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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)Sex-Specific Associations Between Area-Level Poverty and Cardiometabolic Dysfunction Among US Adolescents
Objective: Cardiometabolic disease is the leading cause of mortality in the United States. Cardiometabolic function during adolescence predicts future cardiometabolic disease, yet few studies have examined early determinants of cardiometabolic function. Informed by evidence of sex differences in the prevalence and severity of cardiometabolic disorders and evidence of sexual dimorphism in the stress response, we examined sex differences in the association between living in poverty and cardiometabolic function during adolescence, a precursor of later cardiometabolic disorders. Methods: We linked data from 10 415 adolescents aged 12-19 in the National Health and Nutrition Examination Survey (1999-2012) with US Census–tract data on area-level poverty (percentage of the population living in poverty, grouped into quartiles). We parameterized cardiometabolic dysfunction by summing the z scores of 6 cardiometabolic biomarkers, grouped into quintiles. Hierarchical ordinal models estimated associations. Results: Compared with residents in low-poverty areas, residents in high-poverty areas had elevated odds of cardiometabolic dysfunction (highest quartile of poverty odds ratio [OR] = 1.27; 95% confidence interval [CI], 1.08-1.50). This association was more pronounced among boys than girls (highest quartile of poverty for boys: OR = 1.36; 95% CI, 1.10-1.70; highest quartile of poverty for girls: OR = 1.17; 95% CI, 0.94-1.47). Conclusion: Our study supports the existence of sex-specific associations. These results highlight the potential for community-based programs, such as housing assistance, to improve population health.
Located in MPRC People / Edmond Shenassa, Ph.D. / Edmond Shenassa Publications
Article Reference Troff document (with manpage macros)Effect of Change in Cumulative Psychosocial Stressors on Change in Body Mass Index Over Time
Introduction:  Increased psychosocial stress and obesity are both associated with elevated risk of cardiovascular disease (CVD). However, the effect of change in cumulative psychosocial stressors (stressors) on change in body mass index (BMI) over time is unknown, particularly among older women, a population in whom weight change characterization is complex. Methods and Results:  We examined change in stressors in relation to change in BMI among 20,750 women without CVD or cancer at baseline (2012-13) participating in the Women’s Health Study (WHS) follow-up cohort. Stressors and BMI were collected at two time points 2012-13 (Baseline: T1; mean age=71.8 ± 5.8 years) and 2014-15 (Follow-up: T2; mean age=73.8 ± 5.8 years). Our measures of stressors were comprised of a composite of 8 domains, including acute (e.g. negative life events) and chronic (e.g., financial) stressors. We defined stressors over 3 years of follow-up into four categories: chronically low, delayed, acutely high, and chronically high; and BMI change was grouped into three categories (BMI: loss >3%, gain >3%, and maintenance ± 3%). Women with chronically high stress and delayed stress were younger, current smokers and reported more anxiety/depressive symptoms compared to other women. Women with chronically high stress were more likely to have diabetes, hypertension and hypercholesterolemia than their counterparts. Compared to women who maintained both their BMI and had low stress over time, women with delayed stress or chronically high stress had higher odds of decreased BMI [Delayed: Odds Ratio (OR)  1.16,  95% Confidence Interval (CI):  1.03-1.30 ; Chronically High:  OR=1.12, 95% CI 1.01-1.24 ] ( Table 1 ). Conclusion:  Chronically high and delayed cumulative stress were associated with higher odds of weight loss in older women over 3 years. Future studies are needed to test associations between stressors and metabolic, hormonal and autonomic factors resulting in adiposity or musculoskeletal changes.
