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Henning KN, Omer RD, de Jesus JM, Giombi K, Silverman J, Neal E, Agurs-Collins T, Brown AGM, Pratt C, Yoon SSS, Ajenikoko F, Iturriaga E. Addressing the Harms of Structural Racism on Health in Incarcerated Youth Through Improved Nutrition and Exercise Programs. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02007-y. [PMID: 38647801 DOI: 10.1007/s40615-024-02007-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
Every year, hundreds of thousands of youth across the country enter the juvenile legal system. A significantly disproportionate number of them are youth of color. While youth arrests have declined over the past several decades, racial disparities have increased and persist at every stage of the system. Many youth of color enter the juvenile legal system with a history of trauma and stress that compromises their health and well-being. Arrest, prosecution, and incarceration exacerbate these poor health outcomes. This paper examines several of the health impacts of structural racism in the policing and incarceration of youth of color. The paper begins by highlighting some of the most pressing social determinants of adolescent health and then considers how youth detention and incarceration contribute to unhealthy weight, hypertension, diabetes, and cardiovascular disease through unhealthy food environments, limited physical activity, and the added stress of the incarceration setting. This paper adds to the existing literature on the harms of youth detention and advocates for harms elimination strategies grounded in a public health approach to public safety and community-based alternatives to detention. For those youth who will remain in detention, the authors offer suggestions to reduce harms and improve the health of systems-involved youth, including opportunities for research.
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Affiliation(s)
- Kristin N Henning
- Georgetown Law Juvenile Justice Clinic & Initiative, 600 New Jersey Ave NW, Washington, DC, 20001, USA
| | - Rebba D Omer
- Georgetown Law Juvenile Justice Clinic & Initiative, 600 New Jersey Ave NW, Washington, DC, 20001, USA.
| | - Janet M de Jesus
- Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington, DC, USA
| | | | - Jessi Silverman
- Center for Science in the Public Interest, Washington, DC, USA
| | - Elle Neal
- Multnomah County Health Department, Multnomah County, OR, USA
| | - Tanya Agurs-Collins
- National Cancer Institute, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Charlotte Pratt
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services, Washington, DC, USA
| | | | | | - Erin Iturriaga
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, U.S. Department of Health and Human Services, Washington, DC, USA
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Kim W, Chang K, Lee SY, Ju YJ. Area-level deprivation and handwashing behavior during the COVID-19 pandemic: A multilevel analysis on a nationwide survey in Korea. Int J Environ Health Res 2024; 34:2088-2103. [PMID: 37204032 DOI: 10.1080/09603123.2023.2212600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023]
Abstract
This study investigated the association between area deprivation level and performance of handwashing behavior during the COVID-19 pandemic in Korean adults. This study used data from the 2015 Population and Housing Census data to measure area deprivation level. The 2020 Korea Community Health Survey was used for all other variables, including hand hygiene behavior (August through November 2020). The association between area deprivation level and practice of handwashing behavior was examined using multilevel logistic regression analysis. The study population comprised 215,676 adults aged 19 years or above. Compared to the least area deprived group, the most deprived group was more likely to not wash hands after using the restroom (OR 1.43, 95% CI 1.13-1.82), after coming home (OR 1.85, 95% CI 1.43-2.39), and using soap (OR 1.55, 95% CI 1.29-1.84). The findings suggest the importance of considering area deprivation in implementing policies that promote handwashing, particularly during a pandemic.
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Affiliation(s)
- Woorim Kim
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Kyujin Chang
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Soon Young Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Republic of Korea
| | - Yeong Jun Ju
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon-si, Republic of Korea
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Sun F, Zajacova A, Grol-Prokopczyk H. The geography of arthritis-attributable pain outcomes: a county-level spatial analysis. Pain 2024:00006396-990000000-00509. [PMID: 38284413 DOI: 10.1097/j.pain.0000000000003155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/24/2023] [Indexed: 01/30/2024]
Abstract
ABSTRACT Research on the geographic distribution of pain and arthritis outcomes, especially at the county level, is limited. This is a high-priority topic, however, given the heterogeneity of subnational and substate regions and the importance of county-level governments in shaping population health. Our study provides the most fine-grained picture to date of the geography of pain in the United States. Combining 2011 Behavioral Risk Factor Surveillance System data with county-level data from the Census and other sources, we examined arthritis and arthritis-attributable joint pain, severe joint pain, and activity limitations in US counties. We used small area estimation to estimate county-level prevalences and spatial analyses to visualize and model these outcomes. Models considering spatial structures show superiority over nonspatial models. Counties with higher prevalences of arthritis and arthritis-related outcomes are mostly clustered in the Deep South and Appalachia, while severe consequences of arthritis are particularly common in counties in the Southwest, Pacific Northwest, Georgia, Florida, and Maine. Net of arthritis, county-level percentages of racial/ethnic minority groups are negatively associated with joint pain prevalence, but positively associated with severe joint pain prevalence. Severe joint pain is also more common in counties with more female individuals, separated or divorced residents, more high school noncompleters, fewer chiropractors, and higher opioid prescribing rates. Activity limitations are more common in counties with higher percentages of uninsured people. Our findings show that different spatial processes shape the distribution of different arthritis-related pain outcomes, which may inform local policies and programs to reduce the risk of arthritis and its consequences.
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Affiliation(s)
- Feinuo Sun
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, United States
| | - Anna Zajacova
- Department of Sociology, University of Western Ontario, London, ON, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY, United States
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Browder SE, Rosamond WD. Preventing Heart Failure Readmission in Patients with Low Socioeconomic Position. Curr Cardiol Rep 2023; 25:1535-1542. [PMID: 37751036 PMCID: PMC10863623 DOI: 10.1007/s11886-023-01960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW This review aims to summarize the current burden of heart failure (HF) in the United States, specifically in patients with low socioeconomic position (SEP), and synthesize recommendations to prevent HF-related hospital readmissions in this vulnerable population. RECENT FINDINGS As treatments have improved, HF-related mortality has declined over time, resulting in more patients living with HF. This has led to an increase in hospitalizations, however, putting excess strain on our healthcare system. HF patients with low SEP are a particularly vulnerable group, as they experience higher rates of hospitalization and readmission compared to their high SEP counterparts. The Hospital Readmission Reduction Program (HRRP) was created to motivate interventions that reduce hospital readmissions across diseases, with HF being a primary target. Numerous readmission prevention efforts have been suggested to target the pre-hospitalization, hospitalization, and post-hospitalization phases, including addressing social determinants of health (SDoH), improving coordination of care, optimizing discharge plans, and improving adherence to follow-up care and medication regimens. Many of these proposed interventions show promise in reducing HF-related readmissions and issues surrounding adequate caregiver support may be particularly important to reduce readmissions among persons in low SEP. Reducing HF-related hospital readmissions is possible, even in vulnerable populations like those with low SEP, but this will require coordinated efforts across the healthcare system and throughout the life course of these patients. Caregiver support is a necessary part of optimized care for low SEP HF patients and future efforts should consider interventions that support these caregivers.
