AJPM focus最新文献_第6页

Adoption of New Oral Health Interventions in Primary Care: Qualitative Findings 在初级保健中采用新的口腔保健干预措施：定性研究结果

AJPM focus

Pub Date : 2024-02-24 DOI: 10.1016/j.focus.2024.100214

Gloria C. Bales PhD , Shelley Curtan Med , Neel Agarwal , Sarah D. Ronis MD, MPH , Suchitra Nelson PhD

Introduction

This is the first study to use the Common-Sense Model of Self-Regulation theory for oral health interventions in pediatric practices. The objective of this qualitative study was to assess adoption and implementation of theory-based multilevel oral health interventions, by clinicians (pediatricians and nurse practitioners) participating in a cluster randomized clinical trial, to create an oral health toolkit for widespread dissemination into pediatric practices.

Methods

Semistructured interviews were conducted at the conclusion of the cluster randomized clinical trial with 21 clinicians from 9 practices participating in the intervention arm. Clinicians in this arm received Common-Sense Model of Self-Regulation theory–based education and resources to deliver oral health interventions to parents/caregivers and document in electronic medical record. Semistructured interview questions were based on the Diffusion of Innovations Theory, assessing adoption and implementation. The interviews were coded using NVivo (QRS International) software. Main themes were identified using a thematic analysis approach.

Results

Five themes identified from the interviews included strengths of theory-based oral health training for clinicians, oral health resources to improve quality of care, considerations for efficient future implementation, financial considerations, and parent benefits and challenges. Clinicians found that the theory-based training and resources increased knowledge and confidence when addressing oral health with parents and required only ≤2 minutes in their workflow with no financial consequences. Clinicians reported an increase in oral health awareness among parents but suggested an overall need for more pediatric dentists.

Conclusions

The Common-Sense Model of Self-Regulation theory–based education and resources were well received by clinicians and perceived to be beneficial without adverse impact on workflow or practice finances. An online toolkit is planned because these oral health interventions can be successfully implemented and delivered in medical settings.

引言这是第一项将自我调节常识模型理论用于儿科口腔健康干预的研究。这项定性研究的目的是评估参与分组随机临床试验的临床医生（儿科医生和执业护士）对基于理论的多层次口腔健康干预措施的采纳和实施情况，以创建一个口腔健康工具包，在儿科临床中广泛推广。方法在分组随机临床试验结束后，对参与干预组的 9 家诊所的 21 名临床医生进行了结构化访谈。参与干预组的临床医生接受了基于自我调节常识模型理论的教育和资源，以便向家长/监护人提供口腔健康干预措施，并在电子病历中进行记录。半结构式访谈问题以创新扩散理论为基础，评估采用和实施情况。访谈使用 NVivo（QRS International）软件进行编码。结果从访谈中确定了五个主题，包括临床医生基于理论的口腔健康培训的优势、提高护理质量的口腔健康资源、未来有效实施的考虑因素、财务考虑因素以及家长的益处和挑战。临床医生发现，以理论为基础的培训和资源增加了他们与家长讨论口腔健康问题时的知识和信心，而且只需要在工作流程中花费 ≤ 2 分钟的时间，不会产生任何经济后果。临床医生报告说，家长们对口腔健康的认识有所提高，但认为总体上需要更多的儿童牙科医生。由于这些口腔健康干预措施可以在医疗环境中成功实施和提供，因此计划推出在线工具包。

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引用次数: 0

Prevalence of Diabetes by BMI: China Nutrition and Health Surveillance (2015–2017) and U.S. National Health and Nutrition Examination Survey (2015–2018) 按体重指数划分的糖尿病患病率：中国营养与健康监测（2015-2017年）和美国国家健康与营养调查（2015-2018年）

AJPM focus

Pub Date : 2024-02-24 DOI: 10.1016/j.focus.2024.100215

Dongmei Yu PhD , Crescent B. Martin MA, MPH , Cheryl D. Fryar MSPH , Craig M. Hales MD , Mark S. Eberhardt PhD , Margaret D. Carroll MSPH , Liyun Zhao MPH , Cynthia L. Ogden PhD

Introduction

The risk of diabetes begins at a lower BMI among Asian adults. This study compares the prevalence of diabetes between the U.S. and China by BMI.

Methods

Data from the 2015–2017 China Nutrition and Health Surveillance (n=176,223) and the 2015–2018 U.S. National Health and Nutrition Examination Survey (n=4,464) were used. Diagnosed diabetes was self-reported. Undiagnosed diabetes was no report of diagnosed diabetes and fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%. Predicted age-adjusted prevalence estimates by BMI were produced using sex- and country-specific logistic regression models.

Results

In China, the age-adjusted prevalence of total diabetes was 7.8% (95% CI=7.4%, 8.3%), lower than the 14.6% (95% CI=13.1%, 16.3%) in the U.S. The prevalence of diagnosed diabetes was also lower in China than in the U.S. There were no statistically significant differences in the prevalence of undiagnosed diabetes between China and the U.S. The distribution of BMI in China was lower than in the U.S., and the predicted prevalence of total diabetes was similar between China and the U.S. when comparing adults with the same BMI. The predicted prevalence of undiagnosed diabetes was higher in China than in the U.S. for both men and women, and this disparity increased with BMI. When comparing adults at the same BMI, there was little difference in the prevalence of total diabetes, but diagnosed diabetes was lower in China than in the U.S., and undiagnosed was higher.

