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Dawit R, Goedel WC, Reid SC, Doshi JA, Nunn AS, Chan PA, Dean LT. Geographic variations of pre-exposure prophylaxis reversal and abandonment among United States counties. AIDS 2024; 38:557-566. [PMID: 37976040 PMCID: PMC10922568 DOI: 10.1097/qad.0000000000003790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE In the United States, one in five newly insurer-approved pre-exposure prophylaxis (PrEP) prescriptions are reversed with over 70% of those reversed, being abandoned. Given the Ending the HIV Epidemic (EHE) initiative's goals, we assessed geographic variations of PrEP reversal and abandonment across EHE and non-EHE counties in the United States. DESIGN This was a cross-sectional analysis of secondary data. METHODS Data were collected from Symphony Analytics for adults 18 years and older, with a newly prescribed PrEP claim. Using the proportion of PrEP prescriptions by county, hotspot analysis was conducted utilizing Getis Ord Gi∗ statistics stratified by EHE and non EHE counties. Multivariable logistic regression was used to identify factors associated with residing in hotspots of PrEP reversal or PrEP abandonments. RESULTS Across 516 counties representing 36,204 patients, the overall PrEP reversal rate was 19.4%, whereas the PrEP abandonment rate was 13.7%. Reversals and abandonments were higher for non-EHE (22.7 and 17.1%) than EHE (15.6 and 10.5%) counties. In both EHE and non-EHE counties, younger age, less education, females, and an out-of-pocket cost of greater than $100, were significantly associated with greater likelihood of residing in hotspots of PrEP reversal or abandonment, while Hispanics, Medicaid recipients, and an out-of-pocket cost of $10 or less had lower likelihood of residing in hotspots of reversal and abandonment. CONCLUSION Findings indicate the need for implementation of focused interventions to address disparities observed in PrEP reversal and abandonment. Moreover, to improve primary PrEP adherence, national PrEP access programs should streamline and improve PrEP accessibility across different geographic jurisdictions.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sean C. Reid
- Department of Geography, University of California, Santa Barbara, CA, USA
| | - Jalpa A. Doshi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Dean LT, Chung SE, Gross AL, Clay OJ, Willis SL, McDonough IM, Thomas KR, Marsiske M, Aysola J, Thorpe RJ, Felix C, Berkowitz M, Coe NB. Does Consumer Credit Precede or Follow Health Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial. Innov Aging 2024; 8:igae016. [PMID: 38511203 PMCID: PMC10953618 DOI: 10.1093/geroni/igae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Indexed: 03/22/2024] Open
Abstract
Background and Objectives Consumer credit has shown increasing relevance to the health of older adults; however, studies have not been able to assess the extent to which creditworthiness influences future health or health influences future creditworthiness. We assessed the relationships between 4-year pre and postmorbid consumer credit history and self-rated physical and mental health outcomes among older adults. Research Design and Methods Generalized estimating equations models assessed pre and postmorbid credit history (credit scores, derogatory accounts, and unpaid accounts in collections) and the onset of poor self-rated health (SF-36 score <50) among 1,740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly study from 2001 to 2017, linked to TransUnion consumer credit data. Results In any given year, up to 1/4 of participants had a major derogatory, unpaid, or collections account, and up to 13% of the sample had poor health. Each 50-point increase in credit score trended toward a 5% lower odds of poor health in the next 1 year, a 6% lower odds in the next 2 years, and a statistically significant finding of 13% lower odds by 3 years. A drop in credit score was associated with a 10% greater odds of poor health in the next year, and having a major derogatory account was associated with an 86% greater odds of poor health in the next 3 years. After poor health onset, credit scores continued to see significant losses up to the 3 years, with larger decrements over time. Discussion and Implications Having a major derogatory account or a sudden loss in credit may be a time to monitor older adults for changes in health. After a downturn in health, supporting older adults to manage their debt may help stabilize their credit.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shang-En Chung
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- University of Alabama at Birmingham Alzheimer’s Disease Research Center, Birmingham, Alabama, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ian M McDonough
- Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System and Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, California, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Jaya Aysola
- Department of Medicine and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Baltimore, Maryland, USA
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Melissa Berkowitz
- Department of Medical Ethics and Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Norma B Coe
- Department of Medical Ethics and Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Dean LT, Nunn AS, Chang HY, Bakre S, Goedel WC, Dawit R, Saberi P, Chan PA, Doshi JA. Estimating The Impact Of Out-Of-Pocket Cost Changes On Abandonment Of HIV Pre-Exposure Prophylaxis. Health Aff (Millwood) 2024; 43:36-45. [PMID: 38190604 PMCID: PMC10996384 DOI: 10.1377/hlthaff.2023.00808] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV. Several different developments in the US either threaten to increase or promise to decrease PrEP out-of-pocket costs and access in the coming years. In a sample of 58,529 people with a new insurer-approved PrEP prescription, we estimated risk-adjusted percentages of patients who abandoned (did not fill) their initial prescription across six out-of-pocket cost categories. We then simulated the percentage of patients who would abandon PrEP under hypothetical changes to out-of-pocket costs, ranging from $0 to more than $500. PrEP abandonment rates of 5.5 percent at $0 rose to 42.6 percent at more than $500; even a small increase from $0 to $10 doubled the rate of abandonment. Conversely, abandonment rates that were 48.0 percent with out-of-pocket costs of more than $500 dropped to 7.3 percent when those costs were cut to $0. HIV diagnoses were two to three times higher among patients who abandoned PrEP prescriptions than among those who filled them. These results imply that recent legal challenges to the provision of PrEP with no cost sharing could substantially increase PrEP abandonment and HIV rates, upending progress on the HIV/AIDS epidemic.
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Affiliation(s)
- Lorraine T Dean
- Lorraine T. Dean , Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | | | - Parya Saberi
- Parya Saberi, University of California San Francisco, San Francisco, California
| | | | - Jalpa A Doshi
- Jalpa A. Doshi, University of Pennsylvania, Philadelphia, Pennsylvania
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Dawit R, Predmore Z, Raifman J, Chan PA, Skinner A, Napoleon S, Zanowick-Marr A, Le Brazidec D, Almonte A, Dean LT. Identifying HIV PrEP Attributes to Increase PrEP Use Among Different Groups of Gay, Bisexual, and Other Men Who Have Sex with Men: A Latent Class Analysis of a Discrete Choice Experiment. AIDS Behav 2024; 28:125-134. [PMID: 37474623 DOI: 10.1007/s10461-023-04131-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/22/2023]
Abstract
Daily pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV among gay, bisexual, and other men who have sex with men (GBMSM), although uptake remains suboptimal. By identifying the features of PrEP that appeal to various subgroups of GBMSM, this study aimed to improve PrEP uptake by examining preferences for PrEP use. Adults ≥ 18 years old in six New England states completed an online discrete choice experiment survey. A latent class analysis (LCA) was conducted to identify groups of GBMSM based on four attributes of choices for PrEP (cost, time, side effects, and mode of administration). Multinominal logistic regression was conducted to compare the association between sociodemographic and behavioral characteristics and class memberships. Data from 675 GBMSM were analyzed. A 3-Class model was selected as the best fit model. Class 1 (47.7% of individuals) was identified as having "no specific preferences". Class 2 (18.5% of individuals) were "Cost- and time-conscious" and were significantly more likely to be older, have prior sexually transmitted infection (STI) testing, have low household income, private insurance, and have extreme concerns about HIV risk than those with no specific preference (Class 1). Finally, Class 3 (34.1% of individuals) were "Side effects-conscious" and were more likely to have low income, private insurance, and have moderate and extreme concerns about HIV risk than those with no specific preference (Class 1). Findings indicate that outreach to GBMSM who have never used PrEP should emphasize low cost and short travel times to increase potential PrEP use.
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Affiliation(s)
- Rahel Dawit
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA.
| | | | - Julia Raifman
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Philip A Chan
- Brown University AIDS Program, The Miriam Hospital, Providence, RI, 02906, USA
- Division of Infectious Diseases, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Alexandra Skinner
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Siena Napoleon
- Brown University AIDS Program, The Miriam Hospital, Providence, RI, 02906, USA
| | | | | | - Alexi Almonte
- Brown University AIDS Program, The Miriam Hospital, Providence, RI, 02906, USA
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
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Zhang Y, Leifheit KM, Lee KT, Thorpe RJ, Gaskin DJ, Dean LT. The Association of Oncology Provider Density With Black-White Disparities in Cancer Mortality in US Counties. Cancer Control 2024; 31:10732748241244929. [PMID: 38607968 PMCID: PMC11015762 DOI: 10.1177/10732748241244929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 02/29/2024] [Accepted: 02/08/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Black-White racial disparities in cancer mortality are well-documented in the US. Given the estimated shortage of oncologists over the next decade, understanding how access to oncology care might influence cancer disparities is of considerable importance. We aim to examine the association between oncology provider density in a county and Black-White cancer mortality disparities. METHODS An ecological study of 1048 US counties was performed. Oncology provider density was estimated using the 2013 National Plan and Provider Enumeration System data. Black:White cancer mortality ratio was calculated using 2014-2018 age-standardized cancer mortality rates from State Cancer Profiles. Linear regression with covariate adjustment was constructed to assess the association of provider density with (1) Black:White cancer mortality ratio, and (2) cancer mortality rates overall, and separately among Black and White persons. RESULTS The mean Black:White cancer mortality ratio was 1.12, indicating that cancer mortality rate among Black persons was on average 12% higher than that among White persons. Oncology provider density was significantly associated with greater cancer mortality disparities: every 5 additional oncology providers per 100 000 in a county was associated with a .02 increase in the Black:White cancer mortality ratio (95% CI: .007 to .03); however, the unexpected finding may be explained by further analysis showing that the relationship between oncology provider density and cancer mortality was different by race group. Every 5 additional oncologists per 100 000 was associated with a 1.6 decrease per 100 000 in cancer mortality rates among White persons (95% CI: -3.0 to -.2), whereas oncology provider density was not associated with cancer mortality among Black persons. CONCLUSION Greater oncology provider density was associated with significantly lower cancer mortality among White persons, but not among Black persons. Higher oncology provider density alone may not resolve cancer mortality disparities, thus attention to ensuring equitable care is critical.
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Affiliation(s)
- Yuehan Zhang
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn M. Leifheit
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Kimberley T. Lee
- Departments of Breast Oncology and Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Roland J. Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Darrell J. Gaskin
- Hopkins Center for Health Disparities Solutions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Dunlop AL, Burjak M, Dean LT, Alshawabkeh AN, Avalos LA, Aschner JL, Breton CV, Charifson MA, Cordero J, Dabelea D, D’Sa V, Duarte CS, Elliott AJ, Eick SM, Ferrara A, Fichorova RN, Ganiban JM, Gern JE, Hedderson MM, Herbstman JB, Hipwell AE, Huddleston KC, Karagas M, Karr C, Kerver JM, Koinis-Mitchell D, Lyall K, Madan J, Marsit C, McEvoy CT, Meeker JD, Oken E, O’Shea TM, Padula AM, Sathyanarayana S, Schantz S, Schmidt RJ, Snowden J, Stanford JB, Weiss S, Wright RO, Wright RJ, Zhang X, McGrath M. Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts. Front Public Health 2023; 11:1165089. [PMID: 38098826 PMCID: PMC10719953 DOI: 10.3389/fpubh.2023.1165089] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. Methods We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. Results After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. Conclusion In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.
