Publications by authors named "Makram Talih"

15 Publications

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Mother-reported pain experience between ages 7 and 10: A prospective study in a population-based birth cohort.

Paediatr Perinat Epidemiol 2020 Nov 23. Epub 2020 Nov 23.

Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.

Background: Trajectory studies suggest considerable stability of persistent or recurrent pain in adolescence. This points to the first decade of life as an important aetiologic window for shaping future pain, where the potential for prevention may be optimised.

Objectives: We aimed to quantify changes in mother-reported pain experience in children between ages 7 and 10 and describe clusters of different pain experiences defined by complementary pain features.

Methods: We conducted a prospective study using data from 4036 Generation XXI birth cohort participants recruited in 2005-06. Pain history was reported by mothers at ages 7 and 10 using the Luebeck pain screening questionnaire. We tracked changes in six pain features over time using relative risks (RRs) and their 95% confidence intervals (95% CIs). Clusters were obtained using the k-medoids algorithm.

Results: The risk of severe pain at age 10 increased with increasing severity at age 7, with RRs ranging from 2.18 (95% CI 1.90, 2.50) for multisite to 4.43 (95% CI 3.19, 6.15) for high frequency pain at age 7. A majority of children (59.4%) had transient or no pain but two clusters included children with stable recurrent pain (n = 404, 10.2% of the sample). One of those (n = 177) was characterised by higher probabilities of multisite pain (74.6% and 66.7% at ages 7 and 10, respectively), with psychosocial triggers/contexts (59.3% and 61.0%) and daily-living restrictions (72.2% and 84.6%). Most children in that cluster (58.3%) also self-reported recent pain at age 10 and had more frequent family history of chronic pain (60.5%).

Conclusions: All pain features assessed tracked with a positive gradient between ages 7 and 10, arguing for the significance of the first decade of life in the escalation of the pain experience. Multisite pain and psychosocial attributions appeared to be early markers of more adverse pain experiences.
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http://dx.doi.org/10.1111/ppe.12730DOI Listing
November 2020

Measuring the Magnitude of Health Inequality Between 2 Population Subgroup Proportions.

Am J Epidemiol 2020 09;189(9):987-996

In this paper, we evaluate 11 measures of inequality, d(p1, p2), between 2 proportions p1 and p2, some of which are new to the health disparities literature. These measures are selected because they are continuous, nonnegative, equal to 0 if and only if |p1 - p2| = 0, and maximal when |p1 - p2| = 1. They are also symmetrical [d(p1, p2) = d(p2, p1)] and complement-invariant [d(p1, p2) = d(1 - p2, 1 - p1)]. To study intermeasure agreement, 5 of the 11 measures, including the absolute difference, are retained, because they remain finite and are maximal if and only if |p1 - p2| = 1. Even when the 2 proportions are assumed to be drawn at random from a shared distribution-interpreted as the absence of an avoidable difference-the expected value of d(p1, p2) depends on the shape of the distribution (and the choice of d) and can be quite large. To allow for direct comparisons among measures, we propose a standard measurement unit akin to a z score. For skewed underlying beta distributions, 4 of the 5 retained measures, once standardized, offer more conservative assessments of the magnitude of inequality than the absolute difference. We conclude that, even for measures that share the highlighted mathematical properties, magnitude comparisons are most usefully assessed relative to an elicited or estimated underlying distribution for the 2 proportions.
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http://dx.doi.org/10.1093/aje/kwaa050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483981PMC
September 2020

HPV vaccine status and sexual behavior among young sexually-active women in the US: evidence from the National Health and Nutrition Examination Survey, 2007-2014.

Health Econ Policy Law 2020 10 21;15(4):477-495. Epub 2019 May 21.

University of Porto Institute of Public Health, Rua das Taipas 135, 4050-600Porto, Portugal.

