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Griffith DM, Towfighi A, Manson SM, Littlejohn EL, Skolarus LE. Determinants of Inequities in Neurologic Disease, Health, and Well-being: The NINDS Social Determinants of Health Framework. Neurology 2023; 101:S75-S81. [PMID: 37580154 PMCID: PMC10605947 DOI: 10.1212/wnl.0000000000207566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
A National Institute of Neurological Disorders and Stroke working group developed the Determinants of Inequities in Neurological Disease, Health, and Well-being framework. Our goal was to guide and inspire a new generation of neurologic research that pushes the field to design and test new approaches in pursuit of health equity, population health, and social justice. We seek to expand the lens of those looking to reduce or eliminate racial, socioeconomic status, and other inequities in neurologic disease, health, and well-being to improve our collective ability to create research, programs, and policies that lead to larger, more impactful, and more sustainable change in neurologic disease patterns. In this context, we outline a framework that includes and highlights "upstream" factors in the hopes of enhancing the focus of research, programmatic, and policy efforts to reduce and eliminate inequities in neurologic health and well-being. We explicitly discuss racism and other structural factors to clarify that social determinants are not natural and unchangeable. Populations with a disproportionate burden of neurologic disease are not inherently deficient, despite what some approaches to framing health inequities imply. The framework is presented linearly, but the pathways linking the determinants of neurologic disease, health, and well-being are far more complex than those demonstrated by the arrows included in the figure. The framework highlights the different levels and scale of causation, including the structural and intermediary social determinants and their impact on neurologic health. We offer this framework to refine efforts to contextualize the interpretation of neurologic research findings and suggest new avenues for their application. We illustrate how behavioral and biological factors occur in a social and economic context, factors that have been understudied as points of intervention to reduce inequities in neurologic disease. Considering social and structural determinants of health provides promising new opportunities to achieve neurologic health equity, reach social justice, and improve our science. Extending our work in this fashion is not simply about health equity or social justice but to fundamentally improve the quality of neurologic research by enhancing underlying theory and improving study design and implementation.
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Affiliation(s)
- Derek M Griffith
- From the Department of Health Management and Policy, School of Health, Georgetown University (D.M.G.), Washington, DC; Department of Neurology (A.T.), Keck School of Medicine of the University of Southern California, Los Angeles; University of Colorado Anschutz Medical Campus (S.M.M.), Aurora; National Institute of Neurological Disorders and Stroke (E.L.L.), NIH, Bethesda, MD; and Davee Department of Neurology, Northwestern University, Feinberg School of Medicine (L.E.S.), Chicago, IL.
| | - Amytis Towfighi
- From the Department of Health Management and Policy, School of Health, Georgetown University (D.M.G.), Washington, DC; Department of Neurology (A.T.), Keck School of Medicine of the University of Southern California, Los Angeles; University of Colorado Anschutz Medical Campus (S.M.M.), Aurora; National Institute of Neurological Disorders and Stroke (E.L.L.), NIH, Bethesda, MD; and Davee Department of Neurology, Northwestern University, Feinberg School of Medicine (L.E.S.), Chicago, IL
| | - Spero M Manson
- From the Department of Health Management and Policy, School of Health, Georgetown University (D.M.G.), Washington, DC; Department of Neurology (A.T.), Keck School of Medicine of the University of Southern California, Los Angeles; University of Colorado Anschutz Medical Campus (S.M.M.), Aurora; National Institute of Neurological Disorders and Stroke (E.L.L.), NIH, Bethesda, MD; and Davee Department of Neurology, Northwestern University, Feinberg School of Medicine (L.E.S.), Chicago, IL
| | - Erica L Littlejohn
- From the Department of Health Management and Policy, School of Health, Georgetown University (D.M.G.), Washington, DC; Department of Neurology (A.T.), Keck School of Medicine of the University of Southern California, Los Angeles; University of Colorado Anschutz Medical Campus (S.M.M.), Aurora; National Institute of Neurological Disorders and Stroke (E.L.L.), NIH, Bethesda, MD; and Davee Department of Neurology, Northwestern University, Feinberg School of Medicine (L.E.S.), Chicago, IL
| | - Lesli E Skolarus
- From the Department of Health Management and Policy, School of Health, Georgetown University (D.M.G.), Washington, DC; Department of Neurology (A.T.), Keck School of Medicine of the University of Southern California, Los Angeles; University of Colorado Anschutz Medical Campus (S.M.M.), Aurora; National Institute of Neurological Disorders and Stroke (E.L.L.), NIH, Bethesda, MD; and Davee Department of Neurology, Northwestern University, Feinberg School of Medicine (L.E.S.), Chicago, IL
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Patel S, Kranick J, Manne S, Shah K, Raveis V, Ravenell J, Yi S, Kwon S, Islam N. A Population Health Equity Approach Reveals Persisting Disparities in Colorectal Cancer Screening in New York City South Asian Communities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:804-810. [PMID: 32060860 PMCID: PMC8685893 DOI: 10.1007/s13187-020-01707-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To assess colorectal cancer (CRC) screening among South Asians (SAs) and explore the challenges and facilitators to CRC screening among SA subgroups in New York City (NYC). Fifty-one semi-structured in-depth interviews and surveys were conducted among SA immigrants in NYC. Qualitative results suggested challenges to CRC screening were related to socio-cultural factors, such as a lack of knowledge on CRC and CRC screening, and structural factors, such as cost and language. A physician referral was the most cited facilitator to CRC screening. Participants reported culturally and linguistically adapted education and information on CRC and CRC screening would help to overcome noted challenges. Our findings support the development of targeted, linguistically and culturally adapted campaigns for this population that facilitate access to health systems and leverage natural community assets and social support systems.
