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ABSTRACT: BACKGROUND: We estimated the contribution of smoking to educational differences in mortality and life expectancy between 1971 and 2010 in Finland. METHODS: Eight prospective datasets with baseline in 1970, 1975, 1980, 1985, 1990, 1995, 2000 and 2005 and each linked to a 5-year mortality follow-up were used. We calculated life expectancy at age 50 years with and without smoking-attributable mortality by education and gender. Estimates of smoking-attributable mortality were based on an indirect method that used lung cancer mortality as a proxy for the impact of smoking on mortality from all other causes. RESULTS: Smoking-attributable deaths constituted about 27% of all male deaths above age 50 years in the early 1970s and 17% in the period 2006-2010; these figures were 1% and 4% among women, respectively. The life expectancy differential between men with basic versus high education increased from 3.4 to 4.7 years between 1971-1975 and 2006-2010. In the absence of smoking, these differences would have been 1.5 and 3.4 years, 1.9 years (55%) and 1.3 years (29%) less than those observed. Among women, educational differentials in life expectancy between the most and least educated increased from 2.5 to 3.0 years. This widening was nearly entirely accounted for by the increasing impact of smoking. Among women the contribution of smoking to educational differences had increased from being negligible in 1971-1975 to 16% in 2006-2010. CONCLUSIONS: Among men, the increase in educational differences in mortality in the past decades was driven by factors other than smoking. However, smoking continues to have a major influence on educational differences in mortality among men and its contribution is increasing among women.
Journal of epidemiology and community health 11/2012; · 3.04 Impact Factor
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ABSTRACT: We document social inequalities in cause-specific mortality at ages 35–64 in Finland and the United States, countries with different health systems, income distributions, and social welfare programs for the working-aged population. The education–mortality gradient was the most marked for Finnish men and for causes of death linked to risk-taking, health behaviors, and stress. The association between family income and mortality was curvilinear in both countries. The effects of education and income were strongly attenuated after controlling for each other, marital status, and labor force participation, with the greatest attenuation observed for income in Finland and education in the United States.Cette étude concerne les inégalités en matière de mortalité spécifique par cause dans la tranche d’âge 35–64 ans en Finlande et aux Etats-Unis, deux pays qui diffèrent grandement de par leurs systèmes de soins, échelles de revenus, et politiques sociales en direction de la population d’âge actif. Le gradient de mortalité par niveau d’instruction était le plus accentué pour les hommes en Finlande, et pour les causes de décès liées aux comportements à risques, aux comportements de santé et au stress. L’association entre le revenu du ménage et la mortalité était curvilinéaire dans les deux pays. Les effets du niveau d’instruction et ceux du revenu étaient chacun fortement atténués après introduction de l’autre variable dans le modèle, et introduction du statut matrimonial et de la situation sur le marché du travail, la plus grande réduction étant observée pour le revenu en Finlande et pour le niveau d’instruction aux Etats-Unis.
European Journal of Population 04/2012; 22(2):179-203. · 1.75 Impact Factor
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ABSTRACT: Few prior studies have investigated the health of U.S. immigrants from the former Soviet Union (FSU). Utilizing data from the 2000 U.S. census and the 2000-2007 National Health Interview Survey (NIHS), we compare levels of disability of FSU immigrants with U.S.-born whites (ages 50-84). Our findings suggest an "epidemiologic paradox" in that FSU immigrants possess higher levels of education compared with U.S.-born whites, but report considerably higher disability with and without adjustment for education. Nonetheless, FSU immigrants report lower levels of smoking and heavy alcohol use compared with U.S.-born whites. We further investigate disability by period of arrival among FSU immigrants. Changes in Soviet emigration policies conceivably altered the level of health selectivity among émigrés. We find evidence that FSU immigrants who emigrated during a period when a permission to emigrate was hard to obtain (1970-1986) displayed less disability compared with those who emigrated when these restrictions were less stringent (1987-2000). Finally, we compare disability among Russian-born U.S. immigrants with that of those residing in Russia as a direct test of health selectivity. We find that Russian immigrants report lower levels of disability compared with Russians in Russia, suggesting that they are positively selected for health despite their poor health relative to U.S.-born whites.
