Previous studies have demonstrated the association between food security and cardiometabolic diseases (CMDs), yet none have investigated trends in prevalence of CMDs by food security status in the ...United States (US).
Serial cross-sectional analysis of the US nationally representative data from National Health and Nutrition Examination Survey (1999-2018) was conducted among adults aged 20 years or older. Food security status was defined by the US Household Food Security Survey Module (full, marginal, low, and very low food security). We estimated the age-adjusted prevalence of CMDs including obesity, hypertension, diabetes, and coronary heart disease by food security status. Racial and ethnic disparities in age-adjusted prevalence of CMDs by food security status were also assessed.
A total of 49,738 participants were included in this analysis (weighted mean age 47.3 years; 51.3% women). From 1999 to 2018, the age-adjusted prevalence of CMDs was lower in full food secure group as compared with other groups. For example, trends in hypertension decreased from 49.7% (47.5-51.8%) to 45.9% (43.8-48.0%) (P-trend = 0.002) among the full and from 54.2% (49.9-58.5%) to 49.7% (46.8-52.6%) (P-trend = 0.02) among the marginal but remained stable among the low at 49.7% (47.9-51.6%) and among the very low at 51.1% (48.9-53.3%) (P-interaction = 0.02). Prevalence of diabetes increased from 8.85% (8.15-9.60%) to 12.2% (11.1-13.5%) among the full (P-trend < 0.001), from 16.5% (13.2-20.4%) to 20.9% (18.6-23.5%) (P-trend = 0.045) among the marginal and from 14.6% (11.1-19.0%) to 20.9% (18.8-23.3%) (P-trend = 0.001) among the low but remained stable at 18.8% (17.0-20.9) among the very low (P-trend = 0.35) (P-interaction = 0.03). Racial and ethnic differences in prevalence of CMD by food security status were observed. For example, among individuals with full food secure status, the prevalence of diabetes was 9.08% (95% CI, 8.60-9.59%) for non-Hispanic whites, 17.3% (95% CI, 16.4-18.2%) for non-Hispanic blacks, 16.1% (95% CI, 15.0-17.4%) for Hispanics and 14.9% (95% CI, 13.3-16.7%) for others.
Prevalence of CMDs was greatest among those experiencing food insecurity, and food insecurity disproportionately affected racial/ethnic minorities. Disparities in CMD prevalence by food security status persisted or worsened, especially among racial/ethnic minorities.
Emergency general surgery (EGS) is a critical component of emergency care in the United States. Due to the time sensitiveness of EGS conditions, ensuring adequate spatial access to EGS services is ...paramount for reducing patient morbidity and mortality. Past studies have used travel time to measure spatial access to EGS services, which has its limitations. The major purpose of this paper is to evaluate the utility of a gravity-based spatial access model in measuring spatial access to EGS services in California. Our data sources include the American Hospital Association 2015 Annual Survey, the American Community Survey 2013–2017 five-year average dataset, and background geospatial datasets. We implemented both the gravity-based model and the shortest travel time method and compared them in measuring spatial access to EGS-capable hospitals in California at the census block group level. We analyzed each metric’s ability to identify disparities in spatial access for the population as a whole, and subsequently to identify socio-demographic disparities. Overall, we found that both methods identified similar geographic and socio-demographic patterns of the spatial access. Native Americans and rural residents experienced the greatest disadvantage in spatial access to both general EGS services and advanced EGS services. However, the gravity-based model revealed more disparities in spatial access to EGS services than the travel time model, suggesting that using travel cost alone to measure spatial access to EGS services may underestimate the magnitude of disparities. These findings call for the use of gravity-based models that incorporate measures of population demand and hospital capacity when assessing spatial access to surgical services, and have implications for reallocating surgery resources to address disparities in spatial access.
Leveraging data from a nationally representative school-based adolescent survey, the current study aimed to provide a comprehensive assessment of how family income is associated with multiple ...cognitive and educational outcomes in China and examine the underlying material and psychosocial mechanisms. We found robust associations of family income with school grades, cognitive ability, and study attitude, but not with homework engagement. Moreover, we found that home amenities, i.e., measuring home-based material resources, played the largest mediating role in explaining family income effects on cognitive ability and study attitude. Among the non-monetary or intangible intervening factors, children’s own and peers’ educational aspirations along with mother-child communication were the most important mechanisms. To a lesser extent, family income effects were also attributable to harmonious parent-child and between-parent relationships. The key take-home message is that home environments constitute a prominent setting outside of school exerting powerful influences shaping school outcomes for Chinese adolescents. Our study contributes to a better understanding of how family economic resources are transmitted to children’s cognitive and educational advantages via home material resources, family non-monetary features, children’s agency, and peer influence. Policy implications and future research are discussed.
