American Journal of Preventive Medicine

Pregnancy, Birth, and Infant Outcomes Among Women Who Are Deaf or Hard of Hearing Publication date: Available online 15 January 2020 Source: American Journal of Preventive Medicine Author(s): Monika Mitra, Michael M. McKee, Ilhom Akobirshoev, Anne Valentine, Grant Ritter, Jianying Zhang, Kimberly McKee, Lisa I. Iezzoni Introduction Being deaf or hard of hearing can be marginalizing and associated with inequitable health outcomes. Until recently, there were no U.S. population-based studies of pregnancy outcomes among deaf or hard of hearing women. In light of inconsistent findings in the limited available literature, this study sought to conduct a more rigorous study using population-based, longitudinal linked data to compare pregnancy complications, birth characteristics, and neonatal outcomes between deaf or hard of hearing and non-deaf or hard of hearing women. Methods Researchers conducted a retrospective cohort study in 2019 using the Massachusetts Pregnancy to Early Life Longitudinal data system. This system links all Massachusetts birth certificates, fetal death reports, and delivery- and nondelivery-related hospital discharge records for all infants and their mothers. The study included women with singleton deliveries who gave birth in Massachusetts between January 1998 and December 2013. Results The deaf or hard of hearing women had an increased risk of chronic medical conditions and pregnancy complications including pre-existing diabetes, gestational diabetes, pre-eclampsia and eclampsia, and placental abruption. Deliveries to deaf or hard of hearing women were significantly associated with adverse birth outcomes, including preterm birth, low birth weight or very low weight, and low 1-minute Apgar score or low 5-minute Apgar score. No significant differences were found in size for gestational age, fetal distress, or stillbirth among deaf or hard of hearing women. Conclusions Findings from this 2019 study indicate that deaf or hard of hearing women are at a heightened risk for chronic conditions, pregnancy-related complications, and adverse birth outcomes and underscore the need for systematic investigation of the pregnancy- and neonatal-related risks, complications, costs, mechanisms, and outcomes of deaf or hard of hearing women.

Inequity in California's Smokefree Workplace Laws: A Legal Epidemiologic Analysis of Loophole Closures Publication date: Available online 15 January 2020 Source: American Journal of Preventive Medicine Author(s): Judith J. Prochaska, Maya Hazarika Watts, Leslie Zellers, Darlene Huang, Eric Jay Daza, Joseph Rigdon, Melissa J. Peters, Lisa Henriksen Introduction California's landmark 1994 Smokefree Workplace Act contained numerous exemptions, or loopholes, believed to contribute to inequities in smokefree air protections among low-income communities and communities of color (e.g., permitting smoking in warehouses, hotel common areas). Cities/counties were not prevented from adopting stronger laws. This study coded municipal laws and state law changes (in 2015–2016) for loophole closures and determined their effects in reducing inequities in smokefree workplace protections. Methods Public health attorneys reviewed current laws for 536 of California's 539 cities and counties from January 2017 to May 2018 and coded for 19 loophole closures identified from legislative actions (inter-rater reliability, 87%). The local policy data were linked with population demographics from intercensal estimates (2012–2016) and adult smoking prevalence (2014). The analyses were cross-sectional and conducted in February–June 2019. Results Between 1994 and 2018, jurisdictions closed 6.09 loopholes on average (SD=5.28). Urban jurisdictions closed more loopholes than rural jurisdictions (mean=6.40 vs 3.94, p<0.001), and loophole closure scores correlated positively with population size, median household income, and percentage white, non-Hispanic residents (p<0.001 for all). Population demographics and the loophole closure score explained 43% of the variance in jurisdictions’ adult smoking prevalence. State law changes in 2015–2016 increased loophole closure scores and decreased jurisdiction variation (mean=9.74, SD=3.56); closed more loopholes in rural versus urban jurisdictions (meangain=4.44 vs 3.72, p=0.002); and in less populated, less affluent jurisdictions, with greater racial/ethnic diversity, and higher smoking prevalence (p<0.001 for all). Conclusions Although jurisdictions made important progress in closing loopholes in smokefree air law, state law changes achieved greater reductions in inequities in policy coverage.

