Databyte

Title X Funding Improves Family Planning

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                    [post_content] => Health centers are legally required to feature voluntary family planning among their services, and have the option to apply for Title X grants to improve the quality of their care. The Title X program is a federal grant focused on family planning, and allows participating clinics to access greater resources and contraception services. Many women in underserved communities look to local community health centers for reproductive health care.

The Kaiser Family Foundation recently conducted a survey of community health centers and the breadth of their family planning services. Administered from May to July 2017, the survey captures information on 546 health centers in the 50 states and the District of Columbia.

Compared to non-Title X centers, more Title X-participating centers consistently offer more effective and high-quality family planning services, as the above Figure depicts. Health centers are considered to exhibit the highest level of performance if they provide all of the seven most effective family planning methods onsite or by prescription, adhere to all three best practice methods related to contraceptives, and allow new patients to set up family planning appointments on a same-day or walk-in basis. The three contraceptive best practices are: not requiring a pelvic exam to prescribe oral contraceptives, using the “quick start” method, and dispensing one-year supplies of contraceptives so return visits are unnecessary. Only 2% of non-Title X sites are considered optimal by these criteria, compared to 17% of Title X sites.

Although very few health centers perform at the highest level, the superiority of Title X centers compared to non-Title X centers remains clear across all measures of quality. Recent proposed changes by the current Health and Human Services leadership regarding requirements for Title X funding to community health centers threaten the quality and effectiveness of family planning services provided in the United States.

Graphic: Figure 6 from the report Community Health Centers and Family Planning in an Era of Policy Uncertainty, Susan F. Wood, Julia Strasser, Jessica Sharac, Janelle Wylie, Thao-Chi Tran, Sara Rosenbaum, Caroline Rosenzweig, Laurie Sobel, and Alina Salganicoff. 
                    [post_title] => Title X Funding Improves Family Planning
                    [post_excerpt] => Title X-participating centers consistently offer more effective and high-quality family planning services than non-Title X health centers.
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Title X-participating centers consistently offer more effective and high-quality family planning services than non-Title X health centers.

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Databyte

Childhood Poverty in Philadelphia

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                    [post_content] => About 21% of children in the United States, 15 million, live below the federal poverty line. Some researchers suggest that the federal poverty threshold—a household income measure used to determine eligibility to a variety of government support programs—is set too low and that families actually need about twice that income to cover basic expenses. Using this revised measure, over 40% of children in the United States live in low-income families.

Childhood poverty is not distributed evenly either across the country or within cities. The percentage of children living in poverty in Philadelphia is higher than the US national average. Nearly one-third of Philadelphia’s infants and toddlers live in poverty.

The map above shows the percentage of children under age five living in poverty in Philadelphia by zip code. The darker the color, the higher the proportion of children living in poverty. The disparities are large. Some areas of the city (like in the Northwest region) have less than 10% of children living in poverty, while others (like the Central part of the city) have up to 79% of children living in poverty.

Experiencing poverty during childhood is associated with a host of negative health outcomes. Poor children are more likely to develop asthma, become obese, and experience violence. They are also more likely to be exposed to lead, which can impair cognitive development.

There is work being done to alleviate childhood poverty in the city. Public Citizens for Children and Youth, for instance, is advocating for “increased investment and access to services” through policies such as the Earned Income Tax Credit and the Child Tax Credit.

Map from Child Trends June 2018 Report, The Status of Infants and Toddlers in Philadelphia, David Murphey, Dale Epstein, Sara Shaw, Tyler McDaniel, and Kathryn Steber, Figure 10. Percent of Children Under Age 5 in Poverty, by Zip Code. 2016. 
                    [post_title] => Childhood Poverty in Philadelphia
                    [post_excerpt] => Childhood poverty is not distributed evenly either across the country or within cities. Nearly one-third of Philadelphia’s infants and toddlers live in poverty.
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Childhood poverty is not distributed evenly either across the country or within cities. Nearly one-third of Philadelphia’s infants and toddlers live in poverty.

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Databyte

High Pay Gets Higher, Low Pay Gets Lower

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                    [post_date] => 2018-12-06 07:00:43
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                    [post_content] => An employed person in the United States is healthier than an unemployed person, and a highly-paid employee is more likely to have better health. The federal minimum wage in the United States is currently set at $7.25 per hour. Workers who receive tips are required to receive a minimum of $2.13 per hour. These minimums have not been changed since 2009 and 1996, respectively.

