Michelle L. Rogers

Improved disability population estimates of functional limitation among American children aged 5-17.

Objectives: This paper (a) creates and validates measures for population survey data to assess functional limitation in mobility, self-care, communication, and learning ability for school-age American children; (b) calculates rates of functional limitation using these measures, and provides population estimates of the number of children with limitations; and (c) examines these limitations as a function of socioeconomic factors. Method: The study is based on data for children aged 5–17 collected in the 1994 National Health Interview Survey on Disability. Ordinal values are assigned to survey items in the four functional areas and analyzed to produce scales of high reliability. These measures are used to identify within a 95% confidence interval the number of children with these limitations. Ordered logistic regression models measure the effects of functional limitations on disability and societal limitation. Socioeconomic differences are measured with an ordered logistic regression model that predicts severity and comorbidity. Results: Limitations in learning ability (10.6%) and communication (5.5%) are the most common, with mobility (1.3%) and self-care (0.9%) occurring less often. Six percent of children have one serious functional limitation and 2.0% have two or more serious functional limitations. This corresponds to 4.0 million school-age American children with serious functional limitations. Functional limitation is strongly linked to socioeconomic disadvantage and to residence in single-mother households. Conclusions: Future population research should use multiple-item scales for four distinct areas of functional limitation, and a summary that takes into account both severity and comorbidity. The improved estimates of the number of school-age children with functional limitation in this paper may help contribute to a more informed scientific and policy discussion of functional limitation and disability among American school-age children. Future research on the disability process among children must consider the role of socioeconomic disadvantage and family structure.

Ethnic/racial disparities in hospital procedure volume for lung resection for lung cancer.

Background:Ethnic/racial minorities experience poorer outcomes from lung cancer than non-Hispanic whites. Higher hospital procedure volume is associated with better survival from lung resection for lung cancer. Objectives:We examined whether (1) ethnic/racial minorities are more likely to obtain lung resections at lower volume hospitals, (2) ethnicity/race is associated with inpatient mortality, (3) hospital volume mediates this association, and (4) hospital selection is mediated by racial/ethnic segregation, differences in insurance coverage, or limited hospital choice. Methods:Six years of data from the Nationwide Inpatient Sample (NIS 1998–2003, unweighted n = 50,245, weighted n = 129,506) were used in multivariate models controlling for sociodemographic factors, case complexity, and hospital characteristics. Additional analyses were conducted using the Area Resource File, which provided data on ethnic density and number of surgical hospitals in the hospital region. Results:Blacks/African Americans (odds ratio [OR] = 0.45; 0.34–0.58) and Latinos (OR = 0.44; 0.32–0.63) had lower odds of obtaining lung resection at a high-volume hospital than non-Hispanic whites. Blacks/African Americans (OR = 1.30; 1.01–1.67), Latinos (OR = 1.41; 1.02–1.94), and other racial/ethnic minorities (OR = 1.46; 1.04–2.06) also had higher odds of dying in hospital, but this association was statistically nonsignificant after controlling for hospital volume. Hospital location was not associated with lung resection procedure volume, nor did location mediate the association between ethnicity/race and hospital volume. Conclusions:Ethnic/racial minorities are obtaining lung resection in lower volume hospitals and are more likely to die in hospital. Hospital volume is associated with higher mortality, but health insurance, segregation, and number of surgical hospitals within a county do not account for observed disparities.

Safer storage of firearms at home and risk of suicide: a study of protective factors in a nationally representative sample

Objective: To estimate the protective effect of storing firearms locked or unloaded, or both, on the risk of suicide by firearms among people with relatively low intention to die. Design and setting: Cross sectional survey. The 1993 National Mortality Followback Survey of 22 957 deaths in the United States, representing 2.2 million people, conducted by the National Center for Health Statistics. Participants: Decedent’s next of kin answered questions regarding various aspects of decedent’s life to supplement information from death certificates. Main results: Compared with decedents who stored their firearm unlocked or loaded, those who stored their firearms locked or unloaded, or both, were less likely to commit suicide by firearms (locked: OR = 0.39, 95% CI = 0.24 to 0.66; unloaded OR = 0.30, 95% CI = 0.18 to 0.49). Conclusions: This study further supports the utility of devices and practices intended to reduce the likelihood of unauthorised or impulsive use of firearms.