The purpose of this research is to qualitatively identify perceived concerns about mental disorders among children and related screening practices for mental illness among early childcare and ...education providers.
Qualitative research design with a phenomenological approach was used.
53 early childcare and education providers from Nebraska participated in semi-structured interviews focused on mental disorders and related screening practices among children.
The recorded interviews were transcribed, coded, and systematically analyzed through thematic content analysis.
The analysis identified two themes concerning pediatric mental health disorders and screening practices. The first theme, mental health concerns, includes three categories: perceived level of mental disorder (n=39; 74 %), most common (attention-deficit disorder n=28; 53.8 % and anxiety n=13; 25.6 %), and least common (mood disorders n=5; 10.2 % and substance abuse n=8; 15.4 %). The second theme, screening practices, reflects the use of screening tools and their implication to screen mental disorders and suggested one category: screening measure usage (Ages and Stages and the Modified Checklist for Autism in Toddlers).
Among the 53 participants, 39 or 74 % of them stated their concern about pediatric mental health disorders in their organization, with some of the most commonly reported disorders including attention-deficit/hyperactivity disorder (ADHD) (53.8 %), anxiety (25.6 %), depression (17.9 %), and substance use (15.4 %). Participants were also concerned about the lack of standard screening instruments for mental health issues among children of ages 0 to 5. There is a need for early childcare organizations, healthcare providers, and educational organizations to collaborate and implement a coordinated approach to improving Nebraska's pediatric mental health.
•We consider the social patterning of recent pandemic gun purchases.•Overall, 6% of the sample reported purchasing a new gun during the pandemic.•Pandemic gun purchasers tend to be male, younger, ...US-born, and living in the south.•Pandemic gun purchasers tend to be less educated and recently unemployed.•Pandemic gun purchasers tend to be Republicans and experiencing religious change.
In this paper, we document the social patterning of recent gun purchases to advance a contemporary social epidemiology of the pandemic arms race. We employ cross-sectional survey data from the 2020 Health, Ethnicity and Pandemic Study, which included a national sample of 2,709 community-dwelling adults living in the United States. We use binary logistic regression to model recent pandemic gun purchases as a function of age, sex, race/ethnicity, nativity status, region of residence, marital status, number of children, education, household income, pandemic job change, religious service attendance, pandemic religion change, and political party. Overall, 6% of the sample reported purchasing a new gun during the pandemic. Multivariate regression results suggest that pandemic gun purchasers tend to be male, younger, US-born, less educated, recently unemployed, experiencing changes in their religious beliefs, Republicans, and residents of southern states. To our knowledge, we are among the first to formally document a new population of pandemic gun owners that is characterized by youth, US-nativity, and religious volatility. Our analyses underscore the need for public health initiatives designed to enhance gun-related safety during pandemics, including, for example, addressing underlying motivations for recent gun purchases and improving access to training programs.
Previous studies have suggested that food preference is a good indicator of actual food intake and that sedentary activity preference is a significant predictor of lower physical activity level. But ...no studies have examined the direct relationship between leisure time physical activity (LTPA) preferences and actual LTPA behavior, especially studies using longitudinal data. This study seeks to determine the association between these two variables, and to assess whether the association differs between urban and rural areas in China.
A total of 2427 Chinese adults were included in the analysis. Spearman correlation coefficients were used to test the association between leisure time physical activity preference and behavior, followed by multiple logistic regressions to further examine the association after adjusting for possible confounding variables. Urban-rural differences in the association were investigated through stratified analysis.
In the sample, 63.0% were from urban areas, 47.4% were men, and the mean age was 40. Adjusted estimates based on logistic regression show that LTPA preference was a significant predictor of actual LTPA behavior (OR = 1.05, 95% CI = 1.01-1.09). The correlation was found to be significant among urban residents (OR = 1.06, 95% CI = 1.01-1.10), but not in rural residents.
The study illustrates the predictive value of LTPA preference for actual LTPA behavior. Changing LTPA preference to promote LTPA may be helpful in preventing and controlling chronic disease in China.
•Disparities of COVID-19 cases among race and ethnicity were evident in all age groups.•Infection rate increased 3% for every unit increase in three-generational household.•Three-generational ...household is a key point in school-children-family transmission.
