Showing papers in "American Journal of Public Health in 2011"

Health disparities and health equity: the issue is justice

Abstract: Eliminating health disparities is a Healthy People goal. Given the diverse and sometimes broad definitions of health disparities commonly used, a subcommittee convened by the Secretary's Advisory Committee for Healthy People 2020 proposed an operational definition for use in developing objectives and targets, determining resource allocation priorities, and assessing progress. Based on that subcommittee's work, we propose that health disparities are systematic, plausibly avoidable health differences adversely affecting socially disadvantaged groups; they may reflect social disadvantage, but causality need not be established. This definition, grounded in ethical and human rights principles, focuses on the subset of health differences reflecting social injustice, distinguishing health disparities from other health differences also warranting concerted attention, and from health differences in general. We explain the definition, its underlying concepts, the challenges it addresses, and the rationale for applying it to United States public health policy.

A Meta-Analysis of Disparities in Childhood Sexual Abuse, Parental Physical Abuse, and Peer Victimization Among Sexual Minority and Sexual Nonminority Individuals

Abstract: Objectives. We compared the likelihood of childhood sexual abuse (under age 18), parental physical abuse, and peer victimization based on sexual orientation.Methods. We conducted a meta-analysis of adolescent school-based studies that compared the likelihood of childhood abuse among sexual minorities vs sexual nonminorities.Results. Sexual minority individuals were on average 3.8, 1.2, 1.7, and 2.4 times more likely to experience sexual abuse, parental physical abuse, or assault at school or to miss school through fear, respectively. Moderation analysis showed that disparities between sexual minority and sexual nonminority individuals were larger for (1) males than females for sexual abuse, (2) females than males for assault at school, and (3) bisexual than gay and lesbian for both parental physical abuse and missing school through fear. Disparities did not change between the 1990s and the 2000s.Conclusions. The higher rates of abuse experienced by sexual minority youths may be one of the driving mechanis...

An Agenda for Research on the Sustainability of Public Health Programs

Abstract: Funders of programs in public health and community health are increasingly concerned about the sustainability of changes they initiate. Despite a recent increase in sustainability research and evaluation, this literature has not developed a widely used paradigm for conducting research that can accumulate into generalizable findings. We provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection. We suggest viewing sustainability research as a further stage in the translation or dissemination of research-based interventions into practice. This perspective emphasizes ongoing relationships with earlier stages of a broader diffusion framework, including adoption and implementation processes.

Estimated deaths attributable to social factors in the United States

Abstract: Objectives. We estimated the number of deaths attributable to social factors in the United States. Methods. We conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. We calculated summary relative risk estimates of mortality, and we obtained and used prevalence estimates for each social factor to calculate the population-attributable fraction for each factor. We then calculated the number of deaths attributable to each social factor in the United States in 2000. Results. Approximately 245000 deaths in the United States in 2000 were attributable to low education, 176000 to racial segregation, 162000 to low social support, 133000 to individual-level poverty, 119000 to income inequality, and 39000 to area-level poverty. Conclusions. The estimated number of deaths attributable to social factors in the United States is comparable to the number attributed to pathophysiological and behavioral causes. These findings argue for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations. (Am J Public Health. Published online ahead of print June 16, 2011:e1-e10. doi:10.2105/AJPH.2010.300086).

Impact of Poor Oral Health on Children's School Attendance and Performance

Abstract: Objectives. We examined school days missed for routine dental care versus dental pain or infection to determine the relationship between children's oral health status and school attendance and performance.Methods. We used 2008 data from the North Carolina Child Health Assessment and Monitoring Program. The study sample, weighted to reflect the state's population, included 2183 schoolchildren. Variables assessed included school absences and performance, oral health status, parental education, health insurance coverage, race, and gender.Results. Children with poor oral health status were nearly 3 times more likely (odds ratio = 3.89; 95% confidence interval = 1.96, 7.75) than were their counterparts to miss school as a result of dental pain. Absences caused by pain were associated with poorer school performance (P < .05), but absences for routine care were not. Mediation analyses revealed that oral health status was associated with performance independent of absence for pain.Conclusions. Children with poore...

