Research

Mental Health of Gun Owners’ Children

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                    [post_date] => 2019-04-18 07:00:07
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                    [post_content] => American youth grow up with the highest gun ownership rate in the world and have greater access to guns at home than any other country. One third of US households with children under age 18 are reported to have firearms. And 40% of adolescents living in a household with a firearm say that they have easy access to guns at home. One fifth of gun owners with children under 18 store a gun loaded. More than one third store their gun unlocked. And 1 in 10 store their gun loaded and unlocked.

Most gun owners possess a gun to protect their families, but that very form of protection can harm their children’s health and well-being. For example, children who live in a home where they have easy access to firearms are at risk of homicide, suicide, and gun-related accidents. Relatively little is known about potential mental health consequences for these children. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), I conducted a study to investigate how easy access to guns at home affects the psychological well-being of the children of gun owners.

I found that gaining access to guns at home was significantly related to increased depressive symptoms among children of gun owners. How large is the effect? The changes in depression by removing access to guns at home are similar to the effect of receiving youth depression psychotherapy. In terms of future earning potential, the loss of income caused by depression due to living in a home with a firearm is similar to losing a year of college education.
We all know that reduced household gun ownership levels should improve physical health by reducing the numbers of suicides, homicides, and accidental gun deaths. My findings suggest that it might also enhance the mental health of girls in the household.  
I also found that easy access to a gun at home is especially harmful for girls’ mental health. Why are women more affected? It can be due to the gender differences in perceptions of safety and attitudes toward firearm. Oftentimes, men are more likely to be the gun owners and users, but women are more inclined to describe firearms as a threat to safety. Similarly, women do not believe that gun ownership can reduce their fears of crime and victimization. It is thus not surprising that, as found in my study, adolescent girls may have different psychological responses to a gun in the home than adolescent boys. One mechanism linking in-home firearm access to adolescent depression may be through shifts in the perception of safety in public, especially in the school. In-home firearm access may increase the adolescent's beliefs about the number of classmates taking guns to school. This may in turn make them feel less safe in school because they are concerned about gun crime and violence, gun accidents, and mass shootings. This is consistent with other studies of “weapons effects". Mere exposure to weapons can increase hostile appraisals (e.g., perceiving ambiguous actions by others as aggression). This mechanism may resonate more with female adolescents than their male counterparts due to stark gender differences in attitudes about and behaviors concerning guns. This idea was generally supported by my finding that access to household firearms is negatively associated with perceived school safety only for girls. We all know that reduced household gun ownership levels should improve physical health by reducing the numbers of suicides, homicides, and accidental gun deaths. My findings suggest that it might also enhance the mental health of girls in the household. School security and educational programs may reduce student anxiety about safety in the classroom, hallways, and playgrounds. But such programs don’t address the unease associated with the presence of guns in the home. If parents make more informed decisions about gun ownership and storage, we could reduce national gun-related public health problems. Photo by Mitya Ivanov on Unsplash [post_title] => Mental Health of Gun Owners' Children [post_excerpt] => Children who live in homes with access to firearms are at risk of homicide, suicide, and gun-related accidents. Little is known about mental health effects. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => mental-health-of-gun-owners-children [to_ping] => [pinged] => [post_modified] => 2019-04-17 09:22:42 [post_modified_gmt] => 2019-04-17 13:22:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6735 [menu_order] => 0 [post_type] => bu_research [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 )

Children who live in homes with access to firearms are at risk of homicide, suicide, and gun-related accidents. Little is known about mental health effects.

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Research

Food Melts Shape Shoppers’ Health

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                    [post_date] => 2019-04-17 07:00:46
                    [post_date_gmt] => 2019-04-17 11:00:46
                    [post_content] => As obesity continues to be a pressing health issue, researchers and policy makers have been interested in understanding the influence of food environments on shopping and dietary behaviors, particularly among low-income populations and those participating in the Supplemental Nutrition Assistance Program (SNAP). The lay public is now quite familiar with the concept of “food deserts”, defined by the United States Department of Agriculture as low-income census tracts where the nearest grocery store is greater than 0.5 mile in an urban setting and greater than 10 miles in a rural setting.

Food deserts have been explored as a potential contributor to obesity given trends showing that low-income communities have less access to healthy food and higher rates of obesity compared to higher income communities. Although a grocery store may be available in a community, there is no guarantee that fresh and nutritious foods will be available inside that grocery store, and the availability of healthy foods in a store has been associated with better dietary outcomes.

