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Article Reference Troff document (with manpage macros)Association of Childhood Asthma With Federal Rental Assistance
Importance   Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives   To examine whether participation in the US Department of Housing and Urban Development’s (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants   This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures   Participation in rental assistance provided by HUD. Main Outcomes and Measures   Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results   This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, −29.7 to −6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, −36.6; 95% CI, −54.8 to −18.4) but not housing choice vouchers (percentage point change, −7.2; 95% CI, −24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, −2.7; 95% CI, −12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (−4.3; 95% CI, −8.8 to 0.2 percentage points). Conclusions and Relevance   Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.
Located in MPRC People / Michel Boudreaux, Ph.D. / Michel Boudreaux Publications
Article Reference Troff document (with manpage macros)Navigating a fragmented health care landscape: DACA recipients' shifting access to health care
Deferred Action for Childhood Arrivals (DACA) recipients face an uncertain fate as their future in the United States is being debated. Yet even before the program was introduced in June 2012 and became endangered in September 2017, they encountered challenges in navigating a fragmented health care landscape throughout the United States. This paper focuses on  DACA  recipients' experiences in accessing health care throughout their lives, both before and after receiving DACA. We conducted semi-structured interviews and questionnaires with 30 DACA recipients living in Maryland between April–December 2016. Participants represented 13 countries of origin and ranged in age between 18 and 28. Results demonstrate that DACA recipients have had punctuated coverage throughout their lives and continue to face constrained access despite temporary gains in status. Health care access is further stratified within their mixed-status families. Participants have also experienced shifts in their health care coverage due to moving between jurisdictions with variable eligibility and changing life circumstances related to family, school, and employment. This article underscores the importance of examining young adult immigrants' access to care over time as they weather changes in the broader policy context and in highly variable contexts of reception nationwide, shaped by state, but also county and city policies and programs. The challenges and gaps in coverage DACA recipients face also underscore the need for both health care and immigration reform.
Located in MPRC People / Christina Marisa Getrich, Ph.D. / Christina Getrich Publications
Article Reference Troff document (with manpage macros)Air Quality Assessment of Volatile Organic Compounds Near a Concrete Block Plant and Traffic in Bladensburg, Maryland
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.
Located in MPRC People / Devon Payne-Sturges, Dr.P.H. / Devon Payne-Sturges Publications
Article Reference Troff document (with manpage macros)Park Spaces and the User Experience: Reconsidering the Body in Park Analysis Tools
As a strategy for combating physical inactivity, obesity, and other health conditions, the apperception of greenspace and importance of human-nature relationships have increased in recent decades. With this raised awareness in greenspace, the development of park auditing tools has been positioned primarily in the material conditions (e.g., physical environmental conditions) of parks. An examination of existing park auditing tools has shown that by focusing on particular material conditions, built environment and active living scholars have set aside other characteristics, namely, those that consider the user (e.g., the active human), as a separate concern from the focus of these tools. We have sought to engage with these tools to examine how they can be more effective in analyzing both the physical and human elements of parks and other natural environments.
Located in MPRC People / Jennifer D. Roberts, Dr.P.H., M.P.H. / Jennifer D. Roberts Publications
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)Sexual health of adolescent girls and young women in Central Uganda: exploring perceived coercive aspects of transactional sex
Adolescent girls and young women (AGYW) in Uganda are at risk of early sexual debut, unwanted pregnancy, violence, and disproportionally high HIV infection rates, driven in part by transactional sex. This paper examines the extent to which AGYW’s participation in transactional sex is perceived to be coerced. We conducted 19 focus group discussions and 44 in-depth interviews using semi-structured tools. Interviews were audio recorded, and transcribed verbatim. Data were analysed using a thematic analysis. While AGYW did not necessarily use the language of coercion, their narratives describe a number of coercive aspects in their relationships. First, coercion by force as a result of “de-toothing” a man (whereby they received money or resources but did not wish to provide sex as “obligated” under the implicit “terms” of the relationships). Second, they described the coercive role that receiving resources played in their decision to have sex in the face of men’s verbal insistence. Finally, they discussed having sex as a result of coercive economic circumstances including poverty, and because of peer pressure to uphold modern lifestyles. Support for income-generation activities, microfinance and social protection programmes may help reduce AGYW’s vulnerability to sexual coercion in transactional sex relationships. Targeting gender norms that contribute to unequal power dynamics and social expectations that obligate AGYW to provide sex in return for resources, critically assessing the meaning of consensual sex, and normative interventions building on parents’ efforts to ascertain the source of their daughters’ resources may also reduce AGYW’s vulnerability to coercion.
