Educational Degrees and Adult Mortality Risk in the United States

We present the first published estimates of U. S. adult mortality risk by detailed educational degree, including advanced postsecondary degrees. We use the 1997–2002 National Health Interview Survey (NHIS) Linked Mortality Files and Cox proportional hazards models to reveal wide graded differences in mortality by educational degree. Compared to adults who have a professional degree, those with an MA are 5 percent, those with a BA are 26 percent, those with an AA are 44 percent, those with some college are 65 percent, high school graduates are 80 percent, and those with a GED or 12 or fewer years of schooling are at least 95 percent more likely to die during the follow-up period, net of sociodemographic controls. These differentials vary by gender and cohort. Advanced educational degrees are associated not only with increased workforce skill level but with a reduced risk of death.     

Examining Associations between Health Information Seeking Behavior and Adult Education Status in the U.S.: An Analysis of the 2012 PIAAC Data

This paper presents data from the Program for the International Assessment of Adult Competencies with a focus on the interrelationships among health information seeking behavior (HISB), and health status or use of preventive health measures for U.S. adults both with and without a high school diploma. Key results of ordinal and binary logistic regression analyses indicated that, after controlling for demographic factors, (1) adults with a high school diploma use more text-based health information sources while adults without a high school diploma use more oral sources, (2) using the Internet as a source of health information is more strongly related to reporting excellent/very good health status than having a high school diploma, (3) those without a high school diploma who use the Internet report the largest increase in health status over any other health information source, and (4) for those with learning disability or vision problem, a high facility in reading English is an important predictor of whether the Internet is used as a health information source. The Internet appears to play a key role in both enhancing health status and enabling use of preventive measures for those with and without a high school diploma; although, individuals without a high school diploma who use the Internet for health information derive substantial benefit in health status.     

Demographic determinants of participation in strength training activities among U.S. adults

This study used a health services approach to examine the demographic correlates of participation in strength training activities among U.S. adults. The purpose of this study was to develop a profile of adults who participate in strength training activities and analyze the demographic factors that predict strength training participation. The study was a secondary data analysis employing a nonexperimental correlational design. Subjects for the study were derived from the data source, the 2003 National Health Interview Survey, a multistage probability survey that produced a U.S. representative sample of 29,783 adults capable of participating in strength training. The prevalence of strength training participation among adults was calculated, and a logistic regression equation was used to develop a multivariate model of factors that influence participation. Twenty-one percent of adults participated in strength training activities on at least 2 days of the week. In the regression, participation was associated with age, sex, ethnicity, marital status, level of education, and census region. The likelihood of participating in regular strength training activities was lower among older adults and women but higher with increasing levels of education and with participation in other aerobic type exercise. Strength training professionals should employ public health methodologies to promote continuation of this type of activity among those who were shown to participate regularly and to improve participation among those subgroups with lower levels of activity.     

Association Between Lifting Weights and Metabolic Syndrome among U.S. Adults: 1999-2004 National Health and Nutrition Examination Survey

ABSTRACT: Magyari, PM and Churilla, JR. Association between lifting weights and metabolic syndrome among U.S. adults: 1999-2004 National Health and Nutrition Examination Survey. J Strength Cond Res 26(11): 3113-3117, 2012-The purpose of this cross-sectional study was to determine the proportion of U.S. adults who participate in the resistance exercise modality of lifting weights (LWs) by demographic characteristics and to investigate the impact of LWs on the prevalence and risk of metabolic syndrome (MetS) in a national representative sample of U.S. adults. The sample (n = 5,618) in this cross-sectional study included adults aged ≥20 years who participated in the 1999-2004 National Health and Nutrition Examination Survey. Approximately twice as many men (11.2%; 95% confidence interval [CI] 9.5, 13.1) reported LWs as women did (6.3%; 95% CI 5.2, 7.6) with non-Hispanic Whites (9.6%; 95% CI 8.1, 11.4) reporting the highest levels and Mexican Americans reporting the lowest levels (5.6%; 95% CI 4.4, 7.2) of engaging in LWs. Additionally, higher levels of socioeconomic status were associated with greater levels of self-reported LWs. MetS prevalence was found to be significantly lower among U.S. adults reporting LWs (24.6%; 95% CI 19.3, 30.9) compared with adults not reporting LWs (37.3%; 95% CI 35.5, 39.2) with associated risk reductions of 58% (p < 0.001) and 37% (p < 0.01) in the unadjusted model and model adjusted for demographic variables, respectively. These findings suggest that LWs may play a role in reducing the prevalence and risk of MetS among U.S. adults. Therefore, exercise professionals should strongly encourage the activity of LWs among adults of all ages to promote metabolic health and focus programs designed to increase the adoption of LWs among the subgroups who report the lowest levels of LWs.     

