The long-term health effects of childhood exposure to social and economic policies: A scoping review.

While numerous studies have found a relationship between social and economic policies and short-term health outcomes, fewer studies have explored the long-term health effects of these policies. Given the important association between childhood circumstances and health in adulthood, long-term population health consequences should be considered when designing social and economic policies. This review summarizes the existing literature on the long-term effects of childhood exposure to social and economic policies on adult health, summarizes the findings, the methods employed, and indicates areas for future research. The review process followed the JBI scoping review protocol and PRISMA-ScR reporting guidelines. The search was conducted in three electronic databases (Web of Science, Pub Med, and SCOPUS), and focused on peer-reviewed manuscripts that studied the effects of policy exposures during childhood on health in adulthood. A total of 3471 articles were collected from the databases and 18 were identified as meeting the eligibility criteria. The most commonly studied policies were safety-net policies (N = 6), followed by education policies (N = 5), civil rights policies (N = 3), government investments (N = 3), and child labor laws (N = 1). The health outcomes varied and included chronic conditions, mental health, mortality, and self-rated health. The studies also overwhelmingly employed causal inference techniques (N = 13), including difference-in-differences study designs and instrumental variable analysis. Most studies found long-term positive effects of policies that provided extra resources to historically under-resourced populations, or policies that aimed to increase equality of opportunity. However, there were some studies with null or mixed findings, especially when examining the long-term health effects of education reform. More literature is needed on this important topic, and now is the time to capitalize on longer follow-up periods in currently available data.

Structural Sexism and Preventive Health Care Use in the United States.

Preventive health care use can reduce the risk of disease, disability, and death. Thus, it is critical to understand factors that shape preventive care use. A growing body of research identifies structural sexism as a driver of population health, but it remains unknown if structural sexism is linked to preventive care use and, if so, whether the relationship differs for women and men. Gender performance and gendered power and resource allocation perspectives lead to competing hypotheses regarding these questions. This study explores the relationship between structural sexism and preventive care in gender-stratified, multilevel models that combine data from the Behavioral Risk Factor Surveillance System with state-level data (N = 425,454). We find that in states with more structural sexism, both men and women were less likely to seek preventive care. These findings support the gender performance hypothesis for men and the gendered power and resource allocation hypothesis for men and women.

State-level data on TANF policy changes during the COVID-19 pandemic.

OBJECTIVE: COVID-19 mitigation measures prompted many states to revise the administration of their welfare programs. States adopted policies that varied across the U.S. to respond to the difficulties in fulfilling program requirements, as well as increased financial need. This dataset captures the changes made to Temporary Assistance for Needy Families (TANF) programs during the COVID-19 pandemic, from March 2020 through December 2020. The authors created this dataset as part of a larger study that examined the health effects of TANF policy changes during the COVID-19 pandemic. DATA DESCRIPTION: TANF is the main cash assistance program for low-income families in the U.S., but benefits are often conditional on work requirements and can be revoked if an individual is deemed noncompliant. Structural factors during the COVID-19 pandemic made meeting these criteria more difficult, so some states relaxed their rules and increased their benefits. This dataset captures 24 types of policies that state TANF programs enacted, which of the states enacted each of them, when the policies went into effect, and when applicable, when the policies ended. These data can be used to study the effects of TANF policy changes on various health and programmatic outcomes.

Easing Cash Assistance Rules During COVID-19 Was Associated With Reduced Days Of Poor Physical And Mental Health.

Unemployment rates soared at the beginning of the COVID-19 pandemic in the US, increasing financial stress that can affect physical and mental health. Temporary Assistance for Needy Families (TANF) is the primary cash assistance program for low-income families in the US, with benefits conditional on work activities and subject to suspension. However, many states loosened requirements during the pandemic. Using TANF policy data and data from the Behavioral Risk Factor Surveillance System from the period January 2017-December 2020 with a triple-difference design, we found a general protective effect of supportive changes to TANF on poor physical and mental health days and binge drinking during the COVID-19 pandemic for likely TANF participants. For example, providing emergency cash benefits to those not already participating in TANF, waiving work requirements, waiving or pausing sanctions, and automatically recertifying benefits were associated with reductions in the number of mentally unhealthy days. This study provides support for increasing generosity and easing administrative burdens in safety-net programs to buffer against negative impacts of public health and economic crises.