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Affiliation(s)
- Sydney E Browder
- UNC Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA.
| | - Wayne D Rosamond
- UNC Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC, USA
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Jenkins BD, Rossi E, Pichardo C, Wooten W, Pichardo M, Tang W, Dorsey TH, Ajao A, Hutchison R, Moubadder L, McCullough LE, Bailey-Whyte M, Ambs S. Neighborhood Deprivation and DNA Methylation and Expression of Cancer Genes in Breast Tumors. JAMA Netw Open 2023; 6:e2341651. [PMID: 37930698 PMCID: PMC10628736 DOI: 10.1001/jamanetworkopen.2023.41651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/23/2023] [Indexed: 11/07/2023] Open
Abstract
Importance The biological processes that underlie the association of neighborhood environment with chronic diseases, such as cancer, remain poorly understood. Objective To determine whether differences in breast tissue DNA methylation are associated with neighborhood deprivation among Black and White women with breast cancer. Design, Setting, and Participants This cross-sectional study collected breast tissue from women undergoing surgery for breast cancer between January 1, 1993, and December 31, 2003. Participants were recruited through the University of Maryland Medical Center, with additional collection sites at Baltimore-area hospitals. Data analysis was performed from March 1 through December 1, 2022. Exposure Year 2000 census tract-level socioeconomic deprivation measured via neighborhood deprivation index (NDI) as a standardized score, with Black and White race being ascertained through self-report. Main Outcome and Measures The primary outcome was tissue DNA methylation using genome-wide measurements. The secondary outcome was tissue gene expression. Results Participants included 185 women with breast cancer (110 Black [59.5%], 75 White [40.5%]). Mean (SD) age at surgery was 56.0 (14.1) years. Neighborhood deprivation was higher for Black women than for White women (Mean [SD] NDI, 2.96 [3.03] for Black women and -0.54 [1.91] for White women; difference, -3.50; 95% CI, -4.22 to -2.79; P < .001). In unstratified analysis, 8 hypomethylated CpG sites were identified as associated with the NDI, including sites in 2 tumor suppressor genes, LRIG1 and WWOX. Moreover, expression of the 2 genes inversely correlated with neighborhood deprivation. In the race-stratified analysis, the negative correlation between the LRIG1 gene body CpG site cg26131019 and the NDI remained significant in Black women. A neighborhood deprivation-associated decrease in gene expression was also observed for LRIG1 and WWOX in tumors from Black women. Conclusions and Relevance In this study, high neighborhood deprivation was associated with differences in tissue DNA methylation and gene expression among Black women. These findings suggest that continued investment in public health interventions and policy changes at the neighborhood level may help to remedy biological alterations that could make minoritized populations more susceptible to chronic diseases.
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Affiliation(s)
- Brittany D. Jenkins
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Emily Rossi
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Catherine Pichardo
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - William Wooten
- Department of Biostatistics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Margaret Pichardo
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wei Tang
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
- Data Science & Artificial Intelligence, R&D, AstraZeneca, Gaithersburg, Maryland
| | - Tiffany H. Dorsey
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Anuoluwapo Ajao
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ruby Hutchison
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Leah Moubadder
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lauren E. McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Maeve Bailey-Whyte
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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Marchak K, Singh D, Malavia M, Trivedi P. A Review of Healthcare Disparities Relevant to Interventional Radiology. Semin Intervent Radiol 2023; 40:427-436. [PMID: 37927511 PMCID: PMC10622245 DOI: 10.1055/s-0043-1775878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Racial, ethnic, and gender disparities have received focused attention recently, as they became more visible in the COVID era. We continue to learn more about how healthcare disparities manifest for our patients and, more broadly, the structural underpinnings that result in predictable outcomes gaps. This review summarizes what we know about disparities relevant to interventional radiologists. The prevalence and magnitude of disparities are quantified and discussed where relevant. Specific examples are provided to demonstrate how factors like gender, ethnicity, social status, geography, etc. interact to create inequities in the delivery of interventional radiology (IR) care. Understanding and addressing health disparities in IR is crucial for improving real-world patient outcomes and reducing the economic burden associated with ineffective and low-value care. Finally, the importance of intentional mentorship, outreach, education, and equitable distribution of high-quality healthcare to mitigate these disparities and promote health equity in interventional radiology is discussed.
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Affiliation(s)
- Katherine Marchak
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Davinder Singh
- Division of Diagnostic Radiology/Department of Radiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mira Malavia
- University of Missouri, Kansas City School of Medicine, Kansas City, Missouri
| | - Premal Trivedi
- Division of Interventional Radiology, Department of Radiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
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Quashie NT, García C, Meltzer G, Andrade FCD, Matos-Moreno A. Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007. PLoS One 2023; 18:e0289170. [PMID: 37527246 PMCID: PMC10393176 DOI: 10.1371/journal.pone.0289170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.
