Life experiences associated with change in perpetration of domestic violence.

BACKGROUND: This study assessed whether several adult life experiences, including loss of support, loss of food security, loss of housing, and substance use cessation, are associated with change in domestic violence (DV) perpetration from early to later adulthood. Using 2015 to 2016 cross-sectional, self-report survey data from Medicaid enrollees in Oregon (N = 1620), we assessed change in DV perpetration from early adulthood (19-30 years) to later adulthood (≥ 31 years of age), cut points determined by existing survey questions. Multinomial logistic regression models were constructed to estimate the association between life experiences and physical DV perpetration using odds ratios (OR), adjusting for sociodemographic characteristics, DV victimization, and childhood abuse, bullying, and social support. FINDINGS: Of the 20% of participants who perpetrated DV, 36% perpetrated DV in both early and later adulthood (persisters), 42% discontinued (desisters) and 22% began (late-onsetters) perpetration in later adulthood. Loss of support and loss of food security were both associated with change in DV perpetration (i.e., desistance or late onset of perpetration or both). Loss of support was associated with 9.5 times higher odds of being a desister (OR = 9.5, 95% CI = 1.1, 84.1) and 54.2 times higher odds of being a late-onsetter (OR = 54.2, 95% CI = 6.5, 450.8) of DV perpetration compared to persisters. Loss of food security was associated with 10.3 times higher odds of being a late-onsetter (OR = 10.3, 95% CI = 1.9, 55.4) of DV perpetration compared to persisters. In addition, substance use cessation was associated with 10.3 times higher odds of being a desister (OR = 10.3, 95% CI = 1.9, 56.2) compared to persisters. CONCLUSIONS: Findings suggest that specific life experiences in adulthood, including loss of support, loss of food security, and substance use cessation, are associated with changes in DV perpetration

Associations between neighbourhood characteristics and depression: a twin study.

BACKGROUND: Depression is an important contributor to the global burden of disease. Besides several known individual-level factors that contribute to depression, there is a growing recognition that neighbourhood environment can also profoundly affect mental health. This study assessed associations between three neighbourhood constructs-socioeconomic deprivation, residential instability and income inequality-and depression among adult twin pairs. The twin design is used to examine the association between neighbourhood constructs and depression, controlling for selection factors (ie, genetic and shared environmental factors) that have confounded purported associations. METHODS: We used multilevel random-intercept Poisson regression among 3738 same-sex twin pairs from a community-based twin registry to examine the association between neighbourhood constructs and depression. The within-pair association controls for confounding by genetic and environmental factors shared between twins within a pair, and is the main parameter of interest. Models were adjusted for individual-level income, education and marital status, and further by neighbourhood-level population density. RESULTS: When twins were analysed as individuals (phenotypic model), all neighbourhood constructs were significantly associated with depression. However, only neighbourhood socioeconomic deprivation showed a significant within-pair association with depression. A 10-unit within-pair difference in neighbourhood socioeconomic deprivation was associated with 6% greater depressive symptoms (1.06, 95% CI 1.01 to 1.11); the association did not substantially change in adjusted models. CONCLUSION: This study provides new evidence linking neighbourhood socioeconomic deprivation with greater depression. Future studies should employ longitudinal designs to better test social causation versus social selection

Associations Between Fast-Food Consumption and Body Mass Index: A Cross-Sectional Study in Adult Twins

Obesity is a substantial health problem in the United States, and is associated with many chronic diseases. Previous studies have linked poor dietary habits to obesity. This cross-sectional study aimed to identify the association between body mass index (BMI) and fast-food consumption among 669 same-sex adult twin pairs residing in the Puget Sound region around Seattle, Washington. We calculated twin-pair correlations for BMI and fast-food consumption. We next regressed BMI on fast-food consumption using generalized estimating equations (GEE), and finally estimated the within-pair difference in BMI associated with a difference in fast-food consumption, which controls for all potential genetic and environment characteristics shared between twins within a pair. Twin-pair correlations for fast-food consumption were similar for identical (monozygotic; MZ) and fraternal (dizygotic; DZ) twins, but were substantially higher in MZ than DZ twins for BMI. In the unadjusted GEE model, greater fast-food consumption was associated with larger BMI. For twin pairs overall, and for MZ twins, there was no association between within-pair differences in fast-food consumption and BMI in any model. In contrast, there was a significant association between within-pair differences in fast-food consumption and BMI among DZ twins, suggesting that genetic factors play a role in the observed association. Thus, although variance in fast-food consumption itself is largely driven by environmental factors, the overall association between this specific eating behavior and BMI is largely due to genetic factors