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Affiliation(s)
- Shilpa Patel
- Center for Health Care Strategies 200 American, Metro Blvd # 119, Hamilton, NJ, 08619, USA.
| | - Julie Kranick
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Sharon Manne
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, USA
| | - Krina Shah
- Institute of Environmental Medicine, 57 Old Forge Road, Tuxedo Park, NY, 10987, USA
| | | | - Joseph Ravenell
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Stella Yi
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Simona Kwon
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
| | - Nadia Islam
- Department of Population Health, NYU Langone Medical Center, 180 Madison Avenue, New York, NY, 10016, USA
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Baek M, Outrich MB, Barnett KS, Reece J. Neighborhood-Level Lead Paint Hazard for Children under 6: A Tool for Proactive and Equitable Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052471. [PMID: 33802321 PMCID: PMC7967606 DOI: 10.3390/ijerph18052471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
Lead is well known for its adverse health effects on children, particularly when exposure occurs at earlier ages. The primary source of lead hazards among young children is paint used in buildings built before 1978. Despite being 100% preventable, some children remain exposed and state and local policies often remain reactive. This study presents a methodology for planners and public health practitioners to proactively address lead risks among young children. Using geospatial analyses, this study examines neighborhood level measurement of lead paint hazard in homes and childcare facilities and the concentration of children aged 0–5. Results highlight areas of potential lead paint hazard hotspots within a county in the Midwestern state studied, which coincides with higher concentration of non-white children. This places lead paint hazard in the context of social determinants of health, where existing disparity in distribution of social and economic resources reinforces health inequity. In addition to being proactive, lead poisoning intervention efforts need to be multi-dimensional and coordinated among multiple parties involved. Identifying children in higher lead paint hazard areas, screening and treating them, and repairing their homes and childcare facilities will require close collaboration of healthcare professionals, local housing and planning authorities, and community members.
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Affiliation(s)
- Mikyung Baek
- Kirwan Institute for the Study of Race and Ethnicity, The Ohio State University, Columbus, OH 43201, USA; (M.B.O.); (K.S.B.)
- Correspondence:
| | - Michael B. Outrich
- Kirwan Institute for the Study of Race and Ethnicity, The Ohio State University, Columbus, OH 43201, USA; (M.B.O.); (K.S.B.)
| | - Kierra S. Barnett
- Kirwan Institute for the Study of Race and Ethnicity, The Ohio State University, Columbus, OH 43201, USA; (M.B.O.); (K.S.B.)
