of the China Healthy Cities (Counties) initiative: a nationwide quasi-experimental study. BMJ Glob Health 2022; 7:bmjgh-2021-007154. [PMID: 35264316 PMCID: PMC8915311 DOI: 10.1136/bmjgh-2021-007154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/20/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction The China Healthy Cities (Counties) public health initiative has been at the forefront of China’s efforts to counteract the growing challenges in the urban environment since the 1990s. It primarily focuses on improving the urban living environment. However, the nationwide health impacts of the initiative remain unexplored. Methods We constructed nationwide county-level and city-level panel data from 1996 to 2012 using data on under-5 mortality rates (U5MR), the list of China healthy cities and counties and socioeconomic factors. We used a two-step staggered difference-in-differences approach that exploits variations in the timing of achieving the title of China Healthy City/County. Subgroup analyses by region were performed. Results We included 707 cities in the China Healthy Cities study, and 1631 counties in the China Healthy Counties study. Our results indicate substantial and significant reductions in U5MR associated with the public health initiative in China. The association varies across regions with different socioeconomic statuses. China Healthy Cities were significantly associated with a reduction of 0.7/1000 (95% CI −1.2 to −0.2) in under-5 mortality 5 years after cities gained the title and a decrease of 1.4/1000 (95% CI −2.2 to −0.6) 10 years afterward. Cities from western China saw the largest statistically significant gains with 3.2/1000 and 7.2/1000 reductions in child mortality after 5 and 10 years, respectively. China Healthy Counties were also associated with significant reductions in under-5 mortality 8 years after achieving the title; it was associated with 2.6/1000 reductions in under-5 mortality nationwide and 3.8/1000 reductions in eastern China. Our results are robust to heterogeneous treatment effects across cities/counties over time and various model specifications. Conclusion Our results suggest significant reductions in under-5 mortality associated with this public health intervention focusing on living environment conditions. Future research could explore differential effects across regions and clarify the underlying causal mechanisms.
Collapse
Affiliation(s)
- Dahai Yue
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Xiao Chen
- Center for Health Policy Research, University of California Los Angeles, Los Angeles, California, USA
| | - Yuhui Zhu
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - James Macinko
- Department of Health Policy and Management, University of California Los Angeles, Los Angeles, California, USA
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| |
Collapse
|
25
|
Silva B, Hens N, Gusso G, Lagaert S, Macinko J, Willems S. Dual Use of Public and Private Health Care Services in Brazil. IJERPH 2022; 19:ijerph19031829. [PMID: 35162852 PMCID: PMC8835064 DOI: 10.3390/ijerph19031829] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/04/2022]
Abstract
(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 (n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users (n = 6484; 14.7%). Dual use happened both in the direction of public to private (n = 4628; 67.3%), and of private to public (n = 1855; 32.7%). Higher income had a significant effect on dual use (p < 0.0001), suggesting a dose–response relationship, even after controlling for confounders. Significant effects were also found for region (p < 0.0001) and usual source of care (USC) (p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.
Collapse
Affiliation(s)
- Bianca Silva
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
- Correspondence:
| | - Niel Hens
- Data Science Institute (DSI), I-BioStat, Hasselt University, BE-3500 Hasselt, Belgium;
| | - Gustavo Gusso
- Faculty of Medicine, University of São Paulo, São Paulo 05403-000, Brazil;
| | - Susan Lagaert
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
| | - James Macinko
- Department of Health Policy and Management, University of California Los Angeles, Jonathan and Karin Fielding School of Public Health, Los Angeles, CA 90095, USA;
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, BE-9000 Ghent, Belgium; (S.L.); (S.W.)
| |
Collapse
|
26
|
Lima-Costa MF, Macinko J, Mambrini JVDM. Hesitação vacinal contra a COVID-19 em amostra nacional de idosos brasileiros: iniciativa ELSI-COVID, março de 2021. Epidemiol Serv Saúde 2022; 31:e2021469. [DOI: 10.1590/s1679-49742022000100020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Determinar a prevalência e fatores associados à intenção de se vacinar contra a COVID-19 entre idosos brasileiros. Métodos: Estudo seccional, baseado em entrevistas telefônicas de participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros (60 anos ou mais), conduzidas em 70 municípios, em março de 2021. As análises foram realizadas mediante regressão logística multinomial. Resultados: Entre 4.364 participantes (idade média = 70,1 anos), 91,8% pretendiam se vacinar ou já haviam sido vacinados, 2,5% não tinham essa intenção e 5,7% estavam indecisos. Residentes do Norte e Sudeste brasileiros apresentaram maiores propensões para se vacinar, assim como aqueles com duas ou mais doenças crônicas. Os que se informam sobre a COVID-19 com amigos/familiares/mídia social foram mais propensos a estarem indecisos acerca da vacinação (odds ratio = 3,15; IC95% 1,28;7,77). Conclusão: Identificou-se uma das mais altas prevalências da intenção de se vacinar contra a COVID-19 descritas até a presente data.
