The Effects of Race, Ethnicity, and Maternal Education on Infant Mortality.

BACKGROUND: The state of New Jersey has a large Black/African American (AA) versus White racial disparity in infant mortality and educational level at childbirth. This disparity, measured by rate ratio, increases with greater maternal education among varied racial-ethnic groups. The nature of this disparity measured by rate differences has not been explored. OBJECTIVES: Infant birth and mortality data were used to examine whether racial or ethnic disparities in infant mortality increased with greater maternal education, comparing rate differences and rate ratios. Racial and ethnic variations in the association between maternal education and infant mortality were examined. METHODS: Data were from the New Jersey State Health Assessment Data for all New Jersey births between 2014 and 2018 stratified by race and ethnicity, maternal education, and infant mortality ( n = 481,333). R software was used to create a data set and estimate additive and multiplicative interactions, rate differences, and rate ratios for infant mortality by maternal race/ethnicity and educational levels among four racial-ethnic groups. RESULTS: Infant mortality was significantly greater for Black/AA and Hispanic mothers than for White mothers. At all educational levels, Black/AA mothers had the highest prevalence of infant mortality compared to other racial or ethnic groups. Rate differences in infant mortality showed a decrease in Black/AA-White differences for mothers with a high school education or less compared to mothers with a college degree. However, rate ratios showed an increase in Black/AA-White ratio with increasing education levels for mothers with high school education or less than mothers with a college degree. Risk ratios comparing infant mortality for Black/AA versus Hispanic or Asian mothers showed more than a twofold greater risk at all education levels for Black/AA infants. Finally, college-educated Black/AA mothers had significantly higher rates of infant mortality than White or Hispanic mothers with a high school education or less. DISCUSSION/IMPLICATIONS: Black/AA mothers with a college degree had a higher infant mortality rate than White, Hispanic, or Asian mothers with a high school education or less. Future research should address contextual/systemic contributors to this disparity.

Interactions Between Forced Sexual Intercourse Victimization and Gender on Violent Behaviors: Youth Risk Behavior Survey 2017-2019.

In recent years, the United States has seen an increase in gun-related violence and school shootings. The Centers for Disease Control and Prevention (CDC) estimates that the incidence of gun carrying among high-school students has declined. Nevertheless, an examination of the underlying factors that increase the risk of violence-related behaviors is necessary to develop interventions to decrease gun use among high-school students. General Strain Theory (GST) predicts that victims of violence are (a) significantly more likely to engage in violent behaviors and (b) the increased risk of violent behavior by persons who experience violence is significantly greater among male victims. This research aims to test these predictions of the strain theory with data from the Youth Risk Behavior Survey (YRBS). To that end, it investigates whether the relationship between forced sexual intercourse victimization (FSIV) and gun or weapon carrying or physical fighting is significantly greater among male students. Using R and pooled data from the nationally representative YRBS (2017 and 2019), additive interactions were estimated according to Strengthening the Reporting of Observational Studies in Epidemiology guidelines to determine the association between FSIV and weapon carry, gun carry, or physical fighting. Multiplicative interactions and odds ratios were also estimated for comparison. Results show a high risk of gun and weapon carrying and physical fighting among both male and female students who experience FSIV and a significant relationship between FSIV and increased risk of these violence-related behaviors. Additive interactions show that the relationship between FSIV and these violent behaviors is each significantly greater among male students than female students. Results confirm the predictions of GST and show that FSIV significantly increases the risk of gun carrying and other violence-related behaviors among male and female U.S. high-school students; the increased risk is significantly greater among male students.

Beliefs and willingness towards participating in genetic testing for depression in low-income and racial/ethnic minority mothers at-risk.

PURPOSE: To identify mothers' salient normative, behavioral and control beliefs and willingness towards participating in genetic salivary testing for depression. DESIGN: A qualitative, descriptive design was employed. 41 multi-ethnic mothers completed surveys that underwent directed content analysis according to The Theory of Planned Behavior. Percentages and frequency counts were used to categorize responses and calculate willingness. FINDINGS: Salient beliefs included: Behavioral: Finding a cure/treatment for depression (29.3 %), Normative: Family would approve (46.3 %), and Church associates would disapprove (19.5 %). CONTROL: Lacking information/explanations (34.1 %) as barriers, convenient locations (24.4 %) as facilitators. Most mothers indicated a willingness to participate (90.2 %). CONCLUSIONS: Interventions should target families, emphasize benefits, explain purposes and procedures, and use community based participatory methods.