Health Risk Assessments in Michigan's Medicaid Expansion: Early Experiences in Primary Care Publication date: Available online 15 January 2020 Source: American Journal of Preventive Medicine Author(s): Eunice Zhang, Renuka Tipirneni, Erin R. Beathard, Sunghee Lee, Matthias A. Kirch, Cengiz Salman, Erica Solway, Sarah J. Clark, Adrianne N. Haggins, Edith C. Kieffer, John Z. Ayanian, Susan D. Goold Introduction Michigan is one of 3 states that have implemented health risk assessments for enrollees as a feature of its Medicaid expansion, the Healthy Michigan Plan. This study describes primary care providers’ early experiences with completing health risk assessments with enrollees and examines provider- and practice-level factors that affect health risk assessment completion. Methods All primary care providers caring for ≥12 Healthy Michigan Plan enrollees (n=4,322) were surveyed from June to November 2015, with 2,104 respondents (55.5%). Analyses in 2016–2017 described provider knowledge, attitudes, and experiences with the health risk assessment early in Healthy Michigan Plan implementation; multivariable analyses examined relationships of provider- and practice-level characteristics with health risk assessment completion, as recorded in state data. Results Of the primary care provider respondents, 73% found health risk assessments very or somewhat useful for identifying and discussing health risks, although less than half (47.2%) found them very or somewhat useful for getting patients to change health behaviors. Most primary care provider respondents (65.3%) were unaware of financial incentives for their practices to complete health risk assessments. Nearly all primary care providers had completed at least 1 health risk assessment. The mean health risk assessment completion rate (completed health risk assessments/number of Healthy Michigan Plan enrollees assigned to that primary care provider) was 19.6%; those who lacked familiarity with the health risk assessment had lower completion rates. Conclusions Early in program implementation, health risk assessment completion rates by primary care providers were low and awareness of financial incentives limited. Most primary care provider respondents perceived health risk assessments to be very or somewhat useful in identifying health risks, and about half of primary care providers viewed health risk assessments as very or somewhat useful in helping patients to change health behaviors.

The Impact of Team-Based Primary Care on Guideline-Recommended Disease Screening Publication date: Available online 15 January 2020 Source: American Journal of Preventive Medicine Author(s): Julie Fiset-Laniel, Mamadou Diop, Sylvie Provost, Erin C. Strumpf Introduction Family Medicine Groups, implemented in Quebec in 2002, are interprofessional primary care teams designed to improve timely access to high-quality primary care. This study investigates whether Family Medicine Groups increased rates of guideline-recommended screenings for 3 chronic diseases: colorectal cancer (colonoscopy/sigmoidoscopy), breast cancer (mammography), and osteoporosis (bone mineral density testing). Methods Using population-based administrative health data from the provincial insurer (2000–2010), the authors examined elderly and chronically ill patients who registered with a general practitioner in the first 15 months of the Family Medicine Group policy. Propensity score weighting and a difference-in-differences model estimated differential change in biennial screening rates among Family Medicine Group and non-Family Medicine Group patients over 5 years of follow-up (analysis, 2016–2018). Results Rates of mammography, colonoscopy/sigmoidoscopy, and bone mineral density testing increased after patient registration with a general practitioner, similarly for both Family Medicine Group and non-Family Medicine Group patients. Colonoscopy/sigmoidoscopy rates increased by 9.7% and 10.4% for Family Medicine Group and non-Family Medicine Group patients, mammography rates by 5.3% and 3.4%, and bone mineral density testing by 4.2% and 7.1%. Difference-in-differences estimates showed no detectable effect of Family Medicine Groups on disease screening rates: −0.06 percentage points (95% CI= −0.32, 0.20) for colonoscopy/sigmoidoscopy, 1.01 percentage points (95% CI= −0.25, 2.27) for mammography, and −0.32 (95% CI= −0.71, −0.07) for bone mineral density testing. Conclusions This study found no evidence that Family Medicine Groups affected screening rates for these 3 chronic diseases. Limitations in the implementation of the Family Medicine Group policy in its early years may have contributed to this lack of impact. Interprofessional primary care teams may need to include elements other than organizational changes to increase disease prevention efforts.