Collapse
|
27
|
Macinko J, Firmo JOA, Nascimento-Souza MA, Mambrini JVDM, Peixoto SV. Acesso, utilização e qualidade dos serviços de saúde após um desastre: resultados do Projeto Saúde Brumadinho. Rev bras epidemiol 2022. [DOI: 10.1590/1980-549720220005.supl.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Em janeiro de 2019, uma barragem da mina Córrego do Feijão sofreu um rompimento catastrófico que matou 270 pessoas e causou danos extensos. Não se sabe como a exposição a tal desastre pode afetar a utilização dos serviços de saúde. Métodos: Avaliamos os dados do Projeto Saúde Brumadinho, estudo de coorte que incluiu pessoas expostas ao rompimento da barragem e dois grupos de comparação: pessoas não expostas à mineração ou ao desastre e pessoas de uma comunidade mineira, mas não expostas ao desastre. Os desfechos avaliados foram consulta médica ou hospitalização no último ano, fonte habitual de cuidados, pressão arterial e glicemia verificadas e haver recebido vacinas recomendadas, entre adultos de 18 anos ou mais. A regressão de Poisson robusta ponderada foi usada para avaliar as diferenças entre os expostos e os dois grupos de comparação, controlando por fatores de confusão. Resultados: indivíduos expostos tiveram uma razão de prevalência (RP) 15% maior de relatar uma consulta médica do que os não expostos. Para hospitalização e medidas de pressão arterial e glicemia, não houve diferença significativa entre os grupos. O grupo exposto teve RP 24% maior, e a comunidade mineira RP 143% maior de haver recebido imunizações preventivas em relação ao grupo não exposto. Conclusão: Houve diferenças na utilização dos serviços de saúde entre os indivíduos expostos ao rompimento da barragem. O monitoramento contínuo da situação é necessário, pois as consequências de um evento tão traumático podem levar um tempo considerável para se manifestar.
Collapse
|
28
|
Macinko J, Firmo JOA, Nascimento-Souza MA, Mambrini JVDM, Peixoto SV. Healthcare access, utilization, and quality after a disaster: results from the Brumadinho Health Project. Rev bras epidemiol 2022; 25:e220005. [DOI: 10.1590/1980-549720220005.supl.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/25/2022] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Objective: In January 2019 a dam at the Córrego do Feijão mine suffered a catastrophic failure that killed 270 people and caused extensive damage. It is unknown how exposure to such a disaster might affect healthcare utilization. Methods: We assessed survey data from the Brumadinho Health Project, a cohort study that includes people who were exposed to the dam failure and two comparison groups: people unexposed to mining or the disaster and people from a mining community, but not exposed to the disaster. Main outcomes include any doctor visit or hospitalization in the past year, having a usual source of healthcare, having blood pressure and blood sugar checked, and being up to date with vaccinations, for adults 18 years and over. We used survey-weighted robust Poisson regression to assess differences between those exposed and the two comparison groups while controlling for confounders. Results: In multivariable models, the exposed group had a 15% higher chance of having a doctor visit than the unexposed group. For hospitalization and reports of blood pressure and blood sugar assessments, there was no significant difference among any of the groups. The exposed group had a 24% higher chance and the unexposed mining community had a 143% higher chance of being up to date with immunizations, as compared to the unexposed group. Conclusion: There were some differences in healthcare utilization among individuals exposed to the dam failure. Continued monitoring of the situation is warranted, as the full consequences of such a traumatic event may take considerable time to unfold.
Collapse
|
29
|
Seixas B, Macinko J. Childhood Disadvantage and Later-Life Multimorbidity: Demonstrating Robustness Under Imperfect Identification. Innov Aging 2021. [PMCID: PMC8970155 DOI: 10.1093/geroni/igab046.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This study assesses the relationship between indicators of early childhood disadvantage and later-life multimorbidity within a nationally representative sample of Brazilians aged 50 and over (n = 9,412). Data come from the baseline assessment (2015/2016) of the Brazilian Longitudinal Study of Aging (ELSI). We employed survey-weighted Ordinary Least Squares regression to estimate the effects of individual and combined measures of childhood disadvantage on the total number of chronic conditions in later life. Mediation analysis assessed whether adult socioeconomic status (SES) mediated the relationship between childhood disadvantage and chronic conditions. We found that individual and combined measures of childhood disadvantage were associated with the total number of chronic conditions, even after controlling for potential confounders. Mediation analysis suggested that part of the effect of childhood adversity is mediated by higher SES in adulthood (~10%). A formal strategy of sensitivity analysis showed that omitted variable bias is extremely unlikely. To rule out the observed effect, an unobserved hypothetical confounder would need the explanatory power of the residual variance of both the independent and the dependent variables that is at least 30 times larger than that of BMI or 5 times larger than the explanatory power of age. Results should inform efforts to strengthen interventions targeting early childhood development and to improve other key inputs (such as education) to enhance adult SES and lessen the impact of early life stressors on health in older adulthood.
Collapse
|
30
|
Macinko J, Seixas BV, Mambrini JVDM, Lima-Costa MF. Which older Brazilians will accept a COVID-19 vaccine? Cross-sectional evidence from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). BMJ Open 2021; 11:e049928. [PMID: 34732479 PMCID: PMC8572357 DOI: 10.1136/bmjopen-2021-049928] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Vaccine hesitancy may represent a barrier to effective COVID-19 immunisation campaigns. This study assesses individual, disease-specific and contextual factors associated with COVID-19 vaccine acceptance among a nationally representative sample of older Brazilian adults. DESIGN Cross-sectional analysis of data from household interviews and a supplementary telephone survey. SETTING Brazil and its five geographic regions. PARTICIPANTS Data are derived from 6584 individuals aged 50 years and over who participated in the second wave of the Brazilian Longitudinal Study of Aging. PRIMARY AND SECONDARY OUTCOME MEASURES Survey-weighted multinomial logistic regression assesses factors associated with intending, not intending or being uncertain about one's intention to vaccinate against COVID-19. FINDINGS Seventy-one per cent of study participants intend to receive a COVID-19 vaccine once available, while 17% (representative of nearly 9 million people) have no intention to vaccinate, and 12% are still undecided. Besides age, demographic and health-related factors related to COVID-19 severity and complications were not associated with intention to vaccinate. Those who most trusted social media or friends and family for COVID-19 information and those who did not trust any information source were 68% and 78% more likely to refuse vaccination, respectively, as compared with those who trusted official information sources. People who inconsistently used face masks when outside were 3.4 times more likely than consistent face mask users to intend to refuse vaccination. Higher municipal COVID-19 fatality rates were negatively associated with vaccine refusal. CONCLUSIONS Most national COVID-19 immunisation strategies identify older individuals as among those prioritised for early vaccination, given their increased risk of more severe symptoms and complications of the disease. Because individual, disease-specific, and contextual factors were associated with vaccine acceptance, there is a clear need for multilevel and multichannel information and outreach campaigns to increase COVID-19 vaccine acceptance among vulnerable older populations.