| | - Jason Reece
- City & Regional Planning, Knowlton School of Architecture, The Ohio State University, Columbus, OH 43210, USA;
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Bassaganya-Riera J, Berry EM, Blaak EE, Burlingame B, le Coutre J, van Eden W, El-Sohemy A, German JB, Knorr D, Lacroix C, Muscaritoli M, Nieman DC, Rychlik M, Scholey A, Serafini M. Goals in Nutrition Science 2020-2025. Front Nutr 2021; 7:606378. [PMID: 33665201 PMCID: PMC7923694 DOI: 10.3389/fnut.2020.606378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/26/2020] [Indexed: 12/12/2022] Open
Abstract
Five years ago, with the editorial board of Frontiers in Nutrition, we took a leap of faith to outline the Goals for Nutrition Science - the way we see it (1). Now, in 2020, we can put ourselves to the test and take a look back. Without a doubt we got it right with several of the key directions. To name a few, Sustainable Development Goals (SDGs) for Food and Nutrition are part of the global public agenda, and the SDGs contribute to the structuring of international science and research. Nutritional Science has become a critical element in strengthening work on the SDGs, and the development of appropriate methodologies is built on the groundwork of acquiring and analyzing big datasets. Investigation of the Human Microbiome is providing novel insight on the interrelationship between nutrition, the immune system and disease. Finally, with an advanced definition of the gut-brain-axis we are getting a glimpse into the potential for Nutrition and Brain Health. Various milestones have been achieved, and any look into the future will have to consider the lessons learned from Covid-19 and the sobering awareness about the frailty of our food systems in ensuring global food security. With a view into the coming 5 years from 2020 to 2025, the editorial board has taken a slightly different approach as compared to the previous Goals article. A mind map has been created to outline the key topics in nutrition science. Not surprisingly, when looking ahead, the majority of scientific investigation required will be in the areas of health and sustainability. Johannes le Coutre, Field Chief Editor, Frontiers in Nutrition.
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Affiliation(s)
- Josep Bassaganya-Riera
- Nutritional Immunology and Molecular Medicine Laboratory (NIMML) Institute, Blacksburg, VA, United States
| | - Elliot M Berry
- Braun School of Public Health, Hebrew University - Hadassah Medical School, Jerusalem, Israel
| | - Ellen E Blaak
- Department of Human Biology, Maastricht University, Maastricht, Netherlands
| | | | - Johannes le Coutre
- School of Chemical Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Willem van Eden
- Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, Netherlands
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - J Bruce German
- Department of Food Science and Technology, University of California, Davis, Davis, CA, United States
| | - Dietrich Knorr
- Institute of Food Technology and Chemistry, Technische Universität Berlin, Berlin, Germany
| | - Christophe Lacroix
- Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - David C Nieman
- Human Performance Laboratory, Department of Biology, Appalachian State University, Kannapolis, NC, United States
| | - Michael Rychlik
- Technical University of Munich, Analytical Food Chemistry, Freising, Germany
| | - Andrew Scholey
- Centre for Human Psychopharmacology, Swinburne University, Melbourne, VIC, Australia
| | - Mauro Serafini
- Functional Food and Metabolic Stress Prevention Laboratory, Faculty of Biosciences and Technologies for Agriculture, Food and Environment, University of Teramo, Teramo, Italy
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Khera R, Valero-Elizondo J, Nasir K. Financial Toxicity in Atherosclerotic Cardiovascular Disease in the United States: Current State and Future Directions. J Am Heart Assoc 2020; 9:e017793. [PMID: 32924728 PMCID: PMC7792407 DOI: 10.1161/jaha.120.017793] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) has posed an increasing burden on Americans and the United States healthcare system for decades. In addition, ASCVD has had a substantial economic impact, with national expenditures for ASCVD projected to increase by over 2.5‐fold from 2015 to 2035. This rapid increase in costs associated with health care for ASCVD has consequences for payers, healthcare providers, and patients. The issues to patients are particularly relevant in recent years, with a growing trend of shifting costs of treatment expenses to patients in various forms, such as high deductibles, copays, and coinsurance. Therefore, the issue of “financial toxicity” of health care is gaining significant attention. The term encapsulates the deleterious impact of healthcare expenditures for patients. This includes the economic burden posed by healthcare costs, but also the unintended consequences it creates in form of barriers to necessary medical care, quality of life as well tradeoffs related to non‐health–related necessities. While the societal impact of rising costs related to ASCVD management have been actively studied and debated in policy circles, there is lack of a comprehensive assessment of the current literature on the financial impact of cost sharing for ASCVD patients and their families. In this review we systematically describe the scope and domains of financial toxicity, the instruments that measure various facets of healthcare‐related financial toxicity, and accentuating factors and consequences on patient health and well‐being. We further identify avenues and potential solutions for clinicians to apply in medical practice to mitigate the burden and consequences of out‐of‐pocket costs for ASCVD patients and their families.