Lifecourse Drinking Patterns, Hypertension, and Heart Problems Among U.S. Adults Publication date: Available online 9 January 2020 Source: American Journal of Preventive Medicine Author(s): Camillia K. Lui, William C. Kerr, Libo Li, Nina Mulia, Yu Ye, Edwina Williams, Thomas K. Greenfield, E. Anne Lown Introduction Understanding the role of alcohol in hypertension and heart problems requires a lifecourse perspective accounting for drinking patterns before onset of health problems that distinguishes between lifetime abstinence and former drinking, prior versus current drinking, and overall alcohol consumption in conjunction with heavy episodic drinking. Using prospective data among U.S. adults aged 21–55 years, this study accounts for these lifecourse factors to investigate the effect of alcohol on hypertension and heart problems. Methods Data from the U.S. National Longitudinal Survey of Youth, aged 14–21 years in 1979 and followed through 2012 (n=8,289), were analyzed in 2017–18 to estimate hypertension and heart problems onset from lifecourse drinking patterns. Discrete-time survival models stratified by sex and race/ethnicity, controlling for demographics and time-varying factors of employment, smoking, and obesity. Results Elevated risks for hypertension were found for women drinking >14 drinks/week regardless of any heavy drinking (AOR=1.57, p=0.023) and for men engaged in risky drinking (15–28 drinks/week) together with monthly heavy drinking (AOR=1.64, p=0.016). Having a history of weekly heavy drinking elevated the risk for women but not for men. No significant relationship was evident for alcohol and heart problems onset. Conclusions This study confirms previous findings of increased hypertension risk from higher volume and heavier drinking patterns among women and men but did not find any support for increased heart problems risk, which may be due to the younger age profile of the sample. Further research that incorporates lifecourse drinking patterns is needed to better understand the alcohol–health relationship.

Risk of Stroke With E-Cigarette and Combustible Cigarette Use in Young Adults Publication date: Available online 7 January 2020 Source: American Journal of Preventive Medicine Author(s): Tarang Parekh, Sahithi Pemmasani, Rupak Desai Introduction Rising trends in stroke incidence and hospitalizations because of combustible cigarette smoking have been noted among younger adults. However, the association between e-cigarette use and stroke in this population remains largely unknown. This study examines the association between e-cigarette use with or without a history of previous or concurrent combustible cigarette use and stroke among young adults. Methods Pooled data (2016–2017) were analyzed from the Behavior Risk Factor Surveillance System, a nationally representative, cross-sectional telephone survey, in 2019. The sample size was 161,529 participants aged 18–44 years. The association between e-cigarette use and stroke was examined using logistic regression adjusting for patient demographics, relevant comorbidities without or with history, and concurrent use of combustible cigarette use. Results Current dual use of e-cigarettes and combustible cigarettes was associated with 2.91 times higher odds of stroke versus nonsmokers (AOR=2.91, 95% CI=1.62, 5.25) and 1.83 times higher odds versus current sole combustible cigarette users (AOR=1.83, 95% CI=1.06, 3.17). Compared with nonsmokers, current sole e-cigarette users did not show significantly different odds of stroke (AOR=0.69, 95% CI=0.34, 1.42). However, odds of stroke were lower for sole e-cigarette users versus current sole combustible cigarette users (AOR=0.43, 95% CI=0.20, 0.93). Conclusions Sole e-cigarette use is not associated with greater odds of stroke in young adults. However, if young adults have former or current combustible cigarette use, odds of stroke are significantly increased even compared with current sole combustible cigarette use. Switching from combustible cigarettes to e-cigarettes does not confer stroke benefits.

