Introduction: Educational attainment is a well-established social determinant of health. It affec... more Introduction: Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. However, what is it, specifically, about education that affects health? A literature on the relationship between the educational experience and health outcomes is beginning to emerge, and suggests that school quality may be associated with a wide array of health outcomes, including self-reported health, health behaviors, obesity, and mortality. Methods: In a sample of 400 diverse community-dwelling older adults in California who were surveyed about their childhood socioeconomic experience and current health outcomes, we used multivariable regression to elucidate the associations between several measures of the educational experience (school quality, discrimination at school, school racial/ethnic and socioeconomic charact...
The articles in this special issue make it clear that there are interesting and policy-relevant r... more The articles in this special issue make it clear that there are interesting and policy-relevant research to identify place-based strategies to improve health and reduce health disparities among older adults. The articles also reveal important areas of future research and policy innovation that are needed related to place and aging.
Epidemiologic perspectives & innovations : EP+I, Jan 25, 2005
This article accompanies Len Syme's "Historical Perspective: The social determinants of ... more This article accompanies Len Syme's "Historical Perspective: The social determinants of disease--some roots of the movement." It describes some of Len's role in the development of social epidemiology through mentoring investigators and influencing training programs. It also discusses some challenges for the field and ways to move forward.
... DELIVERY TO THE UNCOORDINATED USER Dominic Coppolo MBA* Jolyon Mitchell PhD Kimberly Wiersema... more ... DELIVERY TO THE UNCOORDINATED USER Dominic Coppolo MBA* Jolyon Mitchell PhD Kimberly Wiersema BA Cathy Dolyle BSc Mark Nagel BSc ... heart rate or QTc-F. Mean % changes in FEV1 one hour post-first dose were 18.1% and 16.3% for LEV and RAC, respectively ...
Background: In 2010, over half of U.S. private sector occupational injuries and illnesses resulte... more Background: In 2010, over half of U.S. private sector occupational injuries and illnesses resulted in lost time, job transfer, or work restrictions. The purpose of this study is to assess the economic, social, and psychological effects on the family members of individuals who suffered a work-related injury. Methods: Telephone survey data were collected from a convenience sample of 34 family members of injured workers from a municipal occupational health clinic. Instruments included the SF-12, Center for Epidemiologic Studies Depression Scale (CES-D), Stanford Presenteeism Scale (SPS), and the Perceived Stress Scale (PSS). Results: Of the 34 participants, the majority were women (71%), non-white (77%), high school graduates (88%), employed (56%), and spouses/partners of workers (68%). Less than half (43%) took unpaid time off and 5% utilized the Family Medical Leave Act (FMLA). Family members reported they spent more money (33%), paid more for medical expenses (22%), experienced decr...
Introduction: Educational attainment is a well-established social determinant of health. It affec... more Introduction: Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. However, what is it, specifically, about education that affects health? A literature on the relationship between the educational experience and health outcomes is beginning to emerge, and suggests that school quality may be associated with a wide array of health outcomes, including self-reported health, health behaviors, obesity, and mortality. Methods: In a sample of 400 diverse community-dwelling older adults in California who were surveyed about their childhood socioeconomic experience and current health outcomes, we used multivariable regression to elucidate the associations between several measures of the educational experience (school quality, discrimination at school, school racial/ethnic and socioeconomic charact...
Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is c... more Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is critical to optimal aging. We present a new conceptual framework for mobility among community-dwelling older adults to help promote an integrated perspective and multidisciplinary research and practice response. Concept mapping engages stakeholders in identifying and organizing ideas on a relevant topic using multi-dimensional scaling and cluster analysis to create visual maps of relationships among ideas. In the first phase, a steering committee composed of members from CDC's Healthy Aging Research Network, along with other national partners, generated the specific focus prompt, One specific action that can lead to positive change in mobility for older adults in the U.S. is More than 200 stakeholders, representing diverse perspectives and disciplines, were asked to generate ideas in response to the prompt. In the second phase, 211 stakeholders rated the items along two dimensions (re...