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Affiliation(s)
- Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Khurram Nasir
- Section of Cardiovascular Medicine, Department of Internal Medicine Yale School of Medicine New Haven CT.,Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart and Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
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Dimitratos SM, German JB, Schaefer SE. Wearable Technology to Quantify the Nutritional Intake of Adults: Validation Study. JMIR Mhealth Uhealth 2020; 8:e16405. [PMID: 32706729 PMCID: PMC7407252 DOI: 10.2196/16405] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/13/2020] [Accepted: 04/10/2020] [Indexed: 01/20/2023] Open
Abstract
Background Wearable and mobile sensor technologies can be useful tools in precision nutrition research and practice, but few are reliable for obtaining accurate and precise measurements of diet and nutrition. Objective This study aimed to assess the ability of wearable technology to monitor the nutritional intake of adult participants. This paper describes the development of a reference method to validate the wristband’s estimation of daily nutritional intake of 25 free-living study participants and to evaluate the accuracy (kcal/day) and practical utility of the technology. Methods Participants were asked to use a nutrition tracking wristband and an accompanying mobile app consistently for two 14-day test periods. A reference method was developed to validate the estimation of daily nutritional intake of participants by the wristband. The research team collaborated with a university dining facility to prepare and serve calibrated study meals and record the energy and macronutrient intake of each participant. A continuous glucose monitoring system was used to measure adherence with dietary reporting protocols, but these findings are not reported. Bland-Altman tests were used to compare the reference and test method outputs (kcal/day). Results A total of 304 input cases were collected of daily dietary intake of participants (kcal/day) measured by both reference and test methods. The Bland-Altman analysis had a mean bias of −105 kcal/day (SD 660), with 95% limits of agreement between −1400 and 1189. The regression equation of the plot was Y=−0.3401X+1963, which was significant (P<.001), indicating a tendency for the wristband to overestimate for lower calorie intake and underestimate for higher intake. Researchers observed transient signal loss from the sensor technology of the wristband to be a major source of error in computing dietary intake among participants. Conclusions This study documents high variability in the accuracy and utility of a wristband sensor to track nutritional intake, highlighting the need for reliable, effective measurement tools to facilitate accurate, precision-based technologies for personal dietary guidance and intervention.
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Affiliation(s)
- Sarah M Dimitratos
- Foods for Health Institute, University of California, Davis, CA, United States
| | - J Bruce German
- Foods for Health Institute, University of California, Davis, CA, United States
| | - Sara E Schaefer
- Foods for Health Institute, University of California, Davis, CA, United States
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Fernández-Gómez E, Martín-Salvador A, Luque-Vara T, Sánchez-Ojeda MA, Navarro-Prado S, Enrique-Mirón C. Content Validation through Expert Judgement of an Instrument on the Nutritional Knowledge, Beliefs, and Habits of Pregnant Women. Nutrients 2020; 12:nu12041136. [PMID: 32325669 PMCID: PMC7230573 DOI: 10.3390/nu12041136] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to conduct content validation through expert judgement of an instrument which explores the nutritional knowledge, beliefs, and habits during pregnancy. This is a psychometric study in which 14 experts participated in the evaluation of each of the questionnaire items, which were divided into two blocks according to the characteristics of sufficiency, clarity, coherence, and relevance. Fleiss’ κ statistic was used to measure strength of agreement. A pre-test with 102 participants was conducted to measure the degree of understandability of the instrument. The strength of agreement obtained for each of the dimensions was almost perfect. For each pair of experts, strength of agreement ranged between substantial and almost perfect. Sufficiency was the characteristic of the questionnaire that obtained the highest values in the two blocks, and was also the most statistically significant (p < 0.001). Coherence was the most statistically significant characteristic in the first block (p = 0.030). Clarity was the most statistically significant characteristic in the second block (p = 0.037). The wording of five of the twenty original items was corrected. The new version of the instrument attained a high degree of understandability. The results suggest that the instrument is valid and may therefore be applied.
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Affiliation(s)
- Elisabet Fernández-Gómez
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, Calle Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (A.M.-S.); (M.A.S.-O.); (S.N.-P.)
| | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, Calle Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (A.M.-S.); (M.A.S.-O.); (S.N.-P.)
| | - Trinidad Luque-Vara
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, Calle Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (A.M.-S.); (M.A.S.-O.); (S.N.-P.)
