AJPH July 2015 highlights

Date: Jul 16 2015

Contact: For copies of articles or full table of contents of an issue, call Kimberly Short, 202-777-2511 or email her.

American Journal of Public Health highlights:

1. Very low probability of attaining normal weight among obese people 
2. Rate of newborn circumcision may be linked to type of health insurance 
3. Health care providers hold implicit and explicit biases based on sexual orientation

Very low probability of attaining normal weight among obese people 
Over a nine-year period, the likelihood of obese people reaching normal weight is very low, according to new research from the American Journal of Public Health.

The UK-based study reviewed patient electronic medical records from the world’s largest primary care database, UK Clinical Practice Research Datalink. Researchers analyzed patterns of body mass index from 278,982 men and women over the age of 20. Specifically, the analysis which spanned from 2004 to 2014, focused on the proportion of patients that attained normal body weight and the proportion of patients that attained five percent weight loss annually. Patients receiving bariatric surgery were not included in the study sample.

Results from the study indicated that the annual chance of patients with simple obesity (BMI 30-35) attaining a normal body weight was 1 in 124 women and 1 in 210 men. The likelihood of attaining normal weight decreased as BMI increased in which 1 in 1290 morbidly obese men and 1 in 677 morbidly obese women attained normal weight annually. However, the probability for attaining a 5 percent decrease in BMI was 1 in 8 for men with morbid obesity and 1 in 7 for women.

“These findings raise questions concerning whether current obesity treatment frameworks, grounded in weight management programs accessed through primary care, may be expected to achieve clinically relevant and sustained reductions in BMI for the vast majority of obese patients and whether they could be expected to do so in the future,” the authors suggest.

[“What is the Probability of an obese person attaining normal body weight: Cohort study using electronic health records.” Contact: Alison Fildes, PhD, University College London, London, United Kingdom]

Rate of newborn circumcision may be linked to type of health insurance 
New research from the American Journal of Public Health finds the recent decrease in the incidence of male newborn circumcision may be linked to state Medicaid plans no longer covering the procedure and shifts in coverage of birth hospitalizations from private insurance to Medicaid.

Researchers reviewed male newborn birth hospitalizations from a sample of hospital discharge data known as the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, to which 45 states contribute data. Trends in circumcision incidence were assessed between 2000 and 2010, with particular interest in whether the birth hospitalization was covered by private insurance or Medicaid.

Results from the study indicate that between 2000 and 2010, circumcision incidence decreased from 61.3 percent to 56.9 percent. Overall, births covered by Medicaid have a lower incidence of circumcision compared to births under private insurance. A notable decrease was observed in the South among births covered by Medicaid. Of note, during this time period many states’ Medicaid no longer covered circumcision. In addition there was a shift, with an increase in the proportion of birth hospitalizations covered by Medicaid.

“Efforts should be made to reduce insurance barriers to newborn circumcision for families that desire the procedure,” the authors conclude.

[“Impact of health insurance type on trends in newborn circumcision, United States, 2000 to 2010.” Contact: media@cdc.gov, Centers for Disease Control and Prevention, Atlanta, Georgia]

Health care providers hold implicit and explicit biases based on sexual orientation
New research from the American Journal of Public Health finds that heterosexual health providers, similar to non-providers, reported moderate to strong implicit preferences for straight people over lesbian women and gay men.

Researchers used results from the Sexuality Implicit Association Test developed to assess presence of implicit bias towards either heterosexual, lesbian and gay individuals. The IAT captured demographic data and test results for more than 200,000 participants between May 2006 and December 2012. In addition, all test takers indicated their explicit preferences towards heterosexual, gay people by endorsing statements ranging from “I strongly prefer straight people to gay people” to “I strongly prefer gay people to straight people.” Using demographic information, the study also categorized each respondent as a medical doctor, nurse, mental health provider, other treatment provider or non-provider to assess attitudes specifically from health care providers.

Results indicated that heterosexual health providers expressed moderate to strong implicit preferences for heterosexual people over lesbian and gay people. In addition, lesbian and gay health providers expressed implicit and explicit preferences for lesbian and gay people over straight people. Bisexual providers were found to have mixed preferences, mental health providers held the weakest implicit bias for heterosexual people and nurses held the strongest implicit bias for heterosexual people.

“For health care organizations that aim to serve these populations, these data suggest an opportunity to examine methods likely to mitigate implicit biases, such as eliminating discretion from decision-making, use of clinical guidelines, awareness of personal bias as self-caution, organizational policies that promote objective decision-making, and inclusion of counter-stereotypical experiences in educational programs,” the authors conclude.