An October health policy brief in Health Affairs highlights fluctuations in wages and how population health reflects these changes. J. Paul Leigh and Juan Du emphasize that the labor market does not strictly follow basic economic assumptions. In particular, they explain that an increase in wages may not reduce quality of work, as an economist critiquing minimum wage hikes might expect. Instead, they argue increased wages can improve productivity by boosting morale.

The wages between 1979 and 2013 only rose notably for those with already very high pay. As the image above depicts, people in the middle wage group have not seen much of an increase in pay over the years, barely reaching a 10% increase in 2009.

Those with very low wages have almost exclusively seen drops in their pay over the decades. Low-wage workers make up 29% of the United States workforce. This means there are 47 million people who are paid poorly for their work.

The authors also explain how increases in the minimum wage can positively impact health, citing prior research on the connections to lower smoking, fewer missed work days, and improved birthweight. While many states are looking to raise their minimum wages in 2019, the authors recommend that those still caught in the debate should approach the decision from both a health and economic perspective.

Graph from “Effects Of Minimum Wages On Population Health, " Health Affairs Health Policy Brief, October 4, 2018. Exhibit 1. DOI: 10.1377/hpb20180622.107025
                    [post_title] => High Pay Gets Higher, Low Pay Gets Lower
                    [post_excerpt] => Middle-wage earners have not seen much of an increase in pay, and low-wage earners have almost exclusively seen drops in their pay over the decades.
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Middle-wage earners have not seen much of an increase in pay, and low-wage earners have almost exclusively seen drops in their pay over the decades.

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Databyte

The Green Ceiling

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                    [post_content] => Climate change disproportionally damages low-income communities and communities of color. Although higher percentages of Americans of color, particularly African Americans, support green climate actions than White Americans, the majority of positions in environmental organizations are held by White individuals, usually White men.

Although environmental organizations have strived to become more diverse over the past five decades, their efforts have been primarily successful targeting White women. They still have a long way to go to diversify across ethnicities.

People of color comprise more than a quarter of the US population (around 38%). Yet, the percentage of paid positions held in environmental institutions by people of color is low. A Green 2.0 report, conducted by Dorceta Taylor from the University of Washington, reviewed diversity among environmental organizations, and the state of current initiatives in place to increase racial diversity in the workplace.

As seen in the chart above, people of color comprise a little over one third of all intern positions across three categories of environmental institutions (NGOs, Government Agencies, and Environmental Foundations). The percentage of ethnic minorities declines by more than half as volunteers move into paid positions; minorities comprise no more than one fifth of all hired staff and leadership positions. Environmental foundations have the highest number of people color on their boards, with the lowest number of board positions reported among environmental NGOs at less than 5%. African American Women are the most underrepresented.

Dorecta Taylor reviews the whiteness of the environmental movement, explaining that since the 1960s, ethnic minorities have been shunned, misunderstood, and marginalized from joining. It took several decades of activists, urging collaboration and drawing parallels across social justice and environmental issues, before the movement opened up to incorporate issues pertaining to poverty and racism. It wasn’t until 1990, when organizations such as the Wilderness Society and the Sierra Club were accused of racist hiring practices, did they publicly step forward to admit that they “had done a miserable job of reaching out to minorities.” Yet workplace diversity is still an ongoing struggle.

Feature image from The Challenge - Green 2.0, graphic titled Unconscious Bias, Discrimination, and Insular Recruiting. 
                    [post_title] => The Green Ceiling
                    [post_excerpt] => Climate change disproportionally damages low-income communities and communities of color. Yet, the majority of positions in environmental organizations are held by White individuals. 
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Climate change disproportionally damages low-income communities and communities of color. Yet, the majority of positions in environmental organizations are held by White individuals.

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Databyte

Boxers or Briefs?

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                    [post_content] => In 1695, Nicolaas Hartsoeker published a paper where he depicted sperm cells as each containing a miniature man. We now know that this is not true, but clearly sperm has been on our collective mind for a long time. Researchers from Boston may have provided some new insight into another age-old question: what affects sperm counts: boxers or briefs?

