Construction and validation of the area level deprivation index for health research: A methodological study based on Nepal Demographic and Health Survey.

Area-level factors may partly explain the heterogeneity in risk factors and disease distribution. Yet, there are a limited number of studies that focus on the development and validation of the area level construct and are primarily from high-income countries. The main objective of the study is to provide a methodological approach to construct and validate the area level construct, the Area Level Deprivation Index in low resource setting.

Colon cancer care of Hispanic people in California: Paradoxical barrio protections seem greatest among vulnerable populations.

We examined paradoxical and advantaging effects on cancer care among socioeconomically vulnerable Hispanic people in California. We secondarily analyzed a colon cancer cohort of 3,877 non-Hispanic white (NHW) and 735 Hispanic people treated between 1995 and 2005. A third of the cohort was selected from high poverty neighborhoods.

Obesity and the burden of health risks among the elderly in Ghana: A population study.

Background: The causes and health risks associated with obesity in young people have been extensively documented, but elderly obesity is less well understood, especially in sub-Saharan Africa. This study examines the relationship between obesity and the risk of chronic diseases, cognitive impairment, and functional disability among the elderly in Ghana. It highlights the social and cultural dimensions of elderly obesity and discusses the implications of related health risks using a socio-ecological model.

Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places.

Background: Better health care among Canada's socioeconomically vulnerable versus America's has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care.

Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014.

Palliative chemotherapy among people living in poverty with metastasised colon cancer: facilitation by primary care and health insurance.

Background: Many Americans with metastasised colon cancer do not receive indicated palliative chemotherapy. We examined the effects of health insurance and physician supplies on such chemotherapy in California.

Methods: We analysed registry data for 1199 people with metastasised colon cancer diagnosed between 1996 and 2000 and followed for 1 year.

Disparities Report: Disparities Among Minority Women With Breast Cancer Living in Impoverished Areas of California.

Background: Interaction effects of poverty and health care insurance coverage on overall survival rates of breast cancer among women of color and non-Hispanic white women were explored.

Methods: We analyzed California registry data for 2,024 women of color (black, Hispanic, Asian, Pacific Islander, American Indian, or other ethnicity) and 4,276 non-Hispanic white women (Anglo-European ancestries and no Hispanic-Latin ethnic backgrounds) diagnosed with breast cancer between the years 1996 and 2000 who were then followed until 2011. The 2000 US census categorized rates of neighborhood poverty.

Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context.

In Liberia, 75% of those who died from 2014 Ebola epidemic were women and the effects of this gruelling epidemic were more severely felt by pregnant women. This immediately raised fears about the long-term impacts of the epidemic on maternal and child health. As part of a larger study, this paper uses Andersen's behavioural model of health care utilization and Goffman's stigma theory to explain the timing and utilization of maternal health services before the outbreak of the Ebola epidemic as a background to the potential long-term effects on maternal health.

Cumulative effects of noise and odour annoyances on environmental and health related quality of life.

Noise and odour annoyances are important considerations in research on health effects of air pollution and traffic noise. Cumulative exposures can occur via several chemical hazards or a combination of chemical and stressor-based hazards, and related health outcomes can be generalized as manifestations of physiological and/or psychological stress responses. A major research challenge in this field is to understand the combined health effects of physiological and psychological responses to exposure.

Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada.

Background: Our research group advanced a health insurance theory to explain Canada's cancer care advantages over America. The late Barbara Starfield theorized that Canada's greater primary care-orientation also plays a critically protective role. We tested the resultant Starfield-Gorey theory by examining the effects of poverty, health insurance and physician supplies, primary care and specialists, on colon cancer care in Ontario and California.

Breast Cancer among Women Living in Poverty: Better Care in Canada than in the United States.

This historical study estimated the protective effects of a universally accessible, single-payer health care system versus a multi-payer system that leaves many uninsured or underinsured by comparing breast cancer care of women living in high poverty neighborhoods in Ontario or California between 1996 and 2011. Women in Canada experienced better care particularly as compared to women who were inadequately insured in the United States. Women in Canada were diagnosed earlier (rate ratio [RR] = 1.

Assessing traffic and industrial contributions to ambient nitrogen dioxide and volatile organic compounds in a low pollution urban environment.

Land use regression (LUR) modeling is an effective method for estimating fine-scale distributions of ambient air pollutants. The objectives of this study are to advance the methodology for use in urban environments with relatively low levels of industrial activity and provide exposure assessments for research on health effects of air pollution. Intraurban distributions of nitrogen dioxide (NO2) and the volatile organic compounds (VOCs) benzene, toluene and m- and p-xylene were characterized based on spatial monitoring and LUR modeling in Ottawa, Ontario, Canada.

Examining the Risk Factors Associated With Hypertension Among the Elderly in Ghana.

Objective: This study sought to examine the risk factors associated with hypertension among the elderly in Ghana. We focused on the association between chronic diseases, socioeconomic factors, and being hypertensive.

Method: Data for the study were drawn from Wave 1 of the 2007/2008 Ghana Study on Global Ageing and Adult Health (SAGE).

Multiplicative disadvantage of being an unmarried and inadequately insured woman living in poverty with colon cancer: historical cohort exploration in California.

Background: Many Americans diagnosed with colon cancer do not receive indicated chemotherapy. Certain unmarried women may be particularly disadvantaged. A 3-way interaction of the multiplicative disadvantages of being an unmarried and inadequately insured woman living in poverty was explored.