Conclusions

Although differences in BMI appear to explain nearly all of the differences in total diabetes prevalence in the 2 countries, not all factors that are associated with diabetes risk have been investigated.

导言亚洲成年人患糖尿病的风险始于较低的体重指数。本研究比较了中美两国按体重指数（BMI）划分的糖尿病患病率。研究采用了2015-2017年中国营养与健康状况监测数据（n=176223）和2015-2018年美国国家健康与营养调查数据（n=4464）。确诊糖尿病为自我报告。未确诊糖尿病是指未报告确诊糖尿病且空腹血浆葡萄糖≥126 mg/dL 或 HbA1c ≥6.5%。结果在中国，经年龄调整的糖尿病总患病率为 7.8%（95% CI=7.4%，8.3%），低于美国的 14.6%（95% CI=13.1%，16.3%）。中国已确诊糖尿病的患病率也低于美国、在比较相同体重指数的成年人时，中国和美国的总糖尿病预测患病率相似。中国男性和女性未确诊糖尿病的预测患病率均高于美国，且这一差距随体重指数的增加而增大。结论虽然体重指数的差异似乎可以解释两国糖尿病总患病率的几乎所有差异，但并非所有与糖尿病风险相关的因素都得到了研究。

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引用次数: 0

Association Between Cardiovascular Health Status and Healthcare Utilization in a Large Integrated Healthcare System 大型综合医疗系统中心血管健康状况与医疗服务利用率之间的关系

AJPM focus

Pub Date : 2024-02-24 DOI: 10.1016/j.focus.2024.100213

Irvin Lien MD , Howard Moffet MPH , Jennifer Liu MPH , Andrew Karter PhD , Matthew Solomon MD, PhD , Alan Go MD , Khurram Nasir MD, MPH , Stephen Sidney MD, MPH , Jamal Rana MD, PhD

Introduction

The American Heart Association Life's Simple 7 schema can be used to categorize patients’ cardiovascular health status as poor, intermediate, or ideal on the basis of smoking, BMI, physical activity, dietary patterns, blood pressure, cholesterol, and fasting blood sugar. This study examined the association between cardiovascular health status and subsequent healthcare utilization.

Methods

This was an observational cohort study of adults from an integrated healthcare delivery system—Kaiser Permanente Northern California—that had outpatient care between 2013 and 2014. Patients were categorized by American Heart Association cardiovascular health status: poor, intermediate, or ideal. Individual-level healthcare utilization and costs in 2015 were accumulated for each patient and compared across the 3 cardiovascular health categories and stratified by age groups.

Results

A total of 991,698 patients were included in the study. A total of 194,003 (19.6%) were aged 18–39 years; 554,129 (55.9%) were aged 40–64 years; and 243,566 (24.6%) were aged ≥65 years. A total of 259,931 (26.2%) had ideal cardiovascular health; 521,580 (52.6%) had intermediate cardiovascular health; and 210,187 (21.2%) had poor cardiovascular health. Healthcare utilization measured by average relative cost per patient increased monotonically across age categories (p<0.001). In addition, cardiovascular health category was inversely associated with lower cost in each age group (p<0.001).

Conclusions

Adults who were younger and had more ideal cardiovascular health had relatively lower healthcare costs across age groups. Interventions to promote better cardiovascular health may improve patient outcomes and reduce overall healthcare expenditures.

导言美国心脏协会的 "生命简单 7 "模式可用于根据吸烟、体重指数、体力活动、饮食模式、血压、胆固醇和空腹血糖将患者的心血管健康状况分为差、中、理想。本研究探讨了心血管健康状况与后续医疗保健利用率之间的关系。方法这是一项观察性队列研究，研究对象是在 2013 年至 2014 年期间接受门诊治疗的综合医疗保健服务系统--北加州凯撒医疗保健公司（Kaiser Permanente Northern California）的成年人。患者按美国心脏协会心血管健康状况分为：差、中等或理想。累计了每位患者在 2015 年的个人医疗保健使用情况和费用，并在 3 个心血管健康状况类别之间进行了比较，还按年龄组进行了分层。共有 194 003 人（19.6%）年龄在 18-39 岁之间；554 129 人（55.9%）年龄在 40-64 岁之间；243 566 人（24.6%）年龄≥65 岁。共有 259,931 人（26.2%）心血管健康状况理想；521,580 人（52.6%）心血管健康状况中等；210,187 人（21.2%）心血管健康状况较差。以每位患者的平均相对成本计算的医疗保健使用率在不同年龄段之间呈单调增长（p<0.001）。此外，在每个年龄组中，心血管健康类别与较低的费用成反比（p<0.001）。结论年龄较小、心血管健康状况较理想的成年人在各年龄组中的医疗费用相对较低。促进心血管健康的干预措施可改善患者的治疗效果并降低总体医疗费用。

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引用次数: 0

U.S. Filipino Adults Have Elevated Prevalence of Hypertension Across the Adult Lifespan: Findings From a Cross-Sectional Electronic Health Record Study 美国菲律宾成年人在整个成年期的高血压患病率较高：一项横断面电子健康记录研究的结果

AJPM focus

Pub Date : 2024-02-23 DOI: 10.1016/j.focus.2024.100211

Nancy P. Gordon ScD , Irvin C. Lien MD , Jamal S. Rana MD, PhD , Joan C. Lo MD

Introduction

The prevalence of hypertension increases with age and differs by race and ethnicity. Among U.S. Asian adults, prevalence is higher for Filipino adults than for other major Asian subgroups, but whether this disparity exists across the adult lifespan is unknown. This study examined hypertension prevalence by age decade, comparing Filipino adults with South Asian, Chinese, Black, Hispanic, and White adults.

