Effects Of Medicaid Expansions On Coverage, Prenatal Care, And Health Among American Indian/Alaska Native Women.

American Indian/Alaska Native (AI/AN) women experience distinct political and health care environments and possess unique health risks and resources. We tested whether state Medicaid expansions under the Affordable Care Act were associated with health insurance, prenatal care, health conditions, and birth outcomes among AI/AN women. Using data from the 2010-19 American Community Survey and 2010-19 US birth certificates, we used a difference-in-differences study design to compare outcomes among AI/AN women before and after Medicaid expansions. Medicaid expansions increased the proportion of AI/AN women reporting health care coverage from both Medicaid and the Indian Health Service (IHS), with larger effects among women living in areas with relatively high percentages of reservation land. Consistent with prior research on the broader population of women, Medicaid expansions had no effects on first-trimester prenatal care usage or birthweight among AI/AN women. We found mixed evidence of increased rates of prepregnancy chronic conditions after the expansions. Our findings demonstrate the importance of Medicaid, the IHS, and tribal health systems as sources of health care coverage for AI/AN women of childbearing age.

County Social Vulnerability and Influenza Vaccine Rates: National and Local Estimates for Medicare Recipients.

INTRODUCTION: Seasonal influenza vaccination among older adults is well below the recommendation of Healthy People 2020. Although geographic disparities in influenza vaccination are well documented, it remains unclear how community attributes correlate with influenza vaccination rates. Social vulnerability measures play an important role in interventions addressing vaccine equity; however, social vulnerability dimensions as corollaries of vaccination are poorly understood. To inform vaccine equity interventions, this analysis investigates spatially varying associations between county social vulnerability and influenza vaccination rate among Medicare recipients. METHODS: County-level 2018 data (N=3,105) from the Centers for Disease Control and Prevention's Social Vulnerability Index were merged with the percentage of Medicare recipients vaccinated against influenza. Multilevel linear regression and geographically weighted regression generated global and local estimates, adjusted for potential confounders. Analyses were conducted in November 2020-April 2021. RESULTS: A 10-percentile point increase in the overall Social Vulnerability Index was associated with an 0.87-point decrease in percentage vaccinated (p<0.001) with substantial variation by Social Vulnerability Index theme and geography. A 10-percentile point increase in socioeconomic vulnerability was associated with a 1.6-point decrease in vaccination (p<0.001) with stronger associations in higher Social Vulnerability Index quartiles and in parts of the Midwest, South, and coastal Northeast. Other Social Vulnerability Index themes had smaller associations with mixed directions: household composition and disability estimates were negative, whereas estimates for minority status and language and housing and transportation were positive. CONCLUSIONS: Medicare recipients in socioeconomically vulnerable counties have low influenza vaccination rates, particularly in select regions of the country. Best practices to improve vaccine access and uptake should be targeted and should explicitly consider local socioeconomic vulnerability.

Strategies to Address COVID-19 Vaccine Hesitancy and Mitigate Health Disparities in Minority Populations.

Beyond the complex logistical task of prioritizing, distributing and safely storing millions of doses of COVID-19 vaccines, state and local governments must simultaneously devise and carry out transparent plans that center equity and overcome the barriers to vaccination facing minority communities. Using insights gleaned from four focus groups conducted with health care and social service professionals serving minority communities in New York State as well as from existing research on vaccination, our results emphasize that vaccine hesitancy and access barriers-particularly within minority communities-pose significant hurdles to achieving widespread uptake of COVID-19 vaccines. Overcoming barriers requires community-engaged campaigns that acknowledge and address the historical injustices and on-going inequities that drive distrust within communities of color, emphasize understandable and culturally appropriate messages that directly address people's concerns about vaccine safety and access, and tap existing community infrastructure to make full use of trusted voices to deliver timely and accurate information about vaccines. Given emerging data and changing conditions, campaigns must also be self-reflective and adaptive, assessing progress and outcomes and reevaluating strategies as needed. However, above all, primary goals should remain focused on transparency, equity and building trust.

Employer Verification Mandates and Infant Health.

In recent decades, several states have enacted their own immigration enforcement policies. This reflects substantial variation in the social environments faced by immigrants and native-born citizens, and has raised concerns about unintended consequences. E-Verify mandates, which require employers to use an electronic system to ascertain legal status as a pre-requisite for employment, are a common example of this trend. Drawing on birth certificate data from 2007-2014, during which 21 states enacted E-Verify mandates, we find that these mandates are associated with a decline in birthweight and gestational age for infants born to immigrant mothers with demographic profiles matching the undocumented population in their state as well as for infants of native-born mothers. In observing negative trends for both immigrants and natives, our findings do not support the hypothesis that E-Verify has a distinct impact on immigrant health; however, the broader economic, political, and demographic contexts that coincide with these policies, which likely impact the broader community of both immigrants and natives, may pose risks to infant health.

The short-term impacts of Earned Income Tax Credit disbursement on health.

