Miriam E. Van Dyke

Geography of Adolescent Obesity in the U.S., 2007-2011.

INTRODUCTION Obesity remains a significant threat to the current and long-term health of U.S. adolescents. The authors developed county-level estimates of adolescent obesity for the contiguous U.S., and then explored the association between 23 conceptually derived area-based correlates of adolescent obesity and ecologic obesity prevalence. METHODS Multilevel small area regression methods applied to the 2007 and 2011-2012 National Survey of Childrens Health produced county-level obesity prevalence estimates for children aged 10-17 years. Exploratory multivariable Bayesian regression estimated the cross-sectional association between nutrition, activity, and macrosocial characteristics of counties and states, and county-level obesity prevalence. All analyses were conducted in 2015. RESULTS Adolescent obesity varies geographically with clusters of high prevalence in the Deep South and Southern Appalachian regions. Geographic disparities and clustering in observed data are largely explained by hypothesized area-based variables. In adjusted models, activity environment, but not nutrition environment variables were associated with county-level obesity prevalence. County violent crime was associated with higher obesity, whereas recreational facility density was associated with lower obesity. Measures of the macrosocial and relational domain, including community SES, community health, and social marginalization, were the strongest correlates of county-level obesity. CONCLUSIONS County-level estimates of adolescent obesity demonstrate notable geographic disparities, which are largely explained by conceptually derived area-based contextual measures. This ecologic exploratory study highlights the importance of taking a multidimensional approach to understanding the social and community context in which adolescents make obesity-relevant behavioral choices.

Socioeconomic Status Discrimination is Associated with Poor Sleep in African-Americans, but not Whites

RATIONALE Research on self-reported experiences of discrimination and health has grown in recent decades, but has largely focused on racial discrimination or overall mistreatment. Less is known about reports of discrimination on the basis of socioeconomic status (SES), despite the fact that SES is one of the most powerful social determinants of health. OBJECTIVE We sought to examine the cross-sectional association between self-reported SES discrimination and subjective sleep quality, an emerging risk factor for disease. We further examined whether associations differed by race or SES. METHODS We used logistic and linear regression to analyze data from a population-based cohort of 425 African-American and White middle-aged adults (67.5% female) in the Southeastern United States. SES discrimination was assessed with a modified Experiences of Discrimination Scale and poor subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. RESULTS In logistic regression models adjusted for age, gender, and education, reports of SES discrimination were associated with poor sleep quality among African-Americans (OR = 2.39 95%, CI = 1.35, 4.24), but not Whites (OR = 1.03, 95% CI = 0.57, 1.87), and the race × SES discrimination interaction was significant at p = 0.04. After additional adjustments for reports of racial and gender discrimination, other psychosocial stressors, body mass index and depressive symptoms, SES discrimination remained a significant predictor of poor sleep among African-Americans, but not Whites. In contrast to findings by race, SES discrimination and sleep associations did not significantly differ by SES. CONCLUSION Findings suggest that reports of SES discrimination may be an important risk factor for subjective sleep quality among African-Americans and support the need to consider the health impact of SES-related stressors in the context of race.

Heart Disease Death Rates Among Blacks and Whites Aged ≥35 Years — United States, 1968–2015

