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DeDent AM, Collard HR, Thakur N. Neighborhood Health and Outcomes in Idiopathic Pulmonary Fibrosis. Ann Am Thorac Soc 2024; 21:402-410. [PMID: 37962494 PMCID: PMC10913773 DOI: 10.1513/annalsats.202304-323oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
Rationale: Living in a disadvantaged neighborhood has been associated with worse survival in people with idiopathic pulmonary fibrosis (IPF), however, prior studies have only examined the impact of neighborhood health on outcomes in IPF as a composite measure. Objectives: To investigate the association between neighborhood health and disease severity, measured by pulmonary function at presentation, and death in follow-up, with an additional focus on the contributions of the neighborhood's underlying physical and social factors to these outcomes. Methods: In a retrospective study of participants from the University of California, San Francisco, IPF Cohort (2001-2020), geocoded home addresses were matched to the California Healthy Places Index (HPI), a census-tract measure of neighborhood health. The HPI comprises 25 indicators of neighborhood health that are organized into eight physical and social domains, each of which is weighted and summed to provide a composite HPI score. Regression models were used to examine associations between the HPI as a continuous variable, in quartiles, and across each physical and social domain of the HPI (higher values indicate greater advantage) and forced vital capacity (FVC) percent predicted (% predicted), diffusing capacity of the lung for carbon monoxide (DlCO) % predicted, and death, adjusting for demographic and clinical covariates. We also studied the interaction between disease severity at presentation and neighborhood health in our time-to-event models. Results: In 783 participants with IPF, each 10% increase in HPI was associated with a 1% increase in FVC % predicted and DlCO % predicted (95% confidence intervals [CIs] = 0.55, 1.72; and 0.49, 1.49, respectively). This association appeared primarily driven by the economic, education, access, and social HPI domains. We also observed differences in the associations of HPI with mortality depending on disease severity at presentation. In participants with normal to mildly impaired FVC % predicted (⩾70%) and DlCO % predicted (⩾60%), decreased HPI was associated with higher mortality (hazard ratio = 2.91 Quartile 1 vs. Quartile 4; 95% CI = 1.20, 7.05). No association was observed between the HPI and death for participants with moderate to severely impaired FVC % predicted and DlCO % predicted. Conclusions: Living in disadvantaged neighborhoods was associated with worse pulmonary function in participants with IPF and was independently associated with increased mortality in participants with normal to mild physiological impairment at presentation.
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Affiliation(s)
- Alison M DeDent
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Harold R Collard
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Neeta Thakur
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
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Meudec M, Affun-Adegbulu C, Cosaert T. Review of health research and data on/with racially minoritised groups: Implications for addressing racism and racial disparities in public health practice and policies in Europe: a study protocol. F1000Res 2023; 12:57. [PMID: 38434645 PMCID: PMC10904934 DOI: 10.12688/f1000research.128331.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 03/05/2024] Open
Abstract
Historically, across Europe, data and research on/with racially minoritised groups have not been collected or carried out in a sufficient, adequate, or appropriate manner. Yet, to understand emerging and existing health disparities among such groups, researchers and policymakers must obtain and use data to build evidence that informs decision-making and action on key structural and social determinants of health. This systematic search and review aims to contribute to closing this gap and promote a race-conscious approach to health research, strengthening the utilisation and deployment of data and research on/with racially minoritised groups in Europe. Its ultimate goal is to improve equality and equity in health*. Concretely, the study will do so by reviewing and critically analysing the usage of the concepts of race, ethnicity, and their related euphemisms and proxies in health-related research. It will examine the collection, use, and deployment of data and research on/with racially minoritised groups in this area. The study will focus on Belgium, France, and the Netherlands, three countries with graphical proximity and several similarities, one of which is the limited attention that is given to racism and racial inequalities in health in research and policy. This choice is also justified by practical knowledge of the context and languages. The results of the review will be used to develop guidance on how to use and deploy data and research on/with racially minoritised groups. The review is part of a larger project which aims to promote race-conscious research and data. The project does this by a three-pronged approach which: 1) highlights the need for a race-conscious approach when collecting and using data, carrying out research on/with racially minoritised groups; 2) builds expertise for their effective use and deployment, and; 3) creates a knowledge network and community of practice for public health researchers working in Europe.
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Affiliation(s)
- Marie Meudec
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Clara Affun-Adegbulu
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
| | - Theo Cosaert
- The Population Data Science Hub, Department of Public Health, Institute of Tropical Medicine, Antwerp, 2000, Belgium
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Bensken WP, Vaca GFB, Williams SM, Khan OI, Jobst BC, Stange KC, Sajatovic M, Koroukian SM. Disparities in adherence and emergency department utilization among people with epilepsy: A machine learning approach. Seizure 2023; 110:169-176. [PMID: 37393863 PMCID: PMC10528555 DOI: 10.1016/j.seizure.2023.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE We used a machine learning approach to identify the combinations of factors that contribute to lower adherence and high emergency department (ED) utilization. METHODS Using Medicaid claims, we identified adherence to anti-seizure medications and the number of ED visits for people with epilepsy in a 2-year follow up period. We used three years of baseline data to identify demographics, disease severity and management, comorbidities, and county-level social factors. Using Classification and Regression Tree (CART) and random forest analyses we identified combinations of baseline factors that predicted lower adherence and ED visits. We further stratified these models by race and ethnicity. RESULTS From 52,175 people with epilepsy, the CART model identified developmental disabilities, age, race and ethnicity, and utilization as top predictors of adherence. When stratified by race and ethnicity, there was variation in the combinations of comorbidities including developmental disabilities, hypertension, and psychiatric comorbidities. Our CART model for ED utilization included a primary split among those with previous injuries, followed by anxiety and mood disorders, headache, back problems, and urinary tract infections. When stratified by race and ethnicity we saw that for Black individuals headache was a top predictor of future ED utilization although this did not appear in other racial and ethnic groups. CONCLUSIONS ASM adherence differed by race and ethnicity, with different combinations of comorbidities predicting lower adherence across racial and ethnic groups. While there were not differences in ED use across races and ethnicity, we observed different combinations of comorbidities that predicted high ED utilization.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Guadalupe Fernandez-Baca Vaca
- Department of Neurology, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Scott M Williams
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Omar I Khan
- Epilepsy Center of Excellence, Baltimore VA Medical Center, US Department of Veterans Affairs, Baltimore, MD, USA
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, NH, Lebanon, USA
| | - Kurt C Stange
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Center for Community Health Integration, Departments of Family Medicine & Community Health, and Sociology, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Bundy JD, Mills KT, He H, LaVeist TA, Ferdinand KC, Chen J, He J. Social determinants of health and premature death among adults in the USA from 1999 to 2018: a national cohort study. Lancet Public Health 2023; 8:e422-e431. [PMID: 37244672 DOI: 10.1016/s2468-2667(23)00081-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 04/14/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Racial and ethnic disparities in mortality persist in the US population. We studied the contribution of social determinants of health (SDoH) to racial and ethnic disparities in premature death. METHODS A nationally representative sample of individuals aged 20-74 years who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were included. Self-reported SDoH (employment, family income, food security, education, access to health care, health insurance, housing instability, and being married or living with a partner) were collected in each survey cycle. Participants were categorised into four groups of race and ethnicity: Black, Hispanic, White, and other. Deaths were ascertained from linkage to the National Death Index with follow-up until 2019. Multiple mediation analysis was used to assess simultaneous contributions of each individual SDoH to racial disparities in premature all-cause mortality. FINDINGS We included 48 170 NHANES participants in our analyses, consisting of 10 543 (21·9%) Black participants, 13 211 (27·4%) Hispanic participants, 19 629 (40·7%) White participants, and 4787 (9·9%) participants of other racial and ethnic groups. Mean survey-weighted age was 44·3 years (95% CI 44·0-44·6), 51·3% (50·9-51·8) of participants were women, and 48·7% (48·2-49·1) were men. 3194 deaths before age 75 years were recorded (930 Black participants, 662 Hispanic participants, 1453 White participants, and 149 other participants). Black adults had significantly higher premature mortality than other racial and ethnic groups (p<0·0001): premature death rates per 100 000 person-years were 852 (95% CI 727-1000) for Black adults, 445 (349-574) for Hispanic adults, 546 (474-630) for White adults, and 521 (336-821) for other adults. Unemployment, lower family income, food insecurity, less than high school education, no private health insurance, and not being married nor living with a partner were significantly and independently associated with premature death. Dose-response associations were observed between cumulative number of unfavourable SDoH and premature all-cause mortality: hazard ratios (HRs) were 1·93 (95% CI 1·61-2·31) for those with one unfavourable SDoH, 2·24 (1·87-2·68) for those with two, 3·98 (3·34-4·73) for those with three, 4·78 (3·98-5·74) for those with four, 6·08 (5·06-7·31) for those with five, and 7·82 (6·60-9·26) for those with six or more unfavourable SDoH (p<0·0001 for linear trend). After adjusting for SDoH, HRs for premature all-cause mortality for Black adults compared with White adults decreased from 1·59 (1·44-1·76) to 1·00 (0·91-1·10), suggesting complete mediation of this racial difference in mortality. INTERPRETATION Unfavourable SDoH are associated with increased rates of premature death and contribute to differences between Black and White racial groups in premature all-cause mortality in the US population. Innovative public health policies and interventions targeting SDoH are needed to reduce premature deaths and health disparities in this population. FUNDING US National Institutes of Health.