Collapse
Affiliation(s)
- James Macinko
- Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
- Department of Community Health Sciences, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| | - Brayan V Seixas
- Department of Health Policy and Management, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA
| | | | - M Fernanda Lima-Costa
- Programa de Pós Graduação em Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Núcleo de Estudos em Saúde Pública e Envelhecimento, Fundacao Oswaldo Cruz Instituto Rene Rachou, Belo Horizonte, Brazil
| |
Collapse
|
31
|
Moucheraud C, Guo H, Macinko J. Trust In Governments And Health Workers Low Globally, Influencing Attitudes Toward Health Information, Vaccines. Health Aff (Millwood) 2021; 40:1215-1224. [PMID: 34339250 DOI: 10.1377/hlthaff.2020.02006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Trust, particularly during emergencies, is essential for effective health care delivery and health policy implementation. We used data from the 2018 Wellcome Global Monitor survey (comprising nationally representative samples from 144 countries) to examine levels and correlates of trust in governments and health workers and attitudes toward vaccines. Only one-quarter of respondents globally expressed a lot of trust in their government (trust was more common among people with less schooling, those living in rural areas, those who were financially comfortable, and those who were older), and fewer than half of respondents globally said that they trust doctors and nurses a lot. People's trust in these institutions was correlated with trust in health or medical advice from them, and with more positive attitudes toward vaccines. Vaccine enthusiasm varied substantially across regions, with safety being the most common concern. Policy makers should understand that the public may have varying levels of trust in different institutions and actors. Although much attention is paid to crafting public health messages, it may be equally important, especially during a pandemic, to identify appropriate, trusted messengers to deliver those messages more effectively to different target populations.
Collapse
Affiliation(s)
- Corrina Moucheraud
- Corrina Moucheraud is an associate professor in the Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, in Los Angeles, California
| | - Huiying Guo
- Huiying Guo is a PhD student in the Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles
| | - James Macinko
- James Macinko is a professor in the Departments of Health Policy and Management and Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles
| |
Collapse
|
32
|
Macinko J, Vaz de Melo Mambrini J, Bof de Andrade F, Drumond Andrade FC, Lazalde GE, Lima-Costa MF. Life-course risk factors are associated with activity of daily living disability in older adults. Eur J Public Health 2021; 31:520-527. [PMID: 33128061 PMCID: PMC8485733 DOI: 10.1093/eurpub/ckaa156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI). METHODS Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability. RESULTS In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country. CONCLUSIONS Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.
Collapse
Affiliation(s)
- James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Correspondence: M. Fernanda Lima-Costa, Instituto de Pesquisas René Rachou, Fundação Oswaldo Cruz, Av. Augusto de Lima 1715, Belo Horizonte 30190002, Brazil, e-mail:
| | | | | | | | - Gabriela E Lazalde
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Maria Fernanda Lima-Costa
- Fundação Oswaldo Cruz, Instituto de Pesquisas René Rachou, Belo Horizonte, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
33
|
Kessler M, Thumé E, Marmot M, Macinko J, Facchini LA, Nedel FB, Wachs LS, Volz PM, de Oliveira C. Family Health Strategy, Primary Health Care, and Social Inequalities in Mortality Among Older Adults in Bagé, Southern Brazil. Am J Public Health 2021; 111:927-936. [PMID: 33734851 DOI: 10.2105/ajph.2020.306146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To investigate the role of the Family Health Strategy (FHS) in reducing social inequalities in mortality over a 9-year follow-up period.Methods. We carried out a population-based cohort study of individuals aged 60 years and older from the city of Bagé, Brazil. Of 1593 participants at baseline (2008), 1314 (82.5%) were included in this 9-year follow-up (2017). We assessed type of primary health care (PHC) coverage and other variables at baseline. In 2017, we ascertained 579 deaths through mortality registers. Hazard ratios and their 95% confidence intervals modeled time to death estimated by Cox regression. We also tested the effect modification between PHC and wealth.Results. The FHS had a protective effect on mortality among individuals aged 60 to 64 years, a result not found among those not covered by the FHS. Interaction analysis showed that the FHS modified the effect of wealth on mortality. The FHS protected the poorest from all-cause mortality (hazard ratio [HR] = 0.59; 95% confidence interval [CI] = 0.36, 0.96) and avoidable mortality (HR = 0.46; 95% CI = 0.25, 0.85).Conclusions. FHS coverage reduced social inequalities in mortality among older adults. Our findings highlight the need to guarantee universal health coverage in Brazil by expanding and strengthening the FHS to promote health equity.