- Correspondence: ; Tel.: +34-686-951-942
| | - María Angustias Sánchez-Ojeda
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, Calle Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (A.M.-S.); (M.A.S.-O.); (S.N.-P.)
| | - Silvia Navarro-Prado
- Department of Nursing, Faculty of Health Sciences, Melilla Campus, University of Granada, Calle Santander s/n, 52001 Melilla, Spain; (E.F.-G.); (A.M.-S.); (M.A.S.-O.); (S.N.-P.)
| | - Carmen Enrique-Mirón
- Department of Inorganic Chemistry, HUM-613 Research Group, Faculty of Health Sciences, Melilla Campus, University of Granada, Calle Santander s/n, 52001 Melilla, Spain;
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Milstein B, Homer J. Which Priorities for Health and Well-Being Stand Out After Accounting for Tangled Threats and Costs? Simulating Potential Intervention Portfolios in Large Urban Counties. Milbank Q 2020; 98:372-398. [PMID: 32027060 PMCID: PMC7296431 DOI: 10.1111/1468-0009.12448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Policy Points Interventions in a regional system with intertwined threats and costs should address those threats that have the strongest, quickest, and most pervasive cross-impacts. Instead of focusing on an individual county's apparent shortcomings, a regional intervention portfolio can yield greater results when it is designed to counter those systemic threats, especially poverty and inadequate social support, that most undermine health and well-being virtually everywhere. Likewise, efforts to reduce smoking, addiction, and violent crime and to improve routine care, health insurance, and youth education are important for most counties to unlock both short- and long-term potential. CONTEXT Counties across the United States must contend with multiple, intertwined threats and costs that defy simple solutions. Decision makers face the necessary but difficult task of prioritizing those interventions with the greatest potential to produce equitable health and well-being. METHODS Using County Health Rankings data for a predefined peer group of 39 urban US counties, we performed statistical regressions to identify 37 cross-impacts among 15 threats to health and well-being. Adding appropriate time delays, we then developed a dynamic model of these cross-impacts and simulated each of the counties over 20 years to assess the likely impact of 12 potential interventions-individually and in a combined portfolio-for three outcomes: (1) years of potential life lost, (2) fraction of adults in fair or poor health, and (3) total spending on urgent services. FINDINGS The combined portfolio yielded improvements by year 20 that are considerably greater than those at year 5, indicating that the time delays have a major effect. Despite the wide variation in threat levels across counties, the list of top-ranked interventions is strikingly similar. Poverty reduction and social support were the most highly ranked interventions, even in the shorter term, for all outcomes in all counties. Interventions affecting smoking, addiction, routine care, health insurance, violent crime, and youth education also were important contributors to some outcomes. CONCLUSIONS To safeguard health and well-being in a system dominated by tangled threats and costs, the most important priorities for a county cannot be simply inferred from a profile of its relative strengths and weaknesses. Two interventions stood out as the top priorities for almost all the counties in this study, and six others also were important contributors. Interventions directed toward these priority areas are likely to yield the greatest impact, irrespective of the county's specifics. A significant concentration of resources in a regional portfolio therefore ought to go to these strongest contributors for equitable health and well-being.
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Affiliation(s)
- Bobby Milstein
- ReThink Health / Rippel Foundation.,MIT Sloan School of Management
| | - Jack Homer
- MIT Sloan School of Management.,Homer Consulting
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Beck AF, Riley CL, Taylor SC, Brokamp C, Kahn RS. Pervasive Income-Based Disparities In Inpatient Bed-Day Rates Across Conditions And Subspecialties. Health Aff (Millwood) 2019; 37:551-559. [PMID: 29608357 DOI: 10.1377/hlthaff.2017.1280] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Building a culture of health in hospitals means more than participating in community partnerships. It also requires an enhanced capacity to recognize and respond to disparities in utilization patterns across populations. We identified all pediatric hospitalizations at Cincinnati Children's Hospital Medical Center, in the period 2011-16. Each hospitalized child's address was geocoded, allowing us to calculate inpatient bed-day rates for each census tract in Hamilton County, Ohio, across all causes and for specific conditions and pediatric subspecialties. We then divided the census tracts into quintiles based on their underlying rates of child poverty and calculated bed-day rates per quintile. Poorer communities disproportionately bore the burden of pediatric hospital days. If children from all of the county's census tracts spent the same amount of time in the hospital each year as those from the most affluent tracts, approximately twenty-two child-years of hospitalization time would be prevented. Of particular note were "hot spots" in high-poverty census tracts neighboring the hospital, where bed-day rates were more than double the county average. Hospitals that address disparities would benefit from a more comprehensive understanding of the culture of health-a culture that is more cohesive inside the hospital and builds bridges into the community.
