Receipt Of Public Assistance Research Articles

A retrospective study of unexpected deaths with alcohol use disorder from Japanese forensic autopsy cases

BackgroundAlcohol use disorder (AUD) is an important target for prevention of alcohol-related problems. In this study, we analyzed forensic autopsy cases to reveal the characteristics of the living conditions and death situations of individuals with AUD. MethodsWe retrospectively investigated 486 cases with a history of alcohol consumption for which a forensic autopsy was performed from 2012 to 2021 in Yamaguchi prefecture. Judgement of AUD was made using DSM-5. Various factors were compared statistically between AUD and non-AUD cases. ResultsOf the 486 cases, 225 (46.2%) were judged to be AUD, including 89 (18.3%) with advanced AUD, 33 (6.8%) were judged not to be AUD, and a judgement could not be made in the remaining cases. AUD was associated with alcohol consumption prior to death. Only 14.3% of the advanced-AUD cases was in treatment for alcohol dependence. The rates of interpersonal, health, financial and legal problems, receipt of public assistance and an extremely cluttered or hoarding house status were higher in all AUD and advanced AUD cases. Living alone, smoking and BMI were also associated with AUD. ConclusionsMany cases of alcohol-related deaths may have AUD, and persons with AUD who undergo a forensic autopsy commonly have multiple socioeconomic factors that may be associated with isolation that is involved in exacerbation of AUD. Further studies of these associations are needed because early diagnosis and treatment of AUD and support for the patient may lead to reduction of alcohol-related deaths.

Outpatient visit behavior in patients with epilepsy: Generalized Epilepsy is more frequently non-attendance than Focal Epilepsy

BackgroundPatients with epilepsy (PWE), especially those with Generalized Epilepsy (GE), are at a high risk of disadvantage caused by non-adherence. It has been suggested that medical visit behavior may be a surrogate indicator of medication adherence. We hypothesized that patients with IGE would adhere poorly to visits. MethodsThis was a retrospective study of PWE who visited the Department of Psychiatry and Neurology at Hokkaido University Hospital between January 2017 and December 2019. Demographic and clinical information on PWE were extracted from medical records and visit data from the medical information system. Non-attendance of outpatient appointments was defined as “not showing up for the day of an appointment without prior notice.” Mixed-effects logistic regression analysis was conducted with non-attendance as the objective variable. ResultsOf the 9151 total appointments, 413 were non-attendances, with an overall non-attendance rate of 4.5%. IGE was a more frequent non-attendance than Focal Epilepsy (FE) (odds ratio (OR) 1.94; 95% confidence interval (CI) 1.17–3.21; p = 0.010). History of public assistance receipt was associated with higher non-attendance (OR 2.04; 95% CI 1.22–3.43; p = 0.007), while higher education (OR 0.64; 95% CI 0.43–0.93; p = 0.021) and farther distance to a hospital (OR 0.33; 95% CI 0.13–0.88; p = 0.022), and higher frequency of visits (OR 0.18; 95% CI 0.04–0.86; p = 0.031) were associated with fewer non-attendances. In a subgroup analysis of patients with GE, women were associated with fewer non-attendance (OR 0.31; 95% CI 0.14–0.72; p = 0.006). ConclusionsGE was more frequent in the non-attendance group than in the FE group. Among patients with GE, females were found to have non-attendance less frequently; however, there was no clear difference in the odds of non-attendance between Juvenile Myoclonic Epilepsy (JME) and IGE other than JME.

Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer Diagnoses

Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer, such as unemployment, public medical spending, and public assistance, may also be sizable. To examine whether a cancer history is associated with receipt of disability insurance, income, employment, and medical spending. This cross-sectional study used data from the Medical Expenditure Panel Study (MEPS) (2010-2016) for a nationally representative sample of US adults aged 50 to 79 years. Data were analyzed from December 2021 to March 2023. Cancer history. The main outcomes were employment, public assistance receipt, disability, and medical expenditures. Variables for race, ethnicity, and age were used as controls. A series of multivariate regression models were used to assess the immediate and 2-year association of a cancer history with disability, income, employment, and medical spending. Of 39 439 unique MEPS respondents included in the study, 52% were female, and the mean (SD) age was 61.44 (8.32) years; 12% of respondents had a history of cancer. Individuals with a cancer history who were aged 50 to 64 years were 9.80 (95% CI, 7.35-12.25) percentage points more likely to have a work-limiting disability and were 9.08 (95% CI, 6.22-11.94) percentage points less likely to be employed compared with individuals in the same age group without a history of cancer. Nationally, cancer accounted for 505 768 fewer employed individuals in the population aged 50 to 64 years. A cancer history was also associated with an increase of $2722 (95% CI, $2131-$3313) in medical spending, $6460 (95% CI, $5254-$7667) in public medical spending, and $515 (95% CI, $337-$692) in other public assistance spending. In this cross-sectional study, a history of cancer was associated with increased likelihood of disability, higher medical spending, and decreased likelihood of employment. These findings suggest there may be gains beyond increased longevity if cancer can be detected and treated earlier.

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Legal issues pertaining to the collection of sociodemographic data in emergency departments.

Effects of prescription opioids on employment, earnings, marriage, disability and mortality: Evidence from state opioid control policies

This article presents estimates of the effects of state prescription opioid control policies on prescription opioid sales, mortality and socioeconomic outcomes of adults. Results indicate that state implementation of a “modern” Prescription Drug Monitoring Program (PDMP) is associated with decreases in opioid sales of between 5% and 20% and that pill mill laws are associated with a decrease in opioid sales of between 15% and 40%. While these policies were associated with reductions in prescription opioid sales they were not significantly associated with drug- and opioid-related mortality, although estimates consistently indicated that these policies reduced mortality. In the case of socioeconomic outcomes, we found consistent evidence that the adoption of a “modern” PDMP was associated with small, but statistically significant reductions in employment of 1% to 2%; small reductions in earnings that were not statistically significant for full sample, but were significant and larger for a low-educated sample; and similarly small, marginally significant increases in receipt of public assistance, particularly for women; and a significant, but small (1%) decline in the probability of being married among females. In contrast, pill mill laws were associated with marginally significant increases in employment of 1% to 2%, but only among those ages 18 to 25; small, but insignificant increases in earnings of males of between 2% to 4%; and a significant, but small (1%) decline in the probability of being married.

A legal dispute resolution intervention for patients with substance use disorders: a study protocol for a randomized controlled trial

BackgroundSubstance use disorders (SUDs) represent major public health concerns and are linked to enhanced risk of legal consequences. Unresolved legal issues may prevent individuals with SUD from completing treatment. Interventions aimed at improving SUD treatment outcomes are limited. Filling that gap, this randomized controlled trial (RCT) tests the ability of a technology-assisted intervention to increase SUD treatment completion rates and improve post-treatment health, economic, justice-system, and housing outcomes.MethodsA randomized controlled trial with a two-year administrative follow-up period will be conducted. Eight hundred Medicaid eligible and uninsured adults receiving SUD treatment will be recruited at community-based non-profit health care clinics in Southeast, Michigan, USA. Using an algorithm embedded in a community-based case management system, we randomly assign all eligible adults to one of two groups. The treatment/intervention group will receive hands-on assistance with a technology aimed at resolving unaddressed legal issues and the control group receives no treatment. Upon enrollment into the intervention, both treatment (n = 400) and control groups (n = 400) retain traditional options to resolve unaddressed legal issues, such as hiring an attorney, but only the treatment group is targeted the technology and offered personalized assistance in navigating the online legal platform. To develop baseline and historical contexts for participants, we collect life course history reports from all participants and intend to link those in each group to administrative data sources. In addition to the randomized controlled trial (RCT), we used an exploratory sequential mixed methods and participatory-based design to develop, test, and administer our life course history instruments to all participants. The primary objective is to test whether targeting no-cost online legal resources to those experiencing SUD improves their long-term recovery and decreases negative health, economic, justice-system, and housing outcomes.DiscussionFindings from this RCT will improve our understanding of the acute socio-legal needs faced by those experiencing SUD and provide recommendations to help target resources toward the areas that best support long-term recovery. The public health impact includes making publicly available a deidentified, longitudinal dataset of uninsured and Medicaid eligible clients in treatment for SUD. Data include an overrepresentation of understudied groups including African American and American Indian Alaska Native persons documented to experience heightened risk for SUD-related premature mortality and justice-system involvement. Within these data, several intended outcome measures can inform the health policy landscape: (1) health, including substance use, disability, mental health diagnosis, and mortality; (2) financial health, including employment, earnings, public assistance receipt, and financial obligations to the state; (3) justice-system involvement, including civil and criminal legal system encounters; (4) housing, including homelessness, household composition, and homeownership.Trial registrationRetrospectively registered # NCT05665179 on December 27, 2022.

