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Ethnicity, Gender, Need for Mental Health Care and Inpatient Mental Health Care Utilization Among American Blacks
Abstracts / Annals of Epidemiology 23 (2013) 581e598
only increased for non-asthmatics on lag day 2: RR¼1.003 (1.000-1.005). Risks for other pollutants often appeared higher for asthmatics but were less consistent. Conclusion: Asthmatics may be more susceptible to acute exposure to traffic-related pollutants, such as NOx and CO, which could trigger PTB.
P34-S. Impact of Aerial Insecticide Spraying on West Nile Virus Disease d North Texas, 2012 D. Ruktanonchai, S. Pillai, S. Stonecipher, N. Lindsey, K. Horiuchi, M. Delorey, B. Biggerstaff, T. Sidwa, J. Zoretic, J. McAllister, R. Nasci, M. Fischer, S. Hills. TX DSHS, Austin, TX Purpose: West Nile virus (WNV) is the leading cause of mosquitoborne disease in the United States. During 2012, four north Texas counties reported >840 WNV cases, six times more than any previous year. In response, larviciding and ground-based adulticide spraying were performed variably throughout the area and, for the first time in north Texas, aerial insecticide spraying was used for WNV control with two counties treated in August. We evaluated aerial spraying's impact on WNV disease. Methods: We defined a case as a resident of one of the four counties who, in 2012, had laboratory-confirmed WNV neuroinvasive disease using the national surveillance case definition. Patients were categorized as living within or outside the aerial-sprayed area. We calculated incidence rate ratios (IRRs) in treated and untreated areas by comparing incidence rates before and after spraying; for unsprayed areas, before and after periods were defined by using spray dates from a corresponding sprayed area. We evaluated aerial spraying's impact by using the ratio and 95% confidence intervals (CIs) of IRRs in treated and untreated areas. Results: In treated areas, the incidence before and after spraying was 7.47 and 0.28 per 100,000 persons, respectively; the IRR was 27.00 (95% CI: 12.70e57.41). In untreated areas, the before and after incidence was 4.80 and 0.45 per 100,000 persons, respectively; the IRR was 10.57 (95% CI: 6.11e18.29). The ratio of these IRRs was 2.55 (95% CI: 1.01e6.49). Conclusion: WNV neuroinvasive disease incidence decreased in the afterspray period in both areas, but the relative change was significantly greater in aerial-sprayed areas.
P35. Associations Between Environmental Characteristics and Weight Status in Elementary School Children R.R. Suminski, J.A. Wasserman, C.A. Mayfield, L.W. Segars, A. Glaros. Kansas City University of Medicine and Biosciences, Kansas City, MO Purpose: In this cross-sectional study we examined associations between food outlets and physical activity facilities and body mass index percentile rankings (BMIp). Methods: Trained investigators visited 43 elementary schools to collect data on a sample (n¼6,939) of Hispanic (36.7%), Black (39.8%), and White (23.5%) boys (51.7%) and girls (mean age ¼ 8.3 y; mean BMIp ¼ 71.3) living in the zip code areas of the schools (i.e., school neighborhoods). In addition, information about the number of convenience, fast food, and grocery stores and park, playground, and fitness facilities in the school neighborhoods was obtained using various search methods (e.g., Internet, in-person audits). Results: Hispanic had significantly higher BMIp than Whites and Blacks. The multi-level regression analyses adjusted for school neighborhood (crime rate) and school (percent free/reduced lunch, PE offered) characteristics, indicated that higher BMIp were associated with fewer parks (Hispanic girls) and fitness facilities (Black boys) and more fast food stores (White and Hispanic boys) (p<0.05). Conclusion: Environmental characteristics of the neighborhoods surrounding elementary schools are associated with the weight status of children attending and living near those schools. The associations vary according to the racial/ethnic background and gender of the child.
P36. Cumulative Neighborhood Risk and Allostatic Load in Adolescents K.P. Theall, E.A. Shirtcliff, S.S. Drury. Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
589
Purpose: We examine the impact of cumulative neighborhood risk on AL among adolescents as a mechanism through which life stress, including neighborhood conditions, may impact health and health inequities. Methods: Multilevel analyses were conducted, weighted for sampling and propensity score matched, among 12-20 year-old adolescents in the NHANES, 1999-2006 (first level, n¼11,886) nested within family/household (second level, n¼6,696) and census tracts (third level, n¼2,191) to examine the contextual effect of cumulative neighborhood risk environment on AL. Results: Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. Even after taking into account household and other individual factors, the likelihood of having a high AL was approximately 10% higher for those living in medium cumulative risk (adjusted OR ¼ 1.09, 95% CI ¼ 1.08, 1.09), 30% higher those living in high (adjusted OR ¼ 1.28, 95% CI ¼ 1.27, 1.30), and 69% higher for those living in very high risk neighborhoods (adjusted OR ¼ 1.69, 95% CI ¼ 1.68, 1.70) compared to those in low risk areas. Conclusion: These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically-mediated negative health outcomes detectable in adolescents.