Methods

This cross-sectional study used 2015–2016 electronic health record data from a Northern California integrated healthcare delivery system for 1,839,603 adults aged 30–79 years, including 128,124 Filipino adults. Hypertension was defined by diagnosis codes. Sex-specific prevalence was calculated by race and ethnicity overall and by 10-year age decade from ages 30–39 years to 70–79 years. The prevalence of hypertension among 5 racial and ethnic groups was compared within each decade (with Filipino as the reference), adjusting for age, English language, diabetes, smoking, and weight category.

Results

Decade-specific prevalence of hypertension among Filipino men and women, respectively, was 9.7% and 8.5% for ages 30–39 years, 26.0% and 23.9% for ages 40–49 years, 45.9% and 44.4% for ages 50–59 years, 65.4% and 63.9% for ages 60–69 years, and 82.1% and 82.9% for ages 70–79 years. Across all age decades, hypertension prevalence among Filipino adults largely tracked with Black adults and was much higher than among South Asian, Chinese, White, and Hispanic adults. This pattern remained after adjusting for covariates, with the largest differences observed for adults aged <60 years.

Conclusions

Similar to Black adults, Filipino adults have persistently higher hypertension prevalence than South Asian, Chinese, Hispanic, and White adults across the adult lifespan. These findings underscore the importance of surveillance and prevention efforts for this high-risk Asian group beginning in early adulthood.

导言：高血压的患病率随着年龄的增长而增加，并且因种族和民族而异。在美国亚裔成年人中，菲律宾裔成年人的患病率高于其他主要亚裔亚群，但这种差异是否存在于成年人的整个生命周期尚不清楚。本研究对菲律宾成年人与南亚、华裔、黑人、西班牙裔和白人成年人的高血压患病率进行了比较，并按年龄段进行了研究。方法这项横断面研究使用了北加州综合医疗保健服务系统提供的 2015-2016 年电子健康记录数据，其中包括 1839603 名年龄在 30-79 岁之间的成年人，包括 128124 名菲律宾成年人。高血压由诊断代码定义。按种族和民族的总体情况以及从 30-39 岁到 70-79 岁的 10 年年龄段计算了性别特异性患病率。在对年龄、英语、糖尿病、吸烟和体重类别进行调整后，比较了 5 个种族和民族群体在每个十年中的高血压患病率（以菲律宾人为参照）。结果菲律宾男性和女性的高血压患病率在不同年代分别为：30-39 岁为 9.7% 和 8.5%，40-49 岁为 26.0% 和 23.9%，50-59 岁为 45.9% 和 44.4%，60-69 岁为 65.4% 和 63.9%，70-79 岁为 82.1% 和 82.9%。在所有年龄段中，菲律宾成年人的高血压患病率与黑人成年人基本一致，远高于南亚人、中国人、白人和西班牙裔成年人。结论与黑人成年人相似，菲律宾成年人在整个成年期的高血压患病率一直高于南亚裔、华裔、西班牙裔和白人成年人。这些发现强调了从成年早期开始对这一高风险亚裔群体进行监测和预防的重要性。

{"title":"U.S. Filipino Adults Have Elevated Prevalence of Hypertension Across the Adult Lifespan: Findings From a Cross-Sectional Electronic Health Record Study","authors":"Nancy P. Gordon ScD , Irvin C. Lien MD , Jamal S. Rana MD, PhD , Joan C. Lo MD","doi":"10.1016/j.focus.2024.100211","DOIUrl":"10.1016/j.focus.2024.100211","url":null,"abstract":"<div><h3>Introduction</h3><p>The prevalence of hypertension increases with age and differs by race and ethnicity. Among U.S. Asian adults, prevalence is higher for Filipino adults than for other major Asian subgroups, but whether this disparity exists across the adult lifespan is unknown. This study examined hypertension prevalence by age decade, comparing Filipino adults with South Asian, Chinese, Black, Hispanic, and White adults.</p></div><div><h3>Methods</h3><p>This cross-sectional study used 2015–2016 electronic health record data from a Northern California integrated healthcare delivery system for 1,839,603 adults aged 30–79 years, including 128,124 Filipino adults. Hypertension was defined by diagnosis codes. Sex-specific prevalence was calculated by race and ethnicity overall and by 10-year age decade from ages 30–39 years to 70–79 years. The prevalence of hypertension among 5 racial and ethnic groups was compared within each decade (with Filipino as the reference), adjusting for age, English language, diabetes, smoking, and weight category.</p></div><div><h3>Results</h3><p>Decade-specific prevalence of hypertension among Filipino men and women, respectively, was 9.7% and 8.5% for ages 30–39 years, 26.0% and 23.9% for ages 40–49 years, 45.9% and 44.4% for ages 50–59 years, 65.4% and 63.9% for ages 60–69 years, and 82.1% and 82.9% for ages 70–79 years. Across all age decades, hypertension prevalence among Filipino adults largely tracked with Black adults and was much higher than among South Asian, Chinese, White, and Hispanic adults. This pattern remained after adjusting for covariates, with the largest differences observed for adults aged <60 years.</p></div><div><h3>Conclusions</h3><p>Similar to Black adults, Filipino adults have persistently higher hypertension prevalence than South Asian, Chinese, Hispanic, and White adults across the adult lifespan. These findings underscore the importance of surveillance and prevention efforts for this high-risk Asian group beginning in early adulthood.</p></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773065424000300/pdfft?md5=76ac5f6deeebc69be222e09d8899f50e&pid=1-s2.0-S2773065424000300-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140462532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cardiovascular Risk Profile Among Reproductive-Aged Women in the U.S.: The Behavioral Risk Factor Surveillance System, 2015–2020 美国育龄妇女的心血管风险概况：行为风险因素监测系统（BRFSS，2015-2020 年）