BACKGROUND: There are conflicting findings regarding long- and short-term effects of income on health. Whereas higher average income is associated with better health, there is evidence that health behaviours worsen in the short-term following income receipt.Prior studies revealing such negative short-term effects of income receipt focus on specific subpopulations and examine a limited set of health outcomes. METHODS: The United States Earned Income Tax Credit (EITC) is an income supplement tied to work, and is the largest poverty reduction programme in the USA. We utilize the fact that EITC recipients typically receive large cash transfers in the months of February,March and April, in order to examine associated changes in health outcomes that can fluctuate on a monthly basis. We examine associations with 30 outcomes in the categories of diet, food security, health behaviours, cardiovascular biomarkers, metabolic biomarkers and infection and immunity among 6925 individuals from the U.S. National Health and Nutrition Survey. Our research design approximates a natural experiment,since whether individuals were sampled during treatment or non-treatment months is independent of social, demographic and health characteristics that do not vary with time. RESULTS: There are both beneficial and detrimental short-term impacts of income receipt.Although there are detrimental impacts on metabolic factors among women, most other impacts are beneficial, including those for food security, smoking and trying to lose weight. CONCLUSIONS: The short-term impacts of EITC income receipt are not universally health promoting, but on balance there are more health benefits than detriments.

Birth weight, infant mortality, and race: twin comparisons and genetic/environmental inputs.

Genetic and environmental inputs may shape population health disparities in varying ways. In this article, we use unique variation involved in twin births to attempt to untangle how genetic and prenatal environmental variation may make different contributions to infant health among white and black populations in the United States. Using twin fixed effects models and data from the 1995-1997 Matched Multiple Birth Dataset we compare birth weight-mortality associations across twin sex composition, zygosity, and race. Findings reveal suggestive differences between fraternal and imputed identical twin estimates for white and black twin pairs.

Aspirin use and cardiovascular events in social networks.

We tested whether friends' and family members' cardiovascular health events and also their own aspirin use are associated with the likelihood that an individual takes aspirin regularly. Analyses were based on longitudinal data on 2724 members of the Framingham Heart Study (based in Massachusetts, U.S.A.) who were linked to friends and family members who were also participants in the same study. Men were more likely to take aspirin if a male friend had recently been taking aspirin, and women were more likely to take aspirin if a brother had recently been taking aspirin. Men were also more likely to take aspirin if a brother recently had a cardiovascular event, and women were more likely to take aspirin if a female friend recently experienced a cardiovascular event. Aspirin use is correlated with the health and behavior of friends and family. These findings add to a growing body of evidence which suggests that behavioral changes that promote cardiovascular health may spread through social networks.

Health care segregation and race disparities in infectious disease: the case of nursing homes and seasonal influenza vaccinations.

Examining nursing home segregation and race disparities in influenza vaccinations, this study demonstrates that segregation may increase both susceptibility and exposure to seasonal flu for black Americans. Evidence based on the 2004 U.S. National Nursing Home Survey shows that individuals in nursing homes with high percentages of black residents have less personal immunity to flu because they are less likely to have been vaccinated against the disease; they may also be more likely to be exposed to flu because more of their coresidents are also unvaccinated. This implies that segregation may generate dual disease hazards for contagious conditions. Segregation appears to limit black Americans' access to personal preventive measures against infection, while spatially concentrating those people who are most likely to become contagious.

Job loss and health in the U.S. labor market.

While U.S. unemployment rates remain low, rates of job loss are high and rising. Job loss is also becoming increasingly common in more advantaged, white-collar occupations. This article is concerned with how these patterns impact the health of U.S. workers. Drawing on recent data from the U.S. Panel Study of Income Dynamics, I find that job loss harms health, beyond sicker people being more likely to lose their jobs. Respondents who lost jobs but were reemployed at the survey faced an increased risk of developing new health conditions; they were not, however, more likely to describe their health in negative terms. This suggests that recent job "churning" within the United States (i.e., high rates of job loss but low unemployment) may impact certain health outcomes but not others. I find no evidence that the health consequences of job loss differ across white- and blue-collar occupations, although health-related selection out of jobs appears stronger within the blue-collar category.

Twin differences in birth weight: the effects of genotype and prenatal environment on neonatal and post-neonatal mortality.

There is much evidence to suggest that both genes and prenatal environment influence life chances. However, recent within-twin estimates also raise questions about how the influence of genes and prenatal environment may vary across different subgroups of a population and over time. This paper explores such potential variation within the 1st year of life. Using data on twin births from the 1995-1997 Matched Multiple Birth Database and an analytic strategy based on the Weinberg assumption, this paper considers how associations between birth weight and infant mortality vary across identical and fraternal twins, gestational age, and time. Results suggest that the influence of genes and prenatal environment vary most significantly by gestational age. In pregnancies that lasted less than 37 weeks, within-twin variation in prenatal environment is able to account for negative associations between birth weight and infant mortality. However, in pregnancies that lasted 37 weeks or longer, underlying genetic variation across fraternal twins appears to be largely responsible for birth weight-mortality associations. Such distinct findings by gestation suggest that genes and prenatal environment may play varying roles in birth weight-mortality associations across different situations.

Reconsidering risk: adapting public policies to intergenerational determinants and biosocial interactions in health-related needs.

According to recent research, interactions between infant health and environment can play crucial roles in clustering health and economic disadvantage among certain families. Researchers have provided a clear example of such intergenerational biosocial cycles when they document that interactions between parental low birth weight status and prenatal environment are associated with the risk of a low birth weight, and that interactions between a child's birth weight status and early childhood environment are associated with adult socioeconomic outcomes. In this article, we consider how existing policies may be revised to more effectively address such interactions between social and biological risk categories. We are particularly concerned in this discussion with revising risk categories so they can encompass biological risk, social risk, and developmental frameworks. A framework of biosocial risk is quite flexible and may be applied to a variety of issues and programs; however, in this article we focus on the single case of low birth weight to illustrate our argument. In considering specific applications, we further explore how attention to biosocial interactions may reshape Medicaid, special education, the Earned Income Tax Credit, and Temporary Assistance for Needy Families.