Demography 03/2012; 49(2):425-47. · 1.93 Impact Factor
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ABSTRACT: This study aimed to test the "healthy immigrant" hypothesis and assess health heterogeneity among newly arrived working-age immigrants (18-64 years) from various regions of origin. Using the 5% sample of the 2000 U.S. Census (PUMS), we found that, compared with their native-born counterparts, immigrants from all regions of the world were less likely to report mental disability and physical disability. Immigrants from selected regions of origin were, however, more likely to report work disability. Significant heterogeneity in disabilities exists among immigrants: Those from Eastern Europe and Southeast Asia reported the highest risk of mental and physical disability, and those from East Asia reported the lowest risk of physical disability. Furthermore, Mexican immigrants reported the lowest risk of mental disability, and Canadian immigrants reported the lowest risk of work disability. Socioeconomic status and English proficiency partially explained these differences. The health advantage of immigrants decreased with longer U.S. residence.
Population Research and Policy Review 06/2011; 30(3):399-418. · 0.76 Impact Factor
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ABSTRACT: Using the 5% Public Use Micro Data Sample (PUMS) from the 2000 U.S. census, we examine differences in disability among eight black subgroups distinguished by place of birth and Hispanic ethnicity. We found that all foreign-born subgroups reported lower levels of physical activity limitations and personal care limitations than native-born blacks. Immigrants from Africa reported lowest levels of disability, followed by non-Hispanic immigrants from the Caribbean. Sociodemographic characteristics and timing of immigration explained the differences between these two groups. The foreign-born health advantage was most evident among the least-educated except among immigrants from Europe/Canada, who also reported the highest levels of disability among the foreign-born. Hispanic identification was associated with poorer health among both native-born and foreign-born blacks.
Demography 03/2011; 48(1):241-65. · 1.93 Impact Factor
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ABSTRACT: We compared health behaviors and health outcomes among US-born, African-born, and Caribbean-born pregnant Black women and examined whether sociodemographic and psychosocial characteristics explained differences among these population subgroups.
We analyzed data from a prospective cohort study conducted in Philadelphia, Pennsylvania, with a series of nested logistic regression models predicting tobacco, alcohol, and marijuana use and measures of physical and mental health.
Foreign-born Black women were significantly less likely to engage in substance use and had better self-rated physical and mental health than did native-born Black women. These findings were largely unchanged by adjustment for sociodemographic and psychosocial characteristics. The foreign-born advantage varied by place of birth: it was somewhat stronger for African-born women than for Caribbean-born women.
Further studies are needed to gain a better understanding of the role of immigrant selectivity and other characteristics that contribute to more favorable health behaviors and health outcomes among foreign-born Blacks than among native-born Blacks in the United States.
American Journal of Public Health 11/2010; 100(11):2185-92. · 3.93 Impact Factor
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ABSTRACT: Birth weight is an indicator of prenatal development associated with health in infancy and childhood, and may be affected by the family environment experienced by the mother during pregnancy. Using data from KwaZulu-Natal, South Africa, we explore the importance of the mother's access to the father and grandparents of the child during pregnancy. Controlling for household socio-economic indicators and maternal characteristics, the survival and residence of the biological father with the mother are positively associated with birth weight. The type of relationship seems to matter: married women have the heaviest newborns, but co-residence with a non-marital partner is also associated with higher birth weight. Access to the maternal grandmother may also be important: women whose mothers are alive have heavier newborns, but no additional benefit is observed from residing together. Co-residence with any grandparent is not associated with birth weight after controlling for the mother's partnership.