Twenty-eight states distribute SNAP benefits in one allotment within the first 10 days of the month, and this has led to questions about how distribution of SNAP benefits may affect shopping patterns and diet. Among individuals receiving food assistance once per month, items purchased and foods consumed vary from the first week after receiving benefits to the last week of benefits (i.e., week prior to receiving the next month of benefits). The general assumption is that food choices do not vary from one week to another; however, anecdotal evidence from low-income Cleveland residents led us to question whether the food available in the store varied over the course of the month, limiting food choices when shopping at the end of the month.
To measure decrease in availability, a phenomenon we refer to as food melt, we calculated the proportion of food items available at the beginning of the month that were no longer available by the end of the month.  
We documented availability, price, and quality of a specific set of 50 food items at the beginning of the month and at the end of the month in neighborhoods in Cleveland, Ohio, where at least 30% of the population received SNAP benefits. We visited 48 stores serving 28 neighborhoods in March and April of 2013. We visited supermarkets (i.e., had at least 6 fresh fruit varieties, 6 fresh vegetable varieties, raw meat, bakery items, and 3 types of milk), large grocery stores (i.e., had at least 3 fresh fruit varieties, 3 fresh vegetable varieties, raw meat or bakery, and low-fat milk), and small grocery stores (i.e., had at least 1 fresh fruit variety, 1 fresh vegetable variety, and any type of milk). We counted available items in several categories at the beginning and at the end of the month. These included produce (14 total); staple goods (14 total); meats (20 total); and junk foods (2 total, chips and soda). To measure decrease in availability, a phenomenon we refer to as food melt, we calculated the proportion of food items available at the beginning of the month that were no longer available by the end of the month. We also documented the price and quality of these items. We found that all stores experienced some degree of food melt indicating less availability of foods at the end of the month compared to the beginning of the month. In one out of five stores, half of the items available at the beginning of the month were no longer available at the end of the month. Overall, more than half of the stores we observed saw substantial melt (25% change or greater) in fruits and vegetables, staple items such as milk, bread or eggs, and meat items, such as fresh or frozen chicken or ground beef. However, food melt was mostly observed in the small grocery stores as opposed to the larger grocery stores or supermarkets. Notably, no junk food (i.e., chips and soda) melt was observed within any store—all stores that had junk food at the beginning of the month had the same amount of junk food items at the end of the month. All but one supermarket observed in this study experienced at least a 10% decline in food availability from the beginning to the end of the month. These findings indicate the consumer food environment may be negatively impacting SNAP purchasing behaviors within even the most robust food retailer establishments (i.e., supermarkets) due to food availability changes from the beginning to the end of the month. Given that environment influences behavior, the shifting availability of nutritious perishable food items over the course of a month may have a negative impact on the shopping practices of SNAP beneficiaries. It is unclear if food melt is driven by shopping practices of individuals or by stocking patterns of retailers. Anecdotally, Cleveland shoppers who use SNAP benefits have indicated that they do most of their shopping at the beginning of the month because the food is gone at the end of the month. Yet some Cleveland retailers share that they observe significantly fewer shoppers at the end of the month and limit their restocking so as not to lose money. It is possible that, in states where SNAP benefits are distributed throughout the month, food melt is not occurring. Documenting food melt in other states with different SNAP distribution schedules is an important next step for informing state SNAP distribution policies to improve food environments, shopping patterns, and dietary outcomes. Photo by Peter Bond on Unsplash [post_title] => Food Melts Shape Shoppers' Health [post_excerpt] => Food melts are defined as a decrease in availability of foods in food retailer establishments, which shapes low-income shoppers' health. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => food-melts-shape-shoppers-health [to_ping] => [pinged] => [post_modified] => 2019-04-16 11:07:28 [post_modified_gmt] => 2019-04-16 15:07:28 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6733 [menu_order] => 0 [post_type] => bu_research [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 )

Food melts are defined as a decrease in availability of foods in food retailer establishments, which shapes low-income shoppers’ health.

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Research

Hijab Can Protect Women from Depression

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                    [post_date] => 2019-04-16 07:00:02
                    [post_date_gmt] => 2019-04-16 11:00:02
                    [post_content] => As the United States has grown more diverse, it has become increasingly common to see Muslim women dressed in traditional attire in public. Indeed, few behaviors are more controversial in contemporary American society than the Islamic practice of hijab, women wearing veils or headscarves. Within the Islamic belief system, many Muslim women above the age of puberty wear the hijab to conform to precepts in the Quran that emphasize the importance of modesty.

