Annie Gjelsvik

Neighborhood Environment, Racial Position, and Risk of Police-Reported Domestic Violence: A Contextual Analysis

Objectives. The purpose of this study was to examine the contribution of neighborhood socioeconomic conditions to risk of police-reported domestic violence in relation to victims race. Data on race came from police forms legally mandated for the reporting of domestic violence and sexual assault. Methods. Using 1990 U.S. census block group data and data for the years 1996–1998 from Rhode Islands domestic violence surveillance system, the authors generated annual and relative risk of police-reported domestic violence and estimates of trends stratified by age, race (black, Hispanic, or white), and neighborhood measures of socioeconomic conditions. Race-specific linear regression models were constructed with average annual risk of police-reported domestic violence as the dependent variable. Results. Across all levels of neighborhood poverty (<5% to 100% of residents living below the federal poverty level), the risk of police-reported domestic violence was higher for Hispanic and black women than for white women. Results from the linear regression models varied by race. For black women, living in a census block group in which fewer than 10% of adults ages ≥25 years were college-educated contributed independently to risk of police-reported domestic violence. Block group measures of relative poverty (≥20% of residents living below 200% of the poverty line) and unemployment (≥10% of adults ages ≥16 years in the labor force but unemployed) did not add to this excess. For Hispanic women, three neighborhood-level measures were significant: percentage of residents living in relative poverty, percentage of residents without college degrees, and percentage of households monolingual in Spanish. A higher degree of linguistic isolation, as defined by the percentage of monolingual Spanish households, decreased risk among the most isolated block groups for Hispanic women. For white women, neighborhood-level measures of poverty, unemployment, and education were significant determinants of police-reported domestic violence. Conclusion. When data on neighborhood conditions at the block group level and their interaction with individual racial position are linked to population-based surveillance systems, domestic violence intervention and prevention efforts can be improved.

Domestic violence incidents with children witnesses: findings from Rhode Island surveillance data.

In this study we analyze factors associated with children witnessing police-reported domestic violence (DV) and determine the age distribution of children witnessing. Rhode Island Department of Health surveillance data (1996-1998) from police forms were used to assess demographic characteristics of victims, characteristics of incidents, whether children were present, and childrens ages. Victim gender, age, race/ethnicity, relationship to suspect, and whether the victim was assaulted were all strong predictors of children witnessing a DV incident. Almost half (48%) of the children who witnessed DV incidents were less than 6 years old. To reach these young children, prevention and intervention programs will need to target parents and caretakers of young children and/or pediatricians.

Association between adverse childhood experiences in the home and pediatric asthma

BACKGROUND Numerous studies suggest that psychosocial factors could contribute to pediatric asthma. OBJECTIVE To examine the relation between single and cumulative adverse childhood experiences (ACEs), a measurement of household dysfunction, on parent report of lifetime asthma in children. METHODS This cross-sectional study used data from the 2011 to 2012 National Survey of Childrens Health, a nationally representative sample of children 0 to 17 years old (n = 92,472). The main exposure was parent or guardian report of 6 ACE exposures (eg, witnessing domestic violence). The relation between ACE exposures and parent-reported diagnosis of childhood asthma was examined using multivariable logistic regression after controlling for demographic, socioeconomic, and behavioral covariates. RESULTS Overall asthma prevalence was 14.6%. Exposure prevalence to any ACE was 29.2%. Increased number of ACE exposures was associated with increased odds of asthma. In the adjusted model, the odds of reporting asthma were 1.28 (95% confidence interval [CI] 1.14-1.43) for those reporting 1 ACE, 1.73 (95% CI 1.27-2.36) for those with 4 ACEs, and 1.61 (95% CI 1.15-2.26) for those with 5 or 6 ACEs compared with those with no ACE exposures. Effects were moderated by Hispanic ethnicity. Hispanic children exposed to 4 ACEs had a 4.46 times increase in lifetime asthma (95% CI 2.46-8.08); white children had a 1.19 times increase (95% CI 0.80-1.79) compared with those exposed to 0 ACE. CONCLUSION This study supports the growing evidence for the biopsychosocial model of asthma onset. Future studies should examine the association between ACEs and specific asthma-related health outcomes.

Correlation between smoking status and cervical cancer screening: a cross-sectional study.

