Preventive medicine
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Preventive medicine · Dec 2020
Adverse social factors and all-cause mortality among male and female patients receiving care in the Veterans Health Administration.
Social factors account more for health outcomes than medical care, yet health services research in this area is limited due to the lack of social factors data contained within electronic health records (EHR) systems. Few investigations have examined how cumulative burdens of co-occurring adverse social factors impact health outcomes. From 293,872 patients in one region of the Veterans Health Administration (VHA), we examined how increasing numbers of adverse social factors extracted from the EHR were associated with mortality across a one-year period for male and female patients. ⋯ Non-specific psychosocial factors were most strongly associated with mortality, followed by social or familial problems. Although women were more likely than men to have multiple adverse social factors, social factors were not associated with mortality among women as they were among men. By incorporating social factors data, health care systems can better understand patient all-cause mortality and identify potential prevention efforts built around social determinants.
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Preventive medicine · Dec 2020
Maternal substance use in pregnancy: Differential prediction by childhood adversity subtypes.
Substance use in pregnancy, including alcohol use, drug use, or smoking, is associated with poor health outcomes for both the mother and her unborn child. Building on previous research that has examined the cumulative impact of Adverse Childhood Experiences (ACEs) on maternal binge drinking and alcohol use in pregnancy, the current study sought to examine the association between maternal ACEs and substance use in pregnancy more broadly, including alcohol use, binge drinking, smoking, and drug use. Furthermore, we also examined how different adversity subtypes, including sexual abuse, family violence (physical abuse, emotional abuse), and household dysfunction, differentially predict maternal substance use behavior. ⋯ There were no significant effects for sexual abuse after controlling for covariates. A dose-response association between the number of ACEs and substance use in pregnancy was also demonstrated. Increased support prior to, and in pregnancy, particularly for women with a history of childhood adversity, is needed to reduce substance use behaviors in pregnancy.
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Preventive medicine · Dec 2020
Unemployment insurance program accessibility and suicide rates in the United States.
Unemployment is a risk factor for suicide. Unemployment insurance is the primary policy tool in the United States for alleviating the burden of unemployment on individuals. Our objective was to estimate the effect of state unemployment insurance accessibility on suicide rates, and effect modification by sociodemographic factors and unemployment rate. ⋯ We assessed effect modification by the state-level unemployment rate, educational attainment, age, gender, and race. Based on fully adjusted models, potential protective effects of higher unemployment insurance recipiency rates appear to be small and restricted to demographic groups at higher risk of suicide including men, non-Hispanic White Americans, and those 45-64 years of age. These groups also generally have higher UI recipiency rates, therefore differences in subgroup estimates may reflect variations in eligibility policies and accessibility of UI programs.
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Preventive medicine · Dec 2020
Disability incidence from 2003-2015: Longitudinal analysis of the contributions of excess BMI and cigarette smoking.
Downward trends in U. S. disability levels are stagnating. Assessing the key contributors to U. ⋯ S. disability incidence. Obesity and smoking are key contributors to disability, accounting for 17-38% of incident disability in U. S. adults.
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Preventive medicine · Dec 2020
The multivariate physical activity signature associated with metabolic health in children and youth: An International Children's Accelerometry Database (ICAD) analysis.
There is solid evidence for an association between physical activity and metabolic health outcomes in children and youth, but for methodological reasons most studies describe the intensity spectrum using only a few summary measures. We aimed to determine the multivariate physical activity intensity signature associated with metabolic health in a large and diverse sample of children and youth, by investigating the association pattern for the entire physical intensity spectrum. We used pooled data from 11 studies and 11,853 participants aged 5.8-18.4 years included in the International Children's Accelerometry Database. ⋯ Associations with the composite metabolic health score were weak for sedentary time and light physical activity, but gradually strengthened with increasing time spent in moderate and vigorous intensities (up to 4000-5000 counts per minute). Association patterns were fairly consistent across sex and age groups, but varied across different metabolic health outcomes. This novel analytic approach suggests that vigorous intensity, rather than less intense activities or sedentary behavior, are related to metabolic health in children and youth.