Patterns of obesogenic neighborhood features and residential property values

Thesis (Master's)--University of Washington, 2012Obesity is a growing problem in the United States, and past research has investigated ways in which neighborhood characteristics may influence obesity prevalence. However, studying features of the obesogenic neighborhood can be difficult because of the need for complex multilevel analyses. Using data from the Seattle Obesity Study, a cross-sectional study of socioeconomic disparities in diet and health based on a representative sample of 2,001 adult residents of King County, WA, we examined property value as a new metric for capturing aspects of the built environment. We used regression analyses to examine the associations between property value and 22 total self-reported access to neighborhood amenities and perception of neighborhood characteristic variables, and further investigated the association between these neighborhood features and BMI. Eight of the 11 access to amenities variables and ten of the 11 neighborhood perception variables were associated with property values (p<0.001). The largest difference in property values due to access to amenities was associated with access to a convenience store ($60,000 lower property value); the largest differences in property value due to neighborhood perceptions was believing the neighborhood to be attractive, ($100,000 higher property value) and trusting the people in the neighborhood ($90,000 higher property value). We further found that the association between neighborhood features and BMI depended on gender. The data provide evidence that, because of its ability to capture complex information about the built environment, neighborhood perceptions, and socioeconomic status in a single metric, property values can be of great use in epidemiology studies

