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  1. Article ; Online: Understanding the Predictors of Low Take-Up of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): A Nationwide Longitudinal Study.

    Guan, Alice / Batra, Akansha / Seligman, Hilary / Hamad, Rita

    Maternal and child health journal

    2023  Volume 27, Issue 10, Page(s) 1795–1810

    Abstract: Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among ... ...

    Abstract Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is among the largest U.S. social safety net programs. Although strong evidence exists regarding the benefits of WIC, take-up (i.e., participation among eligible individuals) has steadily declined in the past decade. This study addresses gaps in our knowledge regarding predictors of WIC take-up during this time.
    Methods: Data were drawn from the 1998-2017 waves of the National Health Interview Study (NHIS), a serial cross-sectional study of the U.S.
    Population: The analytic sample included 23,645 children and 10,297 women eligible for WIC based on self-reported demographic characteristics. To investigate predictors of WIC take-up, we regressed self-reported WIC receipt on a range of individual-level predictors (e.g., age, nativity, income) and state- level predictors (e.g., unemployment rate, governor's political affiliation) using multivariable logistic regression. In secondary analyses, results were additionally stratified by race/ethnicity, time period, and age (for children).
    Results: For both women and children, older maternal age and higher educational attainment were associated with decreased take-up of WIC. Associations differed by race/ethnicity, time period, and state characteristics including caseload of other social programs (e.g., Medicaid).
    Discussion: Our study identifies groups that are less likely to take up WIC benefits for which they are eligible, thereby contributing important evidence to inform programs and policies to increase WIC participation among groups with lower take-up. As WIC evolves past the COVID-19 pandemic, special attention will be needed to ensure that resources to encourage and support the participation of racially and economically marginalized individuals are equitably distributed.
    MeSH term(s) United States ; Humans ; Child ; Female ; Infant ; COVID-19 ; Cross-Sectional Studies ; Longitudinal Studies ; Pandemics ; Ethnicity ; Food Assistance
    Language English
    Publishing date 2023-06-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1339905-6
    ISSN 1573-6628 ; 1092-7875
    ISSN (online) 1573-6628
    ISSN 1092-7875
    DOI 10.1007/s10995-023-03728-y
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  2. Article ; Online: Predictors of WIC uptake among low-income pregnant individuals: a longitudinal nationwide analysis.

    Collin, Daniel F / Guan, Alice / Hamad, Rita

    The American journal of clinical nutrition

    2023  Volume 117, Issue 6, Page(s) 1331–1341

    Abstract: Background: Nutrition during pregnancy is important for maternal and infant health. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for low-income pregnant and postpartum individuals and ... ...

    Abstract Background: Nutrition during pregnancy is important for maternal and infant health. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional support for low-income pregnant and postpartum individuals and children under the age of 5 y. However, WIC participation was in decline in the decade leading up to 2019.
    Objectives: This study examined individual and state predictors associated with WIC uptake among eligible individuals so as to identify subgroups for targeted intervention to improve participation.
    Methods: Data came from the 2004-2019 waves of the Pregnancy Risk Assessment Monitoring System (PRAMS), a national survey of individuals who recently gave birth (N = 288,531). Multivariable logistic regressions were used to examine individual- and state-level and temporal predictors of WIC uptake among WIC-eligible respondents.
    Results: Among WIC-eligible respondents, ages of >35 (OR: 0.68; 95% CI: 0.66, 0.70), more than high school education (OR: 0.63; 95% CI: 062, 0.65), English language proficiency (OR: 0.71; 95% CI: 0.68, 0.74), being married (OR: 0.70; 95% CI: 0.69, 0.72), White race, smaller family size, not having prepregnancy diabetes, and higher income were associated with lower odds of WIC uptake. Respondents in states with higher earned income tax credit rates and in the Northeast, Midwest, and West (compared with the South) had lower WIC uptake. Respondents in states with higher gross domestic product, higher unemployment rates, higher Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and Medicaid caseloads, and Democrat governors had higher uptake; however, effect estimates were small and may not represent a meaningful change. Associations were the strongest during 2009-2015 than during other years, particularly for race/Hispanic origin, language, marital status, prepregnancy diabetes, family size, and prepregnancy.
    Conclusions: This study identified several individual- and state-level characteristics associated with WIC uptake among low-income eligible respondents, paving the way for future interventions to target key subgroups to improve program participation.
    MeSH term(s) Pregnancy ; Infant ; United States ; Child ; Female ; Humans ; Poverty ; Risk Assessment ; Postpartum Period ; Food Assistance ; White
    Language English
    Publishing date 2023-04-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 280048-2
    ISSN 1938-3207 ; 0002-9165
    ISSN (online) 1938-3207
    ISSN 0002-9165
    DOI 10.1016/j.ajcnut.2023.04.023
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  3. Article ; Online: Appropriate Use of the Asian American Demographic Category in Health Disparities Research.