Located in MPRC People / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article Reference Troff document (with manpage macros)The association between first abortion and first-time non-fatal suicide attempt: a longitudinal cohort study of Danish population registries
Background Suicidal ideation due to abortion has been used to justify restrictive US abortion policies. Much research examining abortion and mental health has relied on self-report, has had low participation rates, and did not consider confounding factors. In the present study, we used data that do not rely on self-report and are not affected by low participation rates to examine the association between abortion and non-fatal suicide attempts, adjusting for confounding factors. Methods In this longitudinal cohort study of Danish population registries, we linked data on a cohort of women born in Denmark between Jan 1, 1980, and Dec 30, 1998, who did not die or emigrate from Denmark before their 18th birthday or before study entry. Follow-up started on the woman's 18th birthday or Jan 1, 2000, whichever came last. Follow-up ended at the date of first suicide attempt, date of emigration from Denmark, date of death, or Dec 31, 2016, whichever came first. Women were between the ages of 18 and 36 years during the study period. We used a survival analysis to examine the risk of first suicide attempts or self-harm associated with a first abortion compared with no abortion, in the complete study cohort. To examine incidence rate ratios (IRRs) associated with abortion, we used Poisson regression with the logarithm of woman-years at risk as an offset. We also examined whether the risk of suicide attempts changed before and after the abortion, adjusting for age, calendar year, socioeconomic status, and history of childbirth, mental health, parental mental health, and physical health. Findings Data on 523 280 women were included in this study. Of these, 48 990 (9·4%) women had a record of at least one first-trimester abortion, and 10 216 (2·0%) had a suicide attempt during the study period. Among 48 990 women who had an abortion, 1402 (2·9%) had a first suicide attempt after the first abortion. In our fully-adjusted model which adjusted for all covariates, the risk of first-time non-fatal suicide attempts was similar in the year before an abortion (IRR 2·46 [95% CI 2·22–2·72]) and the year after an abortion (IRR 2·54 [2·29–2·81], p=0·509) compared with women who had not had an abortion, and decreased with increasing time since the abortion (1–5 years IRR 1·90 [1·75–2·06]; ≥5 years IRR 1·73 [1·53–1·96]). Interpretation We found that women who had abortions had a higher risk of non-fatal suicide attempts compared with women who did not have an abortion. However, because the increased risk was the same both the year before and after the abortion, it is not attributable to the abortion. Thus, policies based on the notion that abortion increases women's risk of suicide attempts are misinformed.
Located in MPRC People / Julia Steinberg, Ph.D. / Julia Steinberg Publications
Article Reference Troff document (with manpage macros)Sexual Orientation Disparities in Substance Use: Investigating Social Stress Mechanisms in a National Sample
Introduction: Sexual minorities are disproportionately more likely than heterosexuals to suffer from substance use disorders, but relatively little is known about differences in substance use disorders across diverse sexual minority subgroups. There is also limited understanding of how different social stressors account for sexual orientation disparities in substance use disorders. Methods: Using nationally representative data collected in 2012−2013 (n=34,597), differences in past-year DSM-5 alcohol, cannabis, and tobacco use disorders were assessed across 4 sexual orientation groups (heterosexuals and 3 sexual minority subgroups, lesbian/gay-, bisexual-, and heterosexual-identified sexual minorities). This study assessed whether stressful life events mediated substance use disorder disparities between heterosexuals and each sexual minority subgroup, and whether stressful life events and lesbian, gay, and bisexual discrimination events mediated these substance use disorder differences. Analyses were conducted in 2019. Results: For both men and women, substance use disorders and stress experiences varied by sexual identity. For example, compared with heterosexual men, larger proportions of gay and bisexual men had a past-year alcohol use disorder. Among women, all sexual minority subgroups had higher rates of each substance use disorder than heterosexuals. For each substance use disorder, stressful life events mediated disparities between heterosexuals and sexual minority subgroups, except for heterosexual-identified sexual minority men. Both stressful life events and lesbian, gay, and bisexual discrimination mediated substance use disorder differences between sexual minority subgroups, with stronger indirect effects through lesbian, gay, and bisexual discrimination for lesbians/gay men and stronger indirect effects through stressful life events for bisexual adults, generally. Conclusions: Sexual minority subgroups have a greater prevalence of substance use disorders, mediated through both stressful life events and lesbian, gay, and bisexual discrimination. More research is needed to comprehensively assess the processes underlying sexual orientation substance use disparities.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Substance Use Among a National Sample of Sexual and Gender Minority Adolescents: Intersections of Sex Assigned at Birth and Gender Identity
Purpose:  We examined how substance use differed as a function of sex assigned at birth and gender identity (cisgender, transgender, or nonbinary/genderqueer) by type of substance. We sought to test whether current gender identity and sex assigned at birth were key factors in substance use among a large contemporary sample that included transgender and nonbinary/genderqueer adolescents. Methods:  We analyzed data from a large national U.S. sample of sexual and gender minority (SGM) adolescents (n = 11,129) collected between April and December 2017. Chi-square tests of independence were used to test whether substance use behaviors varied by sex assigned at birth and gender identity. A series of multivariate logistic regression models tested the odds of substance use by sex assigned at birth and gender identity, as well as the interaction between sex assigned at birth and gender identity. Results:  More than half of our sample reported lifetime alcohol use, and one-fourth of the sample reported lifetime marijuana use. Adolescents assigned male at birth had higher prevalence of substance use compared with adolescents assigned female at birth (AFAB). Multivariate models elucidated greater risk for most substance use outcomes for transgender adolescents compared with cisgender adolescents. We found significant interaction effects between gender identity and sex assigned at birth for recent alcohol use and lifetime and recent cigarette use among adolescents AFAB. Conclusions:  These findings have implications for stakeholders who develop nationally representative surveys, researchers who examine substance use disparities among SGM adolescents, and mental health professionals who treat underage substance use among vulnerable populations.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article ReferenceSexual minority youth are at a disadvantage: what now?