AJPM focus

Pub Date : 2024-02-23 DOI: 10.1016/j.focus.2024.100210

Ellen Boakye MD, MPH , Chigolum P. Oyeka MD, MPH , Yaa A. Kwapong MD, MPH , Faith E. Metlock BSN , Sadiya S. Khan MD, MSc , Mamas A. Mamas MBBCh , Amanda M. Perak MD, MS , Pamela S. Douglas MD , Michael C. Honigberg MD, MPP , Khurram Nasir MD, MPH, MSc , Michael J. Blaha MD, MPH , Garima Sharma MD

Introduction

Suboptimal cardiovascular health is associated with adverse pregnancy outcomes and long-term cardiovascular risk. The authors examined trends in cardiovascular risk factors and correlates of suboptimal cardiovascular risk profiles among reproductive-aged U.S. women.

Methods

With data from 335,959 women in the Behavioral Risk Factor Surveillance System (2015–2020), the authors conducted serial cross-sectional analysis among nonpregnant reproductive-aged women (18–44 years) without cardiovascular disease who self-reported information on 8 cardiovascular risk factors selected on the basis of Life's Essential 8 metrics. The authors estimated the prevalence of each risk factor and suboptimal cardiovascular risk profile (≥2 risk factors) and examined trends overall and by age and race/ethnicity. Using multivariable Poisson regression, the authors assessed the sociodemographic correlates of suboptimal cardiovascular risk profile.

Results

The weighted prevalence of women aged <35 years was approximately 64% in each survey year. The prevalence of suboptimal cardiovascular risk profile increased modestly from 72.4% (71.6%–73.3%) in 2015 to 75.9% (75.0%–76.7%) in 2019 (p<0.001). This increase was mainly driven by increases in overweight/obesity (53.1%–58.4%; p<0.001). Between 2015 and 2019, significant increases in suboptimal cardiovascular risk profile were observed among non-Hispanic White (69.8%–72.6%; p<0.001) and Hispanic (75.1%–80.3%; p<0.001) women but not among non-Hispanic Black (82.7%–83.7%; p=0.48) or Asian (68.1%–73.2%; p=0.09) women. Older age, rural residence, and non-Hispanic Black and Hispanic race and ethnicity were associated with a higher prevalence of suboptimal cardiovascular risk profile.

Conclusions

There has been a modest but significant increase in suboptimal cardiovascular risk profile among U.S. women of reproductive age. Urgent preventive efforts are needed to reverse this trend and improve cardiovascular health, particularly among subgroups at increased risk, to mitigate its implications.

导言心血管健康状况不佳与不良妊娠结局和长期心血管风险有关。作者利用行为风险因素监测系统（2015-2020 年）中 335 959 名妇女的数据，对无心血管疾病的非怀孕育龄妇女（18-44 岁）进行了连续横断面分析，这些妇女自我报告了根据 "生命必备 8 项指标 "选出的 8 个心血管风险因素的信息。作者估算了每个风险因素和次优心血管风险状况（≥2 个风险因素）的患病率，并研究了总体趋势以及不同年龄和种族/族裔的趋势。作者使用多变量泊松回归评估了次优心血管风险状况的社会人口学相关因素。结果在每个调查年，35 岁女性的加权患病率约为 64%。次优心血管风险状况的患病率从 2015 年的 72.4%（71.6%-73.3%）小幅上升至 2019 年的 75.9%（75.0%-76.7%）（p<0.001）。这一增长主要是由超重/肥胖（53.1%-58.4%；p<0.001）的增加所驱动的。从 2015 年到 2019 年，在非西班牙裔白人（69.8%-72.6%；p<0.001）和西班牙裔（75.1%-80.3%；p<0.001）妇女中观察到心血管风险状况不达标的人数显著增加，但在非西班牙裔黑人（82.7%-83.7%；p=0.48）或亚裔（68.1%-73.2%；p=0.09）妇女中没有观察到这一现象。年龄较大、居住在农村以及非西班牙裔黑人和西班牙裔种族和民族与心血管风险状况不达标的发生率较高有关。需要采取紧急预防措施来扭转这一趋势，改善心血管健康，尤其是在风险增加的亚群体中，以减轻其影响。

