Ssm-Population Health最新文献

Objectives

Firearm-related crimes and self-inflicted harms pose a significant threat to the safety and well-being of Americans. Investigation of firearm prevalence in the United States (U.S.) has therefore been a center of attention. A critical aspect in this endeavor is to explain whether there are identifiable patterns in firearm acquisition.

Methods

We view firearm acquisition patterning as a spatio-temporal dynamical system distributed across U.S. states that co-evolves with crime rates, political ideology, income levels, population, and the legal environment. We leverage transfer entropy and exponential random graph models along with publicly available data, to statistically reveal the formative factors in how each state’s temporal patterning of firearm acquisition influences other states.

Results

Results help to explain how and why U.S. states influence each other in their firearm acquisition. We establish that state-to-state influences, or lack thereof, in firearm acquisition patterning are explained by states’ percent of gun homicide, firearm law strictness, geographic neighborhood, and citizen ideology. Network-based characteristics, namely, mutuality and transitivity, are also important to explain such influence.

Conclusions

Results suggest that state policies or programs that reduce gun homicides will also help suppress that state’s influence on the patterning of firearm acquisition in other states. Furthermore, states with stricter firearm laws are more likely to influence firearm acquisition in other states, but are themselves shielded from the effects of other states’ firearm acquisition patterns. These results inform future research in public health, criminology, and policy making.

Background

School racial segregation in the US has risen steadily since the 1990s, propelled by Supreme Court decisions rolling back the legacy of Brown v. Board. Quasi-experimental research has shown this resegregation harms Black students' health. However, whether individual or family characteristics (e.g., higher family incomes) are protective against segregation's health harms—or whether segregation is more damaging in regions of the US with fewer public sector investments—remains unclear. We leverage the quasi-random timing of school districts being released from Brown-era integration plans to examine heterogeneity in the association between resegregation and Black students' health.

Methods & findings

We took an instrumental variables approach, using the timing of integration order releases as an instrument for school segregation and analyzing a pre-specified list of theoretically-motivated modifiers in the Panel Study of Income Dynamics. In sensitivity analyses, we fit OLS models that directly adjusted for relevant covariates. Results suggest resegregation may have been particularly harmful in the South, where districts resegregated more quickly after order releases. We find little evidence that the effects of school segregation differed across family income, gender, or age.

Conclusion

The end of court-ordered integration threatens the health of Black communities—especially in the US South. Modestly higher incomes do not appear protective against school segregation's harms. Research using larger samples and alternative measures of school segregation—e.g., between districts, instead of within districts—may further our understanding of segregation's health effects, especially in Northern states.

During the COVID-19 pandemic, nations implemented various preventive measures, triggering varying online responses. This study examines cultural influences on public online stances toward these measures and their impacts on COVID-19 cases/deaths. Stance detection analysis was used to analyze 16,428,557 Tweets regarding COVID-19 preventive measures from 95 countries, selected based on Hofstede's cultural dimensions. To ensure the variety of population, countries were chosen based on Twitter data availability and a minimum sample size of 385 tweets, achieving a 95% confidence level with a 5% margin of error. The weighted regression analysis revealed that the relationship between culture and online stances depends on the cultural congruence of each measure. Specifically, power distance positively predicted stances for all measures, while indulgence had a negative effect overall. Effects of other cultural indices varied across measures. Individualism negatively affected face coverings stances. Uncertainty avoidance influenced lockdown and vaccination stances negatively but had a positive effect on social distancing stances. Long-term orientation negatively affected lockdown and social distancing stances but positively influenced quarantine stances. Cultural tightness only negatively affected face coverings and quarantine stances. Online stances toward face coverings mediated the relationship between cultural indices and COVID-19 cases/deaths. As such, public health officials should consider cultural profiles and use culturally congruent communication strategies when implementing preventive measures for future pandemics. Furthermore, leveraging digital tools is vital in navigating and shaping online stances to enhance the effectiveness of these measures.

Background

Several pelvic area cancers exhibit high incidence rates, and their surgical treatment can result in adverse effects such as urinary and fecal incontinence, significantly impacting patients' quality of life. Post-surgery incontinence is a significant concern, with prevalence rates ranging from 25 to 45% for urinary incontinence and 9–68% for fecal incontinence. Cancer survivors are increasingly turning to YouTube as a platform to connect with others, yet caution is warranted as misinformation is prevalent.

Objective

This study aims to evaluate the information quality in YouTube videos about post-surgical incontinence after pelvic area cancer surgery.

