Journal of Epidemiology and Community Health最新文献

Background: Chronically absent students miss learning opportunities at school, and as a result, may suffer academically and socially. Student absenteeism is rising across the USA, with 14%-30% of K-12 students being chronically absent (missing ≥10% of school days) each year. In 2012, Michigan started Pathways to Potential (P2P)-placing caseworkers in public schools to address the material needs of students that interfere with attendance. In this study, we evaluated the effect of P2P on chronic absenteeism in public schools across Michigan.

Methods: Our quasi-experimental study included 160 Michigan K-12 public schools that began implementing P2P between 2012 and 2016. We evaluated the effect of P2P on chronic absenteeism using administrative data for academic years 2008-2009 through 2018-2019. We used a staggered interrupted time series (ITS) analysis, first modelling a simple ITS for each school, and then pooling effect estimates using random effects meta-analysis. We estimated meta-regressions to investigate heterogeneous treatment effects.

Results: Results suggest P2P reduced chronic absenteeism rates by 7.88% (incidence rate ratio=0.92 (95% CI 0.88 to 0.96)), preventing 21 students from being chronically absent per school per year (95% CI 17.52 to 24.95). There was significant heterogeneity, with greater effects for schools that received a higher P2P dose, were in the eastern region of the state, had wealthier student bodies, and were less racially diverse.

Conclusion: This school-based intervention represents a feasible and effective programme for preventing chronic absenteeism. Further standardising the programme, while ensuring P2P can address diverse needs, may produce more consistent results across schools.

Background: Relationships and sex education (RSE) impacts some sexual behaviours but could be strengthened by incorporating whole-school approaches (eg, building engagement, providing contraception). These can prevent pregnancies and sexually-transmitted infections but are unevaluated in UK schools.

Methods: A cluster-randomised trial of 'Positive Choices' compared it with usual practice in English secondary schools. Intervention comprised: RSE, school-health-promotion councils involving students, student-needs data to tailor provision; student-led campaigns; review of sexual-health services; and parent information. The primary outcome was prevention of non-competent sexual debut (lacking decision autonomy, judging timing as right, partners' equal willingness or contraception).

Results: Of 2845 schools invited, 50 (1.76%) consented, 1 leaving post-allocation. Of 25 control and 24 intervention schools, 4 withdrew pre-endline. 6970 (77.3%) students participated at baseline and 6268 (77.9%) at 33-month endline. Fidelity of whole-school components was suboptimal. No schools achieved 'good' fidelity; two achieved 'adequate' fidelity across components. 11 achieved 'adequate fidelity on selected components' (student-needs report, school-health-promotion council meetings, lessons, parent information). Control schools delivered similar activities to intervention schools. Among 780 (12.44%) students sexually debuting between baseline and endline, non-competent debut was reported by 268 (64.42%) in the control and 240 (65.93%) in the intervention group (risk difference=0.020 (95% CI -0.05 to 0.09)). There were no effects on secondary outcomes. Incremental costs were £1337 per school (£10 per student).

Conclusion: Positive Choices did not prevent non-competent sexual debut (primary outcome) or impact secondary outcomes compared with usual RSE, possibly explained by weak fidelity of whole-school elements and/or comprehensive RSE in control schools.

Trial registration number: ISRCTN16723909.

Background: Between 2022 and 2023, overdose mortality decreased among non-Hispanic (NH) white people but stayed the same or increased among people of colour in the USA. County racialised economic segregation may contribute to overdose mortality.

Methods: We used a Bayesian spatiotemporal approach to assess the association between racialised economic segregation quintile and overdose deaths (overall and race-stratified) in 3133 US counties from 2018 to 2022. Segregation was measured using the Index of Concentration at the Extremes for race/ethnicity and income (ICE_race-income). We included two ICE_race-income measures, one for higher-income NH white and lower-income black residents and another for higher-income NH white and lower-income Hispanic residents. Models included random effects for county, year and county-year interaction, and fixed effects for proportion male, proportion aged 25-44, land area, state and year. We estimated relative risk (RR) by quintile (least vs most privileged) and the difference in overdose mortality per 100 000 (RD) had all counties shifted to the risk of the most advantaged counties (Q5).

Results: Counties with the highest proportion of lower-income racially minoritised residents (Q1) had an increased RR of overdose deaths compared with Q5 counties, both overall (aRRs 1.64 (1.51-1.78); 1.40 (1.29-1.52)), and among subgroups. Had all counties experienced the risk of Q5 counties, we estimated an average reduction in overdose deaths overall (RDs per 100 000: -7.20 (-8.25 to -6.10); -6.37 (-7.38 to -5.25)) and among subgroups.

Conclusion: County racialised economic segregation was associated with overdose mortality risk in 2018-2022. Investment in evidence-based strategies to reduce overdose risk in places experiencing harms related to racialised economic segregation is critical.

Background: Spousal caregiving is linked to increased symptoms of poor mental health among older people. Less is known about the effects of physical health conditions with different progression and level of impairment on spousal mental health among younger people.

Methods: Using Finnish total population register data, we identified 106 673 partnered individuals aged 30-70, newly diagnosed in 2000-2015 with progressive conditions with increasing impairment (Parkinson's disease, multiple sclerosis, dementia), acute conditions with sudden impairment (stroke) and acute conditions without cognitive impairment (myocardial infarction, prostate cancer, female breast cancer), and employed event-study difference-in-difference models to assess short-term and long-term effects on spouses' 6-month probability of psychotropic medication purchases (Anatomical Therapeutic Chemical (ATC) codes N05B, N05C and N06A) by type of health condition.