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Reforming medical education admission and training in low- and middle-income countries: who gets admitted and why it matters
Recent studies reveal public-sector healthcare providers in low- and middle-income countries (LMICs) are frequently absent from work, solicit informal payments for service delivery, and engage in disrespectful or abusive treatment of patients. While extrinsic factors may foster and facilitate these negative practices, it is not often feasible to alter the external environment in low-resource settings. In contrast, healthcare professionals with strong intrinsic motivation and a desire to serve the needs of their community are less likely to engage in these negative behaviors and may draw upon internal incentives to deliver a high quality of care. Reforming medical education admission and training practices in LMICs is one promising strategy for increasing the prevalence of medical professionals with strong intrinsic motivation.
Located in MPRC People / Kenneth Leonard, Ph.D. / Kenneth Leonard Publications
Article Reference Troff document (with manpage macros)Inequalities in the distribution of childhood adversity from birth to 11 years
Objective Exposure to early adversity carries long term harmful consequences for children's health and development. This study aims to 1) estimate the prevalence of childhood adversity for Australian children from infancy to 10-11 years, and 2) document inequalities in the distribution of adversity according to socioeconomic position (SEP), Indigenous status, and ethnicity. Methods Adversity was assessed every two years from 0-1 to 10-11 years in the nationally representative birth cohort of the Longitudinal Study of Australian Children (N=5,107). Adversity included legal problems; family violence; household mental illness; household substance abuse; harsh parenting; parental separation/divorce; unsafe neighborhood; family member death; and bullying (from 4-5 years). Adversities were examined individually and summed for a measure of multiple adversity (2+ adverse experiences). Results By 10-11 years, 52.8% (95% CI 51.0-54.7) of children had been exposed to two or more adversities. When combined with low SEP, children from ethnic minority and from Indigenous backgrounds had four to eight times the odds of exposure to two or more adversities than children from higher SEP Anglo-Euro backgrounds, respectively (OR 4.3, 95% CI 2.8-6.6 and OR 8.1, 95% CI 4.4-14.8). Ethnic minority and Indigenous children from higher SEP backgrounds had increased odds of exposure to multiple adversity than similarly advantaged Anglo-Euro children (OR 1.8, 95% CI 1.4-2.3 and OR 2.3, 95% CI 1.3-4.3, respectively). Conclusions Addressing early adversity is a significant opportunity to promote health over the life course, and reduce health inequalities experienced by marginalized groups of children.
Located in MPRC People / Natalie Slopen, Sc.D. / Natalie Slopen Publications
Article ReferenceAssessing the Role of Health Behaviors, Socioeconomic Status, and Cumulative Stress for Racial/Ethnic Disparities in Obesity
Objective: This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults. Methods: Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was conducted to quantify the extent to which health behaviors (fruit and vegetable consumption and physical activity), SEP, and cumulative stressors (e.g., perceived discrimination, financial strain) each explained differences in obesity prevalence in Black, US-born Hispanic, and non-US-born Hispanic compared with non-Hispanic White participants. Results: SEP and health behaviors did not explain obesity differences between racial/ethnic minorities and White individuals. Having high levels of stress in four or more domains explained 4.46% of the differences between Black and White individuals, whereas having high levels of stress in three domains significantly explained 14.13% of differences between US-born Hispanic and White. Together, the predictors explained less than 20% of differences between any racial/ethnic minority group and White individuals. Conclusions: Exposure to stressors may play a role in obesity disparities, particularly among Black and US-born Hispanic individuals. Other obesity-related risk factors need to be examined to understand the underlying mechanisms explaining obesity disparities.
Located in MPRC People / Natalie Slopen, Sc.D. / Natalie Slopen Publications