Public Health Commons^™

Unconditional Cash Transfers For Reducing Poverty And Vulnerabilities: Effect On Use Of Health Services And Health Outcomes In Low-And Middle-Income Countries, Frank Pega, Sze Yan Liu, Stefan Walter, Roman Pabayo, Ruhi Saith, S L. Lhachimi

Sze Yan Liu

Background

Unconditional cash transfers (UCTs; provided without obligation) for reducing poverty and vulnerabilities (e.g. orphanhood, old age or HIV infection) are a type of social protection intervention that addresses a key social determinant of health (income) in low‐ and middle‐income countries (LMICs). The relative effectiveness of UCTs compared with conditional cash transfers (CCTs; provided so long as the recipient engages in prescribed behaviours such as using a health service or attending school) is unknown.

Objectives

To assess the effects of UCTs for improving health services use and health outcomes in vulnerable children and adults in LMICs. Secondary objectives are to …

Unconditional Cash Transfers For Assistance In Humanitarian Disasters: Effects On The Use Of Health Services And Health Outcomes In Low- And Middle-Income Countries, Frank Pega, Sze Yan Liu, Stefan Walter, S K. Lhachimi

Sze Yan Liu

BACKGROUND:

Unconditional cash transfers (UCTs) are a common social protection intervention that increases income, a key social determinant of health, in disaster contexts in low- and middle-income countries (LMICs).

OBJECTIVES:

To assess the effects of UCTs in improving health services use, health outcomes, social determinants of health, health care expenditure, and local markets and infrastructure in LMICs. We also compared the relative effectiveness of UCTs delivered in-hand with in-kind transfers, conditional cash transfers, and UCTs paid through other mechanisms.

SEARCH METHODS:

We searched 17 academic databases, including the Cochrane Public Health Group Specialised Register, the Cochrane Database of Systematic Reviews …

Trends In Nonresident Abortion Rates In New York City From 2005 To 2015: A Time Series Analysis, Emily White Johansson, Erica Lee Argov, Aileen Langston, Alison Yager, Hannah Searing, Sze Yan Liu

Sze Yan Liu

Abstract

OBJECTIVES:

To examine trends and utilization patterns of NYC abortion services by nonresidents since growing abortion restrictions across many states could drive women to seek care in less restrictive jurisdictions including NYC.

STUDY DESIGN:

We used data from Induced Termination of Pregnancy certificates filed with the NYC Department of Health and Mental Hygiene in 2005-2015. An autoregressive integrated moving average (ARIMA) model was fit to the monthly nonresident abortion rate time series. Pearson's χ² tests determined associations between women's residence and other variables.

RESULTS:

During 2005-2015, 885,816 abortions were reported in NYC, with 76,990 (8.7%) among nonresidents; 50,211 …

The Association Between Blood Pressure And Years Of Schooling Versus Educational Credentials: Test Of The Sheepskin Effect, Sze Yan Liu, Stephen L. Buka, Crystal D. Linkletter, Ichiro Kawachi, Laura Kubzansky, Eric B. Loucks

Sze Yan Liu

Purpose

Attaining a degree may offer greater opportunities for health than years of schooling alone. This study examines whether there is a degree, or “sheepskin”, effect on the association between education and blood pressure.

Methods

Multivariable-adjusted ordinal and linear regression models assessed associations of years of schooling and degree attainment with systolic and diastolic blood pressure in a sample of 552 adults aged 38–47 years.

Results

Years of schooling was inversely associated with systolic blood pressure adjusting for age, gender and race (β=−0.4, 95% CL:−0.7,−0.1 mmHg systolic blood pressure/year of schooling). Additional adjustment for mother’s education, childhood verbal intelligence quotient, …

The Role Of Place In Explaining Racial Heterogeneity In Cognitive Outcomes Among Older Adults, Sze Yan Liu, M Maria Glymou, Laura B. Zahodne, Christopher Weiss, Jennifer J. Manly

Sze Yan Liu

Racially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We …

Structural Racism And Odds For Infant Mortality Among Infants Born In The United States 2010, Roman Pabayo, Amy Ehntholt, Kara L. Davis, Sze Yan Liu, Peter Muening, Daniel Cook

Sze Yan Liu

Abstract

OBJECTIVES:

While ecological studies indicate that high levels of structural racism within US states are associated with elevated infant mortality rates, studies using individual-level data are needed. To determine whether indicators of structural racism are associated with the individual odds for infant mortality among white and black infants in the US.

