All Publications

  • Gender, Depression, and Blue-collar Work: A Retrospective Cohort Study of US Aluminum Manufacturers. Epidemiology (Cambridge, Mass.) Elser, H., Rehkopf, D. H., Meausoone, V., Jewell, N. P., Eisen, E. A., Cullen, M. R. 2019; 30 (3): 435–44


    BACKGROUND: Industrial blue-collar workers face multiple work-related stressors, but evidence regarding the burden of mental illness among today's blue-collar men and women remains limited.METHODS: In this retrospective cohort study, we examined health and employment records for 37,183 blue- and white-collar workers employed by a single US aluminum manufacturer from 2003 to 2013. Using Cox proportional hazards regression, we modeled time to first episode of treated depression by gender and occupational class. Among cases, we modeled rates of depression-related service utilization with generalized gamma regression.RESULTS: Compared with their white-collar counterparts, blue-collar men were more likely to be treated for depression (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) as were blue-collar women (HR = 1.4; 1.2, 1.6). Blue-collar women were most likely to be treated for depression as compared with white-collar men (HR = 3.2; 95% CI = 2.1, 5.0). However, blue-collar workers used depression-related services less frequently than their white-collar counterparts among both men (rate ratio = 0.91; 95% CI = 0.84, 0.98) and women (rate ratio = 0.82; 95% CI = 0.77, 0.88).CONCLUSIONS: Blue-collar women were more likely to be treated for depression than white-collar workers, and blue-collar women were most likely to be treated for depression compared with white-collar men. However, blue-collar men and women used depression-related healthcare services less frequently than white-collar workers. These findings underscore that blue-collar women may be uniquely susceptible to depression, and suggest that blue-collar workers may encounter barriers to care-seeking related mental illness other than their insurance status.

    View details for PubMedID 30964814

  • Association of Preterm Births Among US Latina Women With the 2016 Presidential Election JAMA NETWORK OPEN Gemmill, A., Catalano, R., Casey, J. A., Karasek, D., Alcala, H. E., Elser, H., Torres, J. M. 2019; 2 (7): e197084


    The circumstances surrounding the 2016 US presidential election have been proposed as a significant stressor in the lives of the US Latino population. Few studies to date, however, have evaluated the population health implications of the election for Latina mothers and their children.To determine whether preterm births (gestational age, <37 weeks) among US Latina women increased above expected levels after the 2016 US presidential election.In this national population-based study, an interrupted time series design, used to evaluate whether policies or other population-level changes interrupt a trend in an outcome, compared monthly counts of preterm births to Latina women after the 2016 presidential election with the number expected had the election not taken place. Women residing in the United States who had singleton births during the study period were included. Counts of singleton term and preterm births by month and race/ethnicity from January 1, 2009, through July 30, 2017 (32 860 727 live births), were obtained from the Centers for Disease Control and Prevention Wonder online database. These methods were applied separately to male and female births. Data were analyzed from November 8, 2018, through May 7, 2019.Pregnancy in the 2016 US presidential election.The number of male and female preterm births based on the last menstrual period.Among the 32 860 727 live births recorded during the study period, 11.0% of male and 9.6% of female births to Latina women were preterm compared with 10.2% and 9.3%, respectively, to other women. In the 9-month period beginning with November 2016, an additional 1342 male (95% CI, 795-1889) and 995 female (95% CI, 554-1436) preterm births to Latina women were found above the expected number of preterm births had the election not occurred.The 2016 US presidential election appears to have been associated with an increase in preterm births among US Latina women. Anti-immigration policies have been proposed and enforced in the aftermath of the 2016 presidential election; future research should evaluate the association of these actions with population health.

    View details for DOI 10.1001/jamanetworkopen.2019.7084

    View details for Web of Science ID 000477895900038

    View details for PubMedID 31322687

    View details for PubMedCentralID PMC6647358

  • Developing Tobacco Control Interventions in Permanent Supportive Housing for Formerly Homeless Adults. Health promotion practice Alizaga, N. M., Nguyen, T., Petersen, A. B., Elser, H., Vijayaraghavan, M. 2019: 1524839919839358


    Smoke-free policies are effective population-based strategies to reduce tobacco use yet are uncommon in permanent supportive housing (PSH) for formerly homeless individuals who have high rates of smoking. In this study, we partnered with six supportive housing agencies in the San Francisco Bay Area to examine the implementation of smoke-free policies and cessation services. We administered a questionnaire and conducted in-depth, semistructured interviews with agency directors (n = 6), property management staff (n = 23), and services staff (n = 24) from 23 PSH sites on the barriers to implementing tobacco control interventions. All properties restricted smoking in indoor shared areas, but only two had policies restricting smoking in living areas. While there was staff consensus that smoke-free policies were important to reduce tobacco-related harm, participants disagreed on whether smoke-free policies were aligned with PSH's harm reduction framework. Residents' comorbid mental illness and substance use and the lack of appropriate enforcement tools were barriers to implementation. Using these formative findings, we present a framework for a toolkit of strategies to increase implementation of smoke-free policies and cessation interventions in PSH. Successful implementation of indoor smoke-free policies in PSH will require concurrent cessation services to support smoking cessation efforts and address the mental health and substance use needs of residents.