A limited amount of health care data on Asian Americans and Pacific Islanders (AAPIs) currently e... more A limited amount of health care data on Asian Americans and Pacific Islanders (AAPIs) currently exists, and studies examining medically underserved health service areas for AAPIs remain non-existent. To support the expansion of primary care services among medically underserved AAPIs, the Medically Underserved AAPI Communities (MUAC) project developed an index based on four key indicators (population, poverty, limited English proficiency (LEP), and physician to patient ratio) that affect AAPI health. We utilized the Geographic Information Systems (GIS) approach to identify medically underserved AAPI areas by county across the nation. This prior study identified major county-level gaps between our MUAC index and the federal medically underserved area designations. This work suggested the need for further examination of existing service areas, whether they adequately target AAPIs, and areas of growth required to meet higher need. This current study expands upon this prior work and prov...
Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/e... more Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them. We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs. We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least ...
Racial discrimination has been conceptualized as a biopsychosocial stressor that significantly in... more Racial discrimination has been conceptualized as a biopsychosocial stressor that significantly increases African American men's risk for depression. Few studies have examined socio-contextual modifiers of the racial discrimination-depression relationship among this group. Neighborhood social cohesion is a socio-contextual factor shown to modify the effects of stress on mental health. The current study examines the stress-buffering role of neighborhood social cohesion on the relationship between racial discrimination, and depressive symptoms in a sample of 230 community-residing African American men (aged 18-78; M = 34 years) recruited from barbershops in the Midwest and Southeast regions of the United States in 2007 and 2008. The response rates were 85%. Participants completed measures assessing demographic factors, daily experiences with racism, and neighborhood social cohesion. We used the 12-item Center for Epidemiologic Studies Depression Scale to assess depressive symptoms....
Pediatric Allergy, Immunology, and Pulmonology, 2015
Introduction: Asthma is a common condition affecting many children in child-care centers. The Nat... more Introduction: Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. Methods: The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. Results: The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. Discussion: The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers.
Neighborhood social and built environments have been recognized as important contexts in which he... more Neighborhood social and built environments have been recognized as important contexts in which health is shaped. The authors reviewed the extent to which these neighborhood factors have been addressed in population-level cancer research by scanning the literature for research focused on specific social and/or built environment characteristics and their association with outcomes across the cancer continuum, including incidence, diagnosis, treatment, survivorship, and survival. The commonalities and differences in methodologies across studies, the current challenges in research methodology, and future directions in this research also were addressed. The assessment of social and built environment factors in relation to cancer is a relatively new field, with 82% of the 34 reviewed articles published since 2010. Across the wide range of social and built environment exposures and cancer outcomes considered by the studies, numerous associations were reported. However, the directions and ma...
Journal of applied gerontology : the official journal of the Southern Gerontological Society, Jan 16, 2014
Few studies have examined the health-related consequences of gardening among older adults. This s... more Few studies have examined the health-related consequences of gardening among older adults. This scoping review summarizes and characterizes current research that examines the relationship between physical health and participation in planned gardening activities, including establishing, maintaining, or caring for plants. Six databases were searched. Eligible studies were published between 2000 and 2013, were published in English, and assessed different aspects of physical health (e.g., functional ability, energy expenditure, injury) for older adults who had participated in a planned gardening activity. Of the eight eligible studies identified with these criteria, four assessed energy expenditures and four assessed physical functioning. Studies assessing energy expenditures documented that the majority of gardening tasks were classified into low-to-moderate intensity physical activity. The current literature does not provide sufficient evidence of the physical functioning consequences...
We examined the association of neighborhood social and physical characteristics with ADHD, accoun... more We examined the association of neighborhood social and physical characteristics with ADHD, accounting for individual and family factors. The 2007 National Survey of Child Health, a nationally representative data set, was used (N = 64,076). Three neighborhood scales were generated: social support, amenities, and disorder. Logistic and ordinal logistic regressions were conducted to examine the association of these scales with ADHD diagnosis and severity while adjusting for individual and family characteristics. Eight percent had a child with ADHD: 47% described as mild, 40% moderate, and 13% severe. In adjusted models, lower neighborhood support was associated with increased ADHD diagnosis (odds ratio [OR] = 1.66 [1.05, 2.63]) and severity (OR = 3.74 [1.71, 8.15]); neighborhood amenities or disorder were not significantly associated. Poor parental mental health was associated with ADHD prevalence and severity. Neighborhood social support is a potential area of intervention for childre...