A recent study published in Human Reproduction asked men to report their preference for boxers or briefs and then compared their sperm samples. They measured sperm volume, concentration, and motility.

Each of the circles in the figure above represents one ejaculate, and each white speck contains about 110,000 sperm cells. The left circle depicts ejaculate from a man who reported regularly wearing boxer shorts, and the right circle is from a man who reported wearing briefs or other tight underwear. Men who reported wearing boxers ejaculated a higher concentration of sperm cells.

Tighter underwear (such as briefs) can lead to a higher scrotal temperature, which previous studies have found reduces sperm count. While not definitively causal, the results of this study replicate previous findings on underwear choice and sperm concentration.

Design: David Gaitsgory @dgaitsgo. Source: Type of underwear worn and markers of testicular function among men attending a fertility center. Human Reproduction, Volume 33, Issue 9, 1 September 2018, Pages 1749–1756, https://doi.org/10.1093/humrep/dey259
                    [post_title] => Boxers or Briefs?
                    [post_excerpt] => Researchers may have provided some new insight into the age-old question on what affects sperm counts.
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Researchers may have provided some new insight into the age-old question on what affects sperm counts.

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Databyte

Disparities in Maternal Mortality in California

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                    [post_content] => California’s success in preventing maternal mortality is often cited as an example of how other states can improve maternal care. A recent study by Elliott Main and colleagues describes the key steps California took to reduce maternal mortality.

First, California identified preventable and common causes. The state then gathered private and public partners to improve care by focusing on quality improvement initiatives and specific funding opportunities. Partners included the American College of Obstetricians and Gynecologists, the California Nurse-Midwives Association, and California Hospital Association.

A “low-burden, rapid-cycle data system” was then created so progress could be tracked. The final step included designing and implementing interventions such as quality improvement toolkits that targeted obstetric hemorrhage and preeclampsia. Learning collaboratives allowed staff from participating hospitals to share knowledge and receive training in implementing the toolkits. Three quarters of the hospitals in California participated in the learning groups.

Despite California’s success at cutting the state’s overall maternal mortality rate in half between 2005 (from 13.1 per 100,000 to 7.0 in 2013), racial disparities persist. The graph above shows maternal mortality by race. The red lines represent the number of maternal deaths per 100,000 live births.  Black women die from pregnancy-related causes three to four times more frequently than white women.

Graph: Exhibit 4 from"Addressing Maternal Mortality And Morbidity In California Through Public-Private Partnerships," Elliott K. Main, Cathie Markow, and Jeff Gould. HEALTH AFFAIRS 37, NO. 9 (2018): 1484–1493 ©2018. doi/10.1377/hlthaff.2018.0463
                    [post_title] => Disparities in Maternal Mortality in California
                    [post_excerpt] => California’s success in preventing maternal mortality is often cited as an example of how other states can improve maternal care, but racial disparities persist. 
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California’s success in preventing maternal mortality is often cited as an example of how other states can improve maternal care, but racial disparities persist.

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Databyte

Where Breast Cancer Kills the Most

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                    [post_content] => Fewer new breast cancer cases occur annually among Hispanic women in the United States than non-Hispanic White and Black women. But breast cancer is the top cancer-related cause of death for Hispanic women.

While general breast cancer disparities by race and income are well-understood, little research highlights differences by locations as granular as counties. In a June 2018 report, researchers at Washington University in St. Louis discussed their county-level findings of breast cancer deaths across the United States between 2000 and 2015. They used data from the 2014 County Health Rankings to identify areas with particularly high observed mortality, compared to the expected rate of death from breast cancer.

As the figure depicts, the researchers found that counties with significant risk of breast cancer mortality among Hispanic women were heavily concentrated in the south and southwest. About 51 of the 83 hot spot counties (61%) were located in the south.

A closer look revealed that compared to other counties, these counties had more Hispanic residents; fewer residents in these hot spots had insurance. They also smoked less, and were less likely to receive mammography. Further, the risk of breast cancer mortality was almost 26% higher for Hispanic women in hot spots than for those living elsewhere.

The researchers suggest targeting state and local prevention to address specific issues like low insurance rates, advocating for affordable screening options, and emphasizing quality treatment in hot spot areas may help diminish some gaps that exist in breast cancer mortality.

