Hedwig Lee

Child maltreatment—encompassing neglect and physical, sexual, and emotional abuse of children—is associated with myriad negative physical, mental, and social outcomes. Childhood maltreatment is associated with significantly higher rates of mortality,^1-3 obesity,^1,4-7 and human immunodeficiency virus infection.^1,8 Children who experience maltreatment also have significantly more mental health problems^1,9-14 and are as much as 5 times more likely to attempt suicide.^1,15 Maltreated children are also more likely to engage in criminal behavior than other children^1,16,17 and are more than 50% more likely to have a juvenile record than other children.¹⁷ Child maltreatment also has substantial social costs. Estimates suggest that child maltreatment costs the United States $124 billion annually, with per-person lifetime costs higher than or comparable to those of diseases such as a stroke or type 2 diabetes mellitus.¹⁸ Childhood maltreatment has thus been referred to as “a human rights violation and a global public health problem [that] incurs huge costs for both individuals and society.”^19(p332)

Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients. Discrimination based on criminal record may also negatively impact healthcare access and utilization among ex-prisoners. We conducted a secondary analysis of data from a cross-sectional survey of 172 men recently released from state prison. We examined the association between self-reported criminal record discrimination by healthcare workers and utilization of 1) emergency department (ED) and 2) primary care services. We created staged logistic regression models, adjusting for sociodemographic characteristics and self-reported racial/ethnic discrimination. Among 172 male participants, 42% reported a history of criminal record discrimination by healthcare workers. Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination. Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2-6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7-3.8]. Recently released prisoners report criminal record discrimination by healthcare workers, and this experience may impact healthcare utilization. Future studies should seek to further characterize criminal record discrimination by healthcare workers and prospectively examine its impact on health outcomes.

Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006–2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78–.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development.

Objectives.: Consistent findings show that black Americans have high rates of cardiovascular disease (CVD) and related behavioral risk factors. Despite this body of work, studies on black Americans are generally limited to the 50 U.S. states. We examined variation in CVD and related risk factors among black Americans by comparing those residing within the U.S. Virgin Islands (USVI) with those residing in the 50 U.S. states and Washington, D.C. (US 50/DC) and residing in different regions of the US 50/DC (Northeast, Midwest, South, and West). Methods.: Using data from the 2007 and 2009 Behavioral Risk Factor Surveillance System, we compared CVD and CVD risk factor prevalence in non-Hispanic black people (≥20 years of age) in the USVI and US 50/DC, examining the relative contributions of health behaviors, health insurance, and socioeconomic status (SES). Results.: Accounting for age, sex, education, health insurance, and health behaviors, US 50/DC black Americans were significantly more likely than USVI black people to report ever having a stroke and coronary heart disease, and to be hypertensive, diabetic, or obese While there was heterogeneity by region, similar patterns emerged when comparing the USVI with different regions of the US 50/DC. Conclusion.: USVI black people have lower CVD and risk factor prevalence than US 50/DC black people. These lower rates are not explained by differences in health behaviors or SES. Understanding health in this population may provide important information on the etiology of racial/ethnic variation in health in the U.S. and elsewhere, and highlight relevant public health policies to reduce racial/ethnic group disparities.

BACKGROUND: The rise in adolescent obesity has become a public health concern, especially because of its impact on disadvantaged youth. This article examines the role of disadvantage at the family‐, peer‐, school‐, and neighborhood‐level, to determine which contexts are related to obesity in adolescence and young adulthood.METHODS: We analyzed longitudinal data from Waves I (1994‐1995),II(1996), andIII(2001‐2002) of the National Longitudinal Study of Adolescent Health, a nationally representative population‐based sample of adolescents in grades 7‐12 in 1995 who were followed into young adulthood. We assessed the relationship between obesity in adolescence and young adulthood, and disadvantage (measured by low parent education in adolescence) at the family‐, peer‐, school‐, and neighborhood‐level using multilevel logistic regression.RESULTS: When all levels of disadvantage were modeled simultaneously, school‐level disadvantage was significantly associated with obesity in adolescence for males and females and family‐level disadvantage was significantly associated with obesity in young adulthood for females.CONCLUSIONS: Schools may serve as a primary setting for obesity prevention efforts. Because obesity in adolescence tracks into adulthood, it is important to consider prevention efforts at this stage in the life course, in addition to early childhood, particularly among disadvantaged populations.

Parents play an important role in influencing adolescent health behaviors and parenting practices may be an important pathway through which social disadvantage influences adolescent health behaviors that can persist into adulthood. This analysis uses the National Longitudinal Study of Adolescent Health to examine how parenting practices mediate the association between family socioeconomic disadvantage, measured as low parent education and family welfare/poverty status, and physical activity in adolescence and young adulthood for males and females. Results show that levels of parental control do not differ by family disadvantage. However, disadvantaged parents engage in lower levels of activities and communication with their children compared with nondisadvantaged parents. These behaviors serve to mediate the negative association between disadvantage and physical activity in adolescence, and are associated with physical activity in adulthood. Parenting is an important pathway through which disadvantage influences physical activity in adolescence and the transition to adulthood.

Racial/ethnic disparities in adolescent obesity in the U.S. are stark, and the causes of these disparities are largely unknown. We used a cumulative risk index (CRI) to examine the role of social risk in racial/ethnic disparities in obesity. Using the National Longitudinal Study of Adolescent Health and multinomial logistic regression, we examined the role of this CRI in disparities in obesity in the transition from adolescence to adulthood. Controlling for sociodemographic characteristics, compared with White females, Black and Hispanic females had roughly a 50% increase in the odds of newly-developed obesity in adulthood and a 90% increase in the odds of persistent obesity in adolescence and adulthood. After adding our CRI, the Black-White disparities were attenuated to statistical non-significance. Hispanic-White disparities did not change. There were no disparities in obesity for males. Our results suggest that social risk factors accumulate to explain Black-White disparities in obesity for females.