Why is wearing a veil controversial? Although various explanations exist, many feminists and other Americans view veiling as an oppressive practice. Like other forms of oppression, veiling is believed to cause detrimental health effects, including elevated levels of depressive symptoms by, for instance, implicitly conveying the message that women are second-class citizens relative to men who are not required to veil.

Muslim women who chose to veil, however, have a different perspective. They tend to view hijab as liberating rather than oppressive. When asked why they veil, Muslim women offer a variety of reasons. Included among these are the belief that hijab represents: an expression of one’s spirituality, a way to convey modesty that fosters an internal sense of respect, a manifestation of one's identity as a Muslim, a source of female empowerment, an expression of activism and pride, a means to command increased respect from men in social encounters, a mechanism to enhance emotional and physical intimacy in marriage, a source of emancipation or liberation from western fashion standards, a means to reject objectification and sexual exploitation, and an act of rebellion against western media messages.
Our results underscore the importance of listening to the voices of Muslim women.  
The difference in opinions regarding veiling is not merely academic. The choice to wear or not wear a hijab has real life implications for Muslim women. The general perception that hijab is an unproductive, detrimental practice is widely disseminated by media to the broader society. As a result, women who veil may be viewed as less intelligent or enlightened relative to women who do not veil. Some observers have even called for hijab to be banned in certain public forms such as public schools. Indeed, in France, students are legally prohibited from veiling, or displaying other ostentatiously religious symbols, while in school. To shed some light on this issue, my colleagues and I examined the relationship between veiling and depression with a diverse sample of Muslim women around the United States. We found no support for the common belief that wearing the hijab is linked to depression. In fact, we found the opposite. Muslims who reported wearing the hijab more frequently exhibited lower levels of depressive symptoms. Put differently, wearing a veil appears to protect Muslim women from depression. Our results underscore the importance of listening to the voices of Muslim women. Efforts to discourage Muslim women from veiling are a violation of their internationally recognized human rights. Article 18 of United Nations' Universal Declaration of Human Rights explicitly recognizes the right of women to express their religious beliefs in public settings. Women who choose to veil are simply expressing this fundamental right. Photo by Janko Ferlič on Unsplash [post_title] => Hijab Can Protect Women from Depression [post_excerpt] => Muslim women wearing the hijab more frequently exhibited lower levels of depressive symptoms. Wearing a veil appears to protect women from depression. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => hijab-can-protect-women-from-depression [to_ping] => [pinged] => [post_modified] => 2019-04-17 09:33:58 [post_modified_gmt] => 2019-04-17 13:33:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6730 [menu_order] => 0 [post_type] => bu_research [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 )

Muslim women wearing the hijab more frequently exhibited lower levels of depressive symptoms. Wearing a veil appears to protect women from depression.

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Research

Pushing Policy for Polishes

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                    [post_date] => 2019-04-12 05:00:22
                    [post_date_gmt] => 2019-04-12 09:00:22
                    [post_content] => Nail salon technicians, many nail salon owners as well, are some of the most inspiring hard-working entrepreneurial people I have met through my 15-years of research experience in occupational health. Many of them want the industry to be better and have expressed difficulty choosing safer nail products. I understood this best when studying the composition of plasticizers, which are chemicals that are added to make nail polish more flexible and durable.

My colleagues and I recently documented the evolution of labels and ingredients in nail polish related to plasticizer components. We examined plasticizer content disclosed by the manufacturers versus what we measured in the laboratory for 40 different nail polishes from 12 brands, including regular polish and one long-lasting gel polish. We found that manufacturers may be using potentially toxic plasticizer substitutes, even in products that don’t list them or claim these plasticizers are excluded.

Our study documents how the nail polish industry has been responding to market demands and has started labeling nail polishes using an “n-free” labelling system. The “n” is the number of substances not present. For example, 3-free, the most common label on nail polishes, implies the absence of three known toxic substances, often referred to as the “toxic trio”: toluene, di-n-butyl phthalate (DnBP), and formaldehyde. The higher the n, the more ingredients were removed from the nail polish. Although it is encouraging to see the industry moving towards eliminating some concerning chemicals, many challenges remain when nail technicians or consumers want to choose safer nail polishes.