The Social Determinants of Tuberculosis: From Evidence to Action

Abstract: Growing consensus indicates that progress in tuberculosis control in the low- and middle-income world will require not only investment in strengthening tuberculosis control programs, diagnostics, and treatment but also action on the social determinants of tuberculosis. However, practical ideas for action are scarcer than is notional support for this idea. We developed a framework based on the recent World Health Organization Commission on Social Determinants of Health and on current understanding of the social determinants of tuberculosis. Interventions from outside the health sector—specifically, in social protection and urban planning—have the potential to strengthen tuberculosis control.

Interventions to increase physical activity among healthy adults: meta-analysis of outcomes.

Abstract: Objectives. We conducted a meta-analysis summarizing the effects of interventions designed to increase physical activity among healthy adults.Methods. Our comprehensive searches located 358 reports eligible for inclusion. We used random-effects analyses to synthesize data, and we used meta-analytic analogues of regression and analysis of variance to examine potential moderator variables. We also explored moderator variable robustness and publication bias.Results. We computed meta-analytic results from studies comprising 99 011 participants. The overall mean effect size for comparisons of treatment groups versus control groups was 0.19 (higher mean for treatment participants than for control participants). This effect size is consistent with a mean difference of 496 ambulatory steps per day between treatment and control participants. Exploratory moderator analyses suggested that the characteristics of the most effective interventions were behavioral interventions instead of cognitive interventions, face-to...

A Nationwide Analysis of US Racial/Ethnic Disparities in Smoking Behaviors, Smoking Cessation, and Cessation-Related Factors

Abstract: Objectives. We used nationally representative data to examine racial/ethnic disparities in smoking behaviors, smoking cessation, and factors associated with cessation among US adults. Methods. We analyzed data on adults aged 20 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey, and we examined associations by fitting adjusted logistic regression models to the data. Results. Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement therapy. Conclusions. Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers.

Social Support, Exposure to Violence and Transphobia, and Correlates of Depression Among Male-to-Female Transgender Women With a History of Sex Work

Abstract: Objectives. We determined racial/ethnic differences in social support and exposure to violence and transphobia, and explored correlates of depression among male-to-female transgender women with a history of sex work (THSW).Methods. A total of 573 THSW who worked or resided in San Francisco or Oakland, California, were recruited through street outreach and referrals and completed individual interviews using a structured questionnaire.Results. More than half of Latina and White participants were depressed on the basis of Center For Epidemiologic Studies Depression Scale scores. About three quarters of White participants reported ever having suicidal ideation, of whom 64% reported suicide attempts. Half of the participants reported being physically assaulted, and 38% reported being raped or sexually assaulted before age 18 years. White and African American participants reported transphobia experiences more frequently than did others. Social support, transphobia, suicidal ideation, and levels of income and ed...

Mental Health Promotion in Public Health: Perspectives and Strategies From Positive Psychology

Abstract: Positive psychology is the study of what is “right” about people—their positive attributes, psychological assets, and strengths. Its aim is to understand and foster the factors that allow individuals, communities, and societies to thrive.Cross-sectional, experimental, and longitudinal research demonstrates that positive emotions are associated with numerous benefits related to health, work, family, and economic status. Growing biomedical research supports the view that positive emotions are not merely the opposite of negative emotions but may be independent dimensions of mental affect.The asset-based paradigms of positive psychology offer new approaches for bolstering psychological resilience and promoting mental health. Ultimately, greater synergy between positive psychology and public health might help promote mental health in innovative ways.

Advancing the science of community-level interventions.

Abstract: Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science.

Complex Systems Thinking and Current Impasses in Health Disparities Research

Abstract: Complex systems approaches have received increasing attention in public health because reductionist approaches yield limited insights in the context of dynamic systems. Most discussions have been highly abstract. There is a need to consider the application of complex systems approaches to specific research questions. I review the features of population health problems for which complex systems approaches are most likely to yield new insights, and discuss possible applications of complex systems to health disparities research. I provide illustrative examples of how complex systems approaches may help address unanswered and persistent questions regarding genetic factors, life course processes, place effects, and the impact of upstream policies. The concepts and methods of complex systems may help researchers move beyond current impasse points in health disparities research.