Map: Figure 3: Breast cancer mortality hot spots, among all Hispanic women in the contiguous United States, 2000–2015  from "Mapping hot spots of breast cancer mortality in the United States: place matters for Blacks and Hispanics," Justin Xavier Moore, Kendra J. Royston, Marvin E. Langston. Russell Griffin, Bertha Hidalgo, Henry E. Wang, Graham Colditz, Tomi Akinyemiju, Cancer Causes & Control (2018) 29:737–750, https://doi.org/10.1007/s10552-018-1051-y
                    [post_title] => Where Breast Cancer Kills the Most
                    [post_excerpt] => County-level findings of breast cancer deaths across the United States between 2000 and 2015 showed significant risk of breast cancer mortality among Hispanic women in the south and southwest. 
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County-level findings of breast cancer deaths across the United States between 2000 and 2015 showed significant risk of breast cancer mortality among Hispanic women in the south and southwest.

...more
Databyte

A Rural Paradox: The Affordable Care Act or Medicaid?

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                    [post_content] => Rural Americans generally oppose the Affordable Care Act, even though they have benefited the most from it. To better understand how American communities differ in their health care views and experiences the Washington Post partnered with the Kaiser Family Foundation to create The Survey of Rural America. Over 1000 people living in rural America were surveyed about their political views and health experiences. As reflected in the chart above, although 95% reported Medicaid as “very important” or “somewhat important” for their local community, more than half support the repeal of the Affordable Care Act.

The ACA increased access to health insurance primarily by expanding Medicaid eligibility. Without the ACA, people are at risk of losing their Medicaid eligibility. So why do so many rural Americans support Medicaid while also supporting the repeal the ACA?

“I’ve encountered this paradox in my own research,” says Dr. David K. Jones, Assistant Professor at Boston University School of Public Health. Legislators in Kansas, for instance, supported Medicaid expansion because it provided much-needed funding to local hospitals. “Medicaid financing is critical for struggling hospitals in rural areas. Hospitals would close—indeed some have—if they lose Medicaid funding.” This would harm both patients and the hospital workforce.

Medicaid brings a wide range of health care benefits into rural communities that may be otherwise be absent. Individuals in rural areas are more likely to be self-employed and enrolled in Medicaid due to limited access to employer-sponsored health insurance. Medicaid also enrolls higher percentages of children and seniors in rural versus urban areas.
A poll conducted by Morning Consult found that only 61% of adults understood that repealing the ACA would result in lost Medicaid coverage.  
So if Medicaid is popular in rural America, why isn’t the ACA? Jones suggests that rural residents may be confused about how their Medicaid relates to the ACA. Some states rebrand Medicaid benefits with new names, such as Wisconsin’s “Badger Care.” While marketing Medicaid directly to state residents emphasizes its importance, it may also cause confusion regarding its connection to the ACA. A poll conducted by Morning Consult found that only 61% of adults understood that repealing the ACA would result in lost Medicaid coverage. Other rural Americans may not like the involvement of the federal government in state-run programs. The ACA expansion is directed and funded by the federal government, but administered by individual states. A 2017 study found that a primary objective for Republican legislators involved reducing the federal government’s involvement in health policy. Jones and colleagues found that some states could better implement the ACA’s policies if introduced separately from the ACA. It’s complicated to ascertain the underlying opinions that are reflected in ACA/Medicaid public opinion paradox. Nevertheless, the benefits rural communities gain from affordable and accessible health care are undeniable. Graphs from "The Health Care Views and Experiences of Rural Americans: Findings from the Kaiser Family Foundation/Washington Post Survey of Rural America" by Liz Hamel, Bryan Wu, and Mollyann Brodie, Figure 6 and Figure 4 (detail).  [post_title] => A Rural Paradox: The Affordable Care Act or Medicaid? [post_excerpt] => Why do so many rural Americans who support Medicaid also support repealing the ACA? [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => a-rural-paradox-the-affordable-care-act-or-medicaid [to_ping] => [pinged] => [post_modified] => 2018-10-19 05:49:04 [post_modified_gmt] => 2018-10-19 09:49:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_databyte&p=5717 [menu_order] => 0 [post_type] => bu_databyte [post_mime_type] => [comment_count] => 0 [filter] => raw ) [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [view] => BUPHP_Post_View Object ( [multipage] => [extra_args] => Array ( ) [owner] => BUPHP_Post Object *RECURSION* [_trigger_error:WPLib_Base:private] => 1 ) [extra_args] => Array ( ) [owner] => [_trigger_error:WPLib_Base:private] => 1 )

Why do so many rural Americans who support Medicaid also support repealing the ACA?

