Publications by authors named "Jacqueline M Torres"

43 Publications

Excess death among Latino people in California during the COVID-19 pandemic.

medRxiv 2021 Jan 25. Epub 2021 Jan 25.

Background: Latino people in the US are experiencing higher excess deaths during the COVID-19 pandemic than any other racial/ethnic group, but it is unclear which subgroups within this diverse population are most affected. Such information is necessary to target policies that prevent further excess mortality and reduce inequities.

Methods: Using death certificate data for January 1, 2016 through February 29, 2020 and time-series models, we estimated the expected weekly deaths among Latino people in California from March 1 through October 3, 2020. We quantified excess mortality as observed minus expected deaths and risk ratios (RR) as the ratio of observed to expected deaths. We considered subgroups defined by age, sex, place of birth, education, occupation, and combinations of these factors.

Findings: During the first seven months of the pandemic, Latino deaths in California exceeded expected deaths by 10,316, a 31% increase. Excess death rates were greatest for individuals born in Mexico (RR 1.44; 95% PI, 1.41, 1.48) or Central America (RR 1.49; 95% PI, 1.37, 1.64), with less than a high school degree (RR 1.41; 95% PI, 1.35, 1.46), or in food-and-agriculture (RR 1.60; 95% PI, 1.48, 1.74) or manufacturing occupations (RR 1.59; 95% PI, 1.50, 1.69). Immigrant disadvantages in excess death were magnified among working-age Latinos in essential occupations.

Interpretation: The pandemic has disproportionately impacted mortality among Latino immigrants and Latinos in unprotected essential jobs; Interventions to reduce these disparities should include early vaccination, workplace safety enforcement, and expanded access to medical care.

Funding: National Institute on Aging; UCSF.

Research In Context: Several articles have suggested all-cause excess mortality estimates are superior to official COVID-19 counts for assessing the impact of the pandemic on marginalized populations that lack access to testing and healthcare. We searched PubMed, Google scholar, and the medRxiv preprint database through December 22, 2020 for studies of ("excess mortality" or "excess death") AND ("COVID-19" or "coronavirus") set in the United States and we identified two empirical studies with estimates of excess mortality among Latinos during the pandemic. The study set in California (from our research team) found per capita excess mortality was highest among Black and Latino people. The national study found percent excess mortality was significantly higher among Latino people than any other racial/ethnic group. Neither study further disaggregated the diverse Latino population or provided subgroup estimates to clarify why excess pandemic mortality is so high in this population. In the U.S., official COVID-19 statistics are rarely disaggregated by place of birth, education, or occupation which has resulted in a lack of evidence of how these factors have impacted mortality during the pandemic. No study to date of excess mortality in the U.S. has provided estimates for immigrant or occupational subgroups. Our population-based observational study of all-cause mortality during the COVID-19 pandemic provides the first estimates of within-group heterogeneity among the Latino population in California - one of the populations hardest hit by COVID-19 in the U.S. We provide the first subgroup estimates by place of birth and occupational sector, in addition to combined estimates by foreign-birth and participation in an essential job and education. In doing so, we reveal that Latino immigrants in essential occupations have the highest risk of excess death during the pandemic among working-age Latinos. We highlight the heightened risk of excess mortality associated with food/agriculture and manufacturing occupational sectors, essential sectors in which workers may lack COVID-19 protections. Our study revealed stark disparities in excess mortality during the COVID-19 pandemic among Latinos, pointing to the particularly high vulnerability of Latino immigrants and Latinos in essential jobs. These findings may offer insight into the disproportionate COVID-19 mortality experienced by immigrants or similarly marginalized groups in other contexts. Interventions to reduce these disparities should include policies enforcing occupational safety, especially for immigrant workers, early vaccination, and expanded access to medical care.
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http://dx.doi.org/10.1101/2020.12.18.20248434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7852245PMC
January 2021

Association of US state policy orientation with adverse birth outcomes: a longitudinal analysis.

J Epidemiol Community Health 2021 Jan 6. Epub 2021 Jan 6.

Family Community Medicine, University of California San Francisco, San Francisco, California, USA.

Background: The current US context is marked by extreme right-left partisanship, which means that state policies tend to bundle together and are not experienced in isolation. While prior work has leveraged abrupt shifts in single policies to examine the effects of state policy on birth outcomes, we examined a holistic measure that captures political polarisation.

Methods: Data were drawn from national birth certificates for 2003-2017 (N=56 770 470). Outcomes included preterm birth, low birth weight, small-for-gestational age and other perinatal health measures. The primary exposure was a composite index of right-left state policy orientation, generated from historical data on 135 state policies. Multivariable regressions were used to estimate the association between state policy orientation and each outcome, adjusting for relevant covariates.

Results: Compared with infants born in states with right-leaning policy orientations, those born in left-leaning states had lower odds of adverse birth outcomes (eg, low birth weight: OR 0.95 (0.93, 0.97), preterm birth: OR 0.94 (0.92, 0.95)). Subgroup analyses revealed stronger associations for US-born and White mothers. With the inclusion of state fixed effects, left-leaning policy orientation was no longer associated with lower odds of adverse birth outcomes. Models were otherwise robust to alternative specifications.

Conclusion: While left-leaning state policy orientation has protective associations with a range of birth outcomes, the associations may be explained by stable characteristics of states, at least during the study period. Future studies should examine state policy orientation in association with other health outcomes and study periods.
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http://dx.doi.org/10.1136/jech-2020-214858DOI Listing
January 2021

Associations between unstable housing, obstetric outcomes, and perinatal health care utilization.

Am J Obstet Gynecol MFM 2019 11 16;1(4):100053. Epub 2019 Oct 16.