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Affiliation(s)
- Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Mohamad Burjak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Akram N. Alshawabkeh
- Department of Civil and Environmental Engineering, College of Engineering, Northeastern University, Boston, MA, United States
| | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Judy L. Aschner
- Albert Einstein College of Medicine, Bronx, NY, United States
- Hackensack Meridian School of Medicine, Nutley, NJ, United States
| | - Carrie V. Breton
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, United States
| | - Mia A. Charifson
- Division of Epidemiology, New York University Langone Health Grossman School of Medicine, New York, NY, United States
| | - Jose Cordero
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Viren D’Sa
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Cristiane S. Duarte
- Division of Child and Adolescent Psychiatry, Columbia University-New York State Psychiatric Institute, New York, NY, United States
| | - Amy J. Elliott
- Avera Research Institute, Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Stephanie M. Eick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Raina N. Fichorova
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jody M. Ganiban
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, United States
| | - James E. Gern
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Monique M. Hedderson
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Julie B. Herbstman
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kathi C. Huddleston
- College of Health and Human Services, George Mason University, Fairfax, VA, United States
| | - Margaret Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Catherine Karr
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Jean M. Kerver
- Departments of Epidemiology and Biostatistics and Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Daphne Koinis-Mitchell
- Department of Pediatrics, Rhode Island Hospital and The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Kristen Lyall
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Juliette Madan
- Department of Epidemiology, Pediatrics and Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Carmen Marsit
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
| | - John D. Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Sheela Sathyanarayana
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Susan Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Rebecca J. Schmidt
- Department of Public Health Sciences, MIND Institute, University of California, Davis, Davis, CA, United States
| | - Jessica Snowden
- Departments of Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Scott Weiss
- Department of Medicine, Harvard School of Medicine, Boston, MA, United States
| | - Robert O. Wright
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rosalind J. Wright
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xueying Zhang
- Department of Pediatrics, The Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Dean LT. Correcting the Narrative Toward More Diverse & Inclusive Institutions. Am J Epidemiol 2023; 192:1933-1936. [PMID: 37470504 DOI: 10.1093/aje/kwad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
As the first anniversary of the inaugural Sherman A. James Diverse and Inclusive Epidemiology Award from the Society of Epidemiologic Research approaches, I present a transcript of that session.
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Dean LT, Zhang Y, McCleary RR, Dawit R, Thorpe RJ, Gaskin D. Health Care Expenditures for Black and White US Adults Living Under Similar Conditions. JAMA Health Forum 2023; 4:e233798. [PMID: 37921746 PMCID: PMC10625039 DOI: 10.1001/jamahealthforum.2023.3798] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/24/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Evidence suggests that racial disparities in health outcomes disappear or diminish when Black and White adults in the US live under comparable living conditions; however, whether racial disparities in health care expenditures concomitantly disappear or diminish is unknown. Objective To examine whether disparities in health care expenditures are minimized when Black and White US adults live in similar areas of racial composition and economic condition. Design, Setting, and Participants This cross-sectional study used a nationally representative sample of 7062 non-Hispanic Black or White adults who live in 2238 of 2275 US census tracts with a 5% or greater Black population and who participated in the Medical Expenditure Panel Study (MEPS) in 2016. Differences in total health care expenditures and 6 specific categories of health care expenditures were assessed. Two-part regression models compared expenditures between Black and White adults living in the same Index of Concentration at the Extremes (ICE) quintile, a measure of racialized economic segregation. Estimated dollar amount differences in expenditures were calculated. All analyses were weighted to account for the complex sampling design of the MEPS. Data analysis was performed from December 1, 2019, to August 7, 2023. Exposure Self-reported non-Hispanic Black or non-Hispanic White race. Main Outcomes and Measures Presence and amount of patient out-of-pocket and insurance payments for annual total health care expenditures; office-based, outpatient, emergency department, inpatient hospital, or dental visits; and prescription medicines. ICE quintile 5 (Q5) reflected tracts that were mostly high income with mostly White individuals, whereas Q1 reflected tracts that were mostly low income with mostly Black individuals. Results A total of 7062 MEPS respondents (mean [SD] age, 49 [18] years; 33.1% Black and 66.9% White; 56.1% female and 43.9% male) who lived in census tracts with a 5% or greater Black population in 2016 were studied. In Q5, Black adults had 56% reduced odds of having any health care expenditures (odds ratio, 0.44; 95% CI, 0.27-0.71) compared with White adults, at an estimated $2145 less per year, despite similar health status. Among those in Q5 with any expenditures, Black adults spent 30% less on care (cost ratio, 0.70; 95% CI, 0.56-0.86). In Q3 (most racially and economically integrated), differences in total annual health care spending were minimal ($79 annually; 95% CI, -$1187 to $1345). Conclusions and Relevance In this cross-sectional study of Black and White adults in the US, health care expenditure disparities diminished or disappeared under conditions of both racial and economic equity and equitable health care access; in areas that were mostly high income and had mostly White residents, Black adults spent substantially less. Results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending.
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Affiliation(s)
- Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Analysis Group Inc, New York, New York
| | - Rachael R. McCleary
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rahel Dawit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roland J. Thorpe
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
- Johns Hopkins Alzheimer’s Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Darrell Gaskin
- Johns Hopkins Center for Health Disparities Solutions, Baltimore, Maryland
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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9
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Geffen SR, Poteat T, Dean LT, Malone J, Greene N, Adams MA. Engaging Black sexual minority women in breast cancer research: Lessons in community partnerships. Cancer 2023; 129:3439-3447. [PMID: 37489804 PMCID: PMC10592156 DOI: 10.1002/cncr.34960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Black sexual minority women (BSMW) face significant breast cancer health inequities and are underrepresented in health research because of historical and present-day exclusion. However, there exists no peer-reviewed literature on best practices for the inclusion of BSMW in cancer research. "Our Breast Health: The Access Project" was a national primary data collection study in June 2018 through October 2019 that aimed to identify facilitators and barriers to breast cancer care among BSMW, and that successfully recruited the highest number of BSMW for any national breast cancer screening study at the time of its publication. METHODS The present analysis highlights best practices for reaching BSMW by examining by how effective various recruitment sources were at recruiting BSMW. Recruitment partners were grouped into several categories: (1) cancer focused, (2) Black women or sexual minority women focused, (3) BSMW focused, (4) social media, and (5) other. Then logistic regression was used to estimate the odds that a particular recruitment source category could recruit BSMW compared with other categories. RESULTS Partnerships with community-based organizations led by and intended for BSMW were the most successful at recruiting BSMW, demonstrating the importance of an intersectional approach to recruitment. Community-based organizations focused on BSMW specifically were 26 times more successful in recruiting BSMW to the study compared with recruiting Black women who were not sexual minorities (odds ratio, 26.43 [95% CI, 7.50-93.10]). CONCLUSIONS Successful recruitment enables breast cancer research grounded in the perspectives of BSMW, which can generate key findings that have the potential to remedy longstanding health inequities for this population.
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Affiliation(s)
- Sophia R Geffen
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- CHOP, Philadelphia, Pennsylvania, USA
| | - Tonia Poteat
- University of North Carolina at Chapel Hill School of Medicine, Department of Social Medicine, Chapel Hill, North Carolina, USA
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Johns Hopkins University Bloomberg School of Public Health, Epidemiology, Baltimore, Maryland, USA
| | - Jowanna Malone
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Naomi Greene
- Johns Hopkins University Bloomberg School of Public Health, Health, Behavior and Society, Baltimore, Maryland, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, Atlanta, Georgia, USA
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10
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Dean LT, Chung SE, Gross AL, Clay OJ, Willis SL, Crowe M, McDonough IM, Thomas KR, Marsiske M, Aysola J, Thorpe RJ, Felix C, Berkowitz M, Coe NB. Does Consumer Credit Precede or Follow Changes in Cognitive Impairment Among Older Adults? An Investigation in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Trial. J Aging Health 2023; 35:84S-94S. [PMID: 37994853 DOI: 10.1177/08982643221113715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVES We assessed the relationships between pre- and post-morbid consumer credit history (credit scores, debts unpaid, or in collections) and classification of mild (or greater) cognitive impairment (MCI). METHODS Generalized Estimating Equation models assessed pre-and post-morbid credit history and MCI risk among 1740 participants aged 65+ in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, linked to TransUnion consumer credit data. RESULTS Each 50-point increase in credit score was associated with up to 8% lower odds of MCI in the next 3 years. In contrast, new unpaid collections over doubled the odds of having MCI in the next 3 years. MCI was associated with subsequent credit score declines and a 47%-71% greater risk of having a new unpaid collection in the next 4 years. DISCUSSION Credit declines may signal risk for future MCI. MCI may lead to financial challenges that warrant credit monitoring interventions for older adults.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shang-En Chung
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Alabama at Birmingham Alzheimer's Disease Research Center, Birmingham, AL, USA
| | | | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ian M McDonough
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Kelsey R Thomas
- VA San Diego Healthcare System and Department of Psychiatry, San Diego School of Medicine, University of California, San Diego, CA, USA
| | | | - Jaya Aysola
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Cynthia Felix
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa Berkowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Norma B Coe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Feger DM, Willis SL, Deal J, Dean LT, Gross AL. Disparities in First Instrumental Activity of Daily Living Difficulty between Black and White Older Adults: Findings from the Advanced Cognitive Training in Independent and Vital Elderly Study. J Aging Health 2023; 35:51S-58S. [PMID: 34047230 PMCID: PMC8805632 DOI: 10.1177/08982643211023005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Few studies have examined differences in age of onset of first self-reported instrumental activities of daily living difficulty, much less differences by race. Our objective was to determine whether there are differences in the first reported difficulty with IADLs between Black and white older adults. Methods: We analyzed data from N = 1168 participants in the Advanced Cognitive Training in Independent and Vital Elderly (ACTIVE) study. A multiple group discrete-time multiple-event process survival mixture (MEPSUM) model was used to estimate the hazard of incident IADL difficulty in seven IADL task groups. Results: No statistically significant differences were identified in the first reported IADL task group difficulty between Black and white older adults. Discussion: Our findings indicate similar patterns of early IADL difficulty in Black and white older adults, suggesting that previously reported racial disparities in ability to perform IADLs may be attributable to differences in absolute risk, not timing.
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Affiliation(s)
- Danielle M. Feger
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sherry L. Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jennifer Deal
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alden L. Gross
- Center on Aging and Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Clay OJ, Ball KK, Wheeler KM, Crowe M, Marsiske M, Dean LT, Thorpe RJ, Jones R, Owens JH, Rebok GW, Willis SL. Evaluating Social Determinants of Health Domains and Their Predictive Validity Within Black/African American and White Older Adults From the ACTIVE Trial. J Aging Health 2023; 35:11S-18S. [PMID: 35758171 DOI: 10.1177/08982643221111205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess domains of social determinants of health (SDoH) and their associations with cognition and quality of life. METHOD This investigation uses baseline data from individuals participating in the ACTIVE trial (n = 2505) to reproduce the SDoH domains described in Healthy People 2030 (economic stability, health care, education, neighborhood and built environment, and social and community context). Results: Results support using data from the ACTIVE trial to assess all five SDoH domains, and the ability of the composites to predict baseline performance on measures of cognition and self-reported quality of life within a sample of older adults. Additionally, higher SDoH domain scores were associated with better functioning on composite measures of cognition and higher scores for mental and general health-related quality of life with Access to Healthcare associated with all outcomes. Discussion: These findings can inform investigators interested in assessing multiple domains of SDoH and highlight the importance of access to health care within older Black/African American and White older adults.
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Affiliation(s)
- Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Al, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, Al, USA
- UAB Alzheimer's Disease Research Center, Birmingham, Al, USA
| | - Karlene K Ball
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Al, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, Al, USA
| | - Katie M Wheeler
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Al, USA
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, Al, USA
- Deep South Resource Center for Minority Aging Research, Birmingham, Al, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
| | - Richard Jones
- Department of Psychiatry and Human Behavioral, Brown University, Providence, RI, USA
| | - Joshua H Owens
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - George W Rebok
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center on Aging and Health, Baltimore, MD, USA
| | - Sherry L Willis
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Oyedele NK, Lansey DG, Chiew C, Chan C, Quon H, Dean LT. Development and Testing of a Mobile App to Collect Social Determinants of Health Data in Cancer Settings: Interview Study. JMIR Form Res 2023; 7:e48737. [PMID: 37707880 PMCID: PMC10540013 DOI: 10.2196/48737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems' current technological solutions for identifying and managing patients' SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify. OBJECTIVE We developed and tested a patient-centric SDOH screening tool designed for use on patients' personal mobile phone that preserves patient privacy and confidentiality, collects information about the unmet social needs of patients with cancer, and communicates them to the provider. METHODS We interviewed 22 patients with cancer, oncologists, and social workers associated with a US-based comprehensive cancer center to better understand how patients' SDOH information is collected and reported. After triangulating data obtained from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed an SDOH screening tool mobile app and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members at the same cancer center. We collected patient SDOH data using 36 survey items covering 7 SDOH domains and used validated scales and follow-up interviews to assess the app's usability and acceptability among patients and cancer care team members. RESULTS Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources could be useful and valuable. In the pilot study, 25% (4/16) of app-using patients reported having at least one of the abovementioned social needs; the most common social need was social isolation (7/16, 44%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy but suggested that the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app. CONCLUSIONS Use of a brief, patient-centric, mobile app-based SDOH screening tool can effectively capture SDOH of patients with cancer for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs.