Effectiveness of a Community Health Worker Intervention Among African American and Latino Adults With Type 2 Diabetes: A Randomized Controlled Trial

Abstract: Objectives. We tested the effectiveness of a culturally tailored, behavioral theory-based community health worker intervention for improving glycemic control. Methods. We used a randomized, 6-month delayed control group design among 164 African American and Latino adult participants recruited from 2 health systems in Detroit, Michigan. Our study was guided by the principles of community-based participatory research. Hemoglobin A1c (HbA1c) level was the primary outcome measure. Using an empowerment-based approach, community health workers provided participants with diabetes self-management education and regular home visits, and accompanied them to a clinic visit during the 6-month intervention period. Results. Participants in the intervention group had a mean HbA1c value of 8.6% at baseline, which improved to a value of 7.8% at 6 months, for an adjusted change of -0.8 percentage points (P<.01). There was no change in mean HbA1c among the control group (8.5%). Intervention participants also had significantly greater improvements in self-reported diabetes understanding compared with the control group. Conclusions. This study contributes to the growing evidence for the effectiveness of community health workers and their role in multidisciplinary teams engaged in culturally appropriate health care delivery. (Am J Public Health. Published online ahead of print June 16, 2011: e1-e8. doi:10.2105/AJPH.2010.300106).

Facilitating HIV Disclosure Across Diverse Settings: A Review

Abstract: HIV status disclosure is central to debates about HIV because of its potential for HIV prevention and its links to privacy and confidentiality as human-rights issues. Our review of the HIV-disclosure literature found that few people keep their status completely secret; disclosure tends to be iterative and to be higher in high-income countries; gender shapes disclosure motivations and reactions; involuntary disclosure and low levels of partner disclosure highlight the difficulties faced by health workers; the meaning and process of disclosure differ across settings; stigmatization increases fears of disclosure; and the ethical dilemmas resulting from competing values concerning confidentiality influence the extent to which disclosure can be facilitated. Our results suggest that structural changes, including making more services available, could facilitate HIV disclosure as much as individual approaches and counseling do.

Estimates and Determinants of Sexual Violence Against Women in the Democratic Republic of Congo

Abstract: Objectives. We sought to provide data-based estimates of sexual violence in the Democratic Republic of Congo (DRC) and describe risk factors for such violence.Methods. We used nationally representative household survey data from 3436 women selected to answer the domestic violence module who took part in the 2007 DRC Demographic and Health Survey along with population estimates to estimate levels of sexual violence. We used multivariate logistic regression to analyze correlates of sexual violence.Results. Approximately 1.69 to 1.80 million women reported having been raped in their lifetime (with 407 397–433 785 women reporting having been raped in the preceding 12 months), and approximately 3.07 to 3.37 million women reported experiencing intimate partner sexual violence. Reports of sexual violence were largely independent of individual-level background factors. However, compared with women in Kinshasa, women in Nord-Kivu were significantly more likely to report all types of sexual violence.Conclusions. No...

The influence of social involvement, neighborhood aesthetics, and community garden participation on fruit and vegetable consumption.

Abstract: Objectives. We considered the relationship between an urban adult population's fruit and vegetable consumption and several selected social and psychological processes, beneficial aesthetic experiences, and garden participation. Methods. We conducted a population-based survey representing 436 residents across 58 block groups in Denver, Colorado, from 2006 to 2007. We used multilevel statistical models to evaluate the survey data. Results. Neighborhood aesthetics, social involvement, and community garden participation were significantly associated with fruit and vegetable intake. Community gardeners consumed fruits and vegetables 5.7 times per day, compared with home gardeners (4.6 times per day) and nongardeners (3.9 times per day). Moreover, 56% of community gardeners met national recommendations to consume fruits and vegetables at least 5 times per day, compared with 37% of home gardeners and 25% of nongardeners. Conclusions. Our study results shed light on neighborhood processes that affect food-related behaviors and provides insights about the potential of community gardens to affect these behaviors. The qualities intrinsic to community gardens make them a unique intervention that can narrow the divide between people and the places where food is grown and increase local opportunities to eat better. (Am J Public Health. Published online ahead of print June 16, 2011: e1-e8. doi:10.2105/AJPH.2010.300111).