Department of Epidemiology and Biostatistics, University of California, San Francisco; California Preterm Birth Initiative, University of California, San Francisco.

Background: While there is a growing interest in addressing social determinants of health in clinical settings, there are limited data on the relationship between unstable housing and both obstetric outcomes and health care utilization.

Objective: The objective of the study was to investigate the relationship between unstable housing, obstetric outcomes, and health care utilization after birth.

Study Design: This was a retrospective cohort study. Data were drawn from a database of liveborn neonates linked to their mothers' hospital discharge records (2007-2012) maintained by the California Office of Statewide Health Planning and Development. The analytic sample included singleton pregnancies with both maternal and infant data available, restricted to births between the gestational age of 20 and 44 weeks, who presented at a hospital that documented at least 1 woman as having unstable housing using the International Classification of Diseases, ninth edition, codes (n = 2,898,035). Infants with chromosomal abnormalities and major birth defects were excluded. Women with unstable housing (lack of housing or inadequate housing) were identified using International Classification of Diseases, ninth edition, codes from clinical records. Outcomes of interest included preterm birth (<37 weeks' gestational age), early term birth (37-38 weeks gestational age), preterm labor, preeclampsia, chorioamnionitis, small for gestational age, long birth hospitalization length of stay after delivery (vaginal birth, >2 days; cesarean delivery, >4 days), emergency department visit within 3 months and 1 year after delivery, and readmission within 3 months and 1 year after delivery. We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression.

Results: Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score-matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0-1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2-1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4-1.8, P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1-2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4-3.0, P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2-3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2-3.0, P < .001).

Conclusion: Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.
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http://dx.doi.org/10.1016/j.ajogmf.2019.100053DOI Listing
November 2019

Associations between spousal caregiving and health among older adults in Mexico: A targeted estimation approach.

Int J Geriatr Psychiatry 2021 May 11;36(5):775-783. Epub 2020 Dec 11.

Department of Epidemiology & Biostatistics, UC San Francisco, San Francisco, California, USA.

Objective: To evaluate associations between spousal caregiving and mental and physical health among older adults in Mexico.

Methods: Data come from the Mexican Health & Aging Study, a national population-based study of adults ≥50 years and their spouses (2001-2015). We compared outcomes for spousal caregivers to outcomes for those whose spouses had difficulty with at least one basic or instrumental activity of daily living (I/ADL) but were not providing care; the control group conventionally includes all married respondents regardless of spouse's need for care. We used targeted maximum likelihood estimation to evaluate the associations with past-week depressive symptoms, lower-body functional limitations, and chronic health conditions.

Results: At baseline, 846 women and 629 men had a spouse with ≥1 I/ADL. Of these, 60.9% of women and 52.6% of men were spousal caregivers. Spousal caregiving was associated with more past-week depressive symptoms for men (Marginal Risk Difference (RD): 0.27, 95% confidence internal [CI]: 0.03, 0.51) and women (RD: 0.15, 95% CI: 0.07, 0.23). We could not draw conclusions about associations with lower-body functional limitations and chronic health conditions. On average, all respondents whose spouses had caregiving needs had poorer health than the overall sample.

Conclusion: We found evidence of an association between spousal caregiving and mental health among older Mexican adults with spouses who had need for care. However, our findings suggest that older adults who are both currently providing or at risk of providing spousal care may need targeted programs and policies to support health and long-term care needs.
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http://dx.doi.org/10.1002/gps.5477DOI Listing
May 2021

Association Between Health Care Utilization and Immigration Enforcement Events in San Francisco.

JAMA Netw Open 2020 11 2;3(11):e2025065. Epub 2020 Nov 2.

Department of Epidemiology and Biostatistics, University of California, San Francisco.

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http://dx.doi.org/10.1001/jamanetworkopen.2020.25065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656285PMC
November 2020

Socioeconomic status and colorectal cancer screening behaviors in a vulnerable multiethnic population.

Ethn Health 2020 Oct 29:1-17. Epub 2020 Oct 29.

Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.

Objective: Despite some progress in recent years, colorectal cancer (CRC) screening adherence in the United States is still suboptimal, particularly among disadvantaged groups. In this study, we assessed the association between socioeconomic status (SES) and self-reported screening non-adherence (SNA) in a sample of racial/ethnic minorities living in San Francisco, California.

Design/methods: A total of 376 participants of the San Francisco version of the Health Information National Trends Survey (SF-HINTS) with ages 50-75 years were included in this cross-sectional study. SNA was defined as not reporting blood stool test within the past year and not reporting sigmoidoscopy/colonoscopy within the past 10 years. Poisson regression models with robust variance estimators were used to evaluate the relation of SES with SNA, adjusting for measured confounders. Results are reported as prevalence ratios (PR) and 95% confidence intervals (95% CI).

Results: Overall SNA was 40%. In multivariable models including all respondents, retired participants had significantly lower SNA prevalence than employed participants (PR = 0.46, 95% CI = 0.26 0.83). In stratified analyses by race/ethnicity, Black respondents with less than high school (PR = 1.93, 95% CI = 1.09, 3.43) and those with high school or equivalent (PR = 1.88, 95% CI = 1.16, 3.04) had significantly higher SNA prevalence than those with at least some college. Among non-Hispanic Asian/Pacific Islanders, those disabled had significantly higher prevalence of SNA as compared to employed people (PR = 4.26, 95% CI = 2.11, 8.60). None of the SES indicators were significantly associated to SNA among Hispanics.