Disparities in Sugary Drink Advertising on New York City Streets Publication date: Available online 6 January 2020 Source: American Journal of Preventive Medicine Author(s): Erin A. Dowling, Calpurnyia Roberts, Tamar Adjoian, Shannon M. Farley, Rachel Dannefer Introduction Studies show that outdoor advertisements for unhealthy, consumable products are associated with increased intake and often target youth, low-income neighborhoods, and neighborhoods of color. Despite evidence that overconsumption of sugary drinks contributes to obesity and other chronic conditions, little is known specifically regarding the patterns of outdoor sugary drink advertising. Methods The number of outdoor, street-level advertisements featuring sugary drinks was assessed in a random sample of retail-dense street segments (N=953) in low, medium, and high-poverty neighborhoods in each of New York City's 5 boroughs in 2015. Negative binomial regression was used to determine associations between sugary drink ad density, poverty level, and other census tract-level demographics (2009–2013 estimates) in each borough and New York City overall. Data were analyzed in 2017–2019. Results In New York City and in 3 of 5 boroughs, sugary drink ad density was positively associated with increased percentages of black, non-Latino residents (New York City: incidence rate ratio=1.20, p<0.001; Bronx: incidence rate ratio=1.30, p=0.005; Brooklyn: incidence rate ratio=1.18, p<0.001; Manhattan: incidence rate ratio=1.20, p<0.05). Positive associations were also observed with poverty level in Brooklyn (low versus medium poverty: incidence rate ratio=2.16, p=0.09; low versus high poverty: incidence rate ratio=2.17, p=0.02) and Staten Island (low versus medium poverty: incidence rate ratio=3.27, p=0.03). Conclusions This study found a consistent positive association between the density of outdoor sugary drink advertisements and the presence of non-Latino black residents in New York City and, in some boroughs, evidence of a positive association with neighborhood poverty. These findings highlight the inequities where sugary drinks are advertised in New York City.

Association Between E-Cigarette Use and Chronic Obstructive Pulmonary Disease by Smoking Status: Behavioral Risk Factor Surveillance System 2016 and 2017 Publication date: Available online 2 January 2020 Source: American Journal of Preventive Medicine Author(s): Albert D. Osei, Mohammadhassan Mirbolouk, Olusola A. Orimoloye, Omar Dzaye, S.M. Iftekhar Uddin, Emelia J. Benjamin, Michael E. Hall, Andrew P. DeFilippis, Aruni Bhatnagar, Shyam S. Biswal, Michael J. Blaha Introduction The association between e-cigarette use and chronic bronchitis, emphysema, and chronic obstructive pulmonary disease has not been studied thoroughly, particularly in populations defined by concomitant combustible smoking status. Methods Using pooled 2016 and 2017 data from the Behavioral Risk Factor Surveillance System, investigators studied 705,159 participants with complete self-reported information on e-cigarette use, combustible cigarette use, key covariates, and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. Current e-cigarette use was the main exposure, with current use further classified as daily or occasional use. The main outcome was defined as reported ever having a diagnosis of chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. For all the analyses, multivariable adjusted logistic regression was used, with the study population stratified by combustible cigarette use status (never, former, or current). All the analyses were conducted in 2019. Results Of 705,159 participants, 25,175 (3.6%) were current e-cigarette users, 64,792 (9.2%) current combustible cigarette smokers, 207,905 (29.5%) former combustible cigarette smokers, 432,462 (61.3%) never combustible cigarette smokers, and 14,036 (2.0%) dual users of e-cigarettes and combustible cigarettes. A total of 53,702 (7.6%) participants self-reported chronic bronchitis, emphysema, or chronic obstructive pulmonary disease. Among never combustible cigarette smokers, current e-cigarette use was associated with 75% higher odds of chronic bronchitis, emphysema, or chronic obstructive pulmonary disease compared with never e-cigarette users (OR=1.75, 95% CI=1.25, 2.45), with daily users of e-cigarettes having the highest odds (OR=2.64, 95% CI=1.43, 4.89). Similar associations between e-cigarette use and chronic bronchitis, emphysema, or chronic obstructive pulmonary disease were noted among both former and current combustible cigarette smokers. Conclusions The results suggest possible e-cigarette–related pulmonary toxicity across all the categories of combustible cigarette smoking status, including those who had never smoked combustible cigarettes.