Additive interactions between sex and forced sexual intercourse victimization on depressive symptoms and suicidality: Youth risk behavior survey 2001-2017.

BACKGROUND: Adolescents who have been forced to have sexual intercourse have higher rates of depressive symptoms and suicidality. PURPOSE: This research investigated whether the association between adolescent forced sexual intercourse victimization and depressive symptoms or suicidality varies significantly by sex. METHOD: This secondary analysis pooled cross-sectional data from the Youth Risk Behavior Survey 2001 through 2017 (N = 132,580) using R to estimate adjusted risk differences and additive interactions. FINDINGS: Results show an extremely high prevalence of depressive symptoms and suicidality among adolescents who experience forced sexual victimization. This association is significantly higher among females for depressive symptoms, but significantly higher among males for suicide attempt or suicide attempt requiring treatment. RESULTS: also showed that approximately 40% of both males and females who attempted suicide requiring treatment also had a history of forced sexual intercourse victimization. DISCUSSION: These findings highlight the importance of screening for sexual victimization, depression and suicidality among adolescents.

Interactions Between Race/Ethnicity and Gender on Physical Activity Among US High School Students: Youth Risk Behavior Survey 2011-2017.

BACKGROUND/PURPOSE: Most adolescents do not meet the recommended amount of physical activity. Female, Black, and Hispanic students have significantly less physical activity than White male students. Physical activity of Asian or Multiple Race students have not been reported. The purpose of this research is to estimate differences in physical activity by race/ethnicity and gender among US high school students to examine whether Black Hispanic, Asian and multiple race female students and 11th grade and 12th grade female students have significantly lower physical activity levels. DESIGN/METHODS: This study is a secondary analysis of cross-sectional data from the high school Youth Risk Behavior Survey, a biennial, nationally representative survey of US high school students. Four waves of data were pooled from 2011 to 2017 YRBS (N = 59,397). Dependent variables were the number of active days per week a student was physically active, and whether the student was physically active for zero, 5 or more, or 7 days per week. Data were analyzed using R software. RESULTS: Asian students and students in grade 12 had the fewest number of physically active days per week. Female students were less physically active than male students. Significant negative interactions were measured in female gender by race/ethnicity (Black or Hispanic) and female gender by grade levels for the number of physically active days per week and for zero physically active days per week. The gender disparity in physical activity was significantly more pronounced among Black and Hispanic students. The reduction in physical activity by grade level was also significantly greater among female students. DISCUSSION: Efforts to increase physical activity are especially needed among Asian, Black, and Hispanic, and upper-grade female students. PRACTICAL IMPLICATIONS: Further research is needed to identify explanations and solutions for the significantly lower physical activity among Asians, female minority students, and students in upper grades.

Gender differences in the relationship between prescription opioid misuse and depressive symptoms and suicidality among US High School Students.

BACKGROUND: Prescription opioid misuse and suicide among adolescents are significant health challenges. PURPOSE: This study investigated whether effects of prescription opioid misuse on depressive symptoms and suicidality are greater among female than male students. METHODS: Using the 2017 Youth Risk Behavior Survey (N = 14,765), this research estimated additive interactions using risk differences as well as multiplicative interactions using odds ratios. DISCUSSION: Results showed prescription opioid misuse was associated with significantly greater risks among females than males for depressive symptoms (31.1% vs. 20.8%), suicidal ideation (27.3% vs. 19.1%), suicide attempts (18.1% vs. 11.9%) and suicide attempts requiring treatment (8.5% vs. 4.4%). In contrast, multiplicative interactions using odds ratios were all nonsignificant. CONCLUSIONS: Among students who misused prescription opioids, females compared to males had much higher average predicted margins of depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts requiring treatment. Screening for depression and suicidality among adolescents who misuse prescription opioids, and vice versa, is paramount.