METHODS:

We used data on 2,163,096 white and 590,081 black infants from the 2010 US Cohort Linked Birth/Infant Death Data Files. Structural racism indicators were ratios of relative proportions of blacks to whites for these domains: electoral (registered to vote and voted; state legislature representation), employment (civilian labor …

Structural Racism And Severe Maternal Morbidity In New York State, Sze Yan Liu, Christina Fiorentini, Zinzi Bailey, Mary Huynh, Katherine Mcveigh, Deborah Kaplan

Sze Yan Liu

ABSTRACT

Objective: We examined the association between county-level structural racism indicators and the odds of severe maternal morbidity (SMM) in New York State.

Design: We merged individual-level hospitalization data from the New York State Department of Health Statewide Planning and Research Cooperative System (SPARCS) with county-level data from the American Community Survey and the Vera Institute of Justice from 2011 to 2013 (n = 244 854). Structural racism in each county included in our sample was constructed as the racial inequity (ratio of black to white population) in female educational attainment, female employment, and incarceration.ReSulT S: Multilevel logistic regression analysis …

Self-Reported And Measured Hypertension Among Older Us- And Foreign-Born Adults, Kellee White, Mauricio Avedano, J Robin Moon, Benjamin Capistrant, Sze Yan Liu, M Maria Glymour

Sze Yan Liu

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity …

Residential Modifications And Decline In Physical Function Among Community-Dwelling Elderly, Sze Yan Liu, Kate L. Lapane

Sze Yan Liu

PURPOSE:

The purpose of this study is to quantify the effect of residential modification on decreasing risk of physical function decline in 2 years.

DESIGN:

Cohort study using propensity scores method to control for baseline differences between individuals with residential modifications and those without residential modifications.

PARTICIPANTS:

Participants (N = 9,447) were from the Second Longitudinal Study on Aging, a nationally representative sample of the civilian noninstitutionalized population, aged 70 years and older in the United States at the time of baseline interview in 1994-1995.

METHODS:

Participants self-reported residential modifications at baseline (e.g., railings, bathroom modifications). Decline in physical functioning …

Instrumental Variable Approaches To Identifying The Causal Effect Of Educational Attainment On Dementia Risk, Thu T. Nguyen, Eric Tchetgen Tchetgen, Ichiro Kawachi, Stephen E. Gilman, Stefan Walter, Sze Yan Liu, M Maria Glymour

Sze Yan Liu

PURPOSE:

Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies.

METHODS:

IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) …

Hospital Readmissions For Childhood Asthma: The Role Of Individual And Neighborhood Factors., Sze Yan Liu, Deborah Pearlman

Sze Yan Liu

Objectives

This study used a Cox proportional hazards model to determine whether neighborhood characteristics are associated with risk of readmission for childhood asthma independently of individual characteristics.

Methods

Rhode Island Hospital Discharge Data from 2001 to 2005 were used to identify children younger than 19 years of age at the time of the index (i.e., first) asthma admission, defined as a primary diagnosis of asthma or a primary diagnosis of respiratory illness with a secondary or tertiary diagnosis of asthma (n=2,919). Hazard ratios of repeat hospitalizations for childhood asthma from 2001 to 2005 were estimated, controlling for individual- …

Implications Of Lifecourse Epidemiology For Research On Determinants Of Adult Disease, Sze Yan Liu, R N. Jones, M Maria Glymour

Sze Yan Liu

Many diseases commonly associated with aging are now thought to have social and physiologic antecedents in early life. Understanding how the timing of exposure to early life risk factors influences later-life health may illuminate mechanisms driving adult health inequalities and identify possible points for effective interventions. Recognizing chronic diseases as developing across the lifecourse also has implications for the conduct of research on adult risk factors for disease. We review alternative conceptual models that describe how the timing of risk factor exposure relates to the development of disease. We propose some expansions of lifecourse models to improve their relevance for …

Historical Differences In School Term Length And Measured Blood Pressure: Contributions To Persistent Racial Disparities Among Us-Born Adults, Sze Yan Liu, Jennifer M. Manly, Benjamin Capistrant, M Maria Glymour

Sze Yan Liu

Abstract

Introduction

Legally mandated segregation policies dictated significant differences in the educational experiences of black and white Americans through the first half of the 20^th century, with markedly lower quality in schools attended by black children. We determined whether school term length, a common marker of school quality, was associated with blood pressure and hypertension among a cohort of older Americans who attended school during the de jure segregation era.

