فهرست مطالب mohsen bazargan

The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening.

Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression.

One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5–81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02–2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28–2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01–1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03–1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86–0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16–2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test.

Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.

The African Americans’ health paradox can be defined as better subjective health held of African American individuals compared to White individuals, despite their higher objective and medical adversities such as chronic medical conditions (CMCs). This phenomenon depicts African Americans’ relative resilience (advantage). However, most of the existing literature on this topic is limited to studies comparing African Americans and Whites. There is little research, if any, on this phenomenon among other ethnic groups. To fill this gap in the literature, this study tests the African Americans’ health paradox with consideration of Latinos as the control group. This cross-sectional study collected demographic data, socioeconomic status, CMCs, and subjective health of 734 African American and Latino older adults residing in south Los Angeles. Logistic regression was used for data analysis. 118 Latino and 616 African Americans entered our study. Overall, a higher number of CMCs was associated with lower subjective health, however, a statistically significant interaction between ethnicity and the number of CMCs suggested that this association is weaker for African Americans than Latinos, which is the African American health paradox. African Americans with a higher number of CMCs report better subjective health compared to Latinos with the same number of CMCs. This finding is indicative of a relative advantage of African Americans compared to other ethnic groups.

Minorities’ Diminished Returns (MDRs) refer to the smaller effects ofeducational attainment for ethnic minorities compared to the majority group. As a result of MDRs,research has documented more than expected tobacco use among Hispanics and African Americans(AAs) with high educational attainment. In theory, some of this increased risk may be due to lowertobacco harm knowledge. Accordingly, the present study compared ethnic groups for the associationbetween educational attainment and tobacco harm knowledge among American adults in order tobetter understand a potential mechanism behind MDRs of educational attainment on tobacco use ofHispanics and AAs.

The current cross-sectional study used baseline data of 27,405 adults, which were obtainedfrom the Population Assessment of Tobacco and Health (2013) study a nationally representative surveyin the United States. The independent and dependent variables were educational attainment andtobacco harm knowledge, respectively. In addition, age, gender, employment, and poverty status werethe covariates and ethnicity was the moderator. Finally, linear regression was used to analyze the data.

Educational attainment was inversely associated with tobacco harm knowledge in the pooledsample (b = 0.11, 95% CI = 0.09 - 0.13). Ethnicity showed a statistically significant interaction witheducational attainment (b = -0.05, 95% CI = -0.10 - 0.00 for AAs and b = -0.14, 95% CI = -0.19 - -0.09for Hispanics versus non-Hispanics), suggesting that the effect of educational attainment on tobaccoharm knowledge was smaller for Hispanics and AAs compared to non-Hispanics and Whites.

In general, although high educational attainment increases tobacco harm knowledge,highly educated Hispanics and AAs still report a disproportionately low level of tobacco harmknowledge. Eventually, the MDRs of educational attainment on tobacco harm knowledge may explainwhy highly educated Hispanics remain at high risk of tobacco use.

Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. Minorities’ Diminished Returns (MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American adults. This cross-sectional study included 18,274 non-smoking adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013). The independent variables were educational attainment and poverty status. The dependent variable was second-hand smoke exposure at home. Age and region of residence were the covariates. Ethnicity was the moderator. Overall, individuals with a higher educational attainment (odds ratio [OR] = 0.76, 95% CI = 0.74-0.79) and those who lived out of poverty (OR = 0.56, 95% CI =0.51-0.62) had lower odds of second-hand smoke exposure at home. Hispanic ethnicity showed significant interactions with both SES indicators, suggesting that the protective effects of education and poverty on second-hand smoke exposure at home are smaller for Hispanics (ORs for interaction with education and poverty status = 1.30 and 1.26, P < 0.05) than for Non-Hispanics. In the US, high SES Hispanics remain at high risk of exposure to second-hand smoke at home despite a high education and income. High SES better reduces environmental exposures for non-Hispanic than for Hispanic individuals.

The positive effect of high socioeconomic position (SEP) on health is well established. According Minorities’ Diminished Returns (MDRs) theory, however, the SEP-health link is smaller for Blacks compared to Whites. Using a 25-year follow up data of a national sample, this study tested racial differences in the effects of marital status on life expectancy among American adults.

The data of Americans’ Changing Lives (ACL, 1986 – 2011) were used. The ACL is a nationally representative longitudinal cohort study followed 3,361 White or Blacks adults from 1986 to 2011. The predictor of interest was marital status in 1986. Confounders included demographic factors (age and gender), SEP (education and employment), health behaviors (drinking, smoking, and physical activity), and health status (depressive symptoms, chronic disease, and self-rated health) all measured at baseline. Race was the moderator variable. All-cause mortality was the main dependent variable (outcome). Cox proportional hazard modeling was applied for data analysis.

In the overall sample, individuals who were married at baseline had a lower risk of mortality during the 25 years of follow up. Race altered the effect of marital status on life expectancy, indicating smaller protective effect for Blacks relative to Whites. Race –specific Cox regression models showed an association between marital status and life expectancy for White but not Black Americans.

In line with the MDRs theory, the health gain that follows marital status is diminished for Black Americans compared to White Americans. Only equalizing SEP across racial groups may not be adequate for eliminating racial/ethnic health inequalities. Policies should go beyond SEP and reduce societal and structural barriers that disproportionately hinder Blacks from translating their SEP indicators to desirable health outcomes.