Problem/Condition Heart disease is the leading cause of death in the United States. In 2015, heart disease accounted for approximately 630,000 deaths, representing one in four deaths in the United States. Although heart disease death rates decreased 68% for the total population from 1968 to 2015, marked disparities in decreases exist by race and state. Period Covered 1968–2015. Description of System The National Vital Statistics System (NVSS) data on deaths in the United States were abstracted for heart disease using diagnosis codes from the eighth, ninth, and tenth revisions of the International Classification of Diseases (ICD-8, ICD-9, and ICD-10) for 1968–2015. Population estimates were obtained from NVSS files. National and state-specific heart disease death rates for the total population and by race for adults aged ≥35 years were calculated for 1968–2015. National and state-specific black-white heart disease mortality ratios also were calculated. Death rates were age standardized to the 2000 U.S. standard population. Joinpoint regression was used to perform time trend analyses. Results From 1968 to 2015, heart disease death rates decreased for the total U.S. population among adults aged ≥35 years, from 1,034.5 to 327.2 per 100,000 population, respectively, with variations in the magnitude of decreases by race and state. Rates decreased for the total population an average of 2.4% per year, with greater average decreases among whites (2.4% per year) than blacks (2.2% per year). At the national level, heart disease death rates for blacks and whites were similar at the start of the study period (1968) but began to diverge in the late 1970s, when rates for blacks plateaued while rates for whites continued to decrease. Heart disease death rates among blacks remained higher than among whites for the remainder of the study period. Nationwide, the black-white ratio of heart disease death rates increased from 1.04 in 1968 to 1.21 in 2015, with large increases occurring during the 1970s and 1980s followed by small but steady increases until approximately 2005. Since 2005, modest decreases have occurred in the black-white ratio of heart disease death rates at the national level. The majority of states had increases in black-white mortality ratios from 1968 to 2015. The number of states with black-white mortality ratios >1 increased from 16 (40%) to 27 (67.5%). Interpretation Although heart disease death rates decreased both for blacks and whites from 1968 to 2015, substantial differences in decreases were found by race and state. At the national level and in most states, blacks experienced smaller decreases in heart disease death rates than whites for the majority of the period. Overall, the black-white disparity in heart disease death rates increased from 1968 to 2005, with a modest decrease from 2005 to 2015. Public Health Action Since 1968, substantial increases have occurred in black-white disparities of heart disease death rates in the United States at the national level and in many states. These increases appear to be due to faster decreases in heart disease death rates for whites than blacks, particularly from the late 1970s until the mid-2000s. Despite modest decreases in black-white disparities at the national level since 2005, in 2015, heart disease death rates were 21% higher among blacks than among whites. This study demonstrates the use of NVSS data to conduct surveillance of heart disease death rates by race and of black-white disparities in heart disease death rates. Continued surveillance of temporal trends in heart disease death rates by race can provide valuable information to policy makers and public health practitioners working to reduce heart disease death rates both for blacks and whites and disparities between blacks and whites.

Discrimination and the Health of African Americans: The Potential Importance of Intersectionalities:

Research examining associations between self-reported experiences of discrimination overall (e.g., potentially due to race, gender, socioeconomic status, age) and health—particularly among African Americans—has grown rapidly over the past two decades. Yet recent findings suggest that self-reported experiences of racism alone may be less impactful for the health of African Americans than previously hypothesized. Thus, an approach that captures a broader range of complexities in the study of discrimination and health among African Americans may be warranted. This article presents an argument for the importance of examining intersectionalities in studies of discrimination and physical health in African Americans and provides an overview of research in this area.

Socioeconomic status discrimination and C-reactive protein in African-American and White adults

OBJECTIVES We examined the association between socioeconomic status (SES) discrimination and C-reactive protein (CRP) in a biracial cohort of middle-aged adults using an intersectionality framework. METHODS Participants were 401 African-American and White adults from a population-based cohort in the Southeastern United States. SES discrimination was self-reported with a modified Experiences of Discrimination Scale, and CRP levels were assayed from blood samples. Linear regression analyses were used to examine the associations among SES discrimination, race, education, and CRP after controlling for age, gender, racial and gender discrimination, financial and general stress, body mass index, smoking, sleep quality, and depressive symptoms. Intersectional effects were tested using race×SES discrimination, education×SES discrimination and race×education×SES discrimination interactions. RESULTS Adjusting for sociodemographics, racial discrimination, gender discrimination, and all relevant two-way interaction terms, we observed a significant race×education×SES discrimination interaction (p=0.019). In adjusted models stratified by race and education, SES discrimination was associated with elevated CRP among higher educated African-Americans (β=0.29, p=0.018), but not lower educated African-Americans (β=-0.13, p=0.32); or lower educated (β=-0.02, p=0.92) or higher educated (β=-0.01, p=0.90) Whites. CONCLUSIONS Findings support the relevance of SES discrimination as an important discriminatory stressor for CRP specifically among higher educated African-Americans.

