“I’m Not a Freshi”: Culture Shock, Puberty and Growing Up as British-Bangladeshi Girls

Most people wish to banish the awkwardness and confusion of puberty from their memories, but for Lauren Houghton, puberty has been the focus of her research for more than a decade. Fascinated by the opportunity it presented for biosocial inquiry, Lauren was struck by how few studies have taken a comparative biocultural approach. In a recent publication, Houghton et al. (2020) used mixed-methods in a study called the ABBY Project (Adolescence among Bangladeshi and British Youth) to compare experiences of puberty across cultures in a study of nearly 500 girls aged 5-16 who were either Bangladeshi, first-generation migrant to the UK, second-generation migrant, or white British.

This mixed-method research speaks to the power of speaking with participants rather than just collecting data from participants. The authors had originally predicted the age at puberty to follow a steady decline with increasing time lived in the UK (age at puberty decreasing in this order: Bangladeshi, 1st generation migrants, 2nd generation migrants, then white British).  But the finding that first generation had particularly early puberty was completely unexpected.

The design of Houghton’s fieldwork- two years embedded in the East London school system – allowed for the simultaneous collection of qualitative and quantitative data. This in turn allowed the authors to suggest explanations for why first generation girls seemed to mature so early. One clear finding was that the stigma of being “Freshis” (recent migrants to the UK) expressed by second generation Bangladeshi peers was a source of psychosocial stress.  This stress could be one explanation for the early puberty.

Members of the GAL Club, an after school club offered to schools and participants in exchange for their participation in the ABBY Project.

The social stickiness of this stigma was strengthened by an overall rejection of Bangladeshi culture among the British-Bangladeshi youth. For example, girls denied eating “Rice”, short hand for rice and curry, in front of their friends even though they reported eating it the night before in the 24-hour food recall conducted as part of the study. While they rejected Bangladeshi culture, they embraced being Muslim. Wearing hijab reflected their respectful practice of Islam. In fact, girls living in the UK were more likely to wear hijab than girls in Bangladesh. The girls explained a distinction between practicing the scarf (wearing it irregularly) and being dedicated to it (wearing it every day) (See Figure 1). This distinction became fertile ground to explore biocultural markers of puberty. Through an integrated mixed-methods approach it became clear that practicing the scarf aligned with the onset of adrenarche, a pre-cursor of puberty, and becoming dedicated to it aligned with the onset of menarche (a girl’s first period) for first generation girls (See Figure 2).  This is in sharp contrast to girls in Bangladesh among whom becoming dedicated to the scarf only occurred in early adulthood, if at all. The hijab emerged as a biocultural marker of first generation girls pubertal experience as they came of age in East London.

Ages at biological and cultural markers of puberty in Bangladeshi and British girls in the ABBY Project

Interpreting the results of epidemiological studies is standard practice, however, in this mixed-methods research we were able to turn to sociocultural explanations explicitly observed and inquired about with the actual population understudy to interpret our quantitative findings. The authors did not have to surmise blindly based on their own biased perspectives, but rather could make culturally-informed interpretations. Furthermore, they were able to integrate the qualitative findings with biomarkers, in this case measures of stress hormones. In the era of “big data,” when methodological advances are leading to studies of multiple “-omic” fields (such as genomics, epigenomics, proteomics, metabolomics, and microbiomics) this study is an example of how qualitative methods can add to these omics. “Emics”, the mapping of on-the-ground perspectives, derives from rich discussion with stakeholders directly affected by the problem under consideration. The ABBY Project illustrates how the incorporation of “emics” in addition to “omics” into epidemiologic studies will lead to a more engaged discipline of consequence.

Posted in Ethnicity, Gender, Immigration, Mixed Methods, Social Environments | Leave a comment

Trends in U.S. Women’s Binge Drinking in Middle Adulthood by Socioeconomic Status, 2006-2018

Cluster members Sarah McKetta and Katherine Keyes recently published research regarding national trends in binge drinking among women in the mid-life.

Multiple national surveys have found that women in the mid-life (~30-49) have dramatically increased binge drinking in recent years. While multiple hypotheses have been suggested to explain this increase, few have been empirically investigated. One hypothesized determinant of these trends is that shifts in women’s education and social position may be contributing to increases in binge drinking; if that’s true, the researchers anticipated that the increases in binge drinking prevalence would be concentrated among highly educated women and women with higher socio-economic status.

