Immigration, Educational Attainment, and Subjective Health in the United States.

Objectives: Although educational attainment is a major social determinant of health, according to Marginalization-related Diminished Returns (MDRs), the effect of education tends to be weaker for marginalized groups compared to the privileged groups. While we know more about marginalization due to race and ethnicity, limited information is available on MDRs of educational attainment among US immigrant individuals. Aims: This study compared immigrant and non-immigrant US adults aged 18 and over for the effects of educational attainment on subjective health (self-rated health; SRH). Methods: Data came from General Social Survey (GSS) that recruited a nationally representative sample of US adults from 1972 to 2022. Overall, GSS has enrolled 45,043 individuals who were either immigrant (4,247; 9.4%) and non-immigrant (40,796; 90.6%). The independent variable was educational attainment, the dependent variable was SRH (measured with a single item), confounders were age, gender, race, employment and marital status, and moderator was immigration (nativity) status. Results: Higher educational attainment was associated with higher odds of good SRH (odds ratio OR = 2.08 for 12 years of education, OR = 2.81 for 13-15 years of education, OR = 4.38 for college graduation, and OR = 4.83 for graduate studies). However, we found significant statistical interaction between immigration status and college graduation on SRH, which was indicative of smaller association between college graduation and SRH for immigrant than non-immigrant US adults. Conclusions: In line with MDRs, the association between educational attainment and SRH was weaker for immigrant than non-immigrant. It is essential to implement two sets of policies to achieve health inequalities among immigrant populations: policies that increase educational attainment of immigrants and those that increase the health returns of educational attainment for immigrants.

Monday-Enhanced CEASE Program for Underserved Ethnic Minorities: a Mixed-Methods Study.

BACKGROUND: Due to the persistence of tobacco-related health disparities in the U.S., there is a need for innovative strategies to reach the underserved ethnic minority populations who are most at risk. As contemplations for health behavior modification tend to surge on Mondays, we explored the feasibility and effect of a Monday-enhanced smoking cessation program on quitting outcomes in a low-income ethnic minority community. AIMS: To compare a Monday-enhanced with a standard Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program and understand the overall experiences of participants in the program. METHODS: In this mixed-methods study, affordable housing complexes (n = 4) and a church were randomly assigned either a Monday-enhanced (n = 3) or standard (n = 2) CEASE smoking cessation program. CEASE comprised twelve weekly group counseling sessions facilitated by trained peer motivators plus nicotine replacement products. Participants in the Monday-enhanced arm were encouraged to pick Mondays as a quitting day. Quantitative and qualitative data were collected during the program and at 3-month post-graduation. RESULTS: Seventy-seven participants were enrolled in the study arms. In both groups combined, tobacco consumption reduced from 7.7 to 5.6 cig/day (mean reduction, 2.1; 95% CI: 0.9 to 5.1, p = 0.08). Although no significant difference in quit rate was observed between the two arms, more participants completed the follow-up survey in the Monday-enhanced than standard CEASE program [82.4% vs. 36.0%, p < 0.05]. While qualitative data suggested an overall satisfaction of participants with the program, motivation for quitting was higher in the Monday-enhanced CEASE program compared to the standard CEASE program. CONCLUSION: The Monday-enhanced program is promising and may enhance participants' engagement and willingness to quit smoking, particularly in low-income ethnic minority communities. Further research should include larger sample sizes to better assess the efficacy of a Monday-enhanced program across diverse populations.

Black Americans' Diminished Return of Educational Attainment on Tobacco Use in Baltimore City.

BACKGROUND: Socioeconomic status (SES) indicators such as educational attainment are fundamental factors affecting health. One mechanism through which education affects health is by reducing the likelihood of engaging in high-risk behaviors such as smoking. However, according to the marginalization-related diminished returns (MDRs) theory, the association between education and health may be weaker for marginalized populations such as Black than White, primarily due to racism and discrimination. However, little is known about the racial variations in the differential associations between educational attainment and tobacco use in a local setting. AIM: This study aimed to investigate the differential association between educational attainment and tobacco use among racial groups in a community sample in Baltimore City. METHODS: This cross-sectional study used data from a community survey conducted in 2012-2013 in Baltimore City among adults aged 18 years or older. The participants were 3501 adults. Univariate, bivariate, and logistic regression analyses were performed using Stata to investigate the racial difference in the association between education and two outcomes: current smoking status and menthol tobacco product use. RESULTS: The study found that adults with a graduate degree were less likely to be current smokers (adjusted odds ratio [AOR]: 0.10, 95% confidence interval [CI]: 0.08-0.13) and menthol tobacco users (AOR: 0.10, 95% CI: 0.07-0.14) compared to those with less than high school diploma. The inverse associations between educational attainment and current smoking (AOR: 1.83, 95% CI: 1.05-3.21) and menthol tobacco product use (AOR: 4.73, 95% CI: 2.07-10.80) were weaker for Back individuals than those who were White. CONCLUSION: Due to MDRs of educational attainment, while highly educated White adults show a low risk of tobacco use, educated Black adults remain at a disproportionately increased risk. The study emphasizes the need for better policies and programs that address minorities' diminished return of education for tobacco use.