Population Studies 11/2010; 64(3):229-46. · 1.08 Impact Factor
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ABSTRACT: Relatively few researchers have investigated early antecedents of adult functional limitations in developing countries. In this study, we assessed associations between childhood conditions and adult lower-body functional limitations (LBFL) as well as the potential mediating role of adult socioeconomic status, smoking, body mass index, and chronic diseases or symptoms. Based on data from the Mexican Health and Aging Study (MHAS) of individuals born prior to 1951 and contacted in 2001 and 2003, we found that childhood nutritional deprivation, serious health problems, and family background predict adult LBFL in Mexico. Adjustment for the potential mediators in adulthood attenuates these associations only to a modest degree.
Social Science [?] Medicine 10/2010; 72(1):100-7. · 2.70 Impact Factor
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ABSTRACT: Recruitment and retention of patients for randomized control trial (RCT) studies can provide formidable challenges, particularly with minority and underserved populations. Data are reported for the Philadelphia Collaborative Preterm Prevention Project (PCPPP), a large RCT targeting risk factors for repeat preterm births among women who previously delivered premature (< 35 weeks gestation) infants.
Design of the PCPPP incorporated strategies to maximize recruitment and retention. These included an advanced database system tracking follow-up status and assessment completion rates; cultural sensitivity training for staff; communication to the community and eligible women of the benefits of participation; financial incentives; assistance with transportation and supervised childcare services; and reminder calls for convenient, flexibly scheduled appointments. Analyses reported here: 1) compare recruitment projections to actual enrollment 2) explore recruitment bias; 3) validate the randomization process 4) document the extent to which contact was maintained and complete assessments achieved 5) determine if follow-up was conditioned upon socio-economic status, race/ethnicity, or other factors.
Of eligible women approached, 1,126 (77.7%) agreed to participate fully. Of the 324 not agreeing, 118 (36.4%) completed a short survey. Consenting women were disproportionately from minority and low SES backgrounds: 71.5% consenting were African American, versus 38.8% not consenting. Consenting women were also more likely to report homelessness during their lifetime (14.6% vs. 0.87%) and to be unmarried at the time of delivery (81.6% versus 47.9%). First one-month postpartum assessment was completed for 83.5% (n = 472) of the intervention group (n = 565) and 76% (426) of the control group. Higher assessment completion rates were observed for the intervention group throughout the follow-up. Second, third, fourth and fifth postpartum assessments were 67.6% vs. 57.5%, 60.0% vs. 48.9%, 54.2% vs. 46.3% and 47.3% vs. 40.8%, for the intervention and control group women, respectively. There were no differences in follow-up rates according to race/ethnicity, SES or other factors. Greater retention of the intervention group may reflect the highly-valued nature of the medical and behavior services constituting the intervention arms of the Project.
Findings challenge beliefs that low income and minority women are averse to enrolling and continuing in clinical trials or community studies.
BMC Medical Research Methodology 09/2010; 10:88. · 2.67 Impact Factor
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ABSTRACT: Perceived discrimination is associated with poor mental health and health-compromising behaviors in a range of vulnerable populations, but this link has not been assessed among pregnant women. We aimed to determine whether perceived discrimination was associated with these important targets of maternal health care among low-income pregnant women.
Face-to-face interviews were conducted in English or Spanish with 4,454 multiethnic, low-income, inner-city women at their first prenatal visit at public health centers in Philadelphia, Penn, USA, from 1999 to 2004. Perceived chronic everyday discrimination (moderate and high levels) in addition to experiences of major discrimination, depressive symptomatology (CES-D >or= 23), smoking in pregnancy (current), and recent alcohol use (12 months before pregnancy) were assessed by patients' self-report.
Moderate everyday discrimination was reported by 873 (20%) women, high everyday discrimination by 238 (5%) women, and an experience of major discrimination by 789 (18%) women. Everyday discrimination was independently associated with depressive symptomatology (moderate = prevalence ratio [PR] of 1.58, 95% CI: 1.38-1.79; high = PR of 1.82, 95% CI: 1.49-2.21); smoking (moderate = PR of 1.19, 95% CI: 1.05-1.36; high = PR of 1.41, 95% CI: 1.15-1.74); and recent alcohol use (moderate = PR of 1.23, 95% CI: 1.12-1.36). However, major discrimination was not independently associated with these outcomes.