Trends in Depressive Symptoms and Suicidality: Youth Risk Behavior Survey 2009-2017.

BACKGROUND: Death by suicide is the second leading cause of death among adolescents globally. Healthy People 2020 set a goal to reduce by 10% the rate of suicide attempts that required treatment and designated the Youth Risk Behavior Survey (YRBS) to measure this objective. OBJECTIVES: This study used cross-sectional YRBS data (2009-2017) to (a) investigate whether gender moderates the linear time trend for the rate of depressive symptoms, suicidal ideation, and suicide attempts among high school students within the United States; (b) estimate these same measures stratified by gender; and (c) investigate whether the Healthy People 2020 goal for reduction in suicide attempts was met in 2017 for males and females. METHODS: Secondary analysis of nationally representative high school students using YRBS data 2009-2017 were analyzed using R and the R survey package. Based on Strengthening the Reporting of Observational Studies in Epidemiology guidelines (STROBE), additive interactions using rate difference were compared to multiplicative interactions using odds ratios. RESULTS: Additive interactions were identified between female gender and linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Females, but not males, had positive linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Suicide attempts requiring treatment among females was 36% higher in 2017 than in 2009 but decreased 13% in males during the same period. DISCUSSION: The Healthy People 2020 goal to reduce suicide attempts requiring treatment by 10% has not been met among females. The divergent trends by gender highlight the importance of surveillance measures by gender. Future research is needed to identify better suicide prevention strategies that address underlying factors and are gender specific.

Additive Interactions Between Gender and Bullying Victimization on Depressive Symptoms and Suicidality: Youth Risk Behavior Survey 2011-2015.

BACKGROUND: Bullying victimization is common among adolescents and increases the likelihood of depressive symptoms and suicidality. Two previous meta-analyses have shown that these relationships do not significantly vary by gender. OBJECTIVES: This research investigated whether there are significant positive additive interactions between bullying victimization and female gender on depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts that required treatment. METHODS: For this research, analyses of pooled data from the 2011, 2013, and 2015 Youth Risk Behavior Survey (N = 44,632) were performed to estimate measures of additive interaction, as well as measures of multiplicative interaction in order to examine whether the relationship between bullying victimization and depressive symptoms or suicidality significantly varied by gender. RESULTS: Measures of additive interaction show that the magnitude of the relationship between bullying victimization and depressive symptoms or suicidality is significantly greater among female than male individuals. In contrast, measures of multiplicative interaction indicate that the magnitude of the relationship between bullying and depressive symptoms or suicidality is not significantly greater among female than male individuals. DISCUSSION: Measures of additive interaction are relevant for nursing and population health research. Future research should further explore how and why bullying victimization appears to more profoundly affect female individuals more than male individuals and how to mitigate it.

Trends in bullying victimization by gender among U.S. high school students.

This research used four consecutive waves of data from the National Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control (CDC), to estimate linear time trends by gender in the prevalence of school and electronic bullying victimization among U.S. high school students (N = 61,042). Dependent variables were student self-reported school bullying victimization and electronic bullying victimization during the previous 12 months. Independent variables used to estimate multiple logistic regression models by gender were survey year, race/ethnicity, and grade level. Results showed the prevalence of school bullying increased significantly among females from 2009 (21.2%) to 2015 (24.8%), linear trend OR = 1.08 [1.04, 1.12]; and decreased significantly among males from 2009 (18.7%) to 2015 (15.8%), linear trend OR = 0.93 [0.89, 0.98]. Prevalence of electronic bullying was unchanged between 2011 to 2015 among both male and female students. Asian race, relative to White race, was associated with significantly lower rates of both school and electronic bullying victimization among females, but not males. The incidence of school and electronic bullying victimization was significantly lower among Black and Hispanic students, but not among multiple-race students, regardless of student gender. Healthy People 2020 set a goal to reduce school bullying victimization 10% by 2019. As of 2015, school bullying victimization decreased significantly among males (16% decrease); it significantly increased among females (17% increase). Future research should explore underlying factors related to these divergent trends, and develop effective strategies to reverse the alarming rise in female school bullying victimization.

