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1.
《Annals of epidemiology》2014,24(11):831-836
PurposeMexicans in the United States have lower rates of several important population health metrics than non-Hispanic whites, including infant mortality. This mortality advantage is particularly pronounced among infants born to foreign-born Mexican mothers. However, the literature to date has been relegated to point-in-time studies that preclude a dynamic understanding of ethnic and nativity differences in infant mortality among Mexicans and non-Hispanic whites.MethodsWe assessed secular trends in the relation between Mexican ethnicity, maternal nativity, and infant mortality between 1989 and 2006 using a linked birth–death data set from one US state.ResultsCongruent to previous research, we found a significant mortality advantage among infants of Mexican relative to non-Hispanic white mothers between 1989 and 1991 after adjustment for baseline demographic differences (relative risk = 0.78, 95% confidence interval, 0.62–0.98). However, because of an upward trend in infant mortality among infants of Mexican mothers, the risk of infant mortality was not significantly different from non-Hispanic white mothers in later periods.ConclusionsOur findings suggest that the “Mexican paradox” with respect to infant mortality is resolving. Changing sociocultural norms among Mexican mothers and changes in immigrant selection and immigration processes may explain these observations, suggesting directions for future research. 相似文献
2.
WALTER D. DAWSON NATHAN A. BOUCHER ROBYN STONE COURTNEY H. VAN HOUTVEN 《The Milbank quarterly》2021,99(2):565
Policy Points
- To address systemic problems amplified by COVID‐19, we need to restructure US long‐term services and supports (LTSS) as they relate to both the health care systems and public health systems. We present both near‐term and long‐term policy solutions.
- Seven near‐term policy recommendations include requiring the uniform public reporting of COVID‐19 cases in all LTSS settings; identifying and supporting unpaid caregivers; bolstering protections for the direct care workforce; increasing coordination between public health departments and LTSS agencies and providers; enhancing collaboration and communication across health, LTSS, and public health systems; further reducing barriers to telehealth in LTSS; and providing incentives to care for vulnerable populations.
- Long‐term reform should focus on comprehensive workforce development, comprehensive LTSS financing reform, and the creation of an age‐friendly public health system.
3.
《Journal of the Academy of Nutrition and Dietetics》2014,114(10):1533-1543
BackgroundThe home food environment is complex and has the potential to influence dietary habit development in young people. Several factors may influence the home food environment, including income and race/ethnicity.ObjectiveTo examine the relationship of income and race/ethnicity with three home food environment factors (ie, food availability frequency, family meal patterns [frequency of family and home cooked meals], and family food expenditures).DesignA cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES).ParticipantsA total of 5,096 youth aged 6 to 19 years from a nationally representative sample of US individuals participating in NHANES 2007-10.Statistical analyses performedPrevalence of food availability frequency was assessed for the entire sample, race/ethnicity, poverty income ratio (PIR), and race/ethnicity stratified by PIR. Mean values of family meal patterns and food expenditures were calculated based on race/ethnicity, PIR, and race/ethnicity stratified by PIR using analysis of variance and least squares means. Tests of main effects were used to assess differences in food availability prevalence and mean values of family meal patterns and food expenditures.ResultsNon-Hispanic whites had the highest prevalence of salty snacks (51.1%±1.5%) and fat-free/low-fat milk (39.2%±1.7%) always available. High-income homes had the highest prevalence of fruits (75.4%±2.4%) and fat-free/low-fat milk (38.4%±2.1%) always available. Differences were found for prevalence of food availability when race/ethnicity was stratified by PIR. Non-Hispanic blacks had the lowest prevalence of fat-free/low-fat milk always available across PIR groups. Differences in mean levels of family meal patterns and food expenditures were found for race/ethnicity, PIR, and race/ethnicity stratified by PIR.ConclusionsRace/ethnicity and PIR appear to influence food availability, family meal patterns, and family food expenditures in homes of youth. Knowledge of factors that influence the home food environment could assist in developing effective strategies to improve food environments for young people. 相似文献
4.