Results: Incident stroke had a sudden effect on spousal psychotropic medication purchase probability (2.1 percentage points increase among female and 1.4 percentage points increase among male spouses). Effect size attenuated thereafter, although more slowly among female spouses, yet remained over 1 percentage point in the long term. Smaller (about 0.7 percentage points among female and 0.5 percentage points among male spouses), but also persistent, effect was observed following the diagnosis of acute conditions without cognitive impairments. For progressive conditions, little changes occurred around the time of diagnosis.

Conclusions: Acute onset of physical illness may have sudden and persistent adverse impact on spousal mental health in midlife even when prognosis is good and expectations for spousal care are likely to be limited.

Background: The COVID-19 pandemic reversed a decade of progress in reducing child food insufficiency in the United States. Congress implemented a universal 15% increase in Supplemental Nutrition Assistance Program (SNAP) benefits from January 2021 through September 2021 to address rising child food hardship.

Methods: We conducted a difference-in-differences analysis using US Census Bureau data to evaluate the impact of this temporary expansion on child food insufficiency. We compared 9776 SNAP participating households with 18 961 eligible non-participating households, examining changes before and during the benefit expansion period while accounting for demographic and economic characteristics.

Results: The expansion was associated with a 20% reduction in the odds of child food insufficiency among SNAP participants compared with eligible non-participants (OR = 0.80; 95% CI = 0.66 to 0.97). Hispanic-American households experienced a 39% reduction (OR = 0.61; 95% CI = 0.47 to 0.80), and households with six or more members showed a 33% reduction (OR = 0.67; 95% CI = 0.45 to 1.02).

Conclusions: The 15% SNAP benefit expansion in 2021 effectively reduced child food insufficiency during the pandemic, with particularly strong protective effects among Hispanic-American and large households. These findings support a universal food benefit expansion improving child health needs during a national health and economic crisis.

Background: Early initiation of antenatal care provides timely screening, advice and support. Inequities in early care initiation exist in high-income countries, but there is scant evidence on effective interventions. The community REACH (Research for Equitable Antenatal Care and Health) trial aimed to assess the effectiveness of co-produced place-based interventions to strengthen community support for early care initiation.

Methods: Matched-pair cluster randomised trial in socially disadvantaged and ethnically diverse areas in England. Electoral wards with low rates of early care initiation were matched and randomly allocated to intervention or control (usual care) (n=10 pairs). Following a 3-month co-design phase, community organisations and volunteers in intervention sites conducted targeted outreach activities over 6 months. The primary outcome was initiation of antenatal care by the 12th completed week of pregnancy.

Results: There was no evidence of a difference in the primary outcome (OR 1.07, 95% CI 0.89 to 1.28). There were also no statistically significant differences in rates of emergency caesarean, preterm birth, low birth weight, smoking or breastfeeding. There was a higher rate of care initiation by 10 weeks and fewer antenatal admissions in the intervention arm during the intervention period, although differences were not sustained after it finished.

Conclusion: This rigorous evaluation found a limited impact of short-term place-based interventions to strengthen community support for early initiation of antenatal care. Future initiatives may benefit from embedding in integrated health and care structures to ensure sufficient time and resources for mobilisation of community assets and focusing on smaller 'hyper-local' neighbourhoods. Actions to tackle wider structural and organisational barriers are also needed.

Trial registration number: ISRCTN registry: registration number 63066975. Registered on 18 August 2015.

Background: Future economic transitions have the potential to replicate historical patterns of deindustrialisation. It is important to understand the health consequences of deindustrialisation to help us prevent the long-term health legacies we see in postindustrial communities. This paper presents the case of mental health on the Welsh coalfields as an example of how these health legacies can manifest.

Methods: Data on 180 462 respondents to the Welsh Health Survey between 2003 and 2015 and 57 331 respondents to the National Survey for Wales between 2016 and 2023 were linked to spatial data on historical coal mining activity at the middle super output area level. Linear mixed-effects models were fitted to self-reported mental health and well-being measures as a function of local mining extent, both overall and as a function of generational cohort and sex.

Results: An association between mining extent and mental health was found in both datasets, with residents of areas with greater mining extent reporting worse mental health. This association was strongest in generations who lived through the decline of the mining industry. There was a stronger association for women than men in the older Welsh Health Survey, but moderation by gender was not replicated in the newer National Survey for Wales.

Conclusion: The study underscores the enduring mental health legacy of deindustrialisation and how it is patterned by geography, generation and sex. The health consequences should be an important consideration for industrial policy and attempts to mitigate the effects of future deindustrialisation.

Background: Inequalities in colorectal cancer (CRC) staging and outcomes exist across numerous sociodemographic axes. Early-stage CRC diagnosis is important for treatment success and survival. In this study, we investigate inequalities in CRC staging using registry data for 186 713 first-time CRC cancer diagnoses from 2013 to 2019 in England.

Methods: We employ the novel Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach to National Cancer Registry data. We investigate inequalities in CRC staging (early vs advanced stage) via a logistic MAIHDA. We examine a range of intersectional inequalities in CRC staging, across different age, ethnicity, gender and area-level deprivation groups.

Results: Just over half of the staged cancers in the sample were diagnosed at advanced stage (62%). Results demonstrate notable inequalities in the risk of advanced CRC staging, with a gap of 17 percentage points between the strata with the lowest and highest predicted probability of advanced stage CRC diagnosis. These inequalities exist between age groups, ethnicity and deprivation level, with no evidence of gender-related inequalities when other variables are controlled. However, unexpectedly, we find these inequalities to be almost entirely additive in nature.

Conclusions: These results suggest substantial inequalities in advanced stage CRC diagnosis exist, but that these are driven largely by universal processes of inequality, rather than disadvantages associated with single intersectional strata beyond an additive layering of disadvantage. Policy tools to encourage prompt screening engagement and symptom awareness campaigns in pre-screening age groups may benefit from considering the groups most disadvantaged by that additive layering.