Preventive medicine
-
Preventive medicine · Dec 2017
Trends in food insecurity among California residents from 2001 to 2011: Inequities at the intersection of immigration status and ethnicity.
Although immigrants are healthier than non-immigrants on numerous outcomes, the reverse appears to be true with regards to food insecurity. Most studies ignore heterogeneity in the risk for food insecurity within immigration status and by ethnicity, even though significant variation likely exists. We consider how immigration status and ethnicity are related to trends in food insecurity among Latinos and Asians in California from 2001 through 2011. ⋯ Further, from 2001 through 2009, non-LPR Latinos reported higher risk of food insecurity than naturalized/LPR Latinos. Thus, food insecurity differs between ethnic groups, but also differs within ethnic group by immigration status. Efforts to reduce food insecurity should consider the additional barriers to access that are faced by immigrants, particularly those without legal permanent residency.
-
Preventive medicine · Dec 2017
Cost effectiveness and return on investment of a scalable community weight loss intervention.
This study assessed the lifetime health and economic consequences of an efficacious scalable community weight loss program for overweight and obese adults. We applied a state-transition Markov model to project lifetime economic outcome (US dollar) and the degree of disease averted as a result of a weight loss intervention, compared with no intervention, from a payer perspective. Effect sizes of the intervention on weight loss, by sex, race and ethnicity, and body mass index (BMI) of participants, were derived from a 12-month community program. ⋯ Simulation results showed that among 33,656 participants and at a cost of $2.88 million, the program was predicted to avert (with a corresponding estimated medical costs saved of) 78 cases of coronary heart disease ($28 million), 9 cases of strokes ($971,832), 92 cases of type 2 diabetes ($24 million), 1 case of colorectal cancer ($357,022), and 3 cases of breast cancer ($483,259) over the participant lifetime. The estimated medical costs saved per participant was $1403 ($1077 of African American men and $1532 of Hispanic men), and the ROI was $16.7 ($12.8 for African American men and $18.3 for Hispanic men) for every $1 invested. We concluded that a scalable efficacious community weight loss program provides a cost-effective approach with significant ROI, which will assist informed decisions for future adoption and dissemination.
-
People socially connected with each other often share health risks, possibly due to shared environments and behaviors. In a cohort study, we examined whether incidence of diabetes was different for individuals with recently diagnosed partners compared to individuals similar on other characteristics but whose partners were never diagnosed with diabetes. We analyzed 2007-11 data from Kaiser Permanente Northern California (KPNC), an integrated health system with >3.5 million members. We estimated annual diabetes incidence controlling for demographic, socio-economic, behavioral, and health characteristics. Using propensity score matching and multivariate logistic regression, we compared odds of incident diabetes among co-residing partners ages 18-89years of people who had been diagnosed with diabetes during the previous year (in robustness checks up to the previous three years) and people who had never been diagnosed but were similar on observed characteristics. Partners of newly-diagnosed people had annual diabetes incidence of 16.4/1000, equivalent to10.8 times higher (95%CI: 9.2-12.6) than people whose spouses had never been diagnosed (1.5/1000). Odds remained higher three years after a spouses' diagnosis (45.4 vs. 11.7/1000). Adjusting for other characteristics, odds of diabetes for those with a partner diagnosed in the previous year were 8.7 times higher (CI: 7.4-10.2) than among those whose partner had never been diagnosed. Also, partners of persons with recently-diagnosed diabetes developed diabetes at much higher rates than the general KPNC and U.S. ⋯ Individuals with a recently diagnosed partner could be considered a high-risk population for screening and prevention.
-
Preventive medicine · Dec 2017
E-cigarette use and support for banning e-cigarette use in public places in the European Union.
We investigated the factors associated with support for banning e-cigarette use in public places in the European Union (EU) and how this varies by socio-demographic determinants, use of tobacco, ever use of e-cigarettes and their perceived harm. Data are from the representative Special Eurobarometer for Tobacco survey performed in 2014 (n=27,801) in 28 EU member states. ⋯ Bans of e-cigarette use in public places in Europe have high levels of public support even among former and current tobacco smokers, although this does vary across population groups. As legislators consider approaches to e-cigarette use, public opinion is likely to become more important to the passing and enforcement of any legislation.
-
Preventive medicine · Dec 2017
The differential impact of state tobacco control policies on cessation treatment utilization across established tobacco disparities groups.
Tobacco control policies are effective in promoting quit attempts and increase the likelihood that smokers use evidence-based cessation treatments (e.g., nicotine replacement therapies (NRT), non-NRT medications, behavioral treatment, and/or quitlines). However, what is less clear is how these policies might differentially impact different groups of smokers, perhaps in some cases even widening disparities in the use of evidence-based tobacco dependence treatments. This paper examined how different state-level tobacco control policies impact the use of evidence-based cessation treatments by race/ethnicity, gender, socio-economic status (SES), age, and smoking history. ⋯ The relationship between state level tobacco control policies and the use of behavioral treatments and quitlines did not differ by smoker characteristics. In sum, tobacco control policies differentially impact the use of FDA approved stop smoking medications across different race/ethnicity, age, and SES groups. Understanding such effects can help to target interventions to ensure equal access to evidence-based tobacco dependence treatments.