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Article Reference Troff document (with manpage macros)Black–White Disparities in Preterm Birth: Geographic, Social, and Health Determinants
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.
Located in MPRC People / Marie Thoma, Ph.D. / Marie Thoma Publications
Article Reference Troff document (with manpage macros)Utilization of essential preventive health services among Asians after the implementation of the preventive services provisions of the Affordable Care Act
Utilization of cost-effective essential preventive health services increased after the implementation of the Affordable Care Act’s (ACA) provision that non-grandfathered private insurers provide cost-effective preventive services without cost sharing in 2010. Little is known, however, whether this change is also observed among Asians in the US. We examined patterns of preventive services utilization among Asian subgroups relative to non-Latino whites (whites) after the implementation of the ACA’s preventive services provisions. Using 2013–2016 Medical Expenditure Panel Survey data, we examined utilization trends in preventive services among Asian Indians, Chinese, Filipinos, and other Asians relative to whites. We also ran logistic regression models to estimate the likelihood of having received each of the seven essential preventive services (routine checkups, flu vaccinations, cholesterol screenings, blood pressure checkups, Papanicolaou “pap” tests, mammograms, and colorectal cancer screenings). Compared to whites, Asians had higher rates of utilization of routine checkups, cholesterol screenings, and flu vaccinations, but they had lower utilization rates of blood pressure checkups, pap tests, and mammograms. The patterns of preventive services utilization differed across the Asian subgroups. All Asian subgroups, except for Filipinos, were less likely to have pap tests or mammograms than whites. Moreover, we observed a decreasing trend in having pap tests, mammograms, or colorectal cancer screenings among all Asian subgroups between 2013 and 2016. Our findings suggest that there are low cancer screening rates across Asian subgroups. This indicates the need for programs tailored to specific Asian subgroups to improve cancer screening.
Located in MPRC People / Jie Chen, Ph.D. / Jie Chen Publications
Article Reference Troff document (with manpage macros)Using Google Street View to examine associations between built environment characteristics and U.S. health outcomes
Neighborhood attributes have been shown to influence health, but advances in neighborhood research has been constrained by the lack of neighborhood data for many geographical areas and few neighborhood studies examine features of nonmetropolitan locations. We leveraged a massive source of Google Street View (GSV) images and computer vision to automatically characterize national neighborhood built environments. Using road network data and Google Street View API, from December 15, 2017-May 14, 2018 we retrieved over 16 million GSV images of street intersections across the United States. Computer vision was applied to label each image. We implemented regression models to estimate associations between built environments and county  health outcomes , controlling for county-level demographics, economics, and  population density . At the county level, greater presence of highways was related to lower chronic diseases and  premature mortality . Areas characterized by street view images as ‘rural’ (having limited infrastructure) had higher obesity,  diabetes , fair/poor self-rated health, premature mortality, physical distress, physical inactivity and teen birth rates but lower rates of excessive drinking. Analyses at the  census  tract level for 500 cities revealed similar adverse associations as was seen at the county level for neighborhood indicators of less urban development. Possible mechanisms include the greater abundance of services and facilities found in more developed areas with roads, enabling access to places and resources for promoting health. GSV images represents an underutilized resource for building national data on neighborhoods and examining the influence of built environments on community health outcomes across the United States.
Located in MPRC People / Quynh Nguyen, Ph.D., M.S.P.H. / Quynh Nguyen Publications
Article Reference Troff document (with manpage macros)Between Privilege and Oppression: An Intersectional Analysis of Active Transportation Experiences Among Washington D.C. Area Youth
The use of active transportation (AT), such as walking, cycling, or even public transit, as a means of transport offers an opportunity to increase youth physical activity and improve health. Despite the well-known benefits of AT, there are environmental and social variables that converge on the AT experiences of low-income youth and youth of color (YOC) that have yet to be fully uncovered. This study uses an intersectional framework, largely focusing on the race-gender-class trinity, to examine youth AT within a context of transportation inequity. Theoretically guided by the Ecological Model of Active Transportation, focus groups were completed with two groups of girls (15 participants) and two groups of boys (nine participants) ranging between the ages of 12-15 years who lived within the Washington D.C. area. This research found race, gender, and class to be inhibitors of AT for both boys and girls, but with more pronounced negative influences on girls.
Located in MPRC People / Jennifer D. Roberts, Dr.P.H., M.P.H. / Jennifer D. Roberts Publications
Article ReferenceHealth Care Experiences of Black Transgender Women and Men Who Have Sex With Men
Black sexual and gender minorities (SGM) are at greater risk for HIV compared to their White, cisgender, heterosexual counterparts. Linkage to culturally sensitive health care is, therefore, pivotal for HIV prevention and treatment of Black SGM. Unfortunately, social and structural challenges undermine Black SGM individuals' abilities to obtain adequate health care services, indicating a need to understand Black SGM perceptions of health care. To address this gap, we interviewed Black men who have sex with men and transwomen about their experiences with health care providers. Participants discussed needs and concerns, including provider SGM identity diversity and education; assumptions, judgment, stigma, and discrimination; and ability to establish a personal bond, trust, and familiarity. Black SGM indicated that providers often did not meet their needs in different ways regarding their SGM identities. Findings suggest a need for provider cultural sensitivity education programs that address the needs of Black SGM in health care.
Located in MPRC People / Typhanye Vielka Dyer, Ph.D., MPH / Typhanye Vielka Dyer Publications
Article Reference Troff document (with manpage macros)Tree-based Machine Learning Methods for Survey Research
Predictive modeling methods from the field of machine learning have become a popular tool across various disciplines for exploring and analyzing diverse data. These methods often do not require specific prior knowledge about the functional form of the relationship under study and are able to adapt to complex non-linear and non-additive interrelations between the outcome and its predictors while focusing specifically on prediction performance. This modeling perspective is beginning to be adopted by survey researchers in order to adjust or improve various aspects of data collection and/or survey management. To facilitate this strand of research, this paper (1) provides an introduction to prominent tree-based machine learning methods, (2) reviews and discusses previous and (potential) prospective applications of tree-based supervised learning in survey research, and (3) exemplifies the usage of these techniques in the context of modeling and predicting nonresponse in panel surveys.