We examined racial and ethnic disparities in global health assessment and functional limitations of daily activities among whites, blacks and Hispanics, and within the Hispanic origin among Mexicans, Puerto Ricans, Cubans, and ‘Others’. Logistic regressions were employed to estimate the log odds of reporting ‘poor health’ and ‘having functional limitations’ among 12 814 respondents from the 1987—1988 National Survey of Families and Households. Compared with whites, blacks had an increased risk of reporting poor health and functional limitations. Hispanics had even a higher risk of reporting poor health, but did not have an increased risk of reporting functional limitations. Among Hispanics, Mexicans were more likely than whites to report poor health, whereas Puerto Ricans were more likely than whites to experience functional limitations. Both race and ethnicity remain important factors in explaining the disparities in self‐assessed health status independent of socioeconomic status (SES). Meanwhile, the way self‐assessed health status varies with ethnicity is importantly stratified by SES as measured by income and education. These results suggest that future research should analyze the interplay between ethnicity and SES rather than assuming measuring either captures all the important variation. 相似文献
5.
Using the Los Angeles Family and Neighborhood Survey (L.A.FANS-2; n = 1610), we explore the link between Mexican immigrant acculturation, diet, exercise and obesity. We distinguish Mexican immigrants and 2nd generation Mexicans from 3rd+ generation whites, blacks and Mexicans. First, we examine variation in social and linguistic measures by race/ethnicity, duration of residence and immigrant generation. Second, we consider the association between acculturation, diet and exercise. Third, we evaluate the degree to which acculturation, diet, exercise, and socioeconomic status explain the association between race/ethnicity, immigrant exposure to the US (duration since immigration/generation), and adult obesity. Among immigrants, we find a clear relationship between acculturation measures, exposure to the US, and obesity-related behaviors (diet and exercise). However, the acculturation measures do not clearly account for the link between adult obesity, immigrant duration and generation, and race/ethnicity. 相似文献
6.
JI E. CHANG ALDEN YUANHONG LAI AVNI GUPTA ANN M. NGUYEN CAROLYN A. BERRY DONNA R. SHELLEY 《The Milbank quarterly》2021,99(2):340
Policy Points
- Telehealth has many potential advantages during an infectious disease outbreak such as the COVID‐19 pandemic, and the COVID‐19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode.
- Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID‐19 pandemic.
- Without proactive efforts to address both patient‐ and provider‐related digital barriers associated with socioeconomic status, the wide‐scale implementation of telehealth amid COVID‐19 may reinforce disparities in health access in already marginalized and underserved communities.
- To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them.
7.
Policy Points
- We compared the structure of health care systems and the financial effects of the COVID‐19 pandemic on health care providers in the United States, England, Germany, and Israel: systems incorporating both public and private insurers and providers.
- The negative financial effects on health care providers have been more severe in the United States than elsewhere, owing to the prevalence of activity‐based payment systems, limited direct governmental control over available provider capacity, and the structure of governmental financial relief.
- In a pandemic, activity‐based payment reverses the conventional financial positions of payers and providers and may prevent providers from prioritizing public health because of the desire to avoid revenue loss caused by declines in patient visits.
8.
ERIC S. KIM SCOTT W. DELANEY LOUIS TAY YING CHEN ED DIENER TYLER J. VANDERWEELE 《The Milbank quarterly》2021,99(1):209-239
Policy Points
- Several intergovernmental organizations (Organisation for Economic Co‐operation and Development, World Health Organization, United Nations) are urging countries to use well‐being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions.
- As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well‐being outcomes we might observe from policies aimed at improving life satisfaction.
- The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well‐being, health behaviors, and physical health outcomes.
9.
Chanee D. Fabius Kali S. Thomas 《Journal of the American Medical Directors Association》2019,20(6):703-709
ObjectiveAssisted living (AL) provides housing and personal care to residents who need assistance with daily activities. Few studies have examined black-white disparities in larger (25 + beds) ALs; therefore, little is known about black residents, their prior residential settings, and how they compare to whites in AL. We examined racial differences among a national cohort of AL residents and how the racial variation among AL Medicare Fee-For-Service (FFS) beneficiaries compared to differences among community-dwelling and nursing home cohorts.Study designRetrospective cohort study.ParticipantsWe included (1) a prevalence sample of 442,018 white and black Medicare beneficiaries residing in large AL settings, (2) an incidence sample of new residents (n = 94,741), and (3) 10% random samples of Medicare FFS community-dwelling and nursing home beneficiaries in 2014.MeasuresThe Medicare Master Summary Beneficiary File was used to identify AL residents and provided demographic, entitlement, chronic condition, and health care utilization information. We used the American Community Survey and prior ZIP code tabulation areas of residents to examine differences in prior neighborhoods. Medicare claims and the Minimum Data Set yielded samples of Medicare FFS community-dwelling older adults and nursing home residents.ResultsBlacks were disproportionately represented in AL, younger, more likely to be Medicaid eligible, had higher levels of acuity, and more often lived in ALs with fewer whites and more duals. New black residents entered AL with higher rates of acute care hospitalizations and skilled nursing facility utilization. Across the 3 cohorts, blacks had higher rates of dual-eligibility.ConclusionsBlack-white differences observed among AL residents indicate a need for future work to examine how disparities manifest in differences in care received and residents’ outcomes, as well as the pathways to AL. More research is needed to understand the implications of inequities in AL as they relate to quality and experiences of residents. 相似文献
10.