Neighborhood characteristics, social capital, and depression: a twin study

Thesis (Ph.D.)--University of Washington, 2015INTRODUCTION: Depression is one of the leading contributors to the global burden of disease, and can have a debilitating effect on quality of life. While it is already well-accepted that individual-level factors can influence depression, there is growing recognition of the important role the social and built environment plays in exacerbating or alleviating mental health problems. Depression risk varies across neighborhoods, and differences in neighborhood context may impact depression through diverse pathways, including reduced social services and lack of infrastructure, fear of crime and victimization, and a break down of social trust and community participation. Social capital, a measure of the social environment that encompasses the emotional, economic, and informational resources available to an individual or a group through their social networks, has been hypothesized as a protective factor against depression. It has further been hypothesized as a potential explanatory factor for the association between neighborhood context and depression. There is, however, little consensus about which domains of social capital are most relevant to depression, and while much of the previous literature has shown how social capital differs across neighborhoods, relatively less research is devoted to understanding what causes this variation. Understanding how the neighborhood social and built environment influences depression risk can inform decisions about investing scarce resources in community-based mental health promotion, and may ultimately contribute to a reduction in the burden depression places on individuals and the healthcare system. The goal of this dissertation was to explore pathways linking neighborhood characteristics, social capital, and depression. Although previous literature has evaluated these potential associations, inferences are limited due to concerns about unmeasured genetic and childhood environment confounding and self-selection into neighborhoods. This dissertation contributes to the literature by partially addressing these methodological concerns through the use of a twin study. METHODS: This study uses data from the community-based University of Washington Twin Registry (UWTR). The UWTR contains over 8,000 monozygotic (identical, MZ) and dizygotic (fraternal, DZ) adult twins. It contains extensive survey data on sociodemographics, health behaviors and outcomes, and built environment measures linked to geocoded residential addresses. All twins included in the study were from same-sex pairs. Chapter One assesses the association between five neighborhood environment factors (neighborhood socioeconomic depression, crime, residential instability, gentrification, and income inequality) and depression. Chapter Two examines the association between different domains of social capital (cognitive and structural) and depression, and investigates whether social capital serves as a moderator or a mediator in the neighborhood socioeconomic deprivation-depression pathway. Chapter Three explores possible reasons for the variation of social capital across neighborhoods by assessing the associations between three built environment domains (neighborhood composition, pedestrian-oriented design, and commercial diversity) and social capital in the Puget Sound region of Washington State. All analyses employed a random intercept “within-between” twin model with the outcome hypothesized to follow a Poisson distribution. In this model, the individual-level outcome is regressed on the twin-pair mean exposure and the individual twin’s deviation from their twin pair mean. The within-pair effect is the main parameter of interest because it inherently controls for potential confounding due to genetic and childhood environment factors shared between twins within a pair. RESULTS: In Chapter One, only neighborhood socioeconomic deprivation showed an association with depression in the unadjusted and adjusted models; specifically, higher deprivation was linked to greater depressive symptoms, independent of individual-level sociodemographic characteristics and population density. In Chapter Two, greater cognitive social capital, which refers to how individuals perceive their environment and was measured by sense of belonging, neighborhood social cohesion, workplace connections, and trust, was associated with fewer depressive symptoms. In contrast, structural social capital, which refers to social actions and behaviors and was measured by community participation, volunteerism, and social interactions, was not significantly associated with depression. Further, no social capital measure served as a mediator or a moderator in the neighborhood socioeconomic deprivation-depression association. Finally, in Chapter Three, only property values were linked to any of the neighborhood social capital variables, and these results were mixed. In the unadjusted models, property values were associated with greater sense of belonging, neighborhood social cohesion, and perceived safety; however, the associations were no longer significant in the models adjusted for sociodemographic characteristics. Further, no measure of pedestrian-oriented design or commercial diversity was associated with social capital. CONCLUSION: Overall, these results indicate that both neighborhood socioeconomic deprivation and cognitive social capital are important risk factors for depression, independent of individual-level sociodemographics characteristics. These two factors do not, however, contribute to depression risk through the same pathway, nor does social capital influence the neighborhood socioeconomic deprivation-depression association. Additionally, the study does not provide evidence that differences in characteristics of the built environment can explain differences in the distribution of depression across neighborhoods. This suggests that there is not a strong association between these measures of social capital and built environment, and that specific interventions targeting the built environment may not improve social capital directly. The finding that social capital and neighborhood socioeconomic deprivation do influence depression risk is of great importance; however, other pathways to improving social capital, and therefore depression, will need to be explored

Enhancing Opioid Use Disorder Treatment: Assessing the Impact of Recovery Housing Using a Randomized Controlled Trial

This is a randomized controlled trial assessing the causal impacts of recovery housing for opioid use disorder treatment. Study participants will be assigned randomly to an intervention group (treatment in a clinic plus placement in recovery housing) or control group (treatment in a clinic but without placement in recovery housing). We will follow study participants longitudinally, collecting data on our primary outcome (opioid use, verified by urine screening) and a range of secondary outcomes including objectively measured health and health care outcomes and subjectively measured social, economic, and quality of life outcomes

Social and Behavioral Pathways between Adverse Childhood Experiences and Poor Adult Physical Health: Mediation by Early Adulthood Experiences in a Low-Income Population

Adverse childhood experiences (ACEs) increase the risk of poor health and wellbeing in adulthood. In this study, we tested whether experiences in early adulthood&mdash;intimate partner violence (IPV), substance use, social isolation, and work instability&mdash;mediate the relationship between ACEs and poor physical health in later adulthood. Using data from a large-scale survey of Medicaid enrollees in the Portland metropolitan area, four separate mediation models were constructed to assess the indirect effects of each early adulthood experience and the proportion of the total effect on physical health accounted for by the pathway. Experiencing four or more ACEs increased the risk of poor adult physical health by 50% (RR 1.50). Considered in separate models, mediation by IPV accounted for 14.4% of the total effect; substance use mediated a similar proportion (14.0%). Social isolation was a less substantial mediator (7.6%). Work instability did not mediate the relationship between ACEs and adult physical health in our population. These findings provide evidence that IPV, substance use, and social isolation in early adulthood are part of the pathway between high ACEs and poor adult physical health. Intervening to prevent negative early adult experiences may mitigate some of the long-term effects of childhood trauma on health