US Housing Insecurity and the Health of Very Young Children

Abstract: Objectives. We investigated the association between housing insecurity and the health of very young children.Methods. Between 1998 and 2007, we interviewed 22 069 low-income caregivers with children younger than 3 years who were seen in 7 US urban medical centers. We assessed food insecurity, child health status, developmental risk, weight, and housing insecurity for each child's household. Our indicators for housing insecurity were crowding (> 2 people/bedroom or > 1 family/residence) and multiple moves (≥ 2 moves within the previous year).Results. After adjusting for covariates, crowding was associated with household food insecurity compared with the securely housed (adjusted odds ratio [AOR] = 1.30; 95% confidence interval [CI] = 1.18, 1.43), as were multiple moves (AOR = 1.91; 95% CI = 1.59, 2.28). Crowding was also associated with child food insecurity (AOR = 1.47; 95% CI = 1.34, 1.63), and so were multiple moves (AOR = 2.56; 95% CI = 2.13, 3.08). Multiple moves were associated with fair or poor chil...

Walking and Cycling in the United States, 2001–2009: Evidence From the National Household Travel Surveys

Abstract: Objectives. To assess changes in walking and cycling in the United States between 2001 and 2009.Methods. The 2001 and 2009 National Household Travel Surveys were used to compute the frequency, duration, and distance of walking and cycling per capita. The population-weighted person and trip files were merged to calculate the prevalence of any walking and cycling and of walking and cycling at least 30 minutes per day.Results. The average American made 17 more walk trips in 2009 than in 2001, covering 9 more miles per year, compared with only 2 more bike trips, and 5 more miles cycling. At the population level, the prevalence of “any walking” remained unchanged (about 18%), whereas walking at least 30 minutes per day increased from 7.2% to 8.0%. The prevalence of “any cycling” and cycling 30 minutes per day remained unchanged (1.7% and 0.9%, respectively). Active travel declined for women, children, and seniors, but increased among men, the middle aged, employed, well-educated, and persons without a car.Conc...

Encouraging contraceptive uptake by motivating men to communicate about family planning: the Malawi Male Motivator project.

Abstract: Objectives. We examined the effect of a peer-delivered educational intervention, the Malawi Male Motivator intervention, on couples’ contraceptive uptake. We based the intervention design on the information–motivation–behavioral skills (IMB) model.Methods. In 2008 we recruited 400 men from Malawi's Mangochi province who reported not using any method of contraception. We randomized them into an intervention arm and a control arm, and administered surveys on contraceptive use at baseline and after the intervention. We also conducted in-depth interviews with a subset of intervention participants.Results. After the intervention, contraceptive use increased significantly within both arms (P < .01), and this increase was significantly greater in the intervention arm than it was in the control arm (P < .01). Quantitative and qualitative data indicated that increased ease and frequency of communication within couples were the only significant predictors of uptake (P < .01).Conclusions. Our findings indicate that ...

Racial disparities in exposure, susceptibility, and access to health care in the US H1N1 influenza pandemic.

Abstract: Objectives. We conducted the first empirical examination of disparities in H1N1 exposure, susceptibility to H1N1 complications, and access to health care during the H1N1 influenza pandemic. Methods. We conducted a nationally representative survey among a sample drawn from more than 60 000 US households. We analyzed responses from 1479 adults, including significant numbers of Blacks and Hispanics. The survey asked respondents about their ability to impose social distance in response to public health recommendations, their chronic health conditions, and their access to health care. Results. Risk of exposure to H1N1 was significantly related to race and ethnicity. Spanish-speaking Hispanics were at greatest risk of exposure but were less susceptible to complications from H1N1. Disparities in access to health care remained significant for Spanish-speaking Hispanics after controlling for other demographic factors. We used measures based on prevalence of chronic conditions to determine that Blacks were the most susceptible to complications from H1N1. Conclusions. We found significant race/ethnicity-related disparities in potential risk from H1N1 flu. Disparities in the risks of exposure, susceptibility (particularly to severe disease), and access to health care may interact to exacerbate existing health inequalities and contribute to increased morbidity and mortality in these populations.