Concern has been expressed that human papillomavirus (HPV) vaccination programs might promote risky sexual behavior through mechanisms such as risk compensation, behavioral disinhibition, or perceived endorsement of sexual activity. This study assesses whether HPV vaccination status is associated with any differences in selected sexual behaviors among young sexually-active women in the US. Our dataset includes young, adult female respondents from questionnaire data collected in the National Center for Health Statistics' National Health and Nutrition Examination Survey from 2007 to 2014. The empirical approach implements a doubly robust estimation procedure, based on inverse probability of treatment weighting. For robustness, we implement several specifications for the propensity model and the outcomes model. We find no consistent association between HPV vaccination and condom usage or frequency of sex. Specifically, we find no evidence that HPV vaccination is associated with condom usage or with whether a person had sex more than 52 or more than 104 times per year. We find inconsistent evidence that HPV vaccination is associated with a person having sex more than 12 times per year. As in previous research, HPV vaccination does not appear to have a substantive effect on sexual behavior among young sexually-active women in the US.
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http://dx.doi.org/10.1017/S1744133119000136DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868297PMC
October 2020

National Center for Health Statistics Data Presentation Standards for Proportions.

Vital Health Stat 2 2017 Aug(175):1-22

The National Center for Health Statistics (NCHS) disseminates information on a broad range of health topics through diverse publications. These publications must rely on clear and transparent presentation standards that can be broadly and efficiently applied. Standards are particularly important for large, cross-cutting reports where estimates cannot be individually evaluated and indicators of precision cannot be included alongside the estimates. This report describes the NCHS Data Presentation Standards for Proportions. The multistep NCHS Data Presentation Standards for Proportions are based on a minimum denominator sample size and on the absolute and relative widths of a confidence interval calculated using the Clopper-Pearson method. Proportions (usually multiplied by 100 and expressed as percentages) are the most commonly reported estimates in NCHS reports.
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August 2017

Issues in Developing Multidimensional Indices of State-level Health Inequalities: National Health Interview Survey, 2013-2015.

Vital Health Stat 2 2018 Jun(180):1-40

To describe methodological issues that arise in the construction and design-based estimation of multidimensional indices that aggregate state-specific inequalities in core health measures, using data from the National Health Interview Survey (NHIS).
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June 2018

Response to Scanlan Concerning: Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity.

J Public Health Manag Pract 2016 Nov-Dec;22(6):614-5

Office of Minority Health and Health Equity Centers for Disease Control and Prevention Atlanta, Georgia National Center for Health Statistics Hyattsville, Maryland Office of Minority Health and Health Equity Centers for Disease Control and Prevention Atlanta, Georgia National Center for Health Statistics Hyattsville, Maryland.

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http://dx.doi.org/10.1097/PHH.0000000000000494DOI Listing
August 2019

Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity.

J Public Health Manag Pract 2016 Jan-Feb;22 Suppl 1:S33-42

Office of Minority Health and Health Equity (Drs Penman-Aguilar, Moonesinghe, and Bouye) and National Center for Chronic Disease and Health Promotion (Dr Beckles), Centers for Disease Control and Prevention, Atlanta, Georgia; and National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland (Drs Talih and Huang).

Reduction of health disparities and advancement of health equity in the United States require high-quality data indicative of where the nation stands vis-à-vis health equity, as well as proper analytic tools to facilitate accurate interpretation of these data. This article opens with an overview of health equity and social determinants of health. It then proposes a set of recommended practices in measurement of health disparities, health inequities, and social determinants of health at the national level to support the advancement of health equity, highlighting that (1) differences in health and its determinants that are associated with social position are important to assess; (2) social and structural determinants of health should be assessed and multiple levels of measurement should be considered; (3) the rationale for methodological choices made and measures chosen should be made explicit; (4) groups to be compared should be simultaneously classified by multiple social statuses; and (5) stakeholders and their communication needs can often be considered in the selection of analytic methods. Although much is understood about the role of social determinants of health in shaping the health of populations, researchers should continue to advance understanding of the pathways through which they operate on particular health outcomes. There is still much to learn and implement about how to measure health disparities, health inequities, and social determinants of health at the national level, and the challenges of health equity persist. We anticipate that the present discussion will contribute to the laying of a foundation for standard practice in the monitoring of national progress toward achievement of health equity.
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http://dx.doi.org/10.1097/PHH.0000000000000373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5845853PMC
February 2017

EXAMINING SOCIOECONOMIC HEALTH DISPARITIES USING A RANK-DEPENDENT RÉNYI INDEX.

Authors:
Makram Talih

Ann Appl Stat 2015 Jun;9(2):992-1023

National Center for Health Statistics.