Collapse
Affiliation(s)
- Marciane Kessler
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Elaine Thumé
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Michael Marmot
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - James Macinko
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Luiz Augusto Facchini
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Fúlvio Borges Nedel
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Louriele Soares Wachs
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Pâmela Moraes Volz
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Cesar de Oliveira
- Marciane Kessler, Elaine Thumé, Luiz Augusto Facchini, and Louriele Soares Wachs are with the Department of Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil. Michael Marmot and Cesar de Oliveira are with the Department of Epidemiology & Public Health, University College London, London, UK. James Macinko is with the Department of Health Policy and Management, University of California, Los Angeles. Fúlvio Borges Nedel is with the Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil. Pâmela Moraes Volz is with the Department of Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| |
Collapse
|
34
|
Félix-Beltrán L, Macinko J, Kuhn R. Maternal height and double-burden of malnutrition households in Mexico: stunted children with overweight or obese mothers. Public Health Nutr 2021; 24:106-116. [PMID: 32867877 PMCID: PMC10049080 DOI: 10.1017/s136898002000292x 10.1017/s136898002000292x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To assess the association between short maternal height and four types of mother-child nutritional status groupings within Mexican households. DESIGN We classified mother-child dyads into four groups: stunted child and a non-overweight/non-obese mother (stunting-only), non-stunted child and an overweight/obese mother (overweight-only), stunted child with an overweight/obese mother (double-burden) and households with neither child stunting nor overweight/obese mothers (neither-condition). We assessed the association between maternal height and mother-child nutrition status using multinomial logistic regression, controlling for socio-economic covariates. SETTING Nationally representative cross-section of households from the 2012 Mexican National Health and Nutrition Survey. PARTICIPANTS Children <5 years of age were matched to their mothers, resulting in a sample of 4706 mother-child dyads. RESULTS We found that among children with stunting, 53·3% have an overweight/obese mother. Double-burden was observed in 8·1% of Mexican households. Maternal short stature increased the probability of stunting-only by 3·5% points (p.p.) and double-burden by 9·7 p.p. (P < 0·05). The inverse association was observed for overweight-only and neither-condition households, where the probability of these outcomes decreased by 7·2 and 6 p.p. in households with short-statured mothers (P < 0·05), respectively. CONCLUSIONS Women with short stature are more likely to develop overweight and simultaneously have a stunted child than those who are not short-statured. Our findings underline the challenges faced by public health systems, which have to balance the provision of services for both an undernourished and increasingly overweight/obese population.
Collapse
Affiliation(s)
- Lucía Félix-Beltrán
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E Young Dr S, Los Angeles90095, CA, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E Young Dr S, Los Angeles90095, CA, USA
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
35
|
Macinko J, Seixas BV, Woolley NO, Andrade FBD, Lima-Costa MF. Prevalence and characteristics of Brazilians aged 50 and over that received a doctor's diagnosis of COVID-19: the ELSI-COVID-19 initiative. CAD SAUDE PUBLICA 2020; 36Suppl 3:e00190320. [PMID: 33206833 DOI: 10.1590/0102-311x00190320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused over half a million deaths worldwide. Brazil has been particularly impacted, registering more than 1.3 million infections and 57,000 deaths by late June 2020. Aggregate numbers of cases are essential in modeling the epidemic and planning responses; however, more detailed analysis of risk factors associated with SARS-CoV-2 infection are needed. Our study provides an initial examination of characteristics associated with receiving a doctor's diagnosis of COVID-19 among a nationally representative sample of Brazilians aged 50 and over. Data are derived from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey to ELSI-Brazil participants, known as the ELSI-COVID-19 initiative. The telephone survey was conducted between 26 May and 8 June 2020. Results show that about 2.4% (n = 70) of the sample reported being told by a doctor they had COVID-19, however, only about half of these individuals (n = 37) reported receiving a diagnostic confirmation from viral testing (RT-PCR). Demographic factors (aged 50-60 years), socioeconomic factors (lower household income), health-related factors (obesity, three or more chronic conditions), and geography (living in the Northern region of the country) were positively associated with reporting a COVID-19 diagnosis. Despite the descriptive and preliminary nature of these findings, results reported here suggest the need for more targeted approaches to enhance personal protection and provide greater viral testing options, especially for older, sicker and more vulnerable adults in Brazil.
Collapse
Affiliation(s)
| | | | | | | | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Púbica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| |
Collapse
|
36
|
Freeman T, Gesesew HA, Bambra C, Giugliani ERJ, Popay J, Sanders D, Macinko J, Musolino C, Baum F. Why do some countries do better or worse in life expectancy relative to income? An analysis of Brazil, Ethiopia, and the United States of America. Int J Equity Health 2020; 19:202. [PMID: 33168040 PMCID: PMC7654592 DOI: 10.1186/s12939-020-01315-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND While in general a country's life expectancy increases with national income, some countries "punch above their weight", while some "punch below their weight" - achieving higher or lower life expectancy than would be predicted by their per capita income. Discovering which conditions or policies contribute to this outcome is critical to improving population health globally. METHODS We conducted a mixed-method study which included: analysis of life expectancy relative to income for all countries; an expert opinion study; and scoping reviews of literature and data to examine factors that may impact on life expectancy relative to income in three countries: Ethiopia, Brazil, and the United States. Punching above or below weight status was calculated using life expectancy at birth and gross domestic product per capita for 2014-2018. The scoping reviews covered the political context and history, social determinants of health, civil society, and political participation in each country. RESULTS Possible drivers identified for Ethiopia's extra 3 years life expectancy included community-based health strategies, improving access to safe water, female education and gender empowerment, and the rise of civil society organisations. Brazil punched above its weight by 2 years. Possible drivers identified included socio-political and economic improvements, reduced inequality, female education, health care coverage, civil society, and political participation. The United States' neoliberal economics and limited social security, market-based healthcare, limited public health regulation, weak social safety net, significant increases in income inequality and lower levels of political participation may have contributed to the country punching 2.9 years below weight. CONCLUSIONS The review highlighted potential structural determinants driving differential performance in population health outcomes cross-nationally. These included greater equity, a more inclusive welfare system, high political participation, strong civil society and access to employment, housing, safe water, a clean environment, and education. We recommend research comparing more countries, and also to examine the processes driving within-country inequities.
