Women's Health in California: Health Status, Health Behaviors, Health Insurance Coverage and Use of Services Among California Women Ages 18-64

Based on California Health Interview Survey data, examines women's health status; physical activity, smoking and alcohol use; insurance coverage; access to and sources of health care; and use of preventive screenings; by income, race/ethnicity, and age

California Adolescents Increasingly Inactive

Explores the health benefits of regular exercise; the extent to which adolescents in California are getting adequate levels of physical activity; and factors that affect high rates of inactivity. Provides policy recommendations

Low-Income Adolescents Face More Barriers to Healthy Weight

Examines the causes behind the higher prevalence of obesity among low-income adolescents, including unhealthy food environments, few opportunities for physical activity, and irregular family meals. Makes policy recommendations to address such disparities

Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes

Examines the link between a community's retail food environment -- the ratio of fast-food outlets and convenience stores to grocery stores and produce vendors, with income level as a factor -- and the prevalence of adult obesity and diabetes

The Association between Mediated Deprivation and Ovarian Cancer Survival among African American Women

BACKGROUND: Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer. METHODS: We used mediation analysis to look at the direct and indirect causal effects of deprivation indices with main mediators of the SEER stage at diagnosis and residual disease. The analysis employed Bayesian structural equation models with variable selection. We applied a joint Bayesian structural model for the mediator, including a Weibull mixed model for the vital outcome with deprivation as exposure. We selected modifiers via a Monte Carlo model selection procedure. RESULTS: The results suggest that high SES-related indices, such as Yost, Kolak urbanicity (URB), mobility (MOB) and SES dimensions, and concentrated disadvantage index (CDI), all have a significant impact on improved survival. In contrast, area deprivation index (ADI)/Singh, and area level poverty (POV) did not have a major impact. In some cases, the indirect effects have very wide credible intervals, so the total effect is not well estimated despite the estimation of the direct effect. CONCLUSIONS: First, it is clear that commonly used indices such as Yost, or CDI both significantly impact the survival experience of Black women diagnosed with epithelial ovarian cancer. In addition, the Kolak dimension indices (URB, MOB, mixed immigrant: MICA and SES) also demonstrate a significant association, depending on the mediator. Mediation effects differ according to the mediator chosen

Area-level socioeconomic status and cancer outcomes: Is there an association and can it be explained by behavior?

Thesis (Ph.D.)--University of Washington, 2013Increasingly, area-level socioeconomic status (SES) is recognized as an important predictor of health outcomes and health behaviors independent of individual-level socioeconomic characteristics; however, associations between area-level SES and cancer outcomes are not well understood. Ecologic evidence suggests a relationship between area-level socioeconomic status and cancer incidence and mortality; however, fewer studies have included measures of individual socioeconomic status to assess whether observed associations are due to the compositional effect of the individuals living within the areas of interest. Little is known about individual-level behaviors or risk factors that may explain the pathways through which area-level socioeconomic factors could affect cancer risk. In an effort to summarize risk behaviors that affect cancer risk, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published eight recommendations related to body weight, physical activity and dietary behaviors aimed at reducing cancer incidence worldwide, based on a comprehensive review of the literature related to common cancers. However, the reduction in total and site-specific cancer risk and cancer mortality associated with adhering to these guidelines is unknown. Using data from the VITamins And Lifestyle (VITAL) cohort study, including 77,719 adults aged 50-76 at baseline in 2000-2002 and living in the 13 counties of the Western Washington Surveillance, Epidemiology and End Results (SEER) cancer registry, we examined whether meeting the WCRF/AICR cancer prevention recommendations related to body fatness, physical activity, energy density of the diet, fruit and vegetable intake, consumption of red and processed meats and alcohol use was associated with reductions in total cancer mortality. We further used data from the 2000 U.S. Census to develop an area-level SES index for the block group of residence of each VITAL participant to examine whether area-level SES is associated with total and site-specific cancer incidence and cancer mortality. Finally, we examined whether and to what extent individual modifiable risk factors including the WCRF/AICR recommendations examined plus cancer screening and pack-years of smoking explained the observed association between area-level SES and cancer mortality. Each additional WCRF/AICR recommendation met was associated with a 9% reduction in total cancer mortality (hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.87, 0.96) among participants with no history of cancer at baseline. Meeting at least five recommendations was associated with a 60% reduction in cancer mortality compared with meeting no recommendations (HR: 0.40, 95% CI: 0.25, 0.62). These associations were similar among men and women and among participants older and younger than 65 years at baseline, but the association was somewhat stronger among non-smokers (HR per recommendation: 0.85, 95% CI: 0.78, 0.93) than among ever-smokers (HR: 0.94, 95% CI: 0.88, 1.00; Ptrend = 0.091). After controlling for age, sex, race/ethnicity, and marital status, living in areas in the lowest quintile of area-level SES was associated with increased lung cancer incidence (HR: 2.21, 95% CI: 1.69, 2.90) and colorectal cancer incidence among men (HR: 1.75, 95% CI: 1.14, 2.70) and total cancer mortality (HR: 1.68, 95% CI: 1.47, 1.93) compared with living in areas in the highest quintile of area-level SES. Further controlling for compositional factors including individual education and household income weakened but did not eliminate these associations (HR for lung cancer: 1.43, 95% CI: 1.07, 1.91; HR for colorectal cancer: 1.53, 95% CI: 0.99, 2.38; HR for cancer mortality: 1.28, 95% CI: 1.11, 1.48). Among participants with no history of cancer at baseline, living in areas in the lowest quintile of area-level SES was associated with 77% higher cancer mortality than living in areas in the highest quintile of area-level SES (HR: 1.77, 95% CI: 1.50, 2.11). Adding individual-level modifiable risk factors into the models reduced the observed association by 45% (95% CI: -72%, -15%). In models further controlling for individual education and income, area-level SES remained associated with cancer mortality (HR for highest- vs. lowest-SES areas: 1.37, 95% CI: 1.14, 1.65) and adding modifiable risk factors reduced the association by 37% (95% CI: -93%, 22%). Smoking, screening and physical activity explained the largest proportion of the association in both models. Adherence to the WCRF/AICR cancer prevention recommendations developed to reduce incidence of common cancers could substantially reduce cancer mortality. Living in low-SES areas is associated with increased lung cancer incidence, increased colorectal cancer incidence among men, and higher total cancer mortality. These associations are largely, but not completely, explained by individual education and income. The association between area-level SES and cancer mortality is also partially explained by behavior, particularly smoking, physical activity, and screening; but area-level SES remains associated with cancer mortality after accounting for individual SES and behaviors, suggesting a possible contextual effect of area-level SES independent of these factors

