Smoking Selectivity Among Mexican Immigrants to the United States Using Binational Data, 1999–2012

Mexican immigrants have lower smoking rates than US-born Mexicans, which some scholars attribute to health selection—that individuals who migrate are healthier and have better health behaviors than their non-migrant counterparts. Few studies have examined smoking selectivity using binational data and none have assessed whether selectivity remains constant over time. This study combined binational data from the US and Mexico to examine: 1) the extent to which recent Mexican immigrants (\u3c 10 years) in the US are selected with regard to cigarette smoking compared to non-migrants in Mexico, and 2) whether smoking selectivity varied between 2000 and 2012—a period of declining tobacco use in Mexico and the US. We combined repeated cross-sectional US data (n = 10.901) on adult (ages 20–64) Mexican immigrants and US-born Mexicans from the 1999/2000 and 2011/2012 National Health Interview Survey, and repeated cross-sectional Mexican data on non-migrants (n = 67.188) from the 2000 Encuesta Nacional de Salud and 2012 Encuesta Nacional de Salud y Nutrición. Multinomial logistic regressions, stratified by gender, predicted smoking status (current, former, never) by migration status. At both time points, we found lower overall smoking prevalence among recent US immigrants compared to non-migrants for both genders. Moreover, from the regression analyses, smoking selectivity remained constant between 2000 and 2012 among men, but increased among women. These findings suggest that Mexican immigrants are indeed selected on smoking compared to their non-migrating counterparts, but that selectivity is subject to smoking conditions in the sending countries and may not remain constant over time

Social patterning of chronic disease risk factors: Cross-national and within-country comparisons.

Chronic diseases are traditionally thought to be more important in high-income countries, although most of the burden occurs in low- and middle-income countries. Despite a recent global focus on the social determinants of health, few studies have examined socioeconomic gradients in chronic disease risk within poor countries or across countries at different levels of development. This dissertation uses data from the 2002-2003 WHO World Health Surveys (WHS) and the 2005 National Survey of Risk Factors for Non-communicable Diseases in Argentina to examine (1) differences associated with urbanicity in the prevalence and social patterning of chronic disease risk factors across countries (using WHS), (2) differences associated with urbanicity in the prevalence and social patterning of chronic disease risk factors across regions within a middle-income country (Argentina survey), and (3) differences over time (i.e. by age cohort) in the social patterning of smoking behavior within a country in transition (Argentina survey). The WHS study showed that body mass index (BMI), obesity and diabetes were higher at higher levels of urbanicity for both genders. For men, there was little association between urbanicity and prevalence of smoking; for women, higher prevalence of smoking was associated with higher urbanicity. In the least urban countries those of higher socioeconomic position (SEP) had higher BMI, while the opposite pattern was seen in the most urban countries, especially among women. In contrast, smoking was consistently concentrated among those of lower SEP, especially among men, regardless of level of urbanicity. The studies from Argentina found that the socioeconomic patterning of risk factors was modified by provincial-level urbanicity, such that the inverse patterning became stronger or only emerged in more urban settings, particularly for BMI, high blood pressure and diabetes. There was also evidence that the socioeconomic patterning of smoking was changing with successive birth cohorts, and was increasingly concentrated among those of lower SEP, particularly among women. Taken together, these results highlight a trend, globally and within countries, toward increasing burden of chronic disease risk among those of lower socioeconomic position. This is certain to impact future inequities in chronic disease outcomes unless interventions addressing health disparities are undertaken.Ph.D.Epidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/75971/1/nancyfl_1.pd

Using directed acyclic graphs to guide analyses of neighbourhood health effects: an introduction

