Showing papers in "American Journal of Public Health in 2012"
TL;DR: The history and central tenets of intersectionalities are described, some theoretical and methodological challenges are addressed, and the benefits of intersectionality for public health theory, research, and policy are highlighted.
Abstract: Intersectionality is a theoretical framework that posits that multiple social categories (e.g., race, ethnicity, gender, sexual orientation, socioeconomic status) intersect at the micro level of individual experience to reflect multiple interlocking systems of privilege and oppression at the macro, social-structural level (e.g., racism, sexism, heterosexism). Public health’s commitment to social justice makes it a natural fit with intersectionality’s focus on multiple historically oppressed populations. Yet despite a plethora of research focused on these populations, public health studies that reflect intersectionality in their theoretical frameworks, designs, analyses, or interpretations are rare. Accordingly, I describe the history and central tenets of intersectionality, address some theoretical and methodological challenges, and highlight the benefits of intersectionality for public health theory, research, and policy.
1,745 citations
TL;DR: The findings confirm the need for prevention efforts that address both forms of bullying and their relation to school performance and mental health, and indicate that distress was highest among victims of both cyberbullying and school bullying.
Abstract: Objectives. Using data from a regional census of high school students, we have documented the prevalence of cyberbullying and school bullying victimization and their associations with psychological distress.Methods. In the fall of 2008, 20 406 ninth- through twelfth-grade students in MetroWest Massachusetts completed surveys assessing their bullying victimization and psychological distress, including depressive symptoms, self-injury, and suicidality.Results. A total of 15.8% of students reported cyberbullying and 25.9% reported school bullying in the past 12 months. A majority (59.7%) of cyberbullying victims were also school bullying victims; 36.3% of school bullying victims were also cyberbullying victims. Victimization was higher among nonheterosexually identified youths. Victims report lower school performance and school attachment. Controlled analyses indicated that distress was highest among victims of both cyberbullying and school bullying (adjusted odds ratios [AORs] were from 4.38 for depressive ...
796 citations
TL;DR: It is proposed that further advances in the field will be achieved by focusing dissemination and implementation research on 5 core values: rigor and relevance, efficiency, collaboration, improved capacity, and cumulative knowledge.
Abstract: To address the vast gap between current knowledge and practice in the area of dissemination and implementation research, we address terminology, provide examples of successful applications of this research, discuss key sources of support, and highlight directions and opportunities for future advances. There is a need for research testing approaches to scaling up and sustaining effective interventions, and we propose that further advances in the field will be achieved by focusing dissemination and implementation research on 5 core values: rigor and relevance, efficiency, collaboration, improved capacity, and cumulative knowledge.
627 citations
TL;DR: Clinician implicit race bias and race and compliance stereotyping are associated with markers of poor visit communication and poor ratings of care, particularly among Black patients.
Abstract: Objectives. We examined the associations of clinicians’ implicit attitudes about race with visit communication and patient ratings of care.Methods. In a cross-sectional study of 40 primary care clinicians and 269 patients in urban community-based practices, we measured clinicians’ implicit general race bias and race and compliance stereotyping with 2 implicit association tests and related them to audiotape measures of visit communication and patient ratings.Results. Among Black patients, general race bias was associated with more clinician verbal dominance, lower patient positive affect, and poorer ratings of interpersonal care; race and compliance stereotyping was associated with longer visits, slower speech, less patient centeredness, and poorer ratings of interpersonal care. Among White patients, bias was associated with more verbal dominance and better ratings of interpersonal care; race and compliance stereotyping was associated with less verbal dominance, shorter visits, faster speech, more patient ...
601 citations
TL;DR: An integrated embodied research approach must consider the structural level-past and present de jure and de facto discrimination; the individual level-issues of domains, nativity, and use of both explicit and implicit discrimination measures; and how current research methods likely underestimate the impact of racism on health.
Abstract: The scientific study of how discrimination harms health requires theoretically grounded methods. At issue is how discrimination, as one form of societal injustice, becomes embodied inequality and is manifested as health inequities. As clarified by ecosocial theory, methods must address the lived realities of discrimination as an exploitative and oppressive societal phenomenon operating at multiple levels and involving myriad pathways across both the life course and historical generations. An integrated embodied research approach hence must consider (1) the structural level-past and present de jure and de facto discrimination; (2) the individual level-issues of domains, nativity, and use of both explicit and implicit discrimination measures; and (3) how current research methods likely underestimate the impact of racism on health.
561 citations
TL;DR: In both surveys, non-Hispanic Whites, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes.