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Affiliation(s)
- Andrew F Beck
- Andrew F. Beck ( ) is an associate professor of pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, in Ohio
| | - Carley L Riley
- Carley L. Riley is an assistant professor of pediatrics at the University of Cincinnati College of Medicine and at Cincinnati Children's Hospital Medical Center
| | - Stuart C Taylor
- Stuart C. Taylor is a data analyst in the James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center
| | - Cole Brokamp
- Cole Brokamp is an assistant professor of pediatrics at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center
| | - Robert S Kahn
- Robert S. Kahn is a professor of pediatrics at the University of Cincinnati College of Medicine and at Cincinnati Children's Hospital Medical Center
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Abstract
Jose Ordovas and colleagues consider that nutrition interventions tailored to individual characteristics and behaviours have promise but more work is needed before they can deliver
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Affiliation(s)
- Jose M Ordovas
- JM-USDA-HNRCA at Tufts University, Boston, MA, USA
- Centro Nacional Investigaciones Cardiovasculares, Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Lynnette R Ferguson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Berkowitz SA, Basu S, Meigs JB, Seligman HK. Food Insecurity and Health Care Expenditures in the United States, 2011-2013. Health Serv Res 2018; 53:1600-1620. [PMID: 28608473 PMCID: PMC5980147 DOI: 10.1111/1475-6773.12730] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To determine whether food insecurity, limited or uncertain food access owing to cost, is associated with greater health care expenditures. DATA SOURCE/STUDY SETTING Nationally representative sample of the civilian noninstitutionalized population of the United States (2011 National Health Interview Survey [NHIS] linked to 2012-2013 Medication Expenditure Panel Survey [MEPS]). STUDY DESIGN Longitudinal retrospective cohort. DATA COLLECTION/EXTRACTION METHODS A total of 16,663 individuals underwent assessment of food insecurity, using the 10-item adult 30-day food security module, in the 2011 NHIS. Their total health care expenditures in 2012 and 2013 were recorded in MEPS. Expenditure data were analyzed using zero-inflated negative binomial regression and adjusted for age, gender, race/ethnicity, education, income, insurance, and residence area. PRINCIPAL FINDINGS Fourteen percent of individuals reported food insecurity, representing 41,616,255 Americans. Mean annualized total expenditures were $4,113 (standard error $115); 9.2 percent of all individuals had no health care expenditures. In multivariable analyses, those with food insecurity had significantly greater estimated mean annualized health care expenditures ($6,072 vs. $4,208, p < .0001), an extra $1,863 in health care expenditure per year, or $77.5 billion in additional health care expenditure annually. CONCLUSIONS Food insecurity was associated with greater subsequent health care expenditures. Future studies should determine whether food insecurity interventions can improve health and reduce health care costs.
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Affiliation(s)
- Seth A. Berkowitz
- Division of General Internal MedicineMassachusetts General HospitalBostonMA
- Diabetes Population Health Research CenterMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Sanjay Basu
- Department of MedicineStanford UniversityPalo AltoCA
- Center for Primary CareHarvard Medical SchoolBostonMA
| | - James B. Meigs
- Division of General Internal MedicineMassachusetts General HospitalBostonMA
- Harvard Medical SchoolBostonMA
| | - Hilary K. Seligman
- Division of General Internal MedicineUniversity of California San FranciscoSan FranciscoCA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital & Trauma CenterSan FranciscoCA
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12
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Galea S, Keyes KM. What matters, when, for whom? three questions to guide population health scholarship. Inj Prev 2018; 24:i3-i6. [PMID: 28988201 PMCID: PMC5940569 DOI: 10.1136/injuryprev-2017-042415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/05/2017] [Accepted: 10/02/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Sandro Galea
- Dean’s Office, Boston University, Boston, Massachusetts, USA
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
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13
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Beck AF, Sandel MT, Ryan PH, Kahn RS. Mapping Neighborhood Health Geomarkers To Clinical Care Decisions To Promote Equity In Child Health. Health Aff (Millwood) 2018; 36:999-1005. [PMID: 28583957 DOI: 10.1377/hlthaff.2016.1425] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Health disparities, which can be understood as disadvantages in health associated with one's social, racial, economic, or physical environment, originate in childhood and persist across an individual's life course. One's neighborhood may drive or influence these disparities. Information on neighborhoods that can characterize their risks-what we call place-based risks-is rarely used in patient care. Community-level data, however, could inform and personalize interventions such as arranging for mold removal from the home of a person with asthma from the moment that person's address is recorded at the site of care. Efficient risk identification could lead to the tailoring of recommendations and targeting of resources, to improve care experiences and clinical outcomes while reducing disparities and costs. In this article we highlight how data on place-based social determinants of health from national and local sources could be incorporated more directly into patient-centered care, adding precision to risk assessment and mitigation. We also discuss how this information could stimulate cross-sector interventions that promote health equity: the attainment of the highest level of health for neighborhoods, patient panels, and individuals. Finally, we draw attention to research questions that focus on the role of geographical place at the bedside.
