Elizabeth Crouch

Assessing the interrelatedness of multiple types of adverse childhood experiences and odds for poor health in South Carolina adults

Adverse childhood experiences (ACEs) have been linked to negative health outcomes in adulthood, but little research has been done on the effect of ACEs on the health and well-being of adults in South Carolina (SC). This study analyzed a sample of 9744 respondents who participated in the 2014 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) to examine the relationship among childhood experiences of physical, sexual, and emotional abuse, as well as witnessing household violence, on mental and physical health outcomes in adulthood among SC residents. Twenty-two percent of survey respondents reported poor general health (22.1%), and a smaller proportion reported high frequent mental distress in the past month (13.1%). Each category of childhood experiences was associated with an increase in the risk of poor general health. Individuals reporting three or more types of experiences were more likely to report poor health (aOR 2.89; 95% CI 2.86-2.92) than adults without such experiences. Respondents reporting three or more types of childhood adverse experiences were more likely to report frequent mental distress (aOR 3.29; 95% CI 3.26-3.33) compared to adults who did not report three or more types of adversity. Findings from the SC BRFSS highlight a connection between ACEs and negative health outcomes later in life. Given that results of this study also demonstrated that increased exposure to ACEs was associated with greater odds of negative health in adulthood, preventing adverse events such as experiencing abuse or witnessing domestic violence in childhood will have significant effects on later adult health.

Adverse Childhood Experiences (ACEs) and Alcohol Abuse among South Carolina Adults

ABSTRACT Background: Adverse childhood experiences (ACEs) have been associated with negative adult health outcomes, including alcohol misuse. The impact of ACEs on alcohol use may vary by gender, with ACEs impacting women more than men in coping with adulthood stressors. Objectives: The objective of this study is to examine the gender-specific relationships between ACEs and self-reported binge drinking and heavy drinking in adulthood among South Carolina residents. Methods: This study analyzed a sample of 8492 respondents who completed the 2014 or 2015 South Carolina Behavioral Risk Factor Surveillance System (BRFSS) survey. Logistic regression was used to examine the impact of types and the number of ACEs on binge drinking and heaving drinking in adulthood. Results: Thirty-seven percent of men and 22.8% of women survey respondents reported binge drinking and 12.2% of men and 4.1% of women reported heavy drinking. Almost all categories of ACE were associated with increased odds of reporting binge and heavy drinking; household mental illness had the greatest odds for men (aOR 1.31, 95% CI 1.30–1.33) and emotional abuse had the greatest odds for women (aOR 1.42, 95% CI 1.40–1.43). Men and women with four or more ACEs had greater odds of reporting binge and heavy drinking compared to their counterparts. Conclusions/Importance: Given the potential for negative outcomes associated with alcohol misuse and transmission of risky alcohol-related behaviors from parent to child, strategies that utilize a multigenerational approach could have a large impact on population health.

Economic repercussions of marital infidelity

Purpose – Numerous scholars have studied the propensity and related determinants of marital infidelity across socioeconomic and demographic groups. However, the broader social and economic consequences of infidelity remain an unexplored question, particularly the macroeconomic consequences from the individual impacts on families and households. The paper aims to discuss these issues. Design/methodology/approach – Using income data from the Bureau of Labor and Statistics, the purpose of this paper is twofold: first, to analyze the relationship between the probability of infidelity and income and second, to quantify the cost of marital infidelity on individual families and taxpayers. The results confirm that infidelity makes individual households poorer, but goes further to reveal widespread negative externalities that fall to taxpayers from the consequences of family fragmentation. Findings – The results of this study indicate a review of government policy since numerous government policies contradict the ...