Men's Use of Economic Coercion Against Women in Rural Bangladesh.

Objective: Bangladesh is historically a patriarchal society, but has made recent strides in increasing educational and economic opportunities for women. Yet men continue to perpetrate economic coercion and other forms of intimate partner violence against women in Bangladesh. This study examines how men in rural Bangladesh shape the economic activities of their wives within the context of changing norms around women's involvement in economic domains. Men's perspectives are not often explored in the literature and can provide valuable insight into how and why economic coercion persists. Method: 25 in-depth interviews were conducted with men in rural Bangladesh and analyzed using thematic analysis. Results: Men engaged in economically coercive practices, both implicitly and explicitly. Three themes captured how men perpetrated economic coercion: they held gendered expectations about how and if women should participate in economic activities, they monitored women's activities to ensure they conformed to the men's gendered expectations, and they placed explicit restrictions on women's economic activities to align with and maintain gender inequitable norms. Conclusion: These findings call attention to how men continue to see themselves as dominant over women in rural Bangladesh, despite the progress made in expanding educational and economic opportunities for women. The analysis points to the need for interventions that go beyond increased access to educational and economic programs for women to address the persistence of gender inequitable norms within patriarchal societies.

Extreme response style bias in burn survivors.

This paper explores extreme response style to the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a measure of social participation in burn survivors. We fit a Multidimensional Generalized Partial Credit Model (MGPCM) with a positive extreme response style (PERS) factor and compared this model with the original MGPCM, estimated the impact that PERS has on scores, and examined the personal characteristics that may result in an individual more likely to respond in a fashion that would inflate their true low scores. The average impact of the PERS, based upon the root mean squared bias, ranged from 0.27 to 0.50 of a standard deviation of the scale. Individuals who were older, had participated in a burn survivor support group, and had selected to self-administer the measure were less likely to have a high PERS bias that masks low scores. Future work can consider PERS when measuring the psychosocial impacts of burn injuries and other health conditions.

Social Participation of Burn Survivors and the General Population in Work and Employment: A Life Impact Burn Recovery Evaluation (LIBRE) Profile Study.

INTRODUCTION: Work integration and retention after burn injury is a key outcome. Little is known about how burn survivors reintegrate into the workplace. This article compares scores on the Life Impact Burn Recovery Evaluation (LIBRE) Profile, a burn-specific measure of social participation, between burn survivors and general population samples, focusing on the Work and Employment domain. METHODS: Convenience samples of burn survivors and the U.S. population were obtained. Differences in demographic and clinical characteristics and LIBRE Profile scores were assessed. To examine work and employment, we compared family and friends, social activities, and social interactions scores among working vs nonworking burn survivors. RESULTS: Six hundred and one burn survivors (320 employed) and 2000 U.S. residents (1101 employed) were surveyed. The mean age (P = .06), distributions of sex (P = .35), and Hispanic ethnicity (P = .07) did not differ significantly. Distributions of race (P < .01) and education (P = .01) differed significantly. The burn survivor sample had higher scores, demonstrating higher participation, for work and employment (mean = 49.5, SD = 9.42) than the general sample (mean = 46.94, SD = 8.94; P < .0001), which persisted after adjusting for demographic characteristics. Scores on the three domains administered to all respondents were higher (P < .001) for working than nonworking burn survivors. CONCLUSION: Distributions indicated higher social participation in the burn survivor sample than the general sample. Possible explanations include sample bias; resilience, posttraumatic growth, or response-shift of survivors; and limitations of using items in the general sample. Working burn survivors scored higher than those not working. Future work can explore factors that mediate higher scores and develop interventions.

Reliability & validity of the LIBRE Profile.