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Affiliation(s)
- Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, RI, United States of America
| | - Catherine García
- Department of Human Development and Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion and Population Health, Syracuse University, Syracuse, NY, United States of America
| | - Gabriella Meltzer
- Departments of Epidemiology and Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Flavia C D Andrade
- School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, United States of America
| | - Amílcar Matos-Moreno
- Population Research Institute, The Pennsylvania State University, State College, PA, United States of America
- Clinical Psychology Department, Carlos Albizu University, San Juan, Puerto Rico
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Fiala MA, Silberstein AE, Schroeder MA, Stockerl-Goldstein KE, Vij R. The Dynamics of Financial Toxicity in Multiple Myeloma. Clin Lymphoma Myeloma Leuk 2023; 23:266-272. [PMID: 36754693 DOI: 10.1016/j.clml.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION/BACKGROUND People with multiple myeloma are at risk for financial toxicity due to the high cost of treatment and prolonged treatment duration. However, little data exist regarding financial toxicity among people with myeloma. PATIENTS AND METHODS In this study, a cohort of 135 patients were recruited from an ongoing observational trial to complete the Comprehensive Score for financial Toxicity (COST). Participants were sent follow-up surveys at 3, 6, and 12 months. RESULTS The median age was 68 years; the majority were non-Hispanic whites (88%), male (63%), held a college degree (61%), and had left the workforce (70%). The median time from myeloma diagnosis was 28 months. The median COST score was 27; 48% of participants had a score below 27 and considered to have financial toxicity. The only characteristic associated with financial toxicity was a college degree. After controlling for other covariates, those with a college education were 69% less likely to have financial toxicity. Of the 108 participants who completed a follow-up survey, 34% reported changes in their financial toxicity status at a subsequent time point. Transitioning from not having financial toxicity to having financial toxicity was more common than the reverse. CONCLUSION Because financial toxicity is a dynamic process, which patients are experiencing it at any given time is difficult to predict. Focusing the research agenda on improved detection and intervention may be warranted.
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Affiliation(s)
- Mark A Fiala
- Washington University School of Medicine, St. Louis, MO.
| | | | | | | | - Ravi Vij
- Washington University School of Medicine, St. Louis, MO
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Lord BD, Harris AR, Ambs S. The impact of social and environmental factors on cancer biology in Black Americans. Cancer Causes Control 2023; 34:191-203. [PMID: 36562901 DOI: 10.1007/s10552-022-01664-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Low socioeconomic status (SES) is associated with early onset of chronic diseases and reduced life expectancy. The involvement of neighborhood-level factors in defining cancer risk and outcomes for marginalized communities has been an active area of research for decades. Yet, the biological processes that underlie the impact of SES on chronic health conditions, such as cancer, remain poorly understood. To date, limited studies have shown that chronic life stress is more prevalent in low SES communities and can affect important molecular processes implicated in tumor biology such as DNA methylation, inflammation, and immune response. Further efforts to elucidate how neighborhood-level factors function physiologically to worsen cancer outcomes for disadvantaged communities are underway. This review provides an overview of the current literature on how socioenvironmental factors within neighborhoods contribute to more aggressive tumor biology, specifically in Black U.S. women and men, including the impact of environmental pollutants, neighborhood deprivation, social isolation, structural racism, and discrimination. We also summarize commonly used methods to measure deprivation, discrimination, and structural racism at the neighborhood-level in cancer health disparities research. Finally, we offer recommendations to adopt a multi-faceted intersectional approach to reduce cancer health disparities and develop effective interventions to promote health equity.
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Affiliation(s)
- Brittany D Lord
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bldg. 37/Room 3050, Bethesda, MD, 20892-4258, USA.
| | - Alexandra R Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bldg. 37/Room 3050, Bethesda, MD, 20892-4258, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bldg. 37/Room 3050, Bethesda, MD, 20892-4258, USA
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10
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Cannas Aghedu F, Blais M, Philibert M, Côté I, Samoilenko M, Chamberland L. Social resource patterns and health outcomes among Canadian LGBTQ2+ adults: A latent class analysis. Soc Sci Med 2022; 314:115476. [PMID: 36327629 DOI: 10.1016/j.socscimed.2022.115476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/18/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Decades of research have shown a strong association between wellbeing, health, and social resources. LGBTQ2+ communities are among those who historically have been excluded from accessing quality social resources. However, little is known about how access to different types of resources influences mental health and wellbeing. METHOD Data were drawn from an online sample of 3890 LGBTQ2+ people aged 18 years and older in Quebec, Canada. We identified key social resource patterns (from family of origin, friends, partner, neighbourhood, and LGBTQ2+ community) and investigated differences in socio-demographic and health outcomes across classes. RESULTS A five-class solution best fitted the data, highlighting distinctive patterns in access to five key social resources: moderate friend support access (42.14%), overall high support access (23.51%), high friend support access (18.06%), only close ties support access (10.90%) and overall low support access (5.39%). Marginalized groups (trans and non-binary people, racialized or disabled people, immigrants) were less likely to access diverse, high-quality social resources. Accessing diverse social resources, particularly close ties (e.g., family of origin), was associated with better health outcomes. In the absence of close ties, having at least one other social resource was associated with better health outcomes compared to having limited access to all resources. CONCLUSIONS We found a major imbalance in social resource access among LGBTQ2+ people. Creating safe spaces for LGBTQ2+ people and ensuring access to high-quality social resources is important in sustaining their health and wellbeing.
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Affiliation(s)
- Fabio Cannas Aghedu
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada.
| | - Martin Blais
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada; Département de Sexologie, Université Du Québec à Montréal, Canada
| | | | - Isabel Côté
- Département de Travail Social, Chaire de Recherche Du Canada sur La Procréation pour Autrui et Les Liens Familiaux, Université Du Québec en Outaouais, Québec, Canada
| | - Mariia Samoilenko
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada
| | - Line Chamberland
- Chaire de Recherche sur La Diversité Sexuelle et La Pluralité des Genres, Université Du Québec à Montréal, Canada; Département de Sexologie, Université Du Québec à Montréal, Canada
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11
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Grob F, Bedregal P, Viviani P, Torres C, Becerra C, Leyton B. Cognitive Outcomes in Congenital Hypothyroidism: Impact of Socioeconomic Status - A Case-Control Study. Horm Res Paediatr 2022; 95:224-232. [PMID: 35447623 DOI: 10.1159/000522257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/24/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chile is one of the few high-income countries in Latin America, being a pioneer in implementing a national newborn screening (NBS) program in 1992. Currently, it covers 98% of the population, but no long-term outcomes have been described so far. The aim of this study was to report the neurocognitive outcomes of children with congenital hypothyroidism (CH) diagnosed by the NBS program in Chile between 2005 and 2012 and to identify variables associated with the outcomes. METHODS We performed a case-control study in children with CH born in the two largest regions of the country. The Leiter-R and TEVI-R tests were administered at home to 69 children with CH and 68 matched control subjects. Other variables affecting cognition were obtained. Multivariate logistic regression analyses were performed for Leiter-R and TEVI-R tests, using a model for cases alone and another model for cases and controls. RESULTS No differences in Leiter-R and TEVI-R results were observed between children with CH and the control group. Children who performed better, regardless of whether they had CH, had a higher family income and more assets. CONCLUSIONS These results suggest that the Chilean NBS program strategy results in children with normal language, attention, and memory development. Socioeconomic disadvantage represents a significant detriment in cognitive function.