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Affiliation(s)
- Natasha K Oyedele
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Dina G Lansey
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Cupid Chan
- Pistevo Decision, Herndon, VA, United States
| | - Harry Quon
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Pistevo Decision, Herndon, VA, United States
- Department of Radiation Oncology and Molecular Radiation Sciences, Baltimore, MD, United States
- Departments of Epidemiology and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lorraine T Dean
- Departments of Epidemiology and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
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Villalonga-Olives E, Majercak KR, Wang W, Dean LT, Ransome Y. Different Responses to Social Capital Among Black People and White People: What Racial Differential Item Functioning Reveals for Racial Health Equity. Am J Epidemiol 2023; 192:1264-1273. [PMID: 36928913 DOI: 10.1093/aje/kwad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/02/2022] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
Social capital has been conceptualized as features of social organization, such as networks, and norms that facilitate coordination and cooperation for mutual benefit. Because of long-standing anti-Black structural oppression in the United States, social capital may be associated with health differently for Black people than for other racial/ethnic groups. Our aim was to examine the psychometric properties of social capital indicators, comparing responses from Black and White people to identify whether there is differential item functioning (DIF) in social capital according to race. DIF examines how items are related to a latent construct and whether this relationship differs across groups such as different racial groups. We used data from respondents to the Southeastern Pennsylvania Household Health Survey in 2004, who lived in Philadelphia (n = 2,048), a city with a large Black population. We used item response theory analysis to test for racial DIF. We found DIF across the items, indicating measurement error, which could be related to the way these items were developed (i.e., based on cultural assumptions tested in mainstream White America). Hence, our findings underscore the need to interrogate the assumptions that underly existing social capital items through an equity-based lens, and to take corrective action when developing new items to ensure that they are racially and culturally congruent.
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15
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Ibanhes FH, Fenn N, Le Brazidec D, Napoleon S, Predmore Z, Skinner A, Zanowick-Marr A, Galipeau D, Raifman J, Dean LT, Chan PA. Sexually Transmitted Infections Risk and Interstate Sexual Networks Among Men Who Have Sex With Men in New England. Sex Transm Dis 2023; 50:494-498. [PMID: 37099419 PMCID: PMC10523949 DOI: 10.1097/olq.0000000000001823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
ABSTRACT By investigating relationships between sexual mobility and sexual transmitted infection (STI) risk factors among men who have sex with men, we found that STI history, number of sexual partners, and substance use are associated with increased odds of interstate sexual encounters, suggesting that interjurisdictional approaches to STI prevention are needed.
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Affiliation(s)
| | - Natalie Fenn
- Psychiatry and Human Behavior, Brown University, Providence, RI
| | | | | | | | | | | | | | - Julia Raifman
- Boston University School of Public Health, Boston, MA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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16
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Skinner A, Stein MD, Dean LT, Oldenburg CE, Mimiaga MJ, Chan PA, Mayer KH, Raifman J. Same-Sex Marriage Laws, Provider-Patient Communication, and PrEP Awareness and Use Among Gay, Bisexual, and Other Men Who have Sex with Men in the United States. AIDS Behav 2023; 27:1897-1905. [PMID: 36357809 PMCID: PMC10149581 DOI: 10.1007/s10461-022-03923-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/12/2022]
Abstract
State-level structural stigma and its consequences in healthcare settings shape access to pre-exposure prophylaxis (PrEP) for HIV prevention among gay, bisexual, and other men who have sex with men (GBMSM). Our objective was to assess the relationships between same-sex marriage laws, a measure of structural stigma at the state level, provider-patient communication about sex, and GBMSM awareness and use of PrEP. Using data from the Fenway Institute's MSM Internet Survey collected in 2013 (N = 3296), we conducted modified Poisson regression analyses to evaluate associations between same-sex marriage legality, measures of provider-patient communication, and PrEP awareness and use. Living in a state where same-sex marriage was legal was associated with PrEP awareness (aPR 1.27; 95% CI 1.14, 1.41), as were feeling comfortable discussing with primary care providers that they have had sex with a man (aPR 1.63; 95% CI 1.46, 1.82), discussing with their primary care provider having had condomless sex with a man (aPR 1.65; 95% CI 1.49, 1.82), and discussing with their primary care provider ways to prevent sexual transmission of HIV (aPR 1.39; 95% CI 1.26, 1.54). Each of these three measures of provider-patient communication were additionally associated with PrEP awareness and use. In sum, structural stigma was associated with reduced PrEP awareness and use. Policies that reduce stigma against GBMSM may help to promote PrEP and prevent HIV transmission.
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Affiliation(s)
- Alexandra Skinner
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
| | - Michael D Stein
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Matthew J Mimiaga
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Philip A Chan
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI, USA
| | | | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA
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17
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Ransome Y, Hayashi K, Gamble-George JC, Dean LT, Villalonga-Olives E. Racial and ethnic differences in the association of social cohesion and social capital with HIV testing. SSM Popul Health 2023; 21:101327. [PMID: 36618543 PMCID: PMC9811247 DOI: 10.1016/j.ssmph.2022.101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/24/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
HIV testing rates vary by race and ethnicity. Whether social capital indicators are related to HIV testing and whether these associations differ by race or ethnicity is unknown. Multivariable analysis was used to examine whether social capital (collective engagement and civic and social participation), including social cohesion (trust in neighbors, neighbors willing to help, feelings of belongingness) were associated with testing for HIV in the past 12 months. Participants were white, Black or African American, and Hispanic/Latino adults ages 18 to 44 (N = 2823) from the general population, in Philadelphia, PA who participated in the Southeastern Pennsylvania Household Health Surveys 2010 and 2012. Overall HIV testing in this sample was 42%, and was higher among women, and Black compared to white people. Mean social capital scores were significantly highest among whites. Greater trust in neighbors was associated with lower odds of testing for HIV (adjusted Odds Ratio[aOR]:0.61, 95% CI = 0.49-0.74), and this relationship varied by race/ethnicity, with stronger inverse associations among Hispanic/Latino (aOR = 0.43, p < 0.001) and white adults (aOR = 0.50, p < -0.001) than among Black adults (aOR = 0.75, p < 0.05). Greater neighborhood belongingness (aOR = 1.31, 95% CI = 1.11-1.54) and working together to improve the neighborhood (aOR = 1.33, 95%CI = 1.03-1.73) were associated with higher odds of testing for HIV. Different indicators of social capital were associated with higher as well as lower odds of testing for HIV. These patterns did not vary statistically by race or ethnicity. HIV testing prevention interventions will need to address social capital in design and implementation strategies.
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Affiliation(s)
- Yusuf Ransome
- Social and Behavioral Sciences, Yale University, School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT, 06520, USA
- Corresponding author. Yale School of Public Health, 60 College Street, LEPH 4 th Floor, New Haven, CT, 06520, USA.
| | - Kamden Hayashi
- Department of Health Behavior, University of North Carolina, Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Joyonna C. Gamble-George
- Behavioral Science Training in Drug Abuse Research, New York University Rory Meyers College of Nursing, 380 2nd Avenue, Suite 306, NY, 10010, USA
- Center for Interdisciplinary Research on AIDS, Yale University, School of Public Health, 135 College Street, Suite 200, New Haven, CT, 06510, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6650, Baltimore, MD, 21205, USA
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, 220 Arch Street, 12th Floor, Baltimore, MD, 21201, USA
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Le TK, Cha L, Gee G, Dean LT, Juon HS, Tseng W. Asian American Self-Reported Discrimination in Healthcare and Having a Usual Source of Care. J Racial Ethn Health Disparities 2023; 10:259-270. [PMID: 35018579 DOI: 10.1007/s40615-021-01216-z] [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: 08/19/2021] [Revised: 12/09/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Self-reported racial or ethnic discrimination in a healthcare setting has been linked to worse health outcomes and not having a usual source of care, but has been rarely examined among Asian ethnic subgroups. OBJECTIVE We examined the association between Asian ethnic subgroup and self-reported discrimination in a healthcare setting, and whether both factors were associated with not having a usual source of care. DESIGN Using the California Health Interview Survey (CHIS) 2015-2017, we used logistic regression models to assess associations among Asian ethnic subgroup, self-reported discrimination, and not having a usual source of care. Interactions between race and self-reported discrimination, foreign-born status, poverty level, and limited English proficiency were also analyzed. PARTICIPANTS Respondents represented adults age 18 + residing in California who identified as White, Black, Hispanic, American Indian/Alaska Native, Asian (including Chinese, Filipino, Japanese, Korean, Vietnamese, and Other Asian), and Other. MAIN MEASURES We examined two main outcomes: self-reported discrimination in a healthcare setting and having a usual source of care. KEY RESULTS There were 62,965 respondents. After survey weighting, Asians (OR 1.78, 95% CI 1.19-2.66) as an aggregate group were more likely to report discrimination than non-Hispanic Whites. When Asians were disaggregated, Japanese (3.12, 1.36-7.13) and Koreans (2.42, 1.11-5.29) were more likely to report discrimination than non-Hispanic Whites. Self-reported discrimination was marginally associated with not having a usual source of care (1.25, 0.99-1.57). Koreans were the only group associated with not having a usual source of care (2.10, 1.23-3.60). Foreign-born Chinese (ROR 7.42, 95% CI 1.7-32.32) and foreign-born Japanese (ROR 4.15, 95% CI 0.82-20.95) were more associated with self-reported discrimination than being independently foreign-born and Chinese or Japanese. CONCLUSIONS Differences in self-reported discrimination in a healthcare setting and not having a usual source of care were observed among Asian ethnic subgroups. Better understanding of these differences in their sociocultural contexts will guide interventions to ensure equitable access to healthcare.
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Affiliation(s)
- Thomas K Le
- School of Medicine, Johns Hopkins University, 733 N. Broadway, Suite 137 Miller Research Building, Baltimore, MD, 21205, USA.
| | - Leah Cha
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gilbert Gee
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Lorraine T Dean
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Winston Tseng
- Health Research for Action, Berkeley Public Health, University of California at Berkeley, Berkeley, CA, USA
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Uzzi M, Aune KT, Marineau L, Jones FK, Dean LT, Jackson JW, Latkin CA. An intersectional analysis of historical and contemporary structural racism on non-fatal shootings in Baltimore, Maryland. Inj Prev 2023; 29:85-90. [PMID: 36301795 PMCID: PMC9877125 DOI: 10.1136/ip-2022-044700] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/05/2022] [Indexed: 02/03/2023]
Abstract
Introduction Non-fatal shooting rates vary tremendously within cities in the USA. Factors related to structural racism (both historical and contemporary) could help explain differences in non-fatal shooting rates at the neighbourhood level. Most research assessing the relationship between structural racism and firearm violence only includes one dimension of structural racism. Our study uses an intersectional approach to examine how the interaction of two forms of structural racism is associated with spatial non-fatal shooting disparities in Baltimore, Maryland. Methods We present three additive interaction measures to describe the relationship between historical redlining and contemporary racialized economic segregation on neighbourhood-level non-fatal shootings. Results Our findings revealed that sustained disadvantage census tracts (tracts that experience contemporary socioeconomic disadvantage and were historically redlined) have the highest burden of non-fatal shootings. Sustained disadvantage tracts had on average 24 more non-fatal shootings a year per 10 000 residents compared with similarly populated sustained advantage tracts (tracts that experience contemporary socioeconomic advantage and were not historically redlined). Moreover, we found that between 2015 and 2019, the interaction between redlining and racialized economic segregation explained over one-third of non-fatal shootings (approximately 650 shootings) in sustained disadvantage tracts. Conclusion These findings suggest that the intersection of historical and contemporary structural racism is a fundamental cause of firearm violence inequities in Baltimore. Intersectionality can advance injury prevention research and practice by (1) serving as an analytical tool to expose inequities in injury-related outcomes and (2) informing the development and implementation of injury prevention interventions and policies that prioritise health equity and racial justice.