For a consumer of nail polish, in the salon or at home, reading ingredients in nail products is essential to choosing safer products — especially in lieu of being able to test products for safety ourselves. However, ingredients are not always listed on the bottle or packaging, or the distribution sites. In some instances, to learn about ingredients we had to rely on product safety data sheets, which were not always available on the manufacturer website or distribution sites, or resort to publicly available technical sheets about the products.
Nail salon technicians, many nail salon owners as well, are some of the most inspiring hard-working entrepreneurial people I have met through my 15-years of research experience in occupational health.  
Users wanting to avoid phthalate ingredients, a common plasticizer in nail polish, will not find it easy. Fragrances in nail polish may not disclose phthalate ingredients. N-free labels can help you know what ingredients were removed, but not what was added as a replacement. Specifically, our study identifies the use of bis(2-ethylhexyl) phthalate (DEHP) as a potential substitute to the historically common nail polish plasticizer phthalate DnBP, even among nail polishes with newer n-free labels. We recommend labeling validation, removal of harmful ingredients by chemical class, and safety testing of substitutes, although practical implementation of our recommendations may need much more research to identify feasible and effective solutions. There is also much to be studied beyond n-free claims. Some nail polishes add labels such as “non-toxic,” “organic,” “child safe,” “non-allergenic,” that we did not study. And why should we care about these plasticizers in nail polish? First, workers in nail salons carry a high exposure burden. Second, plasticizer chemicals are everywhere in our environments and nail polish just adds another source of exposure during our lifetime. It is challenging to know the potential negative health impact from exposure chemicals during the occasional manicure. Plasticizers concern public health researchers because many have been associated with negative health concerns including reproductive and endocrine issues. By advancing health research related to nail products, we hope to push policy that helps nail polish users and, most importantly, nail technicians to be healthier. This is just fair! Nail technicians work hard and may be putting their own health at risk to help us relax and feel beautiful. Photo by DESIGNECOLOGIST on Unsplash [post_title] => Pushing Policy for Polishes [post_excerpt] => For a consumer of nail polish, in the salon or at home, reading ingredients in nail products is essential to choose safer products. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => pushing-policy-for-polishes [to_ping] => [pinged] => [post_modified] => 2019-04-10 09:24:48 [post_modified_gmt] => 2019-04-10 13:24:48 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6686 [menu_order] => 0 [post_type] => bu_research [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 )

For a consumer of nail polish, in the salon or at home, reading ingredients in nail products is essential to choose safer products.

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Research

Green Dreams

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                    [post_date] => 2019-04-11 07:00:01
                    [post_date_gmt] => 2019-04-11 11:00:01
                    [post_content] => Urban green space can take many forms including city forests, green roofs, parks, gardens, and greenways. Greater access to green space is associated with less depression and improvements in mood and attention. Urban green space has also been associated with reduced neighborhood crime and enhanced community satisfaction.

But these physical, psychological, and social health benefits of green spaces are not equally distributed across urban populations. Researchers at four US universities examined the association between a neighborhood’s racial mix and income level and access to green space in 59,483 urban census tracts across the U.S over a ten-year period (2001-2011).

To assess level of greenness, the researchers used satellite data known as the normalized difference vegetative index (NDVI). NDVI quantifies vegetation by using remote sensing data and chlorophyll light absorption.

In 2001, neighborhoods with a higher proportion of racial minorities and greater concentration of poverty had less greenspace than neighborhoods with a higher proportion of White residents and higher-income areas. Over the following decade, those neighborhoods with a higher proportion of racial minorities experienced a decrease in vegetation. Conversely, neighborhoods with a higher proportion of White residents experienced an increase in vegetation over the same time period.

The relationship between neighborhood demographics and access to green space continued even after researchers considered the effects of various factors that might explain the association such as population density and-proportion of renters in the neighborhood.
Greater access to green space is associated with less depression and improvements in mood and attention. Urban green space has also been associated with reduced neighborhood crime and enhanced community satisfaction.  
Some cities have addressed the scarcity of green spaces through large green infrastructure projects that involve real estate development, recreation, commerce, tourism, and components of transportation like walking and bicycling. The projects often take place in neighborhoods with low property values. The establishment of such projects often attracts residents with the ability to pay more for rent. Environmental gentrification can occur when wealthy residents move into a low-income neighborhood and displace long-term low-income residents. Instead of mitigating unequal access to green space, large green infrastructure projects run the risk of promoting environmental gentrification. This was the case with the development of the High Line in New York City’s Chelsea neighborhood. From 2004 to 2014, the park’s construction transformed a neighborhood of mostly working-class residents in Manhattan’s West Side to an area rezoned for luxury development. Within 5 years, property values increased by 103% from initial values that sat 8% below the median for Manhattan. Traditional residents of the neighborhood were effectively driven out. Addressing inequities in the distribution of urban green space requires multidisciplinary partnerships between actors such as public health practitioners, urban developers, and environmentalists. The 11th Street Bridge Park project in Washington DC aims to do just that with an Equitable Development Plan that leverages collaboration between such actors and input from community members. Feature image by JL08, Central Park (detail), CC BY-NC-ND 2.0 [post_title] => Green Dreams [post_excerpt] => Greater access to green space is associated with less depression, reduced neighborhood crime, and enhanced community satisfaction. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => green-dreams [to_ping] => [pinged] => [post_modified] => 2019-04-04 14:33:47 [post_modified_gmt] => 2019-04-04 18:33:47 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6675 [menu_order] => 0 [post_type] => bu_research [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 )