    Guan, Alice / Mukherjea, Arnab

    American journal of public health

    2021  Volume 111, Issue 6, Page(s) e15–e16

    MeSH term(s) Asian ; Health Status Disparities ; Healthcare Disparities ; Humans
    Language English
    Publishing date 2021-05-13
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 121100-6
    ISSN 1541-0048 ; 0090-0036 ; 0002-9572
    ISSN (online) 1541-0048
    ISSN 0090-0036 ; 0002-9572
    DOI 10.2105/AJPH.2021.306266
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  4. Article ; Online: Effects of the revised WIC food package on women's and children's health: a quasi-experimental study.

    Guan, Alice / Batra, Akansha / Hamad, Rita

    BMC pregnancy and childbirth

    2022  Volume 22, Issue 1, Page(s) 806

    Abstract: Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was revised in 2009 to be more congruent with national dietary guidelines. There is limited research examining effects of the revision on women's and children' ... ...

    Abstract Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was revised in 2009 to be more congruent with national dietary guidelines. There is limited research examining effects of the revision on women's and children's health. The objective of this study was to evaluate whether the revised WIC food package was associated with various indicators of physical and mental health for women and children.
    Methods: We used 1998-2017 waves of the National Health Interview Survey (N = 81,771 women and 27,780 children) to estimate effects of the revised WIC food package on indicators of health for both women (self-reported health and body mass index) and children (anemia, mental health, and parent-reported health). We used difference-in-differences analysis, a quasi-experimental technique that assessed pre-post differences in outcomes among WIC-recipients while "differencing out" the secular underlying trends among a control group of non-recipients.
    Results: For all outcomes evaluated for women and children, we were unable to rule out the null hypothesis that there was no effect of receiving the revised WIC food package. These findings were confirmed across several secondary analyses conducted to assess heterogeneity of effects and robustness of results.
    Conclusion: While we did not find effects of the revised WIC food package on downstream health indicators, studies using similarly robust methods in other datasets have found shorter-term effects on more proximal outcomes related to diet and nutrition. Effects of the modest WIC revisions may be less impactful on longer-term indicators of health, and future studies should examine the larger COVID-19-era expansion.
    MeSH term(s) Infant ; Child ; Female ; Humans ; Food Assistance ; Child Health ; Women's Health ; COVID-19 ; Food
    Language English
    Publishing date 2022-11-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 2059869-5
    ISSN 1471-2393 ; 1471-2393
    ISSN (online) 1471-2393
    ISSN 1471-2393
    DOI 10.1186/s12884-022-05116-w
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  5. Article ; Online: Commentary: Racism and structural violence: Interconnected threats to health equity.