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Affiliation(s)
- Joshua D Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Katherine T Mills
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Thomas A LaVeist
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Keith C Ferdinand
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Tulane University Translational Science Institute, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
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Mendieta MJ, De Geest SM, Goderis G, Yip O, Deschodt M, Dhaini S. A multi-level perspective on perceived unmet needs for home support in home-dwelling older adults in the Swiss context: a secondary data analysis of a population study. BMC Geriatr 2022; 22:833. [PMID: 36329389 PMCID: PMC9635119 DOI: 10.1186/s12877-022-03479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background Unmet needs for home support occur when any support services perceived by older people as needed are not being received. Not meeting these needs can negatively impact older adults’ quality of life, and increase health care utilization, hospitalizations, institutionalizations, or death. To date there is no consensus in how to define and assess these unmet needs. In parallel, previous research of factors associated with unmet needs for home support has mostly focused on factors at the micro level. Thus, this paper aims to identify the prevalence of unmet needs for home support among a home-dwelling older population and the factors at the macro, meso and micro levels contributing to them. Methods Using an ecological approach we identified multi-level factors associated with the presence of unmet needs for home support among the home-dwelling older population (aged 75+) in Switzerland. This is a secondary cross-sectional analysis of the INSPIRE Population Survey of home-dwelling older adults (n = 8,508) living in Basel-Landschaft in Switzerland, conducted as part of the TRANS-SENIOR Project. Prevalence of perceived unmet needs for home support was self-reported, using a dichotomized question. Multiple logistic regression analyses were performed to investigate the associations of factors at each level with unmet needs for home support. Results 4.3% of participants reported unmet needs for home support, with a median age of 81 years. 45.1% had private health insurance and 6.3% needed additional government support. Being a recipient of other type of government support (OR = 1.65; 95% CI = 1.17–2.29) (macro-); the use of transportation services (OR = 1.74; 95% CI = 1.15–2.57) (meso-); and feeling depressed (OR = 1.40; 95% CI = 1.06–1.85) or abandoned (OR = 2.60; 95% CI = 1.96–3.43) (micro-) increased odds of having perceived unmet needs for home support. Having a private health insurance (macro-) (OR = 0.63; 95% CI = 0.49–0.80), speaking Swiss-German (OR = 0.44; 95% CI = 0.24–0.88) or German (OR = 0.47; 95% CI = 0.24–0.98), having a high level of education [primary (OR = 0.48; 95% CI = 0.24–1.02); secondary (OR = 0.49; 95% CI = 0.25–1.03); tertiary (OR = 0.38; 95% CI = 0.19–0.82); other (OR = 0.31 (0.12–0.75)], having a high score of self-perceived health status [score ≥ 76 (OR = 0.42; 95% CI = 0.20–0.96)] and having informal care (OR = 0.57; 95% CI = 0.45–0.73), among others (micro-) were associated with decreased odds of having perceived unmet needs for home support. Conclusion Our study findings highlight the role of socio-economical inequality in the perception of unmet needs for home support in home-dwelling older adults. In order to address unmet needs in home-dwelling older adults, healthcare leaders and policy makers should focus on strategies to reduce socio-economic inequalities at the different levels in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03479-5.
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Affiliation(s)
- Maria Jose Mendieta
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Sabina M De Geest
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium ,grid.6612.30000 0004 1937 0642Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Geert Goderis
- grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Academic Center of General Practice, KU Leuven, Leuven Belgium
| | - Olivia Yip
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Mieke Deschodt
- grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Leuven Belgium ,grid.410569.f0000 0004 0626 3338Competence Center of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Suzanne Dhaini
- grid.6612.30000 0004 1937 0642Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
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How Do We Define and Measure Health Equity? The State of Current Practice and Tools to Advance Health Equity. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:570-577. [PMID: 35867507 PMCID: PMC9311469 DOI: 10.1097/phh.0000000000001603] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Healthy People establishes national goals and specific measurable objectives to improve the health and well-being of the nation. An overarching goal of Healthy People 2030 is to "eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all." To inform Healthy People 2030 health equity and health disparities content and products, the US Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion (ODPHP), in collaboration with NORC at the University of Chicago, conducted a review of peer-reviewed and gray literature to examine how health equity is defined, conceptualized, and measured by public health professionals. METHODS We reviewed (1) peer-reviewed literature, (2) HHS and other public health organization Web sites, and (3) state and territorial health department plans. We also conducted targeted searches of the gray literature to identify tools and recommendations for measuring health equity. RESULTS While definitions of health equity identified in the scan varied, they often addressed similar concepts, including "highest level of health for all people," "opportunity for all," and "absence of disparities." Measuring health equity is challenging; however, strategies to measure and track progress toward health equity have emerged. There are a range of tools and resources that have the potential to help decision makers address health equity, such as health impact assessments, community health improvement plans, and adapting a Health in All Policies approach. Tools that visualize health equity data also support data-driven decision making. DISCUSSION Using similar language when discussing health equity will help align and advance efforts to improve health and well-being for all. Healthy People objectives, measures, and targets can help public health professionals advance health equity in their work. HHS ODPHP continues to develop Healthy People tools and resources to support public health professionals as they work with cross-sector partners to achieve health equity.
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Randomized, wait-list-controlled pilot study of app-delivered mindfulness for patients reporting chronic pain. Pain Rep 2021; 6:e924. [PMID: 34778688 PMCID: PMC8546841 DOI: 10.1097/pr9.0000000000000924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 12/24/2022] Open
Abstract
App-delivered mindfulness improved social functioning and pain catastrophizing
among patients with chronic pain. Patient characteristics predicted app
engagement, highlighting important considerations for clinical settings. Introduction: Chronic pain creates economic burden and exerts profound individual and
societal harm. Mobile application (app)-delivered mindfulness meditation may
be an important approach to self-management of chronic pain. Objectives: We examined the feasibility, acceptability, and impact of app-delivered
mindfulness meditation on pain cognition and daily functioning among
patients reporting chronic pain. Methods: We used a longitudinal, randomized, and wait-list–controlled design
(NCT03495726) to evaluate changes in self-reported pain severity, pain
catastrophizing, and social and physical functioning among participants
randomized to 6 weeks of app-delivered mindfulness meditation, compared with
participants randomized to a wait-list control group. Results: Although most participants randomized to the mindfulness group used the app
at least once, fewer than half adhered to the instructed program.
Participants who did not use the app scored higher on the helplessness
component of pain catastrophizing at the start of the study and were less
likely to have completed 4 years of college. Participants who reported
feeling pressured to enroll in the study were also less likely to adhere to
the intervention. Compared with participants randomized to wait-list, those
in the mindfulness group reported significant improvements in social
functioning, even after controlling for pain severity. Participants
randomized to the mindfulness intervention also reported significant
improvements in helplessness. App usage was not significantly correlated
with changes in social functioning or helplessness scores. Conclusions: These results suggest that app-delivered mindfulness meditation is beneficial
to patients with chronic pain. Identifying characteristics of patients who
were adherent highlights important considerations for clinical settings.
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Gómez CA, Kleinman DV, Pronk N, Wrenn Gordon GL, Ochiai E, Blakey C, Johnson A, Brewer KH. Addressing Health Equity and Social Determinants of Health Through Healthy People 2030. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:S249-S257. [PMID: 33729197 PMCID: PMC8478299 DOI: 10.1097/phh.0000000000001297] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The evolution of Healthy People reflects growing awareness of health inequities over the life course. Each decade, the initiative has gained understanding of how the nation can achieve health and well-being. To inform Healthy People 2030's visionary goal of achieving health equity in the coming decade, the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee) provided the US Department of Health and Human Services with guidance on key terms, frameworks, and measurement for health equity. Conditions in the environments in which people are born, live, learn, work, play, worship, and age influence health and well-being outcomes, functioning, and quality-of-life outcomes and risks and are mostly responsible for health inequities. No single individual, organization, community, or sector has sole ownership, accountability, or capacity to sustain the health and well-being of an entire population. The COVID-19 pandemic in the United States highlights underlying inequities and disparities in health and health care across segments of the population. Contributing factors that were known prior to the pandemic have led to major discrepancies in rates of infection and death. To reduce health disparities and advance health equity, systems approaches-designed to shift interconnected aspects of public health problems-are needed.
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Affiliation(s)
- Cynthia A. Gómez
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Dushanka V. Kleinman
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Nico Pronk
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Glenda L. Wrenn Gordon
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Emmeline Ochiai
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Carter Blakey
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Ayanna Johnson
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
| | - Karen H. Brewer
- Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Dr Gómez, Dr Kleinman, Dr Pronk, and Dr Wrenn Gordon); Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, US Department of Health and Human Services, Rockville, Maryland (Ms Ochiai, Ms Blakey, and Ms Johnson [former staff]); and Health ConTexts, LLC, Silver Spring, Maryland (Ms Brewer)
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Mhasawade V, Zhao Y, Chunara R. Machine learning and algorithmic fairness in public and population health. NAT MACH INTELL 2021. [DOI: 10.1038/s42256-021-00373-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Auditing the scope of antithrombotic care in iPACT (International Pharmacists for Anticoagulation Care Taskforce) represented countries. Res Social Adm Pharm 2021; 17:1764-1769. [PMID: 33579613 DOI: 10.1016/j.sapharm.2021.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/10/2021] [Accepted: 01/18/2021] [Indexed: 11/23/2022]
Abstract
Countries strive to find suitable solutions to offer health services to their populations. Pharmacist-led services are a possible solution to supplement the care offer with a clear advantage of proximity, with demonstrated expertise in medication use. This paper aims to audit the scope of antithrombotic care services available; and to describe the arrangements adopted for meeting the needs of the population. A multi-stage project involved the development of the list of services, generated during a face-to-face expert meeting; the definition of each service by literature search; and their clustering into three main groups (general, specific and support); resulting in an online audit of each service's availability, the settings where the service was available and the possible providers. The audit was distributed to a taskforce devoted to antithrombotic care representing 22 countries, with response obtained for all. Most reported general services were Transfer of care and Comprehensive Medication Review. Among specific services, Point-of-care testing for INR and renal function and Patient Education on antithrombotic care (antiplatelets and anticoagulants) were the most frequent. Interprofessional Education as a support service was very common, but the use of the Choosing Wisely initiative to inform evidence-based decisions was still limited. There was wide diversity found in arrangements for the provision of services to support patients taking antithrombotic medication, albeit specific services were reported in over half the surveyed countries.
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English CMC. Screening Isn't Enough: A Call to Integrate Behavioral Health Providers in Women's Health and Perinatal Care Settings. Int J Integr Care 2020; 20:12. [PMID: 33262679 PMCID: PMC7678558 DOI: 10.5334/ijic.5640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/20/2022] Open
Abstract
This paper aims to enhance the current understanding of integrated mental health services in the United States and how they can be better incorporated in perinatal and women's health specialty care from the perspective of a behavioral health provider. While much is known about gender disparities of mental health and low recognition and treatment rates for mental health disorders in women's health and perinatal care, few changes are being implemented to embed mental health specialists where they are needed most to close gaps in care. This paper demonstrates the value creation of integrated behavioral health in a midwife practice in the State of Arizona. Clinical and operational workflows can easily be adapted to include a behavioral health service to address mental and behavioral health needs that, when untreated, lead to long-term adverse outcomes in women and their families. Financial barriers that may hinder success of the integrated model are highlighted and discussed.
