Justin T. McDaniel

Inequality as a Powerful Predictor of Infant and Maternal Mortality around the World

Background Maternal and infant mortality are highly devastating, yet, in many cases, preventable events for a community. The human development of a country is a strong predictor of maternal and infant mortality, reflecting the importance of socioeconomic factors in determinants of health. Previous research has shown that the Human Development Index (HDI) predicts infant mortality rate (IMR) and the maternal mortality ratio (MMR). Inequality has also been shown to be associated with worse health in certain populations. The main purpose of the present study was to determine the correlation and predictive power of the Inequality Adjusted Human Development Index (IHDI) as a measure of inequality with the Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR), Early Neonatal Mortality Rate (ENMR), Late Neonatal Mortality Rate (LNMR), and the Post Neonatal Mortality Rate (PNMR). Methods and Findings Data for the present study were downloaded from two sources: infant and maternal mortality data were downloaded from the Global Burden of Disease 2013 Cause of Death Database and the Human Development Index (HDI) and Inequality-Adjusted Human Development Index (IHDI) data were downloaded from the United Nations Development Program (UNDP). Pearson correlation coefficients were estimated, following logarithmic transformations to the data, to examine the relationship between HDI and IHDI with MMR, IMR, ENMR, LNMR, and PNMR. Steiger’s Z test for the equality of two dependent correlations was utilized in order to determine whether the HDI or IHDI was more strongly associated with the outcome variables. Lastly, we constructed OLS regression models in order to determine the predictive power of the HDI and IHDI in terms of the MMR, IMR, ENMR, LNMR, and PNMR. Maternal and infant mortality were both strongly and negatively correlated with both HDI and IHDI; however, Steiger’s Z test for the equality of two dependent correlations revealed that IHDI was more strongly correlated than HDI with MMR (Z = 4.897, p < 0.001), IMR (Z = 2.524, p = 0.012), ENMR (Z = 2.936, p = 0.003), LNMR (Z = 2.272, p = 0.023), and PNMR (Z = 2.277, p = 0.023). Furthermore, side-by-side OLS regression models revealed that, when IHDI was used as the predictor variable instead of HDI, the R 2 value was 0.053 higher for MMR, 0.025 higher for IMR, 0.038 higher for ENMR, 0.029 higher for LNMR, and 0.026 higher for PNMR. Conclusions Even when both the HDI and the IHDI correlate with the infant and maternal mortality rates, the IHDI is a better predictor for these two health indicators. Therefore, these results add more evidence that inequality is playing an important role in determining the health status of various populations in the world and more efforts should be put into programs to fight inequality.

Social determinants of cancer incidence and mortality around the world: an ecological study:

Cancer continues to be a leading cause of mortality and morbidity the world over. While the incidence of cancer is projected to increase by 70% over the next two decades, some research findings suggest a disproportionate distribution of new cancer cases and attendant fatalities across certain regions of the world, with poor and lower income countries worse affected at a time when advances in cancer research, medical technology, and drug development are giving rise to better cancer survival in developed countries. In this study, the role of selected social determinants of health in gauging cancer outcomes relative to incidence across various countries in different regions of the world was explored. The results indicated that the education index, income index, Gini coefficient, availability of cancer control policies and programs, as well as health system performance have an association with and are good predictors of the mortality to incidence ratio (MIR) of lung, breast, cervical, and colorectal cancers. In other words, populations with better education, higher incomes and lower inequalities, active cancer control policies and programs and high performing health systems have better cancer outcomes as reflected in lower MIRs relative to other populations.

Intimate partner violence among postsecondary students with military experience.

The purpose of this study was to explore intimate partner violence (IPV) among student service members and veterans within postsecondary educational settings. Secondary data for the present cross-sectional study were retrieved from the 2011–2014 National College Health Assessment on a nationally representative sample of college students (n = 114,816). Fisher’s exact test (Upton, 1992) was used to determine differences in 3 types of IPV (emotional abuse, physical abuse, and sexual violence) between students with and without military experience (ME). Logistic regression was conducted to determine (a) risk factors for IPV and (b) associations between IPV and certain mental, physical, and behavioral health outcomes among students with ME. Although—in terms of descriptive statistics—self-reported emotional abuse (10.700% vs. 9.000%) and physical abuse (23.200% vs. 20.500%) were higher among students with ME, self-reported sexual violence was more prevalent among students with no ME (8.300% vs. 10.200%). Risk factors for IPV among students with ME included identifying as transgender, identifying as heterosexual, being a graduate student, identifying as an “other” race, and being married. The odds of self-reported mental and physical health problems, as well as unhealthy behaviors (such as binge drinking and suicide attempts), were higher among students with ME who had experienced IPV. The emotional, behavioral, and psychological risks evident from our study substantiate the critical need for higher education professionals to place more emphasis on IPV and its consequences on students’ success.

Mental health outcomes in military veterans: A latent growth curve model.

Some research has suggested that income and mental health are related in the general population. In the present study, we examined the relationship between income and mental health among military service members and veterans. Researchers examined veteran respondents from the 2011–2014 Behavioral Risk Factor Surveillance System (2011, n = 64,594; 2012, n = 59,870; 2013, n = 61,505; 2014, n = 62,120), comparing the frequency of poor mental health days in the last 30 days and income levels. Individual-level data were aggregated to the state-level to permit spatiotemporal analysis. Mental health across states varied over the studied period; some states’ mental health indicators improved, whereas some declined. Changes in income predicted changes in mental health among veterans in each state from 2011 to 2014; states with deceases in the percentage of veterans making <

Regional differences in BMI, obesity, and exercise frequency in a large veteran service organization: A secondary analysis of new veteran member surveys from Team Red, White & Blue

15,000 per year exhibited decreases in poor mental health days. The results illuminate the relationship between mental health and income for military veterans by geographic region. Veteran mental health was at its worst with symptoms reported most frequently (in days) in states with higher percentages of veterans living in poverty. The variability of mental health outcomes by state can be used to inform future programming to meet the needs of military personnel reintegrating into their civilian communities.