GUENDALINA GRAFFIGNA LORENZO PALAMENGHI MARIAROSARIA SAVARESE GRETA CASTELLINI SERENA BARELLO 《The Milbank quarterly》2021,99(2):369
Policy Points
- Preventive measures such as the national lockdown in Italy have been effective in slowing the spread of COVID‐19. However, they also had psychological and economic impacts on people’s lives, which should not be neglected as they may reduce citizens’ trust and compliance with future health mandates.
- Engaging citizens in their own health management and in the collaboration with health care professionals and authorities via the adoption of a collaborative approach to health policy development is fundamental to fostering such measures’ effectiveness.
- Psychosocial analysis of citizens’ concerns and emotional reactions to preventive policies is important in order to plan personalized health communication campaigns.
11.
DANIEL M. WALKER VALERIE A. YEAGER JOHN LAWRENCE ANN SCHECK MCALEARNEY 《The Milbank quarterly》2021,99(2):393
Policy Points
- Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges.
- Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues.
- Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies.
12.
White-Means SI Hersch J 《International journal of health care finance and economics》2005,5(4):351-368
Relative to whites, Hispanics and blacks are less likely to have employer health insurance coverage. We examine whether ethnicity
or race affects employment in traditional jobs or in contingent and alternative work arrangements, and whether ethnicity or
race affects insurance offer, eligibility, and/or enrollment, conditional on employment sector. Health insurance disparities
relative to whites are more pronounced for Hispanics, primarily due to disparities in employment by firms that offer coverage.
Eliminating racial/ethnic disparities in offers, eligibility, and takeup would increase insurance coverage rates of Hispanics
in traditional jobs and of both Hispanics and blacks in contingent and alternative jobs.
JEL classification: I10, J32, J70 相似文献
13.
Lidia Luna Puerta Bernadette Bartlam HsiaoLi Shirley Sun Helen E. Smith 《Health expectations》2020,23(5):1074
BackgroundSingapore is an international research hub, with an emphasis on translational clinical research. Despite growing evidence of the positive impact of public involvement (PPI) in research, it remains rare in Singapore.Aims
- To investigate Singaporean public perspectives around the rationale, role and scope for being involved in health research
- To identify the potential, challenges, facilitators and strategies for implementing PPI in Singapore.
14.
Hikmet J. Jamil Ambili Kariaparambil Rajan Mary Grzybowski Monty Fakhouri Bengt Arnetz 《Journal of community health》2014,39(2):301-309
Race, ethnicity and socioeconomic factors influence the prevalence of obesity and overweight, which are major public health problems. Our objectives were (1) to calculate the prevalence of self-reported obesity and overweight in whites, blacks, Chaldeans, and Arabs in the Detroit metropolitan area; and (2) to examine the odds for self-reported overweight and obesity in the racial and ethnic minorities when compared to whites. The responses to a self-administered survey conducted among the adult residents (n = 2,883) of the Detroit metropolitan area of Michigan were analyzed. Prevalence of overweight and obesity were 47.4 and 34.6 % respectively for the whole sample, while it was 39.9 and 43.6 % for whites, 42.3 and 47.8 % for blacks, 46.2 and 30.3 % for Chaldeans, and 52.2 and 28.5 % for Arabs. The odds for obesity was significantly lower in Arabs [odds ratio (OR) 0.31; 95 % confidence interval (CI) 0.13–0.72] and Chaldeans (OR 0.14; 95 % CI 0.06–0.33) when compared to whites. Chaldeans (OR 0.36; 95 % CI 0.15–0.86) had significantly decreased likelihood for being overweight compared to whites. Odds for obesity and overweight can vary in the different ethnic minorities within whites. Sharing similar living conditions decreases the differences in the odds for overweight and obesity between whites and blacks. Taking into consideration the racial and ethnic differences of the target population may help in developing better programs for fighting overweight and obesity. 相似文献
15.