Mitochondrial DNA copy number dynamics and associations with the prenatal environment from birth through adolescence in a population of Dominican and African American children

Mitochondrial DNA copy number (mtDNAcn) dynamics throughout childhood are poorly understood. We profiled mtDNAcn from birth through adolescence and evaluated how the prenatal environment influences mtDNAcn across childhood. Data were collected from children from New York City followed through 18 years. Using duplexed qRT-PCR, we quantified mtDNAcn relative to nuclear DNA in blood collected from the umbilical cord (n = 450), children aged 5–7 (n = 510), and adolescents aged 15–18 (n = 278). We examined mtDNAcn across childhood with linear mixed-effects models (LMM). Relative mtDNAcn was lowest at birth (mean ± SD: 0.67 ± 0.35) and increased in childhood (1.24 ± 0.50) then slightly declined in adolescence (1.13 ± 0.44). We observed no differences in mtDNAcn by sex or race/ethnicity. mtDNAcn was positively associated with prenatal environmental tobacco smoke exposure (0.077 [ 0.01, 0.14] change in relative mtDNAcn) but negatively associated with maternal completion of high school (-0.066 [-0.13, 0.00]), with the receipt of public assistance at birth (-0.074 [-0.14, -0.01]), and when mother born outside the U.S (-0.061 [-0.13, 0.003]). Infant birth outcomes were not associated with mtDNAcn. MtDNAcn levels were dynamic through childhood and associated with some prenatal factors, underscoring the need for the investigation of longitudinal mtDNAcn for human health research.

The Last Days of the Warren Court: How Justice Brennan Orchestrated Shapiro v. Thompson (1969)