Collapse
Affiliation(s)
- Toby Freeman
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, Australia.
| | - Hailay Abrha Gesesew
- Department of Public Health, Flinders University, Adelaide, Australia
- Department of Epidemiology, Mekelle University, Mekelle, Ethiopia
| | - Clare Bambra
- Institute of Population Health Sciences, Newcastle University, Newcastle, UK
| | | | - Jennie Popay
- Division of Health Research, Lancaster University, Lancashire, UK
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA, Los Angeles, CA, USA
| | - Connie Musolino
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, Australia
| | - Fran Baum
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, Australia
| |
Collapse
|
37
|
Macinko J, Cristina Drumond Andrade F, Bof de Andrade F, Lima-Costa MF. Universal Health Coverage: Are Older Adults Being Left Behind? Evidence From Aging Cohorts In Twenty-Three Countries. Health Aff (Millwood) 2020; 39:1951-1960. [DOI: 10.1377/hlthaff.2019.01570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Macinko
- James Macinko is a professor in the Fielding School of Public Health at the University of California Los Angeles, in Los Angeles, California
| | - Flavia Cristina Drumond Andrade
- Flavia Cristina Drumond Andrade is an associate professor in the School of Social Work at the University of Illinois at Urbana-Champaign, in Urbana, Illinois
| | - Fabiola Bof de Andrade
- Fabiola Bof de Andrade is an assistant professor in the Rene Rachou Research Institute at the Fundação Oswaldo Cruz, in Belo Horizonte, Minas Gerais, Brazil
| | - Maria Fernanda Lima-Costa
- Maria Fernanda Lima-Costa is a professor in the Rene Rachou Research Institute, Fundação Oswaldo Cruz, and the Public Health Postgraduate Program at the Federal University of Minas Gerais, in Belo Horizonte, Brazil
| |
Collapse
|
38
|
Lima-Costa MF, Macinko J, Andrade FBD, Souza Júnior PRBD, Vasconcellos MTLD, Oliveira CMD. ELSI-COVID-19 initiative: methodology of the telephone survey on coronavirus in the Brazilian Longitudinal Study of Aging. CAD SAUDE PUBLICA 2020; 36Suppl 3:e00183120. [PMID: 33053061 DOI: 10.1590/0102-311x00183120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/07/2020] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic (caused by the SARS-CoV-2) is a public health emergency of international concern that particularly affects older people. Brazil is one of the countries most affected by the pandemic, ranking second with the highest number of confirmed cases and deaths worldwide as of mid-June 2020. The ELSI-COVID-19 initiative is based on telephone interviews with participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted on a nationally representative sample of the population aged 50 or older. This initiative aims to provide information on adherence to preventive measures (social distancing, wearing masks, and handwashing/hygiene); reasons for leaving the house, when that was the case; difficulties obtaining medications, medical diagnosis of COVID-19, and receipt of confirmatory results; use of health-care services (recent care-seeking, care-seeking location, care receipt, among other aspects); and mental health (sleep, depression, and loneliness). The first round of telephone interviews was conducted between May 26 and June 8, 2020. The second and third rounds are expected to occur within the coming months. This article presents this initiative methodology and some sociodemographic characteristics of the 6,149 participants in the survey first round, relative the Brazilian population within the same age group.
Collapse
Affiliation(s)
- Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Púbica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | | | | | | |
Collapse
|
39
|
Macinko J, Woolley NO, Seixas BV, Andrade FBD, Lima-Costa MF. Health care seeking due to COVID-19 related symptoms and health care cancellations among older Brazilian adults: the ELSI-COVID-19 initiative. CAD SAUDE PUBLICA 2020; 36Suppl 3:e00181920. [PMID: 33053060 DOI: 10.1590/0102-311x00181920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
The continent of the Americas has the greatest number of people infected and deaths associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the world. Brazil occupies the 2nd position in numbers of infected cases and deaths, preceded only by the United States. Older adults and those with pre-existing chronic illnesses are more vulnerable to the consequences of the virus. The SARS-CoV-2 epidemic has serious consequences for health services. Therefore, an assessment of the pandemic's effect on the older Brazilian population is urgently needed. The study examines the prevalence of COVID-19 related symptoms, care-seeking, and cancellation of surgery or other scheduled medical care among a nationally representative sample of Brazilians aged 50 and over derived from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey (the ELSI-COVID-19 initiative) between late May and early June 2020. About 10.4% of older adults reported any fever, dry cough or difficulty breathing in the 30 days prior to the interview, with the highest prevalence in the North region (50%). Among individuals with symptoms, only 33.6% sought care. Individuals living in the South or Southeast regions were significantly less likely to seek care for COVID-19 related symptoms. Nearly one in six participants had to cancel scheduled surgery or other medical care; this proportion was higher among women, those with more education, and people with multiple chronic conditions. This paper is among the first to investigate the effect of COVID-19 on health care use in Brazil among older adults. Results highlight the need to adapt health care delivery (such as through telemedicine) to ensure the continuity of care as well as the urgent need for wide dissemination of information to guide the population on disease prevention measures and how to obtain healthcare when needed.