Methods

A YouTube search for "Incontinence after cancer surgery" yielded 108 videos, which were subsequently analyzed. To evaluate these videos, several quality assessment tools were utilized, including DISCERN, GQS, JAMA, PEMAT, and MQ-VET. Statistical analyses, such as descriptive statistics and intercorrelation tests, were employed to assess various video attributes, including characteristics, popularity, educational value, quality, and reliability. Also, artificial intelligence techniques like PCA, t-SNE, and UMAP were used for data analysis. HeatMap and Hierarchical Clustering Dendrogram techniques validated the Machine Learning results.

Results

The quality scales presented a high level of correlation one with each other (p < 0.01) and the Artificial Intelligence-based techniques presented clear clustering representations of the dataset samples, which were reinforced by the Heat Map and Hierarchical Clustering Dendrogram.

Conclusions

YouTube videos on "Incontinence after Cancer Surgery" present a "High" quality across multiple scales. The use of AI tools, like PCA, t-SNE, and UMAP, is highlighted for clustering large health datasets, improving data visualization, pattern recognition, and complex healthcare analysis.

Lifestyles are associated with all-cause mortality, yet limited research has explored the association in the elderly population with multimorbidity. We aim to investigate the impact of adopting a healthy lifestyle on reducing the risk of all-cause mortality in older individuals with or without multimorbidity in both China and UK. This prospective study included 29,451 and 173,503 older adults aged 60 and over from Chinese Longitudinal Healthy Longevity Survey (CLHLS) and UK Biobank. Lifestyles and multimorbidity were categorized into three groups, respectively. Cox proportional hazards regression was used to estimate the Hazard Ratios (HRs), 95% confidence intervals (95% CIs), and dose-response for all-cause mortality in relation to lifestyles and multimorbidity, as well as the combination of both factors. During a mean follow-up period of 4.7 years in CLHLS and 12.14 years in UK Biobank, we observed 21,540 and 20,720 deaths, respectively. For participants with two or more conditions, compared to those with an unhealthy lifestyle, adopting a healthy lifestyle was associated with a 27%–41% and 22%–42% reduction in mortality risk in the CLHLS and UK Biobank, respectively; Similarly, for individuals without multimorbidity, this reduction ranged from 18% to 41%. Among participants with multimorbidity, individuals with an unhealthy lifestyle had a higher mortality risk compared to those maintaining a healthy lifestyle, with HRs of 1.15 (95% CI: 1.00, 1.32) and 1.27 (95% CI: 1.16, 1.39) for two conditions, and 1.24 (95% CI: 1.06, 1.45) and 1.73 (95% CI: 1.56, 1.91) for three or more conditions in CLHLS and UK Biobank, respectively. Adherence to a healthy lifestyle can yield comparable mortality benefits for older individuals, regardless of their multimorbidity status. Furthermore, maintaining a healthy lifestyle can alleviate the mortality risks linked to a higher number of diseases.

Background

Despite having higher exposure to stressors, many ethno-racial groups report similar or lower prevalence of clinical depression and anxiety compared to their White counterparts, despite experiencing greater psychosocial risk factors for poor mental health outcomes, thus presenting an epidemiological paradox. Ethno-racial differences in impairment, a diagnostic criterion, may in part explain this paradox.

Methods

We analyzed data from the Healthy Minds Study (2020–2021) and using survey-weighted linear mixed effects models, we tested whether there were ethno-racial differences in impairment across multiple ethno-racial groups at various levels of severity for anxiety and depression.

Results

Black students reported lower mean impairment scores relative to White students at moderate and severe anxiety. Hispanic/Latine students only reported lower impairment relative to White students at severe anxiety. Asian students reported relatively lower mean impairment than White students at mild anxiety, and this difference continued to grow as anxiety severity increased. Similar trends were observed for depression. Black and Hispanic/Latino students reported lower mean impairment scores at moderate to severe depression. Asian students reported lower mean impairment scores beginning at mild depression to severe depression.

Conclusion

Self-reported anxiety and depression related impairment varies by ethno-racial group, with Black, Hispanic/Latinx, and Asian students reporting lower impairment compared to White students at higher levels of symptom severity. These findings open the possibility that racial differences in the impairment criterion of clinical diagnoses may explain some of the racial paradox.