BACKGROUND: Directed acyclic graphs, or DAGs, are a useful graphical tool in epidemiologic research that can help identify appropriate analytical strategies in addition to potential unintended consequences of commonly used methods such as conditioning on mediators. The use of DAGs can be particularly informative in the study of the causal effects of social factors on health. METHODS: The authors consider four specific scenarios in which DAGs may be useful to neighbourhood health effects researchers: (1) identifying variables that need to be adjusted for in estimating neighbourhood health effects, (2) identifying the unintended consequences of estimating "direct" effects by conditioning on a mediator, (3) using DAGs to understand possible sources and consequences of selection bias in neighbourhood health effects research, and (4) using DAGs to identify the consequences of adjustment for variables affected by prior exposure. CONCLUSIONS: The authors present simplified sample DAGs for each scenario and discuss the insights that can be gleaned from the DAGs in each case and the implications these have for analytical approaches.http://deepblue.lib.umich.edu/bitstream/2027.42/60949/1/Usinig directed acyclic graphs to guide analyses of neighborhood health effects.pd

[Self-rated health and social inequalities, Buenos Aires, Argentina, 2005]

Self-rated health is a quality-of-life indicator. This study investigates the impact of individual-level and neighborhood-level socioeconomic characteristics, considered simultaneously, on the state of self-rated health at the individual level in Buenos Aires, Argentina. The study employs a two-level (individual and neighborhood) multilevel analysis, and the data sources were the 2005 Argentina National Risk Factor Survey (multistage probabilistic sample) and the 2001 Population Census. Linear regression shows that higher schooling and income, as well as occupational category, are related to better self-rated health, and increasing age with worse health. In the multilevel analysis, an increase in the proportion (per census tract) of individuals with less schooling was associated with an increase in the proportion of individuals with worse self-rated health. Improving the general health of the population requires strategies and action that reduce the levels of social inequalities in their multiple dimensions, including the individual and neighborhood levels.http://deepblue.lib.umich.edu/bitstream/2027.42/78519/1/AlazraquiDiezRoux2009_CadSaudePublica.pd

Soil nutrient content and water level variation drive mangrove forest aboveground biomass in the lagoonal ecosystem of Aldabra Atoll

Lagoonal mangrove ecosystems are vital for carbon capture, protection of coastlines and conservation of biodiversity. Yet, they are decreasing globally at a higher rate than other mangrove ecosystems. In addition to human drivers, local environmental factors influence the functioning of lagoonal mangrove ecosystems, but their importance and combined effects are relatively unknown. Here, we investigate the drivers of mangrove functioning, approximated by mangrove aboveground biomass (AGB), in a protected lagoonal mangrove ecosystem on Aldabra Atoll, Seychelles. Based on a survey of the mangrove forest structure in 54 plots, we estimated that the mean mangrove forest AGB was 82 ± 13 Mg ha−1. The total AGB of the mangrove area (1720 ha) was nearly 140,600 Mg, equivalent to about 66,100 Mg of carbon stored in the standing biomass on Aldabra. To assess the direct and indirect effects of soil nutrient content, water level variation and soil salinity on mangrove AGB, we used a structural equation model. Our structural equation model explained 82 % of the variation in mangrove AGB. The soil nutrient content (concentration of essential macronutrients in the soil column) had the greatest influence on mangrove AGB variation. Additionally, high variation in water level (change in water depth covering a location) increased mangrove AGB by increasing nutrient content levels. Our results highlight the important contribution of Aldabra's lagoonal ecosystem to Seychelles' carbon storage and the role of hydroperiod as a regulator controlling the availability of crucial nutrients needed for the functioning of mangroves within lagoonal systems. We suggest conservation managers worldwide focus on a holistic ecosystem-level perspective for successful mangrove conservation, including the protection and maintenance of nutrient cycling and hydrological processes

Low hemoglobin at hemodialysis initiation : an international study of anemia management and mortality in the early dialysis period

