Sharon L. Christ

Smoking rate trends in U.S. occupational groups : The 1987 to 2004 national health interview survey

Objective: It is unknown if the gap in smoking rates observed between United States blue- and white-collar workers over the past four decades has continued into the new millennium. Methods: The National Health Interview Survey is a nationally representative survey of the US civilian population. Smoking and current occupational status were assessed over survey periods 1987 to 1994 and 1997 to 2004 (n= 298,042). Results: There were significant annual reductions in smoking rates for all adult US workers in both survey periods. Several blue-collar groups had greater annual smoking rate reductions in the most recent survey period relative to the earlier survey period. However, the majority of blue-collar worker groups had pooled 1997 to 2004 smoking rates in excess of the 24.5% smoking prevalence noted for all workers. Conclusion: Development of effective smoking prevention strategies specifically targeting blue-collar groups is warranted.

Sustained Low Influenza Vaccination Rates in US Healthcare Workers

INTRODUCTION A substantial morbidity and mortality burden attributable to the influenza virus is observed annually in the United States. Healthcare workers are an occupational group at increased risk of exposure, demonstrated to transmit influenza to their patient populations, and vital to the care of these patient populations. The prevention of the spread of the flu is a significant public health concern. In the present study, we examined influenza vaccination rates and their 5-year trends within the major occupational healthcare worker groups and compared them to non-Healthcare Workers. METHODS Using data from the nationally representative 2004-2008 National Health Interview Survey (NHIS), US healthcare workers (n=6349) were analyzed. RESULTS Seasonal influenza vaccination coverage estimates remain low among all healthcare workers, highest among the health diagnosing and treating practitioners (52.3%), and lowest among other healthcare support occupations (32.0%). Among all other occupational groups, pooled influenza vaccination rates were highest for white collar workers (24.7%), and lowest for farm workers (11.7%). There were no significant upward or downward trends in influenza vaccination rates for any healthcare or other occupational worker group during the 5-year survey period. CONCLUSION Improving these low vaccination rates among healthcare workers warrants a comprehensive national approach to influenza prevention that includes education and strong encouragement of routine annual vaccination among healthcare workers. Policy enhancements such as free provision of seasonal influenza vaccine, coverage for treatment and workers compensation for vaccine-related complications are needed.

Reported Eye Care Utilization and Health Insurance Status Among US Adults

OBJECTIVES To estimate prevalence and correlates of eye care utilization by means of data from the National Health Interview Survey. METHODS Nearly 290,000 adults 18 years or older participated in the survey from 1997 through 2005. Eye care utilization was based on self-reported contact with an eye care professional in the past year. Participants were classified by level of visual impairment based on response to 2 questions. The survey and logistic regression procedures in SAS statistical software were used to compute 1997 through 2005 pooled eye care utilization rates and to identify correlates of utilization. RESULTS Overall eye care utilization rates were 58.3%, 49.6%, and 33.7%, respectively, for participants with severe, some, and no visual impairment; rates for respondents without health insurance were 35.9%, 23.8%, and 14.3%, respectively. Multivariable logistic regression analyses completed in racial/ethnic and age category subgroups indicated that no reported visual impairment, lack of health insurance, male sex, and low education were associated with low eye care utilization rates. CONCLUSIONS Interventions designed to increase eye care utilization rates in select sociodemographic subgroups are needed. Overall utilization rates may also be enhanced if progress is made toward dramatically increasing the number of Americans with health insurance.

Heart Rate Variability, Ambient Particulate Matter Air Pollution, and Glucose Homeostasis: The Environmental Epidemiology of Arrhythmogenesis in the Women's Health Initiative

Metabolic neuropathophysiology underlying the prediabetic state may confer susceptibility to the adverse health effects of ambient particulate matter <10 microm in diameter (PM(10)). The authors therefore examined whether impaired glucose homeostasis modifies the effect of PM(10) on heart rate variability in a stratified, random sample of 4,295 Womens Health Initiative clinical trial participants, among whom electrocardiograms and fasting blood draws were repeated at 3-year intervals from 1993 to 2004. In multilevel, mixed models weighted for sampling design and adjusted for clinical and environmental covariables, PM(10) exposure was inversely associated with heart rate variability. Inverse PM(10)-heart rate variability associations were strongest for the root mean square of successive differences in normal-to-normal RR intervals (RMSSD). Among participants with impaired fasting glucose, there were -8.3% (95% confidence interval: -13.9, -2.4) versus -0.6% (95% confidence interval: -2.4, 1.3), -8.4% (95% confidence interval: -13.8, -2.7) versus -0.3% (95% confidence interval: -2.1, 1.6), and -4.3% (95% confidence interval: -9.4, 1.0) versus -0.8% (95% confidence interval: -2.7, 1.0) decreases in the RMSSD per 10-microg/m(3) increase in PM(10) at high versus low levels of insulin (P < 0.01), insulin resistance (P < 0.01), and glucose (P = 0.16), respectively. These associations were stronger among participants with diabetes and weaker among those without diabetes or impaired fasting glucose. The findings suggest that insulin and insulin resistance exacerbate the adverse effect of PM(10) on cardiac autonomic control and thus risk of coronary heart disease among nondiabetic, postmenopausal women with impaired fasting glucose.

