RSS 1.0School of Public Health
Recent Submissions
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Epidemiologic Assessment of Pediatric Inflammatory Bowel Disease Presentation in NYC During COVID-19.Inflammatory Bowel Disease (IBD) pathogenesis is thought to be induced by a mix of genetic susceptibility, microbial populations, and immune triggers such as infections. SARS-nCoV2 may have increased capacity to generate autoimmune disease as evidenced by known spikes in diseases such as Type 1 Diabetes Mellitus. Public health interventions like masking and closures additionally created remarkable drops in typical viral infections, with remarkable shifts in ILI reporting in 2020. This study aims to evaluate the impact of SARS-nCoV2 and associated interventions on pediatric IBD presentation in NYC using records of new diagnoses at a consortium of four institutions between 2016 and June 2022. We fit time series model (ARIMA) to monthly and quarterly number of cases of each disease for January 2016-March 2020 and forecast the period between April 2020 and June 2022. We note no decrease in Ulcerative Colitis or Crohn's Disease in the aftermath of historic low levels of overall viral illness, and statistically significant increases in Crohn's Disease diagnoses and elevation in UC diagnoses creating a trend suggesting overall increase in IBD diagnoses exceeding the baseline rate of increase. These data suggest a possible linkage between SARS-nCoV2 infection rates and subsequent pediatric IBD presentation.
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Horizons and Group Motivational Enhancement Therapy: HIV Prevention for Alcohol-Using Young Black Women, a Randomized Experiment.Black women are at disproportionately greater risk for HIV and sexually transmitted infections than women of other ethnic/racial backgrounds. Alcohol use may further elevate the risk of HIV/sexually transmitted infection acquisition and transmission.
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Hip Fracture and the Weekend Effect: Does Weekend Admission Affect Patient Outcomes?Reduced hospital staffing on weekends is a hypothesized risk factor for adverse health outcomes--commonly referred to as the weekend effect. We conducted a study on the effect of weekend admission on short-term outcomes among US hip fracture patients. We selected Nationwide Inpatient Sample (1998-2010) patients with a principal diagnosis of femoral neck fracture and grouped them by day of admission (weekend or weekday). We used multivariate logistic and linear regression analyses, controlling for age, race, sex, number of comorbidities, and other risk factors, to calculate odds ratios (ORs) of mortality and perioperative complications as well as mean difference in length of hospital stay. Our study population included 96,892 weekend and 248,097 weekday admissions. Compared with patients admitted on weekdays, patients admitted on weekends had lower mortality (OR, 0.94; 95% confidence interval [CI], 0.89-0.99) and shorter mean hospital stay (estimate, 3.74%; 95% CI, 3.40-4.08) but did not differ in risk of perioperative complications (OR, 1.00; 95% CI, 0.98-1.02). Weekend admission did not predict death, perioperative complications, longer hospital stay, or other adverse short-term outcomes. Our study data do not support a weekend effect among hip fracture admissions in the United States.
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Reborn a virgin: adolescents' retracting of virginity pledges and sexual histories.We examined retractions of virginity pledges and of sexual histories among adolescents taking part in waves 1 and 2 of the National Longitudinal Study of Adolescent Health.
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Truth or consequences: the intertemporal consistency of adolescent self-report on the Youth Risk Behavior Survey.Surveys are the primary information source about adolescents' health risk behaviors, but adolescents may not report their behaviors accurately. Survey data are used for formulating adolescent health policy, and inaccurate data can cause mistakes in policy creation and evaluation. The author used test-retest data from the Youth Risk Behavior Survey (United States, 2000) to compare adolescents' responses to 72 questions about their risk behaviors at a 2-week interval. Each question was evaluated for prevalence change and 3 measures of unreliability: inconsistency (retraction and apparent initiation), agreement measured as tetrachoric correlation, and estimated error due to inconsistency assessed with a Bayesian method. Results showed that adolescents report their sex, drug, alcohol, and tobacco histories more consistently than other risk behaviors in a 2-week period, opposite their tendency over longer intervals. Compared with other Youth Risk Behavior Survey topics, most sex, drug, alcohol, and tobacco items had stable prevalence estimates, higher average agreement, and lower estimated measurement error. Adolescents reported their weight control behaviors more unreliably than other behaviors, particularly problematic because of the increased investment in adolescent obesity research and reliance on annual surveys for surveillance and policy evaluation. Most weight control items had unstable prevalence estimates, lower average agreement, and greater estimated measurement error than other topics.