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Affiliation(s)
- Mudia Uzzi
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Gun Violence Solutions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kyle T Aune
- Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lea Marineau
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Forrest K Jones
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rajaprakash M, Dean LT, Palmore M, Johnson SB, Kaufman J, Fallin DM, Ladd-Acosta C. DNA methylation signatures as biomarkers of socioeconomic position. Environ Epigenet 2022; 9:dvac027. [PMID: 36694711 PMCID: PMC9869656 DOI: 10.1093/eep/dvac027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/22/2022] [Accepted: 12/13/2022] [Indexed: 06/12/2023]
Abstract
This review article provides a framework for the use of deoxyribonucleic acid (DNA) methylation (DNAm) biomarkers to study the biological embedding of socioeconomic position (SEP) and summarizes the latest developments in the area. It presents the emerging literature showing associations between individual- and neighborhood-level SEP exposures and DNAm across the life course. In contrast to questionnaire-based methods of assessing SEP, we suggest that DNAm biomarkers may offer an accessible metric to study questions about SEP and health outcomes, acting as a personal dosimeter of exposure. However, further work remains in standardizing SEP measures across studies and evaluating consistency across domains, tissue types, and time periods. Meta-analyses of epigenetic associations with SEP are offered as one approach to confirm the replication of DNAm loci across studies. The development of DNAm biomarkers of SEP would provide a method for examining its impact on health outcomes in a more robust way, increasing the rigor of epidemiological studies.
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Affiliation(s)
- Meghna Rajaprakash
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD 21205, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Lorraine T Dean
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Meredith Palmore
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Joan Kaufman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Daniele M Fallin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Sosnowy C, Predmore Z, Dean LT, Raifman J, Chu C, Galipeau D, Nocka K, Napoleon S, Chan P. Paying for PrEP: A qualitative study of cost factors that impact pre-exposure prophylaxis uptake in the US. Int J STD AIDS 2022; 33:1199-1205. [PMID: 36271632 PMCID: PMC9912748 DOI: 10.1177/09564624221132406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concerns about the actual and perceived costs of pre-exposure prophylaxis (PrEP) continue to be a major barrier to uptake among gay, bisexual and men who have sex with men (GBMSM) in the United States. METHODS We conducted semi-structured interviews with 25 GBMSM who presented for routine health care at a STD clinic in the northeastern United States. The cohort included GBMSM who were or were not currently taking PrEP and represented varied health care coverage and financial resources. We used a structured coding scheme to analyze transcripts and identify themes relevant to cost factors. RESULTS Participants shared their perspectives about PrEP and their experiences with accessing and paying for PrEP. Our findings suggest that health care coverage or financial assistance were essential to PrEP access but were not easily accessible to all people and did not always cover all costs. Therefore, paying for PrEP had to be balanced with other life expenses. Participants had multiple sources for information about PrEP cost and assistance from clinic and pharmacy staff helped reduce burden and resolve difficulties. CONCLUSION Addressing gaps in health care coverage, providing financial support, and improving the enrollment process in a financial assistance program may improve PrEP uptake.
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Affiliation(s)
| | - Zachary Predmore
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- The RAND Corporation, Boston, MA, USA
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Christina Chu
- Department of Medicine, Brown University, Providence, RI, USA
| | - Drew Galipeau
- Department of Medicine, Brown University, Providence, RI, USA
| | - Kristen Nocka
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Siena Napoleon
- Department of Medicine, Brown University, Providence, RI, USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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22
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Islam JY, Turner K, Saeb H, Powell M, Dean LT, Camacho-Rivera M. Financial hardship and mental health among cancer survivors during the COVID-19 pandemic: An analysis of the US COVID-19 Household Impact Survey. Front Public Health 2022; 10:946721. [PMID: 36483249 PMCID: PMC9723235 DOI: 10.3389/fpubh.2022.946721] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Our objective was to (1) identify associated characteristics of financial hardship (FH), and (2) evaluate associations of FH with mental health symptoms among cancer survivors during the COVID-19 pandemic. Methods Using data from the nationally representative COVID-19 Impact Survey, we defined cancer survivors as those with a self-reported diagnosis of cancer (n = 854,7.6%). We defined FH using the following question: "Based on your current financial situation, how would you pay for an unexpected $400 expense?" Multivariable Poisson regression was used to estimate adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) to identify associated characteristics of FH and associations of FH with mental health symptoms among cancer survivors overall and by age (18-59 years/60+ years). Results Forty-one percent of cancer survivors reported FH, with 58% in 18-59 and 33% in 60+ year old respondents. Compared to cancer survivors aged 60+ years, those aged 30-44 (aPR:1.74,95% CI:1.35-2.24), and 45-59 years (aPR:1.60,95% CI:1.27-1.99) were more likely to report FH. Compared to non-Hispanic(NH)-White cancer survivors, NH-Black cancer survivors had a 56% higher prevalence of FH (aPR:1.56; 95% CI: 1.23-1.97). Among 60+ years aged cancer survivors, NH-Black (aPR:1.80; 95% CI: 1.32-2.45) and NH-Asian cancer survivors (aPR:10.70,95% CI:5.6-20.7) were more likely to experience FH compared to their NH-White counterparts. FH was associated with feeling anxious (aPR:1.51,95% CI:1.11-2.05), depressed (aPR:1.66,95% CI:1.25-2.22), and hopeless (aPR:1.84,95% CI:1.38-2.44). Conclusion Minoritized communities, younger adults, and cancer survivors with low socioeconomic status had a higher burden of FH, which was associated with feelings of anxiety, depression, and hopelessness.
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Affiliation(s)
- Jessica Y. Islam
- Cancer Epidemiology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,*Correspondence: Jessica Y. Islam
| | - Kea Turner
- Department of Oncological Sciences, University of South Florida, Tampa, FL, United States,Health Outcomes and Behavior Department, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States,Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Huda Saeb
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Margaux Powell
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Lorraine T. Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States,Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Marlene Camacho-Rivera
- Department of Community Health Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
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Raifman J, Ettman CK, Dean LT, Abdalla SM, Skinner A, Barry CL, Galea S. Economic precarity, loneliness, and suicidal ideation during the COVID-19 pandemic. PLoS One 2022; 17:e0275973. [PMID: 36383566 PMCID: PMC9668199 DOI: 10.1371/journal.pone.0275973] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
The US population faced stressors associated with suicide brought on by the COVID-19 pandemic. Understanding the relationship between stressors and suicidal ideation in the context of the pandemic may inform policies and programs to prevent suicidality and suicide. We compared suicidal ideation between two cross-sectional, nationally representative surveys of adults in the United States: the 2017-2018 National Health and Nutrition Examination Survey (NHANES) and the 2020 COVID-19 and Life Stressors Impact on Mental Health and Well-being (CLIMB) study (conducted March 31 to April 13). We estimated the association between stressors and suicidal ideation in bivariable and multivariable Poisson regression models with robust variance to generate unadjusted and adjusted prevalence ratios (PR and aPR). Suicidal ideation increased from 3.4% in the 2017-2018 NHANES to 16.3% in the 2020 CLIMB survey, and from 5.8% to 26.4% among participants in low-income households. In the multivariable model, difficulty paying rent (aPR: 1.5, 95% CI: 1.2-2.1) and feeling alone (aPR: 1.9, 95% CI: 1.5-2.4) were associated with suicidal ideation but job loss was not (aPR: 0.9, 95% CI: 0.6 to 1.2). Suicidal ideation increased by 12.9 percentage points and was almost 4.8 times higher during the COVID-19 pandemic. Suicidal ideation was more prevalent among people facing difficulty paying rent (31.5%), job loss (24.1%), and loneliness (25.1%), with each stressor associated with suicidal ideation in bivariable models. Difficulty paying rent and loneliness were most associated with suicidal ideation. Policies and programs to support people experiencing economic precarity and loneliness may contribute to suicide prevention.
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Affiliation(s)
- Julia Raifman
- Boston University School of Public Health, Boston, MA, United States of America
| | - Catherine K. Ettman
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Lorraine T. Dean
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Salma M. Abdalla
- Boston University School of Public Health, Boston, MA, United States of America
| | - Alexandra Skinner
- Brown University School of Public Health, Providence, RI, United States of America
| | - Colleen L. Barry
- Cornell Jeb E. Brooks School of Public Policy, Ithaca, NY, United States of America
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, United States of America
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Johnson RM, Hill AV, Jones VC, Powell TW, Dean LT, Gilreath TD. Racial/Ethnic Inequities in Adverse Childhood Experiences and Selected Health-Related Behaviors and Problems Among Maryland Adolescents. Health Promot Pract 2022; 23:935-940. [PMID: 33899564 PMCID: PMC8542051 DOI: 10.1177/15248399211008238] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We examined racial/ethnic inequities in the prevalence of adverse childhood experiences (ACEs) and examined the association between ACEs and selected health-related behaviors and problems. Data for this cross-sectional study come from the 2018 Maryland Youth Risk Behavior Survey/Youth Tobacco Survey, a statewide survey of high school students (n = 40,188). ACEs included caregiver verbal abuse and household food insecurity, substance use or gambling, mental illness, and involvement with the criminal justice system. We estimated the prevalence of ACEs overall and by race/ethnicity, and then used multiple logistic regression to determine associations between ACEs and emotional/behavioral problems, adjusting for race/ethnicity. Outcome variables included emotional distress, poor school performance, suicidal ideation, fighting, alcohol use, and marijuana use. More than one fifth of students reported each individual ACE. Differences in the prevalence of ACEs by race/ethnicity were statistically significant (p < .001). More than one fourth (25.8%) reported one of the five ACEs, 15.1% reported two, and 15.4% reported three or more. For each ACE, reporting having experienced it (vs. not) was associated with a >30% higher prevalence for each of the outcome variables. Among students who reported three or more ACEs (relative to none), the odds of emotional distress and suicidal ideation were more than 8 times greater. Among Maryland adolescents, ACEs are common, are inequitably distributed by race/ethnicity, and are strongly linked to behavioral health. Findings suggest the need to monitor ACEs as a routine component of adolescent health surveillance and to refocus assessment and intervention toward "upstream" factors that shape adolescent health.
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Affiliation(s)
- Renee M. Johnson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ashley V. Hill
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Vanya C. Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Ransome Y, Luan H, Dean LT, Quick H, Nassau T, Kawachi I, Brady KA. Is race-specific neighborhood social cohesion key to reducing racial disparities in late HIV diagnosis: A multiyear ecological study. Spat Spatiotemporal Epidemiol 2022; 42:100508. [PMID: 35934322 PMCID: PMC9912753 DOI: 10.1016/j.sste.2022.100508] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/01/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
We examined whether race/ethnic-specific social cohesion is associated with race/ethnic-specific HIV diagnosis rates using Bayesian space-time zero-inflated Poisson multivariable models, across 376 Census tracts. Social cohesion data were from the Southeastern Pennsylvania Household Health Survey, 2008-2015 and late HIV diagnosis data from eHARS system, 2009-2016. Areas where trust in neighbors reported by Black/African Americans was medium (compared to low) had lower rates of late HIV diagnosis among Black/African Americans (Relative Risk (RR)=0.52, 95% credible interval (CrI)= 0.34, 0.80). In contrast, areas where trust in neighbors reported by Black/African Americans were highest had lower late HIV diagnosis rates among Whites (RR=0.35, 95% CrI= 0.16, 0.76). Race/ethnic-specific differences in social cohesion may have implications for designing interventions aimed at modifying area-level social factors to reduce racial disparities in late HIV diagnosis.