Collapse
Affiliation(s)
| | | | | | | | - Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Púbica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| |
Collapse
|
40
|
Lima-Costa MF, Mambrini JVDM, Andrade FBD, Peixoto SWV, Macinko J. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: the ELSI-COVID-19 initiative. CAD SAUDE PUBLICA 2020; 36Suppl 3:e00193920. [PMID: 33053062 DOI: 10.1590/0102-311x00193920] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/07/2020] [Indexed: 01/10/2023] Open
Abstract
The aim of the study was to examine the prevalence of social distancing, the use of face masks and hand washing when leaving home among Brazilian adults aged 50 or over. Data from 6,149 telephone interviews were used, conducted between May 26 and June 8, 2020 among participants in the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Social distancing was defined by not having left home in the last seven days. Only 32.8% of study participants did not leave home during the period considered, 36.3% left between one and two times, 15.2% between three and five times and 15.7% left every day. The main reasons for leaving home were to buy medicine or food (74.2%), to work (25.1%), to pay bills (24.5%), for health care (10.5%), to exercise (6.2%), and to meet family or friends (8.8%). Among those who left home, 97.3% always wore face masks and 97.3% always performed hand washing. Women left home less often than men. Men left home more often to work and exercise while women left home more often to seek healthcare. Men (odds ratio - OR = 1.84), those with higher education (OR = 1.48 and 1.95 for 5-8 and 9 years, respectively) and urban residents (OR = 1.54) left home more frequently to perform essential activities, regardless of age or other characteristics. Results show low adherence to social distancing, but high prevalence in the reported use of face masks and hand washing.
Collapse
Affiliation(s)
- Maria Fernanda Lima-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.,Programa de Pós-graduação em Saúde Púbica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
| | | | | | | | | |
Collapse
|
41
|
Andrade FBD, Antunes JLF, Andrade FCD, Lima-Costa MFF, Macinko J. Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries. J Dent Res 2020; 99:1341-1347. [PMID: 32623932 DOI: 10.1177/0022034520935854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50 y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20 percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services.
Collapse
Affiliation(s)
- F Bof de Andrade
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J L F Antunes
- Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - F C D Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - M F F Lima-Costa
- Oswaldo Cruz Foundation, Rene Rachou Institute, Belo Horizonte, Brazil
| | - J Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| |
Collapse
|
42
|
Seixas BV, Macinko J. Unavailability of paid sick leave among parents is a barrier for children's utilization of nonemergency health services: Evidence from the National Health Interview Survey. Int J Health Plann Manage 2020; 35:1083-1097. [PMID: 32567169 DOI: 10.1002/hpm.2988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 03/03/2020] [Accepted: 05/01/2020] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess the association between availability of paid sick leave among parents and children's use of several distinct types of nonurgent health services and emergency care. METHODS Using pooled 2013 to 2017 data from the National Health Interview Survey (NHIS), we created dyadic units of observation linking adults with their children (n = 21 235). Descriptive statistics, logistic regressions for binary outcomes, and regular and zero-inflated negative binomial regressions for count outcomes assessed the relationship between parental coverage by paid sick leave benefits and 12 dependent variables related to health care utilization. Regression analyses controlled for a set of child, parent, and family covariates. RESULTS Overall, 58.3% of individuals in our sample reported having paid sick leave in their current or latest job. There are substantial disparities in availability of paid sick leave in terms of parent sex, race, education, and income. Controlling for covariates, the odds of children with at least one parent with access to paid sick leave having any visit to a medical office in the past 12 months are 27% higher than for children whose parents do not have this benefit. Similar positive associations were observed for general doctor visit (OR = 1.18, 95%CI: 1.05-1.32), mental health professional visit (OR = 1.19, 95%CI: 1.01-1.42), and receipt of flu vaccination (OR = 1.21, 95%CI: 1.11-1.33). There was no statistically significant association with emergency room use, once covariates were controlled. CONCLUSIONS Availability of paid sick leave among parents is associated with increased children's utilization of nonemergency health services and primary care.
Collapse
Affiliation(s)
- Brayan V Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| |
Collapse
|
43
|
Kurti M, He Y, Silver D, Giorgio M, von Lampe K, Macinko J, Ye H, Tan F, Mei V. Presence of Counterfeit Marlboro Gold Packs in Licensed Retail Stores in New York City: Evidence From Test Purchases. Nicotine Tob Res 2020; 21:1131-1134. [PMID: 29846723 DOI: 10.1093/ntr/nty096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 05/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND There are no independent studies measuring the availability of premium brand counterfeit cigarettes in New York City from licensed retailers. METHODS We forensically analyzed the cigarette packaging of Marlboro Gold (n = 1021) purchased from licensed tobacco retailers in New York City, using ultraviolet irradiation and light microscopy to determine whether they were counterfeit. RESULTS We find that while only 0.5% (n = 5) of our sample exhibits at least one characteristic synonymous with counterfeit packaging, none of our packs can be conclusively classified as counterfeit. CONCLUSIONS We do not find any counterfeit Marlboro Gold packs purchased at full price from licensed cigarette retailers throughout New York City. Future research using test purchases should include other venues (eg, street and online) and specifically ask for discounts to ascertain the overall presence of counterfeit cigarettes. IMPLICATIONS This is the first study to independently measure the availability of counterfeit cigarette packs purchased at full price from licensed retailers in New York City. We find that none of the Marlboro Gold packs purchased from licensed cigarette retailers are counterfeit.