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Affiliation(s)
- Andrew F Beck
- Andrew F. Beck is an assistant professor of pediatrics at the Cincinnati Children's Hospital Medical Center, in Ohio
| | - Megan T Sandel
- Megan T. Sandel is an associate professor of pediatrics at the Boston University School of Medicine, in Massachusetts
| | - Patrick H Ryan
- Patrick H. Ryan is an associate professor of pediatrics at the Cincinnati Children's Hospital Medical Center
| | - Robert S Kahn
- Robert S. Kahn is a professor of pediatrics at the Cincinnati Children's Hospital Medical Center
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14
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Arora A, Spatz E, Herrin J, Riley C, Roy B, Kell K, Coberley C, Rula E, Krumholz HM. Population Well-Being Measures Help Explain Geographic Disparities In Life Expectancy At The County Level. Health Aff (Millwood) 2018; 35:2075-2082. [PMID: 27834249 DOI: 10.1377/hlthaff.2016.0715] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Geographic disparities in life expectancy are substantial and not fully explained by differences in race and socioeconomic status. To develop policies that address these inequalities, it is essential to identify other factors that account for this variation. In this study we investigated whether population well-being-a comprehensive measure of physical, mental, and social health-helps explain geographic variation in life expectancy. At the county level, we found that for every 1-standard-deviation (4.2-point) increase in the well-being score, life expectancy was 1.9 years higher for females and 2.6 years higher for males. Life expectancy and well-being remained positively associated, even after race, poverty, and education were controlled for. In addition, well-being partially mediated the established associations of race, poverty, and education with life expectancy. These findings highlight well-being as an important metric of a population's health and longevity and as a promising focus for intervention.
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Affiliation(s)
- Anita Arora
- Anita Arora is a Robert Wood Johnson Foundation Clinical Scholar at Yale School of Medicine, in New Haven, Connecticut
| | - Erica Spatz
- Erica Spatz is an assistant professor in the Department of Cardiovascular Medicine, Yale School of Medicine
| | - Jeph Herrin
- Jeph Herrin is an assistant professor in the Department of Cardiovascular Medicine, Yale School of Medicine
| | - Carley Riley
- Carley Riley is an assistant professor at Cincinnati Children's Hospital Medical Center, in Ohio
| | - Brita Roy
- Brita Roy is an assistant professor of medicine, Yale School of Medicine
| | - Kenneth Kell
- Kenneth Kell is senior health outcomes researcher at Healthways, in Franklin, Tennessee
| | - Carter Coberley
- Carter Coberley was vice president of health research and outcomes at Healthways when this work was conducted and now works as an independent consultant
| | - Elizabeth Rula
- Elizabeth Rula is executive director and principal investigator at Healthways, in Franklin, Tennessee
| | - Harlan M Krumholz
- Harlan M. Krumholz is the Harold H. Hines, Jr. Professor of Medicine at Yale School of Medicine and director of the Yale Center for Outcomes Research and Evaluation (CORE)
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15
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Northridge ME, Duane JF. Public Health's Aspirational Identity: Who Do We Want to Be? Am J Public Health 2018; 108:65-66. [DOI: 10.2105/ajph.2017.304156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mary E. Northridge
- Mary E. Northridge is the AJPH editor emerita and is with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY. John F. Duane is an attorney in private practice and Chair, Queens County Bar Association LGBT Committee, New York
| | - John F. Duane
- Mary E. Northridge is the AJPH editor emerita and is with the Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, NY. John F. Duane is an attorney in private practice and Chair, Queens County Bar Association LGBT Committee, New York
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16
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Miller DP, Bazzi AR, Allen HL, Martinson ML, Salas-Wright CP, Jantz K, Crevi K, Rosenbloom DL. A Social Work Approach to Policy: Implications for Population Health. Am J Public Health 2017; 107:S243-S249. [PMID: 29236535 DOI: 10.2105/ajph.2017.304003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The substantial disparities in health and poorer outcomes in the United States relative to peer nations suggest the need to refocus health policy. Through direct contact with the most vulnerable segments of the population, social workers have developed an approach to policy that recognizes the importance of the social environment, the value of social relationships, and the significance of value-driven policymaking. This approach could be used to reorient health, health care, and social policies. Accordingly, social workers can be allies to public health professionals in efforts to eliminate disparities and improve population health.