Conclusions: Participants with lower SES characteristics were less likely to adhere to CRC screening guidelines and being retired was a predictor of compliance. There was evidence of heterogeneity in associations between SES and CRC screening by race/ethnicity. Life circumstances of retired people could provide insights for designing interventions aimed to improve CRC screening uptake in these priority groups. Future efforts should consider mechanisms underlying differences by race/ethnicity.
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http://dx.doi.org/10.1080/13557858.2020.1838454DOI Listing
October 2020

Quantifying Lifecourse Drivers of International Migration: A Cross-national Analysis of Mexico and the United States.

Epidemiology 2021 Jan;32(1):50-60

Department of Epidemiology and Biostatistics, University of California, San Francisco.

Background: Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.

Methods: We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

Results: Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

Conclusions: Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.
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http://dx.doi.org/10.1097/EDE.0000000000001266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708448PMC
January 2021

Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population.

J Am Geriatr Soc 2020 11 2;68(11):2579-2586. Epub 2020 Sep 2.

Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.

Background/objectives: Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles.

Design: Prospective cohort study.

Setting: The Mexican Health and Aging Study is a national population-based study of older adults in Mexico.

Participants: A total of 10,693 Mexican adults aged 50 and older enrolled in 2001 with no history of prior stroke.

Measurements: Depressive symptoms were assessed with a modified 9-item Centers for Epidemiologic Studies Depression Scale (elevated depressive symptom cutoff ≥5) in 2001 and 2003. We evaluated associations between baseline and short-term (2-year) changes in elevated depressive symptoms (categorized as stable low, recently remitted, recent-onset, or stable high symptoms) with incident self-reported or next-of-kin reported doctor-diagnosed stroke through 2015 using Cox proportional hazards models and sensitivity analyses applying inverse probability weights.

Results: Over an average follow-up of 11.4 years (standard deviation = 4.2), 10,693 respondents reported 546 incident strokes. Individuals with elevated baseline depressive symptoms experienced a moderately higher hazard of incident stroke (hazard ratio [HR] = 1.13; 95% confidence interval [CI] = .95-1.36) compared with those without elevated baseline depressive symptoms. In analyses of short-term changes in elevated depressive symptoms (n = 8,808; 414 incident stokes), participants with recent-onset (HR = 1.38; 95% CI = 1.06-1.81) or stable high (HR = 1.42; 95% CI = 1.10-1.84) elevated depressive symptoms had a greater hazard of incident stroke compared to those with stable low/no depressive symptoms, whereas recently remitted (HR = 1.01; 95% CI = .74-1.37) symptoms was not associated with stroke hazard.

Conclusion: Strategies to reduce depressive symptoms merit evaluation as approaches to prevent stroke in middle-income countries. Findings are similar to those in high-income countries but should be replicated in other LMICs.
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http://dx.doi.org/10.1111/jgs.16718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745730PMC
November 2020

When Is Hope Enough? Hopefulness, Discrimination and Racial/Ethnic Disparities in Allostatic Load.

Behav Med 2020 Jul-Sep;46(3-4):189-201

Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University.

Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent's measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included a multiplicative interaction term to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each racial/ethnic group. Hopefulness was associated with lower allostatic load scores, but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites and not associated with allostatic load among Hispanics irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.
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http://dx.doi.org/10.1080/08964289.2020.1729086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458691PMC
July 2021

Difficulty and help with activities of daily living among older adults living alone with cognitive impairment.

Alzheimers Dement 2020 08 26;16(8):1125-1133. Epub 2020 Jun 26.

Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.

Introduction: There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity.

Methods: For U.S. Health and Retirement Study (2000-2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help.

Results: Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46% reported an I/ADL difficulty; 72% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22% more likely to report a difficulty without help, and Latina women were 36% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries.

Discussion: Findings call for targeted efforts to support older adults living alone with cognitive impairment.
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http://dx.doi.org/10.1002/alz.12102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416441PMC
August 2020

US Migration Status of Adult Children and Cognitive Decline Among Older Parents Who Remain in Mexico.

Am J Epidemiol 2020 08;189(8):761-769

Low- and middle-income countries (LMICs) are experiencing rapid aging, a growing dementia burden, and relatively high rates of out-migration among working-age adults. Family member migration status may be a unique societal determinant of cognitive aging in LMIC settings. We aimed to evaluate the association between adult child US migration status and change in cognitive performance scores using data from the Mexican Health and Aging Study, a population-based, national-level cohort study of Mexico adults aged ≥50 years at baseline (2001), with 2-, 12-, and 14-year follow-up waves (2003, 2012, and 2015). Cognitive performance assessments were completed by 5,972 and 4,939 respondents at 11 years and 14 years of follow-up, respectively. For women, having an adult child in the United States was associated with steeper decline in verbal memory scores (e.g., for 9-year change in immediate verbal recall z score, marginal risk difference (RD) = -0.09 (95% confidence interval (CI): -0.16, -0.03); for delayed verbal recall z score, RD = -0.10 (95% CI: -0.17, -0.03)) and overall cognitive performance (for overall cognitive performance z score, RD = -0.04, 95% CI: -0.07, -0.00). There were mostly null associations for men. To our knowledge, this is the first study to have evaluated the association between family member migration status and cognitive decline; future work should be extended to other LMICs facing population aging.
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http://dx.doi.org/10.1093/aje/kwz277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523588PMC
August 2020

Associations Between Social Factor Documentation and Hospital Length of Stay and Readmission Among Children.

Hosp Pediatr 2020 01;10(1):12-19

Psychiatry, and.

Background And Objectives: Social risk factors are linked to children's health, but little is known about how frequently these factors are documented using the (ICD) or whether documentation is associated with health care use outcomes. Using a large administrative database of pediatric hospitalizations, we examined the prevalence of ICD social risk code documentation and hypothesized that social code documentation would be associated with longer length of stay (LOS) and readmission.