Sex Differences in the Relationship Between Asthma and Bullying Victimization Among High School Students in the United States.

BACKGROUND: Children with asthma are often marginalized at school, including bullying victimization. The purpose of this study is to estimate the association between asthma and school or electronic bullying victimization among US high school students, and test whether the association varies significantly by sex. METHODS: Pooled data from five waves of the Youth Risk Behavior Survey (N = 73,074) were used. Additive interactions were estimated in R software as per STROBE guidelines. RESULTS: Asthma increases the risk of bullying victimization among female and male adolescents. The risk of school bullying was significantly greater among female students with asthma (7.3%) compared to males (4.0%, p = .002). Similarly, the increased risk for electronic bullying victimization associated with asthma was significantly greater among female (7.2%) than among male students (3.4%, p < .001). CONCLUSIONS: Targeted educational interventions to decrease bullying victimization among adolescents with asthma are needed to mitigate its negative impacts.

Greater Physical Activity is Associated with Lower Rates of Anxiety and Depression Among Autistic and ADHD Youth: National Survey of Children's Health 2016-2020.

Data from the National Survey of Children's Health 2016-2020 was used to examine the association between physical activity and anxiety and depression among autistic youth, non-autistic youth with ADHD, and non-autistic non-ADHD youth. There was a significant negative association between physical activity and anxiety among all groups. Reduction in anxiety or depression associated with greater physical activity was at least as large or larger among autistic or nonautistic youth with ADHD than among non-autistic non-ADHD youth. Unfortunately, even autistic youth who were physically active 4 to 7 days a week showed very high rates of anxiety (54.5%) and depression (23.1%). Very high levels of dual diagnosis of anxiety and depression in autistic youth and youth with ADHD also emerged. Findings highlight a need to determine the cause-and-effect relationships among physical activity, anxiety, and depression across groups and to prioritize mental health screenings and support for autistic youth and youth with ADHD.

Heightened Anxiety and Depression Among Autistic Adolescents with ADHD: Findings From the National Survey of Children's Health 2016-2019.

Data from the National Survey of Children's Health 2016-2019 was used to examine the co-occurrence of autism and ADHD and the impact on anxiety and depression among adolescents age 12-17. Rates of anxiety and depression were up to ten-fold the prevalence of adolescents not diagnosed with autism or ADHD. Over half of autistic females (57%) and nearly half of autistic males (49%) are also diagnosed with ADHD. Autistic females with ADHD had the highest co-occurrence of anxiety at 72% followed by autistic males with ADHD at 69%. The prevalence of depression was highest among autistic adolescents with ADHD yet was consistent across genders (male/female) at 38-39%. Adolescents diagnosed with autism and/or ADHD are at heightened risk for anxiety and depression.

Additive Interactions Between School Bullying Victimization and Gender on Weapon Carrying Among U.S. High School Students: Youth Risk Behavior Survey 2009 to 2015.

The recent increase in the number of school shootings in the United States is a great concern. Consistent with General Strain Theory, previous research suggests that high school students who perpetrate gun violence have often experienced bullying victimization. This research investigated the interaction between gender and school bullying victimization on gun carrying, weapon carrying, and weapon carrying at school. Estimates of additive interaction were reported as recommended by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and compared with the estimates of multiplicative interaction. Data were used from a nationally representative survey of 61,042 U.S. high school students. Secondary analysis of pooled cross-sectional data from the 2009, 2011, 2013, and 2015 Youth Risk Behavior Survey was done, using R to estimate interactive effects on an additive scale between male gender and school bullying victimization on weapon carrying. A significant association was found between school bullying victimization, and gun and weapon carrying. Estimates of additive interaction show that the relationship between school bullying victimization and gun or weapon carrying is significantly greater among males than females as predicted by General Strain Theory. School bullying victimization increases the rate of gun and weapon carrying among all students, and especially among male students. Most mass school shooters are male and most of them experience some form of bullying victimization. Consequently, bullying prevention is likely to be important in a national effort to reduce gun and weapon violence in U.S. schools. This research also illustrates why estimates of adjusted risk differences and additive interactions should be reported for interpersonal violence research.