Abstract: Objectives. We estimated e-cigarette (electronic nicotine delivery system) awareness, use, and harm perceptions among US adults.Methods. We drew data from 2 surveys conducted in 2010: a national online study (n = 2649) and the Legacy Longitudinal Smoker Cohort (n = 3658). We used multivariable models to examine e-cigarette awareness, use, and harm perceptions.Results. In the online survey, 40.2% (95% confidence interval [CI] = 37.3, 43.1) had heard of e-cigarettes, with awareness highest among current smokers. Utilization was higher among current smokers (11.4%; 95% CI = 9.3, 14.0) than in the total population (3.4%; 95% CI = 2.6, 4.2), with 2.0% (95% CI = 1.0, 3.8) of former smokers and 0.8% (95% CI = 0.35, 1.7) of never-smokers ever using e-cigarettes. In both surveys, non-Hispanic Whites, current smokers, young adults, and those with at least a high-school diploma were most likely to perceive e-cigarettes as less harmful than regular cigarettes.Conclusions. Awareness of e-cigarettes is high, and use am...
499 citations
TL;DR: The literature on neighborhood disparities in access to fast-food outlets and convenience stores was reviewed, finding that low-income neighborhoods offered greater access to food sources that promote unhealthy eating.
Abstract: Environmental justice is concerned with an equitable distribution of environmental burdens. These burdens comprise immediate health hazards as well as subtle inequities, such as limited access to healthy foods.We reviewed the literature on neighborhood disparities in access to fast-food outlets and convenience stores. Low-income neighborhoods offered greater access to food sources that promote unhealthy eating. The distribution of fast-food outlets and convenience stores differed by the racial/ethnic characteristics of the neighborhood.Further research is needed to address the limitations of current studies, identify effective policy actions to achieve environmental justice, and evaluate intervention strategies to promote lifelong healthy eating habits, optimum health, and vibrant communities.
444 citations
TL;DR: There is a need for diverse sampling approaches to monitor transgender health, including adding transgender measures to population-based surveys, and to highlight economic inequities that warrant intervention.
Abstract: Despite higher rates of unemployment and poverty among transgender adults (n = 131; 0.5% weighted) than among nontransgender adults (n = 28 045) in our population-based Massachusetts household sample, few health differences were observed between transgender and nontransgender adults. Transgender adults who are stably housed and participated in a telephone health survey may represent the healthiest segment of the transgender population. Our findings demonstrate a need for diverse sampling approaches to monitor transgender health, including adding transgender measures to population-based surveys, and further highlight economic inequities that warrant intervention.
424 citations
TL;DR: Pediatricians' implicit attitudes about race affect pain management and there is a need to better understand the influence of physicians' unconscious beliefs about race on pain and other areas of care.
Abstract: Objectives. We examined the association between pediatricians’ attitudes about race and treatment recommendations by patients’ race.Methods. We conducted an online survey of academic pediatricians (n = 86). We used 3 Implicit Association Tests to measure implicit attitudes and stereotypes about race. Dependent variables were recommendations for pain management, urinary tract infections, attention deficit hyperactivity disorder, and asthma, measured by case vignettes. We used correlational analysis to assess associations among measures and hierarchical multiple regression to measure the interactive effect of the attitude measures and patients’ race on treatment recommendations.Results. Pediatricians’ implicit (unconscious) attitudes and stereotypes were associated with treatment recommendations. The association between unconscious bias and patient’s race was statistically significant for prescribing a narcotic medication for pain following surgery. As pediatricians’ implicit pro-White bias increased, presc...
406 citations
TL;DR: A framework that shows how racism and health inequities may be viewed from a life course perspective is suggested, which suggests an overarching idea that racism can structure one's time in asset-building contexts or disadvantaged contexts.
Abstract: Recent studies show that racism may influence health inequities. As individuals grow from infancy into old age, they encounter social institutions that may create new exposures to racial bias. Yet, few studies have considered this idea fully. We suggest a framework that shows how racism and health inequities may be viewed from a life course perspective. It applies the ideas of age-patterned exposures, sensitive periods, linked lives, latency period, stress proliferation, historic period, and cohorts. It suggests an overarching idea that racism can structure one’s time in asset-building contexts (e.g., education) or disadvantaged contexts (e.g., prison). This variation in time and exposure can contribute to racial inequities in life expectancy and other health outcomes across the life course and over generations.
374 citations
TL;DR: A color-coded labeling intervention improved sales of healthy items and was enhanced by a choice architecture intervention that increased the visibility and convenience of some green items.