The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites. The current study explored the racial and ethnic differences in the association between educational attainment and Breast Physical Exam (BPE) among women in the U.S. The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis. Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR]=1.11, 95% CI=1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR=0.96, 95% CI=0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02). In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Previous research has documented bidirectional associations between age at childbirth and socioeconomic status (SES) among mothers. Built on the Marginalization-related Diminished Returns (MDRs) theory, this study compares the association between maternal age at childbirth and income between non-Hispanic Blacks and non-Hispanic Whites.

We used the data of the Fragile Families and Child Well-being Study (FFCWS), a longitudinal study from 1998 to 2016 in the United States (US). This study included 2922 women who were non-Hispanic White (n=776) or non-Hispanic Black (n=2146). Maternal age at childbirth was the independent variable, and income was the dependent variable. Educational attainment, marital status, delivery characteristics, car ownership, and welfare dependence were the covariates. For data analysis, linear regressions were applied.

Higher maternal age at childbirth was associated with higher income (adjusted b=0.30). We found a significant interaction between maternal age at childbirth and race on income, suggesting that the positive association between mothers’ age at childbirth and income was weaker for non-Hispanic Blacks than non-Hispanic Whites (b=-1.14, 95% CI=-1.50, -0.77).

Postponing childbirth may have a smaller economic return for non-Hispanic Black women, which is in line with Marginalization-related Diminished Returns theory. Diminished returns of postponing reproduction may be a result of social stratification and structural inequalities that separate the lived experience of Blacks and Whites in the United States.

As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk. This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States. Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data. From all participants, 16.2% were Black and 11.6% were Hispanic with a mean age of 51 years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =1.04, 95% CI = 1.01-1.08) and ethnicity (OR = 1.04, 95% CI =1.01-1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites. The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.

Socioeconomic status (SES) indicators are among the main social determinants of health and illness. Less, however, is known about the role of SES in the epidemiology of polypharmacy in immigrant Latino Americans living in the United States. This research studied the association between three SES indicators, education, income, and employment, and polypharmacy in older first generation Latino American immigrant adults. Data was obtained from the Sacramento Area Latino Study on Aging (SALSA, 1996-2008). A total of 632 older first generation Mexican-American immigrants to the U.S. entered this analysis. The independent variables were education, income, and employment. Polypharmacy was the outcome. Age, gender, physical health, smoking, and drinking were the covariates. Binary logistic regression was used to analyze the data. Employment was associated with lower odds of polypharmacy. The association between education and polypharmacy was above and beyond demographic factors, physical health, health behaviors, and health insurance. Neither education nor income were associated with polypharmacy. Other determinants of polypharmacy were poor self-rated health (SRH) and a higher number of chronic medical conditions (CMCs). Employment appears to be the major SES determinant of polypharmacy in older foreign-born Mexican Americans. Unemployed older Mexican American immigrants with multiple chronic diseases and those who have poor SRH have the highest need for an evaluation of polypharmacy. Given the age group of this population, most of them have health insurance, which provides an opportunity for reducing their polypharmacy.

Although educational attainment is protective against health risk behaviors such as smoking, the Minorities’ Diminished Return theory posits that these protective effects are smaller for ethnic minorities than majority groups. This study compared the effects of educational attainment on the smoking status of American Indian/Alaska Native (AIAN) and White adults. Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21 114 individuals entered the current analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator. Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that suggested that the protective effects of educational attainment against smoking are smaller for AIAN than for Whites. In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites, resulting in additional risk of smoking in highly educated AIANs. To reduce ethnic disparities in tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.

The issue of knowledge on school backpacks among parents has received little attention. The objectives of this study were to assess school backpack carriage and its consistency with parents’ knowledge about children friendly school backpacks. This was a randomized cross-sectional study. Totally 307 elementary school children and 250 parents were recruited to assess parental knowledge about standard school backpacks in 2010. Data collection were carried out on an unscheduled day in order to, children and their par ents prepared school backpacks based on their own previous habits and behaviors. All statistical analyses were performed using version 16.0 of the statistical software package SPSS Approximately, 132 (51.6%) of the parents were not aware of the recommended weight limit for carrying school backpacks and 144 (56.3%) were not aware that the size of the backpack must be proportionate to the upper back region. Significant difference was found for the mean score of awareness of a safe and standard school backpack between fathers and mothers: fathers had more knowledge about school backpack carriages in comparison with mothers (P<0.001). Children, parents and teachers should be educated about the characteristics of a standard backpack, different strategies. Parents are the best advocates for safety promotion and should represent the group most likely to help to significantly reduce backpack related injuries among school children by selecting safe school backpacks, supervising school backpack carrying and checking backpack weights.

To examine the association between alcohol misuse and depression symptoms as it varies among male and female patients. This was a cross-sectional survey of 412 randomly selected adult patients who sought care in the emergency department. The main predictor variables of alcohol misuse were created from AUDIT, RAPS4, binge drinking, alcohol abuse, and alcohol dependence measures. The outcome variable of depression symptoms was measured by the Center for Epidemiological Studies Depression Scale (CES-D, ≥16). There were 41% of women and 35% of men who reported greater depression and 34.1% of men and 9.2% of women reported alcohol misuse. Alcohol misuse, stress, and education level all correlated with greater depression in men whereas age was most significant for women. Men who misused alcohol were 2.5 times more likely to report greater depression (OR=2.47, 95%CI=1.37 – 4.45, P≤0.05). In women, a 10-year increase in age was associated with a 36% increase in the odds of depression (OR=1.55, 95%CI=1.12 – 2.13, P≤0.05). While it may be unrealistic to expect emergency department providers to fully attend to all the mental health needs of their patients, they should use windows of opportunity to identify patients who present with symptoms of depression and/or alcohol misuse for potential intervention.