Health Services P37-S. Ethnicity, Gender, Need for Mental Health Care and Inpatient Mental Health Care Utilization Among American Blacks Shervin Assari MD, MPH. University of Michigan School of Public Health Purpose: To determine the effect of gender on the effect of having a definite need for mental health care on use of inpatient mental health services among a community sample of African Americans and Caribbean Blacks in the United States. Methods: Data came from National Survey of American Life, a national representative data of noninstitutionalized African Americans (n¼3,123) and Caribbean Blacks (n¼1,319). Presence of lifetime psychiatric disorder was independent variable, determined by a modified version of the Composite International Diagnostic Interview. Dependent variable was lifetime inpatient mental health care use. We tested main effects of gender and lifetime psychiatric disorder and their interactions in logistic regressions specific for each ethnic group. We also tested main effect and interactions of ethnicity, gender and any lifetime psychiatric disorder in the pooled sample. Results: Among African Americans (OR¼3.303; 95% CI ¼ 1.015 to 10.753), but not Caribbean Blacks (OR¼0.342; 95% CI¼0.009 to 12.488), male gender increased the odds of inpatient mental health care utilization associated with any lifetime psychiatric disorder. Based on our pooled regression model, the effect of male gender on inpatient mental health care use was larger for African Americans than Caribbean Blacks (OR for interaction term¼ 4.5, 95% CI ¼ 1.3 to 15.8). Conclusion: Among African Americans with serious mental health need, male gender is associated with 3.3 times higher odds of inpatient mental health care use. This gender disparity does not exist among Caribbean Blacks.
P38. The Influence of Surgical Subspecialty Training on InHospital Mortality for Cancer Procedures P. Christos, M. Mazumdar, A. Mushlin. Department of Public Health, Weill Cornell Medical College, New York, NY Purpose: Patients operated on by surgeons with specialty training have been shown to have lower mortality rates. The objective of this study was to evaluate the independent effect of surgical subspecialty training (training) on in-hospital mortality for cancer patients undergoing colectomy or gastrectomy surgical procedures. Methods: We studied all colectomy and gastrectomy (N¼62,719) discharges for cancer from the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database during 1998 to 2006. Training was defined as membership in the Society of Colorectal Surgery or the Society of Surgical Oncology. In-hospital mortality rates were compared for patients operated on by surgeons with and without training, adjusted for patient characteristics, surgeon volume, and hospital volume. Clustering by surgeon was explored with both generalized estimating equations (GEE) and random effects (RE) modeling.
only increased for non-asthmatics on lag day 2: RR¼1.003 (1.000-1.005). Risks for other pollutants often appeared higher for asthmatics but were less consistent. Conclusion: Asthmatics may be more susceptible to acute exposure to traffic-related pollutants, such as NOx and CO, which could trigger PTB.
P34-S. Impact of Aerial Insecticide Spraying on West Nile Virus Disease d North Texas, 2012 D. Ruktanonchai, S. Pillai, S. Stonecipher, N. Lindsey, K. Horiuchi, M. Delorey, B. Biggerstaff, T. Sidwa, J. Zoretic, J. McAllister, R. Nasci, M. Fischer, S. Hills. TX DSHS, Austin, TX Purpose: West Nile virus (WNV) is the leading cause of mosquitoborne disease in the United States. During 2012, four north Texas counties reported >840 WNV cases, six times more than any previous year. In response, larviciding and ground-based adulticide spraying were performed variably throughout the area and, for the first time in north Texas, aerial insecticide spraying was used for WNV control with two counties treated in August. We evaluated aerial spraying's impact on WNV disease. Methods: We defined a case as a resident of one of the four counties who, in 2012, had laboratory-confirmed WNV neuroinvasive disease using the national surveillance case definition. Patients were categorized as living within or outside the aerial-sprayed area. We calculated incidence rate ratios (IRRs) in treated and untreated areas by comparing incidence rates before and after spraying; for unsprayed areas, before and after periods were defined by using spray dates from a corresponding sprayed area. We evaluated aerial spraying's impact by using the ratio and 95% confidence intervals (CIs) of IRRs in treated and untreated areas. Results: In treated areas, the incidence before and after spraying was 7.47 and 0.28 per 100,000 persons, respectively; the IRR was 27.00 (95% CI: 12.70e57.41). In untreated areas, the before and after incidence was 4.80 and 0.45 per 100,000 persons, respectively; the IRR was 10.57 (95% CI: 6.11e18.29). The ratio of these IRRs was 2.55 (95% CI: 1.01e6.49). Conclusion: WNV neuroinvasive disease incidence decreased in the afterspray period in both areas, but the relative change was significantly greater in aerial-sprayed areas.
