Adverse childhood experiences and cognitive disability in the 2019 United States behavioral risk factor surveillance system

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Adverse childhood experiences are positively associated with cognitive disability.

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The associations varied significantly by race and ethnicity.

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Larger associations were observed among Hispanic respondents.

A growing number of studies have found associations between adverse childhood experiences (ACEs) and adult well-being, with disparities between subpopulations. Limited research exists about the association between ACEs and cognitive disability, and variations by race and ethnicity. This study reports a cross-sectional analysis of 2019 Behavioral Risk Factor Surveillance System (BRFSS) data (n = 93 692) conducted in 2021. Logistic regression models examined the association between ACEs and cognitive disability (as defined by serious difficulty concentrating, remembering or making decisions because of a physical, mental, or emotional condition) and whether the association varied by race and ethnicity, adjusting for demographics, (age, gender, marital status), socioeconomic factors (income and education), and perceived general health. Exposures to 1, 2, 3, and 4 or more ACEs were associated with elevated odds of cognitive disability; the association varied by race and ethnicity (p for interaction less than 0.05). In stratified analyses, ACEs were positively associated with cognitive disability among the American Indian/Alaskan Native group, though significant only among those reporting 4 ACEs or more (OR: 2.89; 95% CI 1.25, 6.66). A dose response was observed for Black, White and Hispanic groups though the association was larger among Hispanic respondents. The elevated odds of cognitive disability associated with ACEs warrant additional research to understand mechanisms underlying this relationship across racial and ethnic groups. Additionally, interventions to prevent cognitive disability may benefit from considering ACEs across all populations, particularly among those with highest prevalence.

Time to Modernize: Local Public Health Transitions to Population-Level Interventions

OBJECTIVES

To identify facilitating factors that guide local health departments (LHDs) in their transition from direct clinical service provision to population-level interventions addressing the social determinants of health.

DESIGN

Key informant interviews with LHD leaders and their staff were conducted using a semistructured interview guide. Thematic qualitative analysis was used to identify common characteristics and strategies among the LHD leaders and staff.

PARTICIPANTS

LHDs represented both rural and urban communities with population sizes from 9746 to 919 628 and agencies in Illinois, Montana, North Carolina, Oregon, Tennessee, Washington, and West Virginia.

OUTCOME MEASURE

The impetus and facilitators for transitioning health department services from clinical to population health.

RESULTS

Leaders from 7 LHDs emphasized that an impetus for their transition from direct clinical services to population-level interventions was that it was "time to modernize." Among LHDs interviewed, most included the 10 Essential Public Health Services or Public Health 3.0 in their strategic plan. Adding this focus to their strategic plan facilitated buy-in from local government and the ability to maintain the LHDs' focus on population-level interventions. We found that strong relationships and open communication with community members and partner organizations (eg, federally qualified health centers) were critical facilitators of transition. Themes from interviews were used to identify an initial set of 8 key elements of an effective transition: partnership/leadership, vision/goals, communication, community engagement, interventions, data/evaluation, workforce issues, and sustainability.

CONCLUSIONS

Prevention systems suffer from a lack of adequate health promotion and access to quality care for their community's residents. There is a need for LHDs to access technical support to strategically address complexity and ensure core population-focused prevention. The results shared provide replicable solutions, practices, and methods that enable successful transitions of LHDs toward maximizing their role in population health.

Implementation of the First US Sugar-Sweetened Beverage Tax in Berkeley, CA, 2015-2019

Objectives. To identify lessons learned from implementation of the nation's first sugar-sweetened beverage (SSB) excise tax in 2015 in Berkeley, California.Methods. We interviewed city stakeholders and SSB distributors and retailers (n = 48) from June 2015 to April 2017 and analyzed records through January 2019.Results. Lessons included the importance of thorough and timely communications with distributors and retailers, adequate lead time for implementation, advisory commissions for revenue allocations, and funding of staff, communications, and evaluation before tax collection begins. Early and robust outreach about the tax and programs funded can promote and sustain public support, reduce friction, and facilitate beverage price increases on SSBs only. No retailer reported raising food prices, indicating that Berkeley's SSB tax did not function as a "grocery tax," as industry claimed. Revenue allocations totaled more than $9 million for public health, nutrition, and health equity through 2021.Conclusions. The policy package, context, and implementation process facilitated translating policy into public health outcomes. Further research is needed to understand long-term facilitators and barriers to sustaining public health benefits of Berkeley's tax and how those differ from facilitators and barriers in jurisdictions facing significant industry-funded repeal efforts.