This study demonstrated that perceived chronic everyday discrimination, but not major discrimination, was associated with depressive symptoms and health-compromising behaviors independent of potential confounders, including race and ethnicity, among pregnant low-income women.
Birth 06/2010; 37(2):90-7. · 2.18 Impact Factor
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ABSTRACT: OBJECTIVES: Despite the promotion of breastfeeding as the "ideal" infant feeding method by health experts, breastfeeding continues to be less common among low-income and minority mothers than among other women. This paper investigates how maternal socio-demographic and infant characteristics, household environment, and health behaviors are related to breastfeeding initiation and duration among low-income, inner-city mothers, with a specific focus on differences in breastfeeding behavior by race/ethnicity and nativity status. METHODS: Using data from a community-based, longitudinal study of women in Philadelphia, PA (N=1,140), we estimate logistic regression and Cox proportional hazard models to predict breastfeeding initiation and duration. RESULTS: Both foreign-born black mothers and Hispanic mothers (most of whom were foreign-born) were significantly more likely to breastfeed their infants than non-Hispanic white women, findings that were partly explained by foreign-born and Hispanic mothers' prenatal intention to breastfeed. In contrast to previous studies, we also found that native-born black women were more likely to breastfeed than non-Hispanic white women. CONCLUSION: Our findings suggest that when poor whites and African Americans are similarly situated in an inner-city context, the disparity in their behavior with respect to infant feeding is not as distinct as documented in national surveys. Breastfeeding was also more common among low-income immigrant black women than white or native-born black mothers.
Social Science Quarterly 12/2009; 90(5):1251-1271. · 0.99 Impact Factor
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ABSTRACT: OBJECTIVES: The study of neighborhood effects on health and wellbeing has regained prominence in recent years. Most authors have relied on Census data and other administrative data sources to assess neighborhood characteristics. Less commonly employed, but gaining in popularity, are measures from surveys which ask neighborhood residents about various aspects of their neighborhood environment. Such surveys are a potentially attractive alternative or augmentation to administrative data sources. METHODS: Using data from a study of neighborhood effects on pregnancy outcomes among low income, inner city women in Philadelphia, PA (N=3,988), we examined psychometric and ecometric properties of scales used to assess perceptions of crime and safety, physical disorder and social disorder, and estimated effects of individual and neighborhood level predictors on perceptions. RESULTS: The three perceived neighborhood disorder scales had high internal consistency and good neighborhood level reliability. Several individual attributes of the women predicted perceptions of neighborhood disorder controlling for neighborhood level characteristics (within census tract, fixed-effect estimates). In addition, our objective indicators of neighborhood crime, physical and social disorder were highly significant predictors of women's perceptions, explaining over 70% of the between neighborhood variation in perceptions. CONCLUSIONS: When data on objective neighborhood characteristics are unavailable the inclusion of questions about residents' perceptions of neighborhood conditions in surveys of inner city residents provides a useful alternative to characterize neighborhood conditions.
Social Science Quarterly 12/2009; 90(5):1298-1320. · 0.99 Impact Factor
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ABSTRACT: To assess associations among maternal childhood experiences and subsequent parenting attitudes and use of infant spanking (IS), and determine if attitudes mediate the association between physical abuse exposure and IS.
We performed a prospective study of women who received prenatal care at community health centers in Philadelphia, Pennsylvania. Sociodemographic characteristics, adverse childhood experiences (ACEs), attitudes toward corporal punishment (CP), and IS use were assessed via face-to-face interviews, conducted at the first prenatal care visit, 3 months postpartum, and 11 months postpartum. Bivariate and multiple logistic regression analyses were conducted.
The sample consisted of 1265 mostly black, low-income women. Nineteen percent of the participants valued CP as a means of discipline, and 14% reported IS use. Mothers exposed to childhood physical abuse and verbal hostility were more likely to report IS use than those not exposed (16% vs 10%, P = .002; 17% vs 12%, P = .02, respectively). In the adjusted analyses, maternal exposure to physical abuse, other ACEs, and valuing CP were independently associated with IS use. Attitudes that value CP did not mediate these associations.