Mindful Living with Human Immunodeficiency Virus and AIDS

The purpose of the present study was to examine regional differences in average self-reported BMI, obesity prevalence, and frequent exercise (FE) among members of Team Red, White, and Blue (Team RWB) – a military veteran service organization founded to increase physical activity in veterans. A total of 10,015 military veterans participated in a needs assessment conducted by Team RWB between December 2014 and August 2016. Multivariate regression analysis with bootstrapped coefficients revealed that: BMI was highest in the Midwest region (M = 28.282) of the United States, F(20, 9882) = 105.560, p < 0.001; obesity prevalence was highest in the Southcentral (32.300%) and Southeast (32.200%) regions, x2(9731) = 10,850, p < 0.001; and FE was most prevalent in the Mid-Atlantic region (67.3%), x2(9882) = 11,291, p < 0.001.The results of this study closely mirror results found in studies of the general population. A better understanding of the geographic distribution of these outcomes could guide the targeting of sub-populations for public health programs. In particular, Team Red, White & Blue community growth and other fitness based public health programs could be expanded to reach more veterans.

Rural–Urban Disparities in Physical Activity Among Service Member and Veteran Cancer Survivors

Complementary techniques are useful in treating adverse symptoms of human immunodeficiency virus (HIV) and AIDS, and in preventing disease spread by encouraging screening. This study indicates that HIV diagnosis rates are higher in states where behavioral medicine is practiced; participation in such activities may influence the extent to which someone might closely monitor personal health. A strong evidence-base exists for the recommendation of mindfulness practices that improve rates of primary preventive practices and self-reported quality of life for participants living with chronic conditions such as HIV and AIDS. Access to such programs is an area for future research and practice.

Spiritual Fitness for Military Veterans: A Curriculum Review and Impact Evaluation Using the Duke Religion Index (DUREL)

Abstract This study examined the association of rurality with physical activity (PA) among veteran cancer survivors. Data for this cross-sectional study were obtained from the 2016 Behavioral Risk Factor Surveillance System on a national sample of veterans (n = 63,919). Data were analyzed with geographic information systems and multiple logistic regression analysis. Results showed that rurality was independently associated with decreased likelihood of engagement in PA among veteran cancer survivors. Interventions aimed at increasing PA levels among rural dwelling veteran cancer survivors are needed.

Physical health characteristics of student service members and veterans by sexual orientation

Suicide rates among military veterans exceed those found in the general population. While the exact reasons for these high rates are unknown, contributing factors may include the military’s perceived rejection of patient identities, creating barriers to mental health care within the clinical sector and a mandate for prevention programs. Spiritual fitness has emerged over the last decade as an important concept in human performance optimization and is included among holistic approaches to developing and maintaining mentally fit fighting forces. In attempts to better understand the role that spiritual fitness and religion play in mitigating and/or reducing suicide risk among veterans, the aims of this study were twofold (1) to assess the utility of the Duke Religion Index as a psychometric instrument for use with veterans completing spiritual fitness training and (2) to offer a post-intervention process evaluation of the spiritual fitness module from one resilience program offered to military veterans of Iraq and Afghanistan in 2016. Twenty-eight attendees at the JRWI Wellness Resilient Leadership Retreat completed post-retreat surveys to assess their satisfaction with the coursework and specifically, to assess the spiritual fitness module of the resiliency retreat’s curriculum. In total, the research team reviewed 25 completed post-intervention survey responses (89.3% response rate). Descriptive statistics indicated that respondents (n = 25) were subjectively religious, defined as belief in a higher power practiced in ritualized ways. Over half of program participants indicated they (a) attended religious meetings at least once a week and (b) engaged in private religious activity—such as meditation—at least once a day. Results showed that most program participants reported that the spiritual fitness skills learned during the resilient leadership program were useful (88%) (Z = 3.000, p < 0.001). Additionally, most program participants reported their interest in spiritual exploration was affirmed, renewed, or raised as a result of attending the peer-led resilient leadership program (76%) (Z = 6.000, p = 0.015). Culturally informed prevention programs that emphasize spiritual fitness are indicated for use in veteran outreach and well-being programs. More detailed research is needed to assess curriculum specifics.

Effect of healthcare spending on the relationship between the Human Development Index and maternal and neonatal mortality

Abstract Objective: Little is known about the health status of the diverse population of student service members and veterans (SSM/V) enrolling in higher education in great numbers. The objective of this study was to explore the differences in physical health characteristics by sexual orientation among a national sample of SSM/V. Methods: Using secondary data, a series of maximum likelihood (ML) logistic regression models were estimated to explore physical health characteristics by sexual orientation in a sample of SSM/V. Results: SSM/V that identify as lesbian or gay reported higher rates of treatment and diagnosis for some physical health matters (respiratory illness and HIV) when compared with their heterosexual counterparts. Conclusions: Our findings support the need for campus health officials and policymakers to develop services to address the physical health needs of this population that differ from their peers.