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Bidopia T, Fertig AR, Burke NL, Loth KA, Trofholz AC, Berge JM. Understanding the relationships between acculturation, food insecurity, and food parenting practices among socioeconomically/racially diverse parents. Appetite 2024; 196:107292. [PMID: 38447643 PMCID: PMC10981913 DOI: 10.1016/j.appet.2024.107292] [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: 09/05/2023] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
Research suggests that acculturation and food insecurity are factors that are separately associated with the use of specific food parenting practices among United States (US) families. Certain food parenting practices, such as coercive control and unstructured food parenting practices, are related to negative health consequences in children, such as disordered eating behaviors. The current study aimed to explore associations between acculturation strategies and food parenting practices in a sample of 577 Latinx, Hmong, Somali/Ethiopian, and Multiracial families. A secondary objective was to understand whether food security status significantly modified the relationships between acculturation strategies and food parenting practices. Results showed that acculturation strategies were significantly related to food parenting practices, and patterns in these relationships differed across race and ethnicity. Further, food security status significantly modified the relationship between acculturation strategies and food parenting practices for Latinx, Hmong, and Somali/Ethiopian families, but not for Multiracial families. These results point to the complex relationships among acculturation strategies, food security status, and food parenting practices in immigrant populations in the US. Longitudinal studies exploring the temporal relationships between acculturation strategies, food security status, and food parenting practices would help tease apart how food parenting practices may evolve upon migrating to the US.
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Affiliation(s)
- Tatyana Bidopia
- Fordham University, Department of Psychology, Dealy Hall, 441 East Fordham Road, Bronx, NY, 10458, USA.
| | - Angela R Fertig
- University of Minnesota, Humphrey School of Public Affairs, 301 19th Ave S, Minneapolis, MN 55455, USA.
| | - Natasha L Burke
- Fordham University, Department of Psychology, Dealy Hall, 441 East Fordham Road, Bronx, NY, 10458, USA.
| | - Katie A Loth
- University of Minnesota Medical School, Department of Family Medicine and Community Health, 717 Delaware Street, Minneapolis, MN, 55455, USA.
| | - Amanda C Trofholz
- University of Minnesota Medical School, Department of Family Medicine and Community Health, 717 Delaware Street, Minneapolis, MN, 55455, USA.
| | - Jerica M Berge
- University of Minnesota Medical School, Department of Family Medicine and Community Health, 717 Delaware Street, Minneapolis, MN, 55455, USA.
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Tate AD, Fertig AR, de Brito JN, Ellis ÉM, Carr CP, Trofholz A, Berge JM. Momentary Factors and Study Characteristics Associated With Participant Burden and Protocol Adherence: Ecological Momentary Assessment. JMIR Form Res 2024; 8:e49512. [PMID: 38656787 PMCID: PMC11079761 DOI: 10.2196/49512] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Ecological momentary assessment (EMA) has become a popular mobile health study design to understand the lived experiences of dynamic environments. The numerous study design choices available to EMA researchers, however, may quickly increase participant burden and could affect overall adherence, which could limit the usability of the collected data. OBJECTIVE This study quantifies what study design, participant attributes, and momentary factors may affect self-reported burden and adherence. METHODS The EMA from the Phase 1 Family Matters Study (n=150 adult Black, Hmong, Latino or Latina, Native American, Somali, and White caregivers; n=1392 observation days) was examined to understand how participant self-reported survey burden was related to both design and momentary antecedents of adherence. The daily burden was measured by the question "Overall, how difficult was it for you to fill out the surveys today?" on a 5-item Likert scale (0=not at all and 4=extremely). Daily protocol adherence was defined as completing at least 2 signal-contingent surveys, 1 event-contingent survey, and 1 end-of-day survey each. Stress and mood were measured earlier in the day, sociodemographic and psychosocial characteristics were reported using a comprehensive cross-sectional survey, and EMA timestamps for weekends and weekdays were used to parameterize time-series models to evaluate prospective correlates of end-of-day study burden. RESULTS The burden was low at 1.2 (SD 1.14) indicating "a little" burden on average. Participants with elevated previous 30-day chronic stress levels (mean burden difference: 0.8; P=.04), 1 in 5 more immigrant households (P=.02), and the language primarily spoken in the home (P=.04; 3 in 20 more non-English-speaking households) were found to be population attributes of elevated moderate-high burden. Current and 1-day lagged nonadherence were correlated with elevated 0.39 and 0.36 burdens, respectively (P=.001), and the association decayed by the second day (β=0.08; P=.47). Unit increases in momentary antecedents, including daily depressed mood (P=.002) and across-day change in stress (P=.008), were positively associated with 0.15 and 0.07 higher end-of-day burdens after controlling for current-day adherence. CONCLUSIONS The 8-day EMA implementation appeared to capture momentary sources of stress and depressed mood without substantial burden to a racially or ethnically diverse and immigrant or refugee sample of parents. Attention to sociodemographic attributes (eg, EMA in the primary language of the caregiver) was important for minimizing participant burden and improving data quality. Momentary stress and depressed mood were strong determinants of participant-experienced EMA burden and may affect adherence to mobile health study protocols. There were no strong indicators of EMA design attributes that created a persistent burden for caregivers. EMA stands to be an important observational design to address dynamic public health challenges related to human-environment interactions when the design is carefully tailored to the study population and to study research objectives.