Methods: We analyzed hospitalizations of children ages ≤18 using the 2012 Nationwide Readmissions Database. The following ICD social codes were used as predictors: family member with alcohol and/or drug problem, history of abuse, parental separation, foster care, educational circumstance, housing instability, other economic strain, and legal circumstance. Outcomes included long LOS (top quintile) and readmission within 30 days after discharge. Covariates included individual, hospital, and season variables.

Results: Of 926 073 index hospitalizations, 7432 (0.8%) had social codes. Social code documentation was significantly associated with long LOS. Adjusting for covariates, family alcohol and/or drug problem (odds ratio [OR] 1.65; 95% confidence interval [CI] 1.16-2.35), foster care (OR 2.37, 95% CI 1.53-3.65), other economic strain (OR 2.12, 95% CI 1.38-3.26), and legal circumstances (OR 1.66; 95% CI 1.02-2.71) remained significant predictors of long LOS. Social code documentation was not associated with readmission after adjusting for covariates.

Conclusions: Social ICD codes are associated with prolonged LOS and readmission in pediatric hospitalizations, but they are infrequently documented. Future work exploring these associations could help to determine if addressing social risk factors in inpatient settings might improve child health outcomes.
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http://dx.doi.org/10.1542/hpeds.2019-0123DOI Listing
January 2020

Nativity, Neighborhoods, and Body Composition in the Sacramento Area Latino Study on Aging.

Gerontologist 2020 02;60(2):239-249

Department of Epidemiology and Biostatistics, University of California, San Francisco, California.

Background And Objectives: Globally, obesity influences the risk of many major chronic diseases. Our study examines the association between individual nativity and neighborhood level concentration of immigrants with 10-year changes in weight, body mass index (BMI), and waist circumference (WC) among older Latinos.

Research Design And Methods: The Sacramento Area Latino Study on Aging (SALSA) is a population-based prospective study of community-dwelling older adults of Mexican origin (baseline ages 58-101 years). The primary outcome was repeated measures of weight over a 10-year period for 1,628 respondents. Nativity was defined by participants' reported place of birth (US-born or Latin American foreign born). Neighborhood immigrant concentration was measured as the percentage of foreign born at census tract level (2000 US Census). We used linear mixed models with repeated measures of weight, height, BMI, and WC as dependent variables (level 1), clustered within individuals (level 2) and neighborhood migrant concentration (level 3).

Results: Foreign born (FB) respondents had lower baseline weight than the US-born (mean, 160 vs. 171 lbs, p < .0001). Over time, weight differences between the FB and the US-born decreased by 1.7 lbs/5 years as US-born weight decreased more rapidly. We observed a significant interaction between individual nativity and neighborhood immigrant concentration (p = .012). We found similar patterns for BMI, but did not find statistically significant differences in WC trajectories.

Discussion And Implications: Our study observed significant differences by foreign born vs. US nativity in baseline weight/BMI and in their trajectories over time. Additionally, we found weight/BMI differences in neighborhood immigrant concentration for the FB, but not for the US-born.
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http://dx.doi.org/10.1093/geront/gnz139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7039378PMC
February 2020

Deportation Worry, Cardiovascular Disease Risk Factor Trajectories, and Incident Hypertension: A Community-Based Cohort Study.

J Am Heart Assoc 2019 12 27;8(23):e013086. Epub 2019 Nov 27.

Center for Environmental Research and Children's Health School of Public Health University of California Berkeley CA.

Background Worry about deportation has been associated with cardiovascular disease risk factors in cross-sectional research. No research has evaluated this association longitudinally or examined the association between deportation worry and incident cardiovascular disease outcomes. Methods and Results We used data from an ongoing community-based cohort of 572 women primarily of Mexican origin. We estimated associations between self-reported deportation worry and: (1) trajectories of blood pressure, body mass index, and waist circumference with linear mixed models, and (2) incident hypertension with Cox proportional hazards models. Nearly half (48%) of women reported "a lot," 24% reported "moderate," and 28% reported "not too much" deportation worry. Higher worry at baseline was associated with nonlinear systolic blood pressure and mean arterial pressure trajectories. For example, compared with not too much worry, a lot of worry was associated with a faster initial increase (β, interaction with linear year term: 4.10; 95% CI, 1.17-7.03) followed by a faster decrease in systolic blood pressure (β, interaction with quadratic year term: -0.80; 95% CI, -1.55 to -0.06). There was weak evidence of an association between deportation worry and diastolic blood pressure and no association with body mass index, waist circumference, or pulse pressure trajectories. Among 408 women without baseline hypertension, reporting a lot (hazard ratio, 2.17; 95% CI, 1.15-4.10) and moderate deportation worry (hazard ratio, 2.48; 95% CI, 1.17-4.30) were each associated with greater risk of incident hypertension compared with reporting not too much worry. Conclusions Deportation worry may contribute to widening disparities in some cardiovascular disease risk factors and outcomes over time.
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http://dx.doi.org/10.1161/JAHA.119.013086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912982PMC
December 2019

Using change in a seat belt law to study racially-biased policing in South Carolina.

Prev Med 2020 01 6;130:105884. Epub 2019 Nov 6.

Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC H3A 1A2, Canada.

Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.
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http://dx.doi.org/10.1016/j.ypmed.2019.105884DOI Listing
January 2020

Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review.

Ann Fam Med 2019 09;17(5):436-447

Social Interventions Research and Evaluation Network, Center for Health & Community, University of California, San Francisco, California.

Purpose: Based on the recognition that food insecurity (FI) is associated with poor health across the life course, many US health systems are actively exploring ways to help patients access food resources. This review synthesizes findings from studies examining the effects of health care-based interventions designed to reduce FI.