    Abdiwahab, Ekland / Guan, Alice / Hong, Cindy / Gomez, Scarlett Lin

    Frontiers in public health

    2022  Volume 10, Page(s) 958436

    MeSH term(s) Health Equity ; Health Status Disparities ; Humans ; Public Health ; Racism ; Violence
    Language English
    Publishing date 2022-09-06
    Publishing country Switzerland
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 2711781-9
    ISSN 2296-2565 ; 2296-2565
    ISSN (online) 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2022.958436
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  6. Article ; Online: Lessons Learned from Immigrant Health Cohorts: A Review of the Evidence and Implications for Policy and Practice in Addressing Health Inequities among Asian Americans, Native Hawaiians, and Pacific Islanders.

    Guan, Alice / Talingdan, Ac S / Tanjasiri, Sora P / Kanaya, Alka M / Gomez, Scarlett L

    Annual review of public health

    2023  

    Abstract: The health of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) is uniquely impacted by structural and social determinants of health (SSDH) shaped by immigration policies and colonization practices, patterns of settlement, and racism. ... ...

    Abstract The health of Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPI) is uniquely impacted by structural and social determinants of health (SSDH) shaped by immigration policies and colonization practices, patterns of settlement, and racism. These SSDH also create vast heterogeneity in disease risks across the AANHPI population, with some ethnic groups having high disease burden, often masked with aggregated data. Longitudinal cohort studies are an invaluable tool to identify risk factors of disease, and epidemiologic cohort studies among AANHPI populations have led to seminal discoveries of disease risk factors. This review summarizes the limited but growing literature, with a focus on SSDH factors, from seven longitudinal cohort studies with substantial AANHPI samples. We also discuss key information gaps and recommendations for the next generation of AANHPI cohorts, including oversampling AANHPI ethnic groups; measuring and innovating on measurements of SSDH; emphasizing the involvement of scholars from diverse disciplines; and, most critically, engaging community members to ensure relevancy for public health, policy, and clinical impact. Expected final online publication date for the
    Language English
    Publishing date 2023-12-18
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 760917-6
    ISSN 1545-2093 ; 0163-7525
    ISSN (online) 1545-2093
    ISSN 0163-7525
    DOI 10.1146/annurev-publhealth-060922-040413
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  7. Article ; Online: Dignified Resources and Coping Strategies During the COVID-19 Pandemic: a Qualitative Study of Racially and Economically Marginalized Communities.

    Guan, Alice / Cruz, Tessa / Sowell, Jamaica / Mathias, Brenda / Hassberg, Analena Hope / Shariff-Marco, Salma / Akom, Antwi / DeRouen, Mindy C

    Journal of racial and ethnic health disparities

    2023  

    Abstract: Introduction: Amid the spread of the novel coronavirus (COVID-19), racially and economically marginalized communities experienced a disproportionate burden of disease and social consequences (e.g., unemployment, increased exposure). This study seeks to ... ...

    Abstract Introduction: Amid the spread of the novel coronavirus (COVID-19), racially and economically marginalized communities experienced a disproportionate burden of disease and social consequences (e.g., unemployment, increased exposure). This study seeks to understand strategies that these communities employed to cope with unequal burdens of the pandemic.
    Methods: We utilized qualitative data collected between 2020 and 2021 from a mobile mapping platform designed to facilitate real-time, geocoded data collection on individual's experiences and perceptions of their neighborhoods. Reports were iteratively coded by an academic researcher and community partner. We employed an inductive approach to analysis, which allowed findings to emerge organically without constraint of researcher hypotheses.
    Results: A total of 19 respondents (14 under the age of 45, 16 non-White, 15 with less than half a year of emergency savings) provided 236 qualitative reports. Participants described innovative strategies for exchanging resources as a means of informally networking and building community, the importance of tailored programming (e.g., for specific racial/ethnic groups) in fostering belonging and comfort, and the importance of two specific dimensions of services-interactions with service providers and the quality of goods or services-in providing dignified care.
    Discussion: Amidst exacerbated racial and economic disparities emerging from the COVID-19 pandemic, our study highlights the need for investment in mutual aid, the importance of tailored services and support, and promoting dignity in social services. As other macro-level social stressors become more prevalent as the pandemic continues, these findings can inform how we examine and address them.
    Language English
    Publishing date 2023-10-16
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2760524-3
    ISSN 2196-8837 ; 2197-3792
    ISSN (online) 2196-8837
    ISSN 2197-3792
    DOI 10.1007/s40615-023-01824-x
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  8. Article: An investigation of quantitative methods for assessing intersectionality in health research: A systematic review.