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Affiliation(s)
- Allan D Tate
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, United States
| | - Junia N de Brito
- Department of Family Medicine and Community Health, University of Minnesota Medical School, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Émilie M Ellis
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Christopher Patrick Carr
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, United States
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, University of Minnesota, Twin Cities, Minneapolis, MN, United States
| | - Jerica M Berge
- Department of Family Medicine and Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Pascale J, Fertig AR, Call KT. Using enrollment records to evaluate self-reports of monthly coverage in the redesigned current population survey health insurance module. Health Serv Res 2024; 59:e14285. [PMID: 38263639 PMCID: PMC10915490 DOI: 10.1111/1475-6773.14285] [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: 01/25/2024] Open
Abstract
OBJECTIVE To evaluate the veracity of self-reports of month-level health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS). DATA SOURCES AND STUDY SETTING The CHIME (Comparing Health Insurance Measurement Error) study used health insurance enrollment records from a large regional Midwest insurer as sample for primary data collection in spring 2015. STUDY DESIGN A sample of individuals enrolled in a range of public and private coverage types (including Medicaid and marketplace) was administered the CPS health insurance module, which included questions about month-level coverage, by type, over a 17-18-month time span. Survey data was then matched to enrollment records covering that same time frame, and concordance between the records and self-reports was assessed. DATA COLLECTION/EXTRACTION METHODS Sample was drawn by the insurer's informatics specialists and Census Bureau interviewers conducted the survey. Following data collection, updated enrollment records were matched to the survey data to produce a person-level file of coverage by type at the month-level. PRINCIPAL FINDINGS For 91% of the overall sample, coverage status and type were reported accurately for at least 75% of observed months. Results varied somewhat by stability of coverage. Among those who were continuously covered throughout the 17-18 month observation period (which comprised 64% of the overall sample), that level of reporting accuracy was observed for 94% of the sample; for those who had censored spells (34% of the overall sample), the figure was 87%; and among those with gaps and/or changes according to the records (2% of the overall sample), for 82% of the group at least 75% of months were reported accurately. CONCLUSIONS Findings suggest that reporting accuracy of month-level coverage in the CPS is high and that the survey could become a valuable new data source for studying the dynamics of coverage, including the Medicaid unwinding.
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Affiliation(s)
- Joanne Pascale
- Research and Methodology DirectorateU.S. Census BureauWashingtonDCUSA
| | - Angela R. Fertig
- Humphrey School of Public AffairsUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Kathleen Thiede Call
- School of Public Health and the State Health Access Data Assistance CenterUniversity of MinnesotaMinneapolisMinnesotaUSA
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Berge JM, Fertig AR, Trofholz A, de Brito JN. Real-time predictors of food parenting practices and child eating behaviors in racially/ethnically diverse families. Int J Behav Nutr Phys Act 2023; 20:86. [PMID: 37434195 PMCID: PMC10337081 DOI: 10.1186/s12966-023-01476-4] [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: 03/13/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Prior research has shown associations between controlling food parenting practices (e.g., pressure-to-eat, restriction) and factors that increase risk for cardiovascular disease in children (e.g., low diet quality, obesity). This study aimed to examine associations between real-time parental stress and depressed mood, food parenting practices, and child eating behaviors in a longitudinal cohort study. METHODS Children ages 5-9 years and their families (n = 631) from six racial/ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited for this study through primary care clinics in a large metromolitan area in the US (Minneapolis/St. Paul, MN) in 2016-2019. Ecological momentary assessment was carried out over seven days with parents at two time points, 18 months apart. Adjusted associations between morning stress and depressed mood of parents on food parenting practices and child eating behaviors at the evening meal were examined. Interactions tested whether food security, race/ethnicity and child sex moderated associations. RESULTS High levels of parental stress and depressed mood experienced earlier in the day were associated with controlling food parenting practices and child food fussiness at dinner the same night. Results were dependent on food security status, race/ethnicity, and child sex. CONCLUSIONS Health care professionals may want to consider, or continue, screening parents for stress, depression, and food insecurity during well-child visits and discuss the influence these factors may have on food parenting practices and child eating behaviors. Future research should use real-time interventions such as ecological momentary intervention to reduce parental stress and depressed mood to promote healthy food parenting practices and child eating behaviors.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55414, USA.
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55414, USA
| | - Junia N de Brito
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55414, USA
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Berge JM, Trofholz AC, Aqeel M, Norderud K, Tate A, Fertig AR, Loth K, Mendenhall T, Neumark-Sztainer D. A three-arm randomized controlled trial using ecological momentary intervention, community health workers, and video feedback at family meals to improve child cardiovascular health: the Family Matters study design. BMC Public Health 2023; 23:708. [PMID: 37072737 PMCID: PMC10112996 DOI: 10.1186/s12889-023-15504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. METHODS/DESIGN The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI + Virtual Home Visiting with CHW + Video Feedback; and (3) EMI + Hybrid Home Visiting with CHW + Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n = 525) with increased risk for cardiovascular disease (i.e., BMI ≥ 75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. DISCUSSION This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary intervention, video feedback, and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. TRIAL REGISTRATION This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.