Challenging Assumptions About Minority Participation in US Clinical Research

Abstract: Although extensive research addresses minorities' low participation in clinical research, most focuses almost exclusively on therapeutic trials The existing literature might mask important issues concerning minorities' participation in clinical trials, and minorities might actually be overrepresented in phase I safety studies that require the participation of healthy volunteers It is critical to consider the entire spectrum of clinical research when discussing the participation of disenfranchised groups; the literature on minorities' distrust, poor access, and other barriers to trial participation needs reexamination Minority participation in clinical trials is an important topic in public health discussions because this representation touches on issues of equality and the elimination of disparities, which are core values of the field

Low-Risk Lifestyle Behaviors and All-Cause Mortality: Findings From the National Health and Nutrition Examination Survey III Mortality Study

Abstract: Objectives. We examined the relationship between 4 low-risk behaviors—never smoked, healthy diet, adequate physical activity, and moderate alcohol consumption—and mortality in a representative sample of people in the United States.Methods. We used data from 16958 participants aged 17 years and older in the National Health and Nutrition Examination Survey III Mortality Study from 1988 to 2006.Results. The number of low-risk behaviors was inversely related to the risk for mortality. Compared with participants who had no low-risk behaviors, those who had all 4 experienced reduced all-cause mortality (adjusted hazard ratio [AHR]=0.37; 95% confidence interval [CI]=0.28, 0.49), mortality from malignant neoplasms (AHR=0.34; 95% CI=0.20, 0.56), major cardiovascular disease (AHR=0.35; 95% CI=0.24, 0.50), and other causes (AHR=0.43; 95% CI=0.25, 0.74). The rate advancement periods, representing the equivalent risk from a certain number of years of chronological age, for participants who had all 4 high-risk behavior...

Social network concordance in food choice among spouses, friends, and siblings.

Abstract: Objectives. We investigated whether eating behaviors were concordant among diverse sets of social ties.Methods. We analyzed the socioeconomic and demographic distribution of eating among 3418 members of the Framingham Heart Study observed from 1991 to 2001. We used a data-classification procedure to simplify choices into 7 nonoverlapping patterns that we matched with information on social network ties. We used correlation analysis to examine eating associations among 4 types of peers (spouses, friends, brothers, and sisters). Longitudinal multiple logistic regression was used to evaluate evidence for peer influences on eating.Results. Of all peer types, spouses showed the strongest concordances in eating patterns over time after adjustment for social contextual factors. Across all peers, the eating pattern most likely to be shared by socially connected individuals was “alcohol and snacks.” Models estimating one's current eating pattern on the basis of a peer's prior eating provided supportive evidence of ...

Community Health Workers Can Be a Public Health Force for Change in the United States: Three Actions for a New Paradigm

Abstract: Community health workers (CHWs) have gained increased visibility in the United States. We discuss how to strengthen the roles of CHWs to enable them to become collaborative leaders in dramatically changing health care from “sickness care” systems to systems that provide comprehensive care for individuals and families and supports community and tribal wellness.We recommend drawing on the full spectrum of CHWs’ roles so that they can make optimal contributions to health systems and the building of community capacity for health and wellness.We also urge that CHWs be integrated into ”community health teams” as part of “medical homes” and that evaluation frameworks be improved to better measure community wellness and systems change.

High Burden of Homelessness Among Sexual-Minority Adolescents: Findings From a Representative Massachusetts High School Sample

Abstract: Objectives. We compared the prevalence of current homelessness among adolescents reporting a minority sexual orientation (lesbian/gay, bisexual, unsure, or heterosexual with same-sex sexual partners) with that among exclusively heterosexual adolescents.Methods. We combined data from the 2005 and 2007 Massachusetts Youth Risk Behavior Survey, a representative sample of public school students in grades 9 though 12 (n = 6317).Results. Approximately 25% of lesbian/gay, 15% of bisexual, and 3% of exclusively heterosexual Massachusetts public high school students were homeless. Sexual-minority males and females had an odds of reporting current homelessness that was between 4 and 13 times that of their exclusively heterosexual peers. Sexual-minority youths’ greater likelihood of being homeless was driven by their increased risk of living separately from their parents or guardians.Conclusions. Youth homelessness is linked with numerous threats such as violence, substance use, and mental health problems. Although ...

Early-Life Origins of Adult Disease: National Longitudinal Population-Based Study of the United States

Abstract: Objectives. We examined the relation between low birth weight and childhood family and neighborhood socioeconomic disadvantage and disease onset in adulthood.Methods. Using US nationally representative longitudinal data, we estimated hazard models of the onset of asthma, hypertension, diabetes, and stroke, heart attack, or heart disease. The sample contained 4387 children who were members of the Panel Study of Income Dynamics in 1968; they were followed up to 2007, when they were aged 39 to 56 years. Our research design included sibling comparisons of disease onset among siblings with different birth weights.Results. The odds ratios of having asthma, hypertension, diabetes, and stroke, heart attack, or heart disease by age 50 years for low–birth weight babies vs others were 1.64 (P < .01), 1.51 (P < .01), 2.09 (P < .01), and 2.16 (P < .01), respectively. Adult disease prevalence differed substantially by childhood socioeconomic status (SES). After accounting for childhood socioeconomic factors, we found a...