Methods

National Health and Nutrition Examination Survey I and II data were linked to state level historical information on school term length. We used race and gender-stratified linear regression …

Decreased Births Among Black Female Adolescents Following School Desegregation, Sze Yan Liu, Crystal D. Linkletter, Eric B. Loucks, M. Maria Glymour, Stephen L. Buka

Sze Yan Liu

Although the socioeconomic impact of school desegregation in the U.S. has been well documented, little is known about the health consequences of this policy. The purpose of this study was to quantify the associations between school desegregation and adolescent births among black and white females. We compared the change in prevalence of adolescent births in areas that implemented school desegregation plans in the 1970s with areas that implemented school desegregation plans in other decades, using difference-in-difference methods with 1970 and 1980 Census microdata. School desegregation policy in the U.S. in the 1970s was associated with a significant reduction of 3.2 …

Genetic Vulnerability To Diabetes And Obesity: Does Education Offset The Risk?, Sze Yan Liu, Stefan Walter, Jessica Daniel, David H. Rehkopf, Laura E. Kubzansky, M Maria Glymour

Sze Yan Liu

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n = 8398), we tested whether education modifies genetic risk for obesity …

Effectiveness Of A Large-Scale Distribution Programme Of Free Nicotine Patches: A Prospective Evaluation, Nancy Miller, Thomas R. Frieden, Sze Yan Liu, Thomas D. Matte, Deborah R. Deitcher, K M. Cummings, Christina Chang, Ursula Bauer, Mary T. Bassett

Sze Yan Liu

Abstract

BACKGROUND:

After an increase in cigarette taxes and implementation of smoke-free workplace legislation, the New York City Department of Health and Mental Hygiene, the New York State Department of Health, and the Roswell Park Cancer Institute undertook large-scale distribution of free nicotine replacement therapy (NRT). We did a 6 month follow-up survey to assess the success of this programme in improving smoking cessation on a population basis.

METHODS:

34,090 eligible smokers who phoned a toll-free quitline were sent a 6-week course of nicotine patches (2 weeks each of 21 mg, 14 mg, and 7 mg per day). Brief follow-up …

Discrimination And Telomere Length Among Older Adults In The United States, Sze Yan Liu, Ichiro Kawachi

Sze Yan Liu

Abstract

Objectives:

Chronic stress from experiencing discrimination can lead to long-term changes in psychological and physiologic responses, including shorter leukocyte telomere length. We examined the association between leukocyte telomere length and variations in the association by race or type of discrimination.

Methods:

Our study consisted of 3868 US-born non-Hispanic black (hereinafter, black) and non-Hispanic white (hereinafter, white) adult participants from the 2008 Health and Retirement Study biomarker sample with complete sociodemographic and discrimination information. We examined major lifetime unfair treatment and everyday discrimination. Coarsened exact matching matched exposed and unexposed participants on several sociodemographic factors. Coarsened exact matching creates analytic …

Breast And Cervical Cancer Screening Practices Among Disabled Women Aged 40–75: Does Quality Of The Experience Matter?, Sze Yan Liu, Melissa A. Clark

Sze Yan Liu

Background

Women with disabilities (WWD) face significant barriers accessing healthcare, which may affect rates of routine preventive services. We examined the relationship between disability status and routine breast and cervical cancer screening among middle-aged and older unmarried women and the differences in reported quality of the screening experience.

Methods

Data were from a 2003–2005 cross-sectional survey of 630 unmarried women in Rhode Island, 40–75 years of age, stratified by marital status (previously vs. never married) and partner gender (women who partner with men exclusively [WPM] vs. women who partner with women exclusively or with both women and men [WPW]).