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Affiliation(s)
- Francisca Grob
- Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Bedregal
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paola Viviani
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Torres
- Guillermo Grant Benavente Hospital, Concepción, Chile
| | - Carlos Becerra
- Department of Life Cycle, Head of the National Child Health Program, Ministry of Health of Chile, Santiago, Chile
| | - Bárbara Leyton
- Department of Life Cycle, National Child Health Program, Ministry of Health of Chile, Santiago, Chile
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12
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Mahmoudi J, Zhang L. Health Impacts of the Built and Social Environments, and Travel Behavior: The Case of the Sunshine State. Int J Environ Res Public Health 2022; 19:9102. [PMID: 35897467 DOI: 10.3390/ijerph19159102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022]
Abstract
As physical inactivity statistics for the U.S. population show an alarming trend, many health problems have been increasing among Americans in recent decades. Thus, identification of the factors that influence people’s physical activity levels and health outcomes has become ever more essential to promote public health. The built envSFironment is among the main factors that impact individuals’ health outcomes. However, little is known about the health impacts of built environment factors at large geographical scales such as those of the metropolitan area of residence. Further, the health impacts of travel behavior such as telecommuting and teleshopping remain unclear. This study uses an ecological model framework to probe the roles of travel behavior and built as well as social environments at different spatial levels in health. Instrumental variable binary probit models have been developed to examine the complex interlinks between measures of travel behavior, physical activity levels, built and social environment characteristics, and individuals’ health outcomes. Findings indicate that built and social environment factors at different spatial levels, including the metropolitan area, are correlated with individuals’ health outcomes. Additionally, the findings suggest that increased levels of telecommuting and teleshopping within communities may lead to unfavorable health outcomes. The findings shed light on the most promising policy interventions that can promote public health through modifications targeting people’s travel choices as well as the built and social environments within urban areas.
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13
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Beckie TM, Lengacher C, Rodriguez C, Pares-Avila J, Turner D, Sanchez M, Nair US. A framework for addressing health inequities in sexual and gender diverse populations by nurses. Nurs Outlook 2022; 70:651-663. [DOI: 10.1016/j.outlook.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 11/30/2022]
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14
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Buajitti E, Rosella LC. Neighbourhood socioeconomic improvement, residential mobility and premature death: a population-based cohort study and inverse probability of treatment weighting analysis. Int J Epidemiol 2022; 52:489-500. [PMID: 35656702 PMCID: PMC10114058 DOI: 10.1093/ije/dyac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Causal inference using area-level socioeconomic measures is challenging due to risks of residual confounding and imprecise specification of the neighbourhood-level social exposure. By using multi-linked longitudinal data to address these common limitations, our study aimed to identify protective effects of neighbourhood socioeconomic improvement on premature mortality risk. METHODS We used data from the Canadian Community Health Survey, linked to health administrative data, including longitudinal residential history. Individuals aged 25-69, living in low-socioeconomic status (SES) areas at survey date (n = 8335), were followed up for neighbourhood socioeconomic improvement within 5 years. We captured premature mortality (death before age 75) until 2016. We estimated protective effects of neighbourhood socioeconomic improvement exposures using Cox proportional hazards models. Stabilized inverse probability of treatment weights (IPTW) were used to account for confounding by baseline health, social and behavioural characteristics. Separate analyses were carried out for three exposure specifications: any improvement, improvement by residential mobility (i.e. movers) or improvement in place (non-movers). RESULTS Overall, 36.9% of the study cohort experienced neighbourhood socioeconomic improvement either by residential mobility or improvement in place. There were noted differences in baseline health status, demographics and individual SES between exposure groups. IPTW survival models showed a modest protective effect on premature mortality risk of socioeconomic improvement overall (HR = 0.86; 95% CI 0.63, 1.18). Effects were stronger for improvement in place (HR = 0.67; 95% CI 0.48, 0.93) than for improvement by residential mobility (HR = 1.07, 95% 0.67, 1.51). CONCLUSIONS Our study provides robust evidence that specific neighbourhood socioeconomic improvement exposures are important for determining mortality risks.
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Affiliation(s)
- Emmalin Buajitti
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,ICES, Toronto, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Laboratory Medicine & Pathology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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15
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Lawrence KG, Werder EJ, Sandler DP. Association of neighborhood deprivation with pulmonary function measures among participants in the Gulf Long-Term Follow-up Study. Environ Res 2021; 202:111704. [PMID: 34280418 PMCID: PMC8578346 DOI: 10.1016/j.envres.2021.111704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Individual-level socioeconomic status (SES) has been shown to be an important determinant of lung function. Neighborhood level SES factors may increase psychological and physiologic stress and may also reflect other exposures that can adversely affect lung function, but few studies have considered neighborhood factors. OBJECTIVE Our aim was to assess the association between neighborhood-level SES and lung function. METHODS We cross-sectionally analyzed 6168 spirometry test results from participants in the Gulf long-term Follow-up Study, a large cohort of adults enrolled following the largest maritime oil spill in US history. Outcomes of interest included the forced expiratory volume in 1 s (FEV1; mL), the forced vital capacity (FVC; mL), and the FEV1/FVC ratio (%). Neighborhood deprivation was measured by linking participant home addresses to an existing Area Deprivation Index (ADI) and categorized into quartiles. Individual-level SES measures were collected at enrollment using a structured questionnaire and included income, educational attainment, and financial strain. We used multilevel regression to estimate associations between ADI quartiles and each lung function measure. RESULTS Greater neighborhood deprivation was associated with lower FEV1: βQ2vsQ1: -30 mL (95% CI: -97, 36), βQ3vsQ1: -70 mL (95% CI: -135, -4) and βQ4vsQ1: -104 mL (95% CI: -171, -36). FVC showed similar patterns of associations with neighborhood deprivation. No associations with the FEV1/FVC ratio were observed. CONCLUSION Neighborhood deprivation, a measure incorporating economic and other stressors, was associated with lower FEV1 and FVC, with magnitudes of associations reaching clinically meaningful levels. The impact of this neighborhood SES measure persisted even after adjustment for individual-level SES factors.