    View details for PubMedID 30971139

  • Increased motor vehicle crashes following induced earthquakes in Oklahoma, USA SCIENCE OF THE TOTAL ENVIRONMENT Casey, J. A., Elser, H., Goldman-Mellor, S., Catalano, R. 2019; 650: 2974–79


    Anxiety-inducing life events increase the risk of motor vehicle crashes. We test the hypothesis that earthquakes, known to increase anxiety in the population, also increase the incidence of motor vehicle crashes. Our study took place in Oklahoma, USA where wastewater injection resulted in increased induced seismicity between 2010 and 2016. We identified dates of earthquakes ≥ magnitude 4 (a level felt by most people) with data from the U.S. Geologic Survey. The Oklahoma Highway Safety Office provided county-level monthly vehicle crash counts. We defined high, medium, and low earthquake exposure counties based on the location of earthquake epicenters. Using time-series analyses, we evaluated the association between monthly counts of ≥magnitude 4 earthquakes and motor vehicle crashes by exposure group. Earthquakes ≥ magnitude 4 took place in 38 of 84 study months, and a monthly average of 5813 (SD = 384) crashes occurred between 2010 and 2016. In high-exposure counties, we observed an additional 39.2 motor vehicle crashes per each additional ≥ magnitude 4 earthquake in the prior month (SE = 11.5). We found no association between the timing of ≥magnitude 4 earthquakes and motor vehicle crashes in the medium or low exposure counties. With a binary earthquake exposure variable, we found a 4.6% (SE = 1.4%) increase in motor vehicle crashes in the high exposure counties in the month following 1 or more ≥magnitude 4 earthquakes. Consistent with our hypothesis, there was no association between earthquakes of magnitude ≤ 2.5 and motor vehicle crashes in the high-exposure counties. This novel evidence of an association between induced earthquakes in Oklahoma and motor vehicle crashes warrants future research given the high economic and social costs of such vehicle crashes.

    View details for DOI 10.1016/j.scitotenv.2018.10.043

    View details for Web of Science ID 000447871400124

    View details for PubMedID 30373073

    View details for PubMedCentralID PMC6214370

  • Sun Smoke in Sweden: Perinatal Implications of the Laki Volcanic Eruptions, 1783-1784. Epidemiology (Cambridge, Mass.) Casey, J. A., Gemmill, A., Elser, H., Karasek, D., Catalano, R. 2019; 30 (3): 330–33


    The Icelandic volcano Laki erupted from June 1783 through January 1784. It produced 122 megatons of sulfur dioxide, particulate matter, and acid rain and contributed to one of the coldest winters on record in Western Europe. Although uncontrollable volcanic eruptions continue, few studies have investigated their perinatal health implications.Using the Human Mortality Database, we assessed the association between the Laki event and the secondary sex ratio, infant mortality rates, and the number of births from 1751 to 1800 with time-series models that controlled for temporal trends.The secondary sex ratio decreased 3% below expected levels in 1784 (95% CI = -4%, -1%). Both female and male infant mortality rates exceeded expectation in 1785, by 54% (95% CI = 25%, 83%) and 37% (-1%, 74%), respectively. We observed little change in female live births but a reduction in male live births in 1784.Our findings are consistent with the hypothesis that the large-scale Laki volcanic eruptions of 1783-1784 resulted in adverse perinatal health outcomes in Sweden.