The Last Days of the Warren Court:How Justice Brennan Orchestrated Shapiro v. Thompson (1969) Jordan Lampo (bio) On April 21, 1969, the Supreme Court invalidated state durational residency requirements for receipt of public assistance and helped establish a fundamental, constitutional right to travel in Shapiro v. Thompson.1 In announcing Shapiro, Justice William J. Brennan "read lengthy excerpts" from his majority opinion to spectators in the Courtroom.2 Brennan's prioritization of protecting the poor through the Fourteenth Amendment in Shapiro did not come as a surprise that day. Since he joined the Warren Court in 1956, Brennan and his fellow justices had been addressing wealth discrimination, hoping to apply the Equal Protection Clause to protect the rights of the poor. Chief Justice Earl Warren dissented in Shapiro. This was unusual. Brennan and Warren had been allies for twelve years, more often than not voting together on landmark cases. Notably, the chief justice had voted with the majority and Brennan in: Gideon v. Wainwright (1963),3 holding the Sixth and Fourteenth Amendments guarantee a right for legal counsel to an indigent defendant accused of a felony; Douglas v. California (1963),4 holding that states must provide indigent persons with counsel on a first appeal of right to challenge a criminal conviction; and Harper v. Virginia Board of Elections (1966),5 holding a state law conditioning the vote on payment of a $1.50 poll tax denied equal protection. But Shapiro was different. Brennan had to deploy his persuasive powers to marshal a majority without Warren, who was about to retire. The story of how Brennan orchestrated Shapiro bears re-examination, as it took many twists and turns to arrive at the final decision. Moreover, the case took on heightened drama as some of the justices were worried about antagonizing Congress with a decision that [End Page 75] would require states to pay assistance to indigents at a time when Congress was debating whether to raise judicial salaries. The Warren Court The Warren Court spanned fifteen years (1953–1969) and Brennan served for twelve of them.6 One of Warren's clerks, Robert T. Lasky, summed up the relationship between the chief justice and the associate justice: Spearheaded by … Warren and … Brennan, the Warren Court radically expanded the reaches of the judicial power and altered constitutional law in a way that reverberates to this day. … Warren was the leader of the liberal wing; Brennan would provide its intellectual underpinnings.7 Lasky said Warren knew Brennan, the "intellectual anchor" who did "real hard, heavy lifting from a thinking standpoint," could articulate legal arguments in a manner the former governor of California could not.8 Another clerk, Paul J. Meyer, recalled that Warren and Brennan were always "very close" and that Brennan was "clearly Warren's tight ally of the Court."9 Their companionship has led historians to refer to their overlapping time on the bench not as the "Warren Court," but "the Brennan Court."10 Brennan and Warren mostly voted in lockstep. Warren often tasked Brennan with convincing a fifth justice to join them alongside liberal-leaning Justices Hugo L. Black and William O. Douglas.11 If Brennan was successful in garnering a fifth vote, then Warren would have the assignment power. Often, Warren assigned Brennan to write opinions in seminal cases. Notably, the chief justice assigned him Baker v. Carr,12 the reapportionment case that Warren deemed "the most important case of [his] tenure,"13 and Cooper Click for larger view View full resolution Earl Warren and William J. Brennan served together on the Court for 12 years and mostly voted in lockstep. Above they are shown examining Chief Justice John Marshall's Courtroom notes at the National Archives in 1966. [End Page 76] v. Aaron,14 a 1958 case denouncing Southern resistance to school desegregation. Thurgood Marshall was appointed in 1967, and soon became Brennan's ally.15 Marshall's presence gave the Court a solid block of seven liberal justices. Such a large number of like-minded justices put Brennan at ease—he no longer needed to rely on using Warren's opinion assignment power to force wavering justices to author opinions that aligned with his liberal values...

Mitochondrial DNA Copy Number Dynamics from Birth through Adolescence in a Population of Dominican and African American Children

Background: Mitochondria are vital for cellular energy production, metabolism, and signaling; however, they are uniquely susceptible to damage from environmental toxicants. Mitochondrial DNA copy number (mtDNAcn) is a widely used biomarker in human population studies and is associated with several exposures, including air pollution and metals. Yet, little is known about the dynamics of mtDNAcn throughout childhood and its longitudinal associations with key population characteristics. Our objective was to profile mtDNAcn from birth through adolescence to better inform future environmental health research. Methods: Data were collected from a cohort of mother-child pairs from New York City recruited 1998-2006 and followed through 18 years. Using duplexed qRT-PCR we quantified mtDNAcn relative to nuclear DNA from 662 participants using blood collected from the umbilical cord (n=450), children aged 5-7 (n=510), and adolescents aged 15-18 (n=278). We examined mtDNAcn across childhood with linear mixed-effects models (LMM) and latent class growth models (LGCM). We then examined associations with key population characteristics (maternal lifestyle during pregnancy and birth outcomes). Results: Relative mtDNAcn was lowest at birth (mean ± SD: 0.67 ± 0.35) and increased in childhood (1.24 ± 0.50) then slightly declined in adolescence (1.13 ± 0.44). MtDNAcn values across visits were moderately correlated (r=0.32-0.44). LGCM identified two trajectories of mtDNAcn: a high group (n=615) and a smaller low group (n=47). We observed no differences in mtDNAcn by sex or by race/ethnicity. In LMMs, longitudinal mtDNAcn was positively associated with prenatal environmental tobacco smoke exposure but negatively associated with maternal education and maternal receipt of public assistance at birth. No associations were observed with child birth outcomes. Conclusions: MtDNAcn levels were dynamic through childhood and are associated with prenatal factors. These results underscore the need for the investigation of mtDNAcn dynamics and predictors for environmental health research. Keywords: Biomarkers, mitochondria, mtDNA, children’s environmental health