Evaluating a Nutrition Education Program in an Era of Food Insecurity

ABSTRACT The link between food insecurity and chronic disease has been examined. However, the broader question of whether national policy addressing food insecurity improves chronic disease remains unexplored. This research examines how Americans with limited food resources learn how to maximize nutritional value and food resources through evaluation of the federal program, EFNEP, the Expanded Food and Nutrition Education Program. Using self-reported survey responses, dependent t-tests confirmed an improvement in health behaviors postintervention. Due to the inherent bias of self-reported survey results, this research further examines the association between food insecurity and chronic disease of EFNEP participants through regression analysis.

Uptake of Supplemental Nutrition Assistance Program Benefits by Participants in a Home Visiting Program

In 2015, over 15 percent of U.S. households with children were food insecure at some point during the year. The largest program created to address food insecurity in the United States is the Supplemental Nutritional Assistance Program (SNAP). However, research has suggested that safety net programs such as SNAP may be underutilized by eligible families. This secondary data analysis examined receipt of SNAP benefits among 2,249 SNAP-eligible participants in a South Carolina home visiting program. Benefit status was obtained at program enrollment and six months post-enrollment. Results showed that 15.6 percent of home visiting program participants without SNAP benefits at program enrollment were receiving benefits by six months post-enrollment. Unmarried caregivers were least likely to obtain SNAP benefits. Programs such as home visiting can be important to ensuring that eligible families receive federal assistance promoting food security, and targeted efforts to overcome barriers to SNAP enrollment continue to be important.

Gender and geographic differences in Medicare service utilization during the last six months of life

ABSTRACT End-of-life issues are important for senior women, particularly rural women, who are more likely than their urban counterparts to live alone. The role of residence as a factor for health-care utilization among Medicare beneficiaries during the last six months of life has yet to be investigated. The purpose of this study is to examine whether service utilization in the last six months of life differs across gender and rurality. The sample was restricted to fee-for-service Medicare beneficiaries who died between July 1, 2013, and December 31, 2013 (n = 39,508). The odds of rural beneficiaries using home health (aOR 0.87; 95% CI 0.81–0.93) and/or hospice (aOR 0.82; 95% CI 0.77–0.87) in the last six months of life were lower than urban beneficiaries. Female beneficiaries were more likely to use support services such as hospice (aOR 1.24; 95% CI 1.18–1.29) and/or home health services (aOR 1.07; 95% CI 1.02–1.13) than male beneficiaries. The odds of female beneficiaries using inpatient (aOR 1.14; 95% CI 1.08–1.20) and/or outpatient (aOR 1.06; 95% CI 1.01–1.12) were higher than male beneficiaries. This research is important as we examine the range of health services used during the last six months of life, by gender and rurality. Future research is needed to understand how access to health services, residential isolation, and age- and disease-related factors relate to women’s observed greater use of inpatient, outpatient, hospice, and home health services in the last six months of life.

Rural-Urban Differences in Costs of End-of-Life Care for the Last 6 Months of Life Among Patients with Breast, Lung, or Colorectal Cancer: Rural-Urban End-of-Life Costs in Cancer Patients

PURPOSE The purpose of this study was to examine rural-urban differences in utilization and expenditures in the last 6 months of life for patients with breast, lung, or colorectal cancer. METHODS The study used a 5% sample of the 2013 Medicare Research Identifiable Files to study utilization and expenditures for beneficiaries with breast, lung, or colorectal cancer during the last 6 months before death (n = 6,214). End of life expenditures were calculated as the sum of total Medicare expenditures for inpatient, outpatient, physician, home health, hospice, and skilled nursing facility costs during the last 6 months of life. FINDINGS For each type of cancer, total Medicare expenditures in the last 6 months of life were lower for rural decedents compared to their urban counterparts. During the last 6 months of life, median Medicare expenditures were lower for rural decedents for breast cancer (

Differences in Medicare Utilization and Expenditures in the Last Six Months of Life among Patients with and without Alzheimer's Disease and Related Disorders

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Local entrepreneurial programming: myth or reality– a southern case study

25,698), lung cancer (

Evaluating Loss to Follow-Up in Newborn Hearing Screening in a Southern State

22,814 vs