Results …

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Detecting, Preventing, And Treating Sexually Transmitted Diseases Among Adolescent Arrestees: An Unmet Public Health Need, Christopher Salvatore, Steven Belenko, Richard Dembo, Matthew Rollie, Kristina Childs

Christopher Salvatore

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the “front end” of the juvenile justice system that is detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender- and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD …

Mitsui-7, Heat-Treated, And Nitrogen-Doped Multi-Walled Carbon Nanotubes Elicit Genotoxicity In Human Lung Epithelial Cells, Katelyn J. Siegrist, Steven H. Reynolds, Dale W. Porter, Robert R. Mercer, Alison K. Bauer, David Lowry, Lorenzo Cena, Todd A. Stueckle, Michael L. Kashon, John Wiley, Jeffrey L. Salisbury, John Mastovich, Kristin Bunker, Mark Sparrow, Jason S. Lupoi, Aleksandr B. Stefaniak, Michael J. Keane, Shuji Tsuruoka, Mauricio Terrones, Michael Mccawley, Linda M. Sargent

Lorenzo Cena

Background: The unique physicochemical properties of multi-walled carbon nanotubes (MWCNT) have led to many industrial applications. Due to their low density and small size, MWCNT are easily aerosolized in the workplace making respiratory exposures likely in workers. The International Agency for Research on Cancer designated the pristine Mitsui-7 MWCNT (MWCNT-7) as a Group 2B carcinogen, but there was insufficient data to classify all other MWCNT. Previously, MWCNT exposed to high temperature (MWCNT-HT) or synthesized with nitrogen (MWCNT-ND) have been found to elicit attenuated toxicity; however, their genotoxic and carcinogenic potential are not known. Our aim was to measure the genotoxicity …

Assessment Of Exposure To Composite Nanomaterials And Development Of A Personal Respiratory Deposition Sampler For Nanoparticles, Lorenzo Cena

Lorenzo Cena

The overall goals of this doctoral dissertation are to provide knowledge of workers' exposure to nanomaterials and to assist in the development of standard methods to measure personal exposure to nanomaterials in workplace environments.

To achieve the first goal, a field study investigated airborne particles generated from the weighing of bulk carbon nanotubes (CNTs) and the manual sanding of epoxy test samples reinforced with CNTs. This study also evaluated the effectiveness of three local exhaust ventilation (LEV) conditions (no LEV, custom fume hood and biosafety cabinet) for control of exposure to particles generated during sanding of CNT-epoxy nanocomposites. Particle number …

Socio-Cultural And Linguistic Adaptation Of Cdc Change Action Guide To Conduct A Community Health Assessment In The Dominican Republic: A Multi-Disciplinary And Mixed Methods Approach, Chloe Schockling, Katherine Brown, Michelle Fuentes, Arelis Moore De Peralta

Arelis Moore de Peralta

Background. Third world communities like Las Malvinas, located in the Dominican Republic (DR), often face public health challenges. Instituting healthy communities requires collaborative public health services. The US has used evidence-based initiatives including the CDC’s CHANGE tool to address community health. There is a need to adapt these initiatives to other contexts. Clemson University (CU) students have partnered with Dominican University (UNIBE) and the Las Malvinas community to improve the community’s health and well-being.

Methods. The team’s ACTION steps include: assembling a community team and strategy, reviewing the CHANGE sectors, and gathering the data to use in the CHANGE tool. …

Cues To Cervical Cancer Screening Among U.S.-Hispanic Women, Arelis Moore De Peralta, Bonnie Holaday, Ida Mikisa Hadoto

Arelis Moore de Peralta

Introduction: Hispanic women’s cervical cancer rates are disproportionately high. Cues to cervical cancer screening (Cues to Action) are strategies to activate the decision-making process to get screened for cervical cancer. This study used the health belief model to examine which cues prompt Hispanic women to undergo cervical cancer screening and how perceptions could be potentiated by cues to cervical cancer screening.

Method: A cross-sectional survey was conducted among Hispanic women 18 to 65 years old (n = 220). Generalized linear modeling was used.

