Geography matters: state-level variation in children's oral health care access and oral health status.

Objectives: To ascertain differences across states in children's oral health care access and oral health status and the factors that contribute to those differences.

Study Design: Observational study using cross-sectional surveys.

Methods: Using the 2007 National Survey of Children's Health, we examined state variation in parents' report of children's oral health care access (absence of a preventive dental visit) and oral health status.

An examination of racial/ethnic disparities in children's oral health in the United States.

Objective: To assess the extent factors other than race/ethnicity explain apparent racial/ethnic disparities in children's oral health and oral health care.

Methods: Data were from the 2007 National Survey of Children's Health, for children 2-17 years (n=82,020). Outcomes included parental reports of child's oral health status, receiving preventive dental care, and delayed dental care/unmet need.

Racial disparity trends in children's dental visits: US National Health Interview Survey, 1964-2010.

Background And Objective: Research that has repeatedly documented marked racial/ethnic disparities in US children's receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children's receipt of dental care from 1964 to 2010.

Methods: We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey.

The influence of social involvement, neighborhood aesthetics, and community garden participation on fruit and vegetable consumption.

Objectives: We considered the relationship between an urban adult population's fruit and vegetable consumption and several selected social and psychological processes, beneficial aesthetic experiences, and garden participation.

Methods: We conducted a population-based survey representing 436 residents across 58 block groups in Denver, Colorado, from 2006 to 2007. We used multilevel statistical models to evaluate the survey data.

The intersection of gender and race/ethnicity in smoking behaviors among menthol and non-menthol smokers in the United States.

Aims: To determine whether menthol is related to initiation, quantity or quitting, we examined differences in smoking behaviors among menthol and non-menthol smokers, stratified by gender and race/ethnicity, and adjusting for age, income and educational attainment.

Design: Cross-sectional, using data from the 2005 National Health Interview Survey and Cancer Control Supplement.

Setting: United States.

Assessing a multilevel model of young children's oral health with national survey data.

Objectives: To empirically test a multilevel conceptual model of children's oral health incorporating 22 domains of children's oral health across four levels: child, family, neighborhood and state.

Data Source: The 2003 National Survey of Children's Health, a module of the State and Local Area Integrated Telephone Survey conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, is a nationally representative telephone survey of caregivers of children.

Study Design: We examined child-, family-, neighborhood-, and state-level factors influencing parent's report of children's oral health using a multilevel logistic regression model, estimated for 26 736 children ages 1-5 years.

Prometheus payment model: application to hip and knee replacement surgery.

The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs.

State policy environment and delayed or forgone care among children with special health care needs.

Objective: To evaluate if children with special health care needs (CSHCN) residing in states with more generous public insurance programs were less likely to report delayed or forgone care.

Methods: We used multilevel modeling to evaluate state policy characteristics after controlling for individual characteristics. We used the 2001 National Survey of CSHCN for individual-level data (N=33,317) merged with state-level data, which included measures of the state's public insurance programs (Medicaid eligibility and enrollment, spending on Medicaid, SCHIP and Title V, and income eligibility levels), state poverty level and provider supply (including pediatric primary care and specialty providers).

Influences on children's oral health: a conceptual model.

Objectives: Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.

Low birthweight among US Hispanic/Latino subgroups: the effect of maternal foreign-born status and education.

We investigated whether maternal foreign-born status confers a protective effect against low birthweight (LBW) across US Hispanic/Latino subgroups (i.e., Mexicans, Puerto Ricans, Cubans and Central/South Americans) in the USA, and whether the association between maternal education and LBW varies by Hispanic/Latino subgroup and by foreign-born status.

The impact of public insurance expansions on children's access and use of care.

Objective: Our goal was to examine the impact of the State Children's Health Insurance Program nationally on children's access and use of health care.

Objective: Our data source was the National Health Interview Survey, using 1997 as a baseline, which predates the implementation of the State Children's Health Insurance Program, and 2003 as the end point of the analysis. We analyzed 25,734 children aged 0 to 18 years (1997 and 2003 combined) to examine changes in health insurance coverage rates, health care access, and utilization for children in the State Children's Health Insurance Program target population, defined here as those living in families with incomes between 100% and 199% of the federal poverty level.

Levels of analysis for the study of environmental health disparities.

Reducing racial/ethnic and socioeconomic environmental health disparities requires a comprehensive multilevel conceptual and quantitative approach that recognizes the various levels through which environmental health disparities are produced and perpetuated. We propose a conceptual framework that incorporates the micro level, contained within the local level, which in turn is contained within the macro level. We discuss the utility of multilevel techniques to examine environmental level (both physical and social) and individual-level factors to appropriately quantify and improve our understanding of environmental health disparities.

Disparities in children's use of oral health services.

Objectives: We sought to determine if the recent expansions in Medicaid and the State Children's Health Insurance Program (SCHIP) have resulted in a narrowing of income disparities over time with the use of dental care in children 2 to 17 years of age.

Methods: Six years of data from the National Health Interview Survey were utilized. A trend analysis was conducted using 1983 as a baseline, which predates the expansions, and 2001-2002, the endpoint, which postdates implementation of the expansions.