The Rényi index (RI) is a one-parameter class of indices that summarize health disparities among population groups by measuring divergence between the distributions of disease burden and population shares of these groups. The RI introduced in this paper is a two-parameter class of health disparity indices that also accounts for the association between socioeconomic rank and health; it may be derived from a rank-dependent social welfare function. Two competing classes are discussed and the rank-dependent RI is shown to be more robust to changes in the distribution of either socioeconomic rank or health. The standard error and sampling distribution of the rank-dependent RI are evaluated using linearization and re-sampling techniques, and the methodology is illustrated using health survey data from the U.S. National Health and Nutrition Examination Survey and registry data from the U.S. Surveillance, Epidemiology and End Results Program. Such data underlie many population-based objectives within the U.S. Healthy People 2020 initiative. The rank-dependent RI provides a unified mathematical framework for eliciting various societal positions with regards to the policies that are tied to such wide-reaching public health initiatives. For example, if population groups with lower socioeconomic position were ascertained to be more likely to utilize costly public programs, then the parameters of the RI could be selected to reflect prioritizing those population groups for intervention or treatment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641042PMC
http://dx.doi.org/10.1214/15-aoas822DOI Listing
June 2015

Social determinants of disparities in weight among US children and adolescents.

Ann Epidemiol 2014 Oct 1;24(10):705-713.e2. Epub 2014 Aug 1.

Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.

Purpose: To explore whether contextual variables attenuate disparities in weight among 18,639 US children and adolescents aged 2 to 18 years participating in the National Health and Nutrition Examination Survey, 2001 to 2010.

Methods: Disparities were assessed using the Symmetrized Rényi Index, a new measure that summarizes disparities in the severity of a disease, as well as the prevalence, across multiple population groups. Propensity score subclassification was used to ensure covariate balance between racial and ethnic subgroups and account for individual-level and contextual covariates.

Results: Before propensity score subclassification, significant disparities were evident in the prevalence of overweight and/or obesity and the degree of excess weight among overweight/obese children and adolescents. After propensity score subclassification, racial/ethnic disparities in the prevalence and severity of excess weight were completely attenuated within matched groups, indicating that racial and ethnic differences were explained by social determinants such as neighborhood socioeconomic and demographic factors.

Conclusions: The limited overlap in covariate distributions between various racial/ethnic subgroups warrants further attention in disparities research. The attenuation of disparities within matched groups suggests that social determinants such as neighborhood socioeconomic factors may engender disparities in weight among US children and adolescents.
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http://dx.doi.org/10.1016/j.annepidem.2014.07.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669563PMC
October 2014

Invited commentary: Can changes in the distributions of and associations between education and income bias estimates of temporal trends in health disparities?

Authors:
Makram Talih

Am J Epidemiol 2013 May 7;177(9):882-4. Epub 2013 Apr 7.

Chen et al. (Am J Epidemiol. 2013;177(9):870-881) develop a simulation study for comparing various measures of socioeconomic health disparities when bias can arise from temporal changes in the bivariate distribution of education and income. In this commentary, I argue that, in relation to health, the "meaning" of education cannot be reduced to its socioeconomic value; improved health literacy, for instance, can result in important health benefits. Further, I suggest that unless there is a substantial prior understanding of the data-generating mechanism, directed acyclic graph models should be avoided because causal relationships cannot be inferred from regression. An alternative is to resort to conditional independence graphs, which use only undirected edges. Finally, although the slope index of inequality can, in some specific cases, be seen to reduce bias in temporal comparisons of socioeconomic health disparities, it was not designed for causal inference. The slope index of inequality simply describes the average change in the proportion in poor health when the population is ordered by socioeconomic status.
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http://dx.doi.org/10.1093/aje/kwt042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642842PMC
May 2013

A REFERENCE-INVARIANT HEALTH DISPARITY INDEX BASED ON RÉNYI DIVERGENCE.

Authors:
Makram Talih

Ann Appl Stat 2013;7(2):1217-1243. Epub 2013 Dec 9.

National Center for Health Statistics.