    Guan, Alice / Thomas, Marilyn / Vittinghoff, Eric / Bowleg, Lisa / Mangurian, Christina / Wesson, Paul

    SSM - population health

    2021  Volume 16, Page(s) 100977

    Abstract: Intersectionality is a theoretical framework that investigates how interlocking systems of power and oppression at the societal level influence the lived experiences of historically and socially marginalized groups. Currently, there are no consistent or ... ...

    Abstract Intersectionality is a theoretical framework that investigates how interlocking systems of power and oppression at the societal level influence the lived experiences of historically and socially marginalized groups. Currently, there are no consistent or widely adopted quantitative methods to investigate research questions informed by intersectionality theory. The objective of this systematic review is to describe the current landscape of quantitative methods used to assess intersectionality and to provide recommendations on analytic best practices for future research. We searched PubMed, EMBASE, and the Web of Science in December 2019 to identify studies using analytic quantitative intersectionality approaches published up to December 2019 (PROSPERO CRD42020162686). To be included in the study, articles had to: (1) be empirical research, (2) use a quantitative statistical method, (3) be published in English, and (4) incorporate intersectionality. Our initial search yielded 1889 articles. After screening by title/abstract, methods, and full text review, our final analytic sample included 153 papers. Eight unique classes of quantitative methods were identified, with the majority of studies employing regression with an interaction term. We additionally identified several methods which appear to be at odds with the key tenets of intersectionality. As quantitative intersectionality continues to expand, careful attention is needed to avoid the dilution of the core tenets. Specifically, emphasis on social power is needed as methods continue to be adopted and developed. Additionally, clear explanation of the selection of statistical approaches is needed and, when using regression with interaction terms, researchers should opt for use of the additive scale. Finally, use of methods that are potentially at odds with the tenets of intersectionality should be avoided.
    Language English
    Publishing date 2021-11-20
    Publishing country England
    Document type Journal Article ; Review
    ISSN 2352-8273
    ISSN 2352-8273
    DOI 10.1016/j.ssmph.2021.100977
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  9. Article ; Online: An economic evaluation of cabazitaxel versus a second androgen receptor-targeted agent (ARTA) for patients with metastatic castration-resistant prostate cancer previously treated with docetaxel and an ARTA: the United States payer perspective.

    Morgans, Alicia K / Hutson, Thomas / Guan, Alice Kai Dan / Garcia, David / Zhou, Anna / Drea, Edward / Vogelzang, Nicholas J

    BMC health services research

    2022  Volume 22, Issue 1, Page(s) 916

    Abstract: Background: Cabazitaxel significantly improves clinical outcomes compared with a second androgen receptor-targeted agent (ARTA) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and an ARTA ( ... ...