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Affiliation(s)
- Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT 06520.
| | - Hui Luan
- Department of Geography, Spatial Cognition, Computation, and Complexity (S3C) Lab, University of Oregon, 107D Condon Hall, 1251 University of Oregon, Eugene OR, 97403; School of Geodesy and Geomatics, Wuhan University, 129 Luoyu Road, Wuchang District, Wuhan, Hubei, China, 430079
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, E6650, Baltimore, MD, 21205
| | - Harrison Quick
- Department of Epidemiology and Biostats, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104
| | - Tanner Nassau
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, 1101 Market St., 8th Floor, Philadelphia, PA, 19107
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building 7th Floor, Boston MA, 02115
| | - Kathleen A Brady
- AIDS Activities Coordinating Office, Philadelphia Department of Public Health, 1101 Market St., 8th Floor, Philadelphia, PA, 19107
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Dean LT, Thorpe RJ. What Structural Racism Is (or Is Not) and How to Measure It: Clarity for Public Health and Medical Researchers. Am J Epidemiol 2022; 191:1521-1526. [PMID: 35792088 PMCID: PMC9437815 DOI: 10.1093/aje/kwac112] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [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: 02/10/2022] [Revised: 05/26/2022] [Accepted: 06/23/2022] [Indexed: 01/29/2023] Open
Abstract
Interest in studying structural racism's impacts on health has grown exponentially in recent years. Across these studies, there is much heterogeneity in the definition and measurement of structural racism, leading to mixed interpretations of structural racism's impact on health. A precise definition of structural racism can offer conceptual clarity to inform what mechanisms to investigate and is imperative for conducting high-quality research on it and dismantling it. In this commentary, we trace the evolution of the definitions of structural racism and suggest ways in which the measurement of structural racism should move forward given these definitions.
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Affiliation(s)
- Lorraine T Dean
- Correspondence to Dr. Lorraine T. Dean, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6650, Baltimore, MD 21205 (e-mail: )
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Abstract
Hearing health is inextricably linked to factors beyond biology. Social, demographic, environmental, geographic, and historical influences affect hearing health, but these factors are often unmeasured within traditional biological, clinical, and epidemiological studies of hearing health. With increasing recognition of hearing health over the life course as a public health priority, there is also a growing understanding of existing hearing health inequities at the individual, community, national, and global levels. To make progress in addressing these inequities, public health disciplines, such as social epidemiology, can provide valuable frameworks. With a focus on integrating the biological and functional with social and structural factors influencing health, social epidemiology provides key concepts and approaches for filling existing research and practice gaps. In this review, we introduce the discipline of social epidemiology and its associated concepts to inspire greater cross-disciplinary collaboration for the ultimate goal of advancing hearing health equity.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan J Suen
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Skinner A, Flannery K, Nocka K, Bor J, Dean LT, Jay J, Lipson SK, Cole MB, Benfer EA, Scheckman R, Raderman W, Jones DK, Raifman J. A database of US state policies to mitigate COVID-19 and its economic consequences. BMC Public Health 2022; 22:1124. [PMID: 35659285 PMCID: PMC9166228 DOI: 10.1186/s12889-022-13487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Since COVID-19 first appeared in the United States (US) in January 2020, US states have pursued a wide range of policies to mitigate the spread of the virus and its economic ramifications. Without unified federal guidance, states have been the front lines of the policy response. Main text We created the COVID-19 US State Policy (CUSP) database (https://statepolicies.com/) to document the dates and components of economic relief and public health measures issued at the state level in response to the COVID-19 pandemic. Documented interventions included school and business closures, face mask mandates, directives on vaccine eligibility, eviction moratoria, and expanded unemployment insurance benefits. By providing continually updated information, CUSP was designed to inform rapid-response, policy-relevant research in the context of the COVID-19 pandemic and has been widely used to investigate the impact of state policies on population health and health equity. This paper introduces the CUSP database and highlights how it is already informing the COVID-19 pandemic response in the US. Conclusion CUSP is the most comprehensive publicly available policy database of health, social, and economic policies in response to the COVID-19 pandemic in the US. CUSP documents widespread variation in state policy decisions and implementation dates across the US and serves as a freely available and valuable resource to policymakers and researchers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13487-0.
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Abstract
This review aims to delineate the role of structural racism in the formation and accumulation of social capital and to describe how social capital is leveraged and used differently between Black and White people as a response to the conditions created by structural racism. We draw on critical race theory in public health praxis and restorative justice concepts to reimagine a race-conscious social capital agenda. We document how American capitalism has injured Black people and Black communities' unique construction of forms of social capital to combat systemic oppression. The article proposes an agenda that includes communal restoration that recognizes forms of social capital appreciated and deployed by Black people in the United States that can advance health equity and eliminate health disparities. Developing a race-conscious social capital framing that is inclusive of and guided by Black community members and academics is critical to the implementation of solutions that achieve racial and health equity and socioeconomic mobility.
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Affiliation(s)
- Keon L Gilbert
- Department of Behavioral Health Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA; ,
- Governance Studies, The Brookings Institution, Washington, DC
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA;
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA;
| | - Jerell DeCaille
- Department of Behavioral Health Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA; ,
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA;
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Gilman SE, Aiello A, Galea S, Howe CJ, Kawachi I, Lovasi GS, Dean LT, Oakes JM, Siddiqi A, Glymour MM. Advancing the Social Epidemiology Mission of the American Journal of Epidemiology. Am J Epidemiol 2022; 191:557-560. [PMID: 34791025 DOI: 10.1093/aje/kwab277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/15/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Social epidemiology is concerned with how social forces influence population health. Rather than focusing on a single disease (as in cancer or cardiovascular epidemiology) or a single type of exposure (e.g., nutritional epidemiology), social epidemiology encompasses all the social and economic determinants of health, both historical and contemporary. These include features of social and physical environments, the network of relationships in a society, and the institutions, politics, policies, norms and cultures that shape all of these forces. This commentary presents the perspective of several editors at the Journal with expertise in social epidemiology. We articulate our thinking to encourage submissions to the Journal that: 1) expand knowledge of emerging and underresearched social determinants of population health; 2) advance new empirical evidence on the determinants of health inequities and solutions to advance health equity; 3) generate evidence to inform the translation of research on social determinants of health into public health impact; 4) contribute to innovation in methods to improve the rigor and relevance of social epidemiology; and 5) encourage critical self-reflection on the direction, challenges, successes, and failures of the field.
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Yi JS, Garcia Morales EE, Betz JF, Deal JA, Dean LT, Du S, Goman AM, Griswold ME, Palta P, Rebok GW, Reed NS, Thorpe RJ, Lin FR, Nieman CL. Individual Life-Course Socioeconomic Position and Hearing Aid Use in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2022; 77:645-653. [PMID: 35239947 PMCID: PMC8893260 DOI: 10.1093/gerona/glab273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To measure the association between individual life-course socioeconomic position (SEP) and hearing aid use, we examined childhood and adulthood socioeconomic variables collected at the Atherosclerosis Risk in Communities (ARIC) study baseline visit (1987-1989)/Life Course Socioeconomic Status study (2001-2002) and hearing aid use data collected at visit 6 (2016-2017). METHODS ARIC is a prospective cohort study of older adults (45-64 years) recruited from 4 U.S. communities. This analysis included a subset of 2 470 participants with hearing loss at visit 6 (≥25 decibels hearing level [dB HL] better-ear) with complete hearing aid use data. Childhood SEP variables included parental education, parental occupation, and parental home ownership. Young and older adulthood SEP variables included income, education, occupation, and home ownership. Each life epoch was assigned a score ranging from 0 to 5 and then summed to calculate the individual cumulative SEP score. Multivariable-adjusted logistic regression was used to estimate the association between individual cumulative SEP and hearing aid use. Missing SEP scores were imputed for participants with incomplete socioeconomic data. RESULTS Of the 2 470 participants in the analytic cohort (median [interquartile interval] age 79.9 [76.7-84.0], 1 330 [53.8%] women, 450 [18.2%] Black), 685 (27.7%) participants reported hearing aid use. Higher cumulative SEP was positively associated with hearing aid use (odds ratio [OR] = 1.09, 95% confidence interval [CI]: 1.04-1.14), and slightly stronger for childhood (OR = 1.09, 95% CI: 1.00-1.20) than older adulthood SEP score (OR = 1.06, 95% CI: 0.95-1.18). CONCLUSIONS In this community-based cohort of older adults with hearing loss, higher individual life-course SEP was positively associated with hearing aid use.
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Affiliation(s)
- Julie S Yi
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emmanuel E Garcia Morales
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joshua F Betz
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Simo Du
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adele M Goman
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael E Griswold
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Priya Palta
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, New York, USA
| | - George W Rebok
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Connor AE, Kaur M, Dibble KE, Visvanathan K, Dean LT, Hayes JH. Racialized Economic Segregation and Breast Cancer Mortality among Women in Maryland. Cancer Epidemiol Biomarkers Prev 2022; 31:413-421. [PMID: 34862211 PMCID: PMC8825681 DOI: 10.1158/1055-9965.epi-21-0923] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Our objective was to determine the association between racialized economic segregation and the hazard of breast cancer mortality in Maryland. METHODS Among 35,066 women (24,540 White; 10,526 Black) diagnosed with incident invasive breast cancer in Maryland during 2007 to 2017, exposure to racialized economic segregation was measured at the census tract level using Index of Concentration at the Extremes metrics. HRs and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression for the association between racialized economic segregation and the hazard of breast cancer mortality, accounting for clustering at the census tract level. Models were adjusted for age and stratified by race, median age (<60 years, ≥60 years), and clinical characteristics. RESULTS Overall, the hazard of breast cancer mortality was 1.84 times as high (95% CI, 1.64-2.06) for the least privileged quintile of racialized economic segregation compared with the most privileged quintile. This association differed significantly (P interaction< 0.05) by race and age, with 1.20 (95% CI, 0.90-1.60) times the hazard of breast cancer mortality for Black women versus 1.66 (95% CI, 1.41-1.95) times the hazard for White women, and with greater hazards for younger women (HR, 2.17; 95% CI, 1.83-2.57) than older women (HR, 1.62; 95% CI, 1.40-1.88). CONCLUSIONS Our results suggest that breast cancer survival disparities exist in Maryland among women residing in the least privileged census tracts with lower income households and higher proportions of Black residents. IMPACT Our findings provide new insights into the breast cancer mortality disparities observed among women in Maryland.