One of four overarching goals of Healthy People 2020 (HP2020) is to achieve health equity, eliminate disparities, and improve the health of all groups. In health disparity indices (HDIs) such as the mean log deviation (MLD) and Theil index (TI), disparities are relative to the population average, whereas in the index of disparity (IDisp) the reference is the group with the least adverse health outcome. Although the latter may be preferable, identification of a reference group can be affected by statistical reliability. To address this issue, we propose a new HDI, the Rényi index (RI), which is reference-invariant. When standardized, the RI extends the Atkinson index, where a disparity aversion parameter can incorporate societal values associated with health equity. In addition, both the MLD and TI are limiting cases of the RI. Also, a symmetrized Rényi index (SRI) can be constructed, resulting in a symmetric measure in the two distributions whose relative entropy is being evaluated. We discuss alternative symmetric and reference-invariant HDIs derived from the generalized entropy (GE) class and the Bregman divergence, and argue that the SRI is more robust than its GE-based counterpart to small changes in the distribution of the adverse health outcome. We evaluate the design-based standard errors and bootstrapped sampling distributions for the SRI, and illustrate the proposed methodology using data from the National Health and Nutrition Examination Survey (NHANES) on the 2001-04 prevalence of moderate or severe periodontitis among adults aged 45-74, which tracks Oral Health objective OH-5 in HP2020. Such data, which uses a binary individual-level outcome variable, are typical of HP2020 data.
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http://dx.doi.org/10.1214/12-AOAS621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643429PMC
December 2013

Examining periodontal disease disparities among U.S. adults 20 years of age and older: NHANES III (1988-1994) and NHANES 1999-2004.

Public Health Rep 2012 Sep-Oct;127(5):497-506

The City University of New York, Lehman College, Department of Health Sciences, New York, NY 10468, USA.

Objective: We examined disparities in periodontal disease in U.S. adults according to age, sex, race/ethnicity, country of birth, education, income, and poverty-income ratio within and between the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and NHANES 1999-2004.

Methods: We assessed disparities and changes therein using prevalence differences and ratios, as well as the Symmetrized Theil Index (STI). While these measures document disparities between pairs of population subgroups, and changes in relative disparities between surveys, the STI is a summary measure of health disparities that also tracks between-group disparities relative to the total population.

Results: Prevalence differences and ratios for the prevalence of periodontitis, the mean pocket depth (PD), and the mean clinical attachment loss (CAL) suggest that periodontal disease significantly decreased between NHANES III and NHANES 1999-2004 (p<0.01). However, the STI for the prevalence of periodontitis suggests that disparities significantly increased within categories of race/ethnicity, country of birth, and education in NHANES 1999-2004 compared with NHANES III. These findings were corroborated for mean PD and mean CAL (p<0.001): the overall STI significantly increased for mean PD from 4.53% in NHANES III to 11.02% in NHANES 1999-2004 and for mean CAL for teeth with CAL >0 from 31.73% in NHANES III to 43.36% in NHANES 1999-2004.

Conclusions: Our findings suggest that inequalities in periodontal disease significantly decreased between NHANES III and NHANES 1999-2004 in the total population and across selected characteristics of the population. However, these inequalities increased within groups of the population in NHANES 1999-2004 compared with NHANES III. These findings call attention to the absolute and relative differences not only between population groups across surveys, but also within population groups within and between surveys.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407849PMC
http://dx.doi.org/10.1177/003335491212700505DOI Listing
November 2012

A symmetrized Theil index measure of health disparities: An example using dental caries in U.S. children and adolescents.

Stat Med 2011 Feb 5;30(3):277-90. Epub 2010 Nov 5.

Department of Health Sciences, Lehman College, City University of New York, USA.

While the health status of Americans has generally improved over time, health disparities among groups of the population have been pervasive. Designing a measure that tracks the resulting disparities remains a challenge. In this paper, we propose a new measure of health disparities the Symmetrized Theil Index (STI), and derive its design-based sampling variance in grouped survey data. Because STI is symmetric, it circumvents the drawback of the Theil Index in how groups are weighted: indeed, the latter is mostly influenced by groups with high disease frequencies. Moreover, STI is related to Pearson's chi-square test of independence for binary data, and to the F-test in one-way analysis-of-variance for continuous data. We illustrate our approach using data on dental caries for children and adolescents from the third National Health and Nutrition Examination Surveys (NHANES III; 1988-1994) and NHANES 1999-2004. Tooth decay remains the most common chronic disease in U.S. children and adolescents. Although their oral health has generally improved, we find no change in the prevalence or severity of untreated tooth decay in U.S. children and adolescents between surveys. These findings are consistently observed for both the overall STI and its between-group component across gender, race/ethnicity, country of birth, survey respondent's education, income and poverty-income ratio.
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http://dx.doi.org/10.1002/sim.4114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059777PMC
February 2011

Frequency of recent cocaine and alcohol use affects drug craving and associated responses to stress and drug-related cues.