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Affiliation(s)
- Kaitlyn G Lawrence
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Emily J Werder
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA.
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16
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Taufique ZM, Escher PJ, Gathman TJ, Nickel AJ, Lee DB, Roby BB, Chinnadurai S. Demographic Risk Factors for Malnutrition in Patients With Cleft Lip and Palate. Laryngoscope 2021; 132:1482-1486. [PMID: 34665463 DOI: 10.1002/lary.29899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 10/05/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients with cleft lip and/or palate (CLP) are at increased risk of malnutrition. Acute and chronic malnutrition have been associated with elevated risk of postsurgical wound complications, adding morbidity and cost to patients and their families. To study the association between demographic factors, including insurance type, race, and median neighborhood income (MNI), and malnutrition in patients with CLP. STUDY DESIGN Retrospective cohort study. METHODS Retrospective review was performed in patients undergoing their first cleft-related surgery at a large tertiary pediatric hospital from 2006 to 2018. Demographic data, weight and height at surgery, type of insurance, race, and primary residential address were collected. Geocoded information on MNI was generated using patient address. World Health Organization Z-scores for weight-for-age (WFA) and height-for-age (HFA) were used as proxies for acute and chronic malnutrition, respectively. Linear regression models were generated to analyze the relationship of insurance type, race, and MNI on WFA and HFA Z-scores. RESULTS About 313 patients met inclusion criteria. Increasing MNI predicted increasing WFA Z-score (0.05 increase in WFA per $1,000 increase, P = .047) as well as HFA Z-score (0.09 increase in HFA per $1,000 increase, P = .011). The effect of MNI was not independently modified by race for either WFA (P = .841) nor HFA (P = .404). Race and insurance type did not predict WFA or HFA. CONCLUSIONS Lower MNI is a significant independent risk factor for acute and chronic malnutrition in children with CLP. Combined with previous investigation linking malnutrition to surgical outcomes in this population, this offers a target area for intervention to improve patient outcomes. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Zahrah M Taufique
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Paul J Escher
- University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A
| | - Tyler J Gathman
- University of Minnesota School of Medicine, Minneapolis, Minnesota, U.S.A
| | - Amanda J Nickel
- Children's Research Institute, Children's Minnesota, Minneapolis, Minnesota, U.S.A
| | - Daniel B Lee
- Amherst H. Wilder Foundation, Saint Paul, Minnesota, U.S.A
| | - Brianne B Roby
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Sivakumar Chinnadurai
- ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.,Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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17
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Bhimla A, Mann-Barnes T, Park H, Yeh MC, Do P, Aczon F, Ma GX. Effects of Neighborhood Ethnic Density and Psychosocial Factors on Colorectal Cancer Screening Behavior Among Asian American Adults, Greater Philadelphia and New Jersey, United States, 2014-2019. Prev Chronic Dis 2021; 18:E90. [PMID: 34591753 PMCID: PMC8522502 DOI: 10.5888/pcd18.210062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction We examined how neighborhood ethnic composition influences colorectal cancer (CRC) screening behavior in Asian American adults and explored whether associations between psychosocial predictors, including knowledge, self-efficacy, and barriers affecting CRC screening behavior, varied by level of neighborhood ethnic composition. Methods Filipino, Korean, and Vietnamese Americans (N = 1,158) aged 50 years or older were included in the study. Psychosocial factors associated with CRC screening, CRC screening behavior, and sociodemographic characteristics were extracted from participants’ data. Neighborhood ethnic composition was characterized as the census-tract–level percentage of Asian residents. Participants’ addresses were geocoded to the census tract level to determine whether they resided in an ethnically dense neighborhood. Multilevel logistic regression models were run with and without interaction terms. Results In mixed-effects logistic regression model 1, residing in an ethnically dense neighborhood was associated with lower odds of CRC screening (odds ratio [OR] = 0.65; 95% CI, 0.45–0.93; P = .02) after controlling for age, sex, education, ethnic group, and neighborhood socioeconomic status. Greater perceived barriers to CRC screening (OR = 0.62; 95% CI, 0.50–0.77; P < .001) resulted in significantly lower odds of obtaining a CRC screening, while higher self-efficacy (OR = 1.17, 95% CI, 1.11–1.23, P < .001) was associated with higher odds. In model 2, among those residing in a high ethnic density neighborhood, greater barriers to screening were associated with lower odds of having obtained a CRC screening (OR = 0.53; 95% CI, 0.30–0.96; P = .04). Conclusion We found that residing in an ethnically dense neighborhood indicated higher disparities in obtaining CRC screenings. Future studies should examine socioeconomic and cultural disparities, as well as disparities in the built environment, that are characteristic of ethnically dense neighborhoods and assess the impact of these disparities on CRC screening behaviors.
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Affiliation(s)
- Aisha Bhimla
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Tyrell Mann-Barnes
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Hemi Park
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, New York
| | - Phuong Do
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Ferdinand Aczon
- Ilocano Cultural Association of Greater Philadelphia, Cherry Hill, New Jersey
| | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Clinical Sciences, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Lewis Katz School of Medicine, Temple University, Medical Education and Research Building, 3500 Broad St, Philadelphia, PA 19140.
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18
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Ingram C, Min E, Seto E, Cummings BJ, Farquhar S. Cumulative Impacts and COVID-19: Implications for Low-Income, Minoritized, and Health-Compromised Communities in King County, WA. J Racial Ethn Health Disparities 2021; 9:1210-1224. [PMID: 34128216 PMCID: PMC8202963 DOI: 10.1007/s40615-021-01063-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022]
Abstract
Few studies have assessed how the intersection of social determinants of health and environmental hazards contributes to racial disparities in COVID-19. The aim of our study was to compare COVID-19 disparities in testing and positivity to cumulative environmental health impacts, and to assess how unique social and environmental determinants of health relate to COVID-19 positivity in Seattle, King County, WA, at the census tract level. Publicly available data (n = 397 census tracts) were obtained from Public Health–Seattle & King County, 2018 ACS 5-year estimates, and the Washington Tracking Network. COVID-19 testing and positive case rates as of July 12, 2020, were mapped and compared to Washington State Environmental Health Disparities (EHD) Map cumulative impact rankings. We calculated odds ratios from a series of univariable and multivariable logistic regression analyses using cumulative impact rankings, and community-level socioeconomic, health, and environmental factors as predictors and having ≥ 10% or < 10% census tract positivity as the binary outcome variable. We found a remarkable overlap between Washington EHD cumulative impact rankings and COVID-19 positivity in King County. Census tracts with ≥ 10 % COVID-19 positivity had significantly lower COVID-19 testing rates and higher proportions of people of color and faced a combination of low socioeconomic status–related outcomes, poor community health outcomes, and significantly higher concentrations of fine particulate matter (PM2.5). King County communities experiencing high rates of COVID-19 face a disproportionate cumulative burden of environmental and social inequities. Cumulative environmental health impacts should therefore systematically be considered when assessing for risk of exposure to and health complications resulting from COVID-19.