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Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers.The US government spends more than $200 million annually on abstinence-promotion programs, including virginity pledges. This study compares the sexual activity of adolescent virginity pledgers with matched nonpledgers by using more robust methods than past research.
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Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department.Rapid diagnosis of bloodstream infections (BSIs) in the emergency department (ED) is challenging, with turnaround times exceeding the timeline for rapid diagnosis. We studied the usefulness of procalcitonin as a marker of BSI in 367 adults admitted to our ED with symptoms of systemic infection. Serum samples obtained at the same time as blood cultures were available from 295 patients. Procalcitonin levels were compared with blood culture results and other clinical data obtained during the ED visit. Procalcitonin levels of less than 0.1 ng/mL were considered negative; all other levels were considered positive. In 16 patients, there was evidence of BSI by blood culture, and 12 (75%) of 16 patients had a procalcitonin level of more than 0.1 ng/mL. In 186 (63.1%) of 295 samples, procalcitonin values were less than 0.1 ng/mL, and all were culture negative. With a calculated threshold of 0.1475 ng/mL for procalcitonin, sensitivity and specificity for the procalcitonin assay were 75% and 79%, respectively. The positive predictive value was 17% and the negative predictive value 98% compared with blood cultures. Procalcitonin is a useful marker to rule out sepsis and systemic inflammation in the ED.
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Gun utopias? Firearm access and ownership in Israel and Switzerland.The 2011 attempted assassination of a US representative renewed the national gun control debate. Gun advocates claim mass-casualty events are mitigated and deterred with three policies: (a) permissive gun laws, (b) widespread gun ownership, (c) and encouragement of armed civilians who can intercept shooters. They cite Switzerland and Israel as exemplars. We evaluate these claims with analysis of International Crime Victimization Survey (ICVS) data and translation of laws and original source material. Swiss and Israeli laws limit firearm ownership and require permit renewal one to four times annually. ICVS analysis finds the United States has more firearms per capita and per household than either country. Switzerland and Israel curtail off-duty soldiers' firearm access to prevent firearm deaths. Suicide among soldiers decreased by 40 per cent after the Israeli army's 2006 reforms. Compared with the United States, Switzerland and Israel have lower gun ownership and stricter gun laws, and their policies discourage personal gun ownership.
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Degrees of health disparities: Health status disparities between young adults with high school diplomas, sub-baccalaureate degrees, and baccalaureate degrees.Community colleges have increased post-secondary educational access for disadvantaged youth, but it is unknown how community college degrees fit into the educational gradient of health status disparities. Using data from high school graduates in the National Longitudinal Study of Adolescent Health, we compared young adults ages 26-31 whose highest degrees were high school diplomas (n=5584), sub-baccalaureate credentials (sub-BAs include community college certificates and associate's degrees) (n=2415), and baccalaureate degrees (BAs) (n=3303) on measures of hypertension, obesity, smoking, sleep problems, dyslipidemia, and depression. Comparisons used multivariate Poisson regression with robust standard errors after exact and nearest-neighbor Mahalanobis matching within propensity score calipers on 23 baseline factors measured in 1995. High school graduates and sub-BAs differed significantly on 3 of 23 baseline factors. After matching, sub-BAs were 16% less likely to smoke daily than if they had only a high school diploma but did not differ in other health status measures. Sub-BAs and BAs differed significantly on 14 of 23 baseline factors. After matching, BAs were 60% less likely to smoke daily, 14% less likely to be obese, and 38% less likely to have been diagnosed with depression. Sub-BA degrees are accessible to high school graduates irrespective of academic backgrounds and predict lower smoking prevalence. BAs are less accessible to high school graduates and predict lower chances of smoking, depression, and obesity.
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Cash, cars, and condoms: economic factors in disadvantaged adolescent women's condom use.Evaluate whether adolescent women who received economic benefits from their boyfriends were more likely never to use condoms.