Profile of children investigated for sexual abuse : Association with psychopathology symptoms and services

Sexually abused children may have poor mental health because of their victimization as well as preexisting or co-occurring family problems. However, few studies consider psychopathology in relation to both abuse and other family experiences. This study uses data from the National Survey of Child and Adolescent Well-Being (NSCAW) to create latent subgroups of 553 children investigated for sexual abuse. The study investigates childrens psychological symptoms and child welfare service (CWS) patterns to understand how childrens needs relate to mental health services. Analyses were conducted by child age: 3-7, 8-11, and 12-14. Factor mixture modeling and regression analyses were used. Results show meaningful subgroups of children that relate to different symptom patterns. Among 3- to 7-year-olds, behavioral symptoms are associated with caregiver domestic violence and mental illness. Among 8- to 11-year-olds, depressive symptoms are associated with severe abuse and multiple family problems, whereas posttraumatic stress is associated with chronic, unresolved abuse. Although many children received mental health services, services are not well matched to childrens needs--the substantiation status of the abuse explains services. Implications for CWS and mental health services are discussed.

Reported Skin Cancer Screening of US Adult Workers

BACKGROUND Early detection of skin cancer by skin examination may reduce its associated morbidity and mortality, in particular for workers routinely exposed to sun. OBJECTIVES We sought to describe the proportion of US workers reporting skin cancer screening examination in a representative sample of the US worker population in the National Health Interview Survey. METHODS Report of skin cancer examination in the 2000 and 2005 National Health Interview Survey cancer control supplements were examined by a range of variables. RESULTS Lifetime and 12-month reported clinical skin examination prevalence was 15% and 8%, respectively. Workers with elevated occupational exposure to ultraviolet light were less likely to have ever received a skin examination than the average US worker. Logistic regression analysis identified occupational category and age, sex, race, education level, health insurance, and sun-protective behavior as significant independent correlates of skin cancer examination. LIMITATIONS A limitation is potential healthy worker effect and underestimation of skin cancer screening with self-reported data. CONCLUSIONS Routine examination by primary care physicians frequently does not include a thorough skin examination. Physicians should be even more vigilant with patients at increased risk of excessive occupational sun exposure, as early detection of skin cancer by periodic skin examination decreases morbidity and can improve survival.

Prevalence of the Metabolic Syndrome Among U.S. Workers

OBJECTIVE Differences in the prevalence of cardiovascular disease (CVD) and its risk factors among occupational groups have been found in several studies. Certain types of workers (such as shift workers) may have a greater risk for metabolic syndrome, a precursor of CVD. The objective of this study was to assess the differences in prevalence and risk of metabolic syndrome among occupational groups using nationally representative data of U.S. workers. RESEARCH DESIGN AND METHODS Data from 8,457 employed participants (representing 131 million U.S. adults) of the 1999–2004 National Health and Nutrition Examination Survey were used. Unadjusted and age-adjusted prevalence and simple and multiple logistic regression analyses were conducted, adjusting for several potential confounders (BMI, alcohol drinking, smoking, physical activity, and sociodemographic characteristics) and survey design. RESULTS Of the workers, 20% met the criteria for the metabolic syndrome, with “miscellaneous food preparation and food service workers” and “farm operators, managers, and supervisors” having the greatest age-adjusted prevalence (29.6–31.1%) and “writers, artists, entertainers, and athletes,” and “engineers, architects, scientists” the lowest (8.5–9.2%). In logistic regression analyses “transportation/material moving” workers had significantly greater odds of meeting the criteria for metabolic syndrome relative to “executive, administrative, managerial” professionals (odds ratio 1.70 [95% CI 1.49–2.52]). CONCLUSIONS There is variability in the prevalence of metabolic syndrome by occupational status, with “transportation/material moving” workers at greatest risk for metabolic syndrome. Workplace health promotion programs addressing risk factors for metabolic syndrome that target workers in occupations with the greatest odds may be an efficient way to reach at-risk populations.

