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Campbell D, Gorey KM, Luginaah IN, Zou G, Hamm C, Holowaty EJ. Gender differences on the interacting effects of marital status and health insurance on long-term colon cancer survival in California, 1995-2014. Public Health 2016; 140:258-260. [PMID: 27506641 PMCID: PMC5118043 DOI: 10.1016/j.puhe.2016.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 07/12/2016] [Indexed: 10/21/2022]
Abstract
Objectives Long-term colon cancer survival is not well explained by main effects. We explored the interaction of age, gender, marital status, health insurance and poverty on 10-year colon cancer survival. Methods California registry data were analyzed for 5,776 people diagnosed from 1995 to 2000; followed until 2014. Census data classified neighborhood poverty. We tested interactions with regressions and described them with standardized rates and rate ratios (RR). Results The 5-way interaction was significant, suggesting larger 4-way disadvantages among non-Medicare-eligible people. A significant 4-way interaction was a 3-way interaction in non-high poverty neighborhoods only. Private insurance was protective for unmarried men (RR = 1.60) but not women, while it was protective for married women (RR = 1.22) but not men. This pattern seemed explained by lower-incomes of certain groups of unmarried women and married men and more prevalent underinsuring of unmarried men. Conclusions Structural inequities related to the institutions of marriage and health care seem to affect women and men quite differently. Policy makers ought to be cognizant of such structural imbalances as future reforms of American health care are considered.
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Affiliation(s)
- D Campbell
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
| | - K M Gorey
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, Ontario N9A 0C5, Canada.
| | - I N Luginaah
- Department of Geography, Western University, London, Ontario, Canada
| | - G Zou
- Department of Epidemiology and Biostatistics and Robarts Research Institute, Western University, London, Ontario, Canada
| | - C Hamm
- Windsor Regional Cancer Center and Department of Oncology, Division of Medical Oncology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Fung KY, Luginaah I, Gorey KM, Webster G. Air pollution and daily hospitalization rates for cardiovascular and respiratory diseases in London, Ontario. ACTA ACUST UNITED AC 2005; 62:677-685. [PMID: 20703387 DOI: 10.1080/00207230500367879] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this paper, we examine the role that ambient air pollution plays in exacerbating cardiovascular and respiratory disease hospitalization in London, Ontario from 1 November 1995 to 31 December 2000. The number of daily cardiac and respiratory admissions was linked to concentrations of air pollutants (sulphur dioxide, nitrogen dioxide, ozone, carbon monoxide, coefficient of haze, PM(10)) and weather variables (maximum and minimum of temperature and humidity). Results showed that current day carbon monoxide and coefficient of haze produced significant percentage increase in daily cardiac admissions of 8.0% (95% CI: 1.5-11.5%) and 5.7% (95% CI: 0.9-10.8%) for people < 65 years old. PM(10) was found to be significantly associated with asthma admission in the > 65 group, with percentage increase in cardiac admission of 25% (95% CI: 2.8-52.3%) and 26.0% (95% CI: 5.3-50.9%) for current day and 2-day means, respectively.
