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Objectives: To assess whether the use of firearms explains rural-urban differences in suicide rates. Methods: We performed a retrospective analysis on all 6196 well-characterized adult suicides in Maryland from 2003 through 2015. We computed rate ratios by using census data and then stratified by sex, with adjustment for age and race. Results: Suicide rates were higher in rural compared with urban counties. However, the higher rural suicide rates were limited to firearm suicides (incident rate ratio [IRR] = 1.66; 95% confidence interval [CI] = 1.20, 2.31). Nonfirearm suicide rates were not significantly higher in rural settings. Furthermore, 89% of firearm suicides occurred in men and the higher rural firearm suicide rate was limited to men (IRR = 1.36; 95% CI = 1.09, 1.69). Women were significantly less likely to complete suicide in rural areas (IRR = 0.63; 95% CI = 0.43, 0.94), regardless of method. Conclusions: Male firearm use drives the increased rate of suicide in rural areas. The opposite associations between urbanicity and suicide in men and women may be driven by the male preference for firearms as a method for committing suicide. [ABSTRACT FROM AUTHOR]

The authors offer their perspective on public health challenges in China, including child mortality, health disparities, unsafe food and environmental problems in the country. An overview of regional disparities in life expectancy in China, including higher life expectancy in Beijing, China, is provided.

Objectives. We examined the factors that affect access to municipal water and sewer service for unincorporated communities relying on wells and septic tanks. Methods. Using a multisite case study design, we conducted in-depth, semi-structured interviews with 25 key informants from 3 unincorporated communities in Hoke, New Hanover, and Transylvania counties, North Carolina, July through September 2013. Interviewees included elected officials, health officials, utility providers, and community members. We coded the interviews in ATLAS.ti to identify common themes. Results. Financing for water and sewer service emerged as the predominant factor that influenced decisions to extend these services. Improved health emerged as a minor factor, suggesting that local officials may not place a high emphasis on the health benefits of extending public water and sewer services. Awareness of failed septic systems in communities can prompt city officials to extend sewer service to these areas; however, failed systems are often under-reported. Conclusions. Understanding the health costs and benefits of water and sewer extension and integrating these findings into the local decision-making process may help address disparities in access to municipal services. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether voting patterns in the 2016 US presidential election were correlated with long-run trends in county life expectancy. Methods: I examined county-level voting data from the 2008 and 2016 presidential elections and assessed Donald Trump's share of the 2016 vote, change in the Republican vote share between 2008 and 2016, and changes in absolute numbers of Democratic and Republican votes. County-level estimates of life expectancy at birth were obtained for 1980 and 2014 from the Institute for Health Metrics and Evaluation. Results: Changes in county life expectancy from 1980 to 2014 were strongly negatively associated with Trump's vote share, with less support for Trump in counties experiencing greater survival gains. Counties in which life expectancy stagnated or declined saw a 10-percentage-point increase in the Republican vote share between 2008 and 2016. Conclusions: Residents of counties left out from broader life expectancy gains abandoned the Democratic Party in the 2016 presidential election. Since coming to power, the Trump administration has proposed cuts to health insurance for the poor, social programs, health research, and environmental and worker protections, which are key determinants of population health. Health gaps likely will continue to widen without significant public investment in population health. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine whether aggregate national data for American Indians/Alaska Natives (AIANs) mask geographic variation and substantial subnational disparities in prenatal care utilization. Methods. We used data for US births from 1995 to 1997 and from 2000 to 2002 to examine prenatal care utilization among AIAN and non-Hispanic White mothers. The indicators we studied were late entry into prenatal care and inadequate utilization of prenatal care. We calculated rates and disparities for each indicator at the national, regional, and state levels, and we examined whether estimates for regions and states differed significantly from national estimates. We then estimated state-specific changes in prevalence rates and disparity rates over time. Results. Prenatal care utilization varied by region and state for AIANs and non-Hispanic Whites. In the 12 states with the largest AIAN birth populations, disparities varied dramatically. In addition, some states demonstrated substantial reductions in disparities over time, and other states showed significant increases in disparities. Conclusions. Substantive conclusions about AIAN health care disparities should be geographically specific, and conclusions drawn at the national level may be unsuitable for policymaking and intervention at state and local levels. Efforts to accommodate the geographically specific data needs of AIAN health researchers and others interested in state-level comparisons are warranted. (Am J Public Health. 2010;100:122-128. doi:10.2105/AJPH.2008.148908) [ABSTRACT FROM AUTHOR]

