Communication Policy to Reduce Health Disparities: A Cross-Language Content Analysis of YouTube Television Advertising.

INTRODUCTION: This study aimed to identify disparate health-related marketing across English- and Spanish-language television networks in New York City, ultimately to inform policy that can counteract disproportionate health-related marketing that provides harmful content to and withholds beneficial information from Latinx populations. METHODS: A 2-week composite sample of primetime English-language (National Broadcasting Company and Columbia Broadcasting System) and Spanish-language (Telemundo and Univision) television networks from YouTube television was randomly drawn from September 7, 2022 to September 27, 2022 in New York City. A total of 9,314 health-related television advertisements were identified for systematic media content analysis and coded into categories: alcohol, core or noncore foods/beverages, mental health/tobacco prevention, health insurance, medical centers, and pharmaceuticals. Analyses conducted in 2022-2024 included intercoder reliability and descriptive and rate difference estimates using total advertisement broadcasting time in the full sample and subsamples by language networks on YouTube television. RESULTS: Spanish television networks broadcast greater health-adverse advertisements per hour for alcohol (rate difference=4.91; 95% CI=3.96, 5.85) and noncore foods/beverages (rate difference=13.43; 95% CI=11.52, 15.34) and fewer health-beneficial advertisements per hour for mental health/tobacco prevention (rate difference= -0.99; 95% CI= -1.45, -0.54), health insurance (rate difference= -1.00; 95% CI= -1.44, -0.57), medical centers (rate difference= -0.55; 95% CI= -1.23, 0.12), and pharmaceuticals (rate difference= -5.72; 95% CI= -7.32, -4.11) than New York City primetime English television networks. CONCLUSIONS: Multilevel policy innovation and implementation are required to mitigate primetime television marketing strategies that contribute to health inequities.

Exposing Pittsburgh Landlords To Asset-Framing Narratives: An Experiment To Increase Housing Voucher Participation.

Landlords are essential actors within the rental housing market, and there is much to be learned about their willingness to participate in rental assistance programs that improve access to stable housing. Because the success of these programs, such as the Mobility (Location-Based) Voucher program in Pittsburgh, Pennsylvania, can be derailed by landlord opposition, it is important to test strategies that increase landlords' participation. Using data from a unique survey of Pittsburgh landlords, we found that exposing landlords to an asset-framing narrative that highlighted the social, economic, and health benefits of receiving a mobility voucher increased landlords' reported willingness to rent to a mobility voucher recipient by 21 percentage points. Reported willingness was also higher among landlords who believed that housing affordability was connected to health. Our findings offer insight into how to increase landlords' participation in affordable housing programs that require their engagement to succeed.

Relationships, race/ethnicity, gender, age, and living kidney donation evaluation willingness.

Racial/ethnic and gender disparities in living donor kidney transplantation are large and persistent but incompletely explained. One previously unexplored potential contributor to these disparities is differential willingness to donate to recipients in specific relationships such as children, parents, and friends. We collected and analyzed data from an online sample featuring an experimental vignette in which respondents were asked to rate their willingness to donate to a randomly chosen member of their family or social network. Results show very large differences in respondents' willingness to donate to recipients with different relationships to them, favoring children, spouses/partners, siblings, and parents, and disfavoring friends, aunts/uncles, and coworkers. Evidence suggesting an interactive effect between relationship, respondent race/ethnicity, respondent or recipient gender, was limited to a few cases. At the p < 0.05 level, the parent-recipient gender interaction was statistically significant, favoring mothers over fathers, as was other/multiracial respondents' greater willingness to donate to friends compared to Whites. Additionally, other interactions were significant at the p < 0.10 level, such as Hispanics' and women's higher willingness to donate to parents compared to Whites and men respectively, women's lower willingness to donate to friends compared to men, and Blacks' greater willingness to donate to coworkers than Whites. We also examined differences by age and found that older respondents were less willing to donate to recipients other than their parents. Together these results suggest that differential willingness to donate by relationship group may be a moderately important factor in understanding racial/ethnic and gender disparities in living donor kidney transplantation.

Social network interventions to reduce race disparities in living kidney donation: Design and rationale of the friends and family of kidney transplant patients study (FFKTPS).