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Beyond BA Blinders: Lessons from Occupational Colleges and Certificate Programs for Nontraditional StudentsPostsecondary education mostly focuses on the four-year BA degree. Community colleges are often promoted as the first step toward the ultimate goal of a four-year degree. However, community colleges have extremely poor degree completion rates. There is evidence suggesting better results for their private, two-year counterparts -- particularly for certificate completion. We will focus on occupational colleges -- private accredited colleges that offer career preparation in occupational fields like health care, business, information technology, and others. These institutions challenge many of our preconceptions about college. They are less wedded to college traditions, which raises some interesting questions: Do private colleges offering certificates or AA degrees use different procedures? Should community colleges consider some of these procedures to reduce student difficulties and improve their completion rates? For many community college students, earning a more likely, quick sub-BA credential -- perhaps followed by a four-year degree in the future -- will be preferable to the relatively unlikely pathway from a community college program directly to a four-year BA. In sum, this paper suggests that nontraditional colleges and nontraditional credentials (certificates and AA degrees) deserve much closer attention from researchers, policymakers, and students.
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True love waits: do Southern Baptists? Premarital sexual behavior among newly married Southern Baptist Sunday school students.This study measures premarital sex prevalence, sources of sex education, and support for secular sex education among 151 newly married young adults surveyed at 9 Texas Southern Baptist churches. More than 70% of respondents reported having had premarital vaginal or oral sex, but more than 80% regretted premarital sex. The proportion of premarital sex exceeded 80% in 6 of 9 churches, among men and women married after age 25 and women married before age 21. School sex education was the only source of information about sexually transmitted infections for 57% of respondents, and 65% supported secular sex education despite church opposition.
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Telling truth from Ys: an evaluation of whether the accuracy of self-reported semen exposure assessed by a semen Y-chromosome biomarker predicts pregnancy in a longitudinal cohort study of pregnancy.Adolescents may use condoms inconsistently or incorrectly, or may over-report condom use. This study used a semen exposure biomarker to evaluate the accuracy of female adolescents' reports of condom use and predict subsequent pregnancy.
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Do Jobs Work? Risk and Protective Behaviors Associated with Employment Among Disadvantaged Female Teens in Urban Atlanta.Adolescent employment predicts lower educational engagement and achievement and greater engagement with risk behaviors. Most research has studied middle class rather than disadvantaged adolescents. We identified risk and protective behaviors associated with employment using data from a 3-wave, 12-month study of 715 low-socio-economic status female African American adolescents who were ages 15-21 at baseline. Adolescents who were employed at wave 2 (n=214) were matched with adolescents who were not employed at wave 2 (n=422) using nearest-neighbor matching on baseline factors within propensity score calipers on factors including marijuana use, sex while high, pregnancy risk, and socioeconomic status. We compared employed and non-employed teens on risk behaviors including marijuana use, sex while high or drunk, and a biomarker for semen exposure in the past 14 days. Employed teens were 44% as likely to say that their boyfriend is their primary spending money source and 43% as likely to be emotionally abused, but these benefits did not persist after employment ended. Six months after employment, employed respondents reported using marijuana 57% more often and had sex while drunk or high 2.7 times as frequently. Women who were employed at both waves 2 and 3 were 17% as likely to have their boyfriend as a primary source of spending money and 13% more likely to graduate high school, but they used marijuana twice as often, alcohol 1.6 times as often, had 1.6 times as many sexual partners, and had sex while high or drunk 2.3 times as often. Female teens who work may avoid potentially coercive romantic relationships, but they may buy drugs or alcohol with their earnings.
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Beyond Earnings and Social Reproduction: Can College Lead to Good Jobs Without Reproducing Social Inequalities?College- for- all has become the educational policy in the United States, and it has led to many changes. Postsecondary subbaccalaureate (sub- BA) credentials (certificates and associate’s degrees) are an increasing portion of college credentials, and we examine the implications for the reproduction of social inequalities. We find that despite the growth of sub- BA credentials, many students who enroll in college continue to get no credentials. After replicating prior findings of sub- BA employment and earnings payoffs, using the 2004– 2012 Educational Longitudinal Study (ELS) survey, we analyze the AddHealth survey to see whether sub- BA credentials are associated with jobs with nonmonetary job rewards similar to those BAs get (autonomy, career relevance, and so on). Moreover, although BA degrees often reproduce social and academic inequalities, we examine whether sub- BA credentials pose socioeconomic status (SES) and test score obstacles to credential completion, and to employment and earnings within credentials. Beyond the usual earnings payoffs in prior research, we conclude that sub- BA credentials provide ways college students can attain desirable job rewards while avoiding SES and test score obstacles. We speculate on possible reasons and policy implications.
