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Alternative Trajectories in Body Weight, Mental and Cognitive Health among Older Americans: Roles of Genetics and Earlier SES

They are one of the four research groups chosen for the data contract

Race differences in school attendance across the Jim Crow South and its implications for Black-White disparities in cognitive impairment risk among older adults

PURPOSE: We aimed to estimate latent classes of concurrent polysubstance use and test for sexual orientation differences in latent class memberships with representative data from adolescents living in 19 U.S. states. We also tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships. METHODS: We analyzed data from 119,437 adolescents from 19 states who participated in the 2015 Youth Risk Behavior Survey. Latent class analysis characterized polysubstance use patterns based on self-reported frequency of lifetime and past-month use of alcohol (including heavy episodic drinking), tobacco (cigarettes, cigars, and smokeless tobacco), and marijuana. Multinomial logistic regression models tested differences in latent class memberships by sexual identity. Interaction terms tested whether sex, race/ethnicity, and age moderated the sexual identity differences in polysubstance use class memberships. RESULTS: A six-class model of polysubstance use fit the data best and included nonusers (61.5%), experimental users (12.2%), marijuana-alcohol users (14.8%), tobacco-alcohol users (3.8%), medium-frequency three-substance users (3.6%), and high-frequency three-substance users (4.1%). Gay/lesbian- and bisexual-identified adolescents had significantly higher odds than heterosexual-identified adolescents of being in all of the user classes compared with the nonuser class. These sexual identity differences in latent polysubstance use class memberships were generally larger for females than for males, varied occasionally by race/ethnicity, and were sometimes larger for younger ages. CONCLUSION: Compared with their heterosexual peers, gay/lesbian and bisexual adolescents-especially females-are at heightened risk of engaging in multiple types of polysubstance use. Designing, implementing, and evaluating interventions will likely reduce these sexual orientation disparities.

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations—which provide LGBTQ-focused support and services—have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15–21;  M  = 18.81;  n  = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.

The past several decades have witnessed growing geographic disparities in life expectancy within the United States, yet the mortality experience of U.S. cities has received little attention. We examine changes in men’s life expectancy at birth for the 25 largest U.S. cities from 1990 to 2015, using mortality data with city of residence identifiers. We reveal remarkable increases in life expectancy for several U.S. cities. Men’s life expectancy increased by 13.7 years in San Francisco and Washington, DC, and by 11.8 years in New York between 1990 and 2015, during which overall U.S. life expectancy increased by just 4.8 years. A significant fraction of gains in the top-performing cities relative to the U.S. average is explained by reductions in HIV/AIDS and homicide during the 1990s and 2000s. Although black men tended to see larger life expectancy gains than white men in most cities, changes in socioeconomic and racial population composition also contributed to these trends.

ABSTRACT: The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions. 

ABSTRACT: The Affordable Care Act (ACA) provides financial incentives to prevent substance use disorders (SUDs). Local health departments (LHDs) can receive funds to establish care teams that partner with primary care providers and health systems. This study estimates the potential effect of LHDs on emergency visits for SUDs, using linked data sets from the Healthcare Cost and Utilization Project Emergency Department (ED) sample for the State of Maryland-2012, the National Association of County and City Health Officials Profiles Survey 2013, and Area Health Resource File 2013 to estimate potential effect of LHDs' provision of SUD preventive care and SUD-related policy implementation. Local health department involvement in SUD-related policy during the past 2 years and provision of preventive care for behavioral health in the past year significantly reduced the probability of having a SUD-related ED visit by 11% and 6%, respectively, after controlling for individual characteristics (odds ratio [OR] = 0.89, p < .001; OR = 0.93, p < .001). After adjusting for the individual and contextual factors, LHD involvement in policy was still associated with 14% reduction in SUD-related ED visits (OR = 0.86, p < .001). Results offer insights on the extent to which the LHD activities can possibly affect SUD-related ED visits and provide a foundation for future work to identify effective LHD interventions. 

Background Atmospheric particulate matter (PM) has been associated with endothelial dysfunction, an early marker of cardiovascular risk. Our aim was to extend this research to a genetically homogenous, geographically stable rural population using location-specific moving-average air pollution exposure estimates indexed to the date of endothelial function measurement. Methods We measured endothelial function using brachial artery flow-mediated dilation (FMD) in 615 community-dwelling healthy Amish participants. Exposures to PM < 2.5 μm (PM 2.5 ) and PM < 10 μm (PM 10 ) were estimated at participants’ residential addresses using previously developed geographic information system-based spatio-temporal models and normalized. Associations between PM exposures and FMD were evaluated using linear mixed-effects regression models, and polynomial distributed lag (PDL) models followed by Bayesian model averaging (BMA) were used to assess response to delayed effects occurring across multiple months. Results Exposure to PM 10  was consistently inversely associated with FMD, with the strongest (most negative) association for a 12-month moving average (− 0.09; 95% CI: − 0.15, − 0.03). Associations with PM 2.5  were also strongest for a 12-month moving average but were weaker than for PM 10  (− 0.07; 95% CI: − 0.13, − 0.09). Associations of PM 2.5  and PM 10  with FMD were somewhat stronger in men than in women, particularly for PM 10 . Conclusions Using location-specific moving-average air pollution exposure estimates, we have shown that 12-month moving-average estimates of PM 2.5  and PM 10  exposure are associated with impaired endothelial function in a rural population.

Purpose Limited research has examined maternal experiences of racial/ethnic discrimination in relation to child cardiometabolic health. In this study, we investigated whether maternal experiences of ethnic discrimination were associated with cardiometabolic risk in Hispanic/Latino youth several years later. Methods Our sample included 1146 youth (8–16 years) from the Study of Latino Youth (2012–2014), who were children of the Hispanic Community Health Study/Study of Latinos participants (2008–2011). We used regression models to examine the prospective associations between maternal report of ethnic discrimination in relation to her child's  body mass index  (BMI) z-score,  metabolic syndrome  score (MetS), and high sensitivity  C-reactive protein  (hsCRP) levels 2 years later. Results Maternal ethnic discrimination was associated with youth hsCRP, but not BMI or MetS (P -values >.05). Adjusting for age, nativity, and national background, maternal ethnic discrimination was associated with higher (log) hsCRP levels (β = 0.18, 95% CI = 0.04 to 0.32) in children. This association was robust to adjustment for maternal and household characteristics (β = 0.17, 95% CI = 0.04 to 0.31), as well as  maternal depression  and maternal BMI. Conclusions Maternal ethnic discrimination is associated with inflammation among Hispanic/Latino youth, and not BMI z-score or MetS. Studies are needed to address temporality and pathways.