Pathways from socioeconomic deprivation to bronchiolitis and subsequent childhood asthma

Introduction: Bronchiolitis and childhood asthma are major causes of morbidity among children in the UK, yet there are no preventative or curative measures for most children that develop these conditions. A better understanding of the longitudinal pathways to these conditions is warranted to design effective prevention policies. Using a social determinants of health framework, I explored the pathways between socioeconomic position, bronchiolitis and childhood asthma. Methods: I used national birth cohorts created from linked administrative datasets in my thesis. I used harmonic Poisson regression models to examine associations between socioeconomic deprivation and the seasonality of bronchiolitis admissions in England. I modelled typical trajectories of asthma/wheeze among children in Scotland using latent class growth analysis. Using causal inference methods, I estimated: the socioeconomic disparities in the risk of bronchiolitis admissions that would remain if maternal smoking during pregnancy were eliminated; and the socioeconomic disparities in the risk of chronic trajectories of asthma that would remain if bronchiolitis admissions were eliminated. Results: The peak timing of bronchiolitis admissions varied marginally across England, with earlier peaks in areas with higher population densities. After accounting for seasonal patterns, the North of England had disproportionately higher rates of admissions and, nationwide, disparities followed a socioeconomic gradient. I estimated that eliminating maternal smoking would reduce 20% of socioeconomic disparities in the risk of bronchiolitis admission. I identified four asthma/wheeze trajectories in children: no/infrequent, early-transient, early-persistent and intermediate-onset. Eliminating bronchiolitis admissions could reduce up to 18% of the disparities in the risk of chronic asthma by age ten. Conclusions: Intervening early on the most socioeconomically deprived populations should be central to policies aiming to reduce the incidence of bronchiolitis admissions and asthma. The contribution of other socioeconomically patterned risk factors, including pollution and housing conditions, should be investigated in future work

Behavioral Health among Asian American and Pacific Islanders: The Impact of Acculturation and Receipt of Behavioral Health Services on Depression and Anxiety

Behavioral health models improve access to mental health care by integrating psychology and medicine. While integrated care is supported among the general population, less research focuses on the model with Asian American and Pacific Islanders (AAPIs). AAPIs are low treatment-seeking due to various barriers (e.g., limited English proficiency, stigma, insurance) and acculturation stressors. Using hierarchical linear modeling, this study examined longitudinal depression (PHQ-9) and anxiety (GAD-7) growth trajectories among AAPIs within a behavioral health model and the moderating impact of acculturation and frequency of behavioral health visits. The best fitting model was from a sample who (N = 354; 71.5% female) met the following inclusion criteria: (a) AAPI, (b) over 18 years of age, (c) engaged in three or more behavioral health visits, (d) PHQ-9 and GAD-7 scores at three or more time points, (e) proxy acculturation data. The sample was 39% Vietnamese, mean age was 55.84 (SD = 16.92), and behavioral health visits ranged from 3 to 12. Depression and anxiety growth trajectories indicated significant cubic functions (PHQ-9, β30 = -.077, p \u3c .001; GAD-7, β30 = -.045, p \u3c .001). For depression, there was a non-significant moderating effect of acculturation (β11 = .163, p = .468, β21 = -.005, p = .931, β31 = -.001, p = .770), but significant effect of frequency of behavioral health visits (β12 = .252, p = .005, β22 = -.080, p = .004, β32 = .005, p = .010). For anxiety, there was a non-significant moderating effect of acculturation (β11 = .255, p = .148) and frequency of behavioral health visits (β12 = .126, p = .075) on instantaneous rate of change (i.e., slope). There was a non-significant moderating effect of acculturation (β21 = -.018, p = .687) but significant effect of frequency of behavioral health visits (β22 = -.044, p = .035) on change to the rate of change. Both moderators were non-significant at the cubic level (β31 = -.008, p = .822, β32 = .003, p = .057). Depression and anxiety outcomes among AAPIs improved within the behavioral health model. Moderation by acculturation and frequency of behavioral health visits varied