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Beccia AL, Zubizarreta D, Austin SB, Raifman JR, Chavarro JE, Charlton BM. Trajectories of Mental Distress Among US Women by Sexual Orientation and Racialized Group During the First Year of the COVID-19 Pandemic. Am J Public Health 2024; 114:511-522. [PMID: 38598758 PMCID: PMC11008304 DOI: 10.2105/ajph.2024.307601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Objectives. To describe longitudinal trends in the prevalence of mental distress across the first year of the COVID-19 pandemic (April 2020‒April 2021) among US women at the intersection of sexual orientation and racialized group. Methods. Participants included 49 805 cisgender women and female-identified people from the COVID-19 Sub-Study, a cohort of US adults embedded within the Nurses' Health Studies 2 and 3 and the Growing Up Today Study. We fit generalized estimating equation Poisson models to estimate trends in depressive and anxiety symptoms by sexual orientation (gay or lesbian, bisexual, mostly heterosexual, completely heterosexual); subsequent models explored further differences by racialized group (Asian, Black, Latine, White, other or unlisted). Results. Relative to completely heterosexual peers, gay or lesbian, bisexual, and mostly heterosexual women had a higher prevalence of depressive and anxiety symptoms at each study wave and experienced widening inequities over time. Inequities were largest for sexual minority women of color, although confidence intervals were wide. Conclusions. The COVID-19 pandemic may have exacerbated already-glaring mental health inequities affecting sexual minority women, especially those belonging to marginalized racialized groups. Future research should investigate structural drivers of these patterns to inform policy-oriented interventions. (Am J Public Health. 2024;114(5):511-522. https://doi.org/10.2105/AJPH.2024.307601).
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Affiliation(s)
- Ariel L Beccia
- Ariel L. Beccia is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Dougie Zubizarreta is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. S. Bryn Austin is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Julia R. Raifman is with the Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston. Jorge E. Chavarro is with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Brittany M. Charlton is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - Dougie Zubizarreta
- Ariel L. Beccia is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Dougie Zubizarreta is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. S. Bryn Austin is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Julia R. Raifman is with the Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston. Jorge E. Chavarro is with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Brittany M. Charlton is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - S Bryn Austin
- Ariel L. Beccia is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Dougie Zubizarreta is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. S. Bryn Austin is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Julia R. Raifman is with the Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston. Jorge E. Chavarro is with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Brittany M. Charlton is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - Julia R Raifman
- Ariel L. Beccia is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Dougie Zubizarreta is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. S. Bryn Austin is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Julia R. Raifman is with the Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston. Jorge E. Chavarro is with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Brittany M. Charlton is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - Jorge E Chavarro
- Ariel L. Beccia is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Dougie Zubizarreta is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. S. Bryn Austin is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Julia R. Raifman is with the Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston. Jorge E. Chavarro is with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Brittany M. Charlton is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
| | - Brittany M Charlton
- Ariel L. Beccia is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA. Dougie Zubizarreta is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. S. Bryn Austin is with the Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Julia R. Raifman is with the Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston. Jorge E. Chavarro is with the Department of Nutrition, Harvard T. H. Chan School of Public Health. Brittany M. Charlton is with the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston
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Shafer PR, Lim K, Goutos D, Huberfeld N, Benitez JA, Hsu KS, Raifman JR. Making pandemic era Medicaid continuous coverage automatic in future crises. Health Serv Res 2023; 58:1157-1160. [PMID: 37706551 PMCID: PMC10622290 DOI: 10.1111/1475-6773.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Affiliation(s)
- Paul R. Shafer
- Department of Health Law, Policy, and Management, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Kenneth Lim
- Department of Health Law, Policy, and Management, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Demetri Goutos
- Department of Health Law, Policy, and Management, School of Public HealthBoston UniversityBostonMassachusettsUSA
| | - Nicole Huberfeld
- Department of Health Law, Policy, and Management, School of Public HealthBoston UniversityBostonMassachusettsUSA
- School of LawBoston UniversityBostonMassachusettsUSA
| | - Joseph A. Benitez
- Department of Health Management and PolicyCollege of Public Health, University of KentuckyLexingtonKentuckyUSA
| | - Kevin S. Hsu
- Bureau of Primary Health CareHealth Resources and Services AdministrationRockvilleMarylandUSA
| | - Julia R. Raifman
- Department of Health Law, Policy, and Management, School of Public HealthBoston UniversityBostonMassachusettsUSA
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Howe CJ, Bailey ZD, Raifman JR, Jackson JW. Recommendations for Using Causal Diagrams to Study Racial Health Disparities. Am J Epidemiol 2022; 191:1981-1989. [PMID: 35916384 PMCID: PMC10144617 DOI: 10.1093/aje/kwac140] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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: 03/05/2021] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
There have been calls for race to be denounced as a biological variable and for a greater focus on racism, instead of solely race, when studying racial health disparities in the United States. These calls are grounded in extensive scholarship and the rationale that race is not a biological variable, but instead socially constructed, and that structural/institutional racism is a root cause of race-related health disparities. However, there remains a lack of clear guidance for how best to incorporate these assertions about race and racism into tools, such as causal diagrams, that are commonly used by epidemiologists to study population health. We provide clear recommendations for using causal diagrams to study racial health disparities that were informed by these calls. These recommendations consider a health disparity to be a difference in a health outcome that is related to social, environmental, or economic disadvantage. We present simplified causal diagrams to illustrate how to implement our recommendations. These diagrams can be modified based on the health outcome and hypotheses, or for other group-based differences in health also rooted in disadvantage (e.g., gender). Implementing our recommendations may lead to the publication of more rigorous and informative studies of racial health disparities.