Located in MPRC People / Frauke Kreuter, Ph.D. / Frauke Kreuter Publications
Article Reference Troff document (with manpage macros)Flies Without Borders - Lessons from Chennai on Improving India's Municipal Public Health Services
India’s cities face key challenges to improving public health outcomes. First, unequally distributed public resources create insanitary conditions, especially in slums – threatening everyone’s health, as suggested by poor child growth even amongst the wealthiest. Second, devolving services to elected bodies works poorly for highly technical services like public health. Third, services are highly fragmented. This paper examines the differences in the organisation and management of municipal services in Chennai and Delhi, two cities with sharply contrasting health indicators. Chennai mitigates these challenges by retaining professional management of service delivery and actively serving vulnerable populations − while services in Delhi are quite constrained. Management and institutional issues have received inadequate attention in the public health literature on developing countries, and the policy lessons from Chennai have wide relevance.
Located in MPRC People / Monica Das Gupta, Ph.D. / Monica Das Gupta Publications
Article Reference Troff document (with manpage macros)Social Influences on Drinking Trajectories From Adolescence to Young Adulthood in an Urban Minority Sample
OBJECTIVE: Research on the heterogeneity in drinking patterns of urban minorities within a socioecological framework is rare. The purpose of this study was to explore multiple, distinct patterns of drinking from adolescence to young adulthood in a sample of urban minority youth and to examine the influence of neighborhood, family, and peers on these trajectories. METHOD: Data are from a longitudinal study of 584 (56% male) primarily Black (87%) youth who were first sampled in childhood based on their residence in low-income neighborhoods in Baltimore City and followed up annually through age 26. Data were analyzed using group-based trajectory modeling and multinomial logistic regression. RESULTS: Modeling revealed six trajectories from ages 14 to 26: abstainer, experimenter, adult increasing, young adult increasing, adolescent limited, and adolescent increasing. Neighborhood disadvantage was a risk factor for drinking regardless of the timing of onset. Perceptions of availability, peer drinking, and parental approval for drinking were risk factors for underage drinking trajectories, whereas parental supervision was a significant protective factor. Positive social activities in neighborhoods was protective against increased drinking, whereas a decline in perceptions of peer drinking was associated with adolescent-limited drinking. CONCLUSIONS: Our findings uniquely highlight the importance of developing interventions involving parents for urban minority youth for whom family is particularly relevant in deterring underage drinking. Perhaps most importantly, our data suggest that interventions that support positive social activities in disadvantaged neighborhoods are protective against adolescent drinking and altering perceptions of peer drinking may reduce adolescent drinking among low-income, urban minority youth.
Located in MPRC People / Kerry Green, Ph.D. / Kerry Green Publications
Article ReferenceA Conversation with Maureen Cropper
This article presents an interview with environmental economist Maureen L. Cropper. Maureen completed her Ph.D. at Cornell University and subsequently held positions at the University of California, Riverside, and the University of Southern California. At Riverside, she moved from monetary economics to environmental economics. She then landed at the University of Maryland, where she is a still a professor. She has taken on leadership roles in numerous institutional settings, including the US National Academy of Sciences and the US Environmental Protection Agency (EPA) Science Advisory Board. Her contributions to environmental economics have been groundbreaking and extensive. Together with many collaborators—including former students and colleagues at the University of Maryland, World Bank, EPA, and Resources for the Future—Maureen has produced a body of work that spans theory, methods, and empirical applied economics. Her work covers the environment, energy, climate change, and transportation in both the United States and developing countries.
Located in MPRC People / Maureen Cropper, Ph.D. / Maureen Cropper Publications
Article ReferenceExamining prevalence and correlates of cigarette and marijuana co-use among young adults using ten years of NHANES data
Background Prior research has documented a strong association between cigarette and marijuana use among young adults; it is critical to study patterns and risk factors for co-use. Methods Appended, cross-sectional National Health and Nutrition  Examination Survey (NHANES) data were used to assess prevalence and correlates of cigarette and marijuana co-use among young adults (ages 21–30) over a 10-year period (2005–2014). Respondents (unweighted sample = 4,948) were classified into four categories regarding past-month behavior: neither use, cigarette-only use, marijuana-only use, and co-use of both. Regression models were computed to predict these categories using three waves of NHANES (unweighted sample = 3,073). Results Prevalence of past-month cigarette use decreased from 30.9% in 2005–2006 to 23.7% in 2013–2014 (p = 0.024) while past-month marijuana use (average 18.0%) and past-month co-use (average 9.8%) remained stable during this time. Co-use differed significantly by gender (p < 0.001; average 12.9% men, 6.8% women). Co-users were less likely to be married, more likely to endorse non-Hispanic black racial identity, more likely to have engaged in non-marijuana drug use in their lifetime and more likely to drink alcohol monthly than cigarette-only users. Co-users were more likely to have depressive symptoms, ever use non-marijuana drugs, live with a smoker, and initiate marijuana at a younger age than marijuana-only users. Conclusions Co-use of cigarettes and marijuana remained stable but high over a ten-year period; understanding the unique characteristics, living situations, experiences, and substance use behaviors of co-users can contribute to more effective, tailored prevention and education strategies to reduce the burden of comorbid cigarette and marijuana use.
Located in MPRC People / Kerry Green, Ph.D. / Kerry Green Publications