INTRODUCTION: Racial/ethnic disparities in living donor kidney transplantation (LDKT) are a persistent challenge. Although nearly all directed donations are from members of patients' social networks, little is known about which social network members take steps toward living kidney donation, which do not, and what mechanisms contribute to racial/ethnic LDKT disparities. METHODS: We describe the design and rationale of the Friends and Family of Kidney Transplant Patients Study, a factorial experimental fielding two interventions designed to promote LKD discussions. Participants are kidney transplant candidates at two centers who are interviewed and delivered an intervention by trained center research coordinators. The search intervention advises patients on which social network members are most likely to be LKD contraindication-free; the script intervention advises patients on how to initiate effective LKD discussions. Participants are randomized into four conditions: no intervention, search only, script only, or both search and script. Patients also complete a survey and optionally provide social network member contact information so they can be surveyed directly. This study will seek to enroll 200 transplant candidates. The primary outcome is LDKT receipt. Secondary outcomes include live donor screening and medical evaluations and outcomes. Tertiary outcomes include LDKT self-efficacy, concerns, knowledge, and willingness, measured before and after the interventions. CONCLUSION: This study will assess the effectiveness of two interventions to promote LKD and ameliorate Black-White disparities. It will also collect unprecedented information on transplant candidates' social network members, enabling future work to address network member structural barriers to LKD.

How Facebook is used to promote ENDS products near four Big 10 universities: A qualitative analysis.

Objective: Electronic Nicotine Delivery System (ENDS) proprietors strategically placed near college campuses and pervasive marketing on social media platforms, such as Facebook, are critical to the tobacco industry's effort to acquire new young adult users. Understanding the themes used on Facebook to promote ENDS products to college students is necessary to develop public health messaging to combat the vaping epidemic.Methods: We identified 15 ENDS proprietors located near four Big 10 universities and qualitatively analyzed a random sample of their Facebook posts (n = 405) to identify emerging themes using a grounded theory approach.Results: ENDS proprietors in college towns use Facebook to deploy promotional messaging (n = 319), to market ENDS products as a means of celebration (n = 40), to establish a sense of community (n = 155) among ENDS users, to make marijuana references (n = 36), and to advocate (n = 27) for ENDS products.Conclusions: These themes may increase social acceptability and use of ENDS products among college students.

Racial/ethnic and prior willingness disparities in potential living kidney donors' self-assessed responses to advancing American kidney health regulation.

BACKGROUND: Racial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order- Advancing American Kidney Health (AAKH)- sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes. METHODS: Data from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents' likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses. RESULTS: Majorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not. CONCLUSIONS: Regulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.

Health Savings Plans and Disparities in Access to Care by Race and Ethnicity.

INTRODUCTION: High-deductible health plans are often touted to motivate patients to become informed healthcare purchasers; however, racial/ethnic minorities report that high deductibles prevent them from seeking the needed care. One proposed way to mitigate the financial burden of high-deductible health plans is the use of health savings plans. This cross-sectional study investigates whether chronically ill Blacks and Hispanics enrolled in high-deductible health plans experience greater access to care difficulties than non-Hispanic Whites and whether racial/ethnic disparities are mitigated by the use of health savings plans. METHODS: Weighted, multivariate, linear probability regression models were estimated (analyses were conducted in December 2020), adjusting for individual attributes and contextual factors that may explain the variation in health care access. Chronically ill, U.S.-born Black, Hispanic, and White adults enrolled in a high-deductible health plan from the National Health Interview Survey in 2011-2018 were included. Associations were tested among 3 independent variables-being Black, being Hispanic, and health savings plan utilization (and their interaction)-and access to healthcare outcomes of interest, including affordability-related access, provider-related access, and delayed care. RESULTS: Blacks and Hispanics were less likely to use health savings plans, and Blacks were more likely to experience problems with access to health care. Although the use of health savings plans was found to have a minimal effect on reducing racial/ethnic disparities in affordability-related access, there was also evidence that health savings plans compounded racial/ethnic disparities in provider-related access. CONCLUSIONS: Understanding how health savings plans function to improve access to care within racial/ethnic minority groups may help to inform policy approaches related to their use.

Building the case for housing policy: Understanding public beliefs about housing affordability as a key social determinant of health.

BACKGROUND: The current housing crisis in the U.S. requires the consideration and promotion of policies that improve the circumstances of severe housing cost burdens. Building public awareness of the health impacts associated with housing affordability may be a key prerequisite for policy change. METHODS: Quantitative and qualitative data from a national survey were used to investigate public understandings about housing affordability as a key driver of health. Quantitative and qualitative findings were integrated to test whether any relationships existed between respondents' considerations and concerns about housing affordability and their perceptions about housing affordability as a social determinant of health. FINDINGS: These data support four key findings. First, understandings of the relationship between affordable housing and health are partisan and income-based driven, with Republicans and high-income respondents less likely to acknowledge the effects of housing affordability on health. Second, varied frames of communication about the relationship between housing affordability and health may produce significantly different reactions among political and income subgroups.Third, while there is considerable agreement that housing affordability promotes health when using forced-choice measures, connections between affordable housing and health are not readily volunteered. Finally, the themes of personal responsibility and stability and security significantly resonate with Republicans and high-income earners. CONCLUSIONS: Contextualizing the issue of housing affordability within various domains in ways that effectively resonate with the American public and policymakers and across political and income spectra, is highly imperative.