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Affiliation(s)
- K Y Fung
- University of Windsor, Windsor, Ontario, N9B 3P4, Canada
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Gorey KM, Richter NL, Snider E. Guilt, isolation and hopelessness among female survivors of childhood sexual abuse: effectiveness of group work intervention. Child Abuse Negl 2001; 25:347-355. [PMID: 11414394 DOI: 10.1016/s0145-2134(00)00255-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE This study explores the effects of group work intervention on female survivors' senses of guiltlessness, affiliation and hopefulness. METHOD Secondary comparative analyses of a large quasi-experiment-based clinical data base were accomplished (Richter, Snider, & Gorey): group work intervention (N = 78) and a waiting-list condition (N = 80). RESULTS Group work was found to have beneficial effects on adult female survivors' appropriate sense of guiltlessness for their childhood sexual abuse, as well as on their sense of affiliation and hopefulness. Consistent across the three outcome measures of guilt/guiltlessness, isolation/affiliation and hopelessness/hopefulness, 16 to 18 of every 20 such women who participated in group work did better than the average woman in the waiting-list comparison group. Moreover, these apparent clinical benefits were maintained for 6 months (all p < .01). CONCLUSION Such effects may be characterized as very large, and are generally larger than those previously observed in this field of practice that have typically been based on more general measures of depression, self-esteem or global symptoms.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada
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Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Richter NL, Meyer CM. An international comparison of cancer survival: metropolitan Toronto, Ontario, and Honolulu, Hawaii. Am J Public Health 2000; 90:1866-72. [PMID: 11111258 PMCID: PMC1446420 DOI: 10.2105/ajph.90.12.1866] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Comparisons of cancer survival in Canadian and US metropolitan areas have shown consistent Canadian advantages. This study tests a health insurance hypothesis by comparing cancer survival in Toronto, Ontario, and Honolulu, Hawaii. METHODS Ontario and Hawaii registries provided a total of 9190 and 2895 cancer cases (breast and prostate, 1986-1990, followed until 1996). Socioeconomic data for each person's residence at the time of diagnosis were taken from population censuses. RESULTS Socioeconomic status and cancer survival were directly associated in the US cohort, but not in the Canadian cohort. Compared with similar patients in Honolulu, residents of low-income areas in Toronto experienced 5-year survival advantages for breast and prostate cancer. In support of the health insurance hypothesis, between-country differences were smaller than those observed with other state samples and the Canadian advantage was larger among younger women. CONCLUSIONS Hawaii seems to provide better cancer care than many other states, but patients in Toronto still enjoy a significant survival advantage. Although Hawaii's employer-mandated health insurance coverage seems an effective step toward providing equitable health care, even better care could be expected with a universally accessible, single-payer system.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada.
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Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Richter NL, Meyer CM. An international comparison of cancer survival: relatively poor areas of Toronto, Ontario and three US metropolitan areas. J Public Health Med 2000; 22:343-8. [PMID: 11077908 DOI: 10.1093/pubmed/22.3.343] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This study of cancer survival compared adults in Toronto, Ontario and three US metropolitan areas: Seattle, Washington; San Francisco, California; and Hartford, Connecticut. It examined whether socioeconomic status has a differential effect on cancer survival in Canada and the United States. METHODS The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology and End RESULTS (SEER) programme provided a total of 23,437 and 37,329 population-based primary malignant cancer cases for the Toronto and US samples, respectively (1986-1988, followed until 1994). Census-based measures of socioeconomic status were used to ecologically control absolute income status. RESULTS Among residents of low-income areas, persons in Toronto experienced a 5 year survival advantage for 13 of 15 cancer sites [minimally one gender significant at 95 per cent confidence interval (CI)]. An aggregate 35 per cent survival advantage among the Canadian cohort was demonstrated (survival rate ratio (SRR) = 1.35, 95 per cent CI= 1.30-1.40), and this effect was even larger among younger patients not yet eligible for Medicare coverage in the United States (SRR = 1.46, 95 per cent CI = 1.40-1.52). CONCLUSION Systematically replicating a previous Toronto-Detroit comparison, this study's observed consistent pattern of Canadian survival advantage across various cancer sites suggests that their more equitable access to preventive and therapeutic health care services may be responsible for the difference.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada.
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Affiliation(s)
- K M Gorey
- Social Work Program, University of Windsor, Ontario, Canada.
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Gorey KM, Holowaty EJ, Laukkanen E, Fehringer G, Richter NL. Association between socioeconomic status and cancer incidence in Toronto, Ontario: possible confounding of cancer mortality by incidence and survival. Cancer Prev Control 1998; 2:236-41. [PMID: 10093638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
OBJECTIVE To observe the association between socioeconomic status (SES) and cancer incidence in a cohort of Canadians. DESIGN Cases of primary malignant cancer (83,666) that arose in metropolitan Toronto, Ont., from 1986 to 1993 were ascertained by the Ontario Cancer Registry and linked by residence at the time of diagnosis to a census-based measure of SES. Socioeconomic quintile areas were then compared by cancer incidence. RESULTS Significant associations between SES and cancer incidence in the hypothesized direction--greater incidence in low-income areas--were observed for 15 of 23 cancer sites. CONCLUSIONS These findings, together with the recently observed consistent pattern of significant associations between SES and cancer survival in the United States and the equally consistent pattern of nonsignificant associations in Canada, support the notion that differences in cancer incidence alone explain the observed cancer mortality differentials by SES in Canada. The cancer mortality differential by SES observed in the United States is probably a function of differences in both incidence and length of survival, whereas in Canada such mortality differentials are more likely to be merely a function of differences in incidence by SES. This pattern of associations primarily implicates differences in the 2 health care systems; specifically, the more egalitarian access to preventive, investigative and therapeutic services available in the single-payer Canadian system.