Access to green space, physical activity and mental health: a twin study

Increasing global urbanisation has resulted in a greater proportion of the world's population becoming exposed to risk factors unique to urban areas, and understanding these effects on public health is essential. The aim of this study was to examine the association between access to green space and mental health among adult twin pairs. We used a multilevel random intercept model of same-sex twin pairs (4338 individuals) from the community-based University of Washington Twin Registry to analyse the association between access to green space, as measured by the Normalised Difference Vegetation Index and self-reported depression, stress, and anxiety. The main parameter of interest was the within-pair effect for identical (monozygotic, MZ) twins because it was not subject to confounding by genetic or shared childhood environment factors. Models were adjusted for income, physical activity, neighbourhood deprivation and population density. When treating twins as individuals and not as members of a twin pair, green space was significantly inversely associated with each mental health outcome. The association with depression remained significant in the within-pair MZ univariate and adjusted models; however, there was no within-pair MZ effect for stress or anxiety among the models adjusted for income and physical activity. These results suggest that greater access to green space is associated with less depression, but provide less evidence for effects on stress or anxiety. Understanding the mechanisms linking neighbourhood characteristics to mental health has important public health implications. Future studies should combine twin designs and longitudinal data to strengthen causal inference

Mammogram perceptions, communication, and gaps in care among individuals with non-English language preference in Oregon and Washington states

This study examined perceptions of and communication about mammography as drivers of gaps in screening among individuals with non-English language preference (NELP). A survey was fielded in fall 2021 in five languages (Cantonese, English, Russian, Spanish, or Vietnamese) to individuals identified using electronic medical records in Oregon and Washington. The analytic sample consisted of 420 respondents with a median age of 61; approximately 45% of respondents identified as Asian, 37% as Hispanic, Latino, or Spanish origin, and 18% as some other race, ethnicity, or origin. Logistic regression models examined associations between screening and perception and communication items. Individuals who believed mammograms are unnecessary when healthy (aRR = 0.72 [0.57, 0.91]) or absent symptoms (aRR = 0.85 [0.72, 1.00]) were less likely to report a mammogram within the past two years (i.e., be current). Having a provider recommend (aRR = 1.27 [1.09, 1.47]) and discuss mammography (aRR = 1.18 [1.05, 1.32]) were associated with a higher likelihood of being current. Few respondents received written or verbal information in their preferred language (35% and 28.3%, respectively). Financial and logistical support, including language services were most frequently identified as types of support needed to obtain a mammogram. Overall, misperceptions about mammography may act as a barrier but communication may act as a facilitator for individuals with NELP. Provider-patient communication could be an effective way to encourage mammography. Culturally-responsive health promotion materials and provider communication, available in patients’ preferred language, are needed to combat misperceptions and support ongoing, on-time mammography for NELP patients

Local Housing Choice Voucher Distribution Policies Impact Healthcare Utilization: a Randomized Natural Experiment.

While associations between obtaining affordable housing and improved health care are well documented, insufficient funding often forces housing authorities to prioritize limited housing vouchers to specific populations. We assessed the impact of obtaining housing on health care utilization at two urban housing authorities with different distribution policies: Housing Authority A prioritized seniors and people with disabilities, while Housing Authority B prioritized medically complex individuals and families with school-aged children. Both housing authorities used random selection to distribute vouchers, allowing us to conduct a randomized natural experiment of cases and waitlisted controls. No significant demographic differences were present between those receiving vouchers and waitlisted controls. Housing Authority A vouchers were associated with increased outpatient visits (OR = 1.19; P = 0.051). Housing Authority B vouchers decreased the likelihood of emergency department visits (OR = 0.61; P = 0.042). This study provides evidence that, while obtaining housing can result in better health care outcomes overall, local prioritization policies can influence that impact