Methods: We conducted a systematic review of peer-reviewed literature published from January 2000 through September 2018 that described health care- based FI interventions. Standardized mean differences (SMD) were calculated and pooled when appropriate. Study quality was rated using Grading Recommendations Assessment Development and Evaluation criteria.

Results: Twenty-three studies met the inclusion criteria and examined a range of FI interventions and outcomes. Based on study design and sample size, 74% were rated low or very low quality. Studies of referral-based interventions reported moderate increases in patient food program referrals (SMD = 0.67, 95% CI, 0.36-0.98; SMD = 1.42, 95% CI, 0.76-2.08) and resource use (pooled SMD = 0.54, 95% CI, 0.31-0.78). Studies describing interventions providing food or vouchers reported mixed results for the actual change in fruit/vegetable intake, averaging to no impact when pooled (-0.03, 95% CI, -0.66 to 0.61). Few studies evaluated health or utilization outcomes; these generally reported small but positive effects.

Conclusions: Although a growing base of literature explores health care-based FI interventions, the low number and low quality of studies limit inferences about their effectiveness. More rigorous evaluation of FI interventions that includes health and utilization outcomes is needed to better understand roles for the health care sector in addressing FI.
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http://dx.doi.org/10.1370/afm.2412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7032918PMC
September 2019

Do Deviations From Historical Precipitation Trends Influence Child Nutrition? An Analysis From Uganda.

Am J Epidemiol 2019 11;188(11):1953-1960

Changes in precipitation patterns might have deleterious effects on population health. We used data from the Uganda National Panel Survey from 2009 to 2012 (n = 3,223 children contributing 5,013 assessments) to evaluate the link between rainfall and undernutrition in children under age 5 years. We considered 3 outcomes (underweight, wasting, and stunting) and measured precipitation using household-reported drought and deviations from long-term precipitation trends measured by satellite. We specified multilevel logistic regression models with random effects for the community, village, and individual. Underweight (13%), wasting (4%), and stunting (33%) were common. Reported drought was associated with underweight (marginal risk ratio (RR) = 1.18, 95% confidence interval (CI): 1.04, 1.35) in adjusted analyses. Positive annual deviations (greater rainfall) from long-term precipitation trends were protective against underweight (marginal RR per 50-mm increase = 0.94, 95% CI: 0.92, 0.97) and wasting (marginal RR per 50-mm increase = 0.93, 95% CI: 0.87, 0.98) but not stunting (marginal RR per 50-mm increase = 1.00, 95% CI: 0.98, 1.01). Precipitation was associated with measures of acute but not chronic malnutrition using both objective and subjective measures of exposure. Sudden reductions in rainfall are likely to have acute adverse effects on child nutritional status.
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http://dx.doi.org/10.1093/aje/kwz179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415258PMC
November 2019

Association of Preterm Births Among US Latina Women With the 2016 Presidential Election.

JAMA Netw Open 2019 07 3;2(7):e197084. Epub 2019 Jul 3.

Department of Epidemiology and Biostatistics, University of California, San Francisco.

Importance: The circumstances surrounding the 2016 US presidential election have been proposed as a significant stressor in the lives of the US Latino population. Few studies to date, however, have evaluated the population health implications of the election for Latina mothers and their children.

Objective: To determine whether preterm births (gestational age, <37 weeks) among US Latina women increased above expected levels after the 2016 US presidential election.

Design, Setting, And Participants: In this national population-based study, an interrupted time series design, used to evaluate whether policies or other population-level changes interrupt a trend in an outcome, compared monthly counts of preterm births to Latina women after the 2016 presidential election with the number expected had the election not taken place. Women residing in the United States who had singleton births during the study period were included. Counts of singleton term and preterm births by month and race/ethnicity from January 1, 2009, through July 30, 2017 (32 860 727 live births), were obtained from the Centers for Disease Control and Prevention Wonder online database. These methods were applied separately to male and female births. Data were analyzed from November 8, 2018, through May 7, 2019.

Exposures: Pregnancy in the 2016 US presidential election.

Main Outcomes And Measures: The number of male and female preterm births based on the last menstrual period.

Results: Among the 32 860 727 live births recorded during the study period, 11.0% of male and 9.6% of female births to Latina women were preterm compared with 10.2% and 9.3%, respectively, to other women. In the 9-month period beginning with November 2016, an additional 1342 male (95% CI, 795-1889) and 995 female (95% CI, 554-1436) preterm births to Latina women were found above the expected number of preterm births had the election not occurred.

Conclusions And Relevance: The 2016 US presidential election appears to have been associated with an increase in preterm births among US Latina women. Anti-immigration policies have been proposed and enforced in the aftermath of the 2016 presidential election; future research should evaluate the association of these actions with population health.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.7084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647358PMC
July 2019

Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education.

Int J Geriatr Psychiatry 2019 11 4;34(11):1633-1641. Epub 2019 Aug 4.

Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA.

Objectives: To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity.

Methods: We identified the prevalence of depressive symptoms among US-born adults ages 50 years and older in the 1998 to 2014 waves of the Health and Retirement Study (n = 16 022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus nonrural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms.

Results: In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR = 1.20; 95% CI, 1.12-1.29; marginal predicted probability 10.5% for rural and 8.9% for nonrural childhood residence). Adjusting for US Census birth region and parental education attenuated this association (OR = 1.07; 95% CI, 0.99-1.15; marginal predicted probability 9.9% for rural and 9.3% for nonrural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR = 0.94; 95% CI, 0.87-1.01; marginal predicted probability 9.2% for rural and 9.8% for nonrural).

Conclusions: Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.
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http://dx.doi.org/10.1002/gps.5176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060021PMC
November 2019

An online experiment to assess bias in professional medical coding.

