Measuring inequity: a systematic review of methods used to quantify structural racism

Abstract Objective: To summarize the ways in which researchers have quantified measures of structural racism for the purposes of empirical, quantitative investigation of its associations with physical and mental health outcomes. Methods: Systematic review of literature published January 1, 2007-June 30, 2017. We searched PubMed and EMBASE databases for studies including at least one of the following search terms in the title or abstract: “structural racism”, “systemic racism”, “institutional racism”, “institutionalized racism”. Excluded studies were not original research, not US based, did not quantify an explicitly named indicator of structural racism, or were qualitative designs. Data from full text articles were abstracted and synthesized. Results: Twenty articles met the final inclusion criteria. Articles included measures of structural racism within the following domains: residential neighborhood/housing, perceived racism in social institutions, immigration and border enforcement, political participation, socioeconomic status, criminal justice, and workplace environment. Conclusions: A burgeoning body of work suggest ways to operationalize and measure structural racism in US society for the purposes of exploring its impacts on individual and population health inequities

Impact of Small Group Size on Neighborhood Influences in Multilevel Models

Objective: Although there is a growing body of literature on sample size in multilevel or hierarchical modeling, few studies have examined the impact of group sizeMultilevel, Neighborhood, Body Weight, Obesity, Sample Size

Impact of Small Group Size on Neighborhood Influences in Multilevel Models

Objective: Although there is a growing body of literature on sample size in multilevel or hierarchical modeling, few studies have examined the impact of group size < 5. Design: We examined the impact of a group size less than five on both a continuous and dichotomous outcome in a simple two-level multilevel model utilizing data from two studies. Setting: Models with balanced and unbalanced data of group sizes 2 to 5 were compared to models with complete data. Impact on both fixed and random components were examined. Results: Random components, particularly group-level variance estimates, were more affected by small group size than were fixed components. Both fixed and random standard error estimates were inflated with small group size. Datasets where there are a large number of groups yet all the groups are of very small size may fail to find or even consider a group-level effect when one may exist and also may be under-powered to detect fixed effects. Conclusions: Researchers working with multilevel study designs should be aware of the potential impact of small group size when a large proportion of groups has very small (< 5) sample sizes

Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways

IntroductionMultimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity–HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use.Materials and methodsLatent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 (N = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity–HRQoL relationship.ResultsLCA revealed four profiles, including a Relatively Healthy class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Compared to the Relatively Healthy class, Vascular-Inflammatory class membership was associated with lower physical functioning (β = −5.5; p &lt; 0.001); membership in Vascular-Inflammatory (β = −1.7; p &lt; 0.05), and Respiratory (β = −2.5; p &lt; 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for Vascular-Inflammatory (p &lt; 0.05) and Respiratory (p &lt; 0.05) classes.ConclusionSpecific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services

Genetic sensitivity to the caregiving context: The influence of 5httlpr and BDNF val66met on indiscriminate social behavior ☆ , ☆☆

Evidence that gene × environment interactions can reflect differential sensitivity to the environmental context, rather than risk or resilience, is increasing. To test this model, we examined the genetic contribution to indiscriminate social behavior, in the setting of a randomized controlled trial of foster care compared to institutional rearing. Children enrolled in the Bucharest Early Intervention Project (BEIP) were assessed comprehensively before the age of 30 months and subsequently randomized to either care as usual (CAUG) or high quality foster care (FCG). Indiscriminate social behavior was assessed at four time points, baseline, 30 months, 42 months and 54 months of age, using caregiver report with the Disturbances of Attachment Interview (DAI). General linear mixed-effects models were used to examine the effect of the interaction between group status and functional polymorphisms in Brain Derived Neurotrophic Factor (BDNF) and the Serotonin Transporter (5htt) on levels of indiscriminate behavior over time. Differential susceptibility, relative to levels of indiscriminate behavior, was demonstrated in children with either the s/s 5httlpr genotype or met 66 BDNF allele carriers. Specifically children with either the s/s 5httlpr genotype or met66 carriers in BDNF demonstrated the lowest levels of indiscriminate behavior in the FCG and the highest levels in the CAUG. Children with either the long allele of the 5httlpr or val/val genotype of BDNF demonstrated little difference in levels of indiscriminate behaviors over time and no group × genotype interaction. Children with both plasticity genotypes had the most signs of indiscriminate behavior at 54 months if they were randomized to the CAUG in the institution, while those with both plasticity genotypes randomized to the FCG intervention had the fewest signs at 54 months. Strikingly children with no plasticity alleles demonstrated no intervention effect on levels of indiscriminate behavior at 54 months. These findings represent the first genetic associations reported with indiscriminate social behavior, replicate previous gene × gene × environment findings with these polymorphisms, and add to the growing body of literature supporting a differential susceptibility model of gene × environment interactions in developmental psychopathology