Greater access to green space is associated with less depression, reduced neighborhood crime, and enhanced community satisfaction.

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Research

Fixing Disability

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                    [post_date] => 2019-04-08 07:00:31
                    [post_date_gmt] => 2019-04-08 11:00:31
                    [post_content] => In a recent study, researchers upend the widely held belief that disability among the elderly is impossible to change. By addressing both personal and environmental factors, the CAPABALE (Community Aging in Place Advancing Better Life for Elders) intervention helped low-income, disabled individuals over the age of 65 live at home longer and feel more confident in their ability to take care of themselves.

To test CAPABLE, researchers conducted a randomized clinical trial assessing participants’ ability to do home activities, home safety risk, and participant goals. Goals included things like taking a shower without help, walking downstairs, or getting dressed without pain. The intervention group received home repairs up to $1,300 per individual. Leveling floors or stabilizing stairs allowed participants to practice new activities at home safely. Finally, to address depressive symptoms, participants had regular meetings with study staff to develop and implement coping strategies.

The control group had the same number of interactions with study staff, but simply identified sedentary activities they would like to learn to enjoy more, such as listening to music or using the internet.

What’s striking about this intervention is that it caters to individuals in a way that health care normally doesn’t. Rather than assuming one-size fits all approach, researchers identified that individuals’ unique personal and environmental needs and sought to address each of them.
As we approach 2030, expanding CAPABLE and programs like it should be a priority.  
Nine in 10 intervention group participants reported that, overall, they benefited from the program compared to six in ten of control group participants. This included feeling that the program made it possible to live at home longer (79.8% vs 43.4%) and made life easier and living at home safer (82.3% vs. 43.1%). Participants also felt better equipped to take care of themselves as a result of the program and reported that CAPABLE lessened upset,  associated with their disability than control groups members. Researchers also reported that CAPABLE has the potential to keep costs down without compromising quality of care. In fact, the Centers for Medicare and Medicaid Services (CMS) estimates that the average CAPABLE participant would save Medicare $22,000 over 2 years. Programs like CAPABLE are especially important as the US will have more people above the age of 65 than children by 2030. As people age, many will confront illness and disability – and their associated costs. In 2012, the CMS reported that per-person health care spending among those age 65 and older was five times higher than any other group. The steady rise in Medicare spending has even raised concerns about how long Medicare can remain solvent. In 2018, it was projected that the Medicare Trust Fund (the account all Americans pay into to finance Medicare) would run out of money by 2026. Elderly individuals who are both low-income and disabled are typically eligible for both Medicare and Medicaid (also known as “dual eligibles”) and cost CMS over $300 billion annually. Given that disabilities are common among elderly individuals and are associated with poor quality of life, depression, increased illness, and other negative effects, an increased focus should be placed on how to implement programs like CAPABLE that help individuals regain or maintain functional status at home while also reducing costs. So far CAPABLE has been implemented in 22 cities and 11 rural areas. As we approach 2030, expanding CAPABLE and programs like it should be a priority. Photo by David Sinclair on Unsplash [post_title] => Fixing Disability [post_excerpt] => CAPABLE has the potential to keep costs down without compromising quality of care for elderly populations with disabilities. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => fixing-disability [to_ping] => [pinged] => [post_modified] => 2019-04-09 11:12:37 [post_modified_gmt] => 2019-04-09 15:12:37 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6617 [menu_order] => 0 [post_type] => bu_research [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 )

CAPABLE has the potential to keep costs down without compromising quality of care for elderly populations with disabilities.