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Affiliation(s)
- Avonne E Connor
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Maneet Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kate E Dibble
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Lorraine T Dean
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Jennifer H Hayes
- Maryland Cancer Registry and Prevention & Health Promotion Administration, Maryland Department of Health, Baltimore, Maryland
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Dean LT, Chang HY, Goedel WC, Chan PA, Doshi JA, Nunn AS. Novel population-level proxy measures for suboptimal HIV preexposure prophylaxis initiation and persistence in the USA. AIDS 2021; 35:2375-2381. [PMID: 34723852 PMCID: PMC8564020 DOI: 10.1097/qad.0000000000003030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In the United States (USA), HIV preexposure prophylaxis (PrEP) use is suboptimal. Population-level metrics on PrEP use are limited and focus on prescriptions issued rather than how much prescriptions are picked up. We introduce PrEP reversals, defined as when patients fail to pick up PrEP prescriptions at the pharmacy point-of-sale, as a proxy for PrEP initiation and persistence. DESIGN We analysed PrEP pharmacy claims and HIV diagnoses from a Symphony Health Solutions dataset across all US states from 1 October 2015 to 30 September 2019. METHODS We calculated the percentage of individuals who were newly prescribed PrEP and who reversed (i.e. patient did not pick up an insurance-approved prescription and pharmacy withdrew the claim), delayed (reversed and then picked up within 90 days), very delayed (reversed and then picked up between 90 and 365 days) or abandoned (not picked up within 365 days), and subsequent HIV diagnosis within 365 days. RESULTS Of 59 219 individuals newly prescribed PrEP, 19% reversed their index prescription. Among those, 21% delayed initiation and 8% had very delayed initiation. Seventy-one percent of patients who reversed their initial prescription abandoned it, 6% of whom were diagnosed with HIV---three times higher than those who persisted on PrEP. CONCLUSION Nearly one in five patients newlyprescribed PrEP reversed initial prescriptions, leading to delayed medication access, being lost to PrEP care, and dramatically higher HIV risk. Reversals could be used for real-time nationwide PrEP population-based initiation and persistence tracking, and for identifying patients that might otherwise be lost to care.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hsien-Yen Chang
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Philip A Chan
- Department of Medicine, Brown University
- Rhode Island Department of Health
- Rhode Island Public Health Institute, Providence, Rhode Island
| | - Jalpa A Doshi
- Perelman School of Medicine
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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Lesko CR, Menezes NP, Dean LT, Telljohann H, Biddle LE, Schisterman EF, OBOTEB. What Happens to Your Manuscript: Characteristics of Papers Published in Volume 189. Am J Epidemiol 2021. [DOI: 10.1093/aje/kwab197] [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: 11/12/2022] Open
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Poteat TC, Adams MA, Malone J, Geffen S, Greene N, Nodzenski M, Lockhart AG, Su IH, Dean LT. Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States. Cancer 2021; 127:3514-3522. [PMID: 34287838 DOI: 10.1002/cncr.33629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/10/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation. METHODS This online, cross-sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data. RESULTS BSMW (n = 101) had the highest prevalence of care delays with 5.17-fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43-fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay. CONCLUSIONS Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum.
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Affiliation(s)
- Tonia C Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, Atlanta, Georgia
| | - Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sophia Geffen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Naomi Greene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michael Nodzenski
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexandre G Lockhart
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - I-Hsuan Su
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Abstract
Objective Black/African American people have long reported high, albeit warranted, distrust of the US health care system (HCS); however, Blacks/African Americans are not a homogenous racial/ethnic group. Little information is available on how the subgroup of Black Americans whose families suffered under US chattel slavery, here called Descendants of Africans Enslaved in the United States (DAEUS), view health care institutions. We compared knowledge of unethical treatment and HCS distrust among DAEUS and non-DAEUS. Design and Setting A cross-sectional random-digit dialing survey was administered in 2005 to Blacks/African Americans, aged 21-75 years, from the University of Pennsylvania Clinical Practices in Philadelphia, Penn. Participants Blacks/African Americans self-reported a family history of persons enslaved in the US (DAEUS) or no family history of persons enslaved in the US (non-DAEUS). Main Outcome Measures HCS distrust was measured by a validated scale assessing perceptions of unethical experimentation and active or passive discrimination. Methods We compared responses to the HCS distrust scale using Fisher's exact and t-tests. Results Of 89 respondents, 57% self-reported being DAEUS. A greater percentage of DAEUS reported knowledge of unethical treatment than non-DAEUS (56% vs 21%; P<.001), were significantly more likely to express distrust, and to endorse the presence of covert (eg, insurance-based) than overt forms (eg, race-based) of discrimination by the HCS. Conclusions DAEUS express greater HCS distrust than non-DAEUS, patterned by awareness of unethical treatment and passive discrimination. Understanding how long-term exposure to US institutions influences health is critical to resolving disparities for all Black/African American groups. Rectifying past injustices through reparative institutional measures may improve DAEUS' trust and engagement with the US HCS.
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Affiliation(s)
- Lorraine T Dean
- Departments of Epidemiology, Health Policy & Management, and Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Oncology, Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Genee S Smith
- Department of Environmental Health & Engineering, and the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Ugoji CC, Walker KA, Dean LT, Gross A, Ballantyne CM, Butler K, Hoogeveen RC, Joshu C, Mosley TH, Prizment A, Sharrett AR, Tin A, Varadhan R, Coresh J, Platz EA. Abstract 903: Circulating inflammatory proteins associated with mortality from causes other than the index cancer in older adult cancer survivors in the atherosclerosis risk in communities study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-903] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Inflammation is hypothesized to underlie premature mortality in cancer survivors, yet little is known about the inflammatory proteins and pathways involved.
Methods: 474 long-term (≥5 years) older adult survivors of prostate, breast, colorectal, endometrial or bladder cancers in the ARIC study were followed from visit 5 (2011-13) to 12/2018. At visit 5, 580 plasma inflammatory proteins were assayed using the SomaScan platform, a modified aptamer-based assay. We modeled sub-distribution hazards (sHR) of non-index cancer-related death per log2 increase in each protein, adjusting for age, sex, race, years since cancer diagnosis, renal function, anti-inflammatory drug use, and cancer/CVD shared risk factors. We also investigated these proteins with mortality in survivors of the two most common cancers, prostate and breast. To account for multiple testing, we used Bonferroni correction and false discovery rate. Using Ingenuity Pathway Analysis (Qiagen®) and principal components analysis, we identified protein pathways and upstream regulators most strongly associated with mortality.
Results: Survivors were 21% Black, 56% male, had a mean age of 77 yrs, and median time since diagnosis of 11 yrs. 95 non-cancer (50% CVD) and 34 non-index cancer deaths occurred in 2740 person-yrs of follow-up. After FDR correction, 49 proteins were significantly associated with risk of death. VEGF sR3, complement C1RL, CD9 antigen, insulin-like growth factor-binding protein 7 (IGFBP7), platelet-derived growth factor D (PDGFD) and interferon-induced protein (IFIT2) were most strongly positively associated, with sHR: 2.1-4.4 per two-fold increase. Transmembrane protein (TMEM230), plasminogen, TNFSF12, APOL1, serum amyloid P-component and von Willebrand factor (VWA2) were most strongly inversely associated, with sHR:0.34-0.42. Only IFIT2 remained significant after Bonferroni correction. Associations of some inflammatory proteins differed by cancer site survived. However, 2 proteins, telomeric repeat binding factor (TERF1) and toll-like receptor (TLR2), were associated with increased mortality in all, prostate, and breast cancer survivors. Proteins associated with mortality were enriched for 5 major signaling pathways - MSP-RON, IL-8, glioma/coagulation, glucocorticoid receptor, atherosclerosis, and hepatic fibrosis, and were activated or inhibited by upstream regulators: SOX7, ERG, MYC, and IL4.
Conclusion: Several circulating inflammatory proteins and signaling pathways were associated with premature death in cancer survivors independent of cancer/CVD risk factors. If confirmed, these proteins/pathways may warrant evaluation as potential biomarkers for screening for risk of premature mortality, and possibly as therapeutic targets to prolong lives of cancer survivors. Funding: NHLBI, NCI, NPCR
Citation Format: Chinenye C. Ugoji, Keenan A. Walker, Lorraine T. Dean, Alden Gross, Christie M. Ballantyne, Ken Butler, Ron C. Hoogeveen, Corinne Joshu, Thomas H. Mosley, Anna Prizment, A. Richey Sharrett, Adrienne Tin, Ravi Varadhan, Josef Coresh, Elizabeth A. Platz. Circulating inflammatory proteins associated with mortality from causes other than the index cancer in older adult cancer survivors in the atherosclerosis risk in communities study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 903.
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Affiliation(s)
| | | | | | | | | | - Ken Butler
- 4University of Mississippi Medical Center, Jackson, MS
| | | | | | | | | | | | - Adrienne Tin
- 5University of Mississippi Medical Center, Jackson, MS
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Dean LT, Greene N, Adams MA, Geffen SR, Malone J, Tredway K, Poteat T. Beyond Black and White: race and sexual identity as contributors to healthcare system distrust after breast cancer screening among US women. Psychooncology 2021; 30:1145-1150. [PMID: 33689190 PMCID: PMC8273081 DOI: 10.1002/pon.5670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/17/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Healthcare system distrust (HCSD) has been linked to poor breast cancer outcomes. Previous HSCD analyses have focused on Black-White disparities; however, focusing only on race ignores the complex set of factors that form identity. We quantified the contributions of race and sexual minority (SM) identity to HCSD among US women who had received breast cancer screening. METHODS This cross-sectional study used intersectionality decomposition methods to assess the degree to which racial and SM identity contributed to disparate responses to the validated 9-item HCSD Scale. The sample included online survey participants identifying as a Black or White woman living in the US, with a self-reported abnormal breast cancer screening result in the past 24 months and/or breast cancer diagnosis since 2011. RESULTS Of 649 participants, 49.4% of Black SM women (n = 85) were in the highest HCSD tertile, followed by 37.4% of White SM women (n = 123), 24.4% of Black heterosexual women (n = 156), and 19% of White heterosexual women. Controlling for age, 72% of the disparity in HCSD between Black SM women and White heterosexual women was due to SM status, 23% was due to racial identity, and 3% was due to both racial and SM identity. CONCLUSIONS SM identity emerged as the largest driver of HCSD disparities; however, the combined racial and SM disparity persisted. Excluding sexual identity in HCSD studies may miss an important contributor. Interventions designed to increase the HCS's trustworthiness at the provider and system levels should address both racism and homophobia.
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Affiliation(s)
- Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Naomi Greene
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging, East Point, Georgia, USA
| | - Sophia R. Geffen
- Center for Health Equity Education & Advocacy, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Jowanna Malone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kristi Tredway
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tonia Poteat
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Social Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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Chandran A, Irwin S, Crifasi C, Dean LT. Community Effects of Police-Related Deaths: Associations With Low Birthweight Births and Poverty Among US Counties. Violence Vict 2021; 36:339-346. [PMID: 34103410 PMCID: PMC8377742 DOI: 10.1891/vv-d-20-00047] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Police-related deaths are a public health problem; however, their effects on community-level reproductive health outcomes remain largely unexplored. Among US counties with populations >100,000 (N = 580), we examined the longitudinal association between police-related deaths and rates of low birthweight (LBW) (<2,500 grams) deliveries, with counties stratified by quartiles of poverty. In the two lowest poverty quartiles, two or more police-related deaths were associated with a 5% (incidence rate ratio [IRR]: 1.05, 95% confidence interval [CI]: 1.02, 1.09) and 10% (IRR 1.10, 95% CI: 1.05, 1.15) higher rate of LBW births, respectively. The effect was not significant in the two highest poverty quartiles. No counties are "immune" from the important effects of police-related deaths and therefore the public health importance of police violence is a ubiquitous one regardless of social class or position.
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Affiliation(s)
- Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, US
| | - Stephanie Irwin
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, US
| | - Cassandra Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, US
| | - Lorraine T Dean
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, US
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Barrett BW, Abraham AG, Dean LT, Plankey MW, Friedman MR, Jacobson LP, Teplin LA, Gorbach PM, Surkan PJ. Social inequalities contribute to racial/ethnic disparities in depressive symptomology among men who have sex with men. Soc Psychiatry Psychiatr Epidemiol 2021; 56:259-272. [PMID: 32780176 PMCID: PMC7870462 DOI: 10.1007/s00127-020-01940-7] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 08/07/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Racial/ethnic minorities experience disproportionate rates of depressive symptoms in the United States. The magnitude that underlying factors-such as social inequalities-contribute to these symptoms is unknown. We sought to identify exposures that explain racial/ethnic differences in clinically significant depressive symptomology among men who have sex with men (MSM). METHODS Data from the Multicenter AIDS Cohort Study (MACS), a prospective cohort study, were used to examine clinically significant symptoms of depression (Center for Epidemiologic Studies Depression Scale score ≥ 20) among non-Latinx White, non-Latinx Black, and Latinx MSM. We included 44,823 person-visits by 1729 MSM seen in the study sites of Baltimore/Washington, DC; Chicago; Pittsburgh/Columbus; and Los Angeles from 2000 to 2017. Regression models estimated the percentage of depressive symptom risk explained by social, treatment, and health-related variables related to race/ethnicity. Machine-learning methods were used to predict the impact of mitigating differences in determinants of depressive symptoms by race/ethnicity. RESULTS At the most recent non-missing MACS visit, 16% of non-Latinx White MSM reported clinically significant depressive symptoms, compared to 22% of non-Latinx Black and 25% of Latinx men. We found that income and social-environmental stress were the largest contributors to racial/ethnic disparities in risk for depressive symptoms. Similarly, setting the prevalence of these two exposures to be equal across racial/ethnic groups was estimated to be most effective at reducing levels of clinically significant depressive symptoms. CONCLUSION Results suggested that reducing socioeconomic inequalities and stressful experiences may be effective public health targets to decrease racial/ethnic disparities in depressive symptoms among MSM.