Selected abstracts from the Breastfeeding and Feminism International Conference 2016

Table of contents A1. Infant feeding and poverty: a public health perspective in a global context Lisa H. Amir A2. Mothers’ experiences with galactagogues for lactation: an exploratory cross sectional study Alessandra Bazzano, Shelley Thibeau, Katherine P. Theall A3. The motherhood journey and breastfeeding: from self-efficacy to resilience and social stigma Anna Blair, Karin Cadwell A4. Breastfeeding as an evolutionary adaptive behavior Emily A. Bronson A5. Conflict-of-interest in public health policy: as real as that logo on your website Elizabeth C. Brooks A6. Co-opting sisterhood and motherhood: behind the scenes of Similac’s aggressive social media campaigns Jodine Chase A7. The exclusion of women from the definition of exclusive breastfeeding Ellen Chetwynd, Rebecca Costello, Kathryn Wouk A8. Healthy maternity policies in the workplace: a state health department’s experience with the “Bring Your Infant to Work” program Lindsey Dermid-Gray A9. Implications for a paradigm shift: factors related to breastfeeding among African American women Stephanie Devane-Johnson, Cheryl Woods Giscombe, Miriam Labbok A10. Social experiences of breastfeeding: building bridges between research and policy: an ESRC-funded seminar series in the UK Sally Dowling A11. Manager’s perspectives of lactation breaks Melanie Fraser A12. The challenging second night: a dialogue from two perspectives Jane Grassley, Deborah McCarter-Spaulding, Becky Spencer A13. The role of lactation consultants in two council breastfeeding services in Melbourne, Australia – some preliminary impressions Jennifer Hocking, Pranee Liamputtong A14. Integrating social marketing and community engagement concepts in community breastfeeding programs Sheree H. Keitt, Harumi Reis-Reilly A15. What happens before and after the maternity stay? Creating a community-wide Ten Steps approach Miriam Labbok A16. #RVABREASTFEEDS: cultivating a breastfeeding-friendly community Leslie Lytle A17. Public health vs. free trade: a longitudinal analysis of a global policy to protect breastfeeding Mary Ann Merz A18. Legislative advocacy and grassroots organizing for improved breastfeeding laws in Virginia Kate Noon A19. Breastfeeding and the rights of incarcerated women Krista M Olson A20. Barriers and support for Puerto Rican breastfeeding working mothers Ana M. Parrilla-Rodríguez, José J. Gorrín-Peralta Melissa Pellicier, Zeleida M. Vázquez-Rivera A21. Pumping at work: a daily struggle for Puerto Rican breastfeeding mothers in spite of the law Melissa Pellicier A22. “I saw a wrong and I wanted to stand up for what I thought was right:” a narrative study on becoming a breastfeeding activist Jennifer L. Pemberton A23. Peer breastfeeding support: advocacy and action Catherine McEvilly Pestl A24. Good intentions: a study of breastfeeding intention and postpartum realities among first-time Central Brooklyn mothers Jennifer Pierre, Philip Noyes, Khushbu Srivastava, Sharon Marshall-Taylor A25. Women describing the infant feeding choice: the impact of the WIC breastfeeding classes on infant feeding practices in Ionia, Michigan Jennifer Proto, Sarah Hyland Laurie Brinks A26. Local and state programs and national partnership to reduce disparities through community breastfeeding support Harumi Reis-Reilly, Martelle Esposito, Megan Phillippi A27. Beyond black breastfeeding week: instagram image content analysis for #blackwomendobreastfeed/#bwdbf Cynthia L. Sears, Delores James, Cedric Harville, Kristina Carswell A28. Stakeholder views of breastfeeding education in the K-12 environment: a review of the literature Nicola Singletary, L. Suzanne Goodell, April Fogleman A29. “The Breastfeeding Transition”: a framework for explaining changes in global breastfeeding rates as related to large-scale forces shaping the status of women Paige Hall Smith A30. Breastfeeding, contraception, and ethics, oh my! Advocacy and informed decision-making in the post-partum period Alison M. Stuebe, Amy G. Bryant, Anne Drapkin Lyerly A31. A hard day’s night: juggling nighttime breastfeeding, sleep, and work Cecilia Tomori A32. Empowering change in Indian country through breastfeeding education Amanda L. Watkins, Joan E. Dodgson A33. Servants and “Little Mothers” take charge: work, class, and breastfeeding rates in the early 20th-century U.S. Jacqueline H. Wol

