AJPH November 2015 highlights

Date: Nov 12 2015

AJPH Research: Maltreatment of children of US Army soldiers, Medicaid coverage’s link to outpatient care and chronic disease, health of refugee children in the US

CONTACT: For copies of articles or full table of contents of an issue, call Mandi Yohn at 202-777-2509 or email her at amanda.yohn@apha.org.

American Journal of Public Health highlights:

1. Risk of maltreatment greater for children of US Army soldiers across deployment periods
2. Medicaid coverage linked to improved access to outpatient physician care and greater control of chronic disease
3. Health profiles of refugee children in the US highlight need for multistate, pediatric refugee health database

Risk of maltreatment greater for children of US Army soldiers after deployment periods

Children of U.S. Army soldiers are at greater risk for maltreatment directly following deployment periods, according to a new study in the American Journal of Public Health.

Researchers from the Children’s Hospital of Philadelphia conducted a person-time analysis of substantiated maltreatment reports and medical diagnoses among children of 112,325 deployed U.S. Army soldiers between 2001 and 2007. Data were obtained from the Army Central Registry, Patient Administration Systems and Biostatistics Activity and Defense Manpower Data Center.

Results from the study showed an elevated risk of maltreatment in the six months directly after deployment among children of once-deployed soldiers. Results also showed elevated risk of child maltreatment during soldier deployment, particularly among those soldiers deployed twice during the study period.

“Many of the perpetrators identified in our study cohort were not soldiers themselves, suggesting that a soldier-only response is not enough to reduce risk for families,” authors explained. “These findings can inform efforts by the military to initiate and standardize support and preparation to families during periods of elevated risk.”

[“Differential Child Maltreatment Risk Across Deployment Periods of US Army Soldiers.” Contact: Christine Marie Taylor, Children’s Hospital of Philadelphia, Philadelphia.]

Medicaid coverage linked to improved access to outpatient physician care and greater control of chronic disease

According to new research in the American Journal of Public Health, Medicaid coverage is linked to improved access to outpatient physician care and greater control of chronic disease.

Researchers used 1999–2012 National Health and Nutritional Examination Surveys – administered by the National Center for Health Statistics, a branch of the U.S. Centers for Disease Control and Prevention to identify a nationally representative sample of civilian, non-institutionalized U.S. adults ages 18- 64 with incomes below the federal poverty level. They compared outpatient visit frequency, awareness and control of chronic diseases between the uninsured and those who had Medicaid.

Compared to the uninsured, results showed that respondents with Medicaid were more likely to have at least one outpatient physician visit annually. Among poor persons with evidence of hypertension, Medicaid coverage was associated with greater awareness and control of their condition. Medicaid coverage was also associated with awareness of being overweight. No significant differences were found between insurance groups on awareness or control of diabetes or hypercholesterolemia.

“For states that expanded Medicaid under the Affordable Care Act, enrollment began only one year ago; several states are considering expanding Medicaid in the future. Thus, it will likely take several years before nationally representative data become available on the ACA’s impacts,” the authors explain. “Our data suggests that states expanding Medicaid coverage through the Affordable Care Act will observe improvement in outpatient access to care and chronic disease outcomes.”

[“Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured.”
Andrea Sylvie Christopher, MD, Cambridge Health Alliance, Harvard Medical School, Boston.]

Health profiles of refugee children in the US highlight need for multistate, pediatric refugee health database

Public health screening data from around the country can be used to create a multistate health data set for refugee children living in the U.S., according to a new study in the American Journal of Public Health.

Researchers carried out a retrospective, observational study with data from four sites that have implemented U.S. Centers for Disease Control and Prevention guidelines: Colorado Department of Public Health and Environment’s Refugee Health Program, Minnesota Department of Health’s Refugee Health Program, Thomas Jefferson University’s Department of Family and Community Medicine in Philadelphia and Washington State Department of Health’s Refugee Health Program. They examined data on blood lead level, anemia, hepatitis B virus infection, tuberculosis infection or disease and Strongyloides seropositivity that was available for 8,148 refugee children under age 19 from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq and Somalia.

Through the study, distinct health profiles were identified for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Results showed that hepatitis B was more prevalent among male children than female children and among children 5 years and older. Hepatitis B, tuberculosis and Strongyloides were less common among children who arrived in the United States more recently and the odds of each decreased over the study period.

“This study is important because it demonstrates that it is feasible to create a unified refugee health data set by using public health data from multiple states and that a data set of this type can be used to examine the value of existing screening guidelines,” authors explain. “When feasible, these analyses should focus upon both country of origin and country of departure, as the health profiles of refugee children from a single country of origin may be variable depending on the country of departure. State refugee health programs should also consider including refugee camp as a variable within existing refugee screening databases, as these data may allow for better monitoring of the health status of children from very large, semipermanent refugee camps.”

[“Health Profiles of Newly Arrived Refugee Children in the United States, 2006–2012.” Katherine Yun, MD, MHS, Perelman School of Medicine, University of Pennsylvania, Philadelphia.]

Find a full list of research papers to be published online on November 12, 2015, at 4 p.m. EST below:

  • Inequalities of Income and Inequalities of Longevity: a Cross-Country Study
  • BARRIERS AND FACILITATORS OF CERVICAL SCREENING AMONG SEX WORKERS IN VANCOUVER 
  • Patterns and Trends of Newly Diagnosed HIV Infections among Adults and Adolescents in Correctional and Non-correctional Facilities, United States, 2008 - 2011 
  • Substance use and cumulative exposure to American society: findings from both sides of the U.S.-Mexico border region. 
  • GLOBAL EVOLUTION OF SMOKEFREE LAWS: THE ROLE OF THE WHO FRAMEWORK CONVENTION ON TOBACCO CONTROL 
  • THE EFFECT OF SYSTEMATIC MOTORCYCLE MANAGEMENT ON THE HEALTH SYSTEM IN ZAMBIA: A DISTRICT LEVEL SMALL CLUSTER INTERRUPTED TIME SERIES FIELD TRIAL 
  • Free bus travel and physical activity, gait speed and adiposity in the English Longitudinal Study of Ageing 
  • Association between community-based health financing approach and child stunting in rural Rwanda: an observational study 
  • Helping Young Families: Results of a Randomized Controlled Trial of a Home Visiting Program for Adolescent Parents 
  • Cascade of Care for Hepatitis C Virus Infection within the Veterans Health Administration 
  • Uneasy Alliances: Religious Institutions' Views on Preventing Sexual Transmission of HIV
  • Association Between Sociodemographic Factors and Personal Belief Vaccination Exemptions in California 
  • Healthy Homes/Healthy Families: A randomized controlled trial to reduce energy intake and increase physical activity by improving home environments 
  • Determinants of HIV Risk Among African American Men Who Have Sex with Men 
  • The WHO STEPwise approach to noncommunicable disease risk factor surveillance (STEPS): Challenges and opportunities 
  • Health Profiles of Newly Arrived Refugee Children in the United States, 2006–2012
  • Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured
  • Differential Child Maltreatment Risk Across Deployment Periods of US Army Soldiers

The articles above will be published online November 12, 2015, at 4 p.m. EST 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, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Mandi Yohn at APHA, 202-777-2509, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions department. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $30 and online single article access is $22 at www.ajph.org or for direct customer service, call 202-777-2516, or email.

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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.