Moving Environmental Justice Indoors: Understanding Structural Influences on Residential Exposure Patterns in Low-Income Communities

Abstract: Objectives. The indoor environment has not been fully incorporated into the environmental justice dialogue. To inform strategies to reduce disparities, we developed a framework to identify the individual and place-based drivers of indoor environment quality.Methods. We reviewed empirical evidence of socioeconomic disparities in indoor exposures and key determinants of these exposures for air pollutants, lead, allergens, and semivolatile organic compounds. We also used an indoor air quality model applied to multifamily housing to illustrate how nitrogen dioxide (NO2) and fine particulate matter (PM2.5) vary as a function of factors known to be influenced by socioeconomic status.Results. Indoor concentrations of multiple pollutants are elevated in low-socioeconomic status households. Differences in these exposures are driven by the combined influences of indoor sources, outdoor sources, physical structures, and residential activity patterns. Simulation models confirmed indoor sources’ importance in determin...

The effect of tobacco outlet density and proximity on smoking cessation.

Abstract: Objectives. We examined the influence of tobacco outlet density and residential proximity to tobacco outlets on continuous smoking abstinence 6 months after a quit attempt.Methods. We used continuation ratio logit models to examine the relationships of tobacco outlet density and tobacco outlet proximity with biochemically verified continuous abstinence across weeks 1, 2, 4, and 26 after quitting among 414 adult smokers from Houston, Texas (33% non-Latino White, 34% non-Latino Black, and 33% Latino). Analyses controlled for age, race/ethnicity, partner status, education, gender, employment status, prequit smoking rate, and the number of years smoked.Results. Residential proximity to tobacco outlets, but not tobacco outlet density, provided unique information in the prediction of long-term, continuous abstinence from smoking during a specific quit attempt. Participants residing less than 250 meters (P = .01) or less than 500 meters (P = .04) from the closest tobacco outlet were less likely to be abstinent t...

Racial Discrimination, Psychological Distress, and Self-Rated Health Among US-Born and Foreign-Born Black Americans

Abstract: Objectives. We investigated associations among racial discrimination, psychological distress, and self-rated health among US-born and immigrant Black Americans.Methods. We conducted a cross-sectional analysis of a cohort of employed working-class Black Americans (193 US-born, 275 foreign-born).Results. Both US-born and foreign-born Black participants had high levels of exposure to poverty (51% and 57%, respectively) and racial discrimination (76% and 60%) and reported high levels of severe psychological distress (14% and 16% had a Kessler 6 [K6] score of 13 or greater); 17% and 7% reported fair or poor health. After controlling for relevant covariates, their risk parameters for racial discrimination (high vs no exposure) were 4.0 (95% confidence interval [CI] = 2.3, 5.6) and 3.3 (95% CI = 2.1, 4.5), respectively, for continuous K6 score; corresponding odds ratios for severe psychological distress were 6.9 (95% CI = 1.4, 35.7) and 6.8 (95% CI = 2.5, 18.3). No associations existed between racial discriminat...

Contribution of obesity to international differences in life expectancy.

Abstract: Objectives. The United States has the highest prevalence of obesity and one of the lowest life expectancies among high-income countries. We investigated the relationship between these 2 phenomena.Methods. We estimated the fraction of deaths attributable to obesity by country, age, and sex and reestimated life tables after removing these deaths. To allow for a possible secular decline in obesity risks, we employed alternative risks from a more recent period.Results. In our baseline analysis, obesity reduced US life expectancy at age 50 years in 2006 by 1.54 years (95% confidence interval [CI] = 1.37, 1.93) for women and by 1.85 years (95% CI = 1.62, 2.10) for men. Removing the effects of obesity reduced the US shortfall by 42% (95% CI = 36, 48) for women and 67% (95% CI = 57, 76) for men, relative to countries with higher life expectancies. Using more recently recorded risk data, we estimated that differences in obesity still accounted for a fifth to a third of the shortfall.Conclusions. The high prevalenc...