McKetta and Keyes used data from the National Health Interview Surveys (NHIS) from 2006 to 2018 to examine how trends in binge drinking among women ages 30-49 varied across two different measures of socio-economic status: education and family income.

They found that women had increases in binge drinking at all levels of education and income, but those with higher education and higher income had the most pronounced increases in binge drinking in recent years. For example, among women with less than high school education, the model-based predicted probability of binge drinking in 2006 was 10%, and 13% in 2018, adjusting for covariates (adjusted OR [AOR] 1.02, 95% CI 0.99, 1.04); among those with a college degree, binge drinking increased from a predicted 14% to 34% (AOR 1.10, 95% CI 1.08–1.11).  There appeared to be a threshold at college completion, as the increases among women in higher education categories were nearly identical.  Among women with family incomes less than 100% of the Federal Poverty Level (FPL), the model-based probability of binge drinking increased from 11% to 16% from 2006 to 2018 (AOR 1.03, 95% CI 1.01–1.05); whereas among those at the highest income level, 400% of the FPL or higher, binge drinking increased from 17% to 36% (AOR 1.09, 95% CI 1.07–1.10). In sensitivity analyses examining these trends among men, the socio-economic patterning of trends in binge drinking was much less pronounced.

The authors interpret these findings as evidence that increases in women’s binge drinking are concentrated among women at the highest levels of socio-economic status. This research corroborates previous research demonstrating the importance of college as a risk factor for binge drinking. This research also provides further evidence that alcohol researchers examining determinants of recent trends should be considering social factors, including the changing social landscape for women, such as increases in labor force engagement and role strain for women. The authors caution that the groups traditionally considered “high-risk” (i.e., young, college-aged men) are changing, and that providers should be screening all patients for alcohol consumption.

Posted in Alcohol, Alcohol Consumption, Socioeconomic Status | Leave a comment

Engaging with movement demands on their own terms: Professor Ruth Wilson Gilmore makes the case for abolition

There’s been much discussion about what organizers and protesters “really mean” by their demands to defund the police and abolish police and prisons, as those ideas enter the mainstream discourse.

One troubling pattern is emerging in these discussions among commentators and academics who identify with criminal legal system reform. Instead of openly debating the demands of demonstrators and organizers on their own terms, or admitting they disagree or think they’re infeasible, many are appropriating and coopting elements of the demands they find palatable, while redefining the elements they don’t. For the latter, they claim that people taking the streets aren’t saying what they actually mean, and proceed to offer what they think is a more reasonable interpretation.

Social epidemiologists have a responsibility not to decenter and erase the 30-plus years of brilliant, sophisticated scholarship and organizing that the mostly Black-women-led abolition movement has done to prepare us for this moment. When they, and the protesters and organizers on the ground in Minneapolis and across the country, say “defund the police,” they really mean defund, and when they say “abolish the police” (and prison!) they really mean abolish. And they have mountains of scholarly and popular literature enumerating what they mean in rich detail, which includes concrete, pragmatic, and proven alternative investments.

Sadly, at the very moment when white and/or well-off people least affected by state violence should be stepping back, listening, doing the reading, and amplifying the work of Black scholars, organizers, activists, and movement leaders, they’re centering white liberal subjectivity and pragmatism as normative and “objective,” and engaging in the sort of whitewashing and gaslighting that helps to reproduce white supremacy.

With this in mind, here is some required listening for social epidemiologists: This new two-part podcast interview with Professor Ruth Wilson Gilmore, a founder of the abolition movement and prolific scholaris essential.  In the words of the interviewer, Rutgers journalism Professor Chenjerai Kumanyika, “In addition to concrete lessons for organizers, Ruth Wilson Gilmore makes PROFOUND interventions in at least five different academic disciplines (geography, social work, ecology, criminology, economics, women’s studies etc.).” I would absolutely add public health to that list.