Psychoneuroendocrinology 2005 Oct;30(9):880-91

Department of Psychiatry, Yale University School of Medicine, Substance Abuse Center, Connecticut Mental Health Center, New Haven, 06519, USA.

Rationale: Stress is known to increase drug craving, associated physiological arousal and risk of relapse in drug dependent individuals. However, it is unclear whether these responses are altered by recent frequency of drug use. The current study examined whether frequency of cocaine and alcohol abuse alters drug craving and associated arousal with laboratory exposure to stress and to drug related cues.

Methods: Fifty-four recently abstinent treatment-seeking cocaine abusers who were part of a study on stress and drug craving were categorized into high- and low-frequency users on the basis of their recent cocaine use. The high use cocaine group also consumed significantly more alcohol than the low use cocaine group. Participants were exposed to a brief 5-min guided imagery procedure that involved imagining a recent personal stressful situation, a personal drug-related situation and a neutral-relaxing situation, one imagery session on separate days presented in random order. Subjective (craving and anxiety), cardiovascular (heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP)) and biochemical (adrenocorticotropic hormone (ACTH), cortisol, prolactin) measures were assessed.

Results: High-frequency abusers demonstrated a significantly greater drug craving, anxiety and associated cardiovascular and hypothalamic-pituitary-adrenal (HPA) response to both stress and drug-cue exposure as compared to low-frequency abusers.

Conclusions: Increased frequency of recent cocaine and alcohol use is associated with an enhanced stress and cue-induced drug craving and arousal response that appears to be similar to the effects of cocaine, and one that may increase the vulnerability to drug-seeking behavior and relapse in drug dependent individuals.
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http://dx.doi.org/10.1016/j.psyneuen.2005.05.002DOI Listing
October 2005

Hypothalamic-pituitary-adrenal axis and sympatho-adreno-medullary responses during stress-induced and drug cue-induced cocaine craving states.

Psychopharmacology (Berl) 2003 Oct 4;170(1):62-72. Epub 2003 Jul 4.

Department of Psychiatry, Yale University School of Medicine, S-112 Substance Abuse Center, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, USA.

Rationale: Environmental stimuli associated with cocaine are known to elicit drug craving and increase the likelihood of relapse. However, the psychobiological changes that occur with exposure to these stimuli and in episodes of drug craving are not well understood. This study examined the response of brain stress circuits to environmental stimuli that are known to increase cocaine craving in cocaine dependent individuals.

Methods: Fifty-four treatment seeking cocaine dependent individuals, who were admitted to an inpatient treatment research unit for 2-4 weeks, participated in three laboratory sessions. Subjects were exposed to a brief 5-min guided imagery procedure that involved imagining a recent personal stressful situation, a drug-related situation and a neutral-relaxing situation, one imagery per session presented in random order. Subjective ratings of craving and anxiety, cardiovascular measures, and plasma levels of adrenocorticotrophic hormone (ACTH), cortisol, prolactin, norepinephrine (NE) and epinephrine (EPI) were assessed.

Results: Exposure to stress and to drug cues each resulted in significant increases in cocaine craving and subjective anxiety, pulse rate, systolic blood pressure, ACTH, cortisol, prolactin and NE as compared to the response to neutral imagery. In addition, stress imagery also increased diastolic blood pressure and plasma EPI as compared to responses to the drug cue imagery and neutral-relaxing imagery.

Conclusions: The findings indicate a significant activation of the CRF-HPA axis and noradrenergic/sympatho-adreno-medullary (SAM) system response during stress-induced and drug cue induced cocaine craving states in cocaine dependent individuals. The role of stress system activation in cocaine craving and in cocaine use is discussed.
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http://dx.doi.org/10.1007/s00213-003-1525-8DOI Listing
October 2003