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Affiliation(s)
- Cara M. C. English
- Cummings Graduate Institute for Behavioral Health Studies, US
- Terra’s Place for Maternal Mental Health, US
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12
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Inoue A, Tsutsumi A, Eguchi H, Kachi Y, Shimazu A, Miyaki K, Takahashi M, Kurioka S, Enta K, Kosugi Y, Totsuzaki T, Kawakami N. Workplace social capital and refraining from seeking medical care in Japanese employees: a 1-year prospective cohort study. BMJ Open 2020; 10:e036910. [PMID: 32747350 PMCID: PMC7401998 DOI: 10.1136/bmjopen-2020-036910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES We examined the association of workplace social capital (WSC), including structural and cognitive dimensions, with refraining from seeking medical care (RSMC) among Japanese employees. DESIGN One-year prospective cohort study. SETTING AND PARTICIPANTS We surveyed 8770 employees (6881 men and 1889 women) aged 18-70 years from 12 firms in Japan using a self-administered questionnaire comprising the WSC scale and the items on potential confounders (ie, age, educational attainment and equivalent annual household income) at baseline (from April 2011 to March 2013). OUTCOME MEASURES At a 1-year follow-up, we measured RSMC using a single-item question 'In the past year, have you ever refrained from visiting a hospital, clinic, acupuncturist or dentist despite your sickness (including a slight cold or cavity) or injury?' RESULTS The results of Cox regression with robust variance showed that, after adjusting for potential confounders, the low WSC group (ie, the lowest tertile group) had a significantly higher relative risk (RR) of RSMC compared with the high WSC group (ie, the highest tertile group) among both men and women (overall WSC: RR 1.09 (95% CI 1.01 to 1.17) and 1.20 (95% CI 1.06 to 1.37); structural dimension: RR 1.13 (95% CI 1.04 to 1.22) and 1.25 (95% CI 1.07 to 1.45); and cognitive dimension: RR 1.11 (95% CI 1.03 to 1.20) and 1.21 (95% CI 1.06 to 1.38), respectively). Trend analysis using a continuous score of the WSC scale also showed a significant association of low WSC with a higher risk of RSMC among both men and women. CONCLUSIONS Our findings suggest that the lack of social capital in the workplace is associated with RSMC among Japanese employees.
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Affiliation(s)
- Akiomi Inoue
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Akizumi Tsutsumi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Hisashi Eguchi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
- Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Yuko Kachi
- Department of Public Health, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Akihito Shimazu
- Faculty of Policy Management, Keio University, Fujisawa, Kanagawa, Japan
- Asia Pacific Centre for Work Health and Safety, University of South Australia, Adelaide, South Australia, Australia
| | - Koichi Miyaki
- Research Institute of Occupational Mental Health (RIOMH), Shibuya-ku, Tokyo, Japan
- Innovative Research Center for Preventive Medical Engineering, Nagoya University, Nagoya, Aichi, Japan
| | - Masaya Takahashi
- Research Center for Overwork-Related Disorders, National Institute of Occupational Safety and Health Japan, Kawasaki, Kanagawa, Japan
| | - Sumiko Kurioka
- Faculty of Education, St. Andrew's University of Education, Sakai, Osaka, Japan
| | - Kazuhiko Enta
- Health Care Center, Central Japan Railway Company, Nagoya, Aichi, Japan
| | - Yuki Kosugi
- Kosugi Health Management Office, Toyama, Japan
| | - Takafumi Totsuzaki
- Uchisaiwaicho Medical Center, Mizuho Health Insurance Society, Chiyoda-ku, Tokyo, Japan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Juarez PD, Tabatabai M, Burciaga Valdez R, Hood DB, Im W, Mouton C, Colen C, Al-Hamdan MZ, Matthews-Juarez P, Lichtveld MY, Sarpong D, Ramesh A, Langston MA, Rogers GL, Phillips CA, Reichard JF, Donneyong MM, Blot W. The Effects of Social, Personal, and Behavioral Risk Factors and PM 2.5 on Cardio-Metabolic Disparities in a Cohort of Community Health Center Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3561. [PMID: 32438697 PMCID: PMC7277630 DOI: 10.3390/ijerph17103561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/30/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022]
Abstract
(1) Background: Cardio-metabolic diseases (CMD), including cardiovascular disease, stroke, and diabetes, have numerous common individual and environmental risk factors. Yet, few studies to date have considered how these multiple risk factors together affect CMD disparities between Blacks and Whites. (2) Methods: We linked daily fine particulate matter (PM2.5) measures with survey responses of participants in the Southern Community Cohort Study (SCCS). Generalized linear mixed modeling (GLMM) was used to estimate the relationship between CMD risk and social-demographic characteristics, behavioral and personal risk factors, and exposure levels of PM2.5. (3) Results: The study resulted in four key findings: (1) PM2.5 concentration level was significantly associated with reported CMD, with risk rising by 2.6% for each µg/m3 increase in PM2.5; (2) race did not predict CMD risk when clinical, lifestyle, and environmental risk factors were accounted for; (3) a significant variation of CMD risk was found among participants across states; and (4) multiple personal, clinical, and social-demographic and environmental risk factors played a role in predicting CMD occurrence. (4) Conclusions: Disparities in CMD risk among low social status populations reflect the complex interactions of exposures and cumulative risks for CMD contributed by different personal and environmental factors from natural, built, and social environments.
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Affiliation(s)
- Paul D. Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Mohammad Tabatabai
- School of Graduate Studies and Research, Meharry Medical College, Nashville, TN 37208, USA;
| | - Robert Burciaga Valdez
- RWJF Professor, Department of Family & Community Medicine AND Economics, University of New Mexico, Albuquerque, NM 87131, USA;
| | - Darryl B. Hood
- Department of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, OH 43210, USA;
| | - Wansoo Im
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Charles Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Cynthia Colen
- Department of Sociology, Ohio State University, Columbus, OH 43210, USA;
| | - Mohammad Z. Al-Hamdan
- Universities Space Research Association, NASA Marshall Space Flight Center, Huntsville, AL 35805, USA;
| | - Patricia Matthews-Juarez
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA; (W.I.); (P.M.-J.)
| | - Maureen Y. Lichtveld
- Department of Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA;
| | - Daniel Sarpong
- Department of Biostatistics, Xavier University, Cincinnati, OH 45207, USA;
| | - Aramandla Ramesh
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN 37208, USA;
| | - Michael A. Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA; (M.A.L.); (C.A.P.)
| | - Gary L. Rogers
- National Institute for Computational Sciences, University of Tennessee, Knoxville, TN 37996, USA;
| | - Charles A. Phillips
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN 37996, USA; (M.A.L.); (C.A.P.)
| | - John F. Reichard
- Department of Environmental Health, Risk Science Center, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Macarius M. Donneyong
- Division of Outcomes and Translational Sciences, College of Pharmacy, Ohio State University, Columbus, OH 43210, USA;
| | - William Blot
- Center for Population-based Research, Vanderbilt University, Nashville, TN 37235, USA;
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Vazquez CE, Cubbin C. Associations between breastfeeding duration and overweight/obese among children aged 5-10: a focus on racial/ethnic disparities in California. AIMS Public Health 2020; 6:355-369. [PMID: 31909059 PMCID: PMC6940568 DOI: 10.3934/publichealth.2019.4.355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
Research on the association between breastfeeding and childhood obesity and research on racial/ethnic differences in breastfeeding both show inconsistencies. The current study examines: 1) whether immigrant Hispanic women have higher rates of breastfeeding compared to non-Hispanic (three separate groups: African-American, Asian/Pacific Islander, and White) and U.S.-born Hispanic women; 2) whether children who were breastfed are less likely to be overweight/obese compared to children who were not breastfed; and 3) whether associations between breastfeeding and weight status vary by race/ethnicity/nativity. The study builds on prior literature using representative data from the Geographic Research On Wellbeing study (GROW, 2012–2013) and focusing on ages 5–10 years, an age group that has not been well studied (N = 2675 mother/child dyads). Logistic regression was used to investigate the odds of child obesity (≥95th%) and child overweight (≥85th%) in a series of models: unadjusted (each variable individually), demographic (child's sex, child's age, mother's age, mother's race/ethnicity, and mother's marital status), socioeconomic status (mother's education and family income), and full model (mother's BMI); with breastfeeding included in all models. Interactions between race/ethnicity and breastfeeding duration were also examined. African-American (9.54%) and white (32.8%) women had the lowest and highest rates of ever breastfeeding, respectively. White women breastfed the longest (M = 10.52 months, SE = 0.028) and U.S.-born Hispanic women breastfed the shortest (M = 7.05 months, SE = 0.41), on average. Children of African-American and U.S.-born Hispanic mothers had higher odds of being overweight/obese (74–75%) compared with children of white mothers. No associations were found between breastfeeding duration and child's weight status in adjusted models, nor was there a significant interaction between mother's race/ethnicity and breastfeeding duration on child's weight status; however, mother's own weight status was a significant driver of child's weight status and explained the racial/ethnic disparities. These results provide evidence in favor of there being no association between breastfeeding and childhood obesity.
