Preventive medicine
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Preventive medicine · Sep 2019
Correlates of colorectal cancer screening rates in primary care clinics serving low income, medically underserved populations.
Screening for colorectal cancer (CRC) is effective in reducing CRC burden. Primary care clinics have an important role in increasing screening. We investigated associations between clinic-level CRC screening rates of the clinics serving low income, medically underserved population, and clinic-level screening interventions, clinic characteristics and community contexts. ⋯ These results may help clinics, especially those serving low income, medically underserved populations, select individual or combinations of EBIs suitable to their contexts while considering costs.
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Preventive medicine · Sep 2019
Short-term associations between objective crime, park-use, and park-based physical activity in low-income neighborhoods.
Crime and safety perceptions are commonly cited barriers to park use and physical activity (PA). Given the importance of parks as settings for outdoor recreation and physical activity, the presence of crime may have a detrimental effect on public health. This study uses objective police crime reports and observational park use data to assess type of crime and the time when the crime was committed effects on park user behaviors in 20 parks located in low-income neighborhoods in New York City. ⋯ This relationship was stronger at the 1 month and 3 months' period and weaker at the 1-week period. Violent crimes were strongly associated with lower park use, and crimes proved to be associated with child park use to a greater degree. Girls were more affected by crime than boys.
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Preventive medicine · Sep 2019
Licensed firearm dealer availability and intimate partner homicide: A multilevel analysis in sixteen states.
This paper investigates the association between legal access to firearms in the community through licensed dealers and homicides perpetrated by intimate partners (IPH). We conducted a series of multilevel negative binomial models to assess the relationship between the rate of county-level federally licensed firearm dealers and intimate partner homicides, by gender and age, controlling for leading macro-level correlates of IPH. ⋯ Although data cannot discern that the rate of licensed firearm dealers is linked to greater legal firearm access, our findings focus attention on the role of community factors, including gun stores, as significant risk factors for violence. Policies to reduce legal options to purchase firearms, especially for those with prior domestic violence offenses, may help to decrease intimate partner homicide, but better data tracking is needed to help us understand how guns move from purchase into the hands of IPH perpetrators.
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Preventive medicine · Sep 2019
Affordable Care Act and cancer stage at diagnosis in an underserved population.
The Patient Protection and Affordable Care Act (ACA) has increased insurance coverage among underserved individuals, but the effect of ACA on cancer diagnosis is currently debated, particularly in Medicaid non-expansion states. Therefore, we aimed to assess the effect of ACA implementation on stage at diagnosis among underserved cancer patients in Texas, a Medicaid non-expansion state. We used data from the institutional registry of the JPS Center for Cancer Care, which serves an urban population of underserved cancer patients. ⋯ The prevalence of early- and advanced-stage diagnosis did not appreciably change overall or when stratified by screen-detectable cancers. Our results suggest that ACA implementation decreased the prevalence of uninsured cancer patients but had little effect on cancer stage at diagnosis in an underserved population. Given that Texas is a Medicaid non-expansion state, Medicaid expansion and alternative approaches may need to be further explored to improve earlier cancer diagnosis among underserved individuals.
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Preventive medicine · Sep 2019
Enjoyment, self-efficacy, and physical activity within parent-adolescent dyads: Application of the actor-partner interdependence model.
It is unclear the role of salient psychosocial variables, such as physical activity (PA) enjoyment and self-efficacy, has on PA within parent-adolescent dyads. The purpose of this study was to examine the interdependent relationships among enjoyment, efficacy, and self-reported PA within parent-adolescent dyads using the Actor-Partner Interdependence Model (APIM). The sample consisted of 1854 parent-adolescent dyads enrolled in the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. ⋯ Psychosocial variables explained more variance in adolescent PA (R2 = 0.252) than parent PA (R2 = 0.037) and the strongest standardized path coefficients were adolescent enjoyment (b = 0.24; 95%CI: 0.18-0.29; p < 0.001) and self-efficacy (b = 0.27; 95%CI: 0.22-0.32; p < 0.001) predicting adolescent PA. Adolescent- and parent-driven effects (0.7%-6.5%) and actor-driven effects (3.3%-5.7%) explained the majority of the systematic dyadic covariance in self-reported PA. There is a relatively strong association between adolescent enjoyment and self-efficacy with adolescent PA and the relationship between parent and adolescent self-reported PA is partially explained by parent and adolescent psychosocial variables and actor-driven effects within APIM.