Association of Paid Sick Leave Laws With Foodborne Illness Rates

INTRODUCTION

Previous studies suggest an association between paid sick leave (PSL) and better population health, including fewer infectious and nosocomial gastrointestinal disease outbreaks. Yet few studies examine whether laws requiring employers to offer PSL demonstrate a similar association. This mixed-methods study examined whether laws requiring employers to provide PSL are associated with decreased foodborne illness rates, particularly laws that are more supportive of employees taking leave.

METHODS

The four earliest PSL laws were classified by whether they were more or less supportive of employees taking leave. Jurisdictions with PSL were matched to comparison jurisdictions by population size and density. Using difference-in-differences, monthly foodborne illness rates (2000-2014) in implementation and comparison jurisdictions before and after the laws were effective were compared, stratifying by how supportive the laws were of employees taking leave, and then by disease. The empirical analysis was conducted from 2015-2017.

RESULTS

Foodborne illness rates declined after implementation of the PSL law in jurisdictions with laws more supportive of employees taking leave, but increased in jurisdictions with laws that are less supportive. In adjusted analyses, PSL laws that were more supportive of employees taking sick leave were associated with an adjusted 22% decrease in foodborne illness rates (p=0.005). These results are driven by campylobacteriosis.

CONCLUSIONS

Although the results suggest an association between more supportive PSL laws and decreased foodborne illness rates, they should be interpreted cautiously because the trend is driven by campylobacteriosis, which has low person-to-person transmission.

Changes in prices, sales, consumer spending, and beverage consumption one year after a tax on sugar-sweetened beverages in Berkeley, California, US: A before-and-after study

BACKGROUND

Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake.

METHODS AND FINDINGS

Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015-29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents. Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline. Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers' spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day). Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and independent gas stations (-0.64¢/oz, p = 0.004). Sales-unweighted mean price change from scanner data was +0.67¢/oz (p = 0.00) (sales-weighted, +0.65¢/oz, p = 0.003), with +1.09¢/oz (p < 0.001) for sodas and energy drinks, but a lower change in other categories. Post-tax year 1 scanner data SSB sales (ounces/transaction) in Berkeley stores declined 9.6% (p < 0.001) compared to estimates if the tax were not in place, but rose 6.9% (p < 0.001) for non-Berkeley stores. Sales of untaxed beverages in Berkeley stores rose by 3.5% versus 0.5% (both p < 0.001) for non-Berkeley stores. Overall beverage sales also rose across stores. In Berkeley, sales of water rose by 15.6% (p < 0.001) (exceeding the decline in SSB sales in ounces); untaxed fruit, vegetable, and tea drinks, by 4.37% (p < 0.001); and plain milk, by 0.63% (p = 0.01). Scanner data mean store revenue/consumer spending (dollars per transaction) fell 18¢ less in Berkeley (-$0.36, p < 0.001) than in comparison stores (-$0.54, p < 0.001). Baseline and post-tax Berkeley SSB sales and usual dietary intake were markedly low compared to national levels (at baseline, National Health and Nutrition Examination Survey SSB intake nationally was 131 kcal/d and in Berkeley was 45 kcal/d). Reductions in self-reported mean daily SSB intake in grams (-19.8%, p = 0.49) and in mean per capita SSB caloric intake (-13.3%, p = 0.56) from baseline to post-tax were not statistically significant. Limitations of the study include inability to establish causal links due to observational design, and the absence of health outcomes. Analysis of consumption was limited by the small effect size in relation to high standard error and Berkeley's low baseline consumption.