Examining public knowledge and preferences for adult preventive services coverage.

INTRODUCTION: To examine (1) what individuals know about the existing adult preventive service coverage provisions of the Affordable Care Act (ACA), and (2) which preventive services individuals think should be covered without cost sharing. METHODS: An online panel from Survey Monkey was used to obtain a sample of 2,990 adults age 18 and older in March 2015, analyzed 2015-2017. A 17-item survey instrument was designed and used to evaluate respondents' knowledge of the adult preventive services provision of the ACA. Additionally, we asked whether various preventive services should be covered. The data include age, sex, race/ethnicity, and educational attainment as well as measures of political ideology, previous insurance status, the number of chronic conditions, and usual source of care. RESULTS: Respondents correctly answered 38.6% of the questions about existing coverage under the ACA, while on average respondents thought 12.1 of 15 preventive services should be covered (SD 3.5). Respondents were more knowledgeable about coverage for routine screenings, such as blood pressure (63.4% correct) than potentially stigmatizing screenings, such as for alcohol misuse (28.8% correct). Blood pressure screening received the highest support of coverage (89.8%) while coverage of gym memberships received the lowest support (59.4%). Individuals with conservative ideologies thought fewer services on average should be covered, but the difference was small-around one service less than those with liberal ideologies. CONCLUSIONS: Overwhelmingly, individuals think that most preventive services should be covered without cost sharing. Despite several years of coverage for preventive services, there is still confusion and lack of knowledge about which services are covered.

The medicalization of obesity, bariatric surgery, and population health.

This article examines how the medicalization of obesity validates the use of bariatric surgery to treat obesity in the United States and how expansions in access to bariatric surgery normalize surgical procedures as disease treatment and prevention tools. Building on this discussion, the article poses two questions for population health regarding health technology: (1) to what extent does bariatric surgery treat obesity in the United States while diverting attention away from the ultimate drivers of the epidemic and (2) to what extent does bariatric surgery improve outcomes for some groups in the US population while simultaneously generating disparities? We conduct a brief, historical analysis of the American Medical Association's decision to reclassify obesity as a disease through internal documents, peer-reviewed expert reports, and major media coverage. We use medicalization theory to show how this decision by the American Medical Association channels increased focus on obesity into the realm of medical intervention, particularly bariatric surgery, and use this evidence to review research trends on bariatric surgery. We propose research questions that investigate the population health dimensions of bariatric surgery in the United States and note key areas of future research. Our objective is to generate a discourse that considers bariatric surgery beyond the medical realm to better understand how technological interventions might work collectively with population-level obesity prevention efforts and how, in turn, population health approaches may improve bariatric surgery outcomes.

Increasing public support for food-industry related, obesity prevention policies: The role of a taste-engineering frame and contextualized values.

BACKGROUND: Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectively produce support for new obesity policies. METHODS: We use an online survey experiment to test the effects of exposure to a taste-engineering frame (TEF), the value of consumer knowledge (CK), or the value of consumer safety (CS), on level of support for a range of policies. A random sample of adults, age 18 + living in the United States was included in the study (N = 2580). Ordered logistic regression was used to measure the effects of treatment exposure. The primary outcome was level-of-support for four (4) food-industry related, obesity prevention policies (aka food and beverage policies): 1) require food-manufacturers to disclose the amount of additives in food products on food packaging; 2) require food-manufacturers to advertise food products in accordance with their actual nutritional value; 3) prohibit all high-fat, high-sugar food advertising on television programming watched primarily by children; and 4) increase healthy food availability in work sites, schools, and hospitals. FINDINGS: These data suggest that a taste-engineering frame and contextualized values significantly increase public support for many of the food and beverage policies tested. CONCLUSIONS: Applying a taste-engineering frame and/or contextualized values to address obesity advances a population-based policy agenda to counteract the effects of food-industry strategies.

The Quality of Diabetes Management Among Mexican Adults in California: Does Generational Status Matter?