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Affiliation(s)
- Carolyn Ingram
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Belfield, Dublin 4, Ireland. .,ISPED (Bordeaux School of Public Health) , University of Bordeaux , Bordeaux, France.
| | - Esther Min
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Edmund Seto
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - B J Cummings
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Stephanie Farquhar
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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19
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Rigolon A, Browning MHEM, McAnirlin O, Yoon HV. Green Space and Health Equity: A Systematic Review on the Potential of Green Space to Reduce Health Disparities. Int J Environ Res Public Health 2021; 18:2563. [PMID: 33806546 DOI: 10.3390/ijerph18052563] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023]
Abstract
Disadvantaged groups worldwide, such as low-income and racially/ethnically minoritized people, experience worse health outcomes than more privileged groups, including wealthier and white people. Such health disparities are a major public health issue in several countries around the world. In this systematic review, we examine whether green space shows stronger associations with physical health for disadvantaged groups than for privileged groups. We hypothesize that disadvantaged groups have stronger protective effects from green space because of their greater dependency on proximate green space, as they tend to lack access to other health-promoting resources. We use the preferred reporting items for systematic reviews and meta-analyses (PRISMA) method and search five databases (CINAHL, Cochrane, PubMed, Scopus, and Web of Science) to look for articles that examine whether socioeconomic status (SES) or race/ethnicity modify the green space-health associations. Based on this search, we identify 90 articles meeting our inclusion criteria. We find lower-SES people show more beneficial effects than affluent people, particularly when concerning public green spaces/parks rather than green land covers/greenness. Studies in Europe show stronger protective effects for lower-SES people versus higher-SES people than do studies in North America. We find no notable differences in the protective effects of green space between racial/ethnic groups. Collectively, these results suggest green space might be a tool to advance health equity and provide ways forward for urban planners, parks managers, and public health professionals to address health disparities.
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20
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Abstract
BACKGROUND Louisiana in the summer of 2020 had the highest per capita case count for COVID-19 in the United States and COVID-19 deaths disproportionately affects the African American population. Neighborhood deprivation has been observed to be associated with poorer health outcomes. The purpose of this study was to examine the relationship between neighborhood deprivation and COVID-19 in Louisiana. METHODS The Area Deprivation Index (ADI) was calculated and used to classify neighborhood deprivation at the census tract level. A total of 17 US census variables were used to calculate the ADI for each of the 1148 census tracts in Louisiana. The data were extracted from the American Community Survey (ACS) 2018. The neighborhoods were categorized into quintiles as well as low and high deprivation. The publicly available COVID-19 cumulative case counts by census tract were obtained from the Louisiana Department of Health website on July 31, 2020. Descriptive and Poisson regression analyses were performed. RESULTS Neighborhoods in Louisiana were substantially different with respect to deprivation. The ADI ranged from 136.00 for the most deprived neighborhood and -33.87 in the least deprived neighborhood. We observed that individuals residing in the most deprived neighborhoods had almost a 40% higher risk of COVID-19 compared to those residing in the least deprived neighborhoods. CONCLUSION While the majority of previous studies were focused on very limited socio-environmental factors such as crowding and income, this study used a composite area-based deprivation index to examine the role of neighborhood environment on COVID-19. We observed a positive relationship between neighborhood deprivation and COVID-19 risk in Louisiana. The study findings can be utilized to promote public health preventions measures besides social distancing, wearing a mask while in public and frequent handwashing in vulnerable neighborhoods with greater deprivation.
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Affiliation(s)
- Madhav K. C.
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Evrim Oral
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Susanne Straif-Bourgeois
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Ariane L. Rung
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
| | - Edward S. Peters
- Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, United States of America
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21
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Arora A, Spatz ES, Herrin J, Riley C, Roy B, Rula EY, Kell KP, Krumholz HM. Identifying characteristics of high-poverty counties in the United States with high well-being: an observational cross-sectional study. BMJ Open 2020; 10:e035645. [PMID: 32948545 PMCID: PMC7500307 DOI: 10.1136/bmjopen-2019-035645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify county characteristics associated with high versus low well-being among high-poverty counties. DESIGN Observational cross-sectional study at the county level to investigate the associations of 29 county characteristics with the odds of a high-poverty county reporting population well-being in the top quintile versus the bottom quintile of well-being in the USA. County characteristics representing key determinants of health were drawn from the Robert Wood Johnson Foundation County Health Rankings and Roadmaps population health model. SETTING Counties in the USA that are in the highest quartile of poverty rate. MAIN OUTCOME MEASURE Gallup-Sharecare Well-being Index, a comprehensive population-level measure of physical, mental and social health. Counties were classified as having a well-being index score in the top or bottom 20% of all counties in the USA. RESULTS Among 770 high-poverty counties, 72 were categorised as having high well-being and 311 as having low well-being. The high-well-being counties had a mean well-being score of 71.8 with a SD of 2.3, while the low-well-being counties had a mean well-being score of 60.2 with a SD of 2.8. Among the six domains of well-being, basic access, which includes access to housing and healthcare, and life evaluation, which includes life satisfaction and optimism, differed the most between high-being and low-well-being counties. Among 29 county characteristics tested, six were independently and significantly associated with high well-being (p<0.05). These were lower rates of preventable hospital stays, higher supply of primary care physicians, lower prevalence of smoking, lower physical inactivity, higher percentage of some college education and higher percentage of heavy drinkers. CONCLUSIONS Among 770 high-poverty counties, approximately 9% outperformed expectations, reporting a collective well-being score in the top 20% of all counties in the USA. High-poverty counties reporting high well-being differed from high-poverty counties reporting low well-being in several characteristics.