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Databyte

Water Quality Violations

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                    [post_date] => 2018-10-11 07:00:55
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                    [post_content] => Most Americans have access to safe drinking water. But most isn’t all. When we narrow our focus, we find that pockets of American communities are afflicted with high levels of contaminated water. While the country was focused on Flint, Michigan’s water crisis in 2015, almost 10% of Americans were drinking contaminated water that violated water quality standards. That’s nearly 21 million people. Maura Allaire and colleagues at the University of California, Irvine examined water quality violations across the US from 1982-2015. They analyzed geographic and temporal patterns with the goal of helping state enforcement agencies focus their attention on areas at high risk of contamination.

As depicted in the graph above, rural areas were most likely to experience water quality violations compared to suburban or urban areas. Low-income rural areas were most affected, and rural counties of Texas, Oklahoma, and Idaho had the most violations. Spikes in violations were more likely to occur after implementation of new water quality standards, as communities struggled to decrease contaminant levels to match new standards.

The researchers cite decreasing population size and incomes as common obstacles faced by rural populations when following water purification standards. Rural municipalities often struggle with sufficient staffing and technical capacity to test their water. Rural residents may be less politically engaged in local water quality issues due to language barriers and education constraints.

Rural towns often rely on outside funding and low-interest government loans to support infrastructure to correct water quality violations. However, as of June 2017, over $600 million in grant funding was cut from EPA drinking water programs. The current EPA administration is looking to overturn clean water regulations implemented during the Obama administration, posing further threats towards the public’s health.

Graph by David Gaitsgory @dgaitsgo using data directly from the SDWIS Fed Reporting Services System
                    [post_title] => Water Quality Violations
                    [post_excerpt] => Most Americans have access to safe drinking water, but communities in rural areas are most likely to experience water quality violations. 
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Most Americans have access to safe drinking water, but communities in rural areas are most likely to experience water quality violations.

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Databyte

Resurgence of Black Lung in Central Appalachia

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                    [post_date] => 2018-09-27 07:00:15
                    [post_date_gmt] => 2018-09-27 11:00:15
                    [post_content] => Coal workers’ pneumoconiosis or “black lung” develops when dust particles are inhaled while working in coal mines. These particles can cause both inflammation and scarring in the lungs.

In 1969, the Coal Workers’ Health Surveillance Program (CWHSP) was created with the intention of identifying and stopping the progression of black lung in coal miners. The same bill that created the CWHSP also required companies to limit coal miners’ exposure to dust.

Despite these programs and regulations, central Appalachian coal miners are experiencing a resurgence of black lung. A recent study from researchers at the National Institute for Occupational Safety and Health sought to update the prevalence estimates for black lung in the United States.

Graph A above shows the prevalence of black lung throughout the United States. Graph B shows the prevalence of black lung in central Appalachia, and graph C shows the prevalence of black lung in the United States excluding central Appalachia. In this study, central Appalachia included West Virginia, Kentucky, and Virginia.

Throughout the United States, over 10% of coal miners with 25 years or more of tenure have black lung; in central Appalachia, over 20% of miners with the same experience do. The overall prevalence of black lung in long-tenured coal miners is at its highest level in 25 years.

Feature image: “Continued Increase in Prevalence of Coal Workers’ Pneumoconiosis in the United States, 1970–2017,” David J. Blackley, Cara N. Halldin, A. Scott Laney, American Journal of Public Health 108, no. 9 (September 1, 2018): pp. 1220-1222. DOI: 10.2105/AJPH.2018.304517
                    [post_title] => Resurgence of Black Lung in Central Appalachia
                    [post_excerpt] => The Coal Workers’ Health Surveillance Program (CWHSP) was created to identify and stop the progression of black lung in coal miners. However, coal miners in central Appalachia are experiencing a resurgence of black lung.
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The Coal Workers’ Health Surveillance Program (CWHSP) was created to identify and stop the progression of black lung in coal miners. However, coal miners in central Appalachia are experiencing a resurgence of black lung.

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