CONCLUSIONS

One year following implementation of the nation's first large SSB tax, prices of SSBs increased in many, but not all, settings, SSB sales declined, and sales of untaxed beverages (especially water) and overall study beverages rose in Berkeley; overall consumer spending per transaction in the stores studied did not rise. Price increases for SSBs in two distinct data sources, their timing, and the patterns of change in taxed and untaxed beverage sales suggest that the observed changes may be attributable to the tax. Post-tax self-reported SSB intake did not change significantly compared to baseline. Significant declines in SSB sales, even in this relatively affluent community, accompanied by revenue used for prevention suggest promise for this policy. Evaluation of taxation in jurisdictions with more typical SSB consumption, with controls, is needed to assess broader dietary and potential health impacts.

Age, period, and cohort effects in adult lifetime asthma prevalence in California: an application of hierarchical age-period-cohort analysis

PURPOSE

Using 27 years of survey data, the contributions of age, period, and cohort effects on the increase in adult lifetime asthma prevalence in California were examined.

METHODS

Lifetime asthma diagnosis for adults was assessed in 1984-1992 and 1995-2011 through the California Behavioral Risk Factor Surveillance System, an annual, cross-sectional, population-based survey (n = 144,100). Using date of survey and date of birth, we classified 18,305 adult respondents with lifetime asthma into 7 age groups, 6 periods, and 17 cohorts. Using hierarchical, cross-classified random effects models, birth cohort, period, and age patterns in adult lifetime asthma prevalence were analyzed.

RESULTS

After adjusting for sex, ethnicity, education, and smoking, age effects peak in young adulthood, flatten from 40 to 60 years old, and then decrease in older adulthood. A significant positive trend in asthma prevalence was observed in the two earliest survey periods (1984-1993; P value < .0001). Survey period trends appear to flatten beginning in 2004. Although the overall birth cohort effect was statistically significant, the magnitude of the effect for each birth cohort category was small (P value = .0005).

CONCLUSIONS

We observed that strong age and period effects have been driving the increase in lifetime asthma prevalence in California over the past 3 decades.

Support for Policies to Improve the Nutritional Impact of the Supplemental Nutrition Assistance Program in California

The Supplemental Nutrition Assistance Program (SNAP) provides a vital buffer against hunger and poverty for 47.6 million Americans. Using 2013 California Dietary Practices Survey data, we assessed support for policies to strengthen the nutritional influence of SNAP. Among SNAP participants, support ranged from 74% to 93% for providing monetary incentives for fruits and vegetables, restricting purchases of sugary beverages, and providing more total benefits. Nonparticipants expressed similar levels of support. These approaches may alleviate the burden of diet-related disease in low-income populations.

Current depression among women in California according to residence in the California-Mexico border region

OBJECTIVE

To estimate the prevalence of current depression; examine the relationship between current depression and immigration, health status, health care access, and health behaviors; and assess differences by California-Mexico border region (Imperial and San Diego Counties) among women in California.

METHODS

Using a cross-sectional, representative sample of adult women from the California Women's Health Survey (n = 13 454), a statewide telephone survey, prevalence of current depression and predictors of depression were examined in California and according to border region residence. Depression was assessed with the eight-item Patient Health Questionnaire.

RESULTS

The prevalence of current depression for women in California was 12.0%. It was similar in the border (13.0%) and the nonborder (11.9%) regions. Odds of current depression in women were lower among recent immigrants (< 5 years or 5 to < 10 years in the United States) than in women born in the United States and in immigrants who had been living in the United States for 10 to < 15 years or longer (P < 0.05). Odds ratios for current depression and health status, health care access, and binge drinking were larger in the border region than outside the border region.

CONCLUSIONS

Similar prevalences of current depression were observed among those who live in the border region of California and in those who do not, but the relationship between depression and health status, health care access, and binge drinking varied by border region residence. Ideally, future surveillance of depression and its predictors along the Mexico-California border will be conducted binationally to inform interventions and tracking such as the Healthy Border Program's objectives.