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Research

Wages and Waffles

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                    [post_date] => 2019-04-05 05:00:44
                    [post_date_gmt] => 2019-04-05 09:00:44
                    [post_content] => The United States’ federal minimum wage has failed to keep pace with inflation since 1968, and therefore lower-income populations spend increasingly higher percentages of their paychecks on food. One challenge for low-income individuals seeking a higher quality diet is the cost of healthy foods. If wages increase but food prices remain unchanged, it is possible that low-income individuals would have the means to afford healthier foods. Recently, James Buszkiewicz and colleagues analyzed that premise in Seattle, a city that has been slowly raising its minimum wage and where employers with great than 500 employees were required to raise hourly wages to $15 by 2017.

Buszkiewicz and his team identified six supermarket chains located in Seattle (where wages were going up) and locations outside Seattle, in King County, where there was no requirement to increase wages. For two years, the researchers purchased the same groceries in supermarkets of low-income neighborhoods in both Seattle and King County.



The graph above shows how the cost changed throughout the two years in the two locations. Although food prices were consistently more expensive in Seattle than King County, the change over time was consistent. This means that the increased minimum wage had no effect on the overall cost of the groceries purchased by the researchers. In other words, if the increased minimum wage had had an effect on food prices, the price difference between the locations would have grown over time as Seattle prices increased and those in King County would have remained flat.
The United States’ federal minimum wage has failed to keep pace with inflation since 1968, and therefore lower-income populations spend increasingly higher percentages of their paychecks on food.  
“We see incentive (e.g. Fresh Bucks) and taxation (Seattle Sweetened Beverage Tax) programs as means to curb unhealthy consumption and make healthy choices easier,” says Buszkiewicz. “Given the findings of Jardim (2018) and our finding of null effects on effects on grocery prices, higher earnings could result in low-wage earning families having more money to spend on fresh produce or other healthy items that we know are linked to better diet-related health outcomes.” While there was good news that raising the minimum wages did not hurt supermarket prices in this case, the researchers caution that large supermarket chains’ prices are more likely to be affected by national economic trends, which is important in light of the ongoing push to increase the federal minimum wage. Figure via “The Impact of a City-Level Minimum Wage Policy on Supermarket Food Prices by Food Quality Metrics: A Two-Year Follow Up Study,” International Journal of Environmental Research and Public Health. 2019;16(1). Photo by Fancycrave on Unsplash [post_title] => Wages and Waffles [post_excerpt] => Supermarkets' prices are more likely to be affected by the nation's economy, which is important in light of the push to increase the federal minimum wage. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => wages-and-waffles [to_ping] => [pinged] => [post_modified] => 2019-04-04 14:31:16 [post_modified_gmt] => 2019-04-04 18:31:16 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6691 [menu_order] => 0 [post_type] => bu_research [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 )

Supermarkets’ prices are more likely to be affected by the nation’s economy, which is important in light of the push to increase the federal minimum wage.

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Research

The Algorithms We Live With

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                    [post_date] => 2019-04-04 07:00:29
                    [post_date_gmt] => 2019-04-04 11:00:29
                    [post_content] => Algorithms have the potential to improve health. But do they also have the potential to cause illness or negatively affect our mental health?

Some time ago I began receiving emails from Amazon with hints on how to raise my child. I receive these emails a few times a year. The most recent email said, “Your 5 Year Old: How to raise responsible kids.” I don’t recall signing up  for these emails. More importantly, I don’t have a five year old. But I do have a five year old niece. Five years ago, when my niece was born, we probably spent too much time and money buying baby essentials on Amazon. Is this the data Amazon algorithms used to decide that I have a 5 year old? I don’t know.

These emails have little effect on me. Sometimes I forward them to my sister and other times, I just ignore them. But such messages might have a different effect on a person who has lost a child.

Here’s another scenario. Manyor is pregnant with her first child. She is excited and looking forward to becoming a mom. Manyor signs up for a pregnancy app, which allows her to track her pregnancy and learn about her health as her pregnancy progresses. A few weeks into her pregnancy, Manyor has a miscarriage. She is sad and struggles with her loss. She obviously stops entering information into the pregnancy app.