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Abstract
The current political-economic climate, which is generally supportive of both private and public sector down-sizing, increasingly demands that human service workers assess, engage, and creatively use consumer strengths and resources. This meta-analysis of thirty-seven independent studies provided the means of inferring not only that elder volunteers' sense of well-being seemed to be significantly bolstered through volunteering, but also that such relatively healthy older people represent a significant adjunct resource for meeting some of the service needs of more vulnerable elders, as well as those of other similarly vulnerable groups such as disabled children. Averaging across studies, 85 percent of the "clients" who received service from an older volunteer (e.g., peer-counseling of nursing home residents) scored better on dependent measures (e.g., diminished depression) than the average person in comparison conditions did (U3 = .847 [Cohen, 1988], combined p < .001). The policy implications of such beneficial effects among both older volunteers and the people they serve are discussed.
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Gorey KM, Holowaty EJ, Laukkanen E, Fehringer G, Richter NL. An international comparison of cancer survival: advantage of Toronto's poor over the near poor of Detroit. Can J Public Health 1998. [PMID: 9583250 DOI: 10.1007/bf03404398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly on estimated effectiveness. Important questions concerning the differential effectiveness of case management by specific program, worker, client, and client-worker relationship characteristics remain to be answered.
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Affiliation(s)
- K M Gorey
- Social Work Program, University of Windsor, Ontario.
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Abstract
OBJECTIVE AND METHOD Aggregating across retrospective cohort samples, this integrative review synthesizes the findings of 12 cumulative incidence studies (45 hypotheses) on anorexia nervosa secular trends. RESULTS (1) The female/male anorexia incidence rate ratio was estimated to be 8.20, 18.46 versus 2.25 cases per 100,000 per year, p < .05; (2) female teenagers experienced anorexia at a rate fivefold greater than other women, 50.82 versus 10.37 incident cases per 100,000 per year, p < .001; (3) no secular trend or change in the incidence of anorexia was observed among teenagers, while a near threefold increase was observed over the past 40 years among women in their 20s and 30s, 6.28 (1950-1964) versus 17.70 (1980-1992) cases per 100,000 per year, p < .05; and (4) the two cohort characteristics of age, and the age by year interaction accounted for nearly two thirds of the variability among anorexia incidence estimates, R2 = .614, F(2,27) = 21.49, p < .001. After the two factors of age and the Age x Year interaction were accounted for, none of the other study characteristics, including study year(s), were found to be significantly associated with anorexia incidence, that is, a main effect of time was not observed. DISCUSSION The integrative evidence across the population-based epidemiologic studies covering 40 years in this field suggests strongly that, overall, the incidence of anorexia nervosa, particularly among those very young women at greatest risk of experiencing it, has not increased significantly. However, the risk does seem to have increased significantly among women in their 20s and 30s.
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Affiliation(s)
- D E Pawluck
- School of Social Work, Wayne State University, Detroit, Michigan, USA
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Gorey KM, Holowaty EJ, Laukkanen E, Fehringer G, Richter NL. An international comparison of cancer survival: advantage of Toronto's poor over the near poor of Detroit. Can J Public Health 1998; 89:102-4. [PMID: 9583250 PMCID: PMC6990333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Gallant WA, Gorey KM, Gallant MD, Perry JL, Ryan PK. The association of personality characteristics with parenting problems among alcoholic couples. Am J Drug Alcohol Abuse 1998; 24:119-29. [PMID: 9513633 DOI: 10.3109/00952999809001702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This retrospective cross-sectional study explored the associations of personality characteristics with parenting problems among 25 couples, one or both members of which were identified as alcoholics by virtue of their voluntary past completion of a residential program for alcoholics. Most of them (90%) scored lower, indicating their more problematic parental attitudes and behaviors, on all four scales of the Adult-Adolescent Parenting Inventory (AAPI: inappropriate parental expectations of children, lack empathy for children's needs, value physical punishment, and parent-child role reversal) than average "normal" nonalcoholic, nonabusive adults. Such parenting problems were found to be very highly associated with clients' personality characteristics. For example, schizoid, schizotypal, histrionic, and passive aggressive characteristics (DSM-III-R-based) along with a few other personal characteristics of the couples, accounted for nearly all (90.2%, R2 = .902) of their propensity to reverse roles with their children. Findings also suggested that the identified parenting problems among alcoholic couples are amenable to programmatic intervention: the longer couples had participated in aftercare programs offered by the treatment facility the more appropriate and empathetic was their parenting.