Prenatal exposure to polybrominated diphenyl ethers and BMI Z-scores from 5 to 14 years

BackgroundPolybrominated diphenyl ethers (PBDEs) are flame-retardant compounds widely used in household products until phase out in 2004. PBDEs are endocrine disruptors and are suggested to influence signaling related to weight control. Prenatal exposures to PBDEs may alter childhood adiposity, yet few studies have examined these associations in human populations.MethodsData were collected from a birth cohort of Dominican and African American mother-child pairs from New York City recruited from 1998 to 2006. PBDE congeners BDE-47, − 99, − 100, and − 153 were measured in cord plasma (ng/μL) and dichotomized into low (< 80th percentile) and high (>80th percentile) exposure categories. Height and weight were collected at ages 5, 7, 9, 11, and an ancillary visit from 8 to 14 years (n = 289). Mixed-effects models with random intercepts for participant were used to assess associations between concentrations of individual PBDE congeners or the PBDE sum and child BMI z-scores (BMIz). To assess associations between PBDEs and the change in BMIz over time, models including interactions between PBDE categories and child age and (child age)2 were fit. Quantile g-computation was used to investigate associations between BMIz and the total PBDE mixture. Models were adjusted for baseline maternal covariates: ethnicity, age, education, parity, partnership status, and receipt of public assistance, and child covariates: child sex and cord cholesterol and triglycerides.ResultsThe prevalence of children with obesity at age 5 was 24.2% and increased to 30% at age 11. Neither cord levels of individual PBDEs nor the total PBDE mixture were associated with overall BMIz in childhood. The changes in BMIz across childhood were not different between children with low or high PBDEs. Results were similar when adjusting for postnatal PBDE exposures.ConclusionsPrenatal PBDE exposures were not associated with child growth trajectories in a cohort of Dominican and African American children.

Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

BackgroundGiven the trend of increasing maternal age and associated adverse reproductive outcomes in the US, this study aimed to assess whether this association is due to an independent aging or confounded by sociodemographic, biomedical, or behavioral determinants in a predominantly Black US population.MethodsData was from 8509 women enrolled in the Boston Birth Cohort. Adverse reproductive outcomes included spontaneous preterm delivery, cesarean delivery, and low birth weight. Covariates included sociodemographic (parity, race/ethnicity, education, marital status, income, receipt of public assistance, nativity); biomedical (obesity, hypertensive disorders, diabetes mellitus); and behavioral (consistent intake of multivitamin supplements, support from father of baby, support from family, major stress in pregnancy, cigarette smoking, alcohol intake). Analysis included Lowess and marginal probability plots, crude and adjusted sequential logistic regression models to examine age-outcome associations and to what degree the association can be explained by the above covariables.ResultOverall, the study sample had high levels of spontaneous preterm birth (18%), cesarean delivery (33%) and low birth weight (26%). Unadjusted models showed no significant difference odds of spontaneous preterm birth by maternal age but higher odds of cesarean section (aOR: 1.77, 95% CI: 1.60, 1.95) and low birth weight (aOR: 1.15, 95% CI: 1.04, 1.28) among women 30 years or older. Adjustment for sociodemographic factors, biomedical conditions and behavioral factors revealed higher odds of spontaneous preterm birth: (aOR: 1.30, 95% CI: 1.14, 1.49), cesarean section deliveries (aOR: 1.68, 95% CI: 1.51, 1.87) and low birth weight (aOR: 1.36, 95% CI: 1.21, 1.53). Across all ages, optimal BMI status and consistent multivitamin supplement intake were protective of spontaneous preterm birth and low birth weight.ConclusionIn this high-risk minority population, we demonstrated that the association between increasing maternal age and adverse pregnancy outcomes was due to an independent aging effect and the presence of confounding by sociodemographic, biomedical, and behavioral factors. Some modifiable risk factors to counteract aging effect, include optimizing BMI and consistent intake of multivitamin supplement. A fundamental change in how care is provided to women, particularly low income Black women, is needed with emphasis on the protective role of optimal nutritional status.Trial registrationClinicalTrials.gov Identifier: NCT03228875

Food insecurity risk and alcohol use disorder in US young adults: Findings from the National Longitudinal Study of Adolescent to Adult Health.