Widening of socioeconomic inequalities in U.S. death rates, 1993-2001

Background

Socioeconomic inequalities in death rates from all causes combined widened from 1960 until 1990 in the U.S., largely because cardiovascular death rates decreased more slowly in lower than in higher socioeconomic groups. However, no studies have examined trends in inequalities using recent US national data.

Methodology/Principal Findings

We calculated annual age-standardized death rates from 1993–2001 for 25–64 year old non-Hispanic whites and blacks by level of education for all causes and for the seven most common causes of death using death certificate information from 43 states and Washington, D.C. Regression analysis was used to estimate annual percent change. The inequalities in all cause death rates between Americans with less than high school education and college graduates increased rapidly from 1993 to 2001 due to both significant decreases in mortality from all causes, heart disease, cancer, stroke, and other conditions in the most educated and lack of change or increases among the least educated. For white women, the all cause death rate increased significantly by 3.2 percent per year in the least educated and by 0.7 percent per year in high school graduates. The rate ratio (RR) comparing the least versus most educated increased from 2.9 (95% CI, 2.8–3.1) in 1993 to 4.4 (4.1–4.6) in 2001 among white men, from 2.1 (1.8–2.5) to 3.4 (2.9–3–9) in black men, and from 2.6 (2.4–2.7) to 3.8 (3.6–4.0) in white women.

Conclusion

Socioeconomic inequalities in mortality are increasing rapidly due to continued progress by educated white and black men and white women, and stable or worsening trends among the least educated.     

Requirements of British universities for higher medical degrees.

OBJECTIVE--To examine the requirements and opportunities for obtaining a doctor of medicine or master of surgery degree from a university in the United Kingdom other than the graduate''s own, particularly in the case of foreign graduates. DESIGN--Review of regulations governing the award of doctor of medicine and master of surgery degrees in British universities. SETTING--All 19 universities in the United Kingdom offering clinical courses. MAIN OUTCOME MEASURE--Availability of degrees to graduates of other universities. RESULTS--Opportunities for obtaining a degree differed widely among the medical schools, one university (Edinburgh) not admitting graduates of other universities in any circumstance. Of the remaining universities, none would consider a graduate who had not worked in the area where the medical school was located. CONCLUSION--The wide differences in opportunity among the medical schools may put some foreign graduates at a disadvantage compared with other graduates. This problem may become more severe as the number of graduates from the European Community who settle in Britain increases.     

Trends in the Educational Gradient of U.S. Adult Mortality from 1986 to 2006 by Race, Gender, and Age Group

The educational gradient of U.S. adult mortality became steeper between 1960 and the mid 1980s, but whether it continued to steepen is less clear given a dearth of attention to these trends since that time. This study provides new evidence on trends in the education-mortality gradient from 1986 to 2006 by race, gender, and age among non-Hispanic whites and blacks using data from the 2010 release of the National Health Interview Survey Linked Mortality File. Results show that, for white and black men, the gradient steepened among older ages because declines in mortality risk across education levels were greater among the higher educated. The gradient steepened among white women, and to a much lesser and only marginally significant extent among black women, largely because mortality risk decreased among the college-educated but increased among women with less than a high school degree. Greater returns to higher education and compositional changes within educational strata likely contributed to the trends.     