Abstract: Objectives. We assessed whether a 2-phase labeling and choice architecture intervention would increase sales of healthy food and beverages in a large hospital cafeteria.Methods. Phase 1 was a 3-month color-coded labeling intervention (red = unhealthy, yellow = less healthy, green = healthy). Phase 2 added a 3-month choice architecture intervention that increased the visibility and convenience of some green items. We compared relative changes in 3-month sales from baseline to phase 1 and from phase 1 to phase 2.Results. At baseline (977 793 items, including 199 513 beverages), 24.9% of sales were red and 42.2% were green. Sales of red items decreased in both phases (P < .001), and green items increased in phase 1 (P < .001). The largest changes occurred among beverages. Red beverages decreased 16.5% during phase 1 (P < .001) and further decreased 11.4% in phase 2 (P < .001). Green beverages increased 9.6% in phase 1 (P < .001) and further increased 4.0% in phase 2 (P < .001). Bottled water increased 25.8% ...
TL;DR: An overview of ways that social media can influence suicidal behavior, both negatively and positively, is provided and the evidence of the risk is evaluated.
Abstract: There is increasing evidence that the Internet and social media can influence suicide-related behavior. Important questions are whether this influence poses a significant risk to the public and how public health approaches might be used to address the issue. To address these questions, we provide an overview of ways that social media can influence suicidal behavior, both negatively and positively, and we evaluate the evidence of the risk. We also discuss the legal complexities of this important topic and propose future directions for research and prevention programs based on a public health perspective.
TL;DR: In this paper, the authors assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women.
Abstract: Objectives. We assessed whether multiple psychosocial factors are additive in their relationship to sexual risk behavior and self-reported HIV status (i.e., can be characterized as a syndemic) among young transgender women and the relationship of indicators of social marginalization to psychosocial factors.Methods. Participants (n = 151) were aged 15 to 24 years and lived in Chicago or Los Angeles. We collected data on psychosocial factors (low self-esteem, polysubstance use, victimization related to transgender identity, and intimate partner violence) and social marginalization indicators (history of commercial sex work, homelessness, and incarceration) through an interviewer-administered survey.Results. Syndemic factors were positively and additively related to sexual risk behavior and self-reported HIV infection. In addition, our syndemic index was significantly related to 2 indicators of social marginalization: a history of sex work and previous incarceration.Conclusions. These findings provide eviden...
TL;DR: Better instrumentation, innovative methodology, and strategies are needed for identifying and tracking racial/ethnic discrimination in health care settings.
Abstract: Objectives. We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients.Methods. We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed.Results. Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism...
TL;DR: Suggested public health priorities include better integrating oral health into medical care, implementing community programs to promote healthy behaviors and improve access to preventive services, and developing a comprehensive strategy to address the oral health needs of the homebound and long-term-care residents.
Abstract: Dental disease is largely preventable. Many older adults, however, experience poor oral health. National data for older adults show racial/ethnic and income disparities in untreated dental disease and oral health-related quality of life. Persons reporting poor versus good health also report lower oral health-related quality of life. On the basis of these findings, suggested public health priorities include better integrating oral health into medical care, implementing community programs to promote healthy behaviors and improve access to preventive services, developing a comprehensive strategy to address the oral health needs of the homebound and long-term-care residents, and assessing the feasibility of ensuring a safety net that covers preventive and basic restorative services to eliminate pain and infection.
TL;DR: Tobacco use varies by geography and sociodemographic factors, but remains prevalent among US adults, and evidence-based prevention strategies are needed to decrease tobacco use and the health and economic burden of tobacco-related diseases.
Abstract: Objectives. We assessed the prevalence and sociodemographic correlates of tobacco use among US adults.Methods. We used data from the 2009–2010 National Adult Tobacco Survey, a national landline and cell phone survey of adults aged 18 years and older, to estimate current use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes. We stratified estimates by gender, age, race/ethnicity, education, income, sexual orientation, and US state.Results. National prevalence of current use was 25.2% for any tobacco; 19.5% for cigarettes; 6.6% for cigars, cigarillos, or small cigars; 3.4% for chewing tobacco, snuff, or dip; 1.5% for water pipes; 1.4% for snus; and 1.1% for pipes. Tobacco use was greatest among respondents who were male, younger, of non-Hispanic “other” race/ethnicity, less educated, less wealthy, and lesbian, gay, bisexual, or transgender. Prevalence ranged from 14.1% (Utah) to 37.4% (Kentucky).Conclusions. Tobacco use varies by ge...