BMC Med Inform Decis Mak 2019 06 20;19(1):115. Epub 2019 Jun 20.

Department of Family & Community Medicine, 500 Parnassus Avenue, San Francisco, CA, 94117, USA.

Background: Multiple studies have documented bias in medical decision making, but no studies have examined whether this bias extends to medical coding practices. Medical coding is foundational to the US health care enterprise. We evaluate whether bias based on patient characteristics influences specific coding practices of professional medical coders.

Methods: This is an online experimental study of members of a national professional medical coding organization. Participants were randomly assigned a set of six clinical scenarios reflecting common medical conditions and asked to report encounter level of service codes for these clinical scenarios. Clinical scenarios differed by patient demographics (race, age, gender, ability) or social context (food insecurity, housing security) but were otherwise identical. We estimated Ordinary Least Squares regression models to evaluate differences in outcome average visit level of service by patient demographic characteristics described in the clinical scenarios; we adjusted for coders' age, gender, race, and years of coding experience.

Results: The final analytic sample included 586 respondents who coded at least one clinical scenario. Higher mean level of service was assigned to clinical scenarios describing seniors compared to middle-aged patients in two otherwise identical scenarios, one a patient with type II diabetes mellitus (Coef: 0.28, SE: 0.15) and the other with rheumatoid arthritis (Coef: 0.30, SE: 0.13). Charts describing women were assigned lower level of service than men in patients with asthma exacerbation (Coef: -0.25, SE: 0.13) and rheumatoid arthritis (Coef: -0.20, SE: 0.12). There were no other significant differences in mean complexity score by patient demographics or social needs.

Conclusion: We found limited evidence of bias in professional medical coding practice by patient age and gender, though findings were inconsistent across medical conditions. Low levels of observed bias may reflect medical coding workflow and training practices. Future research is needed to better understand bias in coding and to identify effective and generalizable bias prevention practices.
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http://dx.doi.org/10.1186/s12911-019-0832-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585065PMC
June 2019

Having an Adult Child in the United States, Physical Functioning, and Unmet Needs for Care Among Older Mexican Adults.

Epidemiology 2019 07;30(4):553-560

From the Department of Epidemiology and Biostatistics, School of Medicine. UC San Francisco, San Francisco, CA.

Background: Migration of adult children may impact the health of aging parents who remain in low- and middle-income countries. Prior studies have uncovered mixed associations between adult child migration status and physical functioning of older parents; none to our knowledge has examined the impact on unmet caregiving needs.

Methods: Data come from a population-based study of Mexican adults ≥50 years. We used longitudinal targeted maximum likelihood estimation to estimate associations between having an adult child US migrant and lower-body functional limitations, and both needs and unmet needs for assistance with basic or instrumental activities of daily living (ADLs/IADLs) for 11,806 respondents surveyed over an 11-year period.

Results: For women, having an adult child US migrant at baseline and 2-year follow-up was associated with fewer lower-body functional limitations [marginal risk difference (RD) = -0.14, 95% confidence interval (CI) = -0.26, -0.01] and ADLs/IADLs (RD = -0.08, 95% CI = -0.16, -0.001) at 2-year follow-up. Having an adult child US migrant at all waves was associated with a higher prevalence of functional limitations at 11-year follow-up (RD = 0.04, 95% CI = 0.01, 0.06). Having an adult child US migrant was associated with a higher prevalence of unmet needs for assistance at 2 (RD = 0.13, 95% CI = 0.04, 0.21) and 11-year follow-up for women (RD = 0.07, 95% CI = -0.02, 0.15) and 11-year follow-up for men (RD = 0.08, 95% CI = 0.00, 0.16).

Conclusion: Having an adult child US migrant had mixed associations with physical functioning, but substantial adverse associations with unmet caregiving needs for a cohort of older adults in Mexico.
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http://dx.doi.org/10.1097/EDE.0000000000001016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548567PMC
July 2019

Reconsidering the Relationship between Age at Migration and Health Behaviors among US Immigrants: The Modifying Role of Continued Cross-border Ties.

Adv Med Sociol 2019 ;19:17-45

UCLA Fielding School of Public Health, 650 Charles E Young Dr. S, 21-245C, Los Angeles, CA 90095.

Age-at-migration is commonly utilized as a proxy measure for assimilation. We re-consider this approach by examining the role of continued connection with places of origin on alcohol use. Cross-border connections may diminish the association between earlier age-at-migration and alcohol use by providing an alternative channel of influence for behavioral norms. Alternatively, a stress and coping perspective on cross border ties suggests potentially countervailing impacts of these connections on alcohol use. We use data from the 2002/2003 National Latino and Asian American Study (NLAAS) (n=1641/1630 Asian and Latino origin respondents, respectively). We first estimate the association between age-at-migration (child/adolescent versus adult migrant) and any past-year alcohol use. We subsequently test the interaction between age-at-migration and two measures of cross-border contact. All models are stratified by region of origin and gender. For Latin American-origin women, cross-border ties are associated with increased risk for alcohol use among those who migrated early in life. In contrast, Asian-origin men and women who migrated as adults and have contact with family and friends abroad have the lowest predicted probabilities of past-year alcohol use. The results among Asians support the idea that cross-border ties can be alternative influences on health behavior outcomes, particularly for adult migrants. Overall, we find qualified support for both transnational and assimilationist perspectives on alcohol use behaviors among US immigrants -- as well as the interaction between these two frameworks. The joint influences of cross-border ties and age-at-migration were observed primarily for immigrant women, and not always in expected directions. We nevertheless urge future research to consider both US and country-of-origin influences on a wider range of health and health behavior outcomes for immigrants, as well as the potential intersection between US and cross-border connections.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330705PMC
January 2019

Identifying Food Insecurity in Health Care Settings: A Systematic Scoping Review of the Evidence.