Historical Patterns in the Types of Procedures Performed and Radiation Safety Practices Used in Nuclear Medicine From 1945-2009.

AbstractThe authors evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945–2009 in a sample of U.S. radiologic technologists. In 2013–2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945–1964, 1965–1979, 1980–1989, 1990–1999, and 2000–2009. An overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures was observed across the five time periods. Between 1945–1964 and 2000–2009, the median frequency of diagnostic procedures performed substantially increased (from 5 wk−1 to 30 wk−1), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 mo−1 to 3 mo−1). Also a notable increase was observed in the use of most radiation safety practices from 1945–1964 to 2000–2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks for nuclear medicine technologists.

Work history and radioprotection practices in relation to cancer incidence and mortality in US radiologic technologists performing nuclear medicine procedures

Introduction Technologists working in nuclear medicine (NM) are exposed to higher radiation doses than most other occupationally exposed populations. The aim of this study was to estimate the risk of cancer in NM technologists in relation to work history, procedures performed and radioprotection practices. Methods From the US Radiologic Technologists cohort study, 72 755 radiologic technologists who completed a 2003–2005 questionnaire were followed for cancer mortality through 31 December 2012 and for cancer incidence through completion of a questionnaire in 2012–2013. Multivariable-adjusted models were used to estimate HRs for total cancer incidence and mortality by history of ever performing NM procedures and frequency of performing specific diagnostic or therapeutic NM procedures and associated radiation protection measures by decade. Results During follow-up (mean=7.5 years), 960 incident cancers and 425 cancer deaths were reported among the 22 360 technologists who worked with NM procedures. We observed no increased risk of cancer incidence (HR 0.96, 95% CI 0.89 to 1.04) or death (HR 1.05, 95% CI 0.93 to 1.19) among workers who ever performed NM procedures. HRs for cancer incidence but not mortality were higher for technologists who began performing therapeutic procedures in 1960 and later compared with the 1950s. Frequency of performing diagnostic or therapeutic NM procedures and use of radioprotection measures were not consistently associated with cancer risk. No clear associations were observed for specific cancers, but results were based on small numbers. Conclusion Cancer incidence and mortality were not associated with NM work history practices, including greater frequency of procedures performed.

The Replication Crisis in Epidemiology: Snowball, Snow Job, or Winter Solstice?

Purpose of ReviewLike a snowball rolling down a steep hill, the most recent crisis over the perceived lack of reproducibility of scientific results has outpaced the evidence of crisis. It has led to new actions and new guidelines that have been rushed to market without plans for evaluation, metrics for success, or due consideration of the potential for unintended consequences.Recent FindingsThe perception of the crisis is at least partly a snow job, heavily influenced by a small number of centers lavishly funded by a single foundation, with undue and unsupported attention to preregistration as a solution to the perceived crisis. At the same time, the perception of crisis provides an opportunity for introspection. Two studies’ estimates of association may differ because of undue attention on null hypothesis statistical testing, because of differences in the distribution of effect modifiers, because of differential susceptibility to threats to validity, or for other reasons. Perhaps the expectation of what reproducible epidemiology ought to look like is more misguided than the practice of epidemiology. We advocate for the idea of “replication and advancement.” Studies should not only replicate earlier work, but also improve on it in by enhancing the design or analysis.SummaryAbandoning blind reliance on null hypothesis significance testing for statistical inference, finding consensus on when preregistration of non-randomized study protocols has merit, and focusing on replication and advance are the most certain ways to emerge from this solstice for the better.

