Community-level characteristics of high infant mortality: A tool to identify at-risk communities

Infant mortality (IM) rate is a key indicator of population health and has been gradually improving in the United States. However, it is still a public health problem among minority and low-income communities. Maternal factors explain some of the variation, but community-level factors may also be a contributor. This study examines measures to identify a set of indicators that explain variations in IM at the community-level. Data for 77 communities in a city were obtained from local health databases. We used multivariable linear regression models to examine the strength of the association between IM and maternal, population, community wealth, and social capital characteristics. Community-level IM rates ranged from 2.1 – 25.6 deaths per 1,000 live births in 2000-2002. The final model explained 75% of the variation in IM rates at the community-level (R2=0.75). The model included a high percentage of low birth weight babies, a decline in mothers who began prenatal care in the second trimester, an increase in the percentage of Hispanics, increased unemployment rates, an increase in the percentage of veterans, an increased rate of foreign-born residents, and smaller average family sizes. Social capital variables, homicide rate and vacant housing, were also significant in the final model. Identifying communities at risk for high IM rates is imperative to improve maternal and child health outcomes because of shortages in public health resources. The development of a parsimonious set of community-level indicators can assist public health practitioners in targeting their resources to prevent infant mortality in high-risk communities

Rationale, Design and Methods of Set the Rules : A Tailored Peer-to-Peer Health Information Intervention

Ensuring equitable access to health information is one strategy to promote health equity for underserved communities, especially for low-income African Americans (AAs). Childcare centers are one viable site to deliver health information to address this disparity. This paper describes the methods used in a community-based participatory research project with a childcare facility that aimed to reduce environmental tobacco smoke (ETS) exposure among low-income AA children. Through collaboration and multiple data collection methods, partners identified communication strategies to overcome informational barriers. These initial findings indicated a peer-to-peer health information intervention, entitled “Set the Rules”, as the best strategy to increase awareness. The goal of the intervention was to build knowledge in reducing the harms of ETS exposure. Twelve community members were trained as parent leaders for the “Set the Rules” workshops and conducted workshops with parents. Even though there were barriers interfacing with all centers, parents that attended the workshop (n = 32) found the peer-to-peer intervention novel and quite helpful and will share the information learned with others. This intervention suggests that a childcare setting is a relevant space to increase access to health information to optimize child health outcomes. More research is necessary to determine if this intervention has salience in other childcare settings and across racial/ethnic groups

Measuring the Impact of the Affordable Care Act Medicaid Expansion on Access to Primary Care Using an Interrupted Time Series Approach

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care. METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to 2015. Segmented regression analysis was utilized to determine the impact of policy reform on PH rates. RESULTS: The Affordable Care Act\u27s Medicaid expansion led to decreased rates of PH (improved access to care); however, the finding was not significant (coefficient estimate: -0.0059, CI -0.0225, 0.0107, p = 0.4856). Healthcare system characteristics, such as Medicaid spending per enrollee and Medicaid income eligibility, were associated with a significant decrease in rates of PH (improved access to care). However, the Medicaid-to-Medicare fee index (physician reimbursement) and states with a Democratic state legislature had a significant increase in rates of PH (poor access to care). CONCLUSION: Health policy reform and healthcare delivery characteristics impact access to care. Researchers should continue evaluating such policy changes across more states over longer periods of time. Researchers should translate these findings into cost analysis for state policy-makers to make better-informed decisions for their constituents. CONTRIBUTION TO KNOWLEDGE: Ambulatory care-sensitive conditions are a feasible method for evaluating policy and measuring access to primary care. Policy alone cannot improve access to care. Other factors (trust, communication, policy-makers\u27 motivations and objectives, etc.) must be addressed to improve access

Racial and Ethnic Disparities in Stroke Outcomes: A Scoping Review of Post-Stroke Disability Assessment Tools