BACKGROUND: Although there is increasing knowledge regarding the association between generational status on diabetes risk, less is known about the effects of generational status on diabetes management among Mexicans. OBJECTIVES: We test whether generational status is associated with variations in diabetes processes of care among Mexican adults to optimize disease management. RESEARCH DESIGN: Weighted multivariate logistic regression was used to test the association between generational status on the quality of diabetes care processes and health care utilization adjusting for socioeconomic/demographic factors. Four generational cohorts were constructed: first generation immigrant; second generation; generation 2.5; and third generation. SUBJECTS: We conducted analyses of 3072 self-identified foreign and US-born Mexican adults with diabetes who participated in the 2005, 2007, 2009, and 2011/2012 California Health Interview Surveys. MEASURES: Three diabetes process outcomes were measured, including receipt of at least 1 eye examination, 1 foot examination, or 1 hemoglobin A1C test (HbA1c) in the past year. One secondary prevention outcome was measured, receipt of an annual influenza vaccine. Finally, we measured whether an individual with diabetes received an annual doctor visit. RESULTS: A gradient of progressively decreased odds of receiving an eye examination and HbA1c test were observed and significant for most of the higher generations. Higher generations also had significantly decreased odds of receiving an annual flu vaccine. CONCLUSIONS: Data collection on generational granularity and a specific focus on mixed acculturation status can vitally inform health system improvements in diabetes care among Mexicans in the United States.

Weighing in: the taste-engineering frame in obesity expert discourse.

OBJECTIVES: We sought expert opinion on the problems with 2 dominant obesity-prevention discourse frames-personal responsibility and the environment-and examined alternative frames for understanding and addressing obesity. METHODS: We conducted 60-minute, semistructured interviews with 15 US-based obesity experts. We manually coded and entered interview transcripts into software, generating themes and subthematic areas that captured the debate's essence. RESULTS: Although the environmental frame is the dominant model used in communications with the public and policymakers, several experts found that communicating key messages within this frame was difficult because of the enormity of the obesity problem. A subframe of the environmental frame--the taste-engineering frame--identifies food industry strategies to influence the overconsumption of certain foods and beverages. This emerging frame deconstructs the environmental frame so that causal attributes and responsible agents are more easily identifiable and proposed policies and public health interventions more salient. CONCLUSIONS: Expert interviews are an invaluable resource for understanding how experts use frames in discussing their work and in conversations with the public and policymakers. Future empirical studies testing the effectiveness of the taste-engineering frame on public opinion and support for structural-level health policies are needed.

Race/ethnicity and the relationship between homeownership and health.

OBJECTIVES: We investigated whether race/ethnicity moderates the association between homeownership and health and whether this association is the same for racial/ethnic minorities as for non-Latino Whites. METHODS: With data on US-born Latinos, African Americans, and non-Latino Whites from the 2003, 2005, 2007, and 2009 California Health Interview Survey, we used weighted multivariate regression techniques in fully adjusted models, controlling for socioeconomic and demographic factors, to test the association between homeownership and number of psychological health conditions, number of general health conditions, self-perceived health status, and health trade-offs. RESULTS: Race/ethnicity significantly moderates the effect of homeownership on self-perceived health status, incidence of general health conditions, and health trade-offs, including delays in accessing medical care and delays in obtaining prescription medication. Although homeownership was a robust, independent predictor for each health outcome in the non-Latino White population, the association disappeared in statistical significance for racial/ethnic minorities. CONCLUSIONS: The mechanisms that create a significant association between homeownership and health seem not to be operative for racial/ethnic minorities or are countervailed by other processes, such as possible housing insecurity, that may create an adverse association. Homeownership provides a baseline for future investigations.

The value of social-cognitive theory to reducing preschool TV viewing: a pilot randomized trial.

OBJECTIVE: To (a) reduce the total amount of television viewing to which preschool children are exposed; and (b) shift the balance of exposure away from commercial television toward educational content. METHOD: Randomized controlled clinical trial. Data collected in 2007; analyzed 2008-2011. Participants were 67 English-speaking families in Seattle with a preschool-aged child exposed to more than 90 min of television viewing on average per day. A case manager for each group used in-person conferences, monthly newsletters, and e-mail contact to motivate behavior change around child television viewing (intervention) or child safety (control). RESULTS: Compared to those in the control group, families randomized to the intervention group experienced a significant reduction by 37 minutes/day in total viewing time (95% CI: 5.6-68.7), including a marginally significant reduction by 29 minutes/day in viewing of commercial content (95% CI: -4.6-63). Compared to those in the control group, those in the intervention group experienced a positive change in outcome expectations. There were no significant changes in self-efficacy or volitional control. An advance in stage-of-change was marginally significant. CONCLUSIONS: Targeting commercial TV viewing may prove a successful behavioral intervention to achieve public health goals in this population.