Stunting,IQ, and final school attainment in the Cebu Longitudinal Health and Nutrition Survey birth cohort

School attainment is an important aspect of human capital, and a key determinant of long-term health and well-being. Early life deprivation and poor nutritional status are well known predictors of school entry and progression. We examine the persistence of early life influences and subsequent socioeconomic disadvantage (SED) across the multiple school continuation decisions that lead to final school attainment. Using data from a Philippine birth cohort followed for 35 years, we model 6 continuation decisions: Did not complete elementary school, elementary graduate only (completed grade 6), some secondary schooling, high school graduate, some postsecondary schooling, and college graduate, as well as total years of schooling. We estimate the association of school attainment with early life length for age Z-score (LAZ at 2 years of age) and cognitive development (IQ) as well as underlying indicators of SED and other family influences through early adulthood. The analysis sample includes >1900 participants in the Cebu Longitudinal Health and Nutrition Survey. Females completed, on average, one year more schooling than males, and twice as many females as males were college graduates (29.1 vs 15.0 %). LAZ and one standard deviation of IQ were each independently associated with 0.4 more years of attained schooling. A path model demonstrated strong direct associations of SED with years of schooling as well as indirect associations through LAZ and IQ. Sequential logits used to estimate continuing education decisions show persistent associations of early life LAZ and IQ and schooling even after accounting for changing SED of households over the schooling life course. Filipino parents had high but often unmet educational aspirations for their children because of the child’s loss of interest in school and perceived financial barriers. Results further emphasize the importance of early life SED as a key risk factor for suboptimal school attainment.     

"Tobacco has a purpose, not just a past": Feasibility of developing a culturally appropriate smoking cessation program for a pan-tribal native population

Tobacco has long held spiritual significance to Native people of North America but, because of recreational use, it has become a health risk relatively recently. More Native people smoke than any other ethnic group (41 percent vs. 24 percent in whites and blacks), and death rates caused by tobacco-related diseases are disproportionately high. However, no tested, culturally tailored smoking cessation programs exist for this group. We used a critical-interpretive framework to understand the meaning of tobacco and the feasibility of smoking cessation interventions in a pan-tribal population. In June 2004, the University of Kansas Medical Center (KUMC) and the Oklahoma Area Indian Health Service (IHS) collaborated on six focus groups with (IHS) patients. The patients served represent over 200 different nations. Our participants provided us with modifications to a currently untested program designed by the Muscogee Nation of Oklahoma's Tobacco Prevention Program to enhance cultural appropriateness, including (1) an emphasis on visual presentation and a "Native" look to program educational materials; (2) comprehensive information about tobacco, quitting, and coping among Native people; (3) an acknowledgment and incorporation of traditional tobacco use and its diversity; and (4) the use of talking circles and counseling with Native facilitators.     

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya,South Africa,Tanzania and Zimbabwe

Background

The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria.

Methods and Findings

A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC.

Conclusions

Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention.     

Health care rationing: the public's debate.

OBJECTIVE--To elicit the views of a large nationally representative sample of adults on priorities for health services. DESIGN--An interview survey based on a random sample of people aged 16 and over in Great Britain taken by the Office of Population Censuses and Surveys. SUBJECTS--The response rate to the survey was 75%, and the total number of adults interviewed was 2005. MAIN OUTCOME MEASURES--A priority ranking exercise of health services supplemented with attitude questions about priorities, who should set priorities, and budget allocation. RESULTS--The results of the main priority ranking exercise of 12 health services showed that the highest priority (rank 1) was accorded to "treatments for children with life threatening illness," the next highest priority (rank 2) was accorded to "special care and pain relief for people who are dying." The lowest priorities (11 and 12) were given to "treatment for infertility" and "treatment for people aged 75 and over with life threatening illness." Most respondents thought that surveys like this one should be used in the planning of health services. CONCLUSIONS--The public prioritise treatments specifically for younger rather than older people. There is some public support for people with self inflicted conditions (for example, through tobacco smoking) receiving lower priority for care, which raises ethical issues.     