Building a Culture of Health Through the Built Environment: Adaptable Solutions to Community Well-Being

Characteristics of the built neighborhood environment have been associated with Action Area 1 drivers, but few studies have examined changes in built environment conditions on such drivers. The proposed project will: 1) test the effectiveness of a blight reduction intervention in cluster randomized controlled trial (RCT) on altering specific Action Area 1 drivers—well-being and health interconnectedness, sense of community, and civic engagement—as well as 2) test the causal relation between changes in the drivers and resultant health and social outcomes—specifically, family and youth violence, substance use and mental health. The RCT will be conducted over four years across neighborhoods experiencing high rates of poverty and violence in New Orleans, LA and coupled with qualitative data collection. Findings will provide critical information for policy and prevention efforts and will be immediately translated locally and easily adapted to other urban areas in the U.S

How You Measure Matters: Defining Social Capital in Drought-prone Areas

Social capital, or social connections that a household possesses that can provide support and access to resources, is an important indicator to consider when assessing one\u27s ability to withstand shocks and stressors. This study seeks to operationalize social capital within the context of two disaster-prone settings – Burkina Faso and Niger. Burkina Faso and Niger are two landlocked countries located in the Sahel region of West Africa. They are prone to frequent stressors including drought, flooding, and insect invasions. Secondary data from a representative cross-sectional household survey of 2492 households conducted in May 2015 were re-analyzed. The analysis compared three methods most commonly employed in the literature against a new method and compared each operationalization of social capital. This study identified latent class analysis, as an appropriate method for this context. Selection criteria included method limitations, dataset constraints, interpretability, and the amount of variance the classes contributed to an outcome of interest, food security. The three classes had both a significant and positive association with food security (p \u3c 0.01). Appropriate operationalization was also determined by examining the semipartial R2 of each method. The latent class analysis index had an increment of 0.0064 (Household Food Insecurity Access Scale) and 0.0065 (Dietary Diversity Score), p \u3c 0.001, the highest contribution of all models tested. These findings demonstrate approximate equivalence of findings using different methods; however, latent class analysis may be most appropriate given this context

Neighbourhood alcohol availability and gonorrhea rates: impact of social capital

Social capital and income inequality have been proposed as important mediators of the relation between the material environment and health outcomes. We determined whether indicators of social capital are (i) associated with neighbourhood gonorrhea rates, and (ii) mediate the relation between alcohol outlet density and gonorrhea rate. Longitudinal analyses of age- and sex-adjusted gonorrhea cases reported from 1990 to 1996 in the 445 census tracts affected by the 1992 civil unrest in Los Angeles, California was conducted. The role of alcohol outlets was assessed both as tracts with surrendered off-sale outlets due to the civil unrest and annual off-sale alcohol outlet density rates. Tract level voting rates were used as one indicator of social capital, while neighbourhood structure conducive to social organization was used as another. Neighbourhoods with greater voting over time and greater endogenous social organization experienced 1.9 and 67.2 fewer gonorrhea cases per 100,000. Results also reveal a partial mediating role of social capital on the relationship between alcohol outlet density and gonorrhea rate. The alcohol environment may have a direct or partially mediated role in infectious disease outcomes such as gonorrhea. Our findings support the importance of continuing controls and limits on off-premise alcohol outlet density, as a potential means of reducing gonorrhea rates and increasing social capital