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Affiliation(s)
- Chanelle J Howe
- Correspondence to Dr. Chanelle J. Howe, Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, 121 S. Main Street, Providence, RI 02912 (e-mail: )
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Schnake-Mahl AS, O'Leary G, Mullachery PH, Skinner A, Kolker J, Diez Roux AV, Raifman JR, Bilal U. Higher COVID-19 Vaccination And Narrower Disparities In US Cities With Paid Sick Leave Compared To Those Without. Health Aff (Millwood) 2022; 41:1565-1574. [PMID: 36343316 PMCID: PMC9913883 DOI: 10.1377/hlthaff.2022.00779] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Paid sick leave provides workers with paid time off to receive COVID-19 vaccines and to recover from potential vaccine adverse effects. We hypothesized that US cities with paid sick leave would have higher COVID-19 vaccination coverage and narrower coverage disparities than those without such policies. Using county-level vaccination data and paid sick leave data from thirty-seven large US cities in 2021, we estimated the association between city-level paid sick leave policies and vaccination coverage in the working-age population and repeated the analysis using coverage in the population ages sixty-five and older as a negative control. We also examined associations by neighborhood social vulnerability. Cities with a paid sick leave policy had 17 percent higher vaccination coverage than cities without such a policy. We found stronger associations between paid sick leave and vaccination in the most socially vulnerable neighborhoods compared with the least socially vulnerable ones, and no association in the population ages sixty-five and older. Paid sick leave policies are associated with higher COVID-19 vaccination coverage and narrower coverage disparities. Increasing access to these policies may help increase vaccination and reduce inequities in coverage.
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Affiliation(s)
| | | | - Pricila H Mullachery
- Pricila H. Mullachery, Drexel University and Temple University, Philadelphia, Pennsylvania
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Cole MB, Raifman JR, Assoumou SA, Kim JH. Assessment of Administration and Receipt of COVID-19 Vaccines by Race and Ethnicity in US Federally Qualified Health Centers. JAMA Netw Open 2022; 5:e2142698. [PMID: 35006248 PMCID: PMC8749468 DOI: 10.1001/jamanetworkopen.2021.42698] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 02/01/2023] Open
Affiliation(s)
- Megan B. Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Julia R. Raifman
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - June-Ho Kim
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
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Harlow AF, Lundberg D, Raifman JR, Tan ASL, Streed CG, Benjamin EJ, Stokes AC. Association of Coming Out as Lesbian, Gay, and Bisexual+ and Risk of Cigarette Smoking in a Nationally Representative Sample of Youth and Young Adults. JAMA Pediatr 2021; 175:56-63. [PMID: 33104174 PMCID: PMC7589064 DOI: 10.1001/jamapediatrics.2020.3565] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/23/2020] [Indexed: 01/05/2023]
Abstract
Importance Coming out as lesbian, gay, bisexual, or other identities besides heterosexual (LGB+) may represent a susceptible period for cigarette smoking initiation in youth and young adults. Objective To assess whether young people who change their sexual identity have higher risk of cigarette smoking initiation and current smoking compared with those with consistent sexual identities. Design, Setting, and Participants This cohort study used data from the nationally representative Population Assessment of Tobacco and Health study (wave 1, 2013-2014; wave 2, 2014-2015; wave 3, 2015-2016; wave 4, 2016-2018). Youth and young adults aged 14 to 29 years who were never smokers at wave 1 were included in this study. Analysis began October 2018 and ended June 2020. Exposures Consistent sexual identity (consistently heterosexual, consistently LGB+) vs changing sexual identity (coming out as LGB+, other LGB+ patterns) based on 4 waves of sexual identity data. Identities were further classified by distinguishing between bisexual and lesbian, gay, and other nonheterosexual identities. Main Outcomes and Measures Smoking initiation and current cigarette smoking at wave 4. Results Among 7843 individuals who never smoked at wave 1, 6991 (90.7%) reported a consistent sexual identity, and 852 (9.3%) changed sexual identity across waves. The mean (SE) baseline age of participants who reported consistent heterosexuality was 