Trends and weekly and seasonal cycles in the rate of errors in the clinical management of hospitalized patients

Studies on the rate of adverse events in hospitalized patients seldom examine temporal patterns. This study presents evidence of both weekly and annual cycles. The study is based on a large and diverse data set, with nearly 5 yrs of data from a voluntary staff-incident reporting system of a large public health care provider in rural southeastern Australia. The data of 63 health care facilities were included, ranging from large non-metropolitan hospitals to small community and aged health care facilities. Poisson regression incorporating an observation-driven autoregressive effect using the GLARMA framework was used to explain daily error counts with respect to long-term trend and weekly and annual effects, with procedural volume as an offset. The annual pattern was modeled using a first-order sinusoidal effect. The rate of errors reported demonstrated an increasing annual trend of 13.4% (95% confidence interval [CI] 10.6% to 16.3%); however, this trend was only significant for errors of minor or no harm to the patient. A strong "weekend effect" was observed. The incident rate ratio for the weekend versus weekdays was 2.74 (95% CI 2.55 to 2.93). The weekly pattern was consistent for incidents of all levels of severity, but it was more pronounced for less severe incidents. There was an annual cycle in the rate of incidents, the number of incidents peaking in October, on the 282 nd day of the year (spring in Australia), with an incident rate ratio 1.09 (95% CI 1.05 to 1.14) compared to the annual mean. There was no so-called "killing season" or "July effect," as the peak in incident rate was not related to the commencement of work by new medical school graduates. The major finding of this study is the rate of adverse events is greater on weekends and during spring. The annual pattern appears to be unrelated to the commencement of new graduates and potentially results from seasonal variation in the case mix of patients or the health of the medical workforce that alters health care performance. These mechanisms will need to be elucidated with further research.     

No effect of blood sampling or phytohaemagglutinin injection on postfledging survival in a wild songbird

The injection of phytohaemagglutinin (PHA) and sampling of blood are widely used in studies of wild vertebrates to assess components of immune and endocrine function and health state and to obtain genetic material. Despite the pervasive use of these techniques in the life sciences, their potential effects on survival are rarely considered. For example, whether injection of the immunogen PHA into body parts critical for locomotion (e.g., the prepatagium, or wing web, in birds) affects survival has not been tested. Here, we test whether injection of PHA into the wing web and blood sampling from nestling house wrens affects their subsequent recruitment and survival as breeding adults. Capture‐mark‐recapture analysis on a large sample of young (N = 20,152 fledglings from 3959 broods) treated over 10 years revealed that neither PHA injection nor blood sampling affected individual survival and detection probability. Recruitment as a breeder varied among years, but this variation was not attributable to sampling effort, or the percent of all adults identified at the nest during a given year. Variation in the percent of adults identified was primarily attributable to the effect of nest depredation on our ability to capture nesting pairs. Our results indicating lack of an effect of blood sampling and immune stimulation on survival are encouraging, but we recommend further work to assess the potential negative effects of all commonly used techniques on the survival of study subjects in the wild, including the potential costs associated with mounting various immunological responses.     

Health diary study of Japanese residents in Greater Boston: Variables related to high incidence of health problems

This study was conducted to assess the impact of migration on the incidence of illness episodes and health care seeking behavior among Japanese residents in Greater Boston. Subjects were instructed to keep diaries about illnesses experienced and visits to physicians. A total of 62 problems (0.77 per person) occurred over a four-week period with only 9 problems (15 percent) receiving medical consultation. Residents who were in the U.S. for less than one year had the highest rate of perceived stress and the highest incidence of health problems. The number of people available for support to an individual did not correlate with the occurrence of health problems. Surprisingly no emotional or psychological problems were recorded in the diary in spite of explicit encouragement to note such problems. An increased occasion of family get-togethers compared to that in Japan was perceived as stressful by men, but not by women. This contrasts with the perception of children's educational issues as stressful exclusively by women.     