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引用次数: 0

How Do Anger and Impulsivity Impact Fast-Food Consumption in Transitional Age Youth? 愤怒和冲动如何影响过渡年龄青少年的快餐消费？

AJPM focus

Pub Date : 2024-02-22 DOI: 10.1016/j.focus.2024.100208

Alejandro D. Meruelo MD, PhD , Ty Brumback PhD , William E. Pelham III PhD , Natasha E. Wade PhD , Michael L. Thomas PhD , Emil F. Coccaro MD , Kate B. Nooner PhD , Sandra A. Brown PhD , Susan F. Tapert PhD , Sylvie Mrug PhD

Introduction

Consumption of fast food has been linked to psychiatric distress, violent behaviors, and impulsivity in adolescents. The relationship between eating fast food, anger, and impulsivity has not been widely investigated. The National Consortium on Alcohol and Neurodevelopment in Adolescence community-based cohort consists of 831 youth, half at elevated risk factors for substance use disorders during adolescence, followed annually.

Methods

Impulsivity using Urgency, Premeditation, Perseverance, and Sensation Seeking Impulsive Behavior scale from annual assessments was examined in relation to self-reported fast-food consumption frequency and mobile application questions of anger. This study tested the hypotheses that youth anger may be predicted by fast-food consumption frequency and impulsivity using multiple regression, in addition to whether adolescent fast-food consumption frequency may be predicted by anger and impulsivity.

Results

Among youth, higher anger levels and impulsivity predicted greater frequency of fast-food consumption, and greater fast-food consumption frequency and impulsivity predicted higher anger levels.

Conclusions

This study's longitudinal findings are consistent with those of other studies that have found fast-food consumption and anger associated with impulsivity and also reveal a bidirectional link between anger and fast-food consumption. These results may point attention to food selection considerations for those at risk of anger and poorer psychiatric outcomes.

导言食用快餐与青少年的精神压力、暴力行为和冲动有关。关于吃快餐、愤怒和冲动之间的关系还没有进行广泛的调查。全国青少年酒精和神经发育联合会的社区队列由 831 名青少年组成，其中一半青少年在青春期有药物使用障碍的高危因素，他们每年都会接受跟踪调查。研究方法：使用年度评估中的 "紧迫性"、"预谋性"、"毅力 "和 "寻求感觉的冲动行为 "量表对冲动性与自我报告的快餐消费频率和手机应用中的 "愤怒 "问题之间的关系进行研究。本研究采用多元回归法检验了青少年的愤怒情绪可能受快餐消费频率和冲动行为预测的假设，以及青少年的快餐消费频率是否可能受愤怒情绪和冲动行为预测的假设。结果在青少年中，较高的愤怒水平和冲动性预示着较高的快餐消费频率，而较高的快餐消费频率和冲动性预示着较高的愤怒水平。结论本研究的纵向发现与其他发现快餐消费和愤怒与冲动性相关的研究结果一致，也揭示了愤怒与快餐消费之间的双向联系。这些结果可能会提醒人们在选择食物时注意那些有可能导致愤怒和较差精神状况的人群。

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引用次数: 0

Associations of Historical Redlining With BMI and Waist Circumference in Coronary Artery Risk Development in Young Adults 历史上的赤贫与年轻人冠状动脉风险发展中的体重指数和腰围的关系

AJPM focus

Pub Date : 2024-02-22 DOI: 10.1016/j.focus.2024.100209

Andrea S. Richardson MPH, PhD , Tamara Dubowitz ScD , Kirsten M.M. Beyer PhD , Yuhong Zhou PhD , Kiarri N. Kershaw PhD , Waverly Duck PhD , Feifei Ye PhD , Robin Beckman MPH , Penny Gordon-Larsen PhD , James M. Shikany DrPH , Catarina Kiefe MD, PhD

Introduction

Historical maps of racialized evaluation of mortgage lending risk (i.e., redlined neighborhoods) have been linked to adverse health outcomes. Little research has examined whether living in historically redlined neighborhoods is associated with obesity, differentially by race or gender.

Methods

This is a cross-sectional study to examine whether living in historically redlined neighborhoods is associated with BMI and waist circumference among Black and White adults in 1985–1986. Participants’ addresses were linked to the 1930s Home Owners’ Loan Corporation maps that evaluated mortgage lending risk across neighborhoods. The authors used multilevel linear regression models clustered on Census tract, adjusted for confounders to estimate main effects, and stratified, and interaction models by (1) race, (2) gender, and (3) race by gender with redlining differentially for Black versus White adults and men versus women. To better understand strata differences, they compared Census tract–level median household income across race and gender groups within Home Owners’ Loan Corporation grade.

Results

Black adults (n=2,103) were more likely than White adults (n=1,767) to live in historically rated hazardous areas and to have higher BMI and waist circumference. Redlining and race and redlining and gender interactions for BMI and waist circumference were statistically significant (p<0.10). However, in stratified analyses, the only statistically significant associations were among White participants. White participants living in historically rated hazardous areas had lower BMI ( $β = - 0.63$ [95% CI= −1.11, −0.15]) and lower waist circumference ( $β = - 1.50$ [95% CI= −2.62, −0.38]) than those living in declining areas. Within each Home Owners’ Loan Corporation grade, residents in White participants’ neighborhoods had higher incomes than those living in Black participants’ neighborhoods (p<0.0001). The difference was largest within historically redlined areas. Covariate associations differed for men, women, Black, and White adults, explaining the difference between the interaction and the stratified models. Race by redlining interaction did not vary by gender.