Objectives. Tobacco use is a risk factor for the development and progression of cervical cancer. The purpose of this study was to determine the correlation between smoking status among women and their compliance with cervical cancer screening guidelines. Materials and Methods. A cross-sectional analysis of the Behavioral Risk Factor Surveillance System was performed using the 2006 survey data. Women with no history of hysterectomy who answered the questions regarding smoking status, age, and last Pap smear were included (n = 150,786). Data were weighted for survey design. Results. The overall prevalence of compliance with cervical cancer screening guidelines was 83.9%. The rate of compliance was highest among former smokers (86.7%) compared with never smokers (83.7%) and current smokers (81.7%; p < .001). Among women aged 21 to 65 years, the odds of current smokers having had a Pap test in the past 3 years was 0.70 compared with women who never smoked (95% confidence interval = 0.63-0.77), when controlled for marital status, income, and access to health care. The odds of former smokers complying with screening guidelines were similar to women who never smoked. Conclusions. Women who smoke are at higher risk for developing cervical cancer but have a lower rate of screening for the disease. Efforts to increase prevalence of Pap test compliance should target current smokers.

Association of sickle cell trait with hemoglobin A1c in African Americans

Importance Hemoglobin A1c (HbA1c) reflects past glucose concentrations, but this relationship may differ between those with sickle cell trait (SCT) and those without it. Objective To evaluate the association between SCT and HbA1c for given levels of fasting or 2-hour glucose levels among African Americans. Design, Setting, and Participants Retrospective cohort study using data collected from 7938 participants in 2 community-based cohorts, the Coronary Artery Risk Development in Young Adults (CARDIA) study and the Jackson Heart Study (JHS). From the CARDIA study, 2637 patients contributed a maximum of 2 visits (2005-2011); from the JHS, 5301 participants contributed a maximum of 3 visits (2000-2013). All visits were scheduled at approximately 5-year intervals. Participants without SCT data, those without any concurrent HbA1c and glucose measurements, and those with hemoglobin variants HbSS, HbCC, or HbAC were excluded. Analysis of the primary outcome was conducted using generalized estimating equations (GEE) to examine the association of SCT with HbA1c levels, controlling for fasting or 2-hour glucose measures. Exposures Presence of SCT. Main Outcomes and Measures Hemoglobin A1c stratified by the presence or absence of SCT was the primary outcome measure. Results The analytic sample included 4620 participants (mean age, 52.3 [SD, 11.8] years; 2835 women [61.3%]; 367 [7.9%] with SCT) with 9062 concurrent measures of fasting glucose and HbA1c levels. In unadjusted GEE analyses, for a given fasting glucose, HbA1c values were statistically significantly lower in those with (5.72%) vs those without (6.01%) SCT (mean HbA1c difference, −0.29%; 95% CI, −0.35% to −0.23%). Findings were similar in models adjusted for key risk factors and in analyses using 2001 concurrent measures of 2-hour glucose and HbA1c concentration for those with SCT (mean, 5.35%) vs those without SCT (mean, 5.65%) for a mean HbA1c difference of −0.30% (95% CI, −0.39% to −0.21%). The HbA1c difference by SCT was greater at higher fasting (P = .02 for interaction) and 2-hour (P = .03) glucose concentrations. The prevalence of prediabetes and diabetes was statistically significantly lower among participants with SCT when defined using HbA1c values (29.2% vs 48.6% for prediabetes and 3.8% vs 7.3% for diabetes in 572 observations from participants with SCT and 6877 observations from participants without SCT; P<.001 for both comparisons). Conclusions and Relevance Among African Americans from 2 large, well-established cohorts, participants with SCT had lower levels of HbA1c at any given concentration of fasting or 2-hour glucose compared with participants without SCT. These findings suggest that HbA1c may systematically underestimate past glycemia in black patients with SCT and may require further evaluation.

Mental Health and Bullying in the United States Among Children Aged 6 to 17 Years

This article examines the association between mental health disorders and being identified as a bully among children between the ages of 6 and 17 years. Data from the 2007 National Survey of Children’s Health were examined. A total of 63,997 children had data for both parental reported mental health and bullying status. Bivariate analysis and logistic regression was performed to assess the association between mental health status and being identified as a bully with an age-stratified analysis and sub-analysis by type of mental health disorder. In 2007, 15.2% of U.S. children ages 6 to 17 years were identified as bullies by their parent or guardian. Children with a diagnosis of depression, anxiety, or depression had a threefold increased odds of being a bully. The diagnosis of depression is associated with a 3.31 increased odds (95% CI = [2.7, 4.07]) of being identified as a bully. Children with anxiety and attention deficit and hyperactivity disorder (ADHD) had similar odds. The diagnosis of a mental health disorder is strongly associated with being identified as a bully. In particular, depression, anxiety, and ADHD are strongly associated with being identified as a bully. These findings emphasize the importance of providing psychological support to not only victims of bullying but bullies as well. Understanding the risk profile of childhood bullies is essential in gaining a better grasp of this public health problem and in creating useful and appropriate resources and interventions to decrease bullying.