Two weeks later, she starts receiving reminders from the app. She immediately deletes it. A month later, she is still receiving email reminders asking her to enter information about her pregnancy. Manyor is annoyed. She thought she was recovering well but now she’s unsure. The reminders trigger persistent feelings of grief and guilt. Can we measure the impact of the app’s reminders on Manyor‘s mental health?
Algorithms have the potential to improve health. But do they also have the potential to cause illness or negatively affect our mental health?  
Now let’s talk about Esono who is having marital problems. Esono is struggling with anxiety and insecurity. He uses an internet search engine a few times to gather information on how to improve his marriage. A couple of weeks later, while using the same search engine, he notices ads for how to recover after a failed relationship. He ignores them. The next day, while checking his email, he notices an ad on how to find a good divorce lawyer. Over the next week, he sees versions of these messages posted in his email, social media, and the other Internet platforms he uses. Could these messages worsen Esono’s feelings of anxiety and insecurity? As humans we also have algorithms that we use in our daily decision making. For example, if I find a seat on a crowded bus and the next person who enters is pregnant, using a cane, or accompanied by a small child, I use an algorithm to decide whether or not to give up my seat to them. Or, if a woman arrives at a medical center claiming to have a painful medical condition, caregivers choose whether to believe her or not based on a formula they internalized during their training or previous life experiences. These decisions can influence health. And, similar to computer algorithms, we can update our algorithms as we gather new data and experiences. Algorithms are everywhere. Companies use algorithms to make recommendations and to improve customer experience. Sometimes these algorithms make suggestions for good books and other times, they make suggestions for good divorce lawyers. Algorithms are also constantly trying to make our lives easier, including completing our sentences as we draft emails. But exactly how these algorithms are affecting our health remains unknown. Photo by Daniel Josef on Unsplash [post_title] => The Algorithms We Live With [post_excerpt] => Algorithms have the potential to improve health. But do they also have the potential to cause illness or negatively affect our mental health? [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-algorithms-we-live-with [to_ping] => [pinged] => [post_modified] => 2019-04-04 14:30:42 [post_modified_gmt] => 2019-04-04 18:30:42 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6661 [menu_order] => 0 [post_type] => bu_research [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 )

Algorithms have the potential to improve health. But do they also have the potential to cause illness or negatively affect our mental health?

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Research

Ridesharing and Access to Health Care

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                    [post_date] => 2019-04-03 07:00:12
                    [post_date_gmt] => 2019-04-03 11:00:12
                    [post_content] => Hospitals and clinics who partner with Uber and Lyft may be solving for patients’ transportation needs, but it might not improve access to health care.

This may sound puzzling as transportation has long been understood as a major barrier to care. In a review of 61 studies, transportation was consistently related to missed appointments among low-income or minority patients in the US across various geographic settings, disease types, and age groups. Among the two survey-based studies, 50% reported missing an appointment because they lacked adequate transportation.

The transportation barriers persist for low-income patients despite state Medicaid programs providing non-emergency medical transportation (NEMT) benefits, including vouchers for public transportation and rides from private contractors. Millions miss appointments every year. The delivery of NEMT may be a barrier. Rides are often scheduled days to weeks in advance of an appointment. Travel and wait times can be long because of indirect routes related to picking up and dropping off multiple passengers. Measuring NEMT’s impact on access has been challenging because most services do not collect data on who uses these services, how often, and for what. When travel data is available we cannot easily link it with clinical data to measure outcomes such as missed appointments, avoidable hospitalizations, or better health outcomes.

Ridesharing has been proposed as a promising solution. With companies like Uber and Lyft, a wide network of drivers is readily available for on-demand pick-up or drop-off and the costs can easily be tracked – a likely win-win. Patients could have more reliable rides and a better travel experience. Hospitals, clinics, and insurers could see who uses rides when and measure whether rides reduce missed appointments and improve clinical outcomes.