The relationship between food insecurity and alcohol use disorder remains unknown. The aim of this study was to determine the association between food insecurity risk and alcohol use disorder in a nationally representative sample of young adults. Cross-sectional nationally representative data of 14,786 US young adults aged 24-32 years old from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed to assess a single-item measure of food insecurity risk and Diagnostic and Statistical Manual, 5th Edition (DSM-5) alcohol use disorder. Among young adults, 12% were found to be at risk for food insecurity. Young adults with food insecurity risk had greater odds of moderate (adjusted odds ratio [AOR]: 1.34, 95% confidence interval [CI]: 1.13-1.58) and severe (AOR: 1.67, 95% CI: 1.34-2.07) threshold alcohol use disorder than food-secure young adults, adjusting for age, sex, race/ethnicity, education, income, receipt of public assistance, household size, and smoking. Food insecurity risk was also associated with a 23% higher (95% CI: 11%-37%) number of problematic alcohol use behaviors (e.g., risky behaviors, continued alcohol use despite emotional or physical health problems). Food insecurity risk is associated with problematic patterns of alcohol use. Health care providers should screen for food insecurity and problematic alcohol use in young adults and provide referrals for further resources and treatment when appropriate. This nationally representative study of US young adults is the first to find an association between food insecurity risk and alcohol use disorder using DSM-5 criteria.

Changes in severity of depression and borderline personality disorder symptoms from pregnancy to three years postpartum in adolescent mothers

BackgroundThe transition to motherhood is associated with the emergence or exacerbation of symptoms of emotional distress disorders for many women. Although adolescence is a developmental period of increased risk for mood disorders and emotion dysregulation among women, little is known about changes in emotional distress across the early postpartum years among adolescent mothers. We tested the hypothesis that symptoms of depression and borderline personality disorder (BPD) would differ between pregnant and non-pregnant adolescents, and that these differences would be maintained in the three years following delivery. MethodsData were drawn from the longitudinal Pittsburgh Girls Study: 307 adolescent mothers (14-18 years) and 307 never-pregnant adolescents, matched on age, race and household receipt of public assistance, self-reported severity of depression and BPD across four years. ResultsThere were no group differences on depression severity during or after pregnancy. However, compared with their non-pregnant peers, pregnant adolescents reported more severe BPD symptoms even after comorbid depression symptoms were accounted for, and this group difference was sustained during the following three years. LimitationsFindings are based on a community sample rather than a clinical sample, which may have limited the severity of symptoms captured. ConclusionsFindings suggest that adolescent mothers are a high-risk group for BPD symptoms during and after pregnancy, highlighting pregnancy as a critical window of opportunity to reduce morbidity among young mothers and potential negative effects on the next generation.

Overall mortality in older people receiving physician-led home visits: a multicentre prospective study in Japan.