TL;DR: The findings support the conclusion thatSexual compulsivity is a component of a syndemic framework for HIV risk among MSM and HIV prevention interventions should consider the overlapping and compounding effects of psychosocial problems, including sexual compulsivity.
Abstract: Objectives. We evaluated whether sexual compulsivity fits into a syndemic framework, in which sexual compulsivity is one of a number of co-occurring psychosocial health problems that increase HIV risk among men who have sex with men (MSM).Methods. In 2003 and 2004, we conducted an anonymous cross-sectional survey of MSM in New York City (n = 669) by approaching attendees at gay, lesbian, and bisexual community events. We analyzed data by bivariate and multivariate logistic regression.Results. We found strong positive interrelationships among syndemic factors including sexual compulsivity, depression, childhood sexual abuse, intimate partner violence, and polydrug use. In bivariate analyses, all syndemic health problems except for childhood sexual abuse were positively related to HIV seropositivity and high-risk sexual behavior. Our multivariate models revealed an array of interrelationships among psychosocial health problems. We found amplified effects of these problems on HIV seropositivity and on the li...
TL;DR: Attention to bias or prejudice in harassment and bullying should be incorporated into programs and policies for young people, research on harassment among youths rarely examines the underlying cause.
Abstract: Is harassment based on personal characteristics such as race/ethnicity, sexual orientation, religion, or disability more detrimental than general harassment? In 2 large population-based studies of adolescents, more than one third of those harassed reported bias-based school harassment. Both studies show that bias-based harassment is more strongly associated with compromised health than general harassment. Research on harassment among youths rarely examines the underlying cause. Attention to bias or prejudice in harassment and bullying should be incorporated into programs and policies for young people.
TL;DR: Child abuse and neglect affect long-term health status-increasing risk for diabetes, lung disease, malnutrition,nutrition, and vision problems-and support the need for early health care prevention.
Abstract: Objectives. We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood.Methods. Using a prospective cohort design, we matched children (aged 0–11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age = 41.2 years).Results. After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic s...
TL;DR: This study shows that merely anticipating prejudice leads to both psychological and cardiovascular stress responses, and suggests that vigilance for prejudice may be a contributing factor to racial/ethnic health disparities in the United States.
Abstract: Objectives. We sought to demonstrate that individuals who anticipate interacting with a prejudiced cross-race/ethnicity partner show an exacerbated stress response, as measured through both self-report and hemodynamic and vascular responses, compared with individuals anticipating interacting with a nonprejudiced cross-race/ethnicity partner.Methods. Through a questionnaire exchange with a White interaction partner (a confederate) Latina participants learned that their partner had racial/ethnic biased or egalitarian attitudes. Latina participants reported their cognitive and emotional states, and cardiovascular responses were measured while participants prepared and delivered a speech to the White confederate.Results. Participants who believed that their interaction partner held prejudiced attitudes reported greater concern and more threat emotions before the interaction, and more stress after the interaction, and showed greater cardiovascular response than did participants who believed that their partner ...
TL;DR: In this article, the authors compared cycling injury risks of 14 route types and other route infrastructure features, including cycle tracks and bike lanes, and found that bike lanes had the lowest risk.
Abstract: Objectives. We compared cycling injury risks of 14 route types and other route infrastructure features.Methods. We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip.Results. Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and const...
TL;DR: The public health burdens of mobility disability is examined, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action are examined.
Abstract: Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms.
TL;DR: Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities, and can help guide interventions to address racial and ethnic disparities in health.
Abstract: Several aspects of social psychological science shed light on how unexamined racial/ethnic biases contribute to health care disparities.Biases are complex but systematic, differing by racial/ethnic group and not limited to love–hate polarities. Group images on the universal social cognitive dimensions of competence and warmth determine the content of each group's overall stereotype, distinct emotional prejudices (pity, envy, disgust, pride), and discriminatory tendencies. These biases are often unconscious and occur despite the best intentions.Such ambivalent and automatic biases can influence medical decisions and interactions, systematically producing discrimination in health care and ultimately disparities in health. Understanding how these processes may contribute to bias in health care can help guide interventions to address racial and ethnic disparities in health.
TL;DR: The absence of positive mental health increased the probability of all-cause mortality for men and women at all ages after adjustment for known causes of death.