Lessons learned to improve COVID-19 response in communities with greatest socio-economic vulnerabilities.

BACKGROUND: Vulnerable communities are susceptible to and disproportionately affected by the impacts of the COVID-19 pandemic. Understanding the challenges faced, perceptions, lessons learned, and recommendations of the organizations that provide services in response to COVID-19 to vulnerable communities is critical to improving emergency response and preparedness in these communities. METHODS: This study employed GIS mapping to identify the needs and assets that exist in communities in Baltimore City, where vulnerabilities related to social determinants of health and the burden of the COVID-19 pandemic were greatest. We also conducted an online survey between September 1, 2021, and May 30, 2022, to assess the COVID-19-related services provided by local organizations, challenges faced, perceptions, lessons learned, and recommendations to inform policies, programs, and funding related to improving the COVID-19 response in underserved communities. The survey was disseminated through the online Kobo Toolbox platform to leaders and representatives of organizations in Baltimore City. RESULTS: Based on GIS mapping analysis, we identified three communities as the most vulnerable and 522 organizations involved in the COVID-19 response across Baltimore City. 247 surveys were disseminated, and 50 survey responses were received (20.24% response rate). Out of these organizations, nearly 80% provided services in response to COVID-19 to the identified vulnerable communities. Challenges experienced ranged from funding (29%), and outreach/recruitment (26%), to not having access to updated and accurate information from local officials (32%). CONCLUSIONS: This research highlights critical insights gained related to the experiences of vulnerable populations and suggests ways forward to address challenges faced during the emergency response by providing recommendations for policy and program changes. Furthermore, the findings will help better prepare vulnerable communities for public health emergencies and build more community resilience.

Race by Education Intersectional Differences in Exposure to Tobacco Advertisement in Baltimore City.

Objective: This study aimed to examine the intersectional effects of race and educational attainment on tobacco advertising exposure among adults in Baltimore, given the growing evidence on differential influence of education for Black and White populations. Methods: A survey was conducted in Baltimore, collecting data on educational attainment, demographics, and tobacco advertising exposure among adults (n = 3028, 22.7% 18 - 29, 17.9% 30 - 39, 23.4% 40 - 49, 20.9% 50-59, and 11.1% 60+ years old). The sample included both Black and White adult individuals. Logistic regression analyses were employed to assess the association between educational attainment and tobacco advertising exposure, without and with interaction with race, adjusting for relevant covariates such as age, gender, and employment. Sensitivity analysis also controlled for smoking status. Results: The study results indicated that while high educational attainment is associated with less exposure to tobacco ads, highly educated Black adults report significantly higher tobacco advertising exposure compared to highly educated White adults. Same results were observed after controlling for smoking status. Conclusion: Educational attainment may not exhibit a large protective effect against environmental risks such as tobacco ad exposure for Black populations, possibly because of segregation and racism that hinder highly educated Black people ability to move to low-risk neighborhoods.

Building Capacity for Community-Academia Research Partnerships by Establishing a Physical Infrastructure for Community Engagement: Morgan CARES.

Research partnerships between universities and communities following the principles of community-based participatory research (CBPR) have the potential to eliminate cycles of health disparities. The purpose of this article is to describe the process of establishing a community-campus network with a distinct mission and vision of developing trusting and successful research partnerships that are sustained and effective. In 2019, Morgan CARES was established to facilitate community engagement by founding a community center "within" a low-income residential neighborhood as a safe and accessible hub for creating a vibrant learning community. A community needs assessment and asset mapping was conducted and several necessary resources and services were provided to maximize networking opportunities, nurture innovative ideas and proposals, and provide seed funding. Lessons learned informed the optimization of a theoretical model that has guided the development and implementation of the program's key components. By December 2021, Morgan CARES had recruited 222 community and 137 academic members representing diverse expertise from across Baltimore City. We also successfully established new partnerships and funded a total of 17 small community-academic awards. Although in its early stages, Morgan CARES has established a dynamic learning community following a conceptual framework that could guide future similar initiatives.

Trouble Sleeping and Depression Among US Women Aged 20 to 30 Years.

