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Objectives:  We examined changes in  health care access  and utilization associated with the Patient Protection and  Affordable Care Act  (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design:  Using 2003–2017 California Health Interview Survey data, we examined changes in 4  health care access  measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results:  After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions:  Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.

HIGHLIGHTS: RWJF Health & Society Scholars (HSS) program outcomes evaluated. HSS alumni have higher scholarly productivity and impact than control group. HSS alumni are more engaged in population health research than controls. HSS alumni and controls are similar on other outcome measures. Training programs can be evaluated with adequate attention to selection bias.

Reducing racial/ethnic disparities in preterm birth is a priority for U.S. public health programs. The study objective was to quantify the relative contribution of geographic, sociodemographic, and health determinants to the black, non-Hispanic and white, non-Hispanic preterm birth disparity. Methods Cross-sectional 2016 U.S. birth certificate data (analyzed in 2018–2019) were used. Black–white differences in covariate distributions and preterm birth and very preterm birth rates were examined. Decomposition methods for nonlinear outcomes based on logistic regression were used to quantify the extent to which black–white differences in covariates contributed to preterm birth and very preterm birth disparities. Results Covariate differences between black and white women were found within each category of geographic, sociodemographic, and health characteristics. However, not all covariates contributed substantially to the disparity. Close to 38% of the preterm birth and 31% of the very preterm birth disparity could be explained by black–white covariate differences. The largest contributors to the disparity included maternal education (preterm birth, 11.3%; very preterm birth, 9.0%), marital status/paternity acknowledgment (preterm birth, 13.8%; very preterm birth, 14.7%), source of payment for delivery (preterm birth, 6.2%; very preterm birth, 3.2%), and hypertension in pregnancy (preterm birth, 9.9%; very preterm birth, 8.3%). Interpregnancy interval contributed a more sizable contribution to the disparity (preterm birth, 6.2%, very preterm birth, 6.0%) in sensitivity analyses restricted to all nonfirstborn births. Conclusions These findings demonstrate that the known portion of the disparity in preterm birth is driven by sociodemographic and preconception/prenatal health factors. Public health programs to enhance social support and preconception care, specifically focused on hypertension, may provide an efficient approach for reducing the racial gap in preterm birth.

A concrete block plant located in Bladensburg, Maryland, wants to expand to include a concrete batching plant on the same property. This expansion could further degrade air quality and impact the health of vulnerable residents. The purpose of this study is to provide information on volatile organic compounds (VOCs) levels near residential areas close to commuter traffic and industrial activity associated with the concrete plant. Air quality monitoring was conducted in the community at five sites: (1) Kingdom Missionary Baptist Church, (2) Bladensburg Waterfront Park, (3) Confluence area, (4) Bladensburg Elementary School, and (5) Hillcrest Apartment Complex by using the Atmotube, a wearable, real-time sensor that can measure total VOCs. Sampling was conducted in 30-minute periods to capture morning onpeak, afternoon off-peak, and evening on-peak periods. Traffic counts were also conducted at the sites mentioned earlier to evaluate vehicular activity. Average 30-minute values for cars ranged from 8.33 to 1295.33 cars, whereas mean truck values ranged from 0.00 to 137.67 trucks across all sites. The highest average car count of 1295.33 cars was observed at the confluence area. Mean VOCs concentrations ranged from 0.11 to 0.54 ppm across the monitoring locations. The maximum average VOCs level of 0.54 ppm was observed at Kingdom Missionary Baptist Church on Saturday. Also, the mean VOCs levels observed at the church (0.54 and 0.31 ppm) were higher compared with other locations on Saturday. Our results revealed spatial variations of VOCs levels across all locations. There were higher total VOCs levels at the church, which is the closest location to the concrete block plant.

A concrete block plant located in Bladensburg, Maryland, wants to expand to include a concrete batching plant on the same property. This expansion could further degrade air quality and impact the health of vulnerable residents. The purpose of this study is to provide information on volatile organic compounds (VOCs) levels near residential areas close to commuter traffic and industrial activity associated with the concrete plant. Air quality monitoring was conducted in the community at five sites: (1) Kingdom Missionary Baptist Church, (2) Bladensburg Waterfront Park, (3) Confluence area, (4) Bladensburg Elementary School, and (5) Hillcrest Apartment Complex by using the Atmotube, a wearable, real-time sensor that can measure total VOCs. Sampling was conducted in 30-minute periods to capture morning onpeak, afternoon off-peak, and evening on-peak periods. Traffic counts were also conducted at the sites mentioned earlier to evaluate vehicular activity. Average 30-minute values for cars ranged from 8.33 to 1295.33 cars, whereas mean truck values ranged from 0.00 to 137.67 trucks across all sites. The highest average car count of 1295.33 cars was observed at the confluence area. Mean VOCs concentrations ranged from 0.11 to 0.54 ppm across the monitoring locations. The maximum average VOCs level of 0.54 ppm was observed at Kingdom Missionary Baptist Church on Saturday. Also, the mean VOCs levels observed at the church (0.54 and 0.31 ppm) were higher compared with other locations on Saturday. Our results revealed spatial variations of VOCs levels across all locations. There were higher total VOCs levels at the church, which is the closest location to the concrete block plant.