They further note, “education to reduce sexual prejudice is a growing area of intervention and future research should examine how providers’ implicit and explicit preferences toward sexual orientation affect delivery of care to members of sexual minority populations.”

[“Health care providers’ implicit and explicit attitudes toward lesbian women and gay men.” Contact: Janice Sabin, PhD, MSW, University of Washington, Seattle, Washington]

Find a full list of research papers that were published online on July 16, 2015, at 4 p.m. EDT below:
• Disparities in Reportable Communicable Disease Incidence by Census Tract-Level Poverty, New York City, 2006-2013 
• The Impact of Vaccine Concerns on Racial/ Ethnic Disparities in Influenza Vaccine Uptake Among Healthcare Workers 
• Understanding Trends in Pertussis Incidence: An Agent-based Model Approach
• The Impact of Economic Constraints on Public Health Delivery Systems Structures
• What is the Probability of an Obese Person Attaining Normal Body Weight? Cohort Study Using Electronic Health Records 
• Effectiveness of an Alternative Dental Workforce Model on the Oral Health of Low Income Children in a School-Based Setting 
• How Much Safety-Net Care Could a Mid-level Dental Practitioner Provide? A case study of the portion of care that might be performed under various setting and scope-of-practice assumptions 
• Grab a Cup, Fill it Up! An Intervention to Promote the Convenience of Drinking Water and Increase Student Water Consumption During School Lunch. 
• Vulnerable Bullies: Perpetration of Peer Harassment in Youth Across Sexual Orientation, Weight and Disability Status 
• Resilience and Vulnerability to the Psychological Harm from Flooding: The Role of Social Cohesion
• The Changing Urban Landscape: Interconnections between Race/Ethnic Segregation and Exposure in the Study of Race-Specific Violence Over Time 
• Who Is Being Left Behind? Sociodemographic Disparities in Local Smoke-Free Law Coverage in Ten States 
• Co-Evolution of Information Sharing and Practice Implementation Among North-American Tobacco Cessation Quitlines
• Secondhand Smoke Exposure Among Nonsmoking Adolescents in West Africa 
• Health Care Providers' Implicit and Explicit Attitudes Towards Lesbian Women and Gay Men 
• Let's Get Physical: Sexual Orientation Disparities in Physical Activity, Sports Involvement, and Obesity among a Population-Based Sample of Adolescents
• Drug Use, Sexual Risk, and Syndemic Production among MSM who Engage in Group Sex Encounters 
• Trends in Educational Inequalities in Drug Poisoning Mortality in the United States, 1994-2010
• Buffering Syndemic Effects in a Sexual Risk Reduction Intervention for Male Clients of Female Sex Workers: Results from a Randomized Controlled Trial 
• Police Encounters Among Needle Exchange Clients in Baltimore: Operationalizing Surveillance for Structural Determinants of Health 
• Prescription Disposal Practices: A Two-Year Ecological Study of Drug Drop Box Donations in Appalachia
• High Alcohol Concentration Products Associated with Poverty and State Alcohol Policies
• Diffusion of Impaired Driving Laws Among US States 
• Sex-Related Disparities in Criminal Justice and HIV Treatment Outcomes: A Retrospective Cohort Study of HIV-infected Inmates 
• Disparities in Mental Health Referral and Diagnosis in the NYC Jail Mental Health Service 
• HIV Testing by Transgender Status at Centers for Disease Control and Prevention-Funded Sites in the United States, Puerto Rico and U.S. Virgin Islands, 2009-2011 
• Preventing Infectious Pulmonary Tuberculosis Among Foreign-Born Residents of the United States 
• Flu and Finances: Influenza Outbreaks and Loan Defaults in U.S. Cities, 2004-2012 
• Determining Chronic Disease Prevalence in Local Populations Using Emergency Department Surveillance 
• Mental Health Recovery in the Patient-Centered Medical Home 
• Predictive Modeling and Concentration of the Risk of Suicide: Implication for Preventive Interventions in the US Department of Veterans Affairs 
• Adverse Birth Outcomes in Colorado: Assessing the Impact of a Statewide Initiative to Prevent Unintended Pregnancy 
• Impact of Insurance Type on Trends in Newborn Circumcision, United States, 2000-2010

The articles above were published online July 16, 2015, at 4 p.m. (EDT) by the American Journal of Public Health under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities by strengthening the profession of public health, sharing the latest research and information, promoting best practices and advocating for public health issues and policies grounded in research. More information is available at www.apha.org.