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Long-term exposure to particulate air pollution and brachial artery flow-mediated dilation in the Old Order Amish
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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.
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MPRC People
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Robin Puett, Ph.D.
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Robin Puett Publications
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Air Quality Assessment of Volatile Organic Compounds Near a Concrete Block Plant and Traffic in Bladensburg, Maryland
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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.
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MPRC People
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Sacoby Wilson, Ph.D., M.S.
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Sacoby Wilson Publications
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Environmental Justice and the Food Environment in Prince George’s County, Maryland: Assessment of Three Communities
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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.
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MPRC People
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Sacoby Wilson, Ph.D., M.S.
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Sacoby Wilson Publications
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The COVID-19 epidemic in rural U.S. counties
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Having first reached epidemic proportions in coastal metropolitan areas, COVID-19 has spread 4 around the country. Reported case rates vary across counties from zero to 125 per thousand 5 population (around a state prison in the rural county of Trousdale, Tennessee). Overall, rural 6 counties are underrepresented relative to their share of the population, but a growing proportion 7 of all daily cases and deaths have been reported in rural counties. This analysis uses daily 8 reports for all counties to present the trends and distribution of COVID-19 cases and deaths in 9 rural counties, from late March to May 16, 2020. I describe the relationship between population 10 density and case rates in rural and non-rural counties. Then I focus on noteworthy outbreaks 11 linked to prisons, meat and poultry plants, and nursing homes, many of which are linked to 12 high concentrations of Hispanic, American Indian, and Black populations. The growing 13 epidemic in rural counties is apparently driven by outbreaks concentrated in these institutional 14 settings, which are conducive to transmission. The impact of the epidemic in rural areas may 15 be heightened due to their weaker health infrastructure and more vulnerable populations, 16 especially due to age, socioeconomic status, and health conditions. As a result, the epidemic 17 may contribute to the ongoing decline of health, economic, and social conditions in rural areas.
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MPRC People
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Philip Cohen, Ph.D.
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Philip Cohen Publications
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Barriers to health care access among US adults with chronic conditions and co-occurring serious psychological distress between 2011-2015
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Importance: Nearly 34 million adults – 17 percent of all American adults – have co-occurring mental and physical health conditions. However, the extent to which increased health insurance coverage has facilitated access to needed health care services among this population remains unclear. Objective: Prior research suggests that people with serious psychological distress (SPD) and cancer, heart disease, diabetes, asthma, or hypertension report worse access to care than people with the same physical conditions but no SPD. While the recent expansion in health insurance coverage was expected to improve access to care for people with SPD, access barriers that people with SPD report remain underexplored. Setting: Using the cross-sectional data from the National Health Interview Survey 2011-2015, we examined self-reported health care access barriers among adults (between ages 18 to 64) with SPD and co-occurring physical health conditions. Results: Our sample included 45,294 individuals with chronic conditions (heart disease, high blood pressure, diabetes, cancer, or asthma). Among them, 3,639 also had SPD. After controlling for demographic and socioeconomic factors, results of multivariate logistic regressions showed that individuals with co-occurring SPD and a physical health condition were significantly more likely to report that they had worse health insurance coverage compared to the prior year (OR=1.32, p<0.01), that doctor's office informed that they were not accepting new patients (OR=2.09, p<0.001), that the doctor's office stated they did not accept the particular health insurance they have (OR=1.98, p<0.001), that they couldn't get an appointment soon enough (OR=2.42, p<0.001), they had no transportation to get to the doctor (OR=3.23, p<0.001), and that overall they had trouble finding a doctor/provider (OR=2.12, p<0.001). Conclusions: Our results suggest that despite an increase in health insurance coverage between 2011 and 2015, barriers to access remain a significant concern for individuals with co-occurring SPD and physical health conditions.
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MPRC People
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Jie Chen, Ph.D.
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Jie Chen Publications
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The Effects of the Affordable Care Act on Health Care Access and Utilization Among Asian American Subgroups
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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.
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MPRC People
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Jie Chen, Ph.D.
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Jie Chen Publications
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Flies Without Borders - Lessons from Chennai on Improving India's Municipal Public Health Services
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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.
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MPRC People
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Monica Das Gupta, Ph.D.
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Monica Das Gupta Publications
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Seizing opportunities for intervention: Changing HIV-related knowledge among men who have sex with men and transgender women attending trusted community centers in Nigeria
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Background Knowledge of HIV risk factors and reduction strategies is essential for prevention in key populations such as men who have sex with men (MSM) and transgender women (TGW). We evaluated factors associated with HIV-related knowledge among MSM and TGW and the impact of engagement in care at trusted community health centers in Nigeria. Methods The TRUST/RV368 cohort recruited MSM and TGW in Lagos and Abuja, Nigeria via respondent driven sampling. During study visits every three months, participants underwent structured interviews to collect behavioral data, received HIV education, and were provided free condoms and condom compatible lubricants. Five HIV-related knowledge questions were asked at enrollment and repeated after 9 and 15 months. The mean number of correct responses was calculated for each visit with 95% confidence intervals (CIs). Multivariable Poisson regression was used to calculate adjusted risk ratios and CIs for factors associated with answering more knowledge questions correctly. Results From March 2013 to April 2018, 2122 persons assigned male sex at birth were enrolled, including 234 TGW (11.2%). The mean number of correct responses at enrollment was 2.36 (95% CI: 2.31–2.41) and increased to 2.95 (95% CI: 2.86–3.04) and 3.06 (95% CI: 2.97–3.16) after 9 and 15 months in the study, respectively. Among 534 participants who completed all three HIV-related knowledge assessments, mean number of correct responses rose from 2.70 (95% CI: 2.60–2.80) to 3.02 (95% CI: 2.93–3.13) and then 3.06 (95% CI: 2.96–3.16). Factors associated with increased overall HIV-related knowledge included longer duration of study participation, HIV seropositivity, higher education level, and more frequent internet use. Conclusions There was suboptimal HIV-related knowledge among Nigerian MSM and TGW at that improved modestly with engagement in care. These data demonstrate unmet HIV education needs among Nigerian MSM and TGW and provide insights into modalities that could be used to address these needs.
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Hongjie Liu, Ph.D.
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Hongjie Liu Publications
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Correlates of Health Promotion in a Community Sample of African American Churches
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Though many African American churches offer health promotion activities to their members, less is known about organizational factors that predict the availability of this programming. This study examines organizational capacity as a predictor of the amount and type of health programming offered by a convenience sample of 119 African American churches. Leaders completed a survey of health promotion activities provided in the previous 12 months and a measure of organizational capacity. Churches offered an average of 6.08 (SD = 2.15) different health programs targeting 4.66 (SD = 3.63) topics. Allocation of space and having a health ministry were positively associated with both the number of health programs and health topics addressed. When seeking to initiate health programming in an African American church setting, it is recommended that stakeholders partner with churches that have existing structures to support health promotion such as a health ministry, or help them build this capacity.
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MPRC People
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Craig Fryer, Dr.P.H.
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Craig Fryer Publications
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Life and Death in the American City: Men’s Life Expectancy in 25 Major American Cities From 1990 to 2015
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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.
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Michel Boudreaux, Ph.D.
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Michel Boudreaux Publications