Through two sequential studies, we tested whether ridesharing could reduce missed appointments for Medicaid enrollees with primary care appointments at the University of Pennsylvania Health System. In the pilot study, we found the likelihood of appointment attendance was 2.5-fold higher in a clinic after ridesharing was offered. However, in the more statistically rigorous subsequent trial where we randomized patients to receiving ridesharing versus not, we found no difference.
Hospitals and clinics who partner with Uber and Lyft may be solving for patients’ transportation needs, but it might not improve access to health care.  
Why might this be the case? Through these studies and ongoing work, my team and I have learned a few key lessons. First, identifying who needs transportation, when, and at what cost will be a critical step going forward. For example, patients with diabetes or receiving dialysis may benefit from unrestricted transportation services because the programmatic costs are small compared to downstream costs of disease complications. Providing rides for blood pressure checks may not have the same favorable financial tradeoffs. Second, identifying why a patient misses an appointment remains key. Imagine a patient’s car stops working, but that day their child is also sick or they are now worried about getting groceries for the evening. So, instead of scrambling to find transportation, they skip their appointment because other needs became paramount. Framing appointment attendance as simply a transportation problem doesn’t capture the likely influence of many other social forces. Finally, what if the medical appointment is the wrong problem to solve? What if, instead of structuring appointments around provider schedules and locations, we structured medical care around better patient experiences and the journey through health care? Reframing the problem may lead to non-transportation based solutions, like telemedicine or e-visits. We should meet patients where they are and when convenient. Then patients will be more likely to get the care they need and achieve the outcomes the health sector wants. Achieving better health and access to care is a goal that aligns health care organizations, social services, and public health to care for patients. As national attention is focusing on identifying the social determinants of health, reframing what problem needs solving remains critical. If inadequate transportation is the challenge, then we should provide more and better ride options. If access is the challenge, we need to rethink how health care can be delivered in a more accessible way. Ridesharing may only be a small part of the ultimate solution. Photo by Tim Gouw on Unsplash [post_title] => Ridesharing and Access to Health Care [post_excerpt] => Hospitals and clinics who partner with Uber and Lyft may be solving for patients’ transportation needs, but it might not improve access to health care. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => ridesharing-and-access-to-health-care [to_ping] => [pinged] => [post_modified] => 2019-04-01 12:53:58 [post_modified_gmt] => 2019-04-01 16:53:58 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6610 [menu_order] => 0 [post_type] => bu_research [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 )

Hospitals and clinics who partner with Uber and Lyft may be solving for patients’ transportation needs, but it might not improve access to health care.

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Research

How Does Childhood Trauma Impact Adults’ Health?

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                    [post_date] => 2019-04-02 07:00:26
                    [post_date_gmt] => 2019-04-02 11:00:26
                    [post_content] => Adverse Childhood Experiences (ACEs) are different types of mistreatment, household dysfunction, or neglect that occur during childhood. The investigation of ACEs and how they might affect disease, disability, and early mortality in adulthood began in the 1990s by the CDC and Kaiser Permanente. Although such childhood experiences are unfortunately common in American families, the full range of the effects of ACEs are under-studied.

A study by Nagy Youssef and colleagues looked at the relationship between ACEs and the development of depressive symptoms. They were most interested in resilience, the ability to cope with stress and thrive in the face of adversity, which they believed might mitigate the impact of depression. The researchers evaluated ACE questionnaire scores—a list of particular forms of childhood mistreatments—from over 400 study participants to evaluate their exposure to physical abuse, emotional neglect, domestic violence, and other adverse experiences prior to age 18. The more experiences of childhood adversity, the higher the ACE score.
Resilience develops over the life course. To build resilience and overcome the harmful impacts of abuse, neglect, and household dysfunction, children at risk must first be identified.  
Most participants in the study had mild exposure (an occurrence of 1-2 ACEs) to childhood adversity. Household dysfunction as a result of parental marital discord was found to be the most common ACE. Of particular importance, the investigators showed that ACEs have a dose-response relationship with depression: as the exposure to childhood trauma increases, so too do symptoms of depression. Encouragingly, young adults with high ACE scores who possessed high levels of self-confidence, self-efficacy, and optimism, among other characteristics of resilience, showed fewer depressive symptoms than those with low levels of these attributes. These results suggest that individual resilience mitigates the development of depression in young adults with a history of childhood adversity. Resilience develops over the life course. To build resilience and overcome the harmful impacts of abuse, neglect, and household dysfunction, children at risk must first be identified. The ACE questionnaire and other measures to recognize childhood adversity need to be administered in clinical or school settings. Finding and fostering nurturing relationships within the broader community in which a child grows is key to recover from difficult suffering. Photo by Gaelle Marcel on Unsplash [post_title] => How Does Childhood Trauma Impact Adults' Health? [post_excerpt] => Finding and fostering nurturing relationships within the broader community in which a child grows is key to recover from difficult home suffering. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => how-does-childhood-trauma-impact-adults-health [to_ping] => [pinged] => [post_modified] => 2019-04-04 14:30:24 [post_modified_gmt] => 2019-04-04 18:30:24 [post_content_filtered] => [post_parent] => 0 [guid] => https://www.publichealthpost.org/?post_type=bu_research&p=6615 [menu_order] => 0 [post_type] => bu_research [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 )

Finding and fostering nurturing relationships within the broader community in which a child grows is key to recover from difficult home suffering.

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