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Affiliation(s)
- Christian E Vazquez
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
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Zhang CQ, Chung PK, Zhang R, Schüz B. Socioeconomic Inequalities in Older Adults' Health: The Roles of Neighborhood and Individual-Level Psychosocial and Behavioral Resources. Front Public Health 2019; 7:318. [PMID: 31709222 PMCID: PMC6823619 DOI: 10.3389/fpubh.2019.00318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Chun-Qing Zhang
- Department of Sport and Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Hong Kong.,School of Psychology, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Pak-Kwong Chung
- Department of Sport and Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ru Zhang
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Schüz
- Institute for Public Health and Nursing, University of Bremen, Bremen, Germany
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Berglund E, Lytsy P, Westerling R. Living environment, social support, and informal caregiving are associated with healthcare seeking behaviour and adherence to medication treatment: A cross-sectional population study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1260-1270. [PMID: 31016806 PMCID: PMC6850350 DOI: 10.1111/hsc.12758] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 03/06/2019] [Accepted: 03/21/2019] [Indexed: 05/06/2023]
Abstract
Despite the well-known associations between local environment and health, few studies have focused on environment and healthcare utilisation, for instance healthcare seeking behaviour or adherence. This study was aimed at analysing housing type, behaviour based on perceived local outdoor safety, social support, informal caregiving, demographics, socioeconomics, and long-term illness, and associations with health-seeking and adherence behaviours at a population level. This study used data from the Swedish National Public Health Survey 2004-2014, an annually repeated, large sample, cross-sectional, population-based survey study. In all, questionnaires from 100,433 individuals were returned by post, making the response rate 52.9% (100,433/190,000). Descriptive statistics and multiple logistic regressions were used to investigate associations between explanatory variables and the outcomes of refraining from seeking care and non-adherence behaviour. Living in rented apartment, lodger, a dorm or other was associated with reporting refraining from seeking care (adjusted OR 1.16, 95% CI 1.00-1.22), and non-adherence (adjusted OR 1.22; 95% CI 1.13-1.31). Refraining from going out due to a perceived unsafe neighbourhood was associated with refraining from seeking care (adjusted OR 1.59, 95% CI 1.51-1.67) and non-adherence (adjusted OR 1.26, 95% CI 1.17-1.36). Social support and status as an informal caregiver was associated with higher odds of refraining from seeking medical care and non-adherence. This study suggests that living in rental housing, refraining from going out due to neighbourhood safety concerns, lack of social support or informal caregiver status are associated with lower health-seeking behaviour and non-adherence to prescribed medication.
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Affiliation(s)
- Erik Berglund
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Per Lytsy
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
- Division of Insurance Medicine, Department of Clinical NeuroscienceKarolinska InstituteStockholmSweden
| | - Ragnar Westerling
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
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Organizational Justice and Refraining from Seeking Medical Care Among Japanese Employees: A 1-Year Prospective Cohort Study. Int J Behav Med 2018; 26:76-84. [PMID: 30484083 PMCID: PMC6435618 DOI: 10.1007/s12529-018-9756-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Using a 1-year prospective design, we examined the association of organizational justice (i.e., procedural justice and interactional justice) with refraining from seeking medical care (RSMC) among Japanese employees. Methods We surveyed 2695 employees (1994 men and 701 women) from two factories of a manufacturing company in Japan. A self-administered questionnaire comprising scales for measuring organizational justice (Organizational Justice Questionnaire) and potential confounders (i.e., demographic and socioeconomic characteristics as well as health-related behaviors) was administered at baseline (from April to June 2011). At 1-year follow-up (from April to June 2012), a single-item question was used to measure RSMC during the follow-up period. Multiple logistic regression analysis was conducted by gender. Results After adjusting for potential confounders, low procedural justice and low interactional justice at baseline were found to be significantly associated with higher odds of RSMC during the 1-year follow-up for male employees (odds ratio = 1.33 [95% confidence interval = 1.16–1.52], p < 0.001 and 1.15 [95% confidence interval = 1.02–1.29], p = 0.019, respectively). Similar patterns were observed for female employees (odds ratio = 1.37 [95% confidence interval = 1.08–1.74], p = 0.009 and 1.23 [95% confidence interval = 1.02–1.50], p = 0.035 for low procedural justice and low interactional justice, respectively). Conclusions The present study provided evidence that the lack of organizational justice is positively associated with RSMC among Japanese employees, independently of demographic and socioeconomic characteristics as well as of health-related behaviors.
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Khetani MA, Richardson Z, McManus BM. Social Disparities in Early Intervention Service Use and Provider-Reported Outcomes. J Dev Behav Pediatr 2017; 38:501-509. [PMID: 28723828 PMCID: PMC5573679 DOI: 10.1097/dbp.0000000000000474] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe social disparities in early intervention (EI) service use and provider-reported outcomes. METHODS Secondary data analysis of administrative data to ascertain EI service use of all EI and discipline-specific services and child and family characteristics. Adjusted logistic regression models estimated the odds of receiving each type of core EI service. Adjusted median regression models estimated differences in EI intensity for each type of core EI service. Adjusted ordinal regression models estimated the association between each type of EI therapy service and provider estimates of children's global functional improvement. RESULTS Children with a diagnosis (b = 0.8, SE = 0.2) and those whose caregiver had 12 years of education or less (b = 0.6, SE = 0.3) had higher EI intensity. Black, non-Hispanic (BNH) children had nearly 75% lower odds of receiving physical therapy (PT) (odds ratio [OR] = 0.3, 95% confidence interval [CI], 0.1-0.7) and greater odds of receiving speech therapy (ST) (OR = 3.4, 95% CI, 1.3-9.3) than their white, non-Hispanic (WNH) peers. BNH children who received PT received about an hour less per month (b = -0.7, SE = 0.4) than their WNH peers. Hispanic children (b = 1.0, SE = 0.3) and those with higher family income (b = 0.7, SE = 0.3) received greater intensity of PT compared with their peers who are WNH and from low-income families. Publically insured children had lower intensity of occupational therapy (b = -0.5, SE = 0.3) and ST (b = -0.6, SE = 0.3). Greater intensity of EI services was not associated with greater provider-perceived improvement. CONCLUSION Results suggest disparities, by race and family income, in receipt of EI therapy services. These findings highlight opportunities to customize and coordinate care for improved EI access and care quality.
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Affiliation(s)
- Mary A Khetani
- *Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago (UIC), Chicago, IL; †Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, CO
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Pei L, Toyokawa S, Kobayashi Y. Labor factor barriers to seeking medical services among metropolitan workers: a cross-sectional analysis by sex using the J-SHINE study. J Occup Health 2017; 59:418-427. [PMID: 28794391 PMCID: PMC5635150 DOI: 10.1539/joh.16-0242-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES There is limited evidence on the relationship between labor factors and the decision to refrain from seeking medical services. This study aimed to examine how labor factors are related to medical service access among male and female workers in Tokyo and surrounding areas. METHODS We used data from 4,385 respondents to the survey in the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE), an ongoing epidemiologic household panel study. Surveys from 2010 to 2011 were analyzed. The outcome variable was whether or not an individual refrained from seeking medical services. Labor factors included employment type (permanent, temporary, or self-employed), company size (<100, 100-1,000, or >1,000 employees) and occupation type (white-collar, blue-collar). RESULTS We included a total of 2,013 people after excluding those with missing data (analysis utilization: 45.9%). After adjusting covariates, we found that men working in small companies were more likely to refrain from seeking medical services than were those in medium or large companies (adjusted prevalence ratio [PR]: 1.19, 95% confidence interval [CI]: 1.04-1.37). Among women, however, those in self-employment (PR: 1.38, 95% CI: 1.08-1.77) and blue-collar employment (PR: 1.24, 95% CI: 1.04-1.47) were more likely to refrain than were those classified as permanent or white-collar workers. CONCLUSIONS The relationship between labor factors and refraining from seeking medical services differed among men by company size, and among women by employment type and occupation type.
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Affiliation(s)
- Liying Pei
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Satoshi Toyokawa
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo
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Berglund E, Westerling R, Lytsy P. Social and health-related factors associated with refraining from seeking dental care: A cross-sectional population study. Community Dent Oral Epidemiol 2017; 45:258-265. [PMID: 28169442 DOI: 10.1111/cdoe.12284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Social inequities are considered to affect healthcare utilization, whereas less is known about the factors associated with refraining from seeking dental care. This study aimed to investigate whether people with no social support, long-term illness, caregiver burden and low socioeconomic status (SES) refrained from seeking dental care in higher proportion than the general Swedish population. METHODS This study used cross-sectional questionnaire data from repeated nationwide health surveys during 2004-2013 of a total of 90 845 people. The questionnaire included questions on demographic characteristics, social support, long-term illness, caregiving burden, SES and dental care-seeking behaviour. Descriptive statistics, chi-square tests, correlation analyses and logistic regressions were used to investigate associations between independent variables and dental care-seeking behaviour. RESULTS In the total sample, 15.1% of respondents reported refraining from seeking dental care. Having no emotional social support or having no instrumental social support was separately associated with reporting refraining from seeking dental care in adjusted multivariate models (odds ratio [OR] 1.26, 95% confidence interval [CI] 1.18-1.34 and OR: 1.89, 95% CI: 1.67-2.13, respectively). Having a long-term illness was associated with refraining from seeking dental care in adjusted models (adjusted OR: 1.43, 95% CI: 1.35-1.51). Furthermore, being an informal caregiver was associated with refraining from seeking dental care (adjusted OR: 1.15, 95% CI: 1.07-1.23). Low SES was associated with higher refraining from seeking dental care; the strongest association was with having financial problems (adjusted OR: 3.57, 95% CI: 3.19-4.00). Interaction effects were found between education level and SES, and between social support and long-term illness, and the outcome. CONCLUSIONS The findings in this study imply that having no social support, having long-term illness, being informal caregiver or having financial problems are factors associated with reporting refraining from seeking dental care, on a population basis.
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Affiliation(s)
- Erik Berglund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ragnar Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Per Lytsy
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Denney JT, Kimbro RT, Heck K, Cubbin C. Social Cohesion and Food Insecurity: Insights from the Geographic Research on Wellbeing (GROW) Study. Matern Child Health J 2017; 21:343-350. [PMID: 27439421 PMCID: PMC10627425 DOI: 10.1007/s10995-016-2119-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives Food insecurity in the United States is a stubborn public health issue, affecting more than one in five households with children and disproportionately impacting racial and ethnic minority women and their children. Past research and policy has focused on household predictors of food insecurity, but neglected broader factors, such as perceived neighborhood social cohesion, that might protect those most vulnerable to food insecurity. Methods We use a racially and ethnically diverse data set from the Geographic Research on Wellbeing study (N = 2847) of women and their young children in California to investigate whether social cohesion influences food insecurity and whether it moderates the relationship between race/ethnicity and food insecurity. Results We find that lower levels of perceived residential neighborhood social cohesion associate with higher odds of food insecurity even after considering important household socioeconomic factors. In addition, our results suggest that social cohesion is most relevant for reducing the risk of food insecurity among racial and ethnic minority mothers. For example, the probability of food insecurity for immigrant Latina mothers is nearly 0.40 in neighborhoods where mothers perceive little to no cohesion and less than 0.10 in neighborhoods where mothers perceive high cohesion. Conclusions for Practice Higher levels of neighborhood perceived social cohesion are protective against food insecurity in households with children and especially so for racial and ethnic minority households who are at a heightened risk of food insecurity. Supporting programs that focus on building closer knit communities may be a key to reducing food insecurity overall and for reducing disparities in food insecurity by race and ethnicity.
