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Racial Disparities in the 1918 Flu Pandemic in US Cities: What We Know and Why it Matters Today

Lack of access to a health-promoting food environment can lead to poor health outcomes including obesity which is a problem for African-Americans in Prince George’s County, Maryland. Previous research examined the quality of the food environment at the regional level but did not consider local level indicators. In this study, we utilized an environmental justice framework to examine the local food environment in the County. We collected data from 127 food outlets, (convenience stores, grocery stores, and supermarkets), in three racially and socioeconomically diverse communities – Bladensburg (predominantly African American/ Black, with the lowest median household income); Greenbelt (similar percentage of non-white persons as Hyattsville, with the highest median household income); and Hyattsville (dominated by a Hispanic population). We examined the availability, quality, and accessibility of food within each community, using a modified version of the Johns Hopkins Center for a Livable Future (CLF) healthy food availability index (HFAI).We also used ArcMap 10.6 to examine the spatial distribution of stores in relation to sociodemographic factors and generate descriptive statistics to examine HFAI score differences across the communities, sociodemographic composition, and store types at the block group level. Mean HFAI scores were 7.76, 10.75, and 9.60 for Bladensburg, Greenbelt, and Hyattsville, respectively suggesting a relative disparity in access to diverse healthy and good quality food sources for these communities although these differences were not statistically significant (p=0.79). Statistically significant differences between the communities were found with respect to ethnic stores, stores that sold fresh vegetables (p=0.047), and stores that sold fresh fruits (p=0.012). Getis-Ord Gi Hot Spot Analysis revealed one statistically significant cold spot at 95% confidence, and two others at 90% confidence in Hyattsville, indicating a cluster of low-scoring stores. The results indicate a potential need for expanded food infrastructure in these communities to improve public health. We also identified the need for culturally appropriate foods and proposed ethnic stores as potential salutogens to improve the food environment in culturally diverse neighborhoods.

Payne-Sturges leads multi-disciplinary research team

Michael S. Rendall, University of Maryland; Elizabeth Baker, University of Alabama; Margaret M. Weden, RAND Corporation; 2013-023

Michael S. Rendall, University of Maryland; Elizabeth H. Baker and Margaret M. Weden, RAND Corporation; 2012-010

Background Perceived racial/ethnic discrimination and poor sleep occur across all races/ethnicities in the U.S., though both are most common among racial/ethnic minorities. Few studies have investigated associations between perceived racial/ethnic discrimination and various sleep dimensions in a multiethnic population. Methods We analyzed cross-sectional associations among 40,038 eligible Sister Study participants (enrollment: 2003-2009) who reported ever/never experiencing specific types of everyday (e.g., treated unfairly at a store or restaurant) or major (e.g., unfairly stopped, threatened, or searched by police) discrimination attributed to their race/ethnicity during a follow-up survey in 2008-2012. Participants also reported short sleep duration (<7 hours), sleep debt (≥2-hour difference between longest and shortest sleep duration), frequent napping (≥3 times/week), and insomnia. Poisson regression with robust variance estimation, adjusted for sociodemographic and health characteristics, estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between each type of racial/ethnic discrimination and each sleep dimension, overall and by race/ethnicity. Results Mean age was 55 ± 8.9 years, 89% were NH-white, 8% NH-black, and 3% Hispanic/Latina. NH-black participants were the most likely to report everyday (76% vs. 4% [NH-whites] and 36% [Hispanics/Latinas]) and major racial/ethnic discrimination (52% vs. 2% [NH-whites] and 18% [Hispanics/Latinas]). Participants who experienced both types versus neither were more likely to report short sleep duration (PR=1.17 [95% CI: 1.09-1.25]) and insomnia symptoms (PR=1.10 [1.01-1.20]) but not other poor sleep dimensions. Conclusions Racial/ethnic minority women were most likely to experience racial/ethnic discrimination, which was associated with certain poor sleep dimensions among women of all races/ethnicities.

BACKGROUND:In the new era of value-based payment models and pay for performance, hospitals are in search of the silver bullet strategy or bundle of strategies capable of improving their performance on quality measures. OBJECTIVES:To determine whether there is an association between adoption of hospital-based care coordination strategies and Centers for Medicare and Medicaid Services overall hospital quality (star) ratings and readmission rates. RESEARCH DESIGN:We used survey data from the American Hospital Association (AHA) and categorized respondents by the number of care coordination strategies that they reported having widely implemented. We used multiple logistic regression models to examine the association between the number of strategies and hospital overall rating performance and disease-specific 30-day excess readmission ratios, while controlling for hospital and county characteristics and state-fixed effects. SUBJECTS:A total of 710 general acute care noncritical access hospitals that received star ratings and responded to the 2015 AHA Care Systems and Payment Survey. MEASURES:Centers for Medicare and Medicaid Services overall hospital ratings, 30-day excess readmission ratios. RESULTS:As compared with hospitals with 0-2 strategies, hospitals with 3 to 4 strategies (P=0.007), 5-7 strategies (P=0.002), or 8-12 strategies (P=0.002) had approximately 2.5× the odds of receiving a top rating (4 or 5 stars). Care coordination strategies were positively associated with lower 30-day readmission ratios for patients with chronic medical conditions, but not for surgical patients. Medication reconciliation, visit summaries, outreach after discharge, discharge care plans, and disease management programs were each individually associated with top ratings. CONCLUSIONS:Care coordination strategies are associated with high overall hospital ratings.

Governance Studies at Brookings paper

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.

Increasing number of studies have investigated the impact of maternal exposure to air pollution during pregnancy and adverse birth outcomes, particularly low birth weight (LBW, <2,500 g at birth) and preterm birth (PTB, <37 completed weeks of gestation). We performed a comprehensive review of the peer-reviewed literature and a meta-analysis to quantify the association between maternal exposure to particulate matter with aerodynamic diameter 2.5 and 10 μm (PM 2.5  and PM 10 ) during pregnancy and the risk of LBW and PTB. We identified 20 peer-reviewed articles providing quantitative estimate of exposure and outcome that met our selection criteria. There was significant heterogeneity between studies, particularly for findings related to PM 10  exposure (LBW,  I -squared 54%,  p  = 0.01; PTB,  I -squared = 73%,  p  < 0.01). Results from random-effect meta-analysis suggested a 9% increase in risk of LBW associated with a 10-μg/m 3  increase in PM 2.5  (combined odds ratios (OR), 1.09; 95% confidence interval (CI), 0.90–1.32), but our 95% CI included the null value. We estimated a 15% increase in risk of PTB for each 10-μg/m 3  increase in PM 2.5  (combined OR, 1.15; CI, 1.14–1.16). The magnitude of risk associated with PM 10  exposure was smaller (2% per 10-μg/m 3  increase) and similar in size for both LBW and PTB, neither reaching formal statistical significance. We observed no significant publication bias, with  p  > 0.05 based on both Begg's and Egger's bias tests. Our results suggest that maternal exposure to PM, particularly PM 2.5  may have adverse effect on birth outcomes. Additional mechanistic studies are needed to understand the underlying mechanisms for this association.