The three-generational household was a focal point of concern for school and community the Coronavirus Disease 2019 (COVID-19) transmission. The current study, using small area data and household variables, reported an approach to neighborhood-level COVID-19 mitigation for school reopening and communities returning to normalcy. The study started with an age-stratified Poisson regression to examine the association between the proportion of three-generational households and COVID-19 infection rates based on data from 74 census tracts in Lancaster County, Nebraska, U.S. from March 5, 2020 to August 22, 2020, followed by mapping the model-based risk score by census tract in the study area. We explored the feasibility of using COVID-19 infection rates and vaccination rates to inform decision-making on school opening from March 5, 2020 to February 3, 2021. The overall infection rate increased by 3% for every unit increased in the percentage of three-generational households after controlling for other covariates in the model. The census tracts were classified into low-, medium-, and high-priority neighborhoods for potential community-based interventions, such as targeted messages for household hygiene and isolation strategies.
•Among all factors considered, maternal education contributes the most to racial/ethnic disparities in birth outcomes.•Mother’s health insurance coverage significantly helps explain racial/ethnic ...disparities in birth outcomes.•More research is needed to better account for Black-White disparities in birth outcomes.
This study seeks to quantify and rank the contribution of selected factors to the observed racial/ethnic disparities in low-birth-weight births (LBWBs) and preterm births (PTBs). Based on vital statistics data on births to primiparous women and characteristics of mothers in the State of Nebraska during the period of 2005 to 2014 (n = 93,375), unadjusted and adjusted odds ratios were estimated to examine the association between selected variables and the odds of having LBWBs or PTBs. Fairlie decomposition analysis was performed to quantify the contribution of each selected factor to racial/ethnic differences in LBWB and PTB rates. The prevalence of PTBs was 9.1% among non-Hispanic White (NHW) women, as compared to 12.8% among non-Hispanic Black (NHB) women and 10.6% among Hispanic women. The corresponding prevalence of LBWBs in the three groups were 5.9%, 11.9%, and 7.2%, respectively. The higher educational attainment among NHW women, relative to NHB women accounted for 10% of the observed difference in LBWB rate between the two groups. Health insurance coverage was the second most important factor accounting for the observed disparities in birth outcomes. Addressing socioeconomic disadvantages in NHB and Hispanic women would be important for them to narrow their gaps with NHW women in LBWB and PTB prevalence. More research is needed to identify key factors leading to the disparities in birth outcomes between NHW and NHB women.
During the coronavirus disease 2019 (COVID-19) pandemic, a growing prevalence of racial and ethnic discrimination occurred when many Americans struggled to maintain healthy lifestyles. This study ...investigated the associations of racial and ethnic discrimination with changes in exercise and screen time during the pandemic in the United States.
We included 2,613 adults who self-identified as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic from the Health, Ethnicity, and Pandemic study, a cross-sectional survey conducted among a nationally representative sample of United States adults between October and November 2020. We assessed self-reported racial and ethnic discrimination by measuring COVID-19-related racial and ethnic bias and examined its associations with changes in exercise and screen time using multivariable logistic regression models. We analyzed data between September 2021 and March 2022.
COVID-19-related racial and ethnic bias was associated with decreased exercise time among non-Hispanic Asian (odds ratio OR, 1.46; 95% confidence interval CI, 1.13 to 1.89) and Hispanic people (OR, 1.91; 95% CI, 1.32 to 2.77), and with increased screen time among non-Hispanic Black people (OR, 1.94; 95% CI, 1.33 to 2.85), adjusting for age, sex, education, marital status, annual household income, insurance, and employment status.
Racial and ethnic discrimination may have adversely influenced exercise and screen time changes among racial and ethnic minorities during the COVID-19 pandemic in the United States. Further studies are needed to investigate the mechanisms through which racial and ethnic discrimination can impact lifestyles and to develop potential strategies to address racial and ethnic discrimination as a barrier to healthy lifestyles.
Using subsequent all-cause mortality as a yardstick for retrospective health, this study assessed the comparability of self-rated health (SRH) between non-Hispanic whites and Hispanics.
Based on ...longitudinal data from 6,870 white and 886 Hispanic respondents aged between 51 and 61 in the 1992 Health and Retirement Study, we related SRH in 1992 to risk of mortality in the 1992-2008 period. Logit models were used to predict white-Hispanic differences in reporting fair or poor SRH. Survival curves and cox proportional hazard models were estimated to assess whether and the extent to which the SRH-mortality association differs between non-Hispanic whites and Hispanics.
Hispanic respondents reported worse SRH than whites at the baseline, yet they had similar risk of mortality as whites in the 1992-2008 period. Overall, Hispanics rated their health more pessimistically than whites. This was especially the case for Hispanics who rated their health fair or poor at the baseline, whereas their presumed health conditions, as reflected by subsequent risk of mortality, should be considerably better than their white counterparts.
Health disparities between whites and Hispanics aged between 51 and 61 will be overestimated if the assessment has been solely based on differences in SRH between the two groups. Findings from this study call for caution in relying on SRH to quantify and explain health disparities between non-Hispanic whites and Hispanics in the United States.
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