GEORGE STOYE BEN ZARANKO MARTIN SHIPLEY MARTIN MCKEE ERIC J. BRUNNER 《The Milbank quarterly》2020,98(4):1134-1170
Policy Points
- US policymakers considering proposals to expand public health care (such as “Medicare for all”) as a means of reducing inequalities in health care access and use could learn from the experiences of nations where well‐funded universal health care systems are already in place.
- In England, which has a publicly funded universal health care system, the use of core inpatient services by adults 65 years and older is equal across groups defined by education level, after controlling for health status. However, variation among these groups in the use of outpatient and emergency department care developed between 2010 and 2015, a period of relative financial austerity.
- Based on England''s experience, introducing universal health care in the United States seems likely to reduce, but not entirely eliminate, inequalities in health care use across different population groups.
16.
Policy Points
- Persistent communication inequalities limit racial/ethnic minority access to life‐saving health information and make them more vulnerable to the effects of misinformation.
- Establishing data collection systems that detect and track acute gaps in the supply and/or access of racial/ethnic minority groups to credible health information is long overdue.
- Public investments and support for minority‐serving media and community outlets are needed to close persistent gaps in access to credible health information.
17.
JONATHAN PURTLE RENNIE JOSHI FLICE LÊSCHERBAN ROSIE MAE HENSON ANA V. DIEZ ROUX 《The Milbank quarterly》2021,99(3):794
Policy Points
- Mayoral officials’ opinions about the existence and fairness of health disparities in their city are positively associated with the magnitude of income‐based life expectancy disparity in their city.
- Associations between mayoral officials’ opinions about health disparities in their city and the magnitude of life expectancy disparity in their city are not moderated by the social or fiscal ideology of mayoral officials or the ideology of their constituents.
- Highly visible and publicized information about mortality disparities, such as that related to COVID‐19 disparities, has potential to elevate elected officials’ perceptions of the severity of health disparities and influence their opinions about the issue.
18.
Gender differences in adult health are well documented, but only recently has research begun to investigate how race and ethnicity condition gendered health disparities. This paper contributes to this line of inquiry by assessing gender differences in morbidity across five major US racial and ethnic populations. Using data from the 1997-2001 waves of the National Health Interview Survey, the analysis examines differences in men and women's self-rated health, functional limitations, and life-threatening medical conditions for whites, blacks, Mexicans, Puerto Ricans, and Cubans. For each health outcome, we investigate the utility of socioeconomic factors in accounting for observed disparities. Contrary to finding universal excess in female morbidity, the results show that the magnitude of gender difference varies considerably by racial/ethnic group, health outcome, and comparison category. The most striking findings are the consistently higher levels of functional limitations for all women compared to men in their same racial/ethnic group and the poorer health of black women relative to both white and black men for all health measures, after adjustment for socioeconomic and background factors. The gender gap for all other health measures is more variable, and for Mexican women a difference is only evident for functional limitations and only when compared to Mexican men. Our results underscore the need for more research on the role of race and ethnicity in shaping gendered health inequalities and the mechanisms that lead to such variable patterns of difference across and within US racial and ethnic populations. 相似文献
19.
F. REED JOHNSON JUAN MARCOS GONZALEZ JUICHEN YANG SEMRA OZDEMIR STEVEN KYMES 《The Milbank quarterly》2021,99(3):771
Policy Points
- Public funding for mental health programs must compete with other funding priorities in limited state budgets.
- Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits.
- Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size.
- In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer.
20.
ROBERT HANDFIELD DANIEL JOSEPH FINKENSTADT EUGENE S. SCHNELLER A. BLANTON GODFREY PETER GUINTO 《The Milbank quarterly》2020,98(4):1058-1090
Policy Points
- Reflecting on current response deficiencies, we offer a model for a national contingency supply chain cell (NCSCC) construct to manage the medical materials supply chain in support of emergencies, such as COVID‐19. We develop the following:
- a framework for governance and response to enable a globally independent supply chain;
- a flexible structure to accommodate the requirements of state and county health systems for receiving and distributing materials; and
- a national material “control tower” to improve transparency and real‐time access to material status and location.