Gendered inequalities within Ghana's National Health Insurance Scheme: are poor women being penalized with a late renewal policy?

This article addresses the implications of the mandatory delay in coverage for individuals residing in the Upper West Region (UWR) of Ghana who have dropped out of the National Health Insurance Scheme (NHIS) but later attempt to reenroll. Using data collected in 2011 in Ghana's UWR, we use a negative log-log model (n=1,584) to compare those who remain enrolled in the scheme with those who have dropped out. Women with unreliable incomes, who reported being food-insecure and those living with young children were more likely to drop out (OR range: 1.

Lack of access to chemotherapy for colon cancer: multiplicative disadvantage of being extremely poor, inadequately insured and African American.

Background: Despite evidence of chemotherapy's ability to cure or comfort those with colon cancer, nearly half of such Americans do not receive it. African Americans (AA) seem particularly disadvantaged. An ethnicity by poverty by health insurance interaction was hypothesized such that the multiplicative disadvantage of being extremely poor and inadequately insured is worse for AAs than for non-Hispanic white Americans (NHWA).

Better colon cancer care for extremely poor Canadian women compared with American women.

Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged.

National health insurance scheme enrolment and antenatal care among women in Ghana: is there any relationship?

Objectives: The objective of this study was to examine whether enrolment in the National Health Insurance Scheme (NHIS) affects the likelihood and timing of utilising antenatal care among women in Ghana.

Methods: Data were drawn from the Ghana Demographic and Health Survey, a nationally representative survey collected in 2008. The study used a cross-sectional design to examine the independent effects of NHIS enrolment on two dependent variables (frequency and timing of antenatal visits) among 1610 Ghanaian women.

Care and survival of Mexican American women with node negative breast cancer: historical cohort evidence of health insurance and barrio advantages.

We hypothesized 3-way ethnicity by barrio by health insurance interactions such that the advantages of having adequate health insurance were greatest among Mexican American (MA) women who lived in barrios. Barrios were neighborhoods with relatively high concentrations of MAs (60% or more). Data were analyzed for 194 MA and 2,846 non-Hispanic white women diagnosed with, very treatable, node negative breast cancer in California between 1996 and 2000 and followed until 2011.

Extricating sex and gender in air pollution research: a community-based study on cardinal symptoms of exposure.

This study investigated sex and gender differences in cardinal symptoms of exposure to a mixture of ambient pollutants. A cross sectional population-based study design was utilized in Sarnia, ON, Canada. Stratified random sampling in census tracts of residents aged 18 and over recruited 804 respondents.

Health insurance mediation of the Mexican American non-Hispanic white disparity on early breast cancer diagnosis.

We examined health insurance mediation of the Mexican American (MA) non-Hispanic white (NHW) disparity on early breast cancer diagnosis. Based on social capital and barrio advantage theories, we hypothesized a 3-way ethnicity by poverty by health insurance interaction, that is, that 2-way poverty by health insurance interaction effects would differ between ethnic groups. We secondarily analyzed registry data for 303 MA and 3,611 NHW women diagnosed with breast cancer between 1996 and 2000 who were originally followed until 2011.

Hepatitis B in Ghana's upper west region: a hidden epidemic in need of national policy attention.

Like many countries in Sub-Saharan Africa, Hepatitis B virus (HBV) is highly prevalent in Ghana. Using qualitative methods, this paper draws from the political ecology of health theoretical framework to examine perceptions and understandings of HBV in the Upper West Region of Ghana. The findings reveal that extremely low levels of knowledge and pervasive lay misconceptions about the disease within this geographic context are shaped by large scale structural influences.

Mediation of the effects of living in extremely poor neighborhoods by health insurance: breast cancer care and survival in California, 1996 to 2011.

Background: We examined the mediating effect of health insurance on poverty-breast cancer care and survival relationships and the moderating effect of poverty on health insurance-breast cancer care and survival relationships in California.

Methods: Registry data for 6,300 women with breast cancer diagnosed between 1996 and 2000 and followed until 2011 on stage at diagnosis, surgeries, adjuvant treatments and survival were analyzed. Socioeconomic data were obtained for residences from the 2000 census to categorize neighborhoods: high poverty (30% or more poor), middle poverty (5%-29% poor) and low poverty (less than 5% poor).

Assessing the spatial distribution of nitrogen dioxide in London, Ontario.

Land use regression (LUR) models have been widely used to characterize the spatial distribution of urban air pollution and estimate exposure in epidemiologic studies. However, spatial patterns of air pollution vary greatly between cities due to local source type and distribution. London, Ontario, Canada, is a medium-sized city with relatively few and isolated industrial point sources, which allowed the study to focus on the contribution of different transportation sectors to urban air pollution.

Effects of being uninsured or underinsured and living in extremely poor neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996-2011.

Background: We examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California.

Methods: We analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor), middle poverty (5-29% poor) and low poverty (less than 5% poor).

Associations between self-reported odour annoyance and volatile organic compounds in 'Chemical Valley', Sarnia, Ontario.

Annoyance produced by air pollution has been suggested as a useful proxy for determining ambient air pollution exposure. However, most of the studies, to date, have focused on nitrogen dioxide and sulphur dioxide, with no work done on volatile organic compounds (VOC). This study is aimed at examining the associations between odour annoyance and VOC in 'Chemical Valley', Sarnia, Ontario, Canada.