Results: Spanish media and reminders by mother and doctors were relevant cues. Generalized linear modeling showed …

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Aurora Family Medicine Residents

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

Medically Tailored Meals As A Prescription For Treatment Of Food-Insecure Type 2 Diabetics, Leslie J. Rabaut

Aurora Family Medicine Residents

Type 2 diabetes mellitus is an immense burden to the health of our population and to our current health care system, and the weight of this burden is only projected to multiply in coming years. A nutritious diet is an indispensable aspect of diabetes treatment, and the lack of access to food engenders poor disease-state control, which correlates with increased health care utilization. Interventions aimed at improving access to food through medically tailored meals (MTMs) have demonstrated effectiveness in improving the health of food-insecure type 2 diabetic patients and reducing health care costs. Further studies are necessary to increase the …

Territorial And Trans-Territorial Community-Institutional Partnerships To Build Healthier Communities In Developing Countries: Lessons Learned From A Dominican Republic Low-Resource Community, Arelis Moore De Peralta, Emily Schultz, Katherine Brown, N. Suzanne Falconer

Arelis Moore de Peralta

This descriptive case study examines the value of multi-level partnerships to foster a Building a Healthier Community (BHC) process in a low-resource community in the Dominican Republic. Partnerships developed for this BHC project were categorized under the Global Health Education Framework. Partners included a U.S-based university (trans-territorial partnership), a Dominican university, and various governmental, non-governmental, and community organizations in the Dominican Republic (territorial partnerships). Las Malvinas BHC project is an interdisciplinary and holistic approach to community health and well-being improvement that supports community members’ efforts and at the same time promotes participating students’ global health competence. Strategies, methods, the value …

It’S All About Trust And Respect: Cultural Competence And Cultural Humility In Mobile Health Clinic Services For Underserved Minority Populations, Arelis Moore De Peralta, Melinda Gillispie, Catherine Mobley, Lynette M. Gibson

Arelis Moore de Peralta

To explore participants' perceptions of cultural competence and cultural humility in mobile health clinic (MHC) service delivery, using the Cultural Competence Model (CCM) as an organizing framework. Methods. We conducted five focus groups with an ethnically diverse group of English-and Spanish-speaking men and women, ages 20–67, residing in five underserved neighborhoods in a Southeastern U.S. city. Data analysis followed a thematic approach and iterative qualitative content analysis. Results. Participants expressed a desire for well-trained and caring staff who practice cultural humility. Conclusions. By applying the CCM's five-pronged constellation of cultural abilities, health care personnel could ultimately be more responsive to …

Realmente Tenemos La Capacidad: Engaging Youth To Explore Health In The Dominican Republic Through Photovoice, Catalina Tang Yan, Arelis Moore De Peralta, Edmond P. Bowers, Linda Sprague Martinez

Arelis Moore de Peralta

Youth are often at risk for physical and psychosocial illnesses, and yet their input is rarely included in health assessments and interventions. Two U.S.-based universities partnered with community stakeholders and youth in Las Malvinas II, Dominican Republic to explore factors that promote and/or hinder the health of youth in Las Malvinas II. Youth (n=8) conducted a photovoice, and identified six key health priorities: (1) good nutrition, (2) depression and poverty, (3) violence, (4) sports and neighborhood association, (5) education, and (6) sanitation and community infrastructure. Findings revealed youth’s exploration of complex multi-level determinants of health. This study suggests youth have …

Using Community-Engaged Research To Explore Social Determinants Of Health In A Low-Resource Community In The Dominican Republic: A Community Health Assessment, Arelis Moore De Peralta, Lauren Davis, Katherine Brown, Michelle Fuentes, Suzanne Falconer, Jenneil Charles, Michelle Eichinger

Arelis Moore de Peralta

Introduction:

Previously published community health assessments (CHA) have explored social determinants of health in low-resource, Haitian-majority Dominican communities. The present CHA was conducted in Las Malvinas II, a Dominican-majority low-resource community, and represented a first step for developing a building a healthier community process.

Method:

A binational community–academic partnership adapted the Centers for Disease Control and Prevention’s CHANGE (Community Health Assessment and Group Evaluation) guide to conduct a CHA through community-engaged, mixed-methods research. Data were collected on five community selected public health priorities (i.e., education, sanitation, unwanted pregnancies, chronic disease management, and vaccine-preventable diseases) and community assets through focus groups, …