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Affiliation(s)
- W A Gallant
- School of Social Work, University of Windsor, Ontario, Canada
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Gorey KM, Trevisan M. Secular trends in the United States black/white hypertension prevalence ratio: potential impact of diminishing response rates. Am J Epidemiol 1998; 147:95-9; discussion 100-2. [PMID: 9456997 DOI: 10.1093/oxfordjournals.aje.a009434] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In this integrative review, the authors analyzed 25 studies on hypertension prevalence among black and white adults (1960-1991). The authors made the following inferences: 1) both female (2.59 vs. 1.77) and male (2.20 vs. 1.38) black/white hypertension prevalence ratios have diminished by approximately a third over the past three decades; 2) response rates were significantly lower among the more recent surveys (i.e., 1976 or later, mean 69.2 percent (standard deviation (SD) 6.9) vs. 1960 to 1975, mean 86.1 percent (SD 9.1)); and 3) these two trends are directly associated--response rates may account for a third (women, R2 = 0.362) to nearly a half (men, R2 = 0.469) of the variability in black-white hypertension differentials. These findings suggest that although respondent-based research has found black and white adults in the United States to be increasingly similar in hypertension prevalence, the same may not be true of the entire adult population (responders and nonresponders). The apparent diminishment over time in the black-white hypertension gap is as likely to be a methodological artifact allied with declining response rates as a true parametric phenomenon resultant from substantive factors such as enhanced treatment effectiveness among blacks.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada
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Gorey KM, Trevisan M. Reply to Dr. Eichner's Invited Commentary on "Secular Trends in the United States Black/White Hypertension Prevalence Ratio: Potential Impact of Diminishing Response Rates". Am J Epidemiol 1998. [DOI: 10.1093/oxfordjournals.aje.a009420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gorey KM, Holowaty EJ, Fehringer G, Laukkanen E, Moskowitz A, Webster DJ, Richter NL. An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas. Am J Public Health 1997; 87:1156-63. [PMID: 9240106 PMCID: PMC1380890 DOI: 10.2105/ajph.87.7.1156] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study examined whether socioeconomic status has a differential effect on the survival of adults diagnosed with cancer in Canada and the United States. METHODS The Ontario Cancer Registry and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program provided a total of 58,202 and 76,055 population-based primary malignant cancer cases for Toronto, Ontario, and Detroit, Mich, respectively. Socioeconomic data for each person's residence at time of diagnosis were taken from population censuses. RESULTS In the US cohort, there was a significant association between socioeconomic status and survival for 12 of the 15 most common cancer sites; in the Canadian cohort, there was no such association for 12 of the 15 sites. Among residents of low-income areas, persons in Toronto experienced a survival advantage for 13 of 15 cancer sites at 1- and 5-year follow-up. No such between-country differentials were observed in the middle- or high-income groups. CONCLUSIONS The consistent pattern of a survival advantage in Canada observed across various cancer sites and follow-up periods suggests that Canada's more equitable access to preventive and therapeutic health care services is responsible for the difference.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada
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Gorey KM, Leslie DR. The prevalence of child sexual abuse: integrative review adjustment for potential response and measurement biases. Child Abuse Negl 1997; 21:391-398. [PMID: 9134267 DOI: 10.1016/s0145-2134(96)00180-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This integrative review synthesizes the finding of 16 cross-sectional surveys (25 hypotheses) on the prevalence of child abuse among nonclinical, North American samples. It is essentially a research literature on sexual abuse; only one of the studies assessed physical abuse, and there has not yet been a single study of prevalent child emotional abuse nor neglect. The following summative inferences were made: (1) response rates diminished significantly over time, M = 68% prior to 1985 and M = 49% for more recent surveys, p < .05; (2) unadjusted estimates of the prevalent experience among women and men of childhood sexual abuse was 22.3% and 8.5%, respectively; (3) study response rates and child abuse operational definitions together accounted for half of the observed variability in their abuse prevalence estimates, R2 = .500, p < .05; (4) female and male child sexual abuse prevalence estimates adjusted for response rates (60% or more) were respectively, 16.8% and 7.9%, and adjusted for operational definitions (excluding the broadest, noncontact category) they were 14.5% and 7.2%; (5) after adjustment for response rates and definitions, the prevalence of child sexual abuse was not found to vary significantly over the three decades reviewed. Given the large human costs, both personal and social, of child abuse, and the identified gap in the requisite knowledge needed to steer effective preventive and treatment interventions, it is time to invest in a large, methodologically rigorous, population-based study of child abuse which, if it does nothing else, spares no expense in ensuring very high participation.