Personality, psychiatric disorders, and smoking in middle-aged adults

INTRODUCTION A number of personality traits have been associated with cigarette smoking. Current smokers generally show higher levels of negative emotionality and lower levels of behavioral constraint than former smokers and those who never smoked. However, prior investigations have not examined thoroughly whether these smoking-personality associations are unique to smoking status or simply reflect the fact that these personality traits tend to be elevated across numerous forms of psychopathology. Likewise, prior studies have not addressed whether personality shows differential associations with smoking based on the presence or absence of lifetime psychiatric disorders. METHODS The present study examined these questions using data from 472 current, 311 former, and 324 never-smokers aged 34-44 years. RESULTS Current smokers reported being more reactive to stress, more aggressive, more alienated, and less harm avoidant than both former smokers and never-smokers, whereas former smokers and never-smokers showed similar personality profiles overall. Psychiatric disorder history did not interact with smoking status in predicting personality. Controlling for differences in four major lifetime psychiatric disorders (major depression, alcohol dependence, drug dependence, and conduct disorder) reduced the differences in personality traits associated with smoking status. However, smoking status continued to relate uniquely and significantly to higher levels of negative emotionality and behavioral under control with the most robust effect observed for trait alienation. DISCUSSION These results provide the most comprehensive depiction to date of interrelations among personality, psychopathology, and smoking and suggest an important role of personality in smoking that is not redundant with or conditional upon lifetime psychopathology.

Education and Coronary Heart Disease Risk Associations May Be Affected by Early Life Common Prior Causes: A Propensity Matching Analysis

PURPOSE Education is inversely associated with coronary heart disease (CHD); however whether this is attributable to causal effects of schooling rather than potential confounders existing before school entry (eg, childhood intelligence, childhood economic circumstances, childhood chronic illness, parental mental health) remains unknown. We evaluated whether education is associated with 10-year CHD risk independent of 21 prospectively assessed childhood conditions, in participants ages 38-47 years. METHODS Using linear regression analyses, we evaluated associations of education with 10-year CHD risk, the latter calculated by use of the validated Framingham risk algorithm incorporating diabetes, blood pressure, total and high-density lipoprotein cholesterol, smoking, age, and sex. Propensity score matching incorporated 21 early-life potential confounders. RESULTS Regression analyses demonstrated college graduation was associated with -27.9% lower (95% CI, -36.2, -18.6%) 10-year CHD risk compared with ≤high school after matching on propensity score that included age, sex and race (n = 272); addition of 21 early life potential confounders resulted in effect size of -13.1% (95% CI, -33.4, 13.4; mean n = 110). CONCLUSIONS Participants with college degree had substantially lower risk of CHD (27.9%) after accounting for demographics; the addition of early life potential confounders resulted in a moderate effect size (13.1%), suggesting potential importance of early life factors in explaining observed associations between education and CHD risk.

Comprehensive Cancer Screening among Unmarried Women Aged 40–75 Years: Results from the Cancer Screening Project for Women

OBJECTIVES We explored self-reported rates of individual on-schedule breast, cervical, and colorectal cancer screenings, as well as an aggregate measure of comprehensive screenings, among unmarried women aged 40-75 years. We compared women who partner with women (WPW) or with women and men (WPWM) to women who partner exclusively with men (WPM). We also compared barriers to on-schedule cancer screenings between WPW/WPWM and WPM. METHODS Comparable targeted and respondent-driven sampling methods were used to enroll 213 WPW/WPWM and 417 WPM (n = 630). Logistic regression models were computed to determine if partner gender was associated with each measure of on-schedule screening after controlling for demographic characteristics, health behaviors, and cancer-related experiences. RESULTS Overall, 74.3% of women reported on-schedule breast screening, 78.3% reported on-schedule cervical screening, 66.5% reported on-schedule colorectal screening, and 56.7% reported being on-schedule for comprehensive screening. Partner gender was not associated with any of the measures of on-schedule screening in multivariable analyses. However, women who reported ever putting off, avoiding, or changing the place of screenings because of sexual orientation were less likely to be on-schedule for comprehensive screening. Women who reported barriers associated with taking time from work and body image concerns were also less likely to be on-schedule for comprehensive screening. CONCLUSIONS Barriers to cancer screening were comparable across types of examinations as well as between WPW/WPWM and WPM. Developing health promotion programs for unmarried women that address concomitant detection and prevention behaviors may improve the efficiency and effectiveness of healthcare delivery and ultimately assist in reducing multiple disease risks.

Patient Access to U.S. Physicians Who Conduct Internet or E-mail Consults

BackgroundE-mail communication has the potential to improve communication between patients and doctors.ObjectiveThe objective of the study is to describe the access of patients to physicians who conduct e-mail consults.MethodsWe analyzed data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative cross-sectional survey of office-based physician visits, in 2001, 2002, and 2003. The main outcome measure was the percentage of visits to a provider who reported doing internet or e-mail consults.ResultsThere was fewer than 1 in 10 outpatient visits in 2001 (9.2%) to physicians who reported doing internet or e-mail consults, and this did not increase in 2002 (5.8%) or 2003 (5.5%). Access to these physicians was greater among patients who were male, nonminority, lived in the Western United States, seen for pre-/postoperative care, seen by a primary care provider, and not seen by a nurse during their visit. Access to physicians who conducted internet or e-mail consults was independent of other patient (e.g., chronic conditions), provider (e.g., office setting), and visit (e.g., medications prescribed) characteristics.ConclusionsAccess to physicians who do internet or e-mail consults is generally low and did not increase between 2001 and 2003, despite growth in internet access and in other internet-related activities.