Collapse
Affiliation(s)
- Marin Kurti
- Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ.,Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, Piscataway, NJ
| | - Yi He
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| | - Diana Silver
- Department of Public Health Policy, College of Global Public Health, New York University, New York, NY
| | - Margaret Giorgio
- Department of Public Health Policy, College of Global Public Health, New York University, New York, NY
| | - Klaus von Lampe
- Department of Law, Police Science and Criminal Justice Administration, John Jay College of Criminal Justice, New York, NY
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Hua Ye
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| | - Fidelis Tan
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| | - Victoria Mei
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| |
Collapse
|
44
|
Lloyd-Sherlock P, Billings J, Aredes JDS, Freire Neto JB, Camarano AA, Macedo Coelho Filho J, Firmo JOA, Kalache A, Macinko J, Sempé L, Giacomin KC. Meeting the complex challenge of health and social care provision for rapidly-ageing populations: introducing the concept of "avoidable displacement from home". CAD SAUDE PUBLICA 2020; 36:e00162819. [PMID: 32267376 DOI: 10.1590/0102-311x00162819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022] Open
Abstract
The increasing numbers of people at very old ages pose specific policy challenges for health and social care and highlight the need to rethink established models of service provision. The main objective of this paper is to introduce the concept of "avoidable displacement from home" (ADH). The study argues that ADH builds on and adds value to existing concepts, offering a holistic, person-centered framework for integrated health and social care provision for older people. It also demonstrates that this framework can be applied across different levels, ranging from macro policymaking to organizational and individual decision-making. The paper pays attention to the Brazilian context but argues that ADH is a universally applicable concept.
Collapse
|
45
|
Macinko J, Victora C. Dying to work: the health consequences of economic recession. Lancet Glob Health 2019; 7:e1478-e1479. [PMID: 31607453 DOI: 10.1016/s2214-109x(19)30415-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 01/03/2023] Open
Affiliation(s)
- James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095-1772, USA.
| | - Cesar Victora
- International Center for Equity in Health, Universidade Federal de Pelotas, Pelotas, Brazil
| |
Collapse
|
46
|
Childers KK, Maggard-Gibbons M, Macinko J, Childers CP. National Distribution of Cancer Genetic Testing in the United States: Evidence for a Gender Disparity in Hereditary Breast and Ovarian Cancer. JAMA Oncol 2019; 4:876-879. [PMID: 29710084 DOI: 10.1001/jamaoncol.2018.0340] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kimberly K Childers
- Center for Clinical Genetics and Genomics, Providence Health & Services Southern California, Los Angeles
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
| | - James Macinko
- Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles.,Department of Community Health Services, University of California Los Angeles Fielding School of Public Health, Los Angeles
| | - Christopher P Childers
- Department of Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles.,Department of Health Policy and Management, University of California Los Angeles Fielding School of Public Health, Los Angeles
| |
Collapse
|
47
|
Abstract
Objectives: Relatively little is known about who uses various types of meditation or how health problems and health care barriers might simultaneously impact its use. This article describes the current prevalence of meditation and identifies significant individual and health system-related factors associated with its use. Design: Cross-sectional descriptive analysis of the 2017 National Health Interview Survey analyzed in 2019. Setting/Location: United States. Subjects: The adult, civilian, noninstitutionalized U.S. population. Outcome measures: Self-reported use of any type of meditation in past year (mantra, mindfulness, spiritual, guided imagery, and progressive relaxation) or as part of yoga or t'ai chi practice. Control variables included demographic characteristics, health status, risk behaviors, and health system-related factors (self-reported barriers and facilitators to health care access) hypothesized to be associated with greater meditation use. Results: Over 46 million people (19% of the adult, civilian, noninstitutionalized U.S. population) currently practice some type of meditation. Three main factors predict meditation use: the presence of a health problem (chronic disease, pain, anxiety/depression, and sleeping problems), cost or access barriers to conventional medical care, and individual characteristics (younger age, female sex, and sexual minority status). Conclusions: Meditation is one of the most common forms of complementary and alternative medicine in the United States today. While its health benefits are still emerging, public health practitioners and clinicians should be aware of the increasing use of these therapies to treat common health problems, their relatively low prevalence among some groups that might benefit from them (such as older people, those with less healthy lifestyles, and men), and their higher use among those who face barriers to obtaining conventional care.
Collapse
Affiliation(s)
- James Macinko
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| |
Collapse
|
48
|
Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, de Souza Noronha KVM, Rocha R, Macinko J, Hone T, Tasca R, Giovanella L, Malik AM, Werneck H, Fachini LA, Atun R. Brazil's unified health system: the first 30 years and prospects for the future. Lancet 2019; 394:345-356. [PMID: 31303318 DOI: 10.1016/s0140-6736(19)31243-7] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/18/2019] [Accepted: 05/10/2019] [Indexed: 12/28/2022]
Abstract
In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.