School racial segregation and long-term cardiovascular health among Black adults in the US: A quasi-experimental study

BackgroundCardiovascular disease (CVD) disproportionately affects Black adults in the United States. This is increasingly acknowledged to be due to inequitable distribution of health-promoting resources. One potential contributor is inequities in educational opportunities, although it is unclear what aspects of education are most salient. School racial segregation may affect cardiovascular health by increasing stress, constraining socioeconomic opportunities, and altering health behaviors. We investigated the association between school segregation and Black adults’ CVD risk.Methods and findingsWe leveraged a natural experiment created by quasi-random (i.e., arbitrary) timing of local court decisions since 1991 that released school districts from court-ordered desegregation. We used the Panel Study of Income Dynamics (PSID) (1991 to 2017), linked with district-level school segregation measures and desegregation court order status. The sample included 1,053 Black participants who ever resided in school districts that were under a court desegregation order in 1991. The exposure was mean school segregation during observed schooling years. Outcomes included several adult CVD risk factors and outcomes. We fitted standard ordinary least squares (OLS) multivariable linear regression models, then conducted instrumental variables (IV) analysis, using the proportion of schooling years spent in districts that had been released from court-ordered desegregation as an instrument. We adjusted for individual- and district-level preexposure confounders, birth year, and state fixed effects. In standard linear models, school segregation was associated with a lower probability of good self-rated health (−0.05 percentage points per SD of the segregation index; 95% CI: −0.08, −0.03; p < 0.001) and a higher probability of binge drinking (0.04 percentage points; 95% CI: 0.002, 0.07; p = 0.04) and heart disease (0.01 percentage points; 95% CI: 0.002, 0.15; p = 0.007). IV analyses also found that school segregation was associated with a lower probability of good self-rated health (−0.09 percentage points; 95% CI: −0.17, −0.02, p = 0.02) and a higher probability of binge drinking (0.17 percentage points; 95% CI: 0.04, 0.30, p = 0.008). For IV estimates, only binge drinking was robust to adjustments for multiple hypothesis testing. Limitations included self-reported outcomes and potential residual confounding and exposure misclassification.ConclusionsSchool segregation exposure in childhood may have longstanding impacts on Black adults’ cardiovascular health. Future research should replicate these analyses in larger samples and explore potential mechanisms. Given the recent rise in school segregation, this study has implications for policies and programs to address racial inequities in CVD.

Min Hee Kim and colleagues investigate the association between exposure to school racial segregation in childhood and long-term cardiovascular health among Black adults in the United States.     

Extending lactational amenorrhoea in Manila: a successful breast-feeding education programme.

An experimental breast-feeding education programme conducted at the Philippine General Hospital in Manila demonstrated that women could be motivated to improve their breast-feeding practices and lengthen their period of lactational amenorrhoea in comparison to a control group. Mothers who participated in the programme breast-fed their babies more frequently, delayed the introduction of regular supplements, used fewer bottles and pacifiers and maintained night feeding longer than mothers who were not exposed to the positive breast-feeding messages. The programme was successful in lengthening the period of amenorrhoea among women with elementary, high school, or technical school education, but not among college-educated women. Different educational approaches may be necessary for women of different education levels.     