P35. Associations Between Environmental Characteristics and Weight Status in Elementary School Children R.R. Suminski, J.A. Wasserman, C.A. Mayfield, L.W. Segars, A. Glaros. Kansas City University of Medicine and Biosciences, Kansas City, MO Purpose: In this cross-sectional study we examined associations between food outlets and physical activity facilities and body mass index percentile rankings (BMIp). Methods: Trained investigators visited 43 elementary schools to collect data on a sample (n¼6,939) of Hispanic (36.7%), Black (39.8%), and White (23.5%) boys (51.7%) and girls (mean age ¼ 8.3 y; mean BMIp ¼ 71.3) living in the zip code areas of the schools (i.e., school neighborhoods). In addition, information about the number of convenience, fast food, and grocery stores and park, playground, and fitness facilities in the school neighborhoods was obtained using various search methods (e.g., Internet, in-person audits). Results: Hispanic had significantly higher BMIp than Whites and Blacks. The multi-level regression analyses adjusted for school neighborhood (crime rate) and school (percent free/reduced lunch, PE offered) characteristics, indicated that higher BMIp were associated with fewer parks (Hispanic girls) and fitness facilities (Black boys) and more fast food stores (White and Hispanic boys) (p<0.05). Conclusion: Environmental characteristics of the neighborhoods surrounding elementary schools are associated with the weight status of children attending and living near those schools. The associations vary according to the racial/ethnic background and gender of the child.
P36. Cumulative Neighborhood Risk and Allostatic Load in Adolescents K.P. Theall, E.A. Shirtcliff, S.S. Drury. Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
589
Purpose: We examine the impact of cumulative neighborhood risk on AL among adolescents as a mechanism through which life stress, including neighborhood conditions, may impact health and health inequities. Methods: Multilevel analyses were conducted, weighted for sampling and propensity score matched, among 12-20 year-old adolescents in the NHANES, 1999-2006 (first level, n¼11,886) nested within family/household (second level, n¼6,696) and census tracts (third level, n¼2,191) to examine the contextual effect of cumulative neighborhood risk environment on AL. Results: Approximately 35% of adolescents had 2 or more biomarkers of AL. A significant amount of variance in AL was explained at the neighborhood level. Even after taking into account household and other individual factors, the likelihood of having a high AL was approximately 10% higher for those living in medium cumulative risk (adjusted OR ¼ 1.09, 95% CI ¼ 1.08, 1.09), 30% higher those living in high (adjusted OR ¼ 1.28, 95% CI ¼ 1.27, 1.30), and 69% higher for those living in very high risk neighborhoods (adjusted OR ¼ 1.69, 95% CI ¼ 1.68, 1.70) compared to those in low risk areas. Conclusion: These findings offer support for the hypothesis that neighborhood risks may culminate in a range of biologically-mediated negative health outcomes detectable in adolescents.
Health Services P37-S. Ethnicity, Gender, Need for Mental Health Care and Inpatient Mental Health Care Utilization Among American Blacks Shervin Assari MD, MPH. University of Michigan School of Public Health Purpose: To determine the effect of gender on the effect of having a definite need for mental health care on use of inpatient mental health services among a community sample of African Americans and Caribbean Blacks in the United States. Methods: Data came from National Survey of American Life, a national representative data of noninstitutionalized African Americans (n¼3,123) and Caribbean Blacks (n¼1,319). Presence of lifetime psychiatric disorder was independent variable, determined by a modified version of the Composite International Diagnostic Interview. Dependent variable was lifetime inpatient mental health care use. We tested main effects of gender and lifetime psychiatric disorder and their interactions in logistic regressions specific for each ethnic group. We also tested main effect and interactions of ethnicity, gender and any lifetime psychiatric disorder in the pooled sample. Results: Among African Americans (OR¼3.303; 95% CI ¼ 1.015 to 10.753), but not Caribbean Blacks (OR¼0.342; 95% CI¼0.009 to 12.488), male gender increased the odds of inpatient mental health care utilization associated with any lifetime psychiatric disorder. Based on our pooled regression model, the effect of male gender on inpatient mental health care use was larger for African Americans than Caribbean Blacks (OR for interaction term¼ 4.5, 95% CI ¼ 1.3 to 15.8). Conclusion: Among African Americans with serious mental health need, male gender is associated with 3.3 times higher odds of inpatient mental health care use. This gender disparity does not exist among Caribbean Blacks.
P38. The Influence of Surgical Subspecialty Training on InHospital Mortality for Cancer Procedures P. Christos, M. Mazumdar, A. Mushlin. Department of Public Health, Weill Cornell Medical College, New York, NY Purpose: Patients operated on by surgeons with specialty training have been shown to have lower mortality rates. The objective of this study was to evaluate the independent effect of surgical subspecialty training (training) on in-hospital mortality for cancer patients undergoing colectomy or gastrectomy surgical procedures. Methods: We studied all colectomy and gastrectomy (N¼62,719) discharges for cancer from the New York State Department of Health's Statewide Planning and Research Cooperative System (SPARCS) database during 1998 to 2006. Training was defined as membership in the Society of Colorectal Surgery or the Society of Surgical Oncology. In-hospital mortality rates were compared for patients operated on by surgeons with and without training, adjusted for patient characteristics, surgeon volume, and hospital volume. Clustering by surgeon was explored with both generalized estimating equations (GEE) and random effects (RE) modeling.