Fam Community Health 2019 Jan/Mar;42(1):20-29

Departments of Family & Community Medicine (Dr De Marchis and Dr Gottlieb) and Epidemiology & Biostatistics (Dr Torres), University of California, San Francisco; and Center for Health & Community, University of California, San Francisco (Dr Fichtenberg).

This systematic scoping review explores evidence on food insecurity (FI) screening measures, acceptability, and program implementation in health care settings. Validation studies on brief screening tools suggest that instruments exist that adequately measure the construct of FI. Patients and clinicians found FI screening acceptable in a range of clinical settings, though studies are not high quality and rarely reflect substantial patient diversity. Targeted interventions successfully increased screening rates and reduced screening barriers. More research is needed to understand implementation and effectiveness of FI screening in diverse populations to ensure that evolving practices in this area do not widen health inequities.
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http://dx.doi.org/10.1097/FCH.0000000000000208DOI Listing
January 2019

Longitudinal associations between having an adult child migrant and depressive symptoms among older adults in the Mexican Health and Aging Study.

Int J Epidemiol 2018 10;47(5):1432-1442

Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.

Background: Migration may impact the mental health of family members who remain in places of origin. We examined longitudinal associations between having an adult child migrant and mental health, for middle-aged and older Mexican adults accounting for complex time-varying confounding.

Methods: Mexican Health and Aging Study cohort (N = 11 806) respondents ≥50 years completed a 9-item past-week depressive symptoms scale; scores of ≥5 reflected elevated depressive symptoms. Expected risk differences (RD) for elevated depressive symptoms at each wave due to having at least one (versus no) adult child migrant in the US or in another Mexican city were estimated with longitudinal targeted maximum likelihood estimation.

Results: Women with at least one adult child in the US had a higher adjusted baseline prevalence of elevated depressive symptoms (RD: 0.063, 95% CI: 0.035, 0.091) compared to women with no adult children in the US. Men with at least one child in another Mexican city at all three study waves had a lower adjusted prevalence of elevated depressive symptoms at 11-year follow-up (RD: -0.042, 95% CI: -0.082, -0.003) compared to those with no internal migrant children over those waves. For men and women with ≤3 total children, adverse associations between having an adult child in the US and depressive symptoms persisted beyond baseline.

Conclusions: Associations between having an adult child migrant and depressive symptoms varied by respondent gender, family size, and the location of the child migrant. Trends in population aging and migration bring new urgency to examining associations with other outcomes and in other settings.
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http://dx.doi.org/10.1093/ije/dyy112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6208273PMC
October 2018

Cross-border ties, nativity, and inflammatory markers in a population-based prospective study of Latino adults.

Soc Sci Med 2018 08 16;211:21-30. Epub 2018 May 16.

Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, United States.

Even after migration, immigrants and their descendants may continue to have ties to family and friends who remain in places of origin. Recent research suggests that these cross-border social ties have implications for health, although this scholarship has been limited to self-reported outcomes. Using data from the Sacramento Area Latino Study on Aging (SALSA), we estimate associations between cross-border social ties and inflammatory biomarkers among Latino adults (n = 1786). We find that immigrants who maintained any cross-border connection to family and friends in Latin America had significantly lower levels of baseline interleukin-6 (IL-6) and C-reactive protein (CRP) compared to their US-born counterparts with no cross-border ties. These results held for values of CRP at five-year follow-up for men only. In contrast, US-born women with cross-border ties to family and friends in Latin America had both significantly higher levels of CRP and significantly lower levels of tumor necrosis factor-alpha (TNF-α) at five-year follow-up relative to their US-born counterparts with no cross-border ties. We find descriptively that men who have cross-border ties are also less likely to be socially isolated within local contexts. Considering place-of-origin social connections may contribute critical nuance to studies of immigrant health, including disparities in inflammatory markers that may serve as indicators of underlying chronic disease.
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http://dx.doi.org/10.1016/j.socscimed.2018.05.028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108549PMC
August 2018

Worry About Deportation and Cardiovascular Disease Risk Factors Among Adult Women: The Center for the Health Assessment of Mothers and Children of Salinas Study.

Ann Behav Med 2018 02;52(2):186-193

Division of Community Health and Human Development; Center for Environmental Research and Children©s Health (CERCH), UC Berkeley School of Public Health, Berkeley, CA.

Background: U.S. Latinos report high levels of concern about deportation for themselves or others. No previous research has tested the link between worry about deportation and clinical measures of cardiovascular risk.

Purpose: We estimate the associations between worry about deportation and clinically measured cardiovascular risk factors.

Methods: Data come from the Center for the Health Assessment of Mothers and Children of Salinas study. The analytic sample includes 545 Mexican-origin women.

Results: In multivariable models, reporting a lot of worry about deportation was significantly associated with greater body mass index, greater risk of obesity, larger waist circumference, and higher pulse pressure. Reporting moderate deportation worry was significantly associated with greater risk of overweight and higher systolic blood pressure. Significant associations between worry about deportation and greater body mass index, waist circumference, and pulse pressure, respectively, held after correcting for multiple testing at p < .05.

Conclusions: Worry about deportation may be an important cardiovascular risk factor for ethnic minority populations in the USA.
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http://dx.doi.org/10.1093/abm/kax007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858722PMC
February 2018

The centrality of social ties to climate migration and mental health.

BMC Public Health 2017 07 6;17(1):600. Epub 2017 Jul 6.

Robert Wood Johnson Foundation Health and Society Scholars Program and the Department of Environmental Science, Policy, and Management, University of California, Berkeley, Mulford Hall, 130 Hilgard Way, Berkeley, CA, 94720, USA.

