Christine Eibner

The Women's Health Initiative: The food environment, neighborhood socioeconomic status, BMI, and blood pressure.

Using data (n = 60,775 women) from the Womens Health Initiative Clinical Trial (WHI CT)—a national study of postmenopausal women aged 50–79 years—we analyzed cross‐sectional associations between the availability of different types of food outlets in the 1.5 miles surrounding a womans residence, census tract neighborhood socioeconomic status (NSES), BMI, and blood pressure (BP). We simultaneously modeled NSES and food outlets using linear and logistic regression models, adjusting for multiple sociodemographic factors, population density and random effects at the tract and metropolitan statistical area (MSA) level. We found significant associations between NSES, availability of food outlets and individual‐level measurements of BMI and BP. As grocery store/supermarket availability increased from the 10th to the 90th percentile of its distribution, controlling for confounders, BMI was lower by 0.30 kg/m2. Conversely, as fast‐food outlet availability increased from the 10th to the 90th percentile, BMI was higher by 0.28 kg/m2. When NSES increased from the 10th to the 90th percentile of its distribution, BMI was lower by 1.26 kg/m2. As NSES increased from the 10th to the 90th percentile, systolic and diastolic BP were lower by 1.11 mm Hg and 0.40 mm Hg, respectively. As grocery store/supermarket outlet availability increased from the 10th and 90th percentiles, diastolic BP was lower by 0.31 mm Hg. In this national sample of postmenopausal women, we found important independent associations between the food and socioeconomic environments and BMI and BP. These findings suggest that changes in the neighborhood environment may contribute to efforts to control obesity and hypertension.

Controlling U.S. health care spending--separating promising from unpromising approaches.

Peter Hussey and colleagues identify several policy options that have the potential to reduce health care spending in the United States.

For states that opt out of Medicaid expansion: 3.6 million fewer insured and

The US Supreme Courts ruling on the Affordable Care Act in 2012 allowed states to opt out of the health reform laws Medicaid expansion. Since that ruling, fourteen governors have announced that their states will not expand their Medicaid programs. We used the RAND COMPARE microsimulation to analyze how opting out of Medicaid expansion would affect coverage and spending, and whether alternative policy options-such as partial expansion of Medicaid-could cover as many people at lower costs to states. With fourteen states opting out, we estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by

8.4 billion less in federal payments.

8.4 billion, and state spending on uncompensated care could increase by

The Efficacy of the Rio Hondo Dui Court: A 2-Year Field Experiment.

1 billion in 2016, compared to what would be expected if all states participated in the expansion. These effects were only partially mitigated by alternative options we considered. We conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.

Neighborhood Socioeconomic Status and Cognitive Function in Women

This study reports results from an evaluation of the experimental Rio Hondo driving under the influence (DUI) court of Los Angeles County, California. Interviews and official record checks with 284 research participants who were randomly assigned to a DUI court or a traditional criminal court were assessed at baseline and at 24-month follow-up. The interviews assessed the impact of the DUI court on self-reported drunk driving behavior, the completion of treatment, time spent in jail, alcohol use, and stressful life events. Official record checks assessed the impact of the DUI court on subsequent arrests for driving under the influence and other drinking-related behaviors. Few differences on any outcomes were observed between participants in the experimental DUI court and those assigned to the traditional court. The results suggest that the DUI court model had little additional therapeutic or public safety benefit over the traditional court process. The implication of these findings for the popularity of specialized courts for treating social problems is discussed.