Members of the public health and criminal justice disciplines often work with marginalized populations: people at high risk of drug use, health problems, incarceration, and other difficulties. As these fields increasingly overlap, distinctions between them are blurred, as numerous research reports and funding trends document. However, explicit theoretical and methodological linkages between the 2 disciplines remain rare. A new paradigm that links methods and statistical models of public health with those of their criminal justice counterparts is needed, as are increased linkages between epidemiological analogies, theories, and models and the corresponding tools of criminology. We outline disciplinary commonalities and distinctions, present policy examples that integrate similarities, and propose "epidemiological criminology" as a bridging framework. [ABSTRACT FROM AUTHOR]

Medicare research has shown that there are substantial disparities by race and socioeconomic status In use of services. In this article, I review past research and discuss how findings apply specifically to vulnerable men aged 65 years or older. Six lessons from this review are identified and illustrated here. Disparities in certain measures of health are growing; to reverse this trend, substantial efforts are needed, including dissemination of information about disparities as well as testing of hypotheses regarding underlying causes. (Am J Public Health. 2003;93:753-759) [ABSTRACT FROM AUTHOR]

Objectives. Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. Methods. A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. Results. Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than $9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). Conclusions. There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism. {Am J Public Health. 2002; 92:49-52) [ABSTRACT FROM AUTHOR]

Research on racism as a harmful determinant of population health is in its infancy. Explicitly naming a long-standing problem long recognized by those affected, this work has the potential to galvanize inquiry and action, much as the 1962 publication of the Kempe et al. scientific article on the "battered child syndrome" dramatically increased attention to — and prompted new research on — the myriad consequences of child abuse, a known yet neglected social phenomenon. To further work on connections between racism and health, the author addresses 3 interrelated issues: (1) links between racism, biology, and health; (2) methodological controversies over how to study the impact of racism on health; and (3) debates over whether racism or class underlies racial/ethnic disparities in health. (Am J Public Health. 2003;93:194-199) [ABSTRACT FROM AUTHOR]

This article provides an overview of the magnitude of and trends in racial/ethnic disparities in health for women in the United States. It emphasizes the importance of attending to diversity in the health profiles and populations of minority women. Socioeconomic status is a central determinant of racial/ethnic disparities in health, but several other factors, including medical care, geographic location, migration and acculturation, racism, and exposure to stress and resources also play a role. There is a need for renewed attention to monitoring, understanding, and actively seeking to eliminate racial/ethnic disparities in health. (Am J Public Health. 2002;92:588-597) [ABSTRACT FROM AUTHOR]

The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health. (Am J Public Health. 2003;93:200-208) [ABSTRACT FROM AUTHOR]

Reducing and eliminating disparities in health is a matter of life and death. Each year in the United States, thousands of individuals die unnecessarily from easily preventable diseases and conditions. It is critical that we approach this problem from a broad public health perspective, attacking all of the determinants of health: access to care, behavior, social and physical environments, and overriding policies of universal access to care, physical education in schools, and restricted exposure to toxic substances. We describe the historical background for recognizing and addressing disparities in health, various factors that contribute to disparities, how the public health approach addresses such challenges, and two successful programs that apply the public health approach to reducing disparities in health. Public health leaders must advocate for public health solutions to eliminate disparities in health. (Am J Public Health. 2008;98:400-403. doi:10.2105/ AJPH.2007.123919) [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine whether the association between neighborhood characteristics and health differs for people with and without a chronic condition. Methods. We analyzed data from 2536 adults from the Los Angeles Family and Neighborhood Survey and evaluated the relationship between the presence of a chronic condition at the individual level, neighborhood socioeconomic status (SES), and self-rated health. We constructed multilevel models to evaluate the relationship between the neighborhood SES index and self-rated health for people with and without chronic conditions, after adjustment for other individual characteristics. Results. Having a chronic condition was associated with substantially poorer self-rated health among participants in a deprived area than among those in a more advantaged area. Conclusions. Residence in a disadvantaged neighborhood may be associated with barriers to the management of a chronic condition. Further work is needed to identify the specific characteristics of disadvantaged areas associated with poorer self-rated health for adults with chronic conditions. [ABSTRACT FROM AUTHOR]

Prevention Institute, a nonprofit, national center dedicated to health and well-being, developed a toolkit for health and resilience in vulnerable environments (THRIVE), a community assessment tool, to help communities bolster factors that will improve health outcomes and reduce disparities experienced by racial and ethnic minorities. THRIVE is grounded in research and was developed with input from a national expert panel. It has demonstrated utility in urban, rural, and suburban settings. Within months of piloting, several communities had initiated farmer's markets and youth programs. THRIVE provides a framework for community members, coalitions, public health practitioners, and local decisionmakers to identify factors associated with poor health outcomes in communities of color; engage the range of partners needed to improve community health outcomes, such as planners, elected officials, businesses, housing, and transportation; and take action to remedy disparities. [ABSTRACT FROM AUTHOR]