INTRODUCTION: Depression in women is common, and 1 woman in 4 is likely to have an episode of major depression at some point in her life. Sleep disturbances, which are significantly associated with depression, are increasingly recognized as a determinant of women's health and well-being. Although studies have examined the association between depression and sleep disorders, little research has explored this association among young women. Our study investigated the relationship between sleep problems and depression among women aged 20 to 30. METHODS: We used data on 1,747 women from the US National Health and Nutrition Examination Survey (NHANES) 2009-2016. In addition to univariate and bivariate analysis, we used unadjusted and adjusted logistic regression models to estimate depression in the previous 2 weeks among women who reported ever having trouble sleeping. RESULTS: Of 1,747 study participants, 19.6% reported trouble sleeping and 9.3% reported symptoms of depression. Weighted logistic regression results showed that women who had trouble sleeping were more than 4 times (odds ratio, 4.36; 95% confidence interval, 3.06-6.21; P < .001) more likely than women who did not have trouble sleeping to have had depression in the previous 2 weeks. The results were similar (adjusted odds ratio, 4.11; 95% confidence interval, 2.78-6.06; P < .001) after adjusting for other covariates. CONCLUSION: We found a significant relationship between trouble sleeping and depression among US women aged 20 to 30. Findings suggest the need for regular screening and treatment of sleep disturbances among young women, which may improve their psychological health and reduce depression.

Scaling up contraceptives use in the division with lowest contraceptives use in Bangladesh: sources, methods, and determinants.

BACKGROUND: Total fertility rate (TFR) is high and at a static level for the last two decades in Bangladesh. Reduction of fertility by increasing contraceptives use could reduce maternal and neonatal mortality. To achieve the targeted contraceptive prevalence rate (CPR) of Family Planning 2020 (FP2020) Initiative, it is important to increase CPR in all regions of the country. However, it is lower in Sylhet Division compared to other divisions in Bangladesh. This study looked into the methods, source and determinants of contraceptives use in this division. METHODS: Data from the Bangladesh Demographic and Health Survey 2014 (BDHS 2014) were analyzed. After reporting the sources of obtaining contraceptives and choice of methods, distributions of contraceptives use were reported by selected characteristics. Logistic regression was applied to calculate the odds ratios. RESULTS: A total of 599 women were analyzed. CPR was lower in rural areas compared to urban areas, 45.4% and 58.5%, respectively. The majority of the women received services from governmental sectors. The birth control pill was the most common contraceptive method. The proportion of women using long-acting permanent methods was low (<10%) in both urban and rural areas. In the multivariate analyses, number of alive children (adjusted odds ratio (AOR) of ≥5 children: 1.6, 95% confidence interval (CI): 1.1-2.2), presence of a male child (AOR: 1.7; 95% CI: 1.1-2.6), higher education level of the husband (AOR: 1.7; 95% CI: 1.1-2.6), receiving a visit from a family planning worker (AOR: 2.4; 95% CI: 1.6-3.4) and membership in a non-governmental organization (AOR:1.4, 95% CI: 1.1-1.8) were positively associated with contraceptives use in Sylhet after controlling for age, education level and other contextual factors. Conversely, rural women had the lower likelihood of using contraceptives (AOR: 0.6; 95% CI: 0.4-0.8) than urban women. Women's education level and religion were not statistically significant. CONCLUSIONS: A comprehensive strategy is required for this division to address multiple factors which simultaneously influence contraceptives use. In addition to more awareness programs to increase contraceptives use, providing contraceptive distribution services through family planning workers, involving women with non-governmental organizations and prioritizing rural areas could increase contraceptives use in Sylhet Division.

Factors affecting deliveries attended by skilled birth attendants in Bangladesh.

BACKGROUND: The presence of skilled birth attendants (SBAs) is crucial in childbirth to reduce the maternal mortality ratio (MMR) and to achieve the maternal mortality target of the United Nations' Sustainable Development Goals (SDGs). The aim of this study was to investigate the factors related to childbirths attended by SBAs in Bangladesh. METHODS: Data from the Bangladesh Demographic and Health Survey (2014 BDHS) were analyzed. Logistic regression was applied to calculate crude odds ratios (CORs), adjusted odds ratios (AORs), 95% confidence intervals (CIs), and p-values. RESULTS: In Bangladesh, 35.9% of deliveries were attended by SBAs, and 44.2% of those women received at least one antenatal check-up by a skilled provider. The deliveries by SBAs were less than 50% of the total deliveries in all divisions, excluding Khulna. Known pregnancy complications (AOR: 1.2; 95% CI: 1.1-1.4), higher level of education in both women (AOR: 1.7; 95% CI: 1.2-2.3) and their husbands (AOR: 1.8; 95% CI: 1.3-2.4), receiving antenatal care (ANC) by a skilled provider during the pregnancy period (AOR: 1.5; 95% CI: 1.1-2.1), and higher wealth quintiles (AOR: 3.4; 95% CI: 2.5-4.7) were all significantly associated with an increased likelihood of a delivery by SBAs (p <0.05). In contrast, women living in rural areas (AOR: 0.7; 95% CI: 0.6-0.8) and the Sylhet Division (AOR: 0.4; 95% CI: 0.3-0.5) were less likely to be delivered by SBAs. CONCLUSIONS: To achieve the target of the Government of Bangladesh - 50% of deliveries to be attended by SBAs - it is important to increase ANC services and awareness programs in all seven divisions of Bangladesh. Special focus in rural areas is also required to meet this target. A new study should be conducted to explore the unexamined factors associated with the presence of SBAs during childbirth.