Relationships Among Alcohol Outlet Density, Alcohol use, and Intimate Partner Violence Victimization Among Young Women in the United States

Greater access to alcohol has been widely found to be associated with many negative outcomes including violence perpetration. This study examines the relationship between alcohol outlet density, alcohol use, and intimate partner violence (IPV) victimization among young women in the United States. A direct association between alcohol outlet density in one’s neighborhood and the likelihood of IPV victimization was examined. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health), which followed a nationally representative sample of adolescents into adulthood. Participants were young adult females age 18 to 26 at Wave III. Of the 4,571 female respondents who reported a current heterosexual relationship and had IPV data, 13.2% reported having been the victim of physical violence only and 6.5% experienced sexual only or physical and sexual violence in the relationship during the past year. In the regression models tested, there was no significant direct association between neighborhood alcohol outlet density and IPV victimization nor was there an association between outlet density and drinking behaviors, thus eliminating the possibility of an indirect association. Results of fully adjusted models indicate females who drank heavily, whether infrequently or frequently, were at significant risk for experiencing sexual only IPV or sexual and physical IPV. Asians and Native Americans were at significantly greater odds of experiencing sexual only or sexual and physical IPV compared with non-Hispanic Whites, while non-Hispanic Blacks were at significantly greater odds for physical only IPV. We conclude that a continuous measure of alcohol outlet density was not associated with IPV in models controlling for individual and other neighborhood characteristics. Young women who drink heavily, whether infrequently or frequently, have greater odds of experiencing sexual only or sexual and physical compared to abstainers. Similar to previous study findings, young women living with or married to their partner were at far greater risk of experiencing physical only and/or sexual only or sexual and physical IPV. The study adds to the growing body of literature that examines how community characteristics such as outlet density influence the likelihood of IPV.

Assessment of the effect of visual impairment on mortality through multiple health pathways: Structural equation modeling

PURPOSE To estimate the direct effects of self-reported visual impairment (VI) on health, disability, and mortality and to estimate the indirect effects of VI on mortality through health and disability mediators. METHODS The National Health Interview Survey (NHIS) is a population-based annual survey designed to be representative of the U.S. civilian noninstitutionalized population. The National Death Index of 135,581 NHIS adult participants, 18 years of age and older, from 1986 to 1996 provided the mortality linkage through 2002. A generalized linear structural equation model (GSEM) with latent variable was used to estimate the results of a system of equations with various outcomes. Standard errors and test statistics were corrected for weighting, clustering, and stratification. RESULTS VI affects mortality, when direct adjustment was made for the covariates. Severe VI increases the hazard rate by a factor of 1.28 (95% CI: 1.07-1.53) compared with no VI, and some VI increases the hazard by a factor of 1.13 (95% CI: 1.07-1.20). VI also affects mortality indirectly through self-rated health and disability. The total effects (direct effects plus mediated effects) on the hazard of mortality of severe VI and some VI relative to no VI are hazard ratio (HR) 1.54 (95% CI: 1.28-1.86) and HR 1.23 (95% CI: 1.16-1.31), respectively. CONCLUSIONS In addition to the direct link between VI and mortality, the effects of VI on general health and disability contribute to an increased risk of death. Ignoring the latter may lead to an underestimation of the substantive impact of VI on mortality.

Social Stratification, Social Closure, and Social Class as Determinants of Mental Health Disparities

We review two major strands of sociological theory to understand possible causal processes relevant to the generation of social inequalities and the production of parallel mental health disparities. The first strand, known as the social stratification model, includes gradational measures of socioeconomic status and draws upon Weber’s idea of “life chances.” The second strand includes two relational processes: the neo-Weberian idea of “social closure,” understood in terms of credentialism and unequal control over economic resources, and the neo-Marxian concept of social class, conceptualized as relations of ownership and control over productive assets. We also review classic and recent studies in the extant literature, discuss the interrelationships among social inequalities, race, ethnicity, and gender, and consider social causation and social selection hypotheses to interpret findings on the relationship between social inequalities and mental disorders. In closing, we identify directions for future research in order to address outstanding issues in mental health disparities scholarship.