Mothers who had childhood experiences of violence were more likely to use IS than mothers without such experiences. Intergenerational transmission of CP was evident. Mothers who had experienced physical abuse as a child, when compared to those who had not, were 1.5 times more likely to use IS. Child discipline attitudes and maternal childhood experiences should be discussed early in parenting in order to prevent IS use, particularly among at-risk mothers.
PEDIATRICS 09/2009; 124(2):e278-86. · 4.47 Impact Factor
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ABSTRACT: Based on a nationally representative sample of 8,099 Chinese drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study investigated the long-term health consequences of early-life nutritional status, sibling sex-composition, childhood socio-economic conditions, and place of birth on mortality at ages 80 and above between 1998 and 2005. Better nutritional status in childhood predicted lower mortality at ages 80 and above, net of childhood circumstances, adult socio-economic status, and health behaviours. In addition, sibling sex-composition had long-term health consequences, net of childhood and adult characteristics, such that women benefited from having grown up in families with only daughters, while men benefited from having grown up in families with both sons and daughters. Childhood socio-economic status was only marginally related to old-age mortality and this association was attenuated further by the inclusion of adult characteristics. Place of birth was not a significant predictor of old-age mortality.
Population Studies 04/2009; 63(1):7-20. · 1.08 Impact Factor
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ABSTRACT: Residential context has received increased attention as a possible contributing factor to race/ethnic and socio-economic disparities in birth outcomes in the United States. Utilising vital statistics birth record data, this study examined the association between neighbourhood deprivation and the risk of a term small-for-gestational-age (SGA) birth among non-Hispanic whites and non-Hispanic blacks in eight geographical areas. An SGA birth was defined as a newborn weighing <10th percentile of the sex- and parity-specific birthweight distribution for a given gestational week. Multi-level random intercept logistic regression models were employed and statistical tests were performed to examine whether the association between neighbourhood deprivation and SGA varied by race/ethnicity and study site. The risk of term SGA was higher among non-Hispanic blacks (range 10.8-17.5%) than non-Hispanic whites (range 5.1-9.2%) in all areas and it was higher in cities than in suburban locations. In all areas, non-Hispanic blacks lived in more deprived neighbourhoods than non-Hispanic whites. However, the adjusted associations between neighbourhood deprivation and term SGA did not vary significantly by race/ethnicity or study site. The summary fully adjusted pooled odds ratios, indicating the effect of one standard deviation increase in the deprivation score, were 1.15 [95% CI 1.08, 1.22] for non-Hispanic whites and 1.09 [95% CI 1.05, 1.14] for non-Hispanic blacks. Thus, neighbourhood deprivation was weakly associated with term SGA among both non-Hispanic whites and non-Hispanic blacks.
Paediatric and Perinatal Epidemiology 02/2009; 23(1):87-96. · 2.31 Impact Factor
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ABSTRACT: Although heterogeneity in the timing and persistence of maternal depressive symptomatology has implications for screening and treatment as well as associated maternal and child health outcomes, little is known about this variability. A prospective observational study of 1,735 low-income, multiethnic, inner-city women recruited in pregnancy from 2000 to 2002 and followed prospectively until 2004 (1 prenatal and 3 postpartum interviews) was used to determine whether distinct trajectories of depressive symptomatology can be defined from pregnancy through 2 years postpartum. Analysis was carried out through general growth mixture modeling. A model with 5 trajectory classes characterized the heterogeneity seen in the timing and magnitude of depressive symptoms among the study participants from Philadelphia, Pennsylvania. These classes included the following: 1) always or chronic depressive symptomatology (7%); 2) antepartum only (6%); 3) postpartum, which resolves after the first year postpartum (9%); 4) late, present at 25 months postpartum (7%); and 5) never having depressive symptomatology (71%). Women in these trajectory classes differed in demographic (nativity, education, race, parity) health, health behavior, and psychosocial characteristics (ambivalence about pregnancy and high objective stress). This heterogeneity should be considered in maternal depression programs. Additional research is needed to determine the association of these trajectory classes with maternal and child health outcomes.