Purpose: To identify how post-stroke disability outcomes are assessed in studies that examine racial/ethnic disparities and to map the identified assessment content to the International Classification of Functioning, Disability, and Health (ICF) across the time course of stroke recovery. Methods: We conducted a scoping review of the literature. Articles published between January 2001 and July 2017 were identified through Scopus, PubMed, CINAHL, and PsycINFO according to predefined inclusion and exclusion criteria. Results: We identified 1791 articles through database and hand-searching strategies. Of the articles, 194 met inclusion criteria for full-text review, and 41 met inclusion criteria for study inclusion. The included studies used a variety of outcome measures encompassing domains within the ICF: body functions, activities, participation, and contextual factors across the time course of stroke recovery. We discovered disproportionate representation among racial/ethnic groups in the post-stroke disability disparities literature. Conclusions: A wide variety of assessments are used to examine disparities in post-stroke disability across the time course of stroke recovery. Several studies have identified disparities through a variety of assessments; however, substantial problems abound from the assessments used including inconsistent use of assessments, lacking evidence on the validity of assessments among racial/ethnic groups, and inadequate representation among all racial/ethnic populations comprising the US. Implications for Rehabilitation An enhanced understanding of racial/ethnic disparities in post-stroke disability outcomes is inherently important among rehabilitation practitioners who frequently engage with racial/ethnic minority populations across the time course of stroke recovery. Clinicians should carefully consider the psychometric properties of assessment tools to counter potential racial bias. Clinicians should be aware that many assessments used in stroke rehabilitation lack cultural sensitivity and could result in inaccurate assessment findings

A Cross-Training Program Does Not Alter Self-Reported Physical Activity Levels in Elementary School Children

The purpose of the study was to examine the effects of a school-based cross-training program on body mass index (BMI), attitudes toward physical activity (ATPA), and physical activity (PA) levels of children in the 4th and 5th grades. Children (N = 118) were divided into control (n = 60) and experimental (n = 58) groups based on class availability. While the control group continued academic classes as usual, the experimental group participated in cross-training involving resistance training (RT), calisthenics, and stretching twice a week for 10 weeks. Pre- and post-intervention measures included height, mass, ATPA, and PA. BMI was calculated and ATPA and PA levels were assessed via questionnaire. The groups did not differ significantly (p \u3e .05) for either pre- or post-intervention regarding BMI, ATPA, and PA. However, BMI and PA levels significantly increased over time for both groups (p ≤ .05). Overall, cross-training in a school setting may be a safe and enjoyable option for physical activity participation. BMI and PA increases were likely the result of the natural growth process and seasonal weather pattern changes, respectively. Nevertheless, the cross-training did not detract from PA levels and may have led to an overall increase in PA levels. As subdomain analyses revealed decreased attitude toward health and fitness in the experimental group, shorter programs involving RT with various protocols are recommended

A Cross-Training Program Does Not Alter Self-Reported Physical Activity Levels in Elementary School Children

International Journal of Exercise Science 11(5): 308-318, 2018. The purpose of the study was to examine the effects of a school-based cross-training program on body mass index (BMI), attitudes toward physical activity (ATPA), and physical activity (PA) levels of children in the 4th and 5th grades. Children (N = 118) were divided into control (n = 60) and experimental (n = 58) groups based on class availability. While the control group continued academic classes as usual, the experimental group participated in cross-training involving resistance training (RT), calisthenics, and stretching twice a week for 10 weeks. Pre- and post-intervention measures included height, mass, ATPA, and PA. BMI was calculated and ATPA and PA levels were assessed via questionnaire. The groups did not differ significantly (p \u3e .05) for either pre- or post-intervention regarding BMI, ATPA, and PA. However, BMI and PA levels significantly increased over time for both groups (p ≤ .05). Overall, cross-training in a school setting may be a safe and enjoyable option for physical activity participation. BMI and PA increases were likely the result of the natural growth process and seasonal weather pattern changes, respectively. Nevertheless, the cross-training did not detract from PA levels and may have led to an overall increase in PA levels. As subdomain analyses revealed decreased attitude toward health and fitness in the experimental group, shorter programs involving RT with various protocols are recommended

Preventable hospital admissions among the homeless in California: A retrospective analysis of care for ambulatory care sensitive conditions

Background Limited research exists that investigates hospital admissions for ambulatory care sensitive conditions (ACSCs) among the homeless, who frequently lack a usual source of care. This study profiled ACSC admissions for homeless patients. Methods Bivariate analyses and logistic regression were completed to investigate ACSC and non-ACSC admissions among homeless patients using the 2010 California State Inpatient Database. Results Homeless patients admitted for an ACSC were mostly male, non-Hispanic white, and on average 49.9 years old. In the predictive model, the odds of an ACSC admission among homeless patients increased when they were black, admitted to the emergency department or transferred from another health facility. Having Medicare was associated with a decreased odds of an ACSC admission. Conclusions Specific characteristics are associated with a greater likelihood of an ACSC admission. Research should examine how these characteristics contribute to ACSC hospitalizations and findings should be linked to programs designed to serve as a safety-net for homeless patients to reduce hospitalizations