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Grants
- U54 AG062334 NIA NIH HHS
- U01 HL146205 NHLBI NIH HHS
- U01 HL146208 NHLBI NIH HHS
- U01-HL146242-01 National Heart, Lung, and Blood Institute (US)
- P30-CA006973 Sidney Kimmel Comprehensive Cancer Center
- U01-HL146333-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146240 NHLBI NIH HHS
- U01-HL146192-01 National Heart, Lung, and Blood Institute (US)
- R25-MH083620 NIMH NIH HHS
- U01 HL146241 NHLBI NIH HHS
- U01 HL146333 NHLBI NIH HHS
- R38 AI140299 NIAID NIH HHS
- U01-HL146208-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146245 NHLBI NIH HHS
- U01-HL146241-01 National Heart, Lung, and Blood Institute (US)
- U01-HL146240-01 National Heart, Lung, and Blood Institute (US)
- P30 CA006973 NCI NIH HHS
- P30 AI094189 NIAID NIH HHS
- R25 MH083620 NIMH NIH HHS
- U01-HL146204-01 National Heart, Lung, and Blood Institute (US)
- U01-HL146245-01 National Heart, Lung, and Blood Institute (US)
- K01 CA184288 NCI NIH HHS
- U01-HL146202-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146192 NHLBI NIH HHS
- U01 AI035041 NIAID NIH HHS
- K01-CA184288 NCI NIH HHS
- U01-HL146193-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146242 NHLBI NIH HHS
- P30-AI094189 Johns Hopkins University Center for AIDS Research
- R03-MH103961 NIMH NIH HHS
- U01-HL146203-01 National Heart, Lung, and Blood Institute (US)
- R01 DA022936 NIDA NIH HHS
- R21 AG059505 NIA NIH HHS
- R01-DA022936 NIDA NIH HHS
- U01 HL146201 NHLBI NIH HHS
- U01-HL146194-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146193 NHLBI NIH HHS
- U01 HL146204 NHLBI NIH HHS
- U01 HL146202 NHLBI NIH HHS
- U01 HL146194 NHLBI NIH HHS
- U01-HL146205-01 National Heart, Lung, and Blood Institute (US)
- R03 MH103961 NIMH NIH HHS
- U01-HL146201-01 National Heart, Lung, and Blood Institute (US)
- U01 HL146203 NHLBI NIH HHS
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Affiliation(s)
- Benjamin W Barrett
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Alison G Abraham
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael W Plankey
- Department of Medicine, Medical Center, Georgetown University, Washington, DC, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Linda A Teplin
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pamela J Surkan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Greene N, Malone J, Adams MA, Dean LT, Poteat T. "This is some mess right here": Exploring interactions between Black sexual minority women and health care providers for breast cancer screening and care. Cancer 2021; 127:74-81. [PMID: 32990978 PMCID: PMC7865953 DOI: 10.1002/cncr.33219] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 06/11/2020] [Accepted: 08/13/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Few studies have explored how the intersection of race and sexual identity contribute to breast cancer disparities for Black sexual minority women (SMW). Issues within patient-provider relationships, including bias, contribute to health disparities for minority groups. The authors used constructs from self-determination theory (SDT) to explore the nature of health care provider interactions in breast cancer screening and care among Black SMW. METHODS Participants were sampled nationally through social media, targeted emails, and referrals. Qualitative, in-depth interviews were conducted with 15 Black cisgender SMW, ages 38 to 64 years, who had a breast cancer diagnosis or recent abnormal mammogram. Interviews were conducted face-to-face or online, audio-recorded, and transcribed verbatim. Two analysts coded the interviews. Codes were analyzed across interviews to identify themes salient to SDT. RESULTS Themes aligned with the SDT constructs of relatedness and autonomy. Some participants discussed feeling most understood by Black and/or female providers who shared at least 1 of their identities. Feeling understood through shared identity contributed to participants feeling seen and heard by their providers. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about them based on their race and/or sexual orientation. CONCLUSIONS When interacting with health care providers for breast cancer screening and care, Black SMW face specific challenges related to their multiply marginalized social position. Reducing health care provider bias toward Black SMW may improve patients' desires to continue in care. Providing equitable care while acknowledging and respecting women with multiply marginalized identities may improve the nature of these interactions.
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Affiliation(s)
- Naomi Greene
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society
| | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
| | - Mary Anne Adams
- ZAMI NOBLA: National Organization of Black Lesbians on Aging
| | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
- Sidney Kimmel Cancer Center, Department of Oncology
| | - Tonia Poteat
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology
- University of North Carolina Chapel Hill School of Medicine, Department of Social Medicine
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Ugoji CC, Dean LT, Gross A, Platz EA. Abstract PO-099: Racial differences in the association of circulating inflammatory proteins with mortality from causes other than the index cancer in older adult cancer survivors in the Atherosclerosis Risk in Communities (ARIC) study. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-099] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background Inflammation is strongly hypothesized to underlie premature mortality in cancer survivors. However, little is known about racial differences in the associations of inflammatory proteins with premature mortality in cancer survivors. Methods 474 long-term (≥5 years) older adult survivors of prostate, breast, colorectal, endometrial and bladder cancers in the ARIC study were followed from visit 5 (2011-13) to December 2018. At visit 5, 5000 serum proteins were assayed using the high throughput SOMAscan technology. Using competing risks proportional hazards regression, we evaluated racial differences in the associations of 580 inflammatory proteins measured at visit 5 with deaths from causes other than the index cancer by modeling sub-distribution hazards (sHR) of deaths per log2 increase in each inflammatory protein in Black and White survivors. Models were adjusted for age, sex, race, years since cancer diagnosis, cancer/cardiovascular disease (CVD) shared risk factors such as smoking, history of CVD, diabetes, kidney function, and anti-inflammatory drug use, and included race-protein interaction terms. In a sensitivity analysis, we additionally adjusted for lifecourse SES and access to care. We accounted for multiple testing using Bonferroni correction and false discovery rate Q-values. Results Survivors were 21% Black, 56% male, had a mean age of 76.8 yrs, and median time since diagnosis of 11.4 yrs. 95 non-cancer (50% CVD) and 34 non- index cancer deaths occurred during 2740 person-years of follow-up. Thirty inflammatory proteins, 17 of these in the sensitivity analysis had significantly different (Q<0.05) qualitative or quantitative effects in Black and White survivors. Inflammatory proteins with the most significant racial differences in the sHR of mortality were CD69 (early activation antigen), which was associated with lower mortality in Whites (sHR per Δlog2 (95% CI): 0.47 (0.27,0.82)) and higher mortality in Blacks (2.96 (1.78,4.93), Pint = 1.24 × 10-6], and CCL18 (CC motif chemokine 18), which was associated with higher mortality in Whites (1.83 (1.02,3.28)) and lower mortality in Blacks (0.33 (0.12 0.94), Pint = 4.14 × 10-3). The differential effect of CD69 by race remained significant after Bonferroni correction in the main and sensitivity analysis. Conclusion Associations of some circulating inflammatory proteins with mortality differ in Black and White cancer survivors independent of lifestyle, medical, and social factor confounders. CD69 is upregulated by NF-κB signaling and regulates a variety of crucial immune pathways that depend on host metabolic factors. CCL18 is mainly produced by the innate immune system and genetic variations in encoding genes have been reported. Further studies are needed to evaluate whether racial differences in host metabolic factors or genetic differences modulate effects of these proteins on mortality in Black and White survivors. If confirmed these proteins may warrant focus for characterization as potential therapeutic targets.
Citation Format: Chinenye C. Ugoji, Lorraine T. Dean, Alden Gross, Elizabeth A. Platz. Racial differences in the association of circulating inflammatory proteins with mortality from causes other than the index cancer in older adult cancer survivors in the Atherosclerosis Risk in Communities (ARIC) study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-099.
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Affiliation(s)
| | | | - Alden Gross
- Johns Hopkins School of Public Health, Baltimore, MD
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Tredway K, Cork SJ, Camp MS, Poteat T, Dean LT. Abstract PO-067: LGBTQ patients and cancer care: A scoping review of U.S. physician attitudes, biases, and interactions. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-po-067] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
As lesbian, gay, bisexual, transgender, and queer (LGBTQ) people gain increasing acceptance in U.S. society, physicians are at an important turning point. Older physicians who entered medicine when homophobia was still the norm are interacting with new generations of physicians who have emerged through the cultural debates, and increased acceptance, of LGBTQ people in our society. This dichotomous acceptance of LGBTQ people by physicians makes it unclear the extent and types of biases that remain in medical settings that negatively impact both LGBTQ patients and physicians. In cancer care, data indicate that LGBTQ patients have less timely screenings as compared with the general population, as well as negative beliefs about care and perceptions of heterosexism and homophobia among providers, among other factors. Thus, the effects of perceived homophobia by physicians can cause health disparities and inequity for LGBTQ populations.
Identifying and understanding the scope of LGBTQ biases within medicine, especially in cancer care, will allow us to work at dismantling these biases. This scoping review explores existing literature outlining the types and extent of biased attitudes of physicians within the U.S. towards LGBTQ patients seeking cancer care.
Citation Format: Kristi Tredway, Stephanie J. Cork, Melissa S. Camp, Tonia Poteat, Lorraine T. Dean. LGBTQ patients and cancer care: A scoping review of U.S. physician attitudes, biases, and interactions [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-067.
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Dougherty GB, Golden SH, Gross AL, Colantuoni E, Dean LT. Measuring Structural Racism and Its Association With BMI. Am J Prev Med 2020; 59:530-537. [PMID: 32863079 PMCID: PMC8147662 DOI: 10.1016/j.amepre.2020.05.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Structural racism has attracted increasing interest as an explanation for racial disparities in health, including differences in adiposity. Structural racism has been measured most often with single-indicator proxies (e.g., housing discrimination), which may leave important aspects of structural racism unaccounted for. This paper develops a multi-indicator scale measuring county structural racism in the U.S. and evaluates its association with BMI. METHODS County structural racism was estimated with a confirmatory factor model including indicators reflecting education, housing, employment, criminal justice, and health care. Using Behavioral Risk Factor Surveillance Survey data (2011-2012) and a mixed-effects model, individual BMI was regressed on county structural racism, controlling for county characteristics (mean age, percentage black, percentage female, percentage rural, median income, and region). Analysis occurred 2017-2019. RESULTS The study included 324,572 U.S. adults. A 7-indicator county structural racism model demonstrated acceptable fit. County structural racism was associated with lower BMI. Structural racism and black race exhibited a qualitative interaction with BMI, such that racism was associated with lower BMI in whites and higher BMI in blacks. In a further interaction analysis, county structural racism was associated with larger increases in BMI among black men than black women. County structural racism was associated with reduced BMI for white men and no change for white women. CONCLUSIONS The results confirm structural racism as a latent construct and demonstrate that structural racism can be measured in U.S. counties using publicly available data with methods offering a strong conceptual underpinning and content validity. Further study is necessary to determine whether addressing structural racism may reduce BMI among blacks.