American journal of epidemiology 12/2008; 169(1):24-32. · 5.59 Impact Factor
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ABSTRACT: Using life table measures, we compare educational differentials in all-cause mortality at ages 40 to 70 in Bulgaria to those in Finland and the United States. Specifically, we assess whether the relationship between education and mortality is modified by marital status. Although high education and being married are associated with lower mortality in all three countries, absolute educational differences tend to be smaller among married than unmarried individuals. Absolute differentials by education are largest for Bulgarian men, but in relative terms educational differences are smaller among Bulgarian men than in Finland and the U.S. Among women, Americans experience the largest education-mortality gradients in both relative and absolute terms. Our results indicate a particular need to tackle health hazards among poorly educated men in countries in transition.
Demographic Research 02/2008; 19(60):2011-2042. · 1.20 Impact Factor
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ABSTRACT: Using life table measures, we compare educational differentials in all-cause mortality at ages 40 to 70 in Bulgaria to those in Finland and the United States. Specifically, we assess whether the relationship between education and mortality is modified by marital status. Although high education and being married are associated with lower mortality in all three countries, absolute educational differences tend to be smaller among married than unmarried individuals. Absolute differentials by education are largest for Bulgarian men, but in relative terms educational differences are smaller among Bulgarian men than in Finland and the U.S. Among women, Americans experience the largest education-mortality gradients in both relative and absolute terms. Our results indicate a particular need to tackle health hazards among poorly educated men in countries in transition.
Demographic Research 02/2008; 19(10):2011-2042. · 1.20 Impact Factor
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ABSTRACT: A great deal of research has focused on factors that may contribute to the Hispanic mortality paradox in the United States. In this paper, we examine the role of the salmon bias hypothesis - the selective return of less-healthy Hispanics to their country of birth - on mortality at ages 65 and above. These analyses are based on data drawn from the Master Beneficiary Record and NUMIDENT data files of the Social Security Administration. These data provide the first direct evidence regarding the effect of salmon bias on the Hispanic mortality advantage. Although we confirm the existence of salmon bias, it is of too small a magnitude to be a primary explanation for the lower mortality of Hispanic than NH white primary social security beneficiaries. Longitudinal surveys that follow individuals in and out of the United States are needed to further explore the role of migration in the health and mortality of foreign-born US residents and factors that contribute to the Hispanic mortality paradox.
Population Research and Policy Review 02/2008; 27(5):515-530. · 0.76 Impact Factor
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ABSTRACT: Disparities in preterm birth by race and ethnic group have been demonstrated in the United States. Recent research has focused on the impact of neighborhood context on racial disparities in pregnancy outcomes. The authors utilized vital-record birth certificate data and US Census data from eight geographic areas in four states (Maryland, Michigan, North Carolina, and Pennsylvania) to examine the relation between neighborhood deprivation and preterm birth among non-Hispanic White and Black women. The years covered by the data varied by site and ranged from 1995 to 2001. Results were adjusted for maternal age and education, and specific attention was paid to racial and geographic differences in the relation between neighborhood deprivation and preterm birth. Preterm birth rates were higher for non-Hispanic Blacks (10.42-15.97%) than for non-Hispanic Whites (5.77-9.13%), and neighborhood deprivation index values varied substantially across the eight areas. A significant association was found between neighborhood deprivation and risk of preterm birth; for the first quintile of the deprivation index versus the fifth, the adjusted summary odds ratio was 1.57 (95% confidence interval: 1.41, 1.74) for non-Hispanic Whites and 1.15 (95% confidence interval: 1.08, 1.23) for non-Hispanic Blacks. In this study, deprivation at the neighborhood level was significantly associated with increased risk of preterm birth among both non-Hispanic White women and non-Hispanic Black women.
American journal of epidemiology 02/2008; 167(2):155-63. · 5.59 Impact Factor