Typical measures of childhood socioeconomic status (SES), such as father's occupation, have l... more Typical measures of childhood socioeconomic status (SES), such as father's occupation, have limited the ability to elucidate mechanisms by which childhood SES affects adult health. Mechanisms could include schooling experiences or work opportunities. Having previously used qualitative methods for concept development, we developed new retrospective measures of multiple domains of childhood social and economic circumstances in ethnically diverse older adults. We administered the new measures in a large sample and explored their association with adult SES. We used a cross-sectional survey design with a community sample. The San Francisco Bay Area in California. 400 community-dwelling adults from diverse racial/ethnic backgrounds (Whites, African Americans, Latinos and Asians/Pacific Islanders) aged 55 and older (mean=67 years); 61% were women. We measured attitudes towards schooling, extracurricular activities and adult encouragement and discouragement during the childhood/teen yea...
Successful aging takes on an array of attributes, including optimal health and community particip... more Successful aging takes on an array of attributes, including optimal health and community participation. Research indicates that (1) persons with disabilities, including age-related disabilities, report frequent barriers to community participation, including unsuitable building design (43%), transportation (32%), and sidewalks/curbs (31%), and (2) many seniors report an inability to cross roads safely near their homes. This paper attempts to define mobility-related elements that contribute to optimal health and quality of life, within the context of successful aging. It then examines the impacts of community design on individual mobility, delving into which traditional and nontraditional actors-including architects, urban planners, transportation engineers, occupational therapists, and housing authorities-play critical roles in ensuring that community environments serve as facilitators (rather than barriers) to mobility. As America ages, mobility challenges for seniors will only incr...
Introduction: Educational attainment is a well-established social determinant of health. It affec... more Introduction: Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. However, what is it, specifically, about education that affects health? A literature on the relationship between the educational experience and health outcomes is beginning to emerge, and suggests that school quality may be associated with a wide array of health outcomes, including self-reported health, health behaviors, obesity, and mortality. Methods: In a sample of 400 diverse community-dwelling older adults in California who were surveyed about their childhood socioeconomic experience and current health outcomes, we used multivariable regression to elucidate the associations between several measures of the educational experience (school quality, discrimination at school, school racial/ethnic and socioeconomic charact...
The articles in this special issue make it clear that there are interesting and policy-relevant r... more The articles in this special issue make it clear that there are interesting and policy-relevant research to identify place-based strategies to improve health and reduce health disparities among older adults. The articles also reveal important areas of future research and policy innovation that are needed related to place and aging.
Epidemiologic perspectives & innovations : EP+I, Jan 25, 2005
This article accompanies Len Syme's "Historical Perspective: The social determinants of ... more This article accompanies Len Syme's "Historical Perspective: The social determinants of disease--some roots of the movement." It describes some of Len's role in the development of social epidemiology through mentoring investigators and influencing training programs. It also discusses some challenges for the field and ways to move forward.
... DELIVERY TO THE UNCOORDINATED USER Dominic Coppolo MBA* Jolyon Mitchell PhD Kimberly Wiersema... more ... DELIVERY TO THE UNCOORDINATED USER Dominic Coppolo MBA* Jolyon Mitchell PhD Kimberly Wiersema BA Cathy Dolyle BSc Mark Nagel BSc ... heart rate or QTc-F. Mean % changes in FEV1 one hour post-first dose were 18.1% and 16.3% for LEV and RAC, respectively ...
Background: In 2010, over half of U.S. private sector occupational injuries and illnesses resulte... more Background: In 2010, over half of U.S. private sector occupational injuries and illnesses resulted in lost time, job transfer, or work restrictions. The purpose of this study is to assess the economic, social, and psychological effects on the family members of individuals who suffered a work-related injury. Methods: Telephone survey data were collected from a convenience sample of 34 family members of injured workers from a municipal occupational health clinic. Instruments included the SF-12, Center for Epidemiologic Studies Depression Scale (CES-D), Stanford Presenteeism Scale (SPS), and the Perceived Stress Scale (PSS). Results: Of the 34 participants, the majority were women (71%), non-white (77%), high school graduates (88%), employed (56%), and spouses/partners of workers (68%). Less than half (43%) took unpaid time off and 5% utilized the Family Medical Leave Act (FMLA). Family members reported they spent more money (33%), paid more for medical expenses (22%), experienced decr...
Introduction: Educational attainment is a well-established social determinant of health. It affec... more Introduction: Educational attainment is a well-established social determinant of health. It affects health through many mechanisms such as neural development, biological aging, health literacy and health behaviors, sense of control and empowerment, and life chances. However, what is it, specifically, about education that affects health? A literature on the relationship between the educational experience and health outcomes is beginning to emerge, and suggests that school quality may be associated with a wide array of health outcomes, including self-reported health, health behaviors, obesity, and mortality. Methods: In a sample of 400 diverse community-dwelling older adults in California who were surveyed about their childhood socioeconomic experience and current health outcomes, we used multivariable regression to elucidate the associations between several measures of the educational experience (school quality, discrimination at school, school racial/ethnic and socioeconomic charact...
Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is c... more Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is critical to optimal aging. We present a new conceptual framework for mobility among community-dwelling older adults to help promote an integrated perspective and multidisciplinary research and practice response. Concept mapping engages stakeholders in identifying and organizing ideas on a relevant topic using multi-dimensional scaling and cluster analysis to create visual maps of relationships among ideas. In the first phase, a steering committee composed of members from CDC's Healthy Aging Research Network, along with other national partners, generated the specific focus prompt, One specific action that can lead to positive change in mobility for older adults in the U.S. is More than 200 stakeholders, representing diverse perspectives and disciplines, were asked to generate ideas in response to the prompt. In the second phase, 211 stakeholders rated the items along two dimensions (re...
A limited amount of health care data on Asian Americans and Pacific Islanders (AAPIs) currently e... more A limited amount of health care data on Asian Americans and Pacific Islanders (AAPIs) currently exists, and studies examining medically underserved health service areas for AAPIs remain non-existent. To support the expansion of primary care services among medically underserved AAPIs, the Medically Underserved AAPI Communities (MUAC) project developed an index based on four key indicators (population, poverty, limited English proficiency (LEP), and physician to patient ratio) that affect AAPI health. We utilized the Geographic Information Systems (GIS) approach to identify medically underserved AAPI areas by county across the nation. This prior study identified major county-level gaps between our MUAC index and the federal medically underserved area designations. This work suggested the need for further examination of existing service areas, whether they adequately target AAPIs, and areas of growth required to meet higher need. This current study expands upon this prior work and prov...
Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/e... more Asian American and Pacific Islanders (AAPIs) historically have faced multiple social and racial/ethnic health disparities in the United States. We gathered national-level health-care data on AAPIs and examined medically underserved health service areas for them. We used 2000 U.S. Census data and the Bureau of Primary Health Care (BPHC) 2004 dataset for primary care physician full-time equivalents per 1000 population, as well as AAPI population, AAPI poverty, and AAPI limited English proficiency, to develop an index of medically underserved AAPI counties (MUACs). The index identifies U.S. counties that do not adequately serve AAPIs. We identified 266 counties of medically underserved health service areas for AAPIs across the nation, representing 12% of all U.S. counties. One hundred thirty-eight (52%) MUACs were not designated as BPHC medically underserved counties. Of these counties, 20 (14%) had an AAPI population of at least 10,000, and 29 (21%) had an AAPI population of at least ...
Racial discrimination has been conceptualized as a biopsychosocial stressor that significantly in... more Racial discrimination has been conceptualized as a biopsychosocial stressor that significantly increases African American men's risk for depression. Few studies have examined socio-contextual modifiers of the racial discrimination-depression relationship among this group. Neighborhood social cohesion is a socio-contextual factor shown to modify the effects of stress on mental health. The current study examines the stress-buffering role of neighborhood social cohesion on the relationship between racial discrimination, and depressive symptoms in a sample of 230 community-residing African American men (aged 18-78; M = 34 years) recruited from barbershops in the Midwest and Southeast regions of the United States in 2007 and 2008. The response rates were 85%. Participants completed measures assessing demographic factors, daily experiences with racism, and neighborhood social cohesion. We used the 12-item Center for Epidemiologic Studies Depression Scale to assess depressive symptoms....
Pediatric Allergy, Immunology, and Pulmonology, 2015
Introduction: Asthma is a common condition affecting many children in child-care centers. The Nat... more Introduction: Asthma is a common condition affecting many children in child-care centers. The National Asthma Education and Prevention Program offers recommendations about creating an asthma-friendly child-care setting. However, no studies have investigated the extent to which child-care centers adhere to these recommendations. This study describes the development of a novel instrument to determine the ability of child-care centers to meet national recommendations for asthma. Methods: The Preparing for Asthma in Child Care (PACC) Instrument was developed using information from existing recommendations and standards, the peer-reviewed literature, site visits, and expert interviews. The survey questions were pilot-tested at 36 child-care centers throughout San Francisco. Results: The instrument is composed of 43 items across seven domains: smoking exposure, presence of a medical consultant and policies, management of ventilation and triggers, access to medication, presence of asthma action plans, staff training, and encouragement of physical activity. Discussion: The PACC Instrument is an evidence-based and comprehensive tool designed to identify areas to target to improve asthma care for children in child-care centers.