Risk profiles and preventive measures of falls in elderly persons

Falls in elderly persons are an important health problem. The results of the Longitudinal Aging Study Amsterdam show that thirty percent of older adults over the age of 65 years who live in the community (n = 1285) fall at least once a year. Recurrent falls were reported by about 11% of the participants. In one-year of follow-up, 22 fractures were recorded. In the 'single fall' group 11 subjects (3.9%) suffered from a fracture and in the 'recurrent fall' group 9 subjects (6.1%). The strongest predictors identified in the risk profile for recurrent falls were previous falls, urinary incontinence, visual impairment and functional limitations (Area Under Curve, 0.71). The probability of recurrent falls for subsequent scores of the screening test ranged from 4.7% (95% CI, 4.0-5.4%) to 46.8% (95% CI, 43.0-50.6%). Risk profiles are needed to identify people at high risk. For matters of feasibility and efficiency, preventive measures of falls should preferably be focussed on those subgroups that have the highest risk of falls.     

The shapin of psychiatry by science and humanism. II. An emerging synthesis of science and humanism.

Serological surveys of rubella antibody were carried out using the hemagglutination-inhibition test, with a view to studying the distribution of seroimmune individuals according to age and intermingling with other populations. Specimens were collected from different age groups including infants, children and adults, among the inhabitants of Montreal from 1963 to 1968. From the results obtained it was possible to establish the pattern of rubella antibody development in this urban community. Surveys were also conducted among the inhabitants of Les Iles de la Madeleine, a Canadian island in the Gulf of St. Lawrence, and among the population of Easter Island, an isolated island in the South Pacific remote from any large land mass.It was seen that, among the inhabitants of Montreal, presumably maternally acquired rubella antibody was present in 95% or more of the infants, the same percentage of seroimmune individuals as was found among the adult women 25 to 30 years of age. Passively acquired rubella antibodies decreased rapidly, attaining their lowest levels among children 1 to 2 years old. Rubella infection occurred in young children and its incidence rose steeply from school age to adolescence, leaving 7 to 9% of the adults without antibody. The highest geometric mean antibody titres were found among children 4 to 10 years of age.The same pattern of rubella antibody development was found among the population of Les Iles de la Madeleine, except that in adults the percentages of seropositives reached practically 100%. Antibody titres decreased with advancing age and became lower than those found among children.Detection of rubella antibody in serum samples derived from the inhabitants of Easter Island indicated that this population had experienced rubella infection not long before the Canadian Medical Expedition of 1964-1965. This status is determined from the high proportion of seroimmune individuals in each age group and the uniformly high antibody titre.Island populations appear to represent the ideal subjects for estimating the duration of the immunity conferred by any attenuated rubella vaccine that will eventually be licensed.     

Inequality in Disability in Bangladesh

Objective

To investigate inequality in disability in Bangladesh.

Methods

The study used both household level and individual level data from a large nationally representative data set, Bangladesh’s Household Income and Expenditure Survey - 2010. Principal component analysis was used to construct a wealth index based on household assets from household level data. Then, using data from 49,809 individuals aged 5 years and over, chi-square tests and logistic regression were performed to test the association between wealth level and disability.

Findings

Women and older people are significantly more likely to report having disabilities than men and younger people. For middle and rich families, respectively, there is a 14 percent lower likelihood of reporting disabilities than for poor families. Changes in the probability of having disabilities are linear with increasing wealth. In addition, the study identifies some significant factors affecting disability, namely, age, sex, education, marital status, and place of residence including divisional differences.

Conclusion

In Bangladesh, worse health among the poor argues for policies prioritizing this group while at the same time giving special attention to women and the elderly.     

Effects of drought on child health in Marsabit District,Northern Kenya

This study uses five years of panel data (2009–2013) for Northern Kenya’s Marsabit district to analyze the levels and extent of malnutrition among children aged five and under in that area. We measure drought based on the standardized normalized difference vegetation index (NDVI) and assess its effect on child health using mid-upper arm circumference (MUAC). The results show that approximately 20 percent of the children in the study area are malnourished and a one standard deviation increase in NDVI z-score decreases the probability of child malnourishment by 12–16 percent. These findings suggest that remote sensing data can be usefully applied to develop and evaluate new interventions to reduce drought effects on child malnutrition, including better coping strategies and improved targeting of food aid.