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Affiliation(s)
- Anita Arora
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Erica S Spatz
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeph Herrin
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Brita Roy
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | | | | | - Harlan M Krumholz
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
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22
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Dean CA, Wiltshire J, Liu E, Amamoo MA, Garcia Colato E, Elder K. Confidence in Understanding Health Insurance and Challenges Paying Medical Bills Among Men in the United States. Am J Mens Health 2020; 14:1557988320943359. [PMID: 32693654 PMCID: PMC7376301 DOI: 10.1177/1557988320943359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.
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Affiliation(s)
- Caress A. Dean
- Department of Public and Environmental
Wellness, School of Health Sciences, Oakland University, Rochester, MI, USA
| | | | - Echu Liu
- Department of Health Management and
Policy, Saint Louis University, Saint Louis, MO, USA
| | - M. Ahinee Amamoo
- School of Public Health, Samford
University, Birmingham, AL, USA
| | | | - Keith Elder
- School of Public Health, Samford
University, Birmingham, AL, USA
- Keith Elder, School of Public Health,
Samford University, 800 Lakeshore Drive, Birmingham, AL 35229, USA.
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23
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Zhang Y, Grinspan Z, Khullar D, Unruh MA, Shenkman E, Cohen A, Kaushal R. Developing an actionable patient taxonomy to understand and characterize high-cost Medicare patients. Healthc (Amst) 2020; 8:100406. [PMID: 31918975 DOI: 10.1016/j.hjdsi.2019.100406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/17/2019] [Accepted: 12/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Improving care for high-cost patients requires a better understanding of their characteristics and the ability to effectively target interventions. We developed an actionable taxonomy with clinically meaningful patient categories for high-cost Medicare patients-those in the top 10% of total costs. METHODS A cross-sectional study of a Medicare fee-for-service (FFS) patient cohort in the New York metropolitan area. We merged claims and neighborhood social determinants of health data to map patients into actionable categories. RESULTS Among 428,024 Medicare FFS patients, we mapped the 42,802 high-cost patients into ten overlapping categories, including: multiple chronic conditions, seriously ill, frail, serious mental illness, single condition with high pharmacy cost, chronic pain, end-stage renal disease (ESRD), single high-cost chronic condition, opioid use disorder, and socially vulnerable. Most high-cost patients had multiple chronic conditions (97.4%), followed by serious illness (53.7%) and frailty (48.9%). Patients with ESRD, who were seriously ill, and who were frail were more likely to be high-cost compared to patients in other categories. 72.7% of high-cost patients fell into multiple categories. CONCLUSIONS High-cost patients are highly heterogeneous. A patient taxonomy incorporating medical, behavioral, and social characteristics may help providers better understand their characteristics and health needs. IMPLICATIONS Mapping high-cost patients into clinically meaningful and actionable categories that incorporate medical, behavioral, and social factors could help health systems target interventions. Integrated approaches, including medical care, behavioral health, and social services may be needed to effectively and efficiently care for high-cost patients.
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Affiliation(s)
- Yongkang Zhang
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| | - Zachary Grinspan
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA; Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Dhruv Khullar
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mark Aaron Unruh
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Elizabeth Shenkman
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA
| | - Andrea Cohen
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Rainu Kaushal
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA; Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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24
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Andrews MR, Tamura K, Claudel SE, Xu S, Ceasar JN, Collins BS, Langerman S, Mitchell VM, Baumer Y, Powell-Wiley TM. Geospatial Analysis of Neighborhood Deprivation Index (NDI) for the United States by County. J Maps 2020; 16:101-112. [PMID: 32855653 PMCID: PMC7447192 DOI: 10.1080/17445647.2020.1750066] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 01/12/2020] [Accepted: 02/29/2020] [Indexed: 05/21/2023]
Abstract
Little is known about the spatial clustering of neighborhood deprivation across the United States (U.S.). Using data from the 2010 U.S. Census Bureau, we created a neighborhood deprivation index (NDI: higher NDI indicates higher deprivation/ lower neighborhood socioeconomic status) for each county within the U.S. County level scores were loaded into ArcGIS 10.5.1 where they were mapped and analyzed using Moran's I and Anselin Local Moran's I. Ultimately, NDI varies spatially across the US. The highest NDI scores were found in the Southeastern and Southwestern U.S. states, and inland regions of Southern California. This information is critical for public health initiative development as planners may need to tailor the scale of their efforts based on the higher NDI neighborhoods of the county or geographic region with potentially greater chronic disease burden.
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Affiliation(s)
- Marcus R Andrews
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kosuke Tamura
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sophie E Claudel
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samantha Xu
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joniqua N Ceasar
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Billy S Collins
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Steven Langerman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valerie M Mitchell
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne Baumer
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tiffany M Powell-Wiley
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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25
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Henning-Smith C, Gonzales G. Differences by Sexual Orientation in Perceptions of Neighborhood Cohesion: Implications for Health. J Community Health 2018; 43:578-85. [PMID: 29222737 DOI: 10.1007/s10900-017-0455-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A large body of research documents the relationship between health and place, including the positive association between neighborhood cohesion and health. However, very little research has examined neighborhood cohesion by sexual orientation. This paper addresses that gap by examining differences in perceived neighborhood cohesion by sexual orientation. We use data from the 2016 National Health Interview Survey (n = 28,164 respondents aged 18 years and older) to examine bivariate differences by sexual orientation in four measures of neighborhood cohesion. We then use ordered logistic regression models to assess the relationship between sexual orientation and a scaled measure of neighborhood cohesion, adjusting for socio-demographic characteristics, living arrangements, health status, region, and neighborhood tenure. We find that lesbian, gay, and bisexual (LGB) adults are less likely to say that they live in a close-knit neighborhood (54.6 vs. 65.6%, p < 0.001), they can count on their neighbors (74.7 vs. 83.1%, p < 0.001), they trust their neighbors (75.5 vs. 83.7%, p < 0.001), or people in their neighborhood help each other out (72.9 vs. 83.1%, p < 0.001), compared to heterosexual adults. Even after controlling for socio-demographic factors, neighborhood cohesion scores are lower for LGB adults compared to heterosexual adults (odds ratio of better perceived neighborhood cohesion for sexual minorities: 0.70, p < 0.001). Overall, LGB adults report worse neighborhood cohesion across multiple measures, even after adjusting for individual characteristics and neighborhood tenure. Because living in a cohesive neighborhood is associated with better health outcomes, future research, community-level initiatives, and public policy efforts should focus on creating welcoming neighborhood environments for sexual minorities.