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Affiliation(s)
- Geoff B Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Sherita H Golden
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Zhang M, Jarrett BA, Althoff KN, Burman FS, Camarata L, Coburn SB, Dickerson AS, Foti K, Kaur M, Leifheit KM, Malone J, Moore EA, Mouslim MC, Prata Menezes N, Robsky K, Tang O, Wallace AS, Dean LT. Recommendations to the Society for Epidemiologic Research for Further Promoting Diversity and Inclusion at the Annual Meeting and Beyond. Am J Epidemiol 2020; 189:1037-1041. [PMID: 32602548 PMCID: PMC7666413 DOI: 10.1093/aje/kwaa110] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 01/01/2023] Open
Abstract
Increasing diverse engagement in the Society for Epidemiologic Research (SER) will positively impact the field of epidemiology. As the largest and longest-running epidemiologic society in North America, SER has long been a pioneer in promoting diversity and inclusion. A recent survey of SER members, however, showed there is still room for improving diversity, inclusion, representation, and participation in the Society. In this commentary, as members of both the SER and the Johns Hopkins Bloomberg School of Public Health Department of Epidemiology's Inclusion, Diversity, Equity, Anti-Racism, and Science (Epi IDEAS) Working Group, we recommend 4 goals for the SER Annual Meeting and beyond: 1) convene epidemiologic researchers with diverse backgrounds and ideas; 2) promote an inclusive environment at the SER Annual Meeting; 3) develop, compile, and disseminate best practices to honor diversity in epidemiologic research; and 4) increase prioritization of health disparities research and methods. We also suggest strategies for achieving these goals so that SER can better include, support, and elevate members from historically disadvantaged groups. While our recommendations are tailored specifically to SER, the greater epidemiologic and academic communities could benefit from adopting these goals and strategies within their professional societies and conferences.
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Affiliation(s)
- Mingyu Zhang
- Correspondence to Mingyu Zhang, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-200A, Baltimore, MD 21205 (e-mail: )
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Greene N, Jackson JW, Dean LT. Examining Disparities in Excessive Alcohol Use Among Black and Hispanic Lesbian and Bisexual Women in the United States: An Intersectional Analysis. J Stud Alcohol Drugs 2020; 81:462-470. [PMID: 32800082 PMCID: PMC7437553 DOI: 10.15288/jsad.2020.81.462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE Sexual minority (i.e., lesbian, bisexual) women and racial-ethnic minority groups in the United States are disproportionately harmed by excessive alcohol use. This study examined disparities in excessive alcohol use at the intersection of race-ethnicity and sexual identity for non-Hispanic Black and Hispanic sexual minority women. METHOD Using data from the 2015 National Survey on Drug Use and Health, we compared the age-adjusted prevalence of binge drinking and heavy alcohol use among sexual minority women of color, sexual minority White women, and heterosexual women of color with that of White heterosexual women. The joint disparity is the difference in the prevalence of excessive alcohol use between sexual minority women of color and White heterosexual women. The excess intersectional disparity is the portion of the joint disparity that is due to being both a racial-ethnic minority and a sexual minority woman. RESULTS Black and Hispanic sexual minority women reported the highest prevalence of binge drinking (45.4% and 43.4%, respectively), followed by White sexual minority women (35.7%) and White heterosexual women (23%). Black and Hispanic heterosexual women reported the lowest prevalence of binge drinking (20.8% and 20.2%, respectively). The joint disparity in binge drinking between Black sexual minority women and White heterosexual women was 21.2%, and the excess intersectional disparity was 17.7%. The joint disparity in binge drinking between Hispanic sexual minority women and White heterosexual women was 16.8%, and the excess intersectional disparity was 10.8%. CONCLUSIONS Disparities in excessive alcohol consumption for Black and Hispanic sexual minority women, compared with White heterosexual women, were larger than what would be expected when considering differences by race or sexual identity individually.
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Affiliation(s)
- Naomi Greene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John W Jackson
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lorraine T Dean
- Departments of Epidemiology and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Greene N, Jackson JW, Dean LT. Examining Disparities in Excessive Alcohol Use Among Black and Hispanic Lesbian and Bisexual Women in the United States: An Intersectional Analysis. J Stud Alcohol Drugs 2020; 81:462-470. [PMID: 32800082 PMCID: PMC7437553] [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] [Received: 08/30/2019] [Accepted: 03/19/2020] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE Sexual minority (i.e., lesbian, bisexual) women and racial-ethnic minority groups in the United States are disproportionately harmed by excessive alcohol use. This study examined disparities in excessive alcohol use at the intersection of race-ethnicity and sexual identity for non-Hispanic Black and Hispanic sexual minority women. METHOD Using data from the 2015 National Survey on Drug Use and Health, we compared the age-adjusted prevalence of binge drinking and heavy alcohol use among sexual minority women of color, sexual minority White women, and heterosexual women of color with that of White heterosexual women. The joint disparity is the difference in the prevalence of excessive alcohol use between sexual minority women of color and White heterosexual women. The excess intersectional disparity is the portion of the joint disparity that is due to being both a racial-ethnic minority and a sexual minority woman. RESULTS Black and Hispanic sexual minority women reported the highest prevalence of binge drinking (45.4% and 43.4%, respectively), followed by White sexual minority women (35.7%) and White heterosexual women (23%). Black and Hispanic heterosexual women reported the lowest prevalence of binge drinking (20.8% and 20.2%, respectively). The joint disparity in binge drinking between Black sexual minority women and White heterosexual women was 21.2%, and the excess intersectional disparity was 17.7%. The joint disparity in binge drinking between Hispanic sexual minority women and White heterosexual women was 16.8%, and the excess intersectional disparity was 10.8%. CONCLUSIONS Disparities in excessive alcohol consumption for Black and Hispanic sexual minority women, compared with White heterosexual women, were larger than what would be expected when considering differences by race or sexual identity individually.
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Affiliation(s)
- Naomi Greene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John W. Jackson
- Departments of Epidemiology and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lorraine T. Dean
- Departments of Epidemiology and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Ugoji CC, Dean LT, Platz EA. Abstract D099: Excess burden of major cancer risk factors in racial/ethnic minority adult cancer survivors in the United States (2005–2016). Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-d099] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: While major cancer risk factors (CRFs) are well documented in the US general population, their burden in 16.9 million US cancer survivors has not been described. Continued CRF exposure may contribute to recurrence, second cancers, and other chronic disease risks. Using US representative surveys, we previously reported high CRF prevalences in cancer survivors. To better target health-promoting interventions, sub-populations of survivors with higher CRF burdens need to be identified, especially racial/ethnic minorities who have higher cancer-specific and other chronic disease mortality rates. Thus, we quantified CRF prevalences and trends in cancer survivors by major US racial/ethnic minorities and compared with non-Hispanic Whites (NHW) over 12 years. Methods: We analyzed data for 455 non-Hispanic Black [NHB], 389 Hispanic, and 1739 NHW cancer survivors (self-reported MD diagnosis of cancer except non-melanoma skin) >20 years old who participated in the 2005-16 National Health and Nutrition Examination Surveys. We estimated unadjusted race/ethnicity-specific prevalences of major CRFs – current smoking, alcohol (>2 drinks/day), overweight/obesity (BMI>25 kg/m2), physical inactivity (<10 mins moderate activity/day), self-reported poor/fair diet, and diabetes history – and prevalence trends. We estimated age- and sex-adjusted CRF prevalence ratios and comparing NHB and Hispanic to NHW survivors using Poisson regression. Results: Median time since diagnosis (8 years) did not differ by race/ethnicity. Hispanic survivors were younger and more likely female compared to NHW and NHB survivors. Adjusting for age and sex, compared to NHW survivors, smoking prevalence was 35% higher in NHB survivors but did not differ in Hispanic survivors, and alcohol prevalence was 44% higher in Hispanic survivors, but did not differ in NHB survivors. In both NHB and Hispanic survivors, prevalences of overweight/obesity (NHB 12%, Hispanic 20%), physical inactivity (27%, 20%), poor/fair diet, (48%, 42%), and diabetes history (121%, 98%) were statistically significantly higher than in NHW survivors. CRF prevalences were significantly higher in NHB and Hispanic compared to NHW survivors over 12 years. Conclusions: CRF prevalences are disproportionately higher in Hispanics and NHB compared to NHW cancer survivors, accounting for age and sex, and these patterns have persisted over time. These US nationally representative data may be used to direct interventions for specific CRFs to specific racial/ethnic minority subpopulations of cancer survivors to increase wellbeing.
Citation Format: Chinenye C Ugoji, Lorraine T Dean, Elizabeth A Platz. Excess burden of major cancer risk factors in racial/ethnic minority adult cancer survivors in the United States (2005–2016) [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D099.
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Dean LT, George M, Lee KT, Ashing K. Why individual-level interventions are not enough: Systems-level determinants of oral anticancer medication adherence. Cancer 2020; 126:3606-3612. [PMID: 32438466 PMCID: PMC7467097 DOI: 10.1002/cncr.32946] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 02/06/2023]
Abstract
Nonadherence to oral anticancer medications (OAMs) in the United States is as low as 33% for some cancers. The reasons for nonadherence to these lifesaving medications are multifactorial, yet the majority of studies focus on patient-level factors influencing uptake and adherence. Individually based interventions to increase patient adherence have not been effective, and this warrants attention to factors at the payor, pharmaceutical, and clinical systems levels. Based on the authors' research and clinical experiences, this commentary brings fresh attention to the long-standing issue of OAM nonadherence, a growing quality-of-care issue, from a systems perspective. In this commentary, the key driving factors in pharmaceutical and payor systems (state and federal laws, payor/insurance companies, and pharmaceutical companies), clinical systems (hospitals and providers), and patient contexts that have trickle-down effects on patient adherence to OAMs are outlined. In the end, the authors' recommendations include examining the influence of laws governing OAM drug pricing, OAM supply, and provider reimbursement; reducing the need for prior authorization of long-approved OAMs; identifying cost-effective ways for providers to monitor nonadherence; examining issues of provider bias in OAM prescriptions; and further elucidating in which contexts patients are likely to be able to adhere. These recommendations offer a starting point for an examination of the chain of systems influencing patient adherence and may help to finally resolve persistently high levels of OAM nonadherence.
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Affiliation(s)
- Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Marshalee George
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimberley T Lee
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kimlin Ashing
- City of Hope Comprehensive Cancer Center, Division of Health Equities, City of Hope, Duarte, California, USA
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Hasan MZ, Dean LT, Kennedy CE, Ahuja A, Rao KD, Gupta S. Social capital and utilization of immunization service: A multilevel analysis in rural Uttar Pradesh, India. SSM Popul Health 2020; 10:100545. [PMID: 32405528 PMCID: PMC7211897 DOI: 10.1016/j.ssmph.2020.100545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/15/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 11/25/2022] Open
Abstract
The National Health Policy (2017) of India advocates Universal Health Coverage through inclusive growth, decentralization, and rebuilding a cohesive community through a participatory process. To achieve this goal, understanding social organization, and community relationships - defined as social capital - is critical. This study aimed to explore the influence of individual and community-level social capital on a critical health system performance indicator, three-doses of diphtheria-pertussis-tetanus (DPT3) immunization among 12-59 month children, in rural Uttar Pradesh (UP), India. The analysis is based on a cross-sectional survey from two districts of UP, which included 2239 children 12-59 months of age (level 1) from 1749 households (level 2) nested within 346 communities (level 3). We used multilevel confirmatory factor analysis to generate standardized factor scores of social capital constructs (Organizational Participation, Social Support, Trust and Social Cohesion) of the household heads and mothers both at individual and community level, which were then used in the multilevel logistic regressions to explore the independent and contextual effect of social capital on a child's DPT3 immunization status. The result showed only community-level Social Cohesion of the mothers was associated with a child's DPT3 immunization status (Adjusted odds ratio = 1.25, 95% confidence interval = 1.12-1.54; p = 0.04). Beyond its independent effect on utilization of immunization service, the collective Social Cohesion of the mothers significantly modified the relationship of child age, mother's knowledge of immunization, community wealth, and communities' contact with frontline workers with immunization status of the child. With a strong theoretical underpinning, the result substantially contributes to understanding the individual and contextual predictors of immunization service utilization and further advancing the literature of social capital in India. This study can serve as a starting point to catalyze social capital within the health interventions for achieving wellbeing and the collective development of society.
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Affiliation(s)
- Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lorraine T. Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Akshay Ahuja
- School of Public Policy at Central European University, Budapest, Hungary
| | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shivam Gupta
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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