In the current US political climate, conservative foundations are seeking to frame debates over determinants of racial/ethnic health disparities as a matter of "politically correct" unscientific ideology (concerning the health impacts of discrimination) vs scientific yet "politically incorrect" expertise rooted in biological facts (concerning genes). I draw on historical and contemporary examples to place conservative polemics in context, and also highlight fundamental flaws in their arguments involving the use of spurious categories (e.g., Caucasian), logical fallacies, temporal fallacies, and an erroneous emphasis on gene frequency over gene expression. The larger goal is to strengthen development of a more critical, reflexive, and rigorous science capable of generating evidence useful for rectifying--rather than perpetuating--social disparities in health. [ABSTRACT FROM AUTHOR]

This article reflects on the role of race and genetics in health disparities research. There are advantages and disadvantages in using a biological definition of race in medical research. Advantages include a delineation of genetic clusters by racial group and specificity of race of rare genetic variants. One of the disadvantages of using a biological definition of race in medical research is the premise that the species Homo sapiens consists of a single population and biologically distinct human races do not exist.

Much of the research on women's health has not deepened our understanding of health issues affecting Latinas. Yet integration of research on Latinas into the women's health agenda is important for at least 2 reasons. First, critical public health issues facing Latinas must be better understood if effective interventions designed to eliminate racial and ethnic disparities in health are to be developed and implemented. Second, studies on the health of Latinas represent unique opportunities to advance scientific understandings of underlying processes relevant to the health of other populations. Such research can further our knowledge of the processes underlying cultural adaptation and negotiation of changing sex roles and how these issues affect the health of women. Critical research and empirical approaches that help us to understand how race, ethnicity, sex, and class shape the health of Latinas will inform broader public health issues. (Am J Public Health. 2002;92: 525-529) [ABSTRACT FROM AUTHOR]

Objectives. This study assessed the contribution of age and other risk factors to racial disparities in rates of moderately low birthweight (MLBW; 1500-2499 g) and very low birthweight (VLBW: <1500 g). Methods. Logistic regression models were developed to determine the effects on MLBW and VLBW of maternal age, race, and poverty, adjusting for birth order, smoking, substance abuse, marital status, and educational level. The sample consisted of 158 174 singleton births to US-born African American and White women in New York City between 1987 and 1993. Results. The effects of maternal age on MLBW varied by race and poverty, with the most extreme effects among poor African American women. The effects of maternal age on VLBW also varied by race, but these effects were not moderated by poverty. Community poverty had a significant effect on MLBW among African American women, but no effect on VIBW. The adverse effect of older maternal age on MLBW and VLBW did not vary with community poverty. Conclusions. Older maternal age is associated with reduced birthweight among infants born to African American women, and the age effect is exacerbated by individual poverty. [ABSTRACT FROM AUTHOR]

The author reflects on the health disparities and incarcerated women in the U.S. He announced that the health of incarcerated women is worse than that of incarcerated men and than that of women in the general population. He mentions women prisoners are commonly cited for disciplinary offenses that are typically ignored within male institutions, and while they less violent than their male counterparts.

The author reflects on the importance of improving access to primary health care of poor men, the undeserved, and those living at the economic and social margins in the U.S. She observes that poor men and men of color who live with a tremendous amount of pain are demeaned and devalued in a system that rewards wealth and values some people over others, and die early. However, she announced that the Kellogg Foundation's trustees authorized $3 million for men's health initiative.

The author focuses on the eliminating health disparities especially to men of color who experienced the poorest health outcomes and face the biggest barriers to care in the U.S. He mentions that the men of color continue to struggle against oppression and discrimination that result lesser opportunities to employment, housing, education, and health. He suggests that the men of color must have health insurance coverage to ensure that they have access to culturally competent health care services.

The author reflects on the impact of racism and urban health in the U.S. He mentions that racism has been the primary form of group oppression with deep and penetrating roots that are firmly entrenched in the founding and earliest history in the U.S. He affirmed that the growing health disparities which are rooted from fundamental social structure inequalities pervade U.S. society.

The article responds to an issue article on heat-related mortality among U.S. citizens as compared with among U.S. non-citizen residents. Topics include problems with heat intervention measures among at-risk non-citizens, regional prevalence of heat deaths in the Southwestern U.S., and the need for more accurate reporting of heat-related deaths.

The article discusses the relation of local public health efforts to global effects of climate change. Topics include the regional disparities in climate-related health risks, the role of public health personnel in addressing the effects of climate change, and the roles of state and local governments in responding to climate change.

The author reflects on the issue pertaining to the moral economy of U.S. racial or ethnic health disparities. He mentions that moral economy refers to the norms that governs economic activity in a given society that deals on the ability of dominant groups to treat subordinated people. He added that the role of racism in the overall health of the nation provides the people with real opportunity to directly confront the moral economy that undergirds U.S. racial/ethnic health disparities.