Controlling health care spending in Massachusetts: an analysis of options

OBJECTIVES We examined whether neighborhood socioeconomic status (NSES) is associated with cognitive functioning in older US women and whether this relationship is explained by associations between NSES and vascular, health behavior, and psychosocial factors. METHODS We assessed women aged 65 to 81 years (n = 7479) who were free of dementia and took part in the Womens Health Initiative Memory Study. Linear mixed models examined the cross-sectional association between an NSES index and cognitive functioning scores. A base model adjusted for age, race/ethnicity, education, income, marital status, and hysterectomy. Three groups of potential confounders were examined in separate models: vascular, health behavior, and psychosocial factors. RESULTS Living in a neighborhood with a 1-unit higher NSES value was associated with a level of cognitive functioning that was 0.022 standard deviations higher (P = .02). The association was attenuated but still marginally significant (P < .1) after adjustment for confounders and, according to interaction tests, stronger among younger and non-White women. CONCLUSIONS The socioeconomic status of a womans neighborhood may influence her cognitive functioning. This relationship is only partially explained by vascular, health behavior, or psychosocial factors. Future research is needed on the longitudinal relationships between NSES, cognitive impairment, and cognitive decline.

Ambient Particulate Matter Air Pollution and Venous Thromboembolism in the Women's Health Initiative Hormone Therapy Trials

Massachusetts passed legislation in 2006 ensuring health insurance to most residents, but rising costs and a weak economy threaten the sustainability of the reform. We analyzed 21 options for reducing health care spending in the state and identify those options that might produce savings over the next decade. Long-term solutions will require significant investments in information infrastructure and primary care capacity and fundamental change in health care delivery.

The relationship between urban sprawl and coronary heart disease in women

Background The putative effects of postmenopausal hormone therapy on the association between particulate matter (PM) air pollution and venous thromboembolism (VTE) have not been assessed in a randomized trial of hormone therapy, despite its widespread use among postmenopausal women. Objective In this study, we examined whether hormone therapy modifies the association of PM with VTE risk. Methods Postmenopausal women 50–79 years of age (n = 26,450) who did not have a history of VTE and who were not taking anticoagulants were enrolled in the Women’s Health Initiative Hormone Therapy trials at 40 geographically diverse U.S. clinical centers. The women were randomized to treatment with estrogen versus placebo (E trial) or to estrogen plus progestin versus placebo (E + P trial). We used age-stratified Cox proportional hazard models to examine the association between time to incident, centrally adjudicated VTE, and daily mean PM concentrations spatially interpolated at geocoded addresses of the participants and averaged over 1, 7, 30, and 365 days. Results During the follow-up period (mean, 7.7 years), 508 participants (2.0%) had VTEs at a rate of 2.6 events per 1,000 person-years. Unadjusted and covariate-adjusted VTE risk was not associated with concentrations of PM < 2.5 μm (PM2.5) or < 10 μm (PM10)] in aerodynamic diameter and PM × active treatment interactions were not statistically significant (p > 0.05) regardless of PM averaging period, either before or after combining data from both trials [e.g., combined trial-adjusted hazard ratios (95% confidence intervals) per 10 μg/m3 increase in annual mean PM2.5 and PM10, were 0.93 (0.54–1.60) and 1.05 (0.72–1.53), respectively]. Findings were insensitive to alternative exposure metrics, outcome definitions, time scales, analytic methods, and censoring dates. Conclusions In contrast to prior research, our findings provide little evidence of an association between short-term or long-term PM exposure and VTE, or clinically important modification by randomized exposure to exogenous estrogens among postmenopausal women.

Association Between the Opening of Retail Clinics and Low-Acuity Emergency Department Visits.

Studies have reported relationships between urban sprawl, physical activity, and obesity, but - to date - no studies have considered the relationship between sprawl and coronary heart disease (CHD) endpoints. In this analysis, we use longitudinal data on post-menopausal women from the Womens Health Initiative (WHI) Clinical Trial to analyze the relationship between metropolitan statistical area (MSA)-level urban compactness (the opposite of sprawl) and CHD endpoints including death, any CHD event, and myocardial infarction. Models control for individual and neighborhood socio-demographic characteristics. Women who lived in more compact communities at baseline had a lower probability of experiencing a CHD event and CHD death or MI during the study follow-up period. One component of compactness, high residential density, had a particularly noteworthy effect on outcomes. Finally, exploratory analyses showed evidence that the effects of compactness were moderated by race and region.