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Affiliation(s)
- Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA.
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Marah Aqeel
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Kristin Norderud
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Allan Tate
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Angela R Fertig
- University of Minnesota, Humphrey School of Public Affairs, Minneapolis, MN, USA
| | - Katie Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware Street SE, Room 425, Minneapolis, MN, 55455, USA
| | - Tai Mendenhall
- Department of Family Social Science, University of Minnesota, Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Hazzard VM, Loth KA, Fertig AR, Trofholz AC, de Brito JN, Doering AC, Berge JM. Household food insecurity is associated with greater prevalence and 18-month incidence of a range of disordered eating behaviors in a racially and ethnically diverse sample of parents. Eat Behav 2023; 49:101728. [PMID: 37087982 PMCID: PMC10247411 DOI: 10.1016/j.eatbeh.2023.101728] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/25/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023]
Abstract
This study examined cross-sectional and longitudinal associations between household food insecurity (FI) and a range of disordered eating behaviors (DEBs) and explored whether associations differ by Supplemental Nutrition Assistance Program (SNAP)/Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation. Data came from 1120 racially/ethnically diverse parents (Mage = 35.7 ± 7.8 years at baseline) in the Family Matters longitudinal cohort study. Parents reported on household FI and SNAP/WIC participation at baseline, and on past-year restrictive weight-control behaviors (WCBs; e.g., fasting), compensatory WCBs (e.g., self-induced vomiting), and binge eating at baseline and 18-month follow-up. Sociodemographics-adjusted modified Poisson regressions examined baseline household FI in relation to baseline prevalence and 18-month incidence (i.e., new onset) of each type of DEB. Moderation by SNAP/WIC participation was also tested. Household FI affected 29.6 % of participants and was associated with significantly greater baseline prevalence (prevalence ratios ranging from 1.38 to 2.69) and 18-month incidence (risk ratios ranging from 1.63 to 2.93) of each type of DEB examined. The association between household FI and incident compensatory WCBs differed significantly by SNAP/WIC participation, such that household FI significantly predicted new-onset compensatory WCBs at follow-up only among those participating in SNAP/WIC. Results from this study are the first, to our knowledge, to demonstrate that FI is longitudinally associated with restrictive and compensatory DEBs, thereby highlighting FI as a risk factor not only for binge eating, but for a range of DEBs. These findings emphasize the importance of screening for FI in clinical settings and the need to address structural barriers to food security.
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Affiliation(s)
- Vivienne M Hazzard
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America; Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States of America.
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, MN, United States of America
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Junia N de Brito
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Anne C Doering
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States of America
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7
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Berge JM, Trofholz AC, Aqeel M, Norderud K, Tate A, Fertig AR, Loth K, Mendenhall T, Neumark-Sztainer D. A Three-Arm Randomized Controlled Trial Using Ecological Momentary Intervention, Community Health Workers, and Video Feedback at Family Meals to Improve Child Cardiovascular Health: The Family Matters Study Design. Res Sq 2023:rs.3.rs-2662682. [PMID: 36993265 PMCID: PMC10055649 DOI: 10.21203/rs.3.rs-2662682/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Background: Numerous observational studies show associations between family meal frequency and markers of child cardiovascular health including healthful diet quality and lower weight status. Some studies also show the "quality" of family meals, including dietary quality of the food served and the interpersonal atmosphere during meals, is associated with markers of child cardiovascular health. Additionally, prior intervention research indicates that immediate feedback on health behaviors (e.g., ecological momentary intervention (EMI), video feedback) increases the likelihood of behavior change. However, limited studies have tested the combination of these components in a rigorous clinical trial. The main aim of this paper is to describe the Family Matters study design, data collection protocols, measures, intervention components, process evaluation, and analysis plan. Methods/design: The Family Matters intervention utilizes state-of-the-art intervention methods including EMI, video feedback, and home visiting by Community Health Workers (CHWs) to examine whether increasing the quantity (i.e., frequency) and quality of family meals (i.e., diet quality, interpersonal atmosphere) improves child cardiovascular health. Family Matters is an individual randomized controlled trial that tests combinations of the above factors across three study Arms: (1) EMI; (2) EMI+Virtual Home Visiting with CHW+Video Feedback; and (3) EMI+Hybrid Home Visiting with CHW+Video Feedback. The intervention will be carried out across 6 months with children ages 5-10 (n=525) with increased risk for cardiovascular disease (i.e., BMI ≥75%ile) from low income and racially/ethnically diverse households and their families. Data collection will occur at baseline, post-intervention, and 6 months post-intervention. Primary outcomes include child weight, diet quality, and neck circumference. Discussion: This study will be the first to our knowledge to use multiple innovative methods simultaneously including ecological momentary assessment, intervention, video feedback and home visiting with CHWs within the novel intervention context of family meals to evaluate which combination of intervention components are most effective in improving child cardiovascular health. The Family Matters intervention has high potential public health impact as it aims to change clinical practice by creating a new model of care for child cardiovascular health in primary care. Trial Registration: This trial is registered in clinicaltrials.gov (Trial ID: NCT02669797). Date recorded 5/02/22.