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26
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Abstract
A landmark article published in the American Psychologist (Adler et al., 1994) encouraged psychologists to engage in research on socioeconomic inequality and health. Numerous contributions followed to fill in psychosocial and behavioral pathways. Specifically, we review advances on health inequalities research from a large public-use study (Midlife in the United States [MIDUS]). The Great Recession of 2007 to 2009 and its lingering effects are then reviewed to underscore widening inequality in access to education, employment, and income. Two MIDUS national samples of same-aged adults recruited 2 decades apart are then compared to assess historical changes in socioeconomic, physical health, and well-being profiles from the 1990s to postrecession. Despite historical gains in educational attainment over time, we show that indicators of socioeconomic status, health, and well-being are more compromised in the postrecession sample relative to the 1990s sample. Building on these preliminary findings, we elaborate opportunities for further inquiry by the scientific community to examine whether widening socioeconomic inequalities exacerbated by the Great Recession translate to widening health inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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27
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Ryvicker M, Sridharan S. Neighborhood Environment and Disparities in Health Care Access Among Urban Medicare Beneficiaries With Diabetes: A Retrospective Cohort Study. Inquiry 2018; 55:46958018771414. [PMID: 29717616 PMCID: PMC5946594 DOI: 10.1177/0046958018771414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults' health is sensitive to variations in neighborhood environment, yet few studies have examined how neighborhood factors influence their health care access. This study examined whether neighborhood environmental factors help to explain racial and socioeconomic disparities in health care access and outcomes among urban older adults with diabetes. Data from 123 233 diabetic Medicare beneficiaries aged 65 years and older in New York City were geocoded to measures of neighborhood walkability, public transit access, and primary care supply. In 2008, 6.4% had no office-based "evaluation and management" (E&M) visits. Multilevel logistic regression indicated that this group had greater odds of preventable hospitalization in 2009 (odds ratio = 1.31; 95% confidence interval: 1.22-1.40). Nonwhites and low-income individuals had greater odds of a lapse in E&M visits and of preventable hospitalization. Neighborhood factors did not help to explain these disparities. Further research is needed on the mechanisms underlying these disparities and older adults' ability to navigate health care. Even in an insured population living in a provider-dense city, targeted interventions may be needed to overcome barriers to chronic illness care for older adults in the community.
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28
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Logan AC, Prescott SL, Haahtela T, Katz DL. The importance of the exposome and allostatic load in the planetary health paradigm. J Physiol Anthropol 2018; 37:15. [PMID: 29866162 PMCID: PMC5987475 DOI: 10.1186/s40101-018-0176-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/25/2018] [Indexed: 02/07/2023] Open
Abstract
In 1980, Jonas Salk (1914-1995) encouraged professionals in anthropology and related disciplines to consider the interconnections between "planetary health," sociocultural changes associated with technological advances, and the biology of human health. The concept of planetary health emphasizes that human health is intricately connected to the health of natural systems within the Earth's biosphere; experts in physiological anthropology have illuminated some of the mechanisms by which experiences in natural environments (or the built environment) can promote or detract from health. For example, shinrin-yoku and related research (which first emerged from Japan in the 1990s) helped set in motion international studies that have since examined physiological responses to time spent in natural and/or urban environments. However, in order to advance such findings into planetary health discourse, it will be necessary to further understand how these biological responses (inflammation and the collective of allostatic load) are connected to psychological constructs such as nature relatedness, and pro-social/environmental attitudes and behaviors. The exposome refers to total environmental exposures-detrimental and beneficial-that can help predict biological responses of the organism to environment over time. Advances in "omics" techniques-metagenomics, proteomics, metabolomics-and systems biology are allowing researchers to gain unprecedented insight into the physiological ramifications of human behavior. Objective markers of stress physiology and microbiome research may help illuminate the personal, public, and planetary health consequences of "extinction of experience." At the same time, planetary health as an emerging multidisciplinary concept will be strengthened by input from the perspectives of physiological anthropology.
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Affiliation(s)
- Alan C. Logan
- In-VIVO Global Initiative, Research Group of the Worldwide Universities Network (WUN), 6010 Park Ave, Suite #4081, West New York, NJ 07093 USA
| | - Susan L. Prescott
- School of Medicine, University of Western Australia, Princess Margaret Hospital, PO Box D184, Perth, WA 6001 Australia
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, PO BOX 160, FI-00029 HUS Helsinki, Finland
| | - David L. Katz
- Prevention Research Center, Griffin Hospital, Yale University, 130 Division St, Derby, CT 06418 USA
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29
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Olsen JR, Dundas R, Ellaway A. Are Changes in Neighbourhood Perceptions Associated with Changes in Self-Rated Mental Health in Adults? A 13-Year Repeat Cross-Sectional Study, UK. Int J Environ Res Public Health 2017; 14:E1473. [PMID: 29186035 PMCID: PMC5750892 DOI: 10.3390/ijerph14121473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/23/2017] [Accepted: 11/25/2017] [Indexed: 01/02/2023]
Abstract
The aim of this study was to examine changes in neighbourhood perceptions on self-rated mental health problems over time, and to explore demographic, geographic and socio-economic factors as determinants of increased or decreased anxiety and depression symptoms. We conducted a repeat cross-sectional study of individuals (N: 4480) living in the same areas of west central Scotland in 1997 and 2010. Individuals were asked to complete a questionnaire at both time-points, containing 14 questions relating to neighbourhood perceptions and the Hospital Anxiety and Depression Scale (HADS). A three-level linear regression model was fitted to HADS scores and changes in neighbourhood perceptions over time; controlling for a number of individual and area-level variables. Overall, area-level mean HADS scores decreased from 1997 to 2010. When adjusted for individual and area-level variables, this decrease did not remain for HADS anxiety. Applying an overall 14-scale neighbourhood perception measure, worsening neighbourhood perceptions were associated with small increases in depression (0.04, 95% confidence interval (CI) 0.01 to 0.07) and anxiety (0.04, 95% CI 0.00 to 0.08) scores over time. This highlights a need for local and national policy to target areas where neighbourhood characteristics are substantially deteriorating in order to ensure the mental health of individuals does not worsen.
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Affiliation(s)
- Jonathan R Olsen
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, UK.
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, UK.
| | - Anne Ellaway
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow G2 3QB, UK.
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