Preventive medicine
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Preventive medicine · Mar 2022
Valuing the cross-sector benefits from improving youth health to drive investment in place-based preventive interventions in the US: A simulation modeling study.
Healthcare payment reform has not produced incentives for investing in place-based, or population-level, upstream preventive interventions. This article uses economic modeling to estimate the long-term benefits to different sectors associated with improvements in population health indicators in childhood. This information can motivate policymakers to invest in prevention and provide guidance for cross-sector contracting to align incentives for implementing place-based preventive interventions. ⋯ The median over a 10-year time horizon was $242 (range: $14 to $1357). Benefits at effect sizes of 0.20 were approximately double. Policymakers may be able to build will for additional investment based on these cross-sector returns and communities may be able to capture these cross-sector benefits through contracting to better align incentives for implementing and sustaining place-based preventive interventions.
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Preventive medicine · Mar 2022
Cross-substance patterns of alcohol, cigarette, and cannabis use initiation in Black and White adolescent girls.
Characterizing variations in the timing of alcohol, cigarette, and cannabis use onset both among and between Black and White youth can inform targeted prevention. The current study aimed to capture cross-substance initiation patterns in Black and White girls and characterize these patterns with respect to substance use related socioeconomic, neighborhood, family, community, and individual level factors. Data were drawn from interviews conducted at ages 8 through 17 in an urban sample of girls (n = 2172; 56.86% Black, 43.14% White). ⋯ Class differences centered around cannabis for Black girls (e.g., preceding or following cigarette use) and alcohol for White girls (e.g., (in)consistency over time in greater likelihood of initiation relative to cigarette and cannabis use). Several factors distinguishing the classes were common across race (e.g., externalizing behaviors, friends' cannabis use); some were specific to Black girls (e.g., intentions to smoke cigarettes) or White girls (e.g., primary caregiver problem drinking). Findings underscore the need to recognize a more complex picture than a high-risk/low-risk dichotomy for substance use initiation and to attend to nuanced differences in markers of risky onset pathways between Black and White girls.
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Preventive medicine · Mar 2022
Perceptions of neighborhood dangerousness and changes in sleep quality during the COVID-19 pandemic: Assessing the mediating role of changes in health behaviors.
Numerous studies have demonstrated that neighborhood context contributes to variations in morbidity and mortality. This body of work includes a burgeoning literature that links adverse neighborhood characteristics (e.g., neighborhood poverty and perceptions of disorder and dangerousness) with poorer sleep outcomes. During the COVID-19 pandemic, many neighborhoods exhibited socioeconomic downturns and escalations in crime and violence. ⋯ Regression analyses show that while reports of a neighborhood becoming safer during the pandemic are associated with better sleep quality, reports of a neighborhood becoming more dangerous are associated with worse sleep quality. Mediation analyses also indicate that the association between increased neighborhood dangerousness and poorer sleep quality is partially explained by a concurrent deterioration in diet quality, but not increases in alcohol or cigarette consumption. We conclude with a discussion of the implications of our findings for research and policy on neighborhood context and sleep.
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Preventive medicine · Mar 2022
An examination of physical activity guidelines and health-related quality of life among U.S. older adults.
Physical activity can help improve the poor health-related quality of life in older adult population. Although the Physical Activity Guidelines for Americans recommend both aerobic and muscle strengthening activities for adults, previous studies predominantly focused on aerobic activity with limited research on muscle strengthening activities. The purpose of this cross-sectional study was to examine the relationships between meeting physical activity guidelines (i.e., aerobic activity, muscle strengthening activity) and health-related quality of life in the older adult population. ⋯ Binomial logistic regression was used to examine the relationships between meeting physical activity guidelines and health-related quality of life while adjusting for key covariates (i.e., age, sex, race, education, marital status, employment status, income, body mass index, smoking, drinking, and comorbidities). Participants meeting both or aerobic activity guideline only had significantly lower odds of reporting all components of health-related quality of life (i.e., general health, mental health, physical health, activity limitation) than those who met neither guideline (OR = 0.37-0.58) and those who met muscle strengthening activity guideline only (OR = 0.34 - 0.74). Given the stronger positive association between aerobic activity and health-related quality of life than that between muscle strengthening activity and health-related quality of life, future research should focus on promoting aerobic activity to increase health-related quality of life among older people.
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Preventive medicine · Feb 2022
Repercussions of the COVID-19 pandemic on preventive health services in Brazil.
The increasing burden of non-communicable diseases and limited public financing are major challenges facing health care systems in Latin America. Although COVID-19 severely impacted the Brazilian health care system, it is crucial to further characterize the degree of disruption caused to public health efforts, in order to address and manage long term effects of this pandemic. We therefore quantified the demand for preventive and treatment services from the Brazilian Unified Health System (Sistema Único de Saúde/SUS) in 2020 to evaluate potential repercussions of COVID-19 in this setting. ⋯ The COVID-19 pandemic appears to have led to a dramatic decline in preventative and treatment services provided by SUS to the Brazilian population. Our findings may aid decision-makers in formulating policies to increase the availability of outpatient services in the aftermath of the pandemic. Counter measures will be critical to avoid a resurgence in vaccine-preventable diseases and complications stemming from non-communicable, chronic health conditions.