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Agarwal S, Fertig AR, Trofholz AC, Tate AD, Robinson J, Berge JM. Exploring the associations between neighbourhood food environment, household food insecurity and child weight-related outcomes in socio-economically and racially/ethnically diverse families. Public Health Nutr 2022; 25:1-10. [PMID: 36210770 PMCID: PMC9991713 DOI: 10.1017/s1368980022002130] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/15/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine associations among neighbourhood food environments (NFE), household food insecurity (HFI) and child's weight-related outcomes in a racially/ethnically diverse sample of US-born and immigrant/refugee families. DESIGN This cross-sectional, observational study involving individual and geographic-level data used multilevel models to estimate associations between neighbourhood food environment and child outcomes. Interactions between HFI and NFE were employed to determine whether HFI moderated the association between NFE and child outcomes and whether the associations differed for US-born v. immigrant/refugee groups. SETTING The sample resided in 367 census tracts in the Minneapolis/St. Paul, MN metropolitan area, and the data were collected in 2016-2019. PARTICIPANTS The sample was from the Family Matters study of families (n 1296) with children from six racial/ethnic and immigrant/refugee groups (African American, Latino, Hmong, Native American, Somali/Ethiopian and White). RESULTS Living in a neighbourhood with low perceived access to affordable fresh fruits and vegetables was found to be associated with lower food security (P < 0·01), poorer child diet quality (P < 0·01) and reduced availability of a variety of fruits (P < 0·01), vegetables (P < 0·05) and whole grains in the home (P < 0·01). Moreover, residing in a food desert was found to be associated with a higher child BMI percentile if the child's household was food insecure (P < 0·05). No differences in associations were found for immigrant/refugee groups. CONCLUSIONS Poor NFE were associated with worse weight-related outcomes for children; the association with weight was more pronounced among children with HFI. Interventions aiming to improve child weight-related outcomes should consider both NFE and HFI.
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Affiliation(s)
- Sarthak Agarwal
- Humphrey School of Public Affairs, University of Minnesota, 130 Hubert H. Humphrey Center, 301 19th Ave South, Minneapolis, MN55455, USA
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, 130 Hubert H. Humphrey Center, 301 19th Ave South, Minneapolis, MN55455, USA
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Allan D Tate
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Jenna Robinson
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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9
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Fertig AR, de Brito JN, Trofholz AC, Berge JM. Maternal employment and child weight-related health. Soc Sci Med 2022; 310:115303. [PMID: 36067580 PMCID: PMC9577519 DOI: 10.1016/j.socscimed.2022.115303] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 01/25/2023]
Abstract
Several studies have documented a link between maternal employment and childhood obesity, but the mechanisms are not clear. This study investigated the association of maternal employment with children's weight status and detailed weight-related behaviors using data from Phase I of Family Matters, a cross-sectional, observational study of 150 children aged 5-8 from six racial/ethnic groups (White, Black, Latinx, Native American, Hmong, and Somali) and their families from the Minneapolis/St. Paul, MN metropolitan area recruited in 2015-2016. Weight status (objectively measured), child dietary intake (three 24-h dietary recalls), physical activity (eight days of hip-mounted accelerometer data on children), and sleep (eight daily parent reports on children's sleep hours) were examined across four categories of maternal employment status: stay-at-home caregivers, working part-time, working full-time, and unemployed/unable to work. This study found that children's weight status and physical activity levels were similar across all categories of maternal employment. However, there were significant differences in aspects of children's diets by maternal employment status and, compared to children with stay-at-home mothers, children's sleep was significantly lower if their mother worked full-time. These findings highlight that dietary and sleep interventions tailored to the mother's employment status may be fruitful.
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Affiliation(s)
- Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, 130 Humphrey School 301 19th Avenue South, Minneapolis, MN, 55455, United States.
| | - Junia N de Brito
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St, Suite 300, Minneapolis, MN, 55455, United States
| | - Amanda C Trofholz
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St SE, Suite 400, Minneapolis, MN, 55414, United States
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St SE, Suite 400, Minneapolis, MN, 55414, United States
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Kollannoor-Samuel G, Boelcke-Stennes KA, Nelson J, Martin E, Fertig AR, Schiff J. Supplemental Nutrition Assistance Program Participation is Associated with Lower Health Care Spending among Working Age Adults without Dependents. J Health Care Poor Underserved 2022; 33:737-750. [DOI: 10.1353/hpu.2022.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fertig AR, Trofholz AC, Loth K, Tate AD, Miner M, Neumark-Sztainer D, Westfall EC, Westby A, Berge JM. Kitchen Adequacy and Child Diet Quality in a Racially/Ethnically Diverse Sample. Ecol Food Nutr 2022; 61:81-89. [PMID: 34409899 PMCID: PMC8821113 DOI: 10.1080/03670244.2021.1968848] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study examined kitchen adequacy in a racially/ethnically diverse low-income sample and associations with child diet quality. Families with children age five to seven years old (n = 150) from non-Hispanic white, non-Hispanic Black, Hispanic, Native American, Hmong, and Somali families were recruited through primary care clinics. More than 85% of families had 15 of the 20 kitchen items queried, indicating that the sample had adequate kitchen facilities. Only one item (a kitchen table) was associated with higher overall diet quality of children. In contrast, children living in households with can openers and measuring spoons consumed more sodium and added sugars, respectively.