Mortality burden and prognosis of thin melanomas overall and by subcategory of thickness, SEER registry data, 1992-2013

Background: Thin melanomas cause a high death toll despite excellent prognosis. Objective: We examined melanoma mortality burden and prognosis by categories of thickness within Surveillance, Epidemiology, and End Results (SEER) 13 Registry 1992‐2013. Methods: We divided 49,319 stage I and II melanoma cases diagnosed between 1992 and 2003 into T1 through T4 and then subdivided T1 into 0.01‐0.25 mm, 0.26‐0.50 mm, 0.51‐0.75 mm, and 0.76‐1.00 mm categories. We determined the number and proportion of deaths due to melanoma within 10 years of diagnosis for each thickness category and proportions within T1 subcategories with ulceration. Results: We confirmed prognosis worsened as melanoma thickened from T1 to T4; however, most deaths resulted from melanomas that were diagnosed at the T1 stage. The smallest number of deaths within T1 resulted from 0.01‐0.25 mm–thick melanomas; however, the risk for death within 10 years was greater for those diagnosed with melanoma when tumor depth was 0.01‐0.25 mm than for those diagnosed when tumor depth was 0.26‐0.50 mm. Prognosis worsened with depths starting at 0.51 mm. The pattern within T1 was not explained by ulceration. Limitations: We did not evaluate melanoma subtype, mitotic rate, or other associated features. Conclusion: Thin melanomas are a substantial public health burden. Efforts should be made to diagnose melanoma at the in situ stage.

Incarceration of a Household Member and Hispanic Health Disparities: Childhood Exposure and Adult Chronic Disease Risk Behaviors

Introduction Incarceration of a household member has been linked to poor mental and behavioral health outcomes in children, but less is known about the health behaviors of these children once they reach adulthood. Methods We analyzed data from 81,910 respondents to the 2009–2010 Behavioral Risk Factor Surveillance System to identify associations between the childhood experience of having a household member incarcerated and adult smoking status, weight status, physical activity, and drinking patterns. We used multivariable logistic regression to control for sex, age, education, and additional adverse childhood events in the whole population and in separate models for Hispanic, non-Hispanic white, and non-Hispanic black adults. We also assessed for having multiple risk behaviors. Results People who lived with an incarcerated household member during childhood were more likely as adults than those who did not to engage in smoking (adjusted odds ratio [AOR] 1.50; 95% confidence interval [CI], 1.27–1.77) and heavy drinking (AOR 1.39; 95% CI, 1.03–1.87), after controlling for demographics and additional adverse childhood events. Exposure to incarceration in the household as a child among Hispanic adults was associated with being a smoker, being a heavy drinker, and having multiple risk behaviors and among white adults was associated with being a smoker and having multiple risk behaviors; among black adults there were no significant associations. Conclusion Incarceration of a household member during childhood is associated with adult risk behaviors, and race/ethnicity may be a factor in this association.

Homicide risk across race and class: a small-area analysis in Massachusetts and Rhode Island.

Areas with higher absolute poverty and higher income inequality have been associated with higher risk of homicide victimization. In addition, studies of differential homicide rates have indicated that black persons are at a higher risk of homicide compared to white persons. However, few studies directly compared risk of homicide offending or victimization between Hispanic persons and non-Hispanic white persons, and few studies have attempted to examine the interaction between race and residential neighborhood socioeconomic measures on homicide risk. This population-based retrospective study comprised all white, black, and Hispanic 15-to 44-year-old men included in the 1990 US Census as Rhode Island or Massachusetts residents. Vital statistics registries were linked to 1990 US Census data to provide information on small-area characteristics. Overall, we observed a trend of increasing homicide risk as block-group socioeconomic position descended. The data indicated that block-group poverty, female-headed households, home ownership, and higher education were all strongly associated with homicide risk after stratifying by race and age of victim and adjusting for other block-group socioeconomic characteristics. Race was a strong modifier for absolute risk difference for the relation between risk of homicide and socioeconomic surroundings. Our analyses suggested that area-based interventions that would improve neighborhood social and economic conditions would be effective in decreasing risk of homicide for men.

Adverse childhood events: Incarceration of household members and health-related quality of life in adulthood

Background. Incarceration of a household member has been associated with adverse outcomes for child well-being. Methods. We assessed the association between childhood exposure to the incarceration of a household member and adult health-related quality of life (HRQOL) in the 2009/2010 Behavioral Risk Factor Surveillance System controlling for age, race/ethnicity, education, and additional adverse childhood experiences. Results. Adults who lived in childhood with an incarcerated household member had higher risk of poor HRQOL compared with adults who had not (adjusted relative risk [ARR] 1.18; 95% CI 1.07, 1.31). Among Black adults the association was strongest with the physical health component of HRQOL (ARR 1.58 [95% CI 1.18, 2.12]); among White adults, the association was strongest with the mental health component of HRQOL (ARR 1.29, [95% CI 1.07–1.54]). Conclusions. Living with an incarcerated household member during childhood is associated with higher risk of poor HRQOL during adulthood, suggesting that the collateral damages of incarceration for children are long-term.