Located in MPRC People / Kirsten Stoebenau, Ph.D. / Kristen Stoebenau Publications
Article Reference Troff document (with manpage macros)Sexual Minority Health Disparities: An Examination of Age-Related Trends Across Adulthood In a National Cross-Sectional Sample
Purpose:  Sexual minorities experience signi fi cant health disparities across a variety of mental, behav ioral, and physical health indicators. Yet, an understanding of the etiology and progression of sexual minority health disparities across the lifespan is limited. Methods:  We used the U.S. National Epidemiologic Survey of Alcohol and Related Conditions III to  evaluate the association between sexual minority status and seven past-year health outcomes (alcohol  use disorder, tobacco use disorder, drug use disorder, major depressive episode, generalized anxiety  disorder, sexually transmitted infection, and cardiovascular conditions). To do this, we used unadjusted  and adjusted logistic regression among our study sample (n ¼ 30,999; aged 18 e 65 years) and time- varying effect models to evaluate how sexual orientation differences in these outcomes vary across  adulthood. Results:  Relative to heterosexuals, sexual minorities had elevated odds of past-year alcohol use disorder  and drug use disorder across all ages (18 e 65 years) although the magnitude of the disparity varies by  age. Sexual minorities were also more likely to experience major depressive episode, generalized anxiety  disorder, tobacco use disorder, sexually transmitted infection, and cardiovascular disease, but only at  speci fi c ages. Conclusions:  Sexual minority health disparities vary appreciably across the adult lifespan, thus eluci dating critical periods for focused prevention efforts.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article Reference Troff document (with manpage macros)Cigarette Smoking Disparities Between Sexual Minority and Heterosexual Youth
BACKGROUND: Using a population-based sample of youth, we examined rates of cigarette use and trends in cigarette use disparities between heterosexual youth and 3 subgroups of sexual minority youth (SMY) (ie, lesbian or gay, bisexual, and unsure) from 2005 to 2015. METHODS: Data are from 6 cohorts of the Youth Risk Behavior Survey, a national, biennial, school-based survey of ninth- to 12th-grade students in the United States (n = 404 583). Sex-stratified analyses conducted in 2017 examined trends in 2 cigarette-related behaviors: lifetime cigarette use and heavy cigarette use (20+ days in the past 30). RESULTS: Disparities in lifetime cigarette use between lesbian and heterosexual girls were statistically smaller in 2015 relative to 2005 (adjusted odds ratio [aOR] 0.29; 95% confidence interval [CI] 0.12–0.75; P = .011). Sexual orientation disparities in heavy use were narrower for bisexual boys in 2015 compared with 2005 (aOR 0.39; 95% CI 0.17–0.90; P = .028). Girls and boys unsure of their sexual identity had wider disparities in heavy use in 2015 (aOR 3.85; 95% CI 1.39–11.10; P = .009) relative to 2005 (aOR 2.44; 95% CI 1.22–5.00; P = .012). CONCLUSIONS: SMY remain at greater risk for cigarette-related behaviors despite greater acceptance of lesbian, gay, and bisexual people in the United States. Focused policies and programs aimed at reducing rates of SMY cigarette use are warranted, particularly for youth questioning their sexual identity.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article ReferenceSexual Orientation-Related Disparities in High-Intensity Binge Drinking: Findings from a Nationally Representative Sample
Abstract Purpose: The purpose of this study was to assess sexual orientation differences in high-intensity binge drinking using nationally representative data. Methods: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions III (N = 36,309), a nationally representative sample of U.S. adults collected in 2012–2013. Sex-stratified adjusted logistic regression models were used to test sexual orientation differences in the prevalence of standard (4+ for women and 5+ for men) and high-intensity binge drinking (8+ and 12+ for women; 10+ and 15+ for men) across three dimensions of sexual orientation: sexual attraction, sexual behavior, and sexual identity. Results: Sexual minority women, whether defined on the basis of sexual attraction, behavior, or identity, were more likely than sexual majority women to engage in high-intensity binge drinking at two (adjusted odds ratios [aORs] ranging from 1.52 to 2.90) and three (aORs ranging from 1.61 to 3.27) times the standard cutoff for women (4+). Sexual minority men, depending on sexual orientation dimension, were equally or less likely than sexual majority men to engage in high-intensity binge drinking. Conclusion: This study is the first to document sexual orientation-related disparities in high-intensity binge drinking among adults in the United States using nationally representative data. The results suggest that differences in alcohol-related risk among sexual minority individuals vary depending on sex and sexual orientation dimension.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications
Article ReferenceLGBTQ Youth-Serving Community-Based Organizations: Who Participates and What Difference Does it Make?
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.
Located in MPRC People / Jessica N Fish, Ph.D. / Jessica N Fish Publications