Climate change-related hazards and disasters, known to adversely impact physical and mental health outcomes, are also expected to result in human migration above current levels. Environmentally-motivated migration and displacement may lead to the disruption of existing social ties, with potentially adverse consequences for mobile populations as well as their family members who remain in places of origin. We propose that the disruption of social ties is a key mechanism by which climate-related migration may negatively impact mental health, in particular. Existing social ties may provide social and material resources that buffer mental health stressors related to both prolonged and acute climate events. Preparation for such events may also strengthen these same ties and protect mental health. Communities may leverage social ties, first to mitigate climate change, and second, to adapt and rebuild post-disaster in communities of origin. Additionally, social ties can inform migration decisions and destinations. For example, scholars have found that the drought-motivated adaptive migration of West African Fulbe herders only occurred because of the long-term development of social networks between migrants and non-migrants through trade and seasonal grazing. On the other hand, social ties do not always benefit mental health. Some migrants, including those from poor regions or communities with no formal safety net, may face considerable burden to provide financial and emotional resources to family members who remain in countries of origin. In destination communities, migrants often face significant social marginalization. Therefore, policies and programs that aim to maintain ongoing social ties among migrants and their family and community members may be critically important in efforts to enhance population resilience and adaptation to climate change and to improve mental health outcomes. Several online platforms, like Refugee Start Force, serve to integrate refugees by connecting migrants directly to people and services in destination communities. These efforts may increasingly draw upon novel technologies to support and maintain social networks in the context of population mobility due to climatic and other factors.
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http://dx.doi.org/10.1186/s12889-017-4508-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5498922PMC
July 2017

ICD Social Codes: An Underutilized Resource for Tracking Social Needs.

Med Care 2017 09;55(9):810-816

*Center for Health & Community, UC San Francisco, San Francisco, CA †Children's Hospital Association, Washington, DC ‡Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO §Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO ∥University of Missouri, Pediatric Hospital Medicine Fellowship Children's Mercy Hospital, Kansas City, MO ¶Children's Hospital Association, Overland Park, Kansas, Lenexa, KS #Department of Pediatric Emergency Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN **Department of Family and Community Medicine, University of California at San Francisco, San Francisco, CA.

Background: Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD).

Objective: To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database.

Materials And Methods: Data come from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, a national stratified sample of discharges from 4363 hospitals from 44 US states. We estimate the rate of ICD-9 SDH V code utilization overall and by patient demographics and payer categories. We additionally estimate the rate of SDH V code utilization for: (a) the 5 most common reasons for hospitalization; and (b) the 5 conditions with the highest rates of SDH V code utilization.

Results: Fewer than 2% of overall discharges in the National Inpatient Sample were assigned an SDH V code. There were statistically significant differences in the rate of overall SDH V code utilization by age categories, race/ethnicity, sex, and payer (all P<0.001). Nevertheless, SDH V codes were assigned to <7% of discharges in any demographic or payer subgroup. SDH V code utilization was highest for major diagnostic categories related to mental health and alcohol/substance use-related discharges.

Conclusions: SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.
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http://dx.doi.org/10.1097/MLR.0000000000000764DOI Listing
September 2017

Cross-border Ties as Sources of Risk and Resilience: Do Cross-border Ties Moderate the Relationship between Migration-related Stress and Psychological Distress for Latino Migrants in the United States?

J Health Soc Behav 2016 12 1;57(4):436-452. Epub 2016 Nov 1.

University of Illinois at Urbana-Champaign, Urbana, IL, USA.

Few studies have examined the associations between health and the cross-border ties that migrants maintain with their family members in communities of origin. We draw on theory related to social ties, ethnic identity, and mental health to examine cross-border ties as potential moderators of the association between migration-related stress and psychological distress among Latino migrants. Using data from the National Latino and Asian American Survey, we find that remittance sending is associated with significantly lower levels of psychological distress for Cuban migrants, and difficulty visiting home is associated with significantly greater psychological distress for Puerto Rican migrants. There were significant associations between migration-related stressors and psychological distress, although these associations fell to nonsignificance after accounting for multiple testing. We found little evidence that cross-border ties either buffer or exacerbate the association between migration-related stressors and psychological distress. We consider the findings within the current political and historical context of cross-border ties and separation.
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http://dx.doi.org/10.1177/0022146516667534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444403PMC
December 2016

Transnational ties and the health of sub-Saharan African migrants: The moderating role of gender and family separation.

Soc Sci Med 2016 11 9;168:63-71. Epub 2016 Sep 9.

Hewlett Foundation, Menlo Park, United States.

Recent scholarship has focused on the role that cross-border social and economic ties play in shaping health outcomes for migrant populations. Nevertheless, the extant empirical work on this topic has paid little attention to the health impacts of cross-border separation from close family members. In this paper we examine the association between cross-border ties-and cross-border separation-with the health of sub-Saharan African (SSA) migrant adults living in metropolitan France using data from the nationally representative "Trajectoire et Origines" survey (n = 1980 SSA migrants). In logistic regression analyses we find that remitting money and having a child abroad are each associated with poor health among women, but not men. The effect of remittances on health is also modified by the location of one's children: remittance sending is associated with poor health only for SSA-migrants separated from their children. These findings underscore the importance of examining both cross-border connection and cross-border separation in studies of immigrant health, and also underscore the heterogeneous relationships between cross-border ties and health for men and women. This is the first study to our knowledge that examines the relationship between cross-border ties and health for migrants in Europe, with a focus on SSA-migrants in France. These findings have important implications for the health of the growing immigrant and refugee populations in Europe and around the globe.
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http://dx.doi.org/10.1016/j.socscimed.2016.09.009DOI Listing
November 2016