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Affiliation(s)
- Angela R. Fertig
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, USA
| | - Amanda C. Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Katie Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Allan D. Tate
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, USA
| | - Michael Miner
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, USA
| | - Erin C. Westfall
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Andrea Westby
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Jerica M. Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
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12
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Call KT, Fertig AR, Pascale J. Factors associated with accurate reporting of public and private health insurance type. Health Serv Res 2021; 57:930-943. [PMID: 34448204 PMCID: PMC9264469 DOI: 10.1111/1475-6773.13874] [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] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine factors associated with accurate reporting of private and public health insurance coverage. DATA SOURCES Minnesota health plan enrollment records provided the sample for the Comparing Health Insurance Measurement Error (CHIME) study, a survey conducted in 2015 that randomly assigned enrollees to treatments that included health insurance questions from the American Community Survey (ACS) or the redesigned Current Population Survey Annual Social and Economic Supplement (CPS). STUDY DESIGN Reverse record check study that compared CHIME study survey responses to enrollment records of coverage type (direct purchase on and off the Marketplace, Medicaid, or MinnesotaCare), service use, subsidy receipt, and duration of coverage from a major insurer. DATA COLLECTION METHODS Using matched enrollment and CHIME survey data and logistic regression, we examined correlates of accurate insurance type reporting, including characteristics of the insurance coverage, the covered individual, respondent, and family. PRINCIPAL FINDINGS Reporting accuracy across treatment and coverage type is high (77%-84%). As with past research, accurate reporting of public insurance is higher for people with characteristics consistent with eligibility for public insurance for both survey treatments. For the ACS treatment, reports of direct purchase insurance are more accurate for enrollees who receive a premium subsidy. CONCLUSIONS Given the complexity of health insurance measurement and frequently changing policy environment, differences in reporting accuracy across treatments or coverage types are not surprising. Several results have important implications for data editing and modeling routines. First, adding premium and subsidy questions in federal surveys should prove useful given the finding that subsidy receipt is associated with reporting accuracy. Second, across both survey treatments, people whose opportunity structures (race, ethnicity, and income) match public program eligibility are accurate reporters of this coverage. This evidence supports using these commonly collected demographic variables in simulation, imputation, and editing routines.
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Affiliation(s)
- Kathleen Thiede Call
- School of Public Health and the State Health Access Data Assistance Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angela R Fertig
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota, USA
| | - Joanne Pascale
- U.S. Census Bureau, Washington, District of Columbia, USA
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Abstract
OBJECTIVE To measure the accuracy of survey-reported data on features and type of health insurance coverage. DATA SOURCE Enrollment records from a private insurer were used as sample for primary survey data collection in spring of 2015 using the Current Population Survey health insurance module. STUDY DESIGN A reverse record check study where households with individuals enrolled in a range of public and private health insurance plans (including the marketplace) were administered a telephone survey that included questions about general source of coverage (eg, employer), program name (eg, Medicaid), portal, premium, and subsidies. DATA COLLECTION/EXTRACTION METHODS Survey data were matched back to enrollment records, which indicated coverage status at the time of the survey. Concordance between the records and survey data was assessed. PRINCIPAL FINDINGS Correct reporting of general source of coverage ranged from 77.8 percent to 98.3 percent across coverage type, premium ranged from 91.6 percent to 96.4 percent, and subsidy ranged from 83.0 percent to 91.0 percent. Using a conceptual algorithm to categorize coverage type resulted in sensitivity of 98.3 percent for employer-sponsored enrollees, and 70.6 percent-77.6 percent for the other coverage types, while specificity ranged from 93.9 percent to 99.4 percent across coverage types. CONCLUSIONS Survey reports of features of coverage suggest they are viable items to include in an algorithm to categorize coverage type. Findings have implications beyond the CPS, particularly for marketplace enrollees.
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Affiliation(s)
| | - Angela R. Fertig
- Humphrey School of Public AffairsUniversity of MinnesotaMinneapolisMinnesota
| | - Kathleen Thiede Call
- School of Public Health and the State Health Access Data Assistance CenterUniversity of MinnesotaMinneapolisMinnesota
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14
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Dahlen HM, McCullough JM, Fertig AR, Dowd BE, Riley WJ. Texas Medicaid Payment Reform: Fewer Early Elective Deliveries And Increased Gestational Age And Birthweight. Health Aff (Millwood) 2018; 36:460-467. [PMID: 28264947 DOI: 10.1377/hlthaff.2016.0910] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infants born at full term have better health outcomes. However, one in ten babies in the United States are born via a medically unnecessary early elective delivery: induction of labor, a cesarean section, or both before thirty-nine weeks gestation. In 2011 the Texas Medicaid program sought to reduce the rate of early elective deliveries by denying payment to providers for the procedure. We examined the impact of this policy on clinical care practice and perinatal outcomes by comparing the changes in Texas relative to comparison states. We found that early elective delivery rates fell by as much as 14 percent in Texas after this payment policy change, which led to gains of almost five days in gestational age and six ounces in birthweight among births affected by the policy. The impact on early elective delivery was larger in magnitude for minority patients. Other states may look to this Medicaid payment reform as a model for reducing early elective deliveries and disparities in infant health.