Sex differences in the relationship between prescription opioid misuse and gun and other weapon-carrying behaviors.

BACKGROUND: Previous research shows that adolescent prescription opioid misuse is strongly associated with weapon carrying. METHOD: For this research, data from the nationally representative 2017 Youth Risk Behavior Survey were analyzed. Average marginal predictions were estimated for gun and weapon carrying as a function of prescription opioid misuse and sex. As per STROBE guidelines, additive interactions with risk differences-in addition to multiplicative interactions with odds ratios and risk ratios-were estimated to investigate sex disparities in the effects of prescription opioid misuse on gun and other weapon-carrying. RESULTS: Male US high school students who misused prescription opioids had an especially high prevalence of gun and other weapon carrying. Additive interactions show significantly greater risk differences associated with prescription opioid misuse among male students compared to female students for gun carrying, weapon carrying, and weapon carrying at school. In contrast, multiplicative interactions show lower odds ratios and risk ratios among male students for these same weapon-carrying variables. DISCUSSION: Prescription opioid misuse is a significantly greater risk factor for gun and other weapon carrying among male US high school students, which disproportionately increases the risk for violence perpetration, including suicide among these students. Researchers should follow STROBE guidelines and report additive interactions and risk differences separately by sex when investigating risk factors associated with gun and other weapon carrying.

Health insurance sources for nonelderly patient visits to physician offices, hospital outpatient departments, and emergency departments in the United States.

The authors used data from nationally representative surveys to estimate health insurance sources for non-elderly patient visits to U.S. physicians. Results show that hospital emergency departments attract a greater share of ambulatory care visits by uninsured patients than by patients with either Medicaid or private insurance. Results also show that hospital outpatient departments attract a greater share of visits by uninsured patients or patients with Medicaid than by patients with private insurance. The annual visit rate of uninsured individuals for nonemergency care is less than half of that for individuals with either private insurance or Medicaid. The proportion of uninsured emergency department visits by individuals between the ages of 0 and 64 years was significantly greater than the proportion of uninsured individuals between the ages of 0 and 64 years. In contrast, the proportion of uninsured physician office visits by individuals between the ages of 0 and 64 years was significantly less than the proportion of uninsured individuals between the ages of 0 and 64 years.

Debiasing effects of education about appropriate antibiotic use on consumers' preferences for physicians.

A major goal of this research was to identify an antibiotic education intervention that would increase young adult consumers' preference for physicians who do not unnecessarily prescribe antibiotics for simple acute upper respiratory infections (URIs). Results clearly showed that consumers who read the CDC brochure entitled, "A New Threat to Your Health: Antibiotic Resistance" significantly preferred the physician who would not prescribe antibiotics for a URI on Day 3. They also inferred that this physician had significantly greater ability than the physician who would prescribe antibiotics. In contrast, consumers who did not read the CDC brochure significantly preferred the physician who would prescribe antibiotics for a URI on Day 3. They also inferred that this physician had significantly greater ability and greater concern for patients than the physician who would not prescribe antibiotics. Thus, consumers with low knowledge exhibited a treatment bias and preferred physicians who provided more treatment, and consumer education successfully reversed the treatment bias.

To treat or not to treat: evidence for "treatment bias" when consumers evaluate physicians.

Previous research has generally ignored whether consumers exhibit a "treatment bias" and have more favorable opinions of physicians who provide more treatment even if the benefits of more treatment are equivocal. This research experimentally manipulates three variables, (1) treatment choice (more treatment versus less treatment), (2) interpersonal treatment (patient involvement with treatment decisions), and (3) health outcomes, and examines their influence on respondent's inferences about the physician's ability, concern for patient welfare, quality of care, and accountability for patient death. Results clearly showed evidence of a treatment bias. Consumers made more favorable inferences about the physician in the more treatment condition even though both physicians acknowledged that the less treatment option was recommended for the patient. Results also showed that consumers' inferences about the physician were more favorable in the better health outcomes condition. There was no influence of patient involvement on consumers' inferences about the physician.