Neighborhood contextual influences on depressive symptoms in the elderly.

To understand whether neighborhood contexts contribute to the onset or maintenance of mental health problems independently of individual characteristics requires the use of multilevel study designs and analytical strategies. This study used a multilevel analytical framework to examine the relation between neighborhood context and risk of depressive symptoms, using data from the New Haven component of the Established Populations for Epidemiologic Studies of the Elderly, a community-based sample of noninstitutionalized men and women aged 65 years or older and living in the city of New Haven, Connecticut, in 1982. Neighborhoods were characterized by census-based characteristics and also by measures of the neighborhood service environment using data abstracted from the New Haven telephone book Yellow Pages.

The differential effect of foreign-born status on low birth weight by race/ethnicity and education.

Objectives: This article investigates whether foreign-born status confers a protective effect against low birth weight (LBW) and whether this protective effect varies across racial/ethnic groups and by socioeconomic status (ie, education) within various racial/ethnic groups.

Methods: Logistic regression analyses of the Detail Natality Data, 1998 (n = 2,436,890), were used to examine differentials in LBW by nativity across racial/ethnic groups and by education level.

Results: Although foreign-born status does not protect against LBW among white women (95% confidence interval [CI]: 0.

Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000.

Objectives: We sought to describe the burden of smoking on the US population, using diverse socioeconomic measures.

Methods: We analyzed data from the 2000 National Health Interview Survey.

Results: Overall, the prevalence of current smoking was greatest among persons in--and independently associated with--working class jobs, low educational level, and low income.

Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures--the public health disparities geocoding project (US).

Objectives: To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States.

Methods: Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6016425) or Rhode Island (RI; 1990 population = 1003464) for: STIs (MA: 1994-1998, n = 26535 chlamydia, 7464 gonorrhea, 2619 syphilis; RI: 1994-1996, n = 4473 chlamydia, 1256 gonorrhea, 305 syphilis); TB (MA: 1993-1998, n = 1793; RI: 1985-1994, n = 576), and non-fatal weapons related injuries (MA: 1995-1997, n = 6628).

Choosing area based socioeconomic measures to monitor social inequalities in low birth weight and childhood lead poisoning: The Public Health Disparities Geocoding Project (US).

Study Objectives: : To determine which area based socioeconomic measures can meaningfully be used, at which level of geography, to monitor socioeconomic inequalities in childhood health in the US.

Design: Cross sectional analysis of birth certificate and childhood lead poisoning registry data, geocoded and linked to diverse area based socioeconomic measures that were generated at three geographical levels: census tract, block group, and ZIP code.

Setting: Two US states: Massachusetts (1990 population=6,016,425) and Rhode Island (1990 population=1,003,464).

Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter?: the Public Health Disparities Geocoding Project.

Despite the promise of geocoding and use of area-based socioeconomic measures to overcome the paucity of socioeconomic data in US public health surveillance systems, no consensus exists as to which measures should be used or at which level of geography. The authors generated diverse single-variable and composite area-based socioeconomic measures at the census tract, block group, and zip code level for Massachusetts (1990 population: 6,016,425) and Rhode Island (1990 population: 1,003,464) to investigate their associations with mortality rates (1989-1991: 156,366 resident deaths in Massachusetts and 27,291 in Rhode Island) and incidence of primary invasive cancer (1988-1992: 140,610 resident cases in Massachusetts; 1989-1992: 19,808 resident cases in Rhode Island). Analyses of all-cause and cause-specific mortality rates and all-cause and site-specific cancer incidence rates indicated that: 1) block group and tract socioeconomic measures performed comparably within and across both states, but zip code measures for several outcomes detected no gradients or gradients contrary to those observed with tract and block group measures; 2) similar gradients were detected with categories generated by quintiles and by a priori categorical cutpoints; and 3) measures including data on economic poverty were most robust and detected gradients that were unobserved using measures of only education and wealth.

Using aggregate geographic data to proxy individual socioeconomic status: does size matter?

Objectives: This study assessed whether aggregate-level measures of socioeconomic status (SES) are less biased as proxies for individual-level measures if the unit of geographic aggregation is small in size and population.

Methods: National Health Interview Survey and census data were used to replicate analyses that identified the degree to which aggregate proxies of individual SES bias interpretations of the effects of SES on health.

Results: Ordinary least squares regressions on self-perceived health showed that the coefficients for income and education measured at the tract and block group levels were larger than those at the individual level but smaller than those estimated by Geronimus et al.

The effect of income inequality on the health of selected US demographic groups.

Objectives: This study assessed whether documented effects of income inequality on health are consistent across demographic subgroups of the US population.

Methods: Data from the National Health Interview Survey on White and Black non-Hispanics were used. Logistic regression models were estimated with SUDAAN software.

Aggregation and the measurement of income inequality: effects on morbidity.

This is a cross-sectional study using records from the National Health Interview Survey linked to Census geography. The sample is restricted to white males ages 25-64 in the United States from three years (1989-1991) of the National Health Interview Survey. Perceived health is used to measure morbidity.