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Affiliation(s)
- Justin T Denney
- Kinder Institute Urban Health Program and Department of Sociology, Rice University, 6100 Main St. MS-28, Houston, TX, 77005, USA.
| | - Rachel Tolbert Kimbro
- Kinder Institute Urban Health Program and Department of Sociology, Rice University, 6100 Main St. MS-28, Houston, TX, 77005, USA
| | - Katherine Heck
- Center on Social Disparities in Health, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine Cubbin
- Population Research Center and School of Social Work, University of Texas at Austin, Austin, TX, USA
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Mizuochi M. Social capital and refraining from medical care among elderly people in Japan. BMC Health Serv Res 2016; 16:331. [PMID: 27484252 PMCID: PMC4970323 DOI: 10.1186/s12913-016-1599-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 07/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refraining from required medical care can worsen health, particularly for the elderly, and increase public medical expenditure, which destabilizes the financial aspect of social security. Social capital, such as trust between residents and the norms of reciprocity in the community, is a possible measure to prevent refraining from medical care. METHODS We studied survey data collected in a small area in Japan that included a high response rate (91.6 %) to evaluate refraining from medical care. Self-reported refraining from required medical care from among 1016 elderly people, aged ≥60 (male = 490; female = 526), was used as a dependent variable. Social capital indicators were mean values of people's attitude toward the generalized trust and norms of reciprocity in each community. We estimated the association between community level social capital and individuals' probability of refraining from medical care while controlling individual factors such as age, education, and marital status. RESULTS Logit estimation results showed that only generalized trust is associated with low probability of refraining from medical care among the elderly in small communities. The marginal effect for 0.1 increase in community level trust is 4 % decrease in the probability of refraining from medical care. In larger communities, generalized trust is not associated with the probability of refraining from medical care. CONCLUSIONS This finding suggests that the generalized trust is effective in smaller communities as far as related to access to medical care. In small communities, policy to increase generalized trust to support medical care for elderly is recommended.
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Affiliation(s)
- Masaaki Mizuochi
- Faculty of Policy Studies, Nanzan University, 27 Seirei, Seto, Aichi, Japan.
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Hod T, Goldfarb-Rumyantzev AS. The role of disparities and socioeconomic factors in access to kidney transplantation and its outcome. Ren Fail 2014; 36:1193-9. [PMID: 24988495 DOI: 10.3109/0886022x.2014.934179] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research focused on identifying vulnerable populations and revealing specific risk factors for barriers along the pathway from ESRD to kidney transplantation has been mostly descriptive and the causes of existing disparities remain unclear. However, several socio-economic factors that are associated with the access to and the outcome of the kidney transplantation have been identified. SUMMARY While the presence of racial, gender, and geographic disparities is noted, we were interested mostly to describe potential socio-economic factors associated with and possibly responsible for the presence of such disparities. In this review we focused on five factors: education level, employment status, income, presence of substance addiction or abuse, and marital status. We describe the new method to quantify patients' socio-economic status and identify the group of high risk in terms of the transplant outcome, easily calculated social adaptability index, previously associated with clinical outcome in several patient populations including those with kidney transplant. At the end, based on literature analyzed we offer potential interventions that potentially can be used in order to reduce the degree of disparities. CONCLUSION Based on review of literature socio-economic factors are associated with and possibly responsible for healthcare disparities. Social adaptability index allows quantifying the degree of socio-economic status and identifying the group of high risk for inferior transplant outcome.
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Affiliation(s)
- Tammy Hod
- Division of Nephrology and Center for Vascular Biology Research, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School , Boston , MA
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25
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Shi X, Tubb L, Chen S, Fulda KG, Franks S, Reeves R, Lister G. Associations of health disparities and physical activity with children's health and academic problems. J Exerc Sci Fit 2014. [DOI: 10.1016/j.jesf.2013.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Whyte LA, Kotecha S, Watkins WJ, Jenkins HR. Coeliac disease is more common in children with high socio-economic status. Acta Paediatr 2014; 103:289-94. [PMID: 24188384 DOI: 10.1111/apa.12494] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 09/21/2013] [Accepted: 10/30/2013] [Indexed: 12/11/2022]
Abstract
AIM There are a number of genetic and environmental factors that are associated with an increased risk of developing coeliac disease. Our aim was to determine whether socio-economic deprivation increases or reduces the development of the disease. METHODS A cross-sectional study identified all children <16 years old diagnosed with coeliac disease in the same tertiary paediatric centre between January 1995 and December 2011. Data, including age at diagnosis and postcode, were collected and linked with the quintile rank of the Welsh Index of Multiple Deprivation score 2008, a measure of socio-economic status. RESULTS We included 232 patients and identified a graded association between the prevalence of coeliac disease and socio-economic deprivation, which showed a higher rate in children living in more affluent areas. The largest difference was between the lowest deprivation level (rate/1000 = 1.16) and the highest deprivation level (rate/1000 = 0.49). CONCLUSION In our population, coeliac disease was more common in children in the higher socio-economic groupings. The reasons for this are not clear, but perhaps both the 'hygiene hypothesis' and the health seeking behaviours of parents with high socio-economic status are possible factors in the more frequent diagnosis of coeliac disease in this group.
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Affiliation(s)
- LA Whyte
- Department of Paediatric Gastroenterology; Children's Hospital of Wales; Cardiff UK
| | - S Kotecha
- Department of Child Health; Cardiff University; School of Medicine; Cardiff UK
| | - WJ Watkins
- Department of Child Health; Cardiff University; School of Medicine; Cardiff UK
| | - HR Jenkins
- Department of Paediatric Gastroenterology; Children's Hospital of Wales; Cardiff UK
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Bollini P, Quack-Lötscher K. Guidelines-based indicators to measure quality of antenatal care. J Eval Clin Pract 2013; 19:1060-6. [PMID: 23527697 DOI: 10.1111/jep.12027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2013] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES No comprehensive measurement of quality of antenatal care is available. Late booking or low number of checks are often used as surrogate for poor quality, leaving uncertainty on the actual content of the care received. In order to fill this gap, we have reviewed two sets of clinical guidelines and developed corresponding indicators of quality. METHOD A group of clinicians and methodologists reviewed the National Institute for Clinical Excellency Clinical Guidelines on antenatal care, and the list of prenatal care interventions recommended by the Research and Development Group, both based on evidence of effectiveness of specific interventions. We identified single aspects in three domains: (1) services utilization; (2) screening; and (3) interventions. For each indicator, we defined: (1) eligibility, that is the characteristics of the women to whom the indicator applies; (2) standard, that is the situation when the target is met; and (3) moderators, that is all conditions which legitimately hamper the fulfilment of the standard. RESULTS We developed four indicators of service utilization, 25 of screening and 17 of intervention. The respective eligibility, standard and moderators criteria were described for each indicator. While many indicators could be retrospectively evaluated from medical charts, quality of communication with provider, screening for sensible issues and counselling on behaviours to be avoided could only be obtained with a prospective data collection. CONCLUSIONS The indicators of quality of antenatal care, complemented by measures of social position, social support and immigrant/ethnic status, allow for a careful description of the gaps in quality of care for specific groups of women.
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Wu M, Lagasse LL, Wouldes TA, Arria AM, Wilcox T, Derauf C, Newman E, Shah R, Smith LM, Neal CR, Huestis MA, Dellagrotta S, Lester BM. Predictors of inadequate prenatal care in methamphetamine-using mothers in New Zealand and the United States. Matern Child Health J 2013; 17:566-75. [PMID: 22588827 PMCID: PMC3717345 DOI: 10.1007/s10995-012-1033-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study compared patterns of prenatal care among mothers who used methamphetamine (MA) during pregnancy and non-using mothers in the US and New Zealand (NZ), and evaluated associations among maternal drug use, child protective services (CPS) referral, and inadequate prenatal care in both countries. The sample consisted of 182 mothers in the MA-Exposed and 196 in the Comparison groups in the US, and 107 mothers in the MA-Exposed and 112 in the Comparison groups in NZ. Positive toxicology results and/or maternal report of MA use during pregnancy were used to identify MA use. Information about sociodemographics, prenatal care and prenatal substance use was collected by maternal interview. MA-use during pregnancy is associated with lower socioeconomic status, single marital status, and CPS referral in both NZ and the US. Compared to their non-using counterparts, MA-using mothers in the US had significantly higher rates of inadequate prenatal care. No association was found between inadequate care and MA-use in NZ. In the US, inadequate prenatal care was associated with CPS referral, but not in NZ. Referral to CPS for drug use only composed 40 % of all referrals in the US, but only 15 % of referrals in NZ. In our study population, prenatal MA-use and CPS referral eclipse maternal sociodemographics in explanatory power for inadequate prenatal care. The predominant effect of CPS referral in the US is especially interesting, and should encourage further research on whether the US policy of mandatory reporting discourages drug-using mothers from seeking antenatal care.
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Affiliation(s)
- Min Wu
- Brown Center for the Study of Children at Risk, Warren Alpert Medical School at Brown University and Women and Infants Hospital, Providence, RI, USA.