A concrete block plant located in Bladensburg, Maryland, wants to expand to include a concrete batching plant on the same property. This expansion could further degrade air quality and impact the health of vulnerable residents. The purpose of this study is to provide information on volatile organic compounds (VOCs) levels near residential areas close to commuter traffic and industrial activity associated with the concrete plant. Air quality monitoring was conducted in the community at five sites: (1) Kingdom Missionary Baptist Church, (2) Bladensburg Waterfront Park, (3) Confluence area, (4) Bladensburg Elementary School, and (5) Hillcrest Apartment Complex by using the Atmotube, a wearable, real-time sensor that can measure total VOCs. Sampling was conducted in 30-minute periods to capture morning onpeak, afternoon off-peak, and evening on-peak periods. Traffic counts were also conducted at the sites mentioned earlier to evaluate vehicular activity. Average 30-minute values for cars ranged from 8.33 to 1295.33 cars, whereas mean truck values ranged from 0.00 to 137.67 trucks across all sites. The highest average car count of 1295.33 cars was observed at the confluence area. Mean VOCs concentrations ranged from 0.11 to 0.54 ppm across the monitoring locations. The maximum average VOCs level of 0.54 ppm was observed at Kingdom Missionary Baptist Church on Saturday. Also, the mean VOCs levels observed at the church (0.54 and 0.31 ppm) were higher compared with other locations on Saturday. Our results revealed spatial variations of VOCs levels across all locations. There were higher total VOCs levels at the church, which is the closest location to the concrete block plant.

Mingle Modernity with Tradition: Women Providing for the Elderly in Transitional China

Background Several studies have examined the association between IPI and birth outcomes, but few have explored the association between interpregnancy interval (IPI) and postnatal outcomes. Objective We examined the association between IPI and injury-related infant mortality, a leading cause of postneonatal mortality. Methods We used 2011-2015 US period-linked birth-infant death vital statistics data to generate a multiyear birth cohort of non-first-born singleton births (N = 9 782 029). IPI was defined as the number of months between a live birth and the start of the pregnancy leading to the next live birth. Causes of death in the first year of life were identified using ICD-10 codes. Hazard ratios (HR) for IPI categories were estimated using Cox proportional hazards models adjusted for birth order, county poverty level, and maternal characteristics (marital status, race/ethnicity, education, age at previous birth). Results After adjustment, overall infant mortality (48.1 per 10 000 births) was higher for short and long IPIs compared with IPI 18-23 months (reference): <6, aHR 1.61, 95\% CI 1.54, 1.68; 6-11, aHR 1.22, 95\% CI 1.17, 1.26; and 60+ months, aHR 1.12, 95\% CI 1.08, 1.16. In comparison, the risk of injury-related infant mortality (4.4 per 10 000 births) decreased with longer IPIs: <6, aHR 1.77, 95\% CI 1.55, 2.01; 6-11, aHR 1.41, 95\% CI 1.25, 1.59; 12-17, aHR 1.25, 95\% CI 1.10, 1.41; 24-59, aHR 0.78, 95\% CI 0.69, 0.87; and 60+ months, aHR 0.55, 95\% CI 0.48, 0.62. Conclusion Unlike overall infant mortality, injury-related infant mortality decreased with IPI length. While injury-related deaths are rare, these patterns suggest that the timing between births may be a marker of risk for fatal infant injuries. The first year postpartum may be an ideal time for the delivery of evidence-based injury prevention programmes as well as family planning services.

Sexual and gender minority (SGM) youth experience high rates of victimization leading to health disparities. Community size and community climate are associated with health outcomes among SGM youth; however, we lack studies that include them as covariates alongside victimization to understand their collective impact on health. This study utilized minority stress theory to understand how community context shapes experiences of victimization and health among SGM youth. SGM youth in one Midwestern U.S. state completed an online survey ( n  = 201) with measures of physical health, mental health, community context, and victimization. Data were analyzed via multiple regression using a path analysis framework. Results indicate that perceived climate was associated with mental, but not physical, health; Community size was unrelated to health outcomes. Victimization mediated the association between community climate and mental health. Findings are discussed in light of current literature and implications for research and practice are shared.

Abstract Purpose: The purpose of this study was to assess sexual orientation differences in high-intensity binge drinking using nationally representative data. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions III (N = 36,309), a nationally representative sample of U.S. adults collected in 2012–2013. Sex-stratified adjusted logistic regression models were used to test sexual orientation differences in the prevalence of standard (4+ for women and 5+ for men) and high-intensity binge drinking (8+ and 12+ for women; 10+ and 15+ for men) across three dimensions of sexual orientation: sexual attraction, sexual behavior, and sexual identity. Results: Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking at two (adjusted odds ratios [aORs] ranging from 1.52 to 2.90) and three (aORs ranging from 1.61 to 3.27) times the standard cutoff for women (4+). Sexual minority men, depending on sexual orientation dimension, were equally or less likely than sexual majority men to engage in high-intensity binge drinking. Conclusion: This study is the first to document sexual orientation-related disparities in high-intensity binge drinking among adults in the United States using nationally representative data. The results suggest that differences in alcohol-related risk among sexual minority individuals vary depending on sex and sexual orientation dimension.