U.S. Military Veterans’ Health and Well-Being in the First Year After Service Publication date: Available online 2 January 2020 Source: American Journal of Preventive Medicine Author(s): Dawne S. Vogt, Fanita A. Tyrell, Emily A. Bramande, Yael I. Nillni, Emily C. Taverna, Erin P. Finley, Daniel F. Perkins, Laurel A. Copeland Introduction This study examined the health and well-being of U.S. veterans during the first year after military service and tested several hypotheses regarding differences in veterans’ well-being over time, across life domains, and based on sex, military rank, and deployment history. Methods A national sample of 9,566 veterans was recruited from a roster of all separating U.S. service members in the fall of 2016. Veterans’ status, functioning, and satisfaction with regard to their health, work, and social relationships were assessed within 3 months of separation and then 6 months later. Analyses were completed in 2019. Results Health concerns were most salient for newly separated veterans, with many veterans reporting that they had chronic physical (53%) or mental (33%) health conditions and were less satisfied with their health than either their work or social relationships. By contrast, most veterans reported relatively high vocational and social well-being and only work functioning demonstrated a notable decline in the first year following separation. Enlisted personnel reported consistently poorer health, vocational, and social outcomes compared with their officer counterparts, whereas war zone–deployed veterans reported more health concerns and women endorsed more mental health concerns compared with their nondeployed and male peers. Conclusions Although most newly separated veterans experience high vocational and social well-being as they reintegrate into civilian life, findings point to the need for additional attention to the health of separating service members and bolstered support for enlisted personnel to prevent the development of chronic readjustment challenges within this population.

County Smoke-Free Laws and Cigarette Smoking Among U.S. Adults, 1995–2015 Publication date: January 2020 Source: American Journal of Preventive Medicine, Volume 58, Issue 1 Author(s): Sunday Azagba, Lingpeng Shan, Keely Latham Introduction Tobacco use remains the leading cause of preventable death worldwide. Though research on smoke-free policies in the U.S. exists at the state or national level, there is limited evidence on such policies at the county level. This study examined the association between changes in county-level comprehensive smoke-free laws and smoking behavior among U.S. adults. Methods Data were used from the 1995/1996 to the 2014/2015 Tobacco Use Supplement to the Current Population Survey, analyzed in 2019. Changes in county smoke-free law population coverage over time were used as a natural experiment. Quasi-experimental analyses were performed to examine the association between changes in county-level comprehensive smoke-free laws and smoking behavior (smoking status and number of cigarettes smoked). Results During the study period, current smoking prevalence decreased from 21.6% to 11.9%. Specifically, the prevalence of every day smoking decreased from 17.1% to 9.1% and some days smoking decreased from 4.4% to 2.9%. The number of cigarettes smoked per day for every day smokers decreased from 18.5 to 13.6, and from 5.9 to 4.1 for those who smoked some days. Comprehensive smoke-free legislation was associated with lower odds of cigarette smoking (AOR=0.76, 95% CI=0.74, 0.79). Adults living in counties with comprehensive smoke-free policies smoked fewer cigarettes per day both for every day smokers (β= −1.55, p<0.0001) and some days smokers (β= −0.79, p<0.0001). Conclusions County smoke-free policies in the U.S. may have contributed significantly to the reduction in smoking prevalence as well as the reduction in the number of cigarettes smoked among continuing cigarette smokers.