    View details for DOI 10.1097/EDE.0000000000000977

    View details for PubMedID 30789427

    View details for PubMedCentralID PMC6456407

  • How and why studies disagree about the effects of education on health: A systematic review and meta-analysis of studies of compulsory schooling laws SOCIAL SCIENCE & MEDICINE Hamad, R., Elser, H., Tran, D. C., Rehkopf, D. H., Goodman, S. N. 2018; 212: 168–78


    Rich literatures across multiple disciplines document the association between increased educational attainment and improved health. While quasi-experimental studies have exploited variation in educational policies to more rigorously estimate the health effects of education, there remains disagreement about whether education and health are causally linked. The aim of this study was to conduct a systematic review and meta-analysis to characterize this literature, with a focus on quasi-experimental studies of compulsory schooling laws (CSLs). Articles from 1990 to 2015 were obtained through electronic searches and manual searches of reference lists. We searched for English-language studies and included manuscripts if: (1) they involved original data analysis; (2) outcomes were health-related; and (3) the primary predictor utilized variation in CSLs. We identified 89 articles in 25 countries examining over 25 health outcomes, with over 600 individual point estimates. We systematically characterized heterogeneity on key study design features and conducted a meta-analysis of studies with comparable health outcome and exposure variables. Within countries, studies differed in terms of birth cohorts included, the measurement of health outcomes within a given category, and the type of CSL variation examined. Over 90% of manuscripts included multiple analytic techniques, such as econometric and standard regression methods, with as many as 31 "primary" models in a single study. A qualitative synthesis of study findings indicated that educational attainment has an effect on the majority of health outcomes-most beneficial, some negative-while the meta-analysis demonstrated small beneficial effects for mortality, smoking, and obesity. Future work could focus on inconsistent findings identified by this study, or review the health effects of other types of educational policies.

    View details for PubMedID 30036767

  • Smoking Policy Change Within Permanent Supportive Housing JOURNAL OF COMMUNITY HEALTH Petersen, A., Stewart, H. C., Walters, J., Vijayaraghavan, M. 2018; 43 (2): 312–20


    Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7-9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: -38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.

    View details for DOI 10.1007/s10900-017-0423-7

    View details for Web of Science ID 000426397200015

    View details for PubMedID 28884243

    View details for PubMedCentralID PMC5832576

  • Separating the Bruce and Trivers-Willard effects in theory and in human data AMERICAN JOURNAL OF HUMAN BIOLOGY Catalano, R., Gemmill, A., Casey, J., Karasek, D., Stewart, H., Saxton, K. 2018; 30 (2)


    Theories of reproductive suppression predict that natural selection would conserve mechanisms that abort the gestation of offspring otherwise unlikely to thrive in prevailing environments. Research reports evidence among humans of at least two such mechanisms-the Trivers-Willard and Bruce Effects. No literature, however, compares the mechanisms nor estimates their relative contribution to observed characteristics of human birth cohorts. We describe similarities and differences between the Trivers-Willard and Bruce Effects and explore high quality historical data from Sweden to determine which mechanism better describes temporal variation in the ratio of males to females in birth cohorts.We measure Trivers-Willard exposures with the death rate among women of reproductive age. We measure Bruce exposures with the death rate among children. We use time-series regression methods to estimate the relative contribution of the Trivers-Willard and Bruce Effects to temporal variation in historical Swedish secondary sex ratio data.We find that the Bruce Effect appears to be a better predictor of the secondary sex ratio than does the Trivers-Willard Effect.Attempts to identify mechanisms by which reproductive suppression affects fetal loss and characteristics of human birth cohorts should consider the Bruce Effect as an alternative to the Trivers-Willard Effect.

    View details for DOI 10.1002/ajhb.23074

    View details for Web of Science ID 000427233300002

    View details for PubMedID 29083077

  • Understanding periviable birth: A microeconomic alternative to the dysregulation narrative. Social science & medicine (1982) Catalano, R., Bruckner, T., Avalos, L. A., Stewart, H., Karasek, D., Kariv, S., Gemmill, A., Saxton, K., Casey, J. 2017


    Periviable infants (i.e., those born in the 20th through 26th weeks of gestation) suffer much morbidity and approximately half die in the first year of life. Attempts to explain and predict these births disproportionately invoke a "dysregulation" narrative. Research inspired by this narrative has not led to efficacious interventions. The clinical community has, therefore, urged novel approaches to the problem. We aim to provoke debate by offering the theory, inferred from microeconomics, that risk tolerant women carry, without cognitive involvement, high risk fetuses farther into pregnancy than do other women. These extended high-risk pregnancies historically ended in stillbirth but modern obstetric practices now convert a fraction to periviable births. We argue that this theory deserves testing because it suggests inexpensive and noninvasive screening for pregnancies that might benefit from the costly and invasive interventions clinical research will likely devise.

    View details for DOI 10.1016/j.socscimed.2017.12.014

    View details for PubMedID 29274689

  • Attitudes Toward Smoking Cessation Among Sheltered Homeless Parents Journal of community health Stewart, H. C., Stevenson, T. N., Bruce, J. S., Greenberg, B., Chamberlain, L. J. 2015: 1-9