Conclusions

White adults may have benefitted from historical redlining, which may have reinforced neighborhood processes that generated racial inequality in BMI and waist circumference 50 years later.

导言历史上抵押贷款风险的种族化评估图（即红线社区）与不良健康结果有关。本研究是一项横断面研究，旨在调查 1985-1986 年黑人和白人成年人的体重指数和腰围是否与居住在历史上被划定为红线的社区有关。参与者的地址与 20 世纪 30 年代房屋所有者贷款公司（Home Owners' Loan Corporation）的地图相连，该地图评估了各社区的抵押贷款风险。作者使用多层次线性回归模型对人口普查区进行聚类，并对混杂因素进行调整，以估计主效应，并按(1)种族、(2)性别和(3)种族与性别进行分层和交互模型，对黑人和白人成年人以及男性和女性进行红线区分。为了更好地理解分层差异，他们比较了房屋所有者贷款公司分级中不同种族和性别群体的人口普查区家庭收入中位数。结果黑人成年人（人数=2103）比白人成年人（人数=1767）更有可能居住在历史上被评为危险的地区，其体重指数和腰围也更高。在体重指数和腰围方面，红线与种族以及红线与性别之间的交互作用具有统计学意义（p<0.10）。然而，在分层分析中，唯一具有统计学意义的关联是在白人参与者中。居住在历史危险地区的白人参与者的体重指数（β=-0.63 [95% CI= -1.11, -0.15]）和腰围（β=-1.50 [95% CI= -2.62, -0.38]）均低于居住在衰退地区的白人参与者。在房屋所有者贷款公司的各个等级中，白人参与者所在社区的居民收入高于黑人参与者所在社区的居民（p<0.0001）。在历史上被划为红线的地区，这种差异最大。男性、女性、黑人和白人成年人的协变量关联各不相同，这解释了交互模型和分层模型之间的差异。结论白人成年人可能受益于历史上的重划区，这可能强化了50年后产生BMI和腰围种族不平等的邻里过程。

{"title":"Associations of Historical Redlining With BMI and Waist Circumference in Coronary Artery Risk Development in Young Adults","authors":"Andrea S. Richardson MPH, PhD , Tamara Dubowitz ScD , Kirsten M.M. Beyer PhD , Yuhong Zhou PhD , Kiarri N. Kershaw PhD , Waverly Duck PhD , Feifei Ye PhD , Robin Beckman MPH , Penny Gordon-Larsen PhD , James M. Shikany DrPH , Catarina Kiefe MD, PhD","doi":"10.1016/j.focus.2024.100209","DOIUrl":"https://doi.org/10.1016/j.focus.2024.100209","url":null,"abstract":"<div><h3>Introduction</h3><p>Historical maps of racialized evaluation of mortgage lending risk (i.e., redlined neighborhoods) have been linked to adverse health outcomes. Little research has examined whether living in historically redlined neighborhoods is associated with obesity, differentially by race or gender.</p></div><div><h3>Methods</h3><p>This is a cross-sectional study to examine whether living in historically redlined neighborhoods is associated with BMI and waist circumference among Black and White adults in 1985–1986. Participants’ addresses were linked to the 1930s Home Owners’ Loan Corporation maps that evaluated mortgage lending risk across neighborhoods. The authors used multilevel linear regression models clustered on Census tract, adjusted for confounders to estimate main effects, and stratified, and interaction models by (1) race, (2) gender, and (3) race by gender with redlining differentially for Black versus White adults and men versus women. To better understand strata differences, they compared Census tract–level median household income across race and gender groups within Home Owners’ Loan Corporation grade.</p></div><div><h3>Results</h3><p>Black adults (<em>n</em>=2,103) were more likely than White adults (<em>n</em>=1,767) to live in historically rated hazardous areas and to have higher BMI and waist circumference. Redlining and race and redlining and gender interactions for BMI and waist circumference were statistically significant (<em>p</em><0.10). However, in stratified analyses, the only statistically significant associations were among White participants. White participants living in historically rated hazardous areas had lower BMI (<span><math><mrow><mi>β</mi><mo>=</mo><mspace></mspace><mo>−</mo><mn>0.63</mn></mrow></math></span> [95% CI= −1.11, −0.15]) and lower waist circumference (<span><math><mrow><mi>β</mi><mo>=</mo><mspace></mspace><mo>−</mo><mn>1.50</mn></mrow></math></span> [95% CI= −2.62, −0.38]) than those living in declining areas. Within each Home Owners’ Loan Corporation grade, residents in White participants’ neighborhoods had higher incomes than those living in Black participants’ neighborhoods (<em>p</em><0.0001). The difference was largest within historically redlined areas. Covariate associations differed for men, women, Black, and White adults, explaining the difference between the interaction and the stratified models. Race by redlining interaction did not vary by gender.</p></div><div><h3>Conclusions</h3><p>White adults may have benefitted from historical redlining, which may have reinforced neighborhood processes that generated racial inequality in BMI and waist circumference 50 years later.</p></div>","PeriodicalId":72142,"journal":{"name":"AJPM focus","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773065424000282/pdfft?md5=be95d748e307f831c668eab49da4242b&pid=1-s2.0-S2773065424000282-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140341567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Examining the Association Between Social Needs and Care Gap Closure Among Older Adults Receiving Dental Care 研究接受牙科护理的老年人的社会需求与护理差距缩小之间的关系