Background. Anemia at hemodialysis (HD) initiation is common. Correcting low hemoglobin (Hgb) before HD initiation may improve survival by avoiding potential harms of chronic anemia, high doses of erythropoiesis-stimulating agents (ESAs) and intravenous (IV) iron in the early HD period, and/or rapid Hgb rise. Methods. We included 4604 incident HD patients from 21 countries in the Dialysis Outcomes and Practice Patterns Study Phases 4-5 (2009-15). Because low Hgb at HD start may reflect comorbidity or ESA hyporesponse, we restricted our analysis to the 80% of patients who achieved Hgb >= 10 g/dL 91-120 days after HD start (Month 4). Results. About 53% of these patients had Hgb = 10 g/dL). Month 1 Hgb was associated with first-year HD mortality (adjusted hazard ratio for 1 g/dL higher Hgb was 0.89; 95% confidence interval: 0.81-0.97), despite minimal differences in Month 4 Hgb. Patients with lower Hgb in Month 1 received higher doses of ESA, but not IV iron, over the first 3 months of HD. Results were consistent when excluding catheter users or adjusting for IV iron and ESA dose over the first 3 months. Conclusions. Even among patients with Hgb >= 10 g/dL 3 months later, anemia at HD initiation was common and associated with elevated mortality. A more proactive approach to anemia management in advanced chronic kidney disease (CKD) may thus improve survival on HD, though long-term prospective studies of non-dialysis CKD patients are needed

Inflammation and erythropoiesis-stimulating agent response in hemodialysis patients : a self-matched longitudinal study of anemia management in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Rationale & objective: Previous studies of inflammation and anemia management in hemodialysis (HD) patients may be biased due to patient differences. We used a self-matched longitudinal design to test whether new inflammation, defined as an acute increase in C-reactive protein (CRP) level, reduces hemoglobin response to erythropoiesis-stimulating agent (ESA) treatment. Study design: Self-matched longitudinal design. Setting & participants: 3,568 new inflammation events, defined as CRP level > 10 mg/L following a 3-month period with CRP level ≤ 5 mg/L, were identified from 12,389 HD patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4 to 6 (2009-2018) in 10 countries in which CRP is routinely measured. Predictor: "After" (vs "before") observing a high CRP level. Outcomes: Within-patient changes in hemoglobin level, ESA dose, and ESA hyporesponsiveness (hemoglobin 6,000 [Japan] or >8,000 [Europe] U/wk). Analytical approach: Linear mixed models and modified Poisson regression. Results: Comparing before with after periods, mean hemoglobin level decreased from 11.2 to 10.9 g/dL (adjusted mean change, -0.26 g/dL), while mean ESA dose increased from 6,320 to 6,960 U/wk (adjusted relative change, 8.4%). The prevalence of ESA hyporesponsiveness increased from 7.6% to 12.3%. Both the unadjusted and adjusted prevalence ratios of ESA hyporesponsiveness were 1.68 (95% CI, 1.48-1.91). These associations were consistent in sensitivity analyses varying CRP thresholds and were stronger when the CRP level increase was sustained over the 3-month after period. Limitations: Residual confounding by unmeasured time-varying risk factors for ESA hyporesponsiveness. Conclusions: In the 3 months after HD patients experienced an increase in CRP levels, hemoglobin levels declined quickly, ESA doses increased, and the prevalence of ESA hyporesponsiveness increased appreciably. Routine CRP measurement could identify inflammation as a cause of worsened anemia. In turn, these findings speak to a potentially important role for anemia therapies that are less susceptible to the effects of inflammation

Increasing availability and consumption of single cigarettes: trends and implications for smoking cessation from the ITC Mexico Survey

Determine (1) trends in single cigarette availability and purchasing in Mexico, and (2) the association between neighborhood access to singles and cessation behavior among adult Mexican smokers

Pathways to health: a framework for health-focused research and practice

Public health research and practice is faced with three problems: 1) a focus on disease instead of health, 2) consideration of risk factor/disease relationships one at a time, and 3) attention to individuals with limited regard for the communities in which they live. We propose a framework for health-focused research and practice. This framework encompasses individual and community pathways to health while incorporating the dynamics of context and overall population vulnerability and resilience. Individual pathways to health may differ, but commonalities will exist. By understanding these commonalities, communities can work to support health-promoting pathways in addition to removing barriers. The perspective afforded by viewing health as a dynamic process instead of as a collection of risk factors and diseases expands the number of approaches to improving health globally. Using this approach, multidisciplinary research teams working with active community participants have the potential to reshape health and intervention sciences