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Cairns G, de Andrade M, MacDonald L. Reputation, relationships, risk communication, and the role of trust in the prevention and control of communicable disease: a review. JOURNAL OF HEALTH COMMUNICATION 2013; 18:1550-65. [PMID: 24298887 DOI: 10.1080/10810730.2013.840696] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Population-level compliance with health protective behavioral advice to prevent and control communicable disease is essential to optimal effectiveness. Multiple factors affect perceptions of trustworthiness, and trust in advice providers is a significant predeterminant of compliance. While competency in assessment and management of communicable disease risks is critical, communications competency may be equally important. Organizational reputation, quality of stakeholder relationships and risk information provision strategies are trust moderating factors, whose impact is strongly influenced by the content, timing and coordination of communications. This article synthesizes the findings of 2 literature reviews on trust moderating communications and communicable disease prevention and control. We find a substantial evidence base on risk communication, but limited research on other trust building communications. We note that awareness of good practice historically has been limited although interest and the availability of supporting resources is growing. Good practice and policy elements are identified: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources. Priority areas for future research include process and cost-effectiveness evaluation and the development of frameworks that integrate communication and biomedical disease control and prevention functions, conceptually and at scale.
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Affiliation(s)
- Georgina Cairns
- a Institute for Social Marketing, Stirling Management School, University of Stirling , Stirling , Scotland , United Kingdom
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Crawford ND, Rudolph AE, Jones K, Fuller C. Differences in self-reported discrimination by primary type of drug used among New York City drug users. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2012; 38:588-92. [PMID: 22524147 DOI: 10.3109/00952990.2012.673664] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Illicit drug users experience various forms of discrimination which may vary by type of drug used, as there are different levels of stigma associated with different types of drugs. OBJECTIVES This study investigated self-report of perceived discrimination by primary type of drug used. METHODS This analysis used data from "Social Ties Associated with Risk of Transition into Injection Drug Use" (START), a cross-sectional study of recently initiated injection drug users (IDUs) and prospective study of heroin/crack/cocaine-using non-IDUs (n = 652). Using log binomial regression, the relationship between primary drug used (i.e., single drug used most often) with discrimination due to drug use was examined. RESULTS Heroin users were significantly more likely (Prevalence ratio (PR): 1.52 (95% Confidence interval (CI): 1.15-2.07)) to report discrimination due to drug use compared to cocaine users. CONCLUSION AND SCIENTIFIC SIGNIFICANCE More research is needed to understand the mechanism through which discrimination affects heroin users, and its potential relation with other discrimination-related outcomes, namely depression and drug treatment.
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Affiliation(s)
- Natalie D Crawford
- Department of Epidemiology, Center for Social Epidemiology and Population Health, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
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Braveman PA, Kumanyika S, Fielding J, Laveist T, Borrell LN, Manderscheid R, Troutman A. Health disparities and health equity: the issue is justice. Am J Public Health 2011; 101 Suppl 1:S149-55. [PMID: 21551385 PMCID: PMC3222512 DOI: 10.2105/ajph.2010.300062] [Citation(s) in RCA: 458] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2010] [Indexed: 11/04/2022]
Abstract
Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary's Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee's work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy.
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Meslin EM, Garba I. Biobanking and public health: is a human rights approach the tie that binds? Hum Genet 2011; 130:451-63. [PMID: 21761137 PMCID: PMC7088251 DOI: 10.1007/s00439-011-1061-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 06/30/2011] [Indexed: 10/29/2022]
Abstract
Ethical principles guiding public health and genomic medicine are often at odds: whereas public health practice adopts collectivist principles that emphasize population-based benefits, recent advances in genomic and personalized medicine are grounded in an individualist ethic that privileges informed consent, and the balancing of individual risk and benefit. Indeed, the attraction of personalized medicine is the promise it holds out to help individuals get the "right medicine for the right problem at the right time." Research biobanks are an effective tool in the genomic medicine toolbox. Biobanking in public health presents a unique case study to unpack some of these issues in more detail. For example, there is a long history of using banked tissue obtained under clinical diagnostic conditions for later public health uses. But despite the collectivist approach of public health, the principles applied to the ethical challenges of biobanking (e.g. informed consent, autonomy, privacy) remain individualist. We demonstrate the value of using human rights as a public health ethics framework to address this tension in biobanking by applying it to two illustrative cases.
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Affiliation(s)
- Eric M Meslin
- Indiana University Center for Bioethics, 410 W 10th Street, Suite 3100, Indianapolis, IN 46202, USA.
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Peck MG, Sappenfield WM, Skala J. Perinatal periods of risk: a community approach for using data to improve women and infants' health. Matern Child Health J 2011; 14:864-74. [PMID: 20602162 DOI: 10.1007/s10995-010-0626-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper provides an overview of the origins, purpose, and methods of the Perinatal Periods of Risk (PPOR) approach to community-based planning for action to improve maternal and infant health outcomes. PPOR includes a new analytic framework that enables urban communities to better understand and address fetal and infant mortality. This article serves as the core reference for accompanying specific PPOR methods and practice articles. PPOR is based on core principles of full community engagement and equity and follows a six stage community-based planning process. In Stage 1, communities are mobilized and engaged, related planning efforts aligned, and community and analytic readiness assessed. In Stage 2, feto-infant mortality is mapped, excess mortality is estimated, likely causes of feto-infant mortality are determined, and appropriate actions are suggested. Stage 3 produces action plans for targeted prevention strategies. Stages 4 and 5 include implementation, monitoring, and evaluation. Stage 6 fosters political will to sustain efforts. PPOR can be used in local maternal child health (MCH) practice for improving perinatal outcomes. MCH programs can use PPOR to integrate health assessments, initiate planning, identify significant gaps, target more in-depth inquiry, and suggest clear interventions for lowering feto-infant mortality. PPOR enables greater cooperation in improving MCH through more effective data use, strengthened data capacity, and greater shared understanding of complex infant mortality issues. PPOR offers local health departments and their community partners a comprehensive approach to address the health of women and infants in their jurisdictions.
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Affiliation(s)
- Magda G Peck
- CityMatCH and the Department of Pediatrics, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-2175, USA.
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Ruwe M, Capitman J, Bengiamin M, Soto T. A systematic review and meta-analysis of racial disparities in prenatal care in California: How much? Does insurance matter? SOCIAL WORK IN PUBLIC HEALTH 2010; 25:550-571. [PMID: 21058214 DOI: 10.1080/19371910903344217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This meta-analysis compares California to 13 states with regard to adequacy of prenatal care in the context of the major Medicaid expansion. It shows a reduction in prenatal care inadequacy after 1992, especially in California. It also shows persistent racial ethnic disparities. By examining how California differed from other states, this study provides not only benchmarks for attaining the Healthy People 2010 goal of 90% adequacy but also possible strategies for achieving this goal. Attaining the Healthy People 2010 objective for prenatal care for California as a whole will require further efforts to understand and address racial/ethnic and insurance-related inequalities.
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Affiliation(s)
- Mathilda Ruwe
- Fresno College of Health and Human Services, Central Valley Health Policy Institute, California State University, Fresno, California, USA.
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Urrutia MT, Cianelli R. Disparidad en Salud: Un Fenómeno Multidimensional. HISPANIC HEALTH CARE INTERNATIONAL 2010; 8:23-35. [PMID: 22581053 DOI: 10.1891/1540-4153.8.1.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
La Disparidad en Salud (DS) ha llamado la atención pública desde el siglo pasado, ha sido analizada desde diversas perspectivas y enfoques incluso variados términos han sido utilizados como sinónimos pudiendo llevar a confusión e inequidades al momento de su operacionalización. Sin embargo es importante señalar que las publicaciones coinciden en que la DS es uno de las determinantes esenciales a considerar al momento de definir polĺticas públicas. El propósito de esta publicación es analizar la disparidad en salud incorporando; a) los aspectos claves de su conceptualización, b) la evolución histórica del concepto, c) las estrategias que se han generado para enfrentarla, d) los factores considerados determinantes, y e) los aspectos éticos y la contribución de la investigación en la disminución de la DS.Health Disparities (HD) have been at the center of public attention for the past century. They have been analyzed from diverse perspectives utilizing various terms as synonyms that can lead to confusion and inequality at the moment of operationalization. Despite this, it is important to indicate that publications agree that HD are essential determinants that must be considered in the definition of public policy. The objective of this publication is to analyze health disparities incorporating; (a) key aspects in their conceptualization, (b) the historic evolution of the concept, (c) strategies that have been generated to confront them, (d) determining factors, and (e) ethical aspects and the contribution of research in decreasing HD.
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Affiliation(s)
- Maria-Teresa Urrutia
- Pontificia Universidad Católica de Chile, Escuela de Enfermerĺa, and University of Miami School of Nursing and Health Studies
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Medina-Solís CE, Villalobos-Rodelo JJ, Márquez-Corona MDL, Vallejos-Sánchez AA, Portillo-Núñez CL, Casanova-Rosado AJ. Desigualdades socioeconómicas en la utilización de servicios de salud bucal: estudio en escolares mexicanos de 6 a 12 años de edad. CAD SAUDE PUBLICA 2009; 25:2621-31. [DOI: 10.1590/s0102-311x2009001200009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 09/30/2009] [Indexed: 11/21/2022] Open
Abstract
El objetivo del estudio fue evaluar la asociación entre diversos indicadores socioeconómicos y la utilización de servicios de salud bucal. Se realizó un estudio transversal en 3.048 escolares. La variable utilización de servicios de salud bucal y las variables sociodemográficas y socioeconómicas se colectaron a través de un cuestionario dirigido a las madres. Para determinar las necesidades de salud se realizó un examen clínico bucal a los niños. Las asociaciones ajustadas fueron evaluadas con regresión logística politómica. Las variables asociadas a servicios preventivos y curativos fueron mayor edad, mayor frecuencia de cepillado y menor edad al inicio de cepillado dental, tener seguro público o privado, y mejor nivel socioeconómico. Además, sólo para los servicios preventivos, también se asoció estar inscrito en una escuela privada, y sólo para los servicios curativos, la posesión de automóvil y tener necesidades de salud bucal entre moderadas y muy altas. Los resultados sugieren la existencia de desigualdades socioeconómicas en la utilización de servicios de salud bucal en niños mexicanos.