AJPM focus

Pub Date : 2024-02-22 DOI: 10.1016/j.focus.2024.100212

David M. Mosen PhD, MPH , Matthew P. Banegas PhD, MPH , Daniel J. Pihlstrom DDS , Erin M. Keast MPH , John F. Dickerson PhD , Jeffrey L. Fellows PhD

Introduction

The authors of this study sought to (1) describe the prevalence of social needs and (2) determine whether social needs were associated with closure of care gaps among patients aged ≥65 years seeking dental care.

Methods

In this retrospective cross-sectional study, the authors identified 754 Kaiser Permanente Northwest patients aged ≥65 years who completed an index dental visit; had at least 1 of 23 preventive care gaps (e.g., flu vaccination) or disease management care gaps (e.g., diabetes HbA1c screening test) documented in their medical record; and had completed a social needs assessment through survey evaluating financial strain, food insecurity, housing needs, social isolation, and transportation needs. The authors described the prevalence of social needs at the index visit and then used logistic regression to evaluate the association between the number of social needs (0, 1, ≥2) and closure of all care gaps over the following 60 days (yes versus no), adjusting for patient characteristics. Identification and closure of care gap were assessed through Kaiser Permanente Northwest's Panel Support Tool.

Results

Approximately 28% of patients reported ≥1 social needs. The prevalence of social needs was as follows: social isolation, 13.7%; financial strain, 11.3%; food insecurity, 7.7%; transportation needs, 5.4%; and housing needs, 3.3%. Those with 1 social need were more likely to close care gaps than those with no social needs (OR=1.82, 95% CI=1.17, 2.85). No significant association was found with care gap closure among those with ≥2 versus zero social needs.

Conclusions

The prevalence of social needs was nearly 30% among patients aged ≥65 years with dental and medical coverage. Patients with 1 social need were more likely than those with no social needs to close all care gaps after their visit.

方法在这项回顾性横断面研究中，作者确定了 754 名年龄≥65 岁的 Kaiser Permanente Northwest 患者，这些患者完成了一次牙科就诊；医疗记录中记录了 23 项预防性护理缺口（如流感疫苗接种）或疾病管理护理缺口（如糖尿病 HbA1c 筛查测试）中的至少一项；并通过调查完成了社会需求评估，评估内容包括经济压力、食品安全、社会需求和健康状况、流感疫苗接种）或疾病管理护理缺口（如糖尿病 HbA1c 筛查测试）；并通过调查完成了社会需求评估，评估内容包括经济压力、食品不安全、住房需求、社会隔离和交通需求。作者描述了指标就诊时社会需求的普遍性，然后使用逻辑回归评估了社会需求数量（0、1、≥2）与随后 60 天内所有护理差距的缩小（是与否）之间的关联，并对患者特征进行了调整。结果约 28% 的患者报告的社会需求≥1。社会需求的发生率如下：社会孤立，13.7%；经济压力，11.3%；食品不安全，7.7%；交通需求，5.4%；住房需求，3.3%。与没有社会需求的人相比，有一种社会需求的人更有可能缩小护理差距（OR=1.82，95% CI=1.17，2.85）。在牙科和医疗保险范围内，年龄≥65 岁的患者中社会需求的发生率接近 30%。有一项社会需求的患者比没有社会需求的患者更有可能在就诊后弥补所有护理缺口。

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引用次数: 0

Children's Perception of Food Marketing Across Digital Media Platforms 儿童对数字媒体平台食品营销的看法。

AJPM focus

Pub Date : 2024-02-11 DOI: 10.1016/j.focus.2024.100205

Jennifer E. Carroll PhD , Jennifer A. Emond PhD , Linda L. Griffin PhD , Elizabeth R. Bertone-Johnson ScD , Nicole A. VanKim PhD , Susan R. Sturgeon DrPH

Introduction

Exposure to food marketing increases the risk of poor diet. Children's perception and interpretation of food marketing across digital media platforms is understudied. Children aged 9–11 years are uniquely susceptible to food marketing because children may watch content alone, and it is unclear whether embedded ads are decipherable by children (e.g., social media influencers) and if children are receptive to advertisements.

Methods

The authors collected data from 21 child–parent dyads in 2022 to fill this gap. Children were interviewed about their food marketing exposure and media use and were asked to share their perspectives on food advertisements. Parents completed a survey for household digital devices, demographics, and perception of their child's food advertising knowledge.

Results

This study found that all children generally recognized direct food advertisements, could describe them with varying levels of confidence, and shared examples. Despite self-identifying ads and understanding the intent of advertising, many children are still receptive to advertisements on the basis of engaging content (e.g., liking the ads as entertainment, watching ads even when given the chance to skip the ad) and the food items marketed (e.g., liking the taste of foods).