Neighborhood social cohesion is associated with lower levels of interleukin-6 in African American women

INTRODUCTION Social cohesion is a positive neighborhood characteristic defined by feelings of connectedness and solidarity within a community. Studies have found significant associations between social cohesion and cardiovascular disease (CVD) risk factors and outcomes. Inflammation is one potential physiological pathway linking social cohesion to CVD development, but few studies have evaluated the relationship between social cohesion and inflammatory biomarkers. Prior research has also established that race and gender can modify the effects of neighborhood features, including social cohesion, on CVD risk factors and outcomes. This study aimed to examine the association between social cohesion and the inflammatory biomarkers interleukin-6 (IL-6) and C-reactive protein (CRP) in a cohort of African American and White women and men. MATERIALS AND METHODS Data from the Morehouse and Emory Team Up to Eliminate Health Disparities (META-Health) Study were used to assess the association between social cohesion and inflammation among African American (n = 203) and White (n = 176) adults from the Atlanta metropolitan area. Social cohesion was measured using the social cohesion subscale from the Neighborhood Health Questionnaire. Inflammatory biomarkers were measured from plasma frozen at -70 °C. Multivariable linear regression analyses were conducted, controlling for demographic, clinical, behavioral, and psychosocial factors sequentially. Interaction by race and gender was also examined. RESULTS In models adjusted for age, race, gender, and education, social cohesion was significantly associated with lower levels of IL-6 (β = -0.06, p = 0.03). There was a significant race × social cohesion interaction (p = 0.04), and a marginally significant gender × race × social cohesion interaction (p = 0.09). In race-stratified models controlling for age, gender, and education, social cohesion was associated with lower IL-6 levels in African Americans (β = -0.11, p = 0.01), but not Whites (β = 0.01, p = 0.91). In fully adjusted race- and gender-stratified models, social cohesion was associated with lower levels of IL-6 in African American women only (β = -0.15, p = 0.003). CRP was not associated with social cohesion in fully adjusted models. CONCLUSION The association between social cohesion and lower levels of IL-6 is modified by gender and race, with the strongest association emerging for African American women. Although the pathways through which social cohesion impacts inflammation remain unclear, it is possible that for African American women social cohesion manifests through neighborhood networks.

Socioeconomic and Racial/Ethnic Disparities in Physical Activity Environments in Georgia Elementary Schools

Purpose: This study aimed to characterize physical activity (PA) environments in Georgia public elementary schools and to identify socioeconomic status (SES) and racial/ethnic disparities in PA environments. Design: A school setting PA survey was launched in 2013 to 2014 as a cross-sectional online survey assessing PA environment factors, including facility access and school PA practices, staff PA opportunities, parental involvement in school PA, and out-of-school PA opportunities. Setting: All 1333 Georgia public elementary schools were recruited. Participants: A total of 1083 schools (81.2%) responded. Survey respondents included school administrators, physical education (PE) teachers, and grade-level chairs. Measures: Physical activity environment factors were assessed via an online questionnaire adapted from school PA surveys and articles. Analysis: The chi-square and Fisher exact analyses were conducted to examine the reporting of PA environment factors overall and by school SES, as measured by free/reduced lunch rate, and/or racial/ethnic composition. Results: Overall, many PA environment factors were widely prevalent (ie, gym [99%] or field [79%] access), although some factors such as some PA-related programs (ie, a structured walk/bike program [11%]) were less widely reported. Disparities in school PA environment factors were largely patterned by SES, though they varied for some factors by racial/ethnic composition and across SES within racial/ethnic composition categories. For example, lower SES schools were less likely to report access to blacktops and tracks (p-value < .0001), and higher SES schools were less likely to report access to playgrounds (p-value = .0076). Lower SES schools were also less likely to report “always/often” giving access to PE/PA equipment during recess (p-value < .01). Lower SES and majority nonwhite schools were less likely to report having joint use agreements with community agencies (p-value < .0001). Conclusion: This study highlights SES and racial/ethnic disparities in PA environments in Georgia public elementary schools.