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Affiliation(s)
- Heather M Dahlen
- Heather M. Dahlen is a research associate at Medica Research Institute in Minnetonka, Minnesota
| | - J Mac McCullough
- J. Mac McCullough is an assistant professor in the School for the Science of Health Care Delivery at Arizona State University, in Phoenix
| | - Angela R Fertig
- Angela R. Fertig is a research investigator at Medica Research Institute in Minneapolis, Minnesota
| | - Bryan E Dowd
- Bryan E. Dowd is a professor in the Division of Health Policy and Management at the University of Minnesota, in Minneapolis
| | - William J Riley
- William J. Riley is a professor in the School for the Science of Health Care Delivery, Arizona State University
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15
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Bogan VL, Fertig AR. Mental health and retirement savings: Confounding issues with compounding interest. Health Econ 2018; 27:404-425. [PMID: 28851028 DOI: 10.1002/hec.3579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 06/30/2017] [Accepted: 07/20/2017] [Indexed: 06/07/2023]
Abstract
The questionable ability of the U.S. pension system to provide for the growing elderly population combined with the rising number of people affected by depression and other mental health issues magnifies the need to understand how these household characteristics affect retirement. Mental health problems have a large and significant negative effect on retirement savings. Specifically, psychological distress is associated with decreasing the probability of holding retirement accounts by as much as 24 percentage points and decreasing retirement savings as a share of financial assets by as much as 67 percentage points. The magnitude of these effects underscores the importance of employer management policy and government regulation of these accounts to help ensure households have adequate retirement savings.
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Affiliation(s)
- Vicki L Bogan
- SC Johnson College of Business, 201K Warren Hall, Cornell University, Ithaca, New York, USA
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16
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Carlin CS, Fertig AR, Dowd BE. Affordable Care Act's Mandate Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage. Health Aff (Millwood) 2018; 35:1608-15. [PMID: 27605640 DOI: 10.1377/hlthaff.2015.1457] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 11/05/2022]
Abstract
Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. We examined the impact of this change on women's patterns of choosing prescription contraceptive methods. Using claims data for a sample of midwestern women ages 18-46 with employer-sponsored coverage, we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply. We found that the reduction in cost sharing was associated with a 2.3-percentage-point increase in the choice of any prescription contraceptive, relative to the 30 percent rate of choosing prescription contraceptives before the change in cost sharing. A disproportionate share of this increase came from increased selection of long-term contraception methods. Thus, the removal of cost as a barrier seems to be an important factor in contraceptive choice, and our findings about long-term methods may have implications for rates of unintended pregnancy that require further study.
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Affiliation(s)
- Caroline S Carlin
- Caroline S. Carlin is a research investigator at Medica Research Institute, in Minneapolis, Minnesota
| | - Angela R Fertig
- Angela R. Fertig is a research investigator at Medica Research Institute
| | - Bryan E Dowd
- Bryan E. Dowd is a professor in the Division of Health Policy and Management at the University of Minnesota, in Minneapolis
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17
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Berge JM, Tate A, Trofholz A, Fertig AR, Miner M, Crow S, Neumark-Sztainer D. Momentary Parental Stress and Food-Related Parenting Practices. Pediatrics 2017; 140:peds.2017-2295. [PMID: 29167378 PMCID: PMC5703772 DOI: 10.1542/peds.2017-2295] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Research suggests that stress and depressed mood are associated with food-related parenting practices (ie, parent feeding practices, types of food served at meals). However, current measures of parental stress, depressed mood, and food-related parenting practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations across time and context. Identifying momentary factors that influence parent food-related parenting practices will facilitate the development of effective interventions aimed at promoting healthy food-related parenting practices. In this study, we used ecological momentary assessment to examine the association between momentary factors (eg, stress, depressed mood) occurring early in the day and food-related parenting practices at the evening meal. METHODS Children aged 5 to 7 years and their families (N = 150) from 6 racial and/or ethnic groups (n = 25 each African American, Hispanic/Latino, Hmong, American Indian, Somali, and white families) were recruited for this mixed-methods study through primary care clinics. RESULTS Higher stress and depressed mood earlier in the day predicted pressure-to-eat feeding practices and fewer homemade foods served at meals the same night. Effect modification was found for certain racial and/or ethnic groups with regard to engaging in pressure-to-eat feeding practices (ie, America Indian, Somali) or serving fewer homemade meals (ie, African American, Hispanic/Latino) in the face of high stress or depressed mood. CONCLUSIONS Clinicians may want to consider discussing with parents the influence stress and depressed mood can have on everyday food-related parenting practices. Additionally, future researchers should consider using real-time interventions to reduce parental stress and depressed mood to promote healthy parent food-related parenting practices.