Collapse
Affiliation(s)
- Marcia C Castro
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Collective Health, Health Sciences Sector, Federal University of Paraná, Curitiba, Brazil
| | - Gisele Almeida
- Health Systems and Services Unit, Pan American Health Organization/Regional Office of the World Health Organization, Washington, DC, USA
| | - Naercio Aquino Menezes-Filho
- Center for Public Policy, Insper, São Paulo, Brazil; Department of Economics, University of São Paulo, São Paulo, Brazil
| | - Monica Viegas Andrade
- Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Rudi Rocha
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - James Macinko
- UCLA Fielding School of Public Health, Center for Health Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Thomas Hone
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Renato Tasca
- Health Systems and Services Unit, Pan American Health Organization, Brasília, Brazil
| | - Ligia Giovanella
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Maria Malik
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Heitor Werneck
- Agência Nacional de Saúde Suplementar, Rio de Janeiro, Brazil
| | - Luiz Augusto Fachini
- Center for Epidemiological Research, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| |
Collapse
|
49
|
Vilar-Compte M, Macinko J, Weitzman BC, Avendaño-Villela CM. Short relative leg length is associated with overweight and obesity in Mexican immigrant women. Int J Equity Health 2019; 18:103. [PMID: 31269992 PMCID: PMC6609393 DOI: 10.1186/s12939-019-0988-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 05/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prior research suggests that undernutrition and enteric infections predispose children to stunted growth. Undernutrition and infections have been associated with limited access to healthy diets, lack of sanitation, and access barriers to healthcare – all associated with human rights. Stunting has also been documented to be a major determinant of subsequent obesity and non-communicable diseases. Short leg length relative to stature during adulthood seems to be a good proxy indicator tracking such barriers, and has been reported to be associated with adverse health effects during adulthood. Our objective was to examine the association between relative leg length (as measured by the leg length index, LLI) and measures of adiposity – based on body mass index (BMI) and waist circumference (WC) – in a population of recent Mexican immigrant women to the New York City Area. Methods The analysis was based on a cross-sectional survey of 200 Mexican immigrant women aged 18 to 70 years, whose data were collected between April and November 2008; although for purposes of the current study we restricted the sample to those aged 18 to 59 years. The dependent variables were BMI and WC, both transformed into categorical variables. The main independent variable was LLI, and other correlates were controlled for (i.e. age, education, having had children, characteristics of the community of origin, acculturation, chronic conditions, sedentary behaviors, access to fresh fruits and vegetables). Two probit models were estimated: the first one analyzed the effect of LLI on BMI categories and the second one estimated the effect of LLI on WC. Results The probit assessing the effect of LLI on overweight/obesity suggested that having a short LLI increased the probability of overweight/obesity by 21 percentage points. Results from the probit model estimating the effect of LLI on WC indicated that having a short LLI increased the probability of having abdominal adiposity by 39 percentage points. Both results were statistically significant at p < 0.05. Conclusion The study found an association between having shorter legs relative to one’s height and increased risk of overweight/obesity and abdominal adiposity. Findings support the epidemiological evidence regarding the association between short leg length, early life socioeconomic conditions (i.e. limited access to basic rights), and increased risk of adverse health effects later in life. Electronic supplementary material The online version of this article (10.1186/s12939-019-0988-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mireya Vilar-Compte
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico.
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, UCLA, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA, 90095-1772, USA
| | - Beth C Weitzman
- Department of Nutrition and Food Studies, Health and Public Policy, New York University, 411 Lafayette Street, 5th Floor, New York, NY, 10003, USA
| | - Carlos M Avendaño-Villela
- EQUIDE Research Institute for Equitable Development, Universidad Iberoamericana, Prolongación Paseo de la Reforma 880, Lomas de Santa Fe, 01219, Mexico City, Mexico
| |
Collapse
|
50
|
Corrêa DSRC, Moura AGDOM, Quito MV, Souza HMD, Versiani LM, Leuzzi S, Gottems LBD, Macinko J. Reform movements in the Federal District Health Care System:conversion of the Primary Health Care assistance model. Cien Saude Colet 2019; 24:2031-2041. [PMID: 31269162 DOI: 10.1590/1413-81232018246.08802019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/29/2019] [Indexed: 11/21/2022] Open
Abstract
CONCLUSION The Unified Health System has undergone constant evolution and expansion since the publication of Brazil's 1988 Federal Constitution. The Federal District has provided contributions to the field of Primary Health Care Policy, especially between 2016 and 2018, by defining the Family Health Strategy as the definitive way of organizing Primary Health Care (PHC) services and by establishing a set of actions aimed at conversion of existing PHC services to this model. This article describes and analyzes the key processes of this change. The method used was analysis of ordinances, resolutions, reports and other documents, as well as assessment of data from official databases. We emphasize the development of a normative structure that includes the teams' implementation, the professionals' work processes, changes in medical specialties and reorganization of the health professionals who already worked in PHC. with an effect of increasing the population's Family Health Strategy coverage (in a population of approximately 3 million inhabitants) from 28% to 69% during a two-year period, the experience demonstrates the feasibility of incremental changes in health policies such as defining priorities, better management of the workforce, training and decentralized planning to increase access to health services.
Collapse
Affiliation(s)
| | | | - Marcus Vinícius Quito
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | - Heloiza Machado de Souza
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | - Luciana Martins Versiani
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | - Sérgio Leuzzi
- Secretaria de Estado de Saúde do Distrito Federal. STN, Asa Norte. 70086-900 Brasília DF Brasil.
| | | | - James Macinko
- UCLA Fielding School of Public Health, University of California Los Angeles. Los Angeles CA EUA
| |
Collapse
|