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada
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Abstract
This cumulative incidence study was accomplished among adults in Upstate New York metropolitan areas (Buffalo, Rochester, Syracuse and Albany--1979-1986). It used a new ecological socioeconomic status measure--near poverty status (i.e., below 200% of the federally established poverty criterion, including the poor and near poor)--and observed its association with site-specific cancer incidence (lung, stomach, cervix uteri, prostate, colon, rectum and breast). Findings were: 1) near poverty status is directly associated with each cancer site's incidence and the strength of the associations are similar among blacks and whites for each one and 2) the prevalence of exposure, of living in high near impoverishment areas, is nearly seven-fold greater among blacks; prevalence ratio [PR] = 6.74 (95% confidence interval [CI]:5.07,8.99).
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Affiliation(s)
- K M Gorey
- School of Social Work, University of Windsor, Ontario, Canada
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Gorey KM, Vena JE. Cancer differentials among US blacks and whites: quantitative estimates of socioeconomic-related risks. J Natl Med Assoc 1994; 86:209-15. [PMID: 8189454 PMCID: PMC2568187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This article analyzes 10 studies that assessed the association of socioeconomic status (SES) with cancer occurrence among blacks and whites in the United States. The following summative inferences were made: the associations of SES with cancer are similar among blacks and whites; cancers of organ sites with the most intimate environmental interfaces have the strongest SES-cancer associations (stomach, lung, cervix, and rectum); the prevalence of exposure to low socioeconomic-related risks such as poverty are approximately fourfold greater among blacks; the all-site population attributable risk percent due to low socioeconomic exposure among blacks is estimated to be four times that of whites, and similar data trends were observed for individual cancer sites such as the stomach and lung; and the three cancer sites of the stomach, lung, and cervix uteri account for nearly half of the observed US black-white cancer rate difference. This review also found all 10 of the primary studies in this field to be ecological with respect to socioeconomic exposure measurement, ie, they used aggregate measures (eg, census tract median education or family income) to characterize the individual's exposure. The need for direct empirical validation of such measures to aid in interpretation of the extant data in this field is underscored.
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Affiliation(s)
- K M Gorey
- Department of Social and Preventive Medicine, School of Medicine, State University of New York at Buffalo 14214
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Abstract
The data bases of 18 empirical studies were combined into one comprehensive data set and subjected to meta-analysis. The following trends were observed: (1) surgery has a significantly decompensating impact on the mental status of older persons, and the average effect size observed is modest (r = .37); (2) for all mental status measures included in the review (cognition, delirium and affect), effect size appears to be significantly moderated by patient age; (3) patient sex may be predictive of the kind of mental impairment that is most likely to occur within an older surgery population, with women manifesting a greater affinity for delirious and men for cognitive decompensation; (4) most existing research within this domain of study is either purely descriptive or anecdotal: of 46 studies reviewed, only 18, or 39.1% of the total published output, were of sufficient methodologic rigor to allow for scientifically valid effect-size computations. The implications of these findings for future research are discussed.
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Affiliation(s)
- A G Cryns
- Multidisciplinary Center on Aging, School of Medicine, State University of New York, Buffalo 14214
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