Prenatal healthcare after sentencing reform: heterogeneous effects for prenatal healthcare access and equity

BACKGROUND: High rates of imprisonment in the U.S. have significant health, social, and economic consequences, particularly for marginalized communities. This study examines imprisonment as a contextual driver of receiving prenatal care by evaluating whether early and adequate prenatal care improved after Pennsylvania’s criminal sentencing reform reduced prison admissions. METHODS: We linked individual-level birth certificate microdata on births (n = 999,503) in Pennsylvania (2009–2015), to monthly county-level rates of prison admissions. We apply an interrupted time series approach that contrasts post-policy changes in early and adequate prenatal care across counties where prison admissions were effectively reduced or continued to rise. We then tested whether prenatal care improvements were stronger among Black birthing people and those with lower levels of educational attainment. RESULTS: In counties where prison admissions declined the most after the policy, early prenatal care increased from 69.0% to 73.2%, and inadequate prenatal care decreased from 18.1% to 15.9%. By comparison, improvements in early prenatal care were smaller in counties where prison admissions increased the most post-policy (73.5 to 76.4%) and there was no change to prenatal care inadequacy (14.4% pre and post). We find this pattern of improvements to be particularly strong among Black birthing people and those with lower levels of educational attainment. CONCLUSIONS: Pennsylvania’s sentencing reforms were associated with small advancements in racial and socioeconomic equity in prenatal care.1(PG012452-02) - Trustees Of Columbia University In The City Of New York; Trustees Of Columbia University In The City Of New YorkPublished versio

Amount of Time to Eat Lunch Is Associated with Children’s Selection and Consumption of School Meal Entrée, Fruits, Vegetables, and Milk

Background There are currently no national standards for school lunch period length and little is known about the association between the amount of time students have to eat and school food selection and consumption. Objective Our aim was to examine plate-waste measurements from students in the control arm of the Modifying Eating and Lifestyles at School study (2011 to 2012 school year) to determine the association between amount of time to eat and school meal selection and consumption. Design We used a prospective study design using up to six repeated measures among students during the school year. Participants/setting One thousand and one students in grades 3 to 8 attending six participating elementary and middle schools in an urban, low-income school district where lunch period lengths varied from 20 to 30 minutes were included. Main outcome measures School food selection and consumption were collected using plate-waste methodology. Statistical analyses performed Logistic regression and mixed-model analysis of variance was used to examine food selection and consumption. Results Compared with meal-component selection when students had at least 25 minutes to eat, students were significantly less likely to select a fruit (44% vs 57%; PPPP Conclusions During the school year, a substantial number of students had insufficient time to eat, which was associated with significantly decreased entrée, milk, and vegetable consumption compared with students who had more time to eat. School policies that encourage lunches with at least 25 minutes of seated time might reduce food waste and improve dietary intake

Human Papillomavirus Risk Perceptions Among Young Adult Sexual Minority Cisgender Women and Nonbinary Individuals Assigned Female at Birth

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/148405/1/psrh12087_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/148405/2/psrh12087.pd

Gentrification, Neighborhood Change, and Population Health: a Systematic Review

Abstract Despite a proliferation of research on neighborhood effects on health, how neighborhood economic development, in the form of gentrification, affects health and well-being in the USA is poorly understood, and no systematic assessment of the potential health impacts has been conducted. Further, we know little about whether health impacts differ for residents of neighborhoods undergoing gentrification versus urban development, or other forms of neighborhood socioeconomic ascent. We followed current guidelines for systematic reviews and present data on the study characteristics of the 22 empirical articles that met our inclusion criteria and were published on associations between gentrification, and similar but differently termed processes (e.g., urban regeneration, urban development, neighborhood upgrading), and health published between 2000 and 2018. Our results show that impacts on health vary by outcome assessed, exposure measurement, the larger context-specific determinants of neighborhood change, and analysis decisions including which reference and treatment groups to examine. Studies of the health impacts of gentrification, urban development, and urban regeneration describe similar processes, and synthesis and comparison of their results helps bridge differing theoretical approaches to this emerging research. Our article helps to inform the debate on the impacts of gentrification and urban development for health and suggests that these neighborhood change processes likely have both detrimental and beneficial effects on health. Given the influence of place on health and the trend of increasing gentrification and urban development in many American cities, we discuss how future research can approach understanding and researching the impacts of these processes for population health

Product Reformulation and Nutritional Improvements After New Competitive Food Standards in Schools

Objective: In 2012, Massachusetts enacted school competitive food and beverage standards similar to national Smart Snacks. These standards aim to improve the nutritional quality of competitive snacks. It was previously demonstrated that a majority of foods and beverages were compliant with the standards, but it was unknown whether food manufacturers reformulated products in response to the standards. The present study assessed whether products were reformulated after standards were implemented; the availability of reformulated products outside schools; and whether compliance with the standards improved the nutrient composition of competitive snacks. Design: An observational cohort study documenting all competitive snacks sold before (2012) and after (2013 and 2014) the standards were implemented. Setting: The sample included thirty-six school districts with both a middle and high school. Results: After 2012, energy, saturated fat, Na and sugar decreased and fibre increased among all competitive foods. By 2013, 8 % of foods were reformulated, as were an additional 9 % by 2014. Nearly 15 % of reformulated foods were look-alike products that could not be purchased at supermarkets. Energy and Na in beverages decreased after 2012, in part facilitated by smaller package sizes. Conclusions: Massachusetts’ law was effective in improving the nutritional content of snacks and product reformulation helped schools adhere to the law. This suggests fully implementing Smart Snacks standards may similarly improve the foods available in schools nationally. However, only some healthier reformulated foods were available outside schools

Development and Application of a Lifestyle Score for Prevention of Lethal Prostate Cancer

BackgroundSeveral lifestyle factors have been associated with risk of lethal prostate cancer, but little is known about their combined effect. Our objective was to develop and apply a lifestyle score for prevention of lethal prostate cancer.MethodsWe developed a lifestyle score among 42 701 men in the Health Professionals Follow-up Study (HPFS) followed from 1986 to 2010 and applied it among 20 324 men in the Physicians' Health Study (PHS) followed from 1982 to 2010. One point was given for each of: not currently smoking or quit 10 or more years ago, body mass index under 30 kg/m(2), high vigorous physical activity, high intake of tomatoes and fatty fish, and low intake of processed meat. Diet-only scores (range = 0-3) and total scores (range = 0-6) were calculated. We used multivariable Cox proportional hazards regression to estimate the risk of lethal prostate cancer, adjusting for potential risk factors of lethal prostate cancer. All statistical tests were two-sided.ResultsWe observed 576 lethal prostate cancer events in HPFS and 337 in PHS. Men with 5-6 vs 0-1 points had a 68% decreased risk of lethal prostate cancer (hazard ratio [HR] = 0.32, 95% confidence interval [CI] = 0.19 to 0.52) in HPFS and a non-statistically significant 38% decreased risk (HR = 0.62, 95% CI = 0.30 to 1.26) in PHS. For dietary factors only, men with 3 vs 0 points had a 46% decreased risk (HR = 0.54, 95% CI = 0.30 to 0.96) in the HPFS and a non-statistically significant 30% decreased risk (HR = 0.70, 95% CI = 0.40 to 1.23) in PHS.ConclusionsAdhering to a healthy lifestyle, defined by not smoking, normal body weight, high physical activity, and a healthy diet, may lower risk of lethal prostate cancer