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Affiliation(s)
| | - Allan Tate
- Departments of Family Medicine and Community Health and
| | | | | | - Michael Miner
- Departments of Family Medicine and Community Health and
| | - Scott Crow
- Psychiatry, University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota;,The Emily Program, St Paul, Minnesota
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18
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Farley TA, Halper HS, Carlin AM, Emmerson KM, Foster KN, Fertig AR. Mass Media Campaign to Reduce Consumption of Sugar-Sweetened Beverages in a Rural Area of the United States. Am J Public Health 2017; 107:989-995. [PMID: 28426298 DOI: 10.2105/ajph.2017.303750] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate a mass media campaign to reduce the consumption of sugar-sweetened beverages (SSBs). METHODS We disseminated messages emphasizing the health risks of SSBs through television, digital channels, and local organizations over 15 weeks in 2015-2016 in the Tri-Cities region of northeast Tennessee, southwest Virginia, and southeast Kentucky. We evaluated the campaign with pre- and post-telephone surveys of adults aged 18 to 45 years in the intervention area and by examining changes in beverage sales in the intervention and a matched comparison area in western Virginia. RESULTS Fifty-four percent of postcampaign respondents recalled seeing a campaign advertisement. After the campaign, 53% of respondents believed SSBs were a cause of heart disease, and respondents were more likely postcampaign to consider SSBs a "big cause of diabetes" (75% vs 60%; P < .001). Compared with 12 months before, after the start of the campaign, SSB sales decreased 3.4%, including a 4.1% decrease in soda sales in the intervention area relative to the comparison area (P < .01). CONCLUSIONS This brief media campaign on SSBs was followed by intended changes in beliefs and consumption. Public Health Implications. Additional media campaigns on SSBs should be attempted and evaluated.
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Affiliation(s)
- Thomas A Farley
- Thomas A. Farley, Hayli S. Halper, and Anne M. Carlin are with The Public Good Projects, New York, NY. Karen M. Emmerson is with Edge Research, Arlington, VA. Kelly N. Foster is with the Department of Sociology and Anthropology, East Tennessee State University, Johnson City. Angela R. Fertig is with Medica Research Institute, Minneapolis, MN
| | - Hayli S Halper
- Thomas A. Farley, Hayli S. Halper, and Anne M. Carlin are with The Public Good Projects, New York, NY. Karen M. Emmerson is with Edge Research, Arlington, VA. Kelly N. Foster is with the Department of Sociology and Anthropology, East Tennessee State University, Johnson City. Angela R. Fertig is with Medica Research Institute, Minneapolis, MN
| | - Anne M Carlin
- Thomas A. Farley, Hayli S. Halper, and Anne M. Carlin are with The Public Good Projects, New York, NY. Karen M. Emmerson is with Edge Research, Arlington, VA. Kelly N. Foster is with the Department of Sociology and Anthropology, East Tennessee State University, Johnson City. Angela R. Fertig is with Medica Research Institute, Minneapolis, MN
| | - Karen M Emmerson
- Thomas A. Farley, Hayli S. Halper, and Anne M. Carlin are with The Public Good Projects, New York, NY. Karen M. Emmerson is with Edge Research, Arlington, VA. Kelly N. Foster is with the Department of Sociology and Anthropology, East Tennessee State University, Johnson City. Angela R. Fertig is with Medica Research Institute, Minneapolis, MN
| | - Kelly N Foster
- Thomas A. Farley, Hayli S. Halper, and Anne M. Carlin are with The Public Good Projects, New York, NY. Karen M. Emmerson is with Edge Research, Arlington, VA. Kelly N. Foster is with the Department of Sociology and Anthropology, East Tennessee State University, Johnson City. Angela R. Fertig is with Medica Research Institute, Minneapolis, MN
| | - Angela R Fertig
- Thomas A. Farley, Hayli S. Halper, and Anne M. Carlin are with The Public Good Projects, New York, NY. Karen M. Emmerson is with Edge Research, Arlington, VA. Kelly N. Foster is with the Department of Sociology and Anthropology, East Tennessee State University, Johnson City. Angela R. Fertig is with Medica Research Institute, Minneapolis, MN
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19
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Fertig AR, Carlin CS, Dowd B. Contraceptive Choice After the Affordable Care Act. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Dahlen HM, McCoullough M, Fertig AR, Dowd B, Riley W. The Effect of Hard-Stop Medicaid Payment Reform on Early Elective Deliveries. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Fertig AR, Carlin CS, Ode SB, Long SK. Pent-Up Demand After the Affordable Care Act. J Patient Cent Res Rev 2016. [DOI: 10.17294/2330-0698.1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Fertig AR, Corso PS, Balasubramaniam D. Benefits and costs of a free community-based primary care clinic. J Health Hum Serv Adm 2012; 34:456-470. [PMID: 22530286] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This study estimates the benefits and costs of a free clinic providing primary care services. Using matched data from a free clinic and its corresponding regional hospital on a sample of newly enrolled clinic patients, patients' non-urgent emergency department (ED) and inpatient hospital costs in the year prior to clinic enrollment were compared to those in the year following enrollment to obtain financial benefits. We compare these to annual estimates of the costs associated with the delivery of primary care to these patients. For our sample (n = 207), the annual non-urgent ED and inpatient costs at the hospital fell by $170 per patient after clinic enrollment. However, the cost associated with delivering primary care in the first year after clinic enrollment cost $505 per patient. The presence of a free primary care clinic reduces hospital costs associated with non-urgent ED use and inpatient care. These reductions in costs need to be sustained for at least 3 years to offset the costs associated with the initially high diagnostic and treatment costs involved in the delivery of primary care to an uninsured population.
