Prescription Drug Costs: Does Neighborhood Matter?

The price of pharmaceuticals can impact one’s ability to purchase needed medication(s). If one cannot afford necessary prescriptions the resulting medication noncompliance can lead to further health complications, increasing the risk of disability, disease progression, and mortality (Mojtabai & Olfson, 2003; Sherbourne, Hays, Ordway, DiMatteo, & Kravitz, 2010). In this research study we aim to answer two questions: (1) Is there a relationship between neighborhood characteristics (population size, race/ethnic composition, median income, and crime) and access to pharmacies?; and (2) Is there a relationship between neighborhood characteristics and pharmaceutical prices? Using 2009-2013 American Community Survey Data, Census block group data was used to identify geographic areas within the City of Flint, Michigan with similar population sizes. Based upon the block group data, the city was then divided into 4 general areas. Among these 4 areas (NE, NW, SE, & SW), a total of eight block groups, 2 block groups per area, were selected. A 1 mile radius of each block group was used when identifying pharmacies. Identified pharmacies were telephoned and asked the out of pocket costs for a 1-month and 90-day supply of four commonly prescribed diabetes medications: Glipizide 5mg, Metformin 500mg, U-100 Humulin N and U-100 Novolin N. This research study will allow us to gain important knowledge about local community health resources and the relationships between neighborhood characteristics, pharmacy access, and variability among diabetes prescription drug costs. This information can also be used to inform patients about the benefits of comparison shopping for needed prescriptions

Knowledge, confidence, and reported behaviors that promote safe water drinking among women of reproductive age

IntroductionDrinking lead contaminated water during pregnancy is associated with infant mortality. All women of reproductive age are advised by health agencies to adhere to healthy behaviors due to the chance of unintended pregnancy. Our objectives are to understand knowledge, confidence, and reported behaviors that promote safe water drinking and prevent lead exposure among women of reproductive age.MethodsA survey among females of reproductive age from the University of Michigan - Flint was administered. A total of 83 females who wished to become pregnant one day participated.ResultsLow levels of knowledge, confidence, and reported preventative health behaviors related to safe water drinking and lead exposure prevention existed. Specifically, 71.1% of respondents (59 of 83) were not at all or were somewhat confident in their ability to choose an appropriate lead water filter. Most participants rated their knowledge on how to decrease exposure to lead during pregnancy as poor/fair. No statistically significant differences were detected between respondents residing inside and outside of the city of Flint, Michigan for most variables assessed.ConclusionWhile the small sample size is a limitation, the study adds to an area of scarce research. Despite widespread media attention and resources directed toward reducing the negative health effects of lead exposure following the Flint Water Crisis, significant gaps in knowledge related to safe water drinking remain. Interventions are needed to increase knowledge, confidence, and healthy behaviors that promote safe water drinking among women of reproductive age

Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas

The study aims to determine if recent intimate partner violence (IPV) is a prenatal risk factor for postpartum depression (PPD) among pregnant Latinas seeking prenatal care. A prospective observational study followed Latinas from pregnancy through 13 months postpartum. Prenatal predictors of PPD included depression, recent IPV exposure, remote IPV exposure, non-IPV trauma history, poverty, low social support, acculturation, high parity, and low education. Postpartum depression was measured at 3, 7, and 13 months after birth with the Beck's Depression Inventory—Fast Screen. Strength of association was evaluated using bivariate and multivariable odds ratio analysis. Subjects were predominantly low income, monolingual Spanish, and foreign-born, with mean age of 27.7. Recent IPV, prenatal depression, non-IPV trauma, and low social support were associated with greater likelihood of PPD in bivariate analyses. Recent IPV and prenatal depression continued to show significant association with PPD in multivariate analyses, with greater odds of PPD associated with recent IPV than with prenatal depression (adjusted OR = 5.38, p < 0.0001 for recent IPV and adjusted OR = 3.48, p< 0.0001 for prenatal depression). Recent IPV exposure is a strong, independent prenatal predictor of PPD among Latinas. Screening and referral for both IPV and PPD during pregnancy may help reduce postpartum mental health morbidity among Latinas

American Dreams, Latino Realities: Interrogating the Intersections of Race/Ethnicity, Gender, and Nativity on Select Acculturative Stressors and Depressive Symptoms among Mexican-Origin Adults.

A main tenet of American Dream narratives is the desire to improve one’s socio-economic status. Less central to these dream narratives however, are considerations regarding the costs and consequences not fulfilling one’s goals may pose. Indeed, psycho-social and structural challenges to integrating into the U.S. labor market can serve as important sources of acculturative stress for Mexican-origin populations. Diminishing opportunities for low and semi-skilled labor and the need for dual-income households, make it difficult to maintain highly valued traditional (patriarchal) gender beliefs regarding employment and bread-winning roles. Barriers to social mobility may also negatively influence attitudes towards one’s life chances of socio-economic success. This research explores these two acculturative stress concepts: 1) inability to maintain valued gender roles; and 2) increasingly negative attitudes about one’s life chances of socio-economic success in a sample of Mexican-origin adults. Using data from the Mexican American Prevalence and Services Survey (MAPSS), the relationships between traditional gender beliefs and attitudes toward life chances of success to depressive symptoms are studied in a sample of 3,012 foreign and US-born Mexican-origin adults. Employing an intersectionality research perspective, the influence of various aspects of one’s social identity (i.e., gender, nativity, and employment status) on the experience of these acculturative stressors is also examined. Higher order interactions are tested for traditional gender beliefs and employment by gender and nativity. Likewise, higher order interactions for attitudes towards life chances of success and employment by gender, nativity, and discrimination are investigated. Results show that more (vs. less) traditional gender beliefs and more (vs. less) negative attitudes about one’s life chances of success are significantly related to higher levels of depressive symptoms, net of demographic covariates and other acculturative stressors (i.e., discrimination, language barriers, and legal status worries). Employment status was the only significant moderator identified in the higher-order interactions. Being employed buffered against the negative effects of traditional gender beliefs and negative attitudes toward success on depressive symptoms for men, but not women. In this research, gendered vulnerabilities and buffers to acculturative stress are identified and their implications for future mental health research are discussed.Ph.D.Health Behavior & Health EducationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/62264/1/llapeyro_1.pd

Income and Self-Rated Mental Health: Diminished Returns for High Income Black Americans

Background: The minorities&rsquo; diminished return theory suggests that socioeconomic position (SEP) generates smaller health gains for racial/ethnic minorities compared to Whites. The current study was a Black&ndash;White comparison of the association between household income and self-rated mental health (SRMH). Methods: This cross-sectional study used data from the 2017 State of the State Survey (SOSS). With representative sampling, the SOSS generates results that are generalizable to the state of Michigan. This study included 881 adults, (n = 92) Black and (n = 782) White. The independent variable was household income. The dependent variable was SRMH, measured using a single item. Age, gender, and participation in the labor force were covariates. Race/ethnicity was the focal moderator. Logistic regression models were used for data analysis. Results: Overall, higher household income was associated with better SRMH, net of covariates. An interaction was found between race/ethnicity and household income on SRMH, suggesting a smaller, or nonexistent, protective effect for Blacks compared to Whites. In race/ethnicity-stratified models, higher household income was associated with better SRMH for Whites but not Blacks. Conclusion: Supporting the minorities&rsquo; diminished return theory, our study documents differential effects for income on SRHM for Blacks and Whites, where Whites but not Blacks appear to benefit from their income. Given this, researchers and policy makers are cautioned against making assumptions that racial groups benefit equally from similar economic resources

Binational utilization and barriers to care among Mexican American border residents with diabetes

OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management