BackgroundJapan has the most rapidly ageing population in the world. The Japanese government has, therefore, promoted physician-led home health care for frail and disabled people.ObjectivesTo describe mortality among older people receiving physician-led health care at home or at a nursing home in Japan and to identify risk factors.MethodsThis was a multicentre prospective cohort study. Participants were aged ≥65 years and had started to receive regular physician-led health care at home or at nursing homes from 13 facilities between 1 February 2013 and 31 January 2016. The observation period ended on 31 January 2017. We used a biopsychosocial approach for exploratory analysis of 13 variables to identify mortality risk factors.ResultsThe median (25th to 75th percentile) observation time was 417 (121–744) days. Of 825 participants, 380 died. The total cumulative survival for 180, 360, 720 and 1440 days was 73.4% (95% confidence interval: 70.2–76.3), 64.2% (60.8–67.5), 52.6% (48.8–56.3) and 34.6% (23.5–46.0). The Kaplan–Meier cumulative survival curve showed a steep drop during the first 6 months of observation. A multivariate Cox proportional hazard model showed that sex (male), high Charlson Comorbidity Index score, low serum albumin level, low Barthel Index score, receipt of oxygen therapy, high Cornell Scale for Depression in Dementia score and non-receipt of public assistance were associated with mortality.ConclusionsOverall mortality in physician-led home visits in Japan was described and mortality risk factors identified. Public assistance receipt was associated with lower mortality.

The Association of Advanced Math Course-Taking by American Youth on Subsequent Receipt of Public Assistance

Helping people move to independence is often cited as a primary goal of public assistance policies in the United States. Over the past several decades, welfare reform efforts in the US have promoted the idea of a work-first approach. Research shows that this approach has discouraged or at least made it harder for some students to attend college while meeting the work requirements for aid. How can those students who need public assistance increase their chances of finding a sustainable job and thus not need to rely on the public support system after high school? To address this question, this study used a sample of 3,384 student responses from the National Longitudinal Study of Adolescent to Adult Health and a recursive bivariate probit model to analyze the association between advanced math course-taking in high school and the probability of subsequent receipt of public assistance. The empirical results suggest that taking advanced math courses in high school is associated with a lower probability of receiving public assistance for recent graduates. These findings are particularly important for school social workers who work in conjunction with teachers and school counselors to help at-risk students improve their chances of future financial independence.

Public Assistance and Homeless Shelter Trajectories

We study public assistance participation among homeless shelter users, characterizing the trajectories of public assistance receipt for individuals before and after they enter shelters and analyzing the influence of public assistance participation on subsequent shelter use. Our analysis identifies three distinct groups of shelter users based on personal characteristics and prior patterns of public assistance use. These groups are differentiated by their patterns of no use, increasing use, and high use of public assistance. For all three groups, increased participation in public assistance programs following the first observed homeless shelter entry reduces subsequent shelter use. The analysis draws attention to the potential role of public assistance programs and strengthened coordination of services for the prevention of homelessness.

Disentangling individual, school, and neighborhood effects on screen time among adolescents and young adults in the United States

ObjectivesTo examine the association between individual, neighborhood, and school-level influences on individual screen time among adolescents and young adults (AYAs) in the National Longitudinal Study of Adolescent to Adult Health. MethodsWe classified screen time continuously as self-reported total hours per week of television, videos, and video/computer games at baseline and categorical as extended screen time (≥14 h per week). We fit cross-classified multilevel models (CCMM) to examine to examine the individual-, school- and neighborhood-level demographic and socioeconomic factors associated with screen time. Models were fit using MLwiN with Bayesian estimation procedures. ResultsAYAs reported an average of 22.8 (SD = 19.4) and 21.9 (SD = 20.3) hours of screen time, respectively. At the individual level, younger age, male sex, Black/multiracial race, receipt of public assistance, and lower parental education were associated with higher screen time. At the school level, being out of session (i.e., school and national holidays including summer), having a higher proportion of non-White students, and having a lower proportion of parents with a college education were associated with higher individual screen time. ConclusionsWe found that individual-level factors most influence youth screen time, with smaller contributions from school factors.

Childhood maltreatment and lead levels in middle adulthood: A prospective examination of the roles of individual socio-economic and neighborhood characteristics.