BACKGROUND: The Life Impact Burn Recovery Evaluation (LIBRE) Profile© was developed using Item Response Theory methods to assess social participation after a burn injury. The LIBRE Profile measures six areas of social participation: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. It can be administered through a computerized adaptive test or through fixed short forms. The goal of this study was to further examine the psychometric properties of the LIBRE Profile, including reliability and validity. METHODS: We examined the validity of the LIBRE Profile by administering the six LIBRE Profile scales as well as legacy measures that assessed similar constructs. We calculated the Pearson correlations between the LIBRE Profile scales and the scores on the same-domain and cross-domain legacy measures to evaluate convergent and divergent validity. We then administered the LIBRE Profile scales a second time, seven to ten days after the first administration, to a sample of adult burn survivors to evaluate test-retest reliability. We calculated repeatability coefficients, standard error of measurement, and minimal detectable change to establish the threshold beyond which the amount of change observed across an episode of care cannot be explained as measurement error. RESULTS: For reliability, the repeatability coefficients ranged from 7.31 to 9.27 and SEMs ranged from 2.62 to 3.39 for all six scales. MDC90 values ranged from 6.08 to 7.86 points, and MDC95 values ranged from 7.26 to 9.40 points. All correlations between the LIBRE Profile scales and legacy measures are significant (p<0.05) and in the expected directions for both convergent and divergent validity. CONCLUSIONS: This study provided evidence for the reliability and validity of the LIBRE Profile, one of the first tools that measures exclusively the social participation after a burn injury.

Social Interactions and Social Activities After Burn Injury: A Life Impact Burn Recovery Evaluation (LIBRE) Study.

Social interactions and activities are key components of social recovery following burn injuries. The objective of this study is to determine the predictors of these areas of social recovery. This study provides a secondary analysis of a cross-sectional survey of adult burn survivors. The Life Impact Burn Recovery Evaluation-192 was administered to 601 burn survivors for the field-testing of the Life Impact Burn Recovery Evaluation Profile. Survivors aged 18 years and older with injuries ≥5% total BSA or burns to critical areas (hands, feet, face, or genitals) were eligible to participate. Multivariate linear regression analyses were used to determine predictors of the Social Activities and Social Interactions scale scores. A total of 599 people completed the Social Interactions and Social Activities scales. Of these, 77% identified as White Non-Hispanic, 55% were female, 55% were unmarried, and 80% had burns to critical areas. Participants had a mean age of 45 years, a mean time since burn injury of 15 years, and a mean burn size of 41% total BSA. Younger age (P < .01) and being married/living with a significant other (P ≤ .01) were associated with higher Social Activities and Social Interactions scale scores. Individual item responses reveal that survivors had lower scores on items related to participating in outdoor activities (30.4%) or feeling uncomfortable with their appearance (32.4% report dressing to avoid stares). Social interactions and activities are long-term challenges for burn survivors. It is important for clinicians to identify patients who may struggle with social recovery in order to focus on future community-based interventions.

The Associations of Gender With Social Participation of Burn Survivors: A Life Impact Burn Recovery Evaluation Profile Study.

Burn injury can be debilitating and affect survivors' quality of life in a profound fashion. Burn injury may also lead to serious psychosocial challenges that have not been adequately studied and addressed. Specifically, there has been limited research into the associations of burn injury on community reintegration based on gender. This work analyzed data from 601 burn survivors who completed field testing of a new measure of social participation for burn survivors, the Life Impact Burn Recovery Evaluation (LIBRE) Profile. Differences in item responses between men and women were examined. Scores on the six LIBRE Profile scales were then compared between men and women using analysis of variance and adjusted linear multivariate regression modeling. Overall, men scored significantly better than women on four of the six LIBRE Profile scales: Sexual Relationships, Social Interactions, Work & Employment, and Romantic Relationships. Differences were not substantially reduced after adjustment for demographic characteristics and burn size. Men scored better than women in most of the areas measured by the LIBRE Profile. These gender differences are potentially important for managing burn patients during the post-injury recovery period.

Development of clinical process measures for pediatric burn care: Understanding variation in practice patterns.

