US States with the Highest Rates of Gun Ownership

Via:  https://atlas.qz.com/charts/NJt0vesF

Police Killings and Police Deaths Are Public Health Data and Can Be Counted

Summary Points 

• During the past year, the United States has experienced major controversies—and civil unrest—regarding the endemic problem of police violence and police deaths.
• Although deaths of police officers are well documented, no reliable official US data exist on the number of persons killed by the police, in part because of long-standing and well-documented resistance of police departments to making these data public.
• These deaths, however, are countable, as evidenced by “The Counted,” a website launched on June 1, 2015, by the newspaper The Guardian, published in the United Kingdom, which quickly revealed that by June 9, 2015, over 500 people in the US had been killed by the police since January 1, 2015, twice what would be expected based on estimates from the US Federal Bureau of Intelligence (FBI).
• Law-enforcement–related deaths, of both persons killed by law enforcement agents and also law enforcement agents killed in the line of duty, are a public health concern, not solely a criminal justice concern, since these events involve mortality and affect the well-being of the families and communities of the deceased; therefore, law-enforcement–related deaths are public health data, not solely criminal justice data.
• We propose that law-enforcement–related deaths be treated as a notifiable condition, which would allow public health departments to report these data in real-time, at the local as well as national level, thereby providing data needed to understand and prevent the problem.

Below:  US deaths due to legal intervention: national and city-specific annual 5-year moving average rate (per 100,000) among US black men and white men ages 15–34, 1960–2011

Full article at:  http://goo.gl/xgEpZl

By:  Nancy Krieger, Jarvis T. Chen, Pamela D. Waterman, Mathew V. Kiang, Justin Feldman

Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America

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The Association of Low Parental Monitoring with Early Substance Use in European American and African American Adolescent Girls

OBJECTIVE:

Research indicates that low parental monitoring increases the risk for early substance use. Because low parental monitoring tends to co-occur with other familial and neighborhood factors, the specificity of the association is challenging to establish. Using logistic regression and propensity score analyses, we examined associations between low parental monitoring and early substance use in European American (EA) and African American (AA) girls, controlling for risk factors associated with low parental monitoring.

METHOD:

Participants were 3,133 EA and 523 AA girls from the Missouri Adolescent Female Twin Study with data on parental monitoring assessed via self-report questionnaire, and with ages at first use of alcohol, tobacco, and cannabis queried in at least one of three diagnostic interviews (median ages = 15, 22, and 24 years).

RESULTS:

The rate of early alcohol use was greater in EA than AA girls, whereas the proportion of AA girls reporting low parental monitoring was higher than in EA girls. EA girls who experienced low parental monitoring were at elevated risk for early alcohol, tobacco, and cannabis use, findings supported in both logistic regression and propensity score analyses. Evidence regarding associations between low parental monitoring and risk for early substance use was less definitive for AA girls.

CONCLUSIONS:

Findings highlight the role of parental monitoring in modifying risk for early substance use in EA girls. However, we know little regarding the unique effects, if any, of low parental monitoring on the timing of first substance use in AA girls.

Purchase full article at:  http://goo.gl/ugNROH

By:  Blustein EC1,2, Munn-Chernoff MA3,4,5, Grant JD3,4, Sartor CE3,4,6, Waldron M3,7, Bucholz KK3,4, Madden PA3,4, Heath AC3,4.

• 1Department of Biology, Rhodes College, Memphis, Tennessee.
• 2College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
• 3Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
• 4Alcoholism Research Center, Washington University School of Medicine, St. Louis, Missouri.
• 5Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
• 6Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
• 7Department of Counseling and Educational Psychology, Indiana University School of Education, Bloomington, Indiana. 

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Women’s Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration–approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential.

Half of the pregnancies in the United States are unintended.1 Cost is a barrier to contraceptive use; in fact, when contraception is provided at no cost, women choose more effective and more expensive methods, such as long-acting reversible contraceptives (LARCs)—which include intrauterine devices (IUDs) and contraceptive implants—and have fewer unintended pregnancies.2,3 The Patient Protection and Affordable Care Act (ACA; Pub L No. 111–148) eliminates the cost barrier to contraception for most women with private health insurance by mandating coverage without patient cost sharing for Food and Drug Administration–approved contraceptive methods and tubal sterilization.4 Although this contraceptive coverage requirement went into effect in August 2012,5 whether privately insured women are aware of their newly expanded contraceptive benefits is unknown.