    Abstract Background: Cabazitaxel significantly improves clinical outcomes compared with a second androgen receptor-targeted agent (ARTA) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel and an ARTA (abiraterone or enzalutamide), as demonstrated in the CARD trial (NCT02485691). We aimed to estimate healthcare costs avoided with the use of cabazitaxel as a third-line (3 L) treatment versus a second ARTA from a US payer perspective.
    Methods: Model inputs were based on the CARD trial, published sources, and estimates of typical clinical care patterns by genitourinary oncologists (n = 3). Assessed time points were 6, 12, 18, and 24 months. Outcomes included progression-free survival (PFS), radiographic PFS (rPFS), and overall survival (OS); hospitalization and intensive care unit (ICU) days; and costs (reported in 2020 US dollar [USD] and converted into Euro) to manage symptomatic skeletal events (SSEs), adverse events (AEs), and end-of-life care.
    Results: At 18 months, in a cohort of 100 patients, the use of cabazitaxel was estimated to result in 9 more patients achieving rPFS, 2 more patients achieving PFS, and 17 more survivors versus a second ARTA. The costs of SSEs, AEs, and end-of-life care were $498,909 (€424,073), $276,198 (€234,768), and $808,785 (€687,468), respectively, for cabazitaxel and $627,569 (€533,434), $251,124 (€213,455), and $1,028,294 (€874,050), respectively, for a second ARTA. Cabazitaxel was estimated to be associated with a 21% reduction in both SSE management and end-of-life care costs. Hospitalization cost was $1,442,870 (€1,226,440) for cabazitaxel and $1,728,394 (€1,469,135) for a second ARTA, representing an estimated 17% reduction in these costs. Cabazitaxel, as compared with a second ARTA, was associated with 58 fewer hospitalization days and 2 fewer ICU days and was estimated to avoid $323,095 (€274,630, 17%) in total costs, driven by SSEs management and end-of-life care.
    Conclusion: The use of cabazitaxel as a 3 L treatment after docetaxel and an ARTA in patients with mCRPC is estimated to result in clinical benefits (longer rPFS, PFS, and OS) and lower healthcare resource utilization (fewer hospitalization and ICU days), compared with a second ARTA.
    MeSH term(s) Antineoplastic Agents/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Cost-Benefit Analysis ; Docetaxel/therapeutic use ; Humans ; Male ; Prostatic Neoplasms, Castration-Resistant/drug therapy ; Prostatic Neoplasms, Castration-Resistant/pathology ; Receptors, Androgen/therapeutic use ; Taxoids ; Treatment Outcome ; United States
    Chemical Substances Antineoplastic Agents ; Receptors, Androgen ; Taxoids ; Docetaxel (15H5577CQD) ; cabazitaxel (51F690397J)
    Language English
    Publishing date 2022-07-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-022-08274-x
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  10. Article ; Online: The Revised WIC Food Package and Child Development: A Quasi-Experimental Study.

    Guan, Alice / Hamad, Rita / Batra, Akansha / Bush, Nicole R / Tylavsky, Frances A / LeWinn, Kaja Z

    Pediatrics

    2021  Volume 147, Issue 2

    Abstract: Background and objectives: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), one of the largest US safety net programs, was revised in 2009 to be more congruent with dietary guidelines. We hypothesize that this revision ... ...

    Abstract Background and objectives: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), one of the largest US safety net programs, was revised in 2009 to be more congruent with dietary guidelines. We hypothesize that this revision led to improvements in child development.
    Methods: Data were drawn from a cohort of women and children enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study from 2006 to 2011 (Shelby County, TN;
    Results: The revised WIC food package led to increased length-for-age
    Conclusions: This study provides some of the first evidence that children of mothers who received the revised WIC food package during pregnancy had improved developmental outcomes in the first 2 years of life. These findings highlight the value of WIC in improving early developmental outcomes among vulnerable children. The need to implement and expand policies supporting the health of marginalized groups has never been more salient, particularly given the nation's rising economic and social disparities.
    MeSH term(s) Adult ; Child ; Child Development/physiology ; Child Health/economics ; Child Health/trends ; Child, Preschool ; Cohort Studies ; Female ; Food Assistance/economics ; Food Assistance/trends ; Humans ; Longitudinal Studies ; Male ; Mental Status and Dementia Tests ; Non-Randomized Controlled Trials as Topic/methods ; Non-Randomized Controlled Trials as Topic/trends ; Nutrition Policy/economics ; Nutrition Policy/trends
    Language English
    Publishing date 2021-01-26
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2020-1853
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