BACKGROUND: There has been little systematic examination of variation in pediatric burn care clinical practices and its effect on outcomes. As a first step, current clinical care processes need to be operationally defined. The highly specialized burn care units of the Shriners Hospitals for Children system present an opportunity to describe the processes of care. The aim of this study was to develop a set of process-based measures for pediatric burn care and examine adherence to them by providers in a cohort of pediatric burn patients. METHODS: We conducted a systematic literature review to compile a set of process-based indicators. These measures were refined by an expert panel of burn care providers, yielding 36 process-based indicators in four clinical areas: initial evaluation and resuscitation, acute excisional surgery and critical care, psychosocial and pain control, and reconstruction and aftercare. We assessed variability in adherence to the indicators in a cohort of 1,076 children with burns at four regional pediatric burn programs in the Shriners Hospital system. The percentages of the cohort at each of the four sites were as follows: Boston, 20.8%; Cincinnati, 21.1%; Galveston, 36.0%; and Sacramento, 22.1%. The cohort included children who received care between 2006 and 2010. RESULTS: Adherence to the process indicators varied both across sites and by clinical area. Adherence was lowest for the clinical areas of acute excisional surgery and critical care, with a range of 35% to 48% across sites, followed by initial evaluation and resuscitation (range, 34%-60%). In contrast, the clinical areas of psychosocial and pain control and reconstruction and aftercare had relatively high adherence across sites, with ranges of 62% to 93% and 71% to 87%, respectively. Of the 36 process indicators, 89% differed significantly in adherence between clinical sites (p < 0.05). Acute excisional surgery and critical care exhibited the most variability. CONCLUSION: The development of this set of process-based measures represents an important step in the assessment of clinical practice in pediatric burn care. Substantial variation was observed in practices of pediatric burn care. However, further research is needed to link these process-based measures to clinical outcomes. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

Developing Item Response Theory-Based Short Forms to Measure the Social Impact of Burn Injuries.

OBJECTIVE: To develop self-reported short forms for the Life Impact Burn Recovery Evaluation (LIBRE) Profile. DESIGN: Short forms based on the item parameters of discrimination and average difficulty. SETTING: A support network for burn survivors, peer support networks, social media, and mailings. PARTICIPANTS: Burn survivors (N=601) older than 18 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The LIBRE Profile. RESULTS: Ten-item short forms were developed to cover the 6 LIBRE Profile scales: Relationships with Family & Friends, Social Interactions, Social Activities, Work & Employment, Romantic Relationships, and Sexual Relationships. Ceiling effects were ≤15% for all scales; floor effects were <1% for all scales. The marginal reliability of the short forms ranged from .85 to .89. CONCLUSIONS: The LIBRE Profile-Short Forms demonstrated credible psychometric properties. The short form version provides a viable alternative to administering the LIBRE Profile when resources do not allow computer or Internet access. The full item bank, computerized adaptive test, and short forms are all scored along the same metric, and therefore scores are comparable regardless of the mode of administration.

Development of the life impact burn recovery evaluation (LIBRE) profile: assessing burn survivors' social participation.

PURPOSE: Measuring the impact burn injuries have on social participation is integral to understanding and improving survivors' quality of life, yet there are no existing instruments that comprehensively measure the social participation of burn survivors. This project aimed to develop the Life Impact Burn Recovery Evaluation Profile (LIBRE), a patient-reported multidimensional assessment for understanding the social participation after burn injuries. METHODS: 192 questions representing multiple social participation areas were administered to a convenience sample of 601 burn survivors. Exploratory factor analysis and confirmatory factor analysis (CFA) were used to identify the underlying structure of the data. Using item response theory methods, a Graded Response Model was applied for each identified sub-domain. The resultant multidimensional LIBRE Profile can be administered via Computerized Adaptive Testing (CAT) or fixed short forms. RESULTS: The study sample included 54.7% women with a mean age of 44.6 (SD 15.9) years. The average time since burn injury was 15.4 years (0-74 years) and the average total body surface area burned was 40% (1-97%). The CFA indicated acceptable fit statistics (CFI range 0.913-0.977, TLI range 0.904-0.974, RMSEA range 0.06-0.096). The six unidimensional scales were named: relationships with family and friends, social interactions, social activities, work and employment, romantic relationships, and sexual relationships. The marginal reliability of the full item bank and CATs ranged from 0.84 to 0.93, with ceiling effects less than 15% for all scales. CONCLUSIONS: The LIBRE Profile is a promising new measure of social participation following a burn injury that enables burn survivors and their care providers to measure social participation.