...Privately insured women are largely unaware of their contraceptive benefits under the ACA, and a substantial proportion would switch methods if there were no cost barrier. It is unclear whether the high proportion of women reporting “I don’t know” about coverage reflects a lack of method awareness or a lack of knowledge about coverage, which is a study limitation.

Before the ACA, studies suggested that full contraceptive coverage could increase use of LARCs and reduce unintended pregnancies and abortions. In 2002, the Kaiser Foundation Health Plan in California sent quarterly outreach publications to inform enrollees of their policy change to include 100% coverage of injectables and LARCs, resulting in a significant increase in the use of these methods.7 In the CHOICE project, women in the St. Louis, Missouri, region received dedicated counseling promoting LARCs and were provided no-cost contraception, resulting in a high uptake of LARCs and a reduction in unintended pregnancy.3 These demonstrations suggest that the ACA mandate may not lead to more effective contraceptive method use without efforts to inform both women and health care providers of the coverage mandate and to provide accurate information about method options. Furthermore, it is not clear whether insurers are complying with the mandate8 or if there is an adequate workforce to provide LARCs.9 Although system-level barriers to female sterilization under Medicaid regulations are well recognized, low awareness of coverage for sterilization may prove to be a barrier even among privately insured women.10

For the ACA contraceptive coverage mandate to affect the use of effective contraception, raising women’s awareness of the expanded benefit is an essential first step. Private insurers, health care providers, and policymakers must do a better job of communicating the benefit, or this could be a missed opportunity to reduce unintended pregnancies and abortions among US women.

Below:  Awareness of contraceptive coverage based on the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?”: Pennsylvania, 2014. Note. IUD = intrauterine device. The sample size was n = 987.

Full article at:  http://goo.gl/QT25sl

By: Cynthia H. Chuang, MD, MSc, Julie L. Mitchell, DO, Diana L. Velott, MPA, MS, Richard S. Legro, MD, Erik B. Lehman, MS, Lindsay Confer, MPH, and Carol S. Weisman, PhD

Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine.

Corresponding author.

Correspondence should be sent to Cynthia H. Chuang, MD, MSc, 500 University Drive, HO34, Division of General Internal Medicine, Penn State Hershey, Hershey, PA 17033 (e-mail: ude.usp.cmh@gnauhcc). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

Contributors

C. H. Chuang was the principal investigator for the MyNewOptions study; she conceptualized the study and wrote the article. J. L. Mitchell, D. L. Velott, R. S. Legro, E. B. Lehman, L. Confer, and C. S. Weisman contributed to data interpretation and to writing the article. E. B. Lehman analyzed the data.

 

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Childhood Lead Exposure & Sexually Transmitted Infections: New Evidence

The adverse health effects of lead exposure in children are well documented and include intellectual and behavioral maladies. Childhood lead exposure has also been linked to impulsive behaviors, which, in turn, are associated with a host of negative health outcomes including an increased risk for sexually transmitted infections (STI). The purpose of this study was to assess the association of lead exposure with STI rates across census tracts in St. Louis City, Missouri.

Incident cases of gonorrhea and chlamydia (GC) during 2011 were identified from the Missouri Department of Health and Senior Services and aggregated by census tract. We also geocoded the home address of 59,645 children >72 months in age who had blood lead level tests performed in St. Louis City from 1996 to 2007. Traditional regression and Bayesian spatial models were used to determine the relationship between GC and lead exposure while accounting for confounders (condom and alcohol availability, crime, and an index of concentrated disadvantage).

Incident GC rates were found to cluster across census tracts (Moran's I=0.13, p=0.006). After accounting for confounders and their spatial dependence, a linear relationship existed between lead exposure and GC incidence across census tracts, with higher GC rates occurring in the northern part of St. Louis City 

At the census-tract level, higher lead exposure is associated with higher STI rates. Visualizing these patterns through maps may help deliver targeted interventions to reduce geographic disparities in GC rates.

Purchase full article at: http://goo.gl/1ovVY3

By: Nelson EJ1, Shacham E2, Boutwell BB3, Rosenfeld R4, Schootman M2, Vaughn M5, Lewis R6.

• 1Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA. Electronic address: nelsonej@slu.edu.
• 2Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA.
• 3Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA; School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA. Electronic address: bboutwell@slu.edu.
• 4Department of Criminology and Criminal Justice, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 6312, USA. Electronic address: richard_rosenfeld@umsl.edu.
• 5School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA.
• 6Department of Environmental and Occupational Health, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA. Electronic address: lewisrd@slu.edu.  

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