BackgroundLead is a common environmental hazard because of its past use as an additive to gasoline and household paint. Some evidence suggests that children with histories of child abuse and neglect are at elevated risk for residence in communities and households with less desirable characteristics and high levels of exposure to environmental hazards and toxins.ObjectivesTo understand whether childhood maltreatment leads to higher levels of household dust lead and blood lead in adulthood and the extent to which characteristics of a person’s physical environment or individual level socio-economic status (SES) (based on unemployment, poverty, and receipt of public assistance) contribute to understanding the relationship.MethodsA large prospective cohort design study in which abused and neglected children (ages 0–11) were matched with non-maltreated children and assessed in adulthood. Objective and subjective neighborhood characteristics were assessed at approximate age 40 and household dust lead (cleaned and less often cleaned) and blood lead levels were measured at age 41. Blood was collected through venipuncture by a registered nurse as part of a medical status exam.ResultsChildhood maltreatment predicted higher levels of dust lead in less often cleaned household places, residence in worse neighborhoods defined by objective (census tract data) and subjective (reports of physical disorder and lack of social cohesion and control), and higher levels of poverty, receiving public assistance, and unemployment. Only objective neighborhood characteristics mediated the relationship between childhood maltreatment and dust lead level in adulthood. There were also significant paths from objective neighborhood disadvantage and individual level SES to higher levels of blood lead.DiscussionThirty years after their childhood experiences, individuals with documented histories of childhood maltreatment are at higher risk for living in environments as adults with elevated lead levels that may impact other aspects of their lives and compromise their health.

Socioeconomic Correlates of Obesity in African-American and Caribbean-Black Men and Women.

The high prevalence of obesity among Black Americans warrants additional investigation into its relationship with socioeconomic position (SEP), sex, and ethnicity. This cross-sectional study utilizes 2001–2003 data from the National Survey of American Life, a nationally representative sample of 3570 African-Americans and 1621 Caribbean-Blacks aged 18 years and older. Multivariate logistic regression models stratified by ethnicity and sex describe the independent associations between obesity and multilevel socioeconomic factors after adjustment for age, other SEP measures at the individual, family and neighborhood levels, and health behaviors such as physical activity, alcohol intake, and smoking. A positive relationship was observed between obesity and family income among African-American and Caribbean-Black men. Receipt of public assistance was a strongly associated factor for obesity in Caribbean-Black men and women. Among African-American women, inverse relationships were observed between obesity and education, occupation, and family income; residence within a neighborhood with a supermarket also decreased their odds of obesity. Residence in a neighborhood with a park decreased the odds of obesity only among African-American men, whereas residence in a neighborhood with a supermarket decreased the odds of obesity among Caribbean-Black men. The social patterning of obesity by individual, household, and neighborhood socioeconomic resources differs for African-American and Caribbean-Black men and women within these cross-sectional analyses; an appreciation of these differences may be a prerequisite for developing effective weight control interventions and policies for these two populations.

Utility of digital Respondent Driven Sampling to recruit community-dwelling emerging adults for assessment of drinking and related risks

IntroductionEmerging adulthood often entails heightened risk-taking, including risky drinking, and research is needed to guide intervention development and delivery. This study adapted Respondent Driven Sampling, a peer-driven recruitment method, to a digital platform (d-RDS) and evaluated its utility to recruit community-dwelling emerging adult (EA) risky drinkers, who are under-served and more difficult to reach for assessment and intervention than their college student peers. Materials and methodsCommunity-dwelling EA risky drinkers (N = 357) were recruited using d-RDS (M age = 23.6 years, 64.0% women). Peers recruited peers in an iterative fashion. Participants completed a web-based cross-sectional survey of drinking practices and problems and associated risk and protective factors. Resultsd-RDS successfully recruited EA risky drinkers. On average, the sample reported recent drinking exceeding low-risk drinking guidelines and 8.80 negative consequences in the past three months. Compared to age-matched respondents from the representative U.S. National Survey on Drug Use and Health, the sample reported more past month drinking days and more drinks consumed per drinking day (ps < 0.001). At higher consumption levels, predicted positive associations were found with lower education and receipt of public assistance. ConclusionsResults supported the utility of d-RDS as a sampling method and grassroots platform for research and intervention with community-dwelling EA drinkers who are harder to reach than traditional college students. The study provides a method and lays an empirical foundation for extending efficacious alcohol brief interventions with college drinkers to this underserved population.