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23
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Park JM, Fertig AR, Allison PD. Physical and mental health, cognitive development, and health care use by housing status of low-income young children in 20 American cities: a prospective cohort study. Am J Public Health 2011; 101 Suppl 1:S255-61. [PMID: 21551380 DOI: 10.2105/ajph.2010.300098] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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 We assessed the independent effect of homeless and doubled-up episodes on physical and mental health, cognitive development, and health care use among children. METHODS We used data from 4 waves of the Fragile Families and Child Wellbeing Study, involving a sample of 2631 low-income children in 20 large US cities who have been followed since birth. Multivariate analyses involved logistic regression using the hybrid method to include both fixed and random effects. RESULTS Of the sample, 9.8% experienced homelessness and an additional 23.6% had a doubled-up episode. Housing status had little significant adverse effect on child physical or mental health, cognitive development, or health care use. CONCLUSIONS Family and environmental stressors common to many children in poverty, rather than just homeless and doubled-up episodes, were associated with young children's poor health and cognitive development and high health care use. Practitioners need to identify and respond to parental and family needs for support services in addition to housing assistance to effectively improve the health and development of young children who experience residential instability, particularly those in homeless families.
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Affiliation(s)
- Jung Min Park
- School of Social Work, University of Illinois at Urbana---Champaign, USA.
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24
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Corso PS, Fertig AR. The economic impact of child maltreatment in the United States: are the estimates credible? Child Abuse Negl 2010; 34:296-304. [PMID: 20347486 DOI: 10.1016/j.chiabu.2009.09.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 09/03/2009] [Accepted: 09/08/2009] [Indexed: 05/29/2023]
Affiliation(s)
- Phaedra S Corso
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA 30602, USA
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Abstract
There is a debate about the extent to which the effect of prenatal smoking on infant health outcomes is causal. Poor outcomes could be attributable to mother characteristics, which are correlated with smoking. I examine the importance of selection on the effect of prenatal smoking by using three British cohorts where the mothers' knowledge about the harms of prenatal smoking varied substantially. I find that the effect of smoking on the probability of a low birth weight birth conditional on gestation is slightly more than twice as large in 2000 compared with 1958, implying that selection could explain as much as 50% of the current association between smoking and birth outcomes.
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Affiliation(s)
- Angela R Fertig
- Department of Health Policy and Management, University of Georgia, Athens, GA, USA.
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26
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Fertig AR, Watson T. Minimum drinking age laws and infant health outcomes. J Health Econ 2009; 28:737-747. [PMID: 19345434 DOI: 10.1016/j.jhealeco.2009.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 02/18/2009] [Accepted: 02/24/2009] [Indexed: 05/27/2023]
Abstract
Alcohol policies have potentially far-reaching impacts on risky sexual behavior, prenatal health behaviors, and subsequent outcomes for infants. After finding initial evidence in the National Longitudinal Survey of Youth (NLSY) that changes in the minimum legal drinking age (MLDA) are related to prenatal drinking, we examine whether the drinking age influences birth outcomes. Using data from the National Vital Statistics (NVS) for the years 1978-1988, we find that a drinking age of 18 is associated with adverse outcomes among births to young mothers-including higher incidences of low birth weight and premature birth, but not congenital anomalies. The effects are largest among black women. We also report evidence that the MLDA laws alter the composition of births that occur. In states with lenient drinking laws, young black mothers are less likely to report paternal information on the birth certificate, particularly in states with restrictive abortion policies. The evidence suggests that lenient drinking laws generate poor birth outcomes in part because they increase the number of unplanned pregnancies.
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Abstract
This paper explores the relationship between public housing, health outcomes, and health behaviors among low-income housing residents. While public housing can be a dangerous and unhealthy environment in which to live, the subsidized rent may free up resources for nutritious food and health care. In addition, public housing may be of higher quality than the available alternatives, it may provide easier access to health clinics willing to serve the poor, and it may link residents to social support networks, which can improve mental health and the ability to access higher-quality grocery stores. To test whether there is a "back-door" health benefit to the public housing program, we analyze data from the Fragile Families and Child Wellbeing Study. We minimize the effects of selection into public housing with controls and instrumental variables estimation and find that the results are somewhat sensitive to the instrumental variable used, and thus, we conclude that we are unable to detect a robust health benefit from public housing for our measures of health. However, we do find some evidence that public housing residency has mixed effects on domestic violence, increases obesity, and worsens mothers' overall health status.
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Affiliation(s)
- Angela R Fertig
- College of Public Health, Carl Vinson Institute of Government, University of Georgia, USA
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