February 2020 Highlights

Date: Feb 20 2020

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

American Journal of Public Health April issue research highlights

Low level of education linked to early death

People with low education levels who live in urban areas are more likely to die prematurely than their more-educated counterparts, according to new research in the April issue of APHA’s American Journal of Public Health.

Researchers examined health records between 1985 and 2017 of over 5,000 participants in the Coronary Artery Risk Development in Young Adults study. Recruited in the mid 1980s, participants were middle age and lived in four urban areas: Birmingham, Alabama; Chicago; Minneapolis, Minnesota; and Oakland, California. About half of the participants were black and half were white, and gender was split at around 50%.

Researchers looked that at the cause of death for more than 400 participants, finding that limited education — defined as a high school degree or less— was a major factor predicting premature death, with lifelong poverty adding to the likelihood of an early death.

The most common causes of death were cancer, cardiovascular disease and AIDS. Across genders and races, black men most often died prematurely from homicide, white men most often died of AIDS, and women overall most often died of cancer.

Education level was the major predictor of longevity. Age-adjusted mortality rates were significantly higher for blacks than for whites and decreased as educational attainment increased.

“City-level policies that support the achievement of equality in educational attainment — for example, increasing affordable housing options and access to high-quality early childhood education — are testable approaches to eliminating observed racial and ethnic disparities in health and longevity,” the study authors wrote.

[Author contact: Brita Roy, MD, MPH, MHS, Department of Internal Medicine, Yale School of Medicine, New Haven, CT . “Education, Race/Ethnicity, and Causes of Premature Mortality Among Middle-Aged Adults in 4 US Urban Communities: Results From CARDIA, 1985–2017.”]

Paid sick leave laws reduce working while sick

Requiring employers to provide paid sick leave results in fewer employees working while sick, analysis of a recent state law finds.

Published in the April issue of AJPH, the study surveyed workers before and after a Washington law went into effect in January 2018. Under the law, all employers — regardless of size or industry — must provide paid leave, which employees can use to care for themselves or a family member.

Study researcher Daniel Schneider, PhD, an assistant professor of sociology at the University of California-Berkeley, placed online ads to recruit workers in retail and food service, sectors that many times do not offer paid sick leave benefits. Over 12,700 workers from Washington and comparison states took the survey.

Before the Washington law was enacted, 70% of participants in the state reported working while they were sick, while only 59% did so afterward. Schneider determined that the new law expanded worker access to paid sick leave by 28%.

“These results support the ideas that policy levers that may be perceived as quite distal to health outcomes, such as labor policy, can have important effects on public health by shaping important socio-economic determinants of health and well-being,” Schneider wrote.

[Author contact: Daniel Schneider, Department of Sociology, University of California, Berkeley. "Paid Sick Leave in Washington State: Evidence on Employee Outcomes, 2016-2018"]

Same-sex marriage recognition increases spousal health benefits

Legal recognition of same-sex marriages in the U.S. has increased the number of adults covered by employee-sponsored health insurance, a study in AJPH’s April issue finds.

Between 2004 and 2015 in the U.S., same-sex marriage went from being legal in one state, Massachusetts, to being legal in all states, spurred by a Supreme Court decision that ended state bans.

Researchers created models that included data from the American Community Survey, a household demographic report collected by the U.S. Census Bureau, from 2008 to 2017, and data on when states passed laws making same-sex marriage legal.

From 2008 to 2017, marriage equality resulted nationally in a 0.61% increase in spousal employer sponsored health insurance, researchers said. This means that an estimated 11.6 million more people were covered by employee-sponsored health insurance, with gains observed among both men and women.

“Marriage equality played a critical role in expanding access to employer-sponsored insurance,” researchers said. “This has far-reaching health benefits for those newly insured, and may offer out-of-pocket savings or access to more comprehensive benefits for those switching from a non-group or public plan.”

[Author contact: Janell Downing, PhD, Portland State University School of Public Health, Portland. “Same-Sex Marriage and Gains in Employer-Sponsored Insurance for US Adults, 2008-2017”]

US syringe programs more than double since 2015

Syringe service programs — which reduce infections and provide support for people with opioid addiction — have more than doubled in the U.S. in recent years, a study in AJPH’s February issue finds.

Researchers examined data from the Buyers’ Club of the Dave Purchase Project/North American Syringe Exchange Network, which supplies up to 95% of syringes to U.S. outreach programs.

From 1988 to 2016, the U.S. did not allow federal funds to be used for syringe service programs. But as the opioid epidemic worsened, the federal government loosened the ban by approving the funding as long as services met certain conditions.

The number of syringe service programs, which are usually operated by health departments or nonprofit organizations, increased from 141 in 2015 to 292 in 2018. Syringe purchases increased from 42 million to over 87 million.

Syringe service programs supply clean needles for people who inject drugs and can reduce HIV and hepatitis C infections by 50%, according to the Centers for Disease Control and Prevention. They can also help prevent overdose deaths and connect people to testing and medication-assisted treatment for opioid use disorder.

“Ensuring high-quality services in these new programs will be critical to successfully addressing the current epidemic,” researchers said.

[Author Contact: Don C. Des Jarlais, PhD, School of Global Public Health, New York University, New York, NY. “Expansion of Syringe Service Programs in the United States, 2015-2018”]

AJPH  articles published online Feb. 20 include:

  • influenza Vaccination and Migration at the US Southern Border
  • Moving from the National Negro Health Week to the National Public Health Week in America
  • On knowingly Setting Unrealistic Goals in Public Health
  • Alcohol Industry Involvement in the Moderate Alcohol and Cardiovascular Health (MACH) Trial
  • Charity Care Characteristics and Expenditures among US Tax-Exempt Hospitals in 2016
  • Tobacco retail licensing and density three years after license regulations in Philadelphia, Pennsylvania (2012-2019)
  • Baltimore Ceasefire 365: Estimated impact of a recurring community-led ceasefire on gun violence
  • Deportation of family members of US-citizen Latinos and misuse of prescription drugs (United States, 2019)
  • Hurricane Harvey Hospital Flood Impacts: Accuracy of Federal Emergency Management Agency Flood Hazard Areas in Harris County, Texas

The articles above will be published online Feb. 20 at 4 p.m. EDT by AJPH 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. AJPH 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 Arnice Cottom at APHA. 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. For direct customer service, call 202-777-2516, or email us.

To stay up-to-date on the latest in public health research, sign up for new content email alerts.


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. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a nearly 150-year perspective and brings together members from all fields of public health. Visit www.apha.org.