20.1 (0.8) years; consistently LGB+, 20.0 (3.7) years; coming out as LGB+, 18.0 (2.9) years, and other LGB+ pattern, 20.3 (3.8) years. A total of 14.1% (weighted) initiated smoking, and 6.3% were current smokers at wave 4. Compared with consistently heterosexual identities, coming out as LGB+ (23% vs 13%; odds ratio [OR], 1.72; 95% CI, 1.34-2.20), consistently LGB+ identities (17% vs 13%; OR, 1.45; 95% CI, 1.03-2.04), and other LGB+ patterns (17% vs 13%; OR, 1.47; 95% CI, 1.04-2.08) were positively associated with smoking initiation by wave 4. Compared with consistently heterosexual identities, ORs for smoking initiation were 2.24 (28% vs 13%; 95% CI, 1.72-2.92) for coming out as bisexual, 1.99 (23% vs 13%; 95% CI, 1.20-3.29) for consistently LGB+ with change to/from bisexual, and 2.20 (23% vs 13%; 95% CI, 1.40-3.46) for other LGB+ patterns with change to/from bisexual identity. Current smoking estimates were similar to those for smoking initiation. Conclusions and Relevance Compared with consistently heterosexual identities, changing sexual identity over follow-up was associated with smoking initiation and current smoking. The risk associated with changing sexual identities was concentrated among participants coming out as bisexual or reporting other changes in their identity to/from being bisexual. More research is needed on mechanisms underlying the association between changing sexual identity and smoking initiation to inform tailored prevention programs and tobacco regulations.
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Affiliation(s)
- Alyssa F. Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Dielle Lundberg
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Julia R. Raifman
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Andy S. L. Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia
| | - Carl G. Streed
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emelia J. Benjamin
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Andrew C. Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
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Raifman MA, Raifman JR. Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income. Am J Prev Med 2020; 59:137-139. [PMID: 32430225 PMCID: PMC7183932 DOI: 10.1016/j.amepre.2020.04.003] [Citation(s) in RCA: 318] [Impact Index Per Article: 79.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew A Raifman
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts.
| | - Julia R Raifman
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
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Knopov A, Sherman RJ, Raifman JR, Larson E, Siegel MB. Household Gun Ownership and Youth Suicide Rates at the State Level, 2005-2015. Am J Prev Med 2019; 56:335-342. [PMID: 30661885 PMCID: PMC6380939 DOI: 10.1016/j.amepre.2018.10.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 06/25/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Determining whether the prevalence of gun ownership is associated with youth suicide is critical to inform policy to address this problem. The objective of this study is to investigate the relationship between the prevalence of household gun ownership in a state and that state's rate of youth suicide. METHODS This study, conducted in 2018, involved a secondary analysis of state-level data for the U.S. using multivariable linear regression. The relationship between the prevalence of household gun ownership and youth (aged 10-19 years) suicide rates was examined in a time-lagged analysis of state-level household gun ownership in 2004 and youth suicide rates in the subsequent decade (2005-2015), while controlling for the prevalence of youth suicide attempts and other risk factors. RESULTS Household gun ownership was positively associated with the overall youth suicide rate. For each 10 percentage-point increase in household gun ownership, the youth suicide rate increased by 26.9% (95% CI=14.0%, 39.8%). CONCLUSIONS Because states with high levels of household gun ownership are likely to experience higher youth suicide rates, these states should be especially concerned about implementing programs and policies to ameliorate this risk.
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Affiliation(s)
- Anita Knopov
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Rebecca J Sherman
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Julia R Raifman
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Elysia Larson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Michael B Siegel
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.
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