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Affiliation(s)
- Daniel P Miller
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - Angela R Bazzi
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - Heidi L Allen
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - Melissa L Martinson
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - Christopher P Salas-Wright
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - Kathryn Jantz
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - Katherine Crevi
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
| | - David L Rosenbloom
- Daniel P. Miller, Christopher P. Salas-Wright, and Katherine Crevi are with the School of Social Work, Boston University, Boston, MA. Angela R. Bazzi and David L. Rosenbloom are with the School of Public Health, Boston University. Heidi L. Allen is with the School of Social Work, Columbia University, New York, NY. Melissa L. Martinson is with the School of Social Work, University of Washington, Seattle. Kathryn Jantz is with the Steadman Group, Denver, CO
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17
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Samuriwo R. Grand convergence in wound healing - The imperative for collaboration in research, innovation and quality improvement. J Tissue Viability 2017; 27:80-81. [PMID: 29103915 DOI: 10.1016/j.jtv.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/16/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Ray Samuriwo
- Chair of the Tissue Viability Society Board of Trustees, UK; School of Healthcare Sciences, Cardiff University, UK; Wales Centre for Evidence Based Care, Cardiff University, UK; Cardiff Institute for Tissue Engineering and Repair (CITER), Cardiff University, UK.
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18
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Beck AF, Huang B, Wheeler K, Lawson NR, Kahn RS, Riley CL. The Child Opportunity Index and Disparities in Pediatric Asthma Hospitalizations Across One Ohio Metropolitan Area, 2011-2013. J Pediatr 2017; 190:200-206.e1. [PMID: 29144247 PMCID: PMC5708858 DOI: 10.1016/j.jpeds.2017.08.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/30/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether the Child Opportunity Index (COI), a nationally available measure of relative educational, health/environmental, and social/economic opportunity across census tracts within metropolitan areas, is associated with population- and patient-level asthma morbidity. STUDY DESIGN This population-based retrospective cohort study was conducted between 2011 and 2013 in a southwest Ohio county. Participants included all children aged 1-16 years with hospitalizations or emergency department visits for asthma or wheezing at a major pediatric hospital. Patients were identified using discharge diagnosis codes and geocoded to their home census tract. The primary population-level outcome was census tract asthma hospitalization rate. The primary patient-level outcome was rehospitalization within 12 months of the index hospitalization. Census tract opportunity was characterized using the COI and its educational, health/environmental, and social/economic domains. RESULTS Across 222 in-county census tracts, there were 2539 geocoded hospitalizations. The median asthma-related hospitalization rate was 5.0 per 1000 children per year (IQR, 1.9-8.9). Median hospitalization rates in very low, low, moderate, high, and very high opportunity tracts were 9.1, 7.6, 4.6, 2.1, and 1.8 per 1000, respectively (P < .0001). The social/economic domain had the most variables significantly associated with the outcome at the population level. The adjusted patient-level analyses showed that the COI was not significantly associated with a patient's risk of rehospitalization within 12 months. CONCLUSIONS The COI was associated with population-level asthma morbidity. The details provided by the COI may inform interventions aimed at increasing opportunity and reducing morbidity across regions.
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Affiliation(s)
- Andrew F. Beck
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A,Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | | | - Nikki R. Lawson
- University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Robert S. Kahn
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Carley L. Riley
- Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, U.S.A
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19
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Scott C. Incorporating Lawyers on the Interprofessional Team to Promote Health and Health Equity. ACTA ACUST UNITED AC 2017. [DOI: 10.18060/3911.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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20
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Logan RA. Seeking an expanded, multidimensional conceptual approach to health literacy and health disparities research. ACTA ACUST UNITED AC 2017. [DOI: 10.3233/isu-160809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Robert A. Logan
- National Library of Medicine (NLM), 8600 Rockville Pike, Bethesda, MD 20894, USA. E-mail:
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21
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Berman S. Can We Go Beyond Care Process Measures to a New Child Health Policy? Pediatrics 2016; 138:peds.2016-2823. [PMID: 27940723 DOI: 10.1542/peds.2016-2823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Stephen Berman
- Pediatrics and Public Health, University of Colorado School of Medicine, Colorado School of Public Health, and Children's Hospital Colorado, Aurora, Colorado
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22
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Zonderman AB, Mode NA, Ejiogu N, Evans MK. Race and Poverty Status as a Risk for Overall Mortality in Community-Dwelling Middle-Aged Adults. JAMA Intern Med 2016; 176:1394-5. [PMID: 27428269 PMCID: PMC5831185 DOI: 10.1001/jamainternmed.2016.3649] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Nicolle A Mode
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Ngozi Ejiogu
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, Maryland
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