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December 2021 highlights from the American Journal of Public Health

Date: Dec 10 2021

To request a full copy of any of these studies or for information on scheduling interviews with an expert, contact APHA Media Relations.

American Journal of Public Health December issue highlights:

  • Home health care workers report poor physical, mental health
  • Racial disparities in COVID-19 infection among active military
  • Few food companies have reduced portion sizes
  • Overdoses driving up deaths among Los Angeles homeless residents

Home health care workers report poor physical, mental health

Home health care workers typically report worse physical and mental health than other low-wage health workers who don’t work in people’s homes, according to new research in the December AJPH.

Using 2014-2018 data from the Behavioral Risk Factor Surveillance System, researchers compared nearly 3,000 home health care workers against two groups: health care aides and health care support workers. Researchers found that more than 26% of home health care workers reported fair or poor general health, about 14% had poor physical health and nearly 21% had poor mental health — all significantly higher percentages than the comparison groups.

The home health care field is made up mostly of women and minorities, and workers are typically poorly compensated and have limited opportunities for career advancement, study authors noted.

“As the population ages, and as people with disabilities and chronic diseases want to remain at home, the demand for (home health care workers) will continue to grow,” researchers wrote. “Yet, the health of this workforce is suboptimal, which limits their own well-being as well as their ability to meet the needs of their patients.”

[Author contact: Madeline Sterling, Weill Cornell Medicine, New York, New York. “Prevalence and Predictors of Home Health Care Workers’ General, Physical, and Mental Health: Findings from the 2014-2018 Behavioral Risk Factor Surveillance System”]

Racial disparities in COVID-19 infection among active military

Like the general population, the military also reported racial disparities in COVID-19 infections and hospitalizations, finds a new study published in the December issue of AJPH

To conduct the study, researchers calculated the incidence of COVID-19 testing, infection and hospitalization among active U.S. military service members in 2020. Overall, researchers found that more than 10% tested positive for COVID-19 and just more than 1% of those infected were hospitalized. But while Black and Hispanic members had a similar COVID-19 testing rate to whites, they faced a higher risk of infection and hospitalization. Officer rank was not associated with COVID-19 infection, but was tied to a much lower risk of hospitalization.

The study noted that such disparities persisted despite all members being eligible for health coverage.

“Persistent disparities are likely the result of subtle and complex social and societal mechanisms, such as distrust in the health care system, delays in care and culturally inappropriate care,” researchers wrote. “Although these factors are believed to be largely mitigated in the (Department of Defense), this study suggests that the impact of these societal forces persists to some degree even in the military.”

[Author contact: James Mancuso, Uniformed Services University, Bethesda, Maryland. “Racial and Ethnic Disparities in COVID-19 Infection and Hospitalization in the Active Component U.S. Military”]

Few food companies have reduced portion sizes

Despite rising obesity and overweight among Americans, few food companies have reduced their portion sizes.

In a new study in December’s AJPH, researchers analyzed the sizes of single-serving, ultra-processed food products that they had been tracking since 2002 — specifically, packaged products such as candy bars, soda and beer and fast foods such as hamburgers, French fries and fountain sodas. They found that few companies had reduced their portion sizes in the last two decades, and all still sold portions up to five times larger than when first introduced. 

For instance, the original size of a Coca-Cola bottle was 6.5 ounces. Now, the sugary drink comes in six different sizes all marketed as single servings, from 7.5 ounces to 24 ounces. 

“Our data indicate that voluntary approaches to portion-size reduction are unlikely to be effective on their own,” researchers wrote. “We think it is time to also consider caps and other legislatively mandated national policy options to require the food industry to make smaller food portions more available, convenient and inexpensive.”

[Author contact: Lisa Young, Department of Nutrition and Food Studies, New York University, New York, New York. “Portion Sizes of Ultra-Processed Foods in the United States, 2002 to 2021”]

Overdoses driving up deaths among Los Angeles homeless residents

Deaths have increased among residents who are homeless and living in Los Angeles County, with fatal drug overdose a leading cause, according to a study in the December issue of AJPH

In analyzing medical examiner and death certificate data from 2015 to 2019, researchers found that deaths among people experiencing homelessness went up from 741 to 1,267, with the crude mortality rate increasing by 24%. Such mortality rates increased more among women, than for men. Black people who were homeless experienced a 40% increase in mortality over the study period, compared to a 10% increase among whites and 16% increase among Hispanics. 

The top five causes of death identified were: drug overdose, coronary heart disease, traffic injury, homicide and suicide. Drug overdose death rates went up “precipitously,” researchers wrote, surpassing coronary heart disease in 2017 as the leading cause of death among the county’s homeless residents. 

“These methods can be adapted by other urban jurisdictions seeking to better understand and reduce mortality in their homeless populations,” the study stated.

[Author contact: Will Nicholas, Los Angeles County Department of Public Health, Los Angeles, California. “Using Point-in-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015-2019”]

Check out the full list of AJPH research papers that published online in our First Look area.

These articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. AJPH is published by the American Public Health Association and is available at

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