Women's Health in California: Health Status, Health Behaviors. Health Insurance Coverage and Use of Services Among California Women Ages 18-64

This report examines important health concerns of nonelderly women (ages 18-64) in California, including their health status, selected health behaviors, health insurance coverage, usual source of care and access to health care. The authors examine how these health measures vary among women by family income and by race/ethnicity, with a focus on women often disproportionately affected by lack of consistent policies that promote health and access to health care. They also look at difference by age group, to examine the changing health care issues and needs of women at different points in their lives. Using data from the 2005 and 2001 California Health Interview Survey, the first section of the report examines women's self-reported health status, activity limitations and health condition prevalence. The second section of the report looks at selected health behaviors -- physical activity level, smoking and alcohol use. The third section covers the current state of health insurance coverage for women, including the characteristics of uninsured women. Finally, the report addresses issues of access to care: where women receive care; their use of safety-net providers; and their use of physician services and preventive screenings

Teens Living in Disadvantaged Neighborhoods Lack Access to Parks and Get Less Physical Activity

Teens living in neighborhoods with high concentrations of low-income households are unlikely to have a safe park near their home and are more likely to get less physical activity, according to this policy brief from the UCLA Center for Health Policy Research. The policy brief finds the same trends among teens in neighborhoods with higher unemployment rates, lower levels of education and higher levels of household crowding. Based on data from the 2003 California Health Interview Survey, the U.S. Census and park location information, this policy brief examines adolescent physical activity and access to parks as a function of the characteristics of the neighborhoods in which they live. Specifically, this brief shows that physical activity and access to parks vary with neighborhood characteristics, including concentration of low-income households, crowding, unemployment rates and level of education. These neighborhood characteristics serve as indicators of neighborhood disadvantage and point to neighborhoods that are likely to have limited resources

Access to Safe Parks Helps Increase Physical Activity Among Teenagers

More than one in four California adolescents -- nearly one million in all -- get less than the recommended levels of physical activity, but neighborhood characteristics and access to safe parks have an important effect on whether teens meet activity recommendations, and whether they get any activity at all reports this new health policy research brief using data from the 2003 California Health Interview Survey (CHIS 2003). More teens with access to a safe park get regular physical activity and fewer who have access to a safe park are inactive compared to those who do not have access to a safe park. Access to parks is particularly important for the activity levels of adolescents living in urban areas and for those from low-income families, those living in multi-unit apartment buildings, and those living in neighborhoods perceived as unsafe. This brief presents policy recommendations aimed at improving neighborhood environments and access to parks to encourage physical activity by California adolescents