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Affiliation(s)
| | | | | | | | - Carlos López Portillo-Núñez
- Delegación del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México; Universidad Autónoma de Sinaloa, México
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Scribner RA, Theall KP, Simonsen NR, Mason KE, Yu Q. Misspecification of the effect of race in fixed effects models of health inequalities. Soc Sci Med 2009; 69:1584-91. [PMID: 19800158 DOI: 10.1016/j.socscimed.2009.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Indexed: 10/20/2022]
Abstract
The purpose of this study is to characterize the different results obtained when analyzing health inequalities data in which individuals are nested within their neighborhoods and a single level model is used to characterize risk rather than a multilevel model. The inability of single level models to characterize between neighborhood variance in risk may affect the level of risk attributed to black race if blacks are differentially distributed in high risk neighborhoods. The research replicates in Los Angeles an approach applied by a different group of researchers in Massachusetts (Subramanian, Chen, Rehkopf, Waterman, & Krieger, 2005). Single level and multilevel models were used to analyze Los Angeles County, California, US all-cause mortality data for the years 1989-1991, modeled as 29,936 cells (deaths and population denominators cross-tabulated by age, gender, and race/ethnicity) nested within 1552 census tracts. Overall blacks had 1.27 times the risk of mortality compared to whites. However, multilevel models demonstrated considerable between census tract variance in mortality for both blacks and whites which was partially explained by neighborhood poverty. Comparing the results of equivalent single level and multilevel models, the mortality odds ratio for blacks compared to the white reference group reversed itself, indicating greater risk for blacks in the single level model and lower risk in the multilevel model. Adding an area based socioeconomic measure (ABSM) to the single level model reduced but did not remove the discrepancy. Predictions of mortality risk for the interaction of race and age group demonstrate that all single level models exaggerated the mortality risk associated with black race. We conclude that characterizing health inequalities in mortality for blacks using single level models, which do not account for the cross level interaction created by the greater likelihood of black residence in neighborhoods where the risk of mortality is greater regardless of race, can exaggerate the risk of mortality attributable to the individual level effects of black race.
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Affiliation(s)
- Richard Allen Scribner
- Louisiana State University Health Sciences Center, School of Public Health, New Orleans, LA 70112, United States.
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Bruckner TA, Saxton KB, Anderson E, Goldman S, Gould JB. From paradox to disparity: trends in neonatal death in very low birth weight non-Hispanic black and white infants, 1989-2004. J Pediatr 2009; 155:482-7. [PMID: 19615693 DOI: 10.1016/j.jpeds.2009.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Revised: 03/24/2009] [Accepted: 04/17/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To examine temporal trends in race-specific neonatal death in California to determine whether the overall decline in mortality attenuated the paradoxical survival advantage of very low birth weight (VLBW; birth weight < 1500 g) non-Hispanic black infants relative to VLBW non-Hispanic white infants. STUDY DESIGN The data set comprised the California birth cohort file on non-Hispanic black and non-Hispanic white VLBW neonatal mortality for 1989-2004. Logistic regression methods were used to control for potentially confounding maternal characteristics. RESULTS In 1989 and 1990, non-Hispanic black VLBW infants demonstrated a paradox of lower neonatal mortality (adjusted odds ratio [aOR] = 0.84; 95% confidence interval [CI] = 0.75-0.94). This survival advantage disappeared after 1991, however. In 2003 and 2004, the incidence of neonatal mortality increased in non-Hispanic black VLBW infants but decreased in non-Hispanic white VLBW infants, resulting in a racial disparity (aOR = 1.34; 95% CI = 1.14-1.56). CONCLUSIONS An initial survival paradox transformed into a disparity. The magnitude of this non-Hispanic black/non-Hispanic white VLBW disparity rose to its highest levels in the last 2 years of the study period. Moreover, the steady mortality increase in VLBW non-Hispanic black VLBW infants since 2001 reversed the secular decline in neonatal mortality in this population. Our findings underscore the need to augment strategies to improve the health trajectory of gestation in non-Hispanic black women.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California Irvine, Irvine, CA 92697, USA.
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Crouse Quinn S. Crisis and emergency risk communication in a pandemic: a model for building capacity and resilience of minority communities. Health Promot Pract 2009; 9:18S-25S. [PMID: 18936256 DOI: 10.1177/1524839908324022] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As public health agencies prepare for pandemic influenza, it is evident from our experience with Hurricane Katrina that these events will occur in the same social, historical, and cultural milieu in which marked distrust of government and health disparities already exist. This article grapples with the challenges of crisis and emergency risk communication with special populations during a pandemic. Recognizing that targeting messages to specific groups poses significant difficulties at that time, this article proposes a model of community engagement, disaster risk education, and crisis and emergency risk communication to prepare minority communities and government agencies to work effectively in a pandemic, build the capacity of each to respond, and strengthen the trust that is critical at such moments. Examples of such engagement and potential strategies to enhance trust include tools familiar to many health educators.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Driscoll DL, Rupert DJ, Golin CE, McCormack LA, Sheridan SL, Welch BM, Poehlman JA. Promoting prostate-specific antigen informed decision-making. Evaluating two community-level interventions. Am J Prev Med 2008; 35:87-94. [PMID: 18617077 DOI: 10.1016/j.amepre.2008.04.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/19/2008] [Accepted: 04/03/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND Most medical associations recommend that patients make informed decisions about whether to be screened for prostate cancer with the prostate-specific antigen (PSA) test. Studies assessing how to promote PSA informed decision-making (IDM) have been conducted almost exclusively in healthcare settings; there is a need for similar research in community settings. METHODS This paper describes the results of a 5-year study (2002--2007) in which two community-level interventions were developed, implemented, and evaluated in matched upper- and lower-SES comparison communities in Greensboro and Wilmington, North Carolina. Both interventions promoted PSA informed decision-making. One intervention (PSA-Only) consisted of educational information about prostate cancer and the PSA test, and the other (Men's Health) included additional information about recognizing and preventing heart attack, stroke, and colon cancer. Structured survey, semistructured interview, and structured observational data were combined to compare participating community residents' pre/post changes in knowledge, intentions, and behaviors related to PSA IDM. RESULTS The community-level interventions successfully engaged community participants in discussions, educated individuals, encouraged deliberation of information, and facilitated PSA test discussions with physicians. Men who participated in the PSA-Only educational sessions were more likely than those who attended the Men's Health educational sessions to discuss the PSA test with their physician (p=0.037). CONCLUSIONS When prospective SES-related confounding factors are matched across comparison communities, PSA IDM interventions can be shown to promote IDM. Framing the PSA test decision relative to less-ambiguous screening decisions does not appear to increase the likelihood of PSA IDM.
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Affiliation(s)
- David L Driscoll
- RTI International, Research Triangle Park, North Carolina 27709, USA.
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Medina-Solis CE, Maupomé G, del Socorro HM, Pérez-Núñez R, Avila-Burgos L, Lamadrid-Figueroa H. Dental health services utilization and associated factors in children 6 to 12 years old in a low-income country. J Public Health Dent 2008; 68:39-45. [PMID: 18179470 DOI: 10.1111/j.1752-7325.2007.00056.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua. MATERIAL AND METHODS A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression. RESULTS The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs. CONCLUSION Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used.
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Affiliation(s)
- Carlo Eduardo Medina-Solis
- Area Académica de Odontología del Instituto de Ciencias de la Salud de la Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, México.
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Bass LE, Warehime MN. Do Health Insurance and Residence Pattern the Likelihood of Tubal Sterilization among American Women? POPULATION RESEARCH AND POLICY REVIEW 2008. [DOI: 10.1007/s11113-008-9082-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cerdá M, Buka SL, Rich-Edwards JW. Neighborhood influences on the association between maternal age and birthweight: a multilevel investigation of age-related disparities in health. Soc Sci Med 2008; 66:2048-60. [PMID: 18313187 DOI: 10.1016/j.socscimed.2008.01.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Indexed: 11/18/2022]
Abstract
It was hypothesized that the relationship between maternal age and infant birthweight varies significantly across neighborhoods and that such variation can be predicted by neighborhood characteristics. We analyzed 229,613 singleton births of mothers aged 20-45 years from Chicago, USA in 1997-2002. Random coefficient models were used to estimate the between-neighborhood variation in age-birthweight slopes, and both intercepts- and-slopes-as-outcomes models were used to evaluate area-level predictors of such variation. The crude maternal age-birthweight slopes for neighborhoods ranged from a decrease of 17 g to an increase of 10 g per year of maternal age. Adjustment for individual-level covariates reduced but did not eliminate this between-neighborhood variation. Concentrated poverty was a significant neighborhood-level predictor of the age-birthweight slope, explaining 44.4% of the between-neighborhood variation in slopes. Neighborhoods of higher economic disadvantage showed a more negative age-birthweight slope. The findings support the hypothesis that the relationship between maternal age and birthweight varies between neighborhoods. Indicators of neighborhood disadvantage help to explain such differences.
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Affiliation(s)
- Magdalena Cerdá
- Department of Epidemiology, University of Michigan, 3632 SPH Tower, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA.
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Kim S, Egerter S, Cubbin C, Takahashi ER, Braveman P. Potential implications of missing income data in population-based surveys: an example from a postpartum survey in California. Public Health Rep 2008; 122:753-63. [PMID: 18051668 DOI: 10.1177/003335490712200607] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Income data are often missing for substantial proportions of survey participants and these records are often dropped from analyses. To explore the implications of excluding records with missing income, we examined characteristics of survey participants with and without income information. METHODS Using statewide population-based postpartum survey data from the California Maternal and Infant Health Assessment, we compared the age, education, parity, marital status, timely prenatal care initiation, and neighborhood poverty characteristics of women with and without reported income data, overall, and by race/ethnicity/nativity. RESULTS Overall, compared with respondents who reported income, respondents with missing income information generally appeared younger, less educated, and of lower parity. They were more likely to be unmarried, to have received delayed or no prenatal care, and to reside in poor neighborhoods; and they generally appeared more similar to lower- than higher-income women. However, the patterns appeared to vary by racial/ethnic/nativity group. For example, among U.S.-born African American women, the characteristics of the missing-income group were generally similar to those of low-income women, while European American women with missing income information more closely resembled their moderate-income counterparts. CONCLUSIONS Respondents with missing income information may not be a random subset of population-based survey participants and may differ on other relevant sociodemographic characteristics. Before deciding how to deal analytically with missing income information, researchers should examine relevant characteristics and consider how different approaches could affect study findings. Particularly for ethnically diverse populations, we recommend including a missing income category or employing multiple-imputation techniques rather than excluding those records.