Restrictive federal and state immigration policies create conditions of employment exclusion that may negatively influence the health of immigrants. In particular, these policy effects are reflected in labor market and workplace experiences that determine the types of work and employment opportunities that immigrants are able to access and pursue. This study examines the relationship between both cumulative and individual measures of employment exclusion and self-rated health and psychological distress among Asian and Latino immigrants in California, and whether this relationship is modified by legal status. We used data from the Research on Immigrant Health and State Policy (RIGHTS) study (n = 2010). We used both multivariable logistic regression and linear regression models for our analyses. For cumulative models, labor market exclusion was associated with poor health (OR = 1.21, 95% CI: 1.01, 1.46). Workplace exclusion was also associated with poor self-rated health (OR = 1.45, 95% CI: 1.15, 1.82) and increased psychological distress (β = 0.69, 95% CI: 0.31, 1.07). For individual measures of employment exclusion, settling for a job – a labor market exclusion – and working in a dangerous job and experiencing wage theft – workplace exclusions – were associated with poor health and increased psychological distress. There was no evidence that the association between employment exclusions and health varied by legal status. These findings demonstrate that the combined effect of employment exclusions is detrimental to immigrant health. To improve population health, public health researchers should continue to interrogate the policy conditions at the federal, state, and local level that exclude immigrants from employment opportunities and workplace protections.

Health equity is fundamental to improving the health of populations, but in recent decades progress towards this goal has been mixed. To better support this mission, a deeper understanding of the local heterogeneity within population-level health equity is vital. This analysis presents trends in average health and health equity in the United States at the local level from 1990 to 2019 using three different health outcomes: mortality, self-reported health status, and healthy days. Furthermore, it examines the association between these measures of average health and health equity with several structural factors. Results indicate growing levels of geographic inequality disproportionately impacting less urbanized parts of the country, with rural counties experiencing the largest declines in health equity, followed by Medium and Small Metropolitan counties. Additionally, lower levels of health equity are associated with poorer local socioeconomic context, including several measures that are proxies for structural racism. Altogether, these findings strongly suggest social and economic factors play a pivotal role in explaining growing levels of geographic health inequality in the United States. Policymakers invested in improving health equity must adopt holistic and upstream approaches to improve and equalize economic opportunity as a means of fostering health equity.

Background

Longstanding research has shown strong inequalities in low birthweight by household income. However, most such research has focused on Anglophone countries, while evidence emerging from other developed countries suggest a stronger role of education rather than incomes in creating inequalities at birth. This paper compares gradients in low birthweight by maternal education, as well as explores underlying mechanisms contributing to these gradients, in France, the United States, and the United Kingdom.

Methods

Analyses are based on harmonized data from large, nationally-representative samples from France, UK and US. We use regression models and decomposition methods to explore the relative role of several possible mechanisms in producing birthweight inequalities.

Results

Inequalities in low birth weight across maternal education groups were relatively similar in the United States, the United Kingdom and France. However, the individual-level mechanisms producing such inequalities varied substantially across the three countries, with income being most important in the US, pregnancy smoking being most evident in France, and the UK occupying an intermediate position. Differences in the mechanisms producing birth health inequalities mirror differences in the policy environment in the three countries.

Conclusion

While inequalities in health appear from the earliest moments in many countries, our results suggest research on birth health inequalities, and therefore policies, is not easily generalizable across national contexts, and call for more scholarship in uncovering the “whys” of health inequalities in a variety of contexts.

Background

Maternal education is one of key factors affecting nurturing environment which significantly impacts children's height levels throughout their developmental stages. However, the influence of maternal education on children’s height is less studied. This study aims to investigate the dynamic influence of maternal education on children's height among Chinese children aged 0-18 years.

Methods

Children undergoing health examinations from January 2021 to September 2023 were included in this study. Clinical information including height, weight, maternal pregnancy history, blood specimens for bone metabolism-related indicators and maternal education level was collected. Children's height was categorized into 14 groups based on age and gender percentiles, following WHO 2006 growth standards. One-way analysis of variance (ANOVA), linear regression, chi-square test and Fisher's exact test were applied for data analysis.

Results

A total of 6269 samples were collected, including 3654 males and 2615 females, with an average age of 8.38 (3.97) for males and 7.89 (3.55) for females. Significant correlations between maternal education level, birth weight, birth order, weight percentile, vitamin D, serum phosphorus, alkaline phosphatase levels, and children's height were identified. Birth weight's influence on height varied across age groups. Compared with normal birth weight children, low birth weight children exhibited catch-up growth within the first 6 years and a subsequent gradual widening of the height gap from 6 to 18 years old. Remarkably, the impact of maternal education on height became more pronounced among children above 3–6 years old, which can mitigate the effect of low birth weight on height.

Conclusion

We found that weight percentile, birth weight, birth order, bone marker levels, and maternal education level have significant effect on height. Maternal education attenuates the impact of low birth weight on height. The findings indicated that maternal education plays a consistent and critical role in promoting robust and healthy growth.