Employer-Based Insurance: Coverage and Cost

Explores the variation in cost by employers and enrollees, types of employers that offer coverage, access to coverage by workers, and how costs would change, especially for small businesses, if new policies required coverage for all full-time workers

Relative deprivation, poor health habits and mortality.

Abstract While a large body of evidence relates low absolute income to premature mortality, a recent and growing literature argues that relative income influences health as well. Low relative income, or being deprived relative to one's reference group, may cause stress and depression. These conditions are linked to mortality both directly (via heart disease, high blood pressure, and suicide) and indirectly (via increased smoking, poor eating habits, and alcohol abuse). Evidence from biology supports the notion that relative status may influence health outcomes. In this paper, we use restricted-use micro-level data from the National Health Interview Survey (NHIS) Multiple Cause of Death Files (MCOD) from 1988 to 1991 to examine whether relative deprivation increases the probability of dying. We define reference groups using a combination of characteristics including state, race, education, and age, and measure relative deprivation with Yitzhaki's index. Our use of individual-level data allows us to for control for characteristics that are specific to reference group. Results indicate that high relative deprivation increases the probability of dying in all age groups and for those death categories with a high behavioral component. Those with high relative deprivation are more likely to self-report poor health, have high blood pressure or disabilities, and have a host of poor health habits including smoking, not wearing safety belts, high body mass index and not exercising. For nearly all health measures, our results suggest that much of the observed statistical relationship between absolute level of income and health found in previous work is actually measuring the impacts of relative deprivation on health

Ambient Particulate Matter Air Pollution and Venous Thromboembolism in the Women’s Health Initiative Hormone Therapy Trials

BackgroundThe putative effects of postmenopausal hormone therapy on the association between particulate matter (PM) air pollution and venous thromboembolism (VTE) have not been assessed in a randomized trial of hormone therapy, despite its widespread use among postmenopausal women.ObjectiveIn this study, we examined whether hormone therapy modifies the association of PM with VTE risk.MethodsPostmenopausal women 50–79 years of age (n = 26,450) who did not have a history of VTE and who were not taking anticoagulants were enrolled in the Women’s Health Initiative Hormone Therapy trials at 40 geographically diverse U.S. clinical centers. The women were randomized to treatment with estrogen versus placebo (E trial) or to estrogen plus progestin versus placebo (E + P trial). We used age-stratified Cox proportional hazard models to examine the association between time to incident, centrally adjudicated VTE, and daily mean PM concentrations spatially interpolated at geocoded addresses of the participants and averaged over 1, 7, 30, and 365 days.ResultsDuring the follow-up period (mean, 7.7 years), 508 participants (2.0%) had VTEs at a rate of 2.6 events per 1,000 person-years. Unadjusted and covariate-adjusted VTE risk was not associated with concentrations of PM 0.05) regardless of PM averaging period, either before or after combining data from both trials [e.g., combined trial-adjusted hazard ratios (95% confidence intervals) per 10 μg/m3 increase in annual mean PM2.5 and PM10, were 0.93 (0.54–1.60) and 1.05 (0.72–1.53), respectively]. Findings were insensitive to alternative exposure metrics, outcome definitions, time scales, analytic methods, and censoring dates.ConclusionsIn contrast to prior research, our findings provide little evidence of an association between short-term or long-term PM exposure and VTE, or clinically important modification by randomized exposure to exogenous estrogens among postmenopausal women

The relationship between urban sprawl and coronary heart disease in women

Studies have reported relationships between urban sprawl, physical activity, and obesity, but—to date—no studies have considered the relationship between sprawl and coronary heart disease (CHD) endpoints. In this analysis, we use longitudinal data on post-menopausal women from the Women’s Health Initiative (WHI) Clinical Trial to analyze the relationship between metropolitan statistical area (MSA)-level urban compactness (the opposite of sprawl) and CHD endpoints including death, any CHD event, and myocardial infarction. Models control for individual and neighborhood sociodemographic characteristics. Women who lived in more compact communities at baseline had a lower probability of experiencing a CHD event and CHD death or MI during the study follow-up period. One component of compactness, high residential density, had a particularly noteworthy effect on outcomes. Finally, exploratory analyses showed evidence that the effects of compactness were moderated by race and region

The Women's Health Initiative: The Food Environment, Neighborhood Socioeconomic Status, BMI, and Blood Pressure

Using data (n=60,775 women) from the Women’s Health Initiative Clinical Trial (WHI CT)— a national study of postmenopausal women aged 50 to 79 years — we analyzed cross-sectional associations between the availability of different types of food outlets in the 1.5 miles surrounding a woman’s residence, census tract neighborhood socioeconomic status (NSES), body mass index (BMI) and blood pressure (BP)

Relative Deprivation, Poor Health Habits and Mortality

Using individual-level on males data from the 1988-1991 National Health Interview Survey Multiple Cause of Death Files, we examine the impact of relative deprivation within a reference group on health. We use measures of relative deprivation based on Yitzhaki’s index and define reference groups using combinations of state, race, education, and age. Those with high relative deprivation have a higher probability of death, are more likely to self-report poor health, have high blood pressure or disabilities, and have a host of poor health habits including smoking, not wearing safety belts, high body mass index and not exercising.

Post-Deployment Stress: What Families Should Know, What Families Can Do

Information is covered for families of veterans returning from deployment in Iraq or Afghanistan about post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and other emotional and behavioral problems that veterans may face. Before developing this pamphlet, companion to CP-534-IADIF (Post-Deployment Stress: What You Should Know, What You Can Do), RAND surveyed a couple hundred existing educational materials on these topics. The researchers then coded and classified these materials and reviewed them to identify gaps in information and to isolate the best materials from which to draw upon. Based on these refined materials, the booklet was further improved by feedback from RAND Corporation experts, other military mental health experts, and nine focus groups including service members and their families

The Women\u27s Health Initiative: The food environment, neighborhood socioeconomic status, BMI, and blood pressure

Using data (n = 60,775 women) from the Women\u27s Health Initiative Clinical Trial (WHI CT)-a national study of postmenopausal women aged 50-79 years-we analyzed cross-sectional associations between the availability of different types of food outlets in the 1.5 miles surrounding a woman\u27s residence, census tract neighborhood socioeconomic status (NSES), BMI, and blood pressure (BP). We simultaneously modeled NSES and food outlets using linear and logistic regression models, adjusting for multiple sociodemographic factors, population density and random effects at the tract and metropolitan statistical area (MSA) level. We found significant associations between NSES, availability of food outlets and individual-level measurements of BMI and BP. As grocery store/supermarket availability increased from the 10th to the 90th percentile of its distribution, controlling for confounders, BMI was lower by 0.30 kg/m(2). Conversely, as fast-food outlet availability increased from the 10th to the 90th percentile, BMI was higher by 0.28 kg/m(2). When NSES increased from the 10th to the 90th percentile of its distribution, BMI was lower by 1.26 kg/m(2). As NSES increased from the 10th to the 90th percentile, systolic and diastolic BP were lower by 1.11 mm Hg and 0.40 mm Hg, respectively. As grocery store/supermarket outlet availability increased from the 10th and 90th percentiles, diastolic BP was lower by 0.31 mm Hg. In this national sample of postmenopausal women, we found important independent associations between the food and socioeconomic environments and BMI and BP. These findings suggest that changes in the neighborhood environment may contribute to efforts to control obesity and hypertension