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Affiliation(s)
- Soowon Kim
- Center on Social Disparities in Health, Department of Family and Community Medicine, University of California, San Francisco, 500 Parnassus Ave, San Francisco, CA 94143-0900, USA
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Heaman MI, Green CG, Newburn-Cook CV, Elliott LJ, Helewa ME. Social inequalities in use of prenatal care in Manitoba. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 29:806-16. [PMID: 17915064 DOI: 10.1016/s1701-2163(16)32637-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Analysis of regional variations in use of prenatal care to identify individual-level and neighbourhood-level determinants of inadequate prenatal care among women giving birth in the province of Manitoba. METHODS Data were obtained from Manitoba Health administrative databases and the 1996 Canadian Census. An index of prenatal care use was calculated for each singleton live birth from 1991 to 2000 (N = 149,291). Births were geocoded into 498 geographic districts, and a spatial analysis was conducted, consisting of data visualization, spatial clustering, and data modelling using Poisson regression. RESULTS We found wide variation in rates of inadequate prenatal care across geographic areas, ranging from 1.1% to 21.5%. Higher rates of inadequate care were found in the inner-city of Winnipeg and in northern Manitoba. After adjusting for individual characteristics, the highest rates of inadequate prenatal care were among women living in neighbourhoods with the lowest average family income, the highest proportion of the population who were unemployed, the highest rates of recent immigrants, the highest percentage of the population reporting Aboriginal status, the highest percentage of single parent families, the highest percentage of the population with fewer than nine years of education, and the highest rates of women who smoked during pregnancy. CONCLUSION Social inequalities exist in the use of prenatal care among Manitoba women, despite there being a universally funded health care system. Regional disparities in rates of inadequate prenatal care emphasize the need for further research to determine specific risk factors for inadequate prenatal care in socioeconomically disadvantaged neighbourhoods, followed by provision of effective targeted services.
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Du XL, Meyer TE, Franzini L. Meta-analysis of racial disparities in survival in association with socioeconomic status among men and women with colon cancer. Cancer 2007; 109:2161-70. [PMID: 17455219 DOI: 10.1002/cncr.22664] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have addressed racial disparities in survival for colon cancer by adequately incorporating both treatment and socioeconomic factors, and the findings from those studies have been inconsistent. The objectives of the current study were to systematically review the existing literature and provide a more stable estimate of the measures of association between socioeconomic status and racial disparities in survival for colon cancer by undertaking a meta-analysis. METHODS For this meta-analysis, the authors searched the MEDLINE database to identify articles published in English from 1966 to August 2006 that met the following inclusion criteria: original research articles that addressed the association between race/ethnicity and survival in patients with colon or colorectal cancer after adjusting for socioeconomic status. In total, 66 full articles were reviewed, and 56 of those articles were excluded, which left 10 studies for the final analysis. RESULTS The pooled hazard ratio (HR) for African Americans compared with Caucasians was 1.14 (95% confidence interval [95% CI], 1.00-1.29) for all-cause mortality and 1.13 (95% CI, 1.01-1.28) for colon cancer-specific mortality. The test for homogeneity of the HR was statistically significant across the studies for all-cause mortality (Q=31.69; P<.001) but was not significant across the studies for colon cancer-specific mortality (Q=7.45; P=.114). CONCLUSIONS Racial disparities in survival for colon cancer between African Americans and Caucasians were only marginally significant after adjusting for socioeconomic factors and treatment. Attempts to modify treatment and socioeconomic factors with the objective of reducing racial disparities in health outcomes may have important clinical and public health implications.
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Affiliation(s)
- Xianglin L Du
- Division of Epidemiology, School of Public Health, University of Texas Health Science Center, Houston, Texas 77030, USA.
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Wamala S, Merlo J, Boström G, Hogstedt C. Perceived discrimination, socioeconomic disadvantage and refraining from seeking medical treatment in Sweden. J Epidemiol Community Health 2007; 61:409-15. [PMID: 17435207 PMCID: PMC2465685 DOI: 10.1136/jech.2006.049999] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2006] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To analyse the association between perceived discrimination and refraining from seeking required medical treatment and the contribution of socioeconomic disadvantage. DESIGN AND SETTING Data from the Swedish National Survey of Public Health 2004 were used for analysis. Respondents were asked whether they had refrained from seeking required medical treatment during the past 3 months. Perceived discrimination was based on whether respondents reported that they had been treated in a way that made them feel humiliated (due to ethnicity/race, religion, gender, sexual orientation, age or disability). The Socioeconomic Disadvantage Index (SDI) was developed to measure economic deprivation (social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves). PARTICIPANTS Swedish population-based survey of 14,736 men and 17,115 women. MAIN RESULTS Both perceived discrimination and socioeconomic disadvantage were independently associated with refraining from seeking medical treatment. Experiences of frequent discrimination even without any socioeconomic disadvantage were associated with three to nine-fold increased odds for refraining from seeking medical treatment. A combination of both frequent discrimination and severe SDI was associated with a multiplicative effect on refraining from seeking medical treatment, but this effect was statistically more conclusive among women (OR = 11.6, 95% CI 8.1 to 16.6; Synergy Index (SI) = 2.0 (95% CI 1.2 to 3.2)) than among men (OR = 12, 95% CI 7.7 to 18.7; SI = 1.6 (95% CI 1.3 to 2.1)). CONCLUSIONS The goal of equitable access to healthcare services cannot be achieved without public health strategies that confront and tackle discrimination in society and specifically in the healthcare setting.
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Wamala S, Merlo J, Bostrom G, Hogstedt C, Agren G. Socioeconomic disadvantage and primary non-adherence with medication in Sweden. Int J Qual Health Care 2007; 19:134-40. [PMID: 17449480 DOI: 10.1093/intqhc/mzm011] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Lack of adherence with pharmacological therapy is a public health concern that compels tremendous costs for the health care system and the community. To analyse the association between socioeconomic disadvantage and primary non-adherence with medication, and to explore possible mediating effects of trust in health care and lifestyle profile. DESIGN Cross-sectional population-based study based on data from the Swedish national public health surveys 2004-2005. PARTICIPANTS The study comprised 13603 men and 18292 women aged 21-84 years who had any contact with a physician at a hospital or primary care centre. Measures Primary non-adherence with medication based on whether respondents reported that they refrained from purchasing at the pharmacy prescribed medication. Socioeconomic Disadvantage Index was based on four different indicators of economic deprivation. RESULTS Socioeconomic disadvantage was associated with primary non-adherence with medication independent of long-term illness, risky lifestyle, low education, living alone and low trust for health care. This association increased with older age, particularly among women. Among individuals aged 21-34 years, severe compared with no socioeconomic disadvantage, was associated with two-fold increased odds for non-adherence with medication. The corresponding odds among individuals aged 65-84 years were three-fold increase among elderly men (OR=3.3, 95% CI: 1.4-7.8) and six-fold increase among elderly women (OR=6.2, 95% CI: 2.5-15.3). Yet every seventh elderly woman aged 65-84 years suffered from long-term illness. CONCLUSIONS Results indicate that health policies for 'care on equal terms' in Sweden have been less successful in relation to equitable access to prescribed medication, especially among the elderly.
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Ross JS, Bernheim SM, Bradley EH, Teng HM, Gallo WT. Use of preventive care by the working poor in the United States. Prev Med 2007; 44:254-9. [PMID: 17196642 PMCID: PMC1810564 DOI: 10.1016/j.ypmed.2006.11.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 11/02/2006] [Accepted: 11/06/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Examine the association between poverty and preventive care use among older working adults. METHOD Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200% of the federal poverty level were defined as poor. RESULTS Among 10,088 older working adults, overall preventive care use ranged from 38% (influenza vaccination) to 76% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95% CI, 0.86-0.96), prostate cancer (RR 0.89, 95% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95% CI, 0.84-1.01). CONCLUSION The older working poor are at modestly increased risk for not receiving preventive care.
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Affiliation(s)
- Joseph S Ross
- Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Du XL, Fang S, Vernon SW, El-Serag H, Shih YT, Davila J, Rasmus ML. Racial disparities and socioeconomic status in association with survival in a large population-based cohort of elderly patients with colon cancer. Cancer 2007; 110:660-9. [PMID: 17582625 DOI: 10.1002/cncr.22826] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND To the authors' knowledge, few studies have addressed racial disparities in the survival of patients with colon cancer by adequately incorporating treatment and socioeconomic factors in addition to patient and tumor characteristics. METHODS The authors studied a nationwide and population-based, retrospective cohort of 18,492 men and women who were diagnosed with stage II or III colon cancer at age >or=65 years between 1992 and 1999. This cohort was identified from the Surveillance, Epidemiology, and End Results (SEER) cancer registries-Medicare linked databases and included up to 11 years of follow-up. RESULTS A larger proportion (70%) of African-American patients with colon cancer fell into the poorest quartiles of socioeconomic status compared with Caucasians (21%). Patients who lived in communities with the lowest socioeconomic level had 19% higher all-cause mortality compared with patients who lived in communities with the highest socioeconomic status (hazards ratio [HR], 1.19; 95% confidence interval [95% CI], 1.13-1.26; P < .001 for trend). The risk of dying was reduced only slightly after controlling for race/ethnicity (HR, 1.17; 95% CI, 1.10-1.24). Compared with Caucasian patients with colon cancer, African-American patients were 21% more likely to die after controlling for age, sex, comorbidity scores, tumor stage, and grade (HR, 1.21; 95% CI, 1.12-1.30). After also adjusting for definitive therapy and socioeconomic status, the HR of mortality was only marginally significantly higher in African Americans compared with Caucasians for all-cause mortality (HR, 1.10; 95% CI, 1.02-1.19) and colon cancer-specific mortality (HR, 1.16; 95% CI, 1.01-1.33). CONCLUSIONS Lower socioeconomic status and lack of definitive treatment were associated strongly with decreased survival in both men and women with colon cancer. Racial disparities in survival were explained substantially by differences in socioeconomic status.
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Affiliation(s)
- Xianglin L Du
- Division of Epidemiology, School of Public Health, The University of Texas Health Science Center, Houston, Texas, USA.
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