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Money isn't everything: job satisfaction, nonmonetary job rewards, and sub-baccalaureate credentials.Some researchers and reformers have raised doubts about whether sub-BA credentials lead to good jobs. This study finds that young working adults (ages 25-32) report that nonmonetary rewards such as autonomy and career relevance are more strongly related to job satisfaction than earnings is. Controlling for background differences, young adults with BA and graduate degrees have the greatest nonmonetary job rewards, followed by those with associate's degrees and certificate credentials, all of whom have significantly greater nonmonetary job rewards than high school graduates. Students who attend college without earning credentials report few job rewards, and no better autonomy and career-relevance than high school graduates. Parents, advisors, and policymakers should inform students of nonmonetary job rewards they likely will value as young adult workers in addition to earnings, and which credentials lead to these job rewards.
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Predicting Unprotected Sex and Unplanned Pregnancy among Urban African-American Adolescent Girls Using the Theory of Gender and Power.Reproductive coercion has been hypothesized as a cause of unprotected sex and unplanned pregnancies, but research has focused on a narrow set of potential sources of reproductive coercion. We identified and evaluated eight potential sources of reproductive coercion from the Theory of Gender and Power including economic inequality between adolescent girls and their boyfriends, cohabitation, and age differences. The sample comprised sexually active African-American female adolescents, ages 15-21. At baseline (n = 715), 6 months (n = 607), and 12 months (n = 605), participants completed a 40-min interview and were tested for semen Y-chromosome with polymerase chain reaction from a self-administered vaginal swab. We predicted unprotected sex and pregnancy using multivariate regression controlling for demographics, economic factors, relationship attributes, and intervention status using a Poisson working model. Factors associated with unprotected sex included cohabitation (incidence risk ratio (IRR) 1.48, 95 % confidence interval (1.22, 1.81)), physical abuse (IRR 1.55 (1.21, 2.00)), emotional abuse (IRR 1.31 (1.06, 1.63)), and having a boyfriend as a primary source of spending money (IRR 1.18 (1.00, 1.39)). Factors associated with unplanned pregnancy 6 months later included being at least 4 years younger than the boyfriend (IRR 1.68 (1.14, 2.49)) and cohabitation (2.19 (1.35, 3.56)). Among minors, cohabitation predicted even larger risks of unprotected sex (IRR 1.93 (1.23, 3.03)) and unplanned pregnancy (3.84 (1.47, 10.0)). Adolescent cohabitation is a marker for unprotected sex and unplanned pregnancy, especially among minors. Cohabitation may have stemmed from greater commitment, but the shortage of affordable housing in urban areas could induce women to stay in relationships for housing. Pregnancy prevention interventions should attempt to delay cohabitation until adulthood and help cohabiting adolescents to find affordable housing.
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Semen says: assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarker.Researchers often assess condom use only among participants who report recent sexual behaviour, excluding participants who report no recent vaginal sex or who did not answer questions about their sexual behaviour, but self-reported sexual behaviour may be inaccurate. This study uses a semen Y-chromosome biomarker to assess semen exposure among participants who reported sexual abstinence or did not report their sexual behaviour.
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Educational and criminal justice outcomes 12 years after school suspension.A third of US students are suspended over a K-12 school career. Suspended youth have worse adult outcomes than non-suspended students, but these outcomes could be due to selection bias: that is, suspended youth may have had worse outcomes even without suspension. This study compares the educational and criminal justice outcomes of 480 youth suspended for the first time with those of 1193 matched non-suspended youth from a nationally representative sample. Prior to suspension, the suspended and non-suspended youth did not differ on 60 pre-suspension variables including students' self-reported delinquency and risk behaviors, parents' reports of socioeconomic status, and administrators' reports of school disciplinary policies. Twelve years after suspension (ages 25-32), suspended youth were less likely than matched non-suspended youth to have earned bachelors degrees or high school diplomas, and were more likely to have been arrested and on probation, suggesting that suspension rather than selection bias explains negative outcomes.
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Disabilities and Degrees: Identifying Health Impairments that Predict Lower Chances of College Enrollment and Graduation in a Nationally Representative Sample.Community colleges have increased post-secondary educational access for youth, including individuals with disabilities, but completion rates remain low. This study tests the hypothesis that health conditions that reduce social integration predict lower educational attainment among community college students.