Conclusions

These findings suggest that knowledge of advertisement exposure and intent of advertising are not sufficient to reduce receptiveness of unhealthy food ad exposure. Additional research on the potential impacts of embedded ads, such as through social media influencers, is needed to understand children's interaction with the current digital media landscape.

导言接触食品营销会增加不良饮食的风险。儿童对数字媒体平台上食品营销的感知和解读研究不足。9-11岁的儿童特别容易受到食品营销的影响，因为儿童可能会独自观看内容，而且目前还不清楚儿童是否能解读嵌入式广告（如社交媒体的影响者），也不清楚儿童是否能接受广告。他们就儿童接触食品营销和使用媒体的情况进行了访谈，并要求儿童分享他们对食品广告的看法。结果这项研究发现，所有儿童都能普遍辨认出直接的食品广告，并能以不同程度的自信描述这些广告，还能分享广告实例。尽管能自我识别广告并理解广告的意图，但许多儿童仍会因广告内容吸引人（如喜欢将广告作为娱乐，即使有机会跳过广告也会观看）和广告推销的食品（如喜欢食品的味道）而接受广告。要了解儿童与当前数字媒体环境的互动，还需要对嵌入式广告（如通过社交媒体影响者）的潜在影响进行更多研究。

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引用次数: 0

Cohort Study of Downgraded Misdemeanor Convictions and Subsequent Violent Crime: Differences by Defendant Race and Ethnicity 关于降级轻罪定罪和后续暴力犯罪的队列研究：被告种族和民族的差异

AJPM focus

Pub Date : 2024-02-11 DOI: 10.1016/j.focus.2024.100206

Julia P. Schleimer MPH , Miriam J. Haviland PhD, MSPH , Amy Gallagher MPH , Ayah Mustafa BS , Rachel Ross MPH , Garen Wintemute MD, MPH , Deirdre Bowen JD, PhD , Ali Rowhani-Rahbar MD, PhD, MPH

Introduction

Criminal convictions may be imperfect markers of criminalized behavior, in part because of criminal legal system processes (e.g., plea bargaining). In this retrospective cohort study of individuals convicted of misdemeanors, authors compared the risk of subsequent criminal charges for a violent crime among those initially charged with a felony with that among those initially charged with only misdemeanors, overall and by defendant race and ethnicity.

Methods

The study population included individuals aged ≥18 years who were convicted of a misdemeanor in Washington Superior Courts from January 1, 2015 to December 31, 2019. Those with and without initial felony charges were age/gender matched in a 4:1 ratio. The primary outcome was the first subsequent violent crime charge in Washington Superior Courts through December 31, 2020. Data were analyzed with Fine–Gray hazard models from June 2022 to November 2023.

Results

There were 3,841 individuals with initial felony charges and 956 with initial misdemeanor charges only. Median follow-up was 2.4 years for both groups. During follow-up, there were 166 new violent crime charges. In multivariable models, White defendants with initial felony charges had a greater risk of subsequent violent crime charges (subdistribution hazard ratio=2.58; 95% CI=1.24, 5.36) than White defendants with initial misdemeanor charges only. Among Black and Hispanic/Latinx defendants, initial felony versus misdemeanor charges were not associated with subsequent violent crime charges (subdistribution hazard ratio=0.93; 95% CI=0.44, 1.97 among Black defendants; subdistribution hazard ratio=0.49; 95% CI=0.15, 1.57 among Hispanic/Latinx defendants).

Conclusions

Findings suggest differential associations between downgrading of felony charges to misdemeanor convictions and future violent crime charges by defendant race and ethnicity, with implications for inequitable collateral consequences of criminal convictions.

导言：刑事定罪可能是刑事犯罪行为的不完美标志，部分原因在于刑事法律系统程序（如辩诉交易）。在这项针对因轻罪被定罪者的回顾性队列研究中，作者比较了最初被控重罪者与最初仅被控轻罪者因暴力犯罪而受到后续刑事指控的风险，包括总体风险以及被告种族和民族风险。有和没有初次重罪指控的人按 4:1 的比例进行年龄/性别匹配。主要结果是到 2020 年 12 月 31 日在华盛顿州高级法院的首次后续暴力犯罪指控。采用 Fine-Gray 危险模型对 2022 年 6 月至 2023 年 11 月期间的数据进行了分析。结果有 3841 人受到初次重罪指控，956 人仅受到初次轻罪指控。两组的随访时间中位数均为 2.4 年。在跟踪期间，共有 166 项新的暴力犯罪指控。在多变量模型中，初次受到重罪指控的白人被告随后受到暴力犯罪指控的风险（子分布危险比=2.58；95% CI=1.24，5.36）高于初次仅受到轻罪指控的白人被告。在黑人和西班牙裔/拉丁裔被告中，最初的重罪指控与轻罪指控与随后的暴力犯罪指控无关（在黑人被告中，次分布危险比=0.93；95% CI=0.44，1.97；在西班牙裔/拉丁裔被告中，次分布危险比=0.49；95% CI=0.15，1.57）。结论研究结果表明，根据被告的种族和族裔，重罪指控降级为轻罪定罪与未来暴力犯罪指控之间存在不同的关联，这对刑事定罪的不公平附带后果具有影响。

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引用次数: 0