Differential response effects of data collection mode in a cancer screening study of unmarried women ages 40-75 years: a randomized trial.

BackgroundLittle is known about the impact of data collection method on self-reported cancer screening behaviours, particularly among hard-to-reach populations. The purpose of this study is to examine the effects of data collection mode on response to indicators of cancer screenings by unmarried middle-aged and older women.MethodsThree survey methods were evaluated for collecting data about mammography and Papanicolaou (hereafter, Pap) testing among heterosexual and sexual minority (e.g., lesbian and bisexual) women. Women ages 40–75 were recruited from June 2003 – June 2005 in Rhode Island. They were randomly assigned to receive: Self-Administered Mailed Questionnaire [SAMQ; N = 202], Computer-Assisted Telephone Interview [CATI; N = 200], or Computer-Assisted Self-Interview [CASI; N = 197]. Logistic regression models were computed to assess survey mode differences for 13 self-reported items related to cancer screenings, adjusting for age, education, income, race, marital status, partner gender, and recruitment source.ResultsCompared to women assigned to CATI, women assigned to SAMQ were less likely to report two or more years between most recent mammograms (CATI = 23.2% vs. SAMQ = 17.7%; AOR = 0.5, 95% CI = 0.3 – 0.8) and women assigned to CASI were slightly less likely to report being overdue for mammography (CATI = 16.5% vs. CASI = 11.8%; AOR = 0.5, 95% CI = 0.3 – 1.0) and Pap testing (CATI = 14.9% vs. CASI = 10.0%; AOR = 0.5, 95% CI = 0.2 – 1.0). There were no other consistent mode effects.ConclusionAmong participants in this sample, mode of data collection had little effect on the reporting of mammography and Pap testing behaviours. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection for use in monitoring indicators of cancer detection and control.

Patient-provider communication and cancer screening among unmarried women.

OBJECTIVES Unmarried women are less likely than married women to receive recommended cancer screenings. Patient-provider communication is a consistent predictor of cancer screening among women. The purpose of this study was to investigate the relationship between patient and provider communication, barriers to cancer screening, and on-schedule breast and cervical cancer screening (BCCS) among unmarried women. METHODS Data were from the Cancer Screening Project for Women, a 2003-2005 survey examining cancer screening practices. We computed polytomous logistic regression models to examine the relationship between communication (communication about tests, communication about sexual and intimate relationships), barriers to screening, and on-schedule BCCS among unmarried women. RESULTS A total of 630 women were enrolled, and 605 women completed the baseline questionnaire. Overall, more than 60% reported on-schedule BCCS. More than half reported that their providers communicated about BCCS most or all of the time. Fewer than half communicated about sexual history and intimate relationships. Women who reported that their providers communicated about screening tests and their sexual and intimate relationships were more likely to be on-schedule for BCCS. CONCLUSION Patient-provider communication about multiple topics may encourage women to remain on-schedule for their recommended cancer screenings. Longitudinal research should be conducted to examine whether communication predicts BCCS, and to examine how patient and provider characteristics may influence communication in order to promote adherence to screening guidelines for unmarried women. PRACTICE IMPLICATIONS Comprehensive communication that goes beyond information about screening tests may impact adherence to cancer screening guidelines.

Peer associations for substance use and exercise in a college student social network.

UNLABELLED Substance use and exercise have opposite trajectories in young adulthood, and research indicates that peers are influential for both of these health behaviors, but simultaneous investigations of peer associations with substance use and exercise have not been conducted. OBJECTIVE Use a college residence hall peer network to examine associations between peer behaviors and alcohol use, marijuana use, and exercise behavior. METHOD 129 undergraduates (51.9% female, 48.1% non-Hispanic White; 84.5% first-year students) in one residence hall completed a Web-based survey of substance use and exercise and identified up to 10 students in the residence hall who were important to them. Two social network analytic methods, community detection cluster analysis and network autocorrelation modeling, were used to identify peer groupings and to examine the associations between peer and participant behaviors, respectively. RESULTS Participants nominated an average of 4.1 residence hall members, and 53.9% of the ties were reciprocal. 6 clusters were identified that differed significantly on demographics, college activities, substance use, and exercise. Weekly volume of alcohol consumed among nominated peers was significantly associated with that of participants, and all other covariates, including gender and athlete status, were not significant. Peer marijuana use also was associated with participant use after controlling for covariates. Exercise levels of nominated peers were not associated with exercise levels of participants. CONCLUSIONS College student networks may be good targets for health-related prevention programs. Programs that use close-proximity peers to influence the behavior of others might be more effective with substance use as the target behavior than exercise.