Neighborhood social and built environments have been recognized as important contexts in which he... more Neighborhood social and built environments have been recognized as important contexts in which health is shaped. The authors reviewed the extent to which these neighborhood factors have been addressed in population-level cancer research by scanning the literature for research focused on specific social and/or built environment characteristics and their association with outcomes across the cancer continuum, including incidence, diagnosis, treatment, survivorship, and survival. The commonalities and differences in methodologies across studies, the current challenges in research methodology, and future directions in this research also were addressed. The assessment of social and built environment factors in relation to cancer is a relatively new field, with 82% of the 34 reviewed articles published since 2010. Across the wide range of social and built environment exposures and cancer outcomes considered by the studies, numerous associations were reported. However, the directions and ma...
Journal of applied gerontology : the official journal of the Southern Gerontological Society, Jan 16, 2014
Few studies have examined the health-related consequences of gardening among older adults. This s... more Few studies have examined the health-related consequences of gardening among older adults. This scoping review summarizes and characterizes current research that examines the relationship between physical health and participation in planned gardening activities, including establishing, maintaining, or caring for plants. Six databases were searched. Eligible studies were published between 2000 and 2013, were published in English, and assessed different aspects of physical health (e.g., functional ability, energy expenditure, injury) for older adults who had participated in a planned gardening activity. Of the eight eligible studies identified with these criteria, four assessed energy expenditures and four assessed physical functioning. Studies assessing energy expenditures documented that the majority of gardening tasks were classified into low-to-moderate intensity physical activity. The current literature does not provide sufficient evidence of the physical functioning consequences...
We examined the association of neighborhood social and physical characteristics with ADHD, accoun... more We examined the association of neighborhood social and physical characteristics with ADHD, accounting for individual and family factors. The 2007 National Survey of Child Health, a nationally representative data set, was used (N = 64,076). Three neighborhood scales were generated: social support, amenities, and disorder. Logistic and ordinal logistic regressions were conducted to examine the association of these scales with ADHD diagnosis and severity while adjusting for individual and family characteristics. Eight percent had a child with ADHD: 47% described as mild, 40% moderate, and 13% severe. In adjusted models, lower neighborhood support was associated with increased ADHD diagnosis (odds ratio [OR] = 1.66 [1.05, 2.63]) and severity (OR = 3.74 [1.71, 8.15]); neighborhood amenities or disorder were not significantly associated. Poor parental mental health was associated with ADHD prevalence and severity. Neighborhood social support is a potential area of intervention for childre...
Typical measures of childhood socioeconomic status (SES), such as father's occupation, have l... more Typical measures of childhood socioeconomic status (SES), such as father's occupation, have limited the ability to elucidate mechanisms by which childhood SES affects adult health. Mechanisms could include schooling experiences or work opportunities. Having previously used qualitative methods for concept development, we developed new retrospective measures of multiple domains of childhood social and economic circumstances in ethnically diverse older adults. We administered the new measures in a large sample and explored their association with adult SES. We used a cross-sectional survey design with a community sample. The San Francisco Bay Area in California. 400 community-dwelling adults from diverse racial/ethnic backgrounds (Whites, African Americans, Latinos and Asians/Pacific Islanders) aged 55 and older (mean=67 years); 61% were women. We measured attitudes towards schooling, extracurricular activities and adult encouragement and discouragement during the childhood/teen yea...
Successful aging takes on an array of attributes, including optimal health and community particip... more Successful aging takes on an array of attributes, including optimal health and community participation. Research indicates that (1) persons with disabilities, including age-related disabilities, report frequent barriers to community participation, including unsuitable building design (43%), transportation (32%), and sidewalks/curbs (31%), and (2) many seniors report an inability to cross roads safely near their homes. This paper attempts to define mobility-related elements that contribute to optimal health and quality of life, within the context of successful aging. It then examines the impacts of community design on individual mobility, delving into which traditional and nontraditional actors-including architects, urban planners, transportation engineers, occupational therapists, and housing authorities-play critical roles in ensuring that community environments serve as facilitators (rather than barriers) to mobility. As America ages, mobility challenges for seniors will only incr...
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