Abstract: Objectives. We investigated whether positive mental health predicts all-cause mortality.Methods. Data were from the Midlife in the United States (MIDUS) study (n = 3032), which at baseline in 1995 measured positive mental health (flourishing and not) and past-year mental illness (major depressive episode, panic attacks, and generalized anxiety disorders), and linked respondents with National Death Index records in a 10-year follow-up ending in 2005. Covariates were age, gender, race, education, any past-year mental illness, smoking, physical inactivity, physical diseases, and physical disease risk factors.Results. A total of 6.3% of participants died during the study period. The final and fully adjusted odds ratio of mortality was 1.62 (95% confidence interval [CI] = 1.00, 2.62; P = .05) for adults who were not flourishing, relative to participants with flourishing mental health. Age, gender, race, education, smoking, physical inactivity, cardiovascular disease, and HIV/AIDS were significant predictors of...
TL;DR: Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.
Abstract: Objectives. We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates.Methods. We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study.Results. Of 169 included articles, 89.2% reported beneficial relationships—but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (–14.2%), those examining direct measures of obesity (–6.2%), or those with an academic first author (–3.4%) were less likely to find a beneficial relationship.Conclusions. Policymakers a...
TL;DR: Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another.
Abstract: Objectives. We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk.Methods. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables.Results. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level so...
TL;DR: Associations between SES and adolescent mental disorders are most directly the result of perceived social status, an aspect of SES that might be more amenable to interventions than objective aspects of S ES.
Abstract: Objectives. Although previous research has shown that low socioeconomic status (SES) is associated with mental illness, it is unclear which aspects of SES are most important. We investigated this issue by examining associations between 5 aspects of SES and adolescent mental disorders.Methods. Data came from a national survey of US adolescents (n = 6483). Associations among absolute SES (parental income and education), relative SES (relative deprivation, subjective social status), and community level income variation (Gini coefficient) with past-year mental disorders were examined.Results. Subjective social status (mean 0, variance 1) was most consistently associated with mental disorder. Odds ratios with mood, anxiety, substance, and behavior disorders after controlling for other SES indicators were all statistically significant and in the range of 0.7 to 0.8. Associations were strongest for White adolescents. Parent education was associated with low risk for anxiety disorder, relative deprivation with hi...
TL;DR: The analysis showed strong positive effects of local violence on parental distress, providing suggestive evidence that parental responses may be a likely pathway by which local violence affects young children.
Abstract: Objectives. We examined whether the burden of violence in a child’s community environment alters the child’s behavior and functioning in the classroom setting.Methods. To identify the effects of local violence, we exploited variation in the timing of local homicides, based on data from the Chicago Police Department, relative to the timing of interview assessments conducted as part of a randomized controlled trial conducted with preschoolers in Head Start programs from 2004–2006, the Chicago School Readiness Project. We compared children’s scores when exposed to recent local violence with scores when no recent violence had occurred to identify causal effects.Results. When children were assessed within a week of a homicide that occurred near their home, they exhibited lower levels of attention and impulse control and lower preacademic skills. The analysis showed strong positive effects of local violence on parental distress, providing suggestive evidence that parental responses may be a likely pathway by wh...
TL;DR: For example, this article found that after the legalization of same-sex marriage in Massachusetts, sexual minority men had a statistically significant decrease in medical care visits (mean = 5.00 vs mean = 4.67; P =.05; Cohen's d = 0.17), mental health care visits, and mental health costs (means = $2442.28 vs. mean = $2137.41).
Abstract: Objectives. We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of same-sex marriage laws in Massachusetts in 2003.Methods. We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts.Results. In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean = 5.00 vs mean = 4.67; P = .05; Cohen's d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen's d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen's d = 0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men.Conclusions. Policies that confer protections to same-sex couples may be effect...
TL;DR: Mortality rates for suicide, poisoning, and falls rose substantially over the past decade, and suicide has surpassed motor vehicle traffic crashes as the leading cause of injury mortality.
Abstract: Objectives. We have described national trends for the 5 leading external causes of injury mortality.Methods. We used negative binomial regression and annual underlying cause-of-death data for US residents for 2000 through 2009.Results. Mortality rates for unintentional poisoning, unintentional falls, and suicide increased by 128%, 71%, and 15%, respectively. The unintentional motor vehicle traffic crash mortality rate declined 25%. Suicide ranked first as a cause of injury mortality, followed by motor vehicle traffic crashes, poisoning, falls, and homicide. Females had a lower injury mortality rate than did males. The adjusted fall mortality rate displayed a positive age gradient. Blacks and Hispanics had lower adjusted motor vehicle traffic crash and suicide mortality rates and higher adjusted homicide rates than did Whites, and a lower unadjusted total injury mortality rate.Conclusions. Mortality rates for suicide, poisoning, and falls rose substantially over the past decade. Suicide has surpassed motor...