– Seth J. Prins, PhD MPH, Assistant Professor of Epidemiology and Sociomedical Sciences

 

Podcast on the The Intercept

https://theintercept.com/2020/06/10/ruth-wilson-gilmore-makes-the-case-for-abolition/?utm_medium=social&utm_source=twitter&utm_campaign=theintercept

And here are spotify links:

Part 1

https://open.spotify.com/episode/1A86xwTCAD3TPH1n9447xk?si=-6vI4dBFTvWJPYIZTZmSFw

Part 2

https://open.spotify.com/episode/5wZl1wMiCtngw5zOA4SGiq?si=KVxVlkZ8QbqfcyoiZAKBTw

Finally, here are some excellent compendia of readings, interviews, and other resources on abolition and transformative justice:

https://transformharm.org/

https://www.radicalhistoryreview.org/abusablepast/reading-towards-abolition-a-reading-list-on-policing-rebellion-and-the-criminalization-of-blackness/

https://medium.com/@micahherskind/resource-guide-prisons-policing-and-punishment-effb5e0f6620

 

 

 

Posted in Mass Incarceration | Leave a comment

How neighborhoods and infrastructure can impact HIV transmission among Black sexual minority men

Individual risky behaviors (ex. condomless sex, multiple partners, drug use) have long been a focus of HIV research and intervention strategies for sexual minority men (SMM). However, focusing on the individual level obscures the effects of broader societal influences and disparities. Importantly, Black SMM experience higher rates of HIV infection than their white counterparts, despite engaging in similar or fewer HIV risk behaviors. Individual behaviors cannot explain this disparity, and behavior-focused interventions cannot close this gap.

It is important to consider the upstream, structural causes of health disparities, especially those that are modifiable, in order to inform justice-oriented interventions. One such upstream cause is neighborhood factors.

Neighborhood problems — such as excessive noise, speeding cars, trash and litter, and lack of access to adequate food, shopping, sidewalks, parks and playgrounds — can have an impact on residents’ health. There are three major ways that these neighborhood problems operate on health. First, these problems can be stressors that prompt residents to engage in unhealthy behaviors as coping mechanisms (ex. Illicit drug use). Second, neighborhoods that are less pleasant to spend time in and more difficult to navigate can lack the social cohesion and community that can be protective when it comes to health behaviors. And third, neighborhood problems are often indicative of general disinvestment. The accompanying lack of access to material resources and services that might help residents avoid unhealthy behaviors and promote health preservation.

Dr. Dustin Duncan and colleagues at Columbia’s Spatial Epidemiology Lab conducted a study of 377 Black SMM in Jackson, Mississippi and Atlanta, Georgia to look for connections between neighborhood problems and HIV. Their findings suggest that “structural interventions that improve community infrastructure to reduce neighborhood problems (e.g., trash and litter) could help to alleviate the incidence of HIV among Black MSM in the Deep South.”

The study’s main finding was that a higher number of neighborhood problems was associated with drug use before or during sex. As a result, neighborhood problems could be considered a risk factor for HIV transmission.

We know that neighborhood problems are the by-product of historical neglect, especially of racially and economically segregated areas. Improving the infrastructure of these underserved neighborhoods could be one step in alleviating the incidence of HIV among Black SMM in the Deep South.

 

Reference: Duncan DT, Sutton MY, Park SH, Callander D, Kim B, Jeffries WL 4th, Henny KD, Harry-Hernández S, Barber S, Hickson DA. Associations Between Neighborhood Problems and Sexual Behaviors Among Black Men Who Have Sex with Men in the Deep South: The MARI Study. Arch Sex Behav. 2020 Jan;49(1):185-193.

 

Posted in Health Disparities, Neighborhood Disadvantage, Neighborhood Environments, Physical Disorder, Race, Racial Segregation, Urban Health | Leave a comment

“Black men loving Black men is the revolutionary act”1: Racial sexual exclusivity as both an effect and a protection against discrimination for Black sexual minority men

Often in public health, sexual relationships between Black gay, bisexual, and other sexual minority men (SMM) are framed as sources of risk and disease, especially in terms of HIV transmission. However, Black queer activists have long known that cultivating loving relationships between Black gay men is a way to build community, and can be a source of strength and resilience in the face racial discrimination. In response, researchers from Columbia’s Spatial Epidemiology Lab conducted a study to measure how sexual relationships between Black SMM can function as positive and preventive responses to racial discrimination, and associated psychological effects like depression symptoms.

The study involved 312 cisgender Black SMMs from the U.S. Deep South, in Jackson, Mississippi and Atlanta, Georgia. They were surveyed the assess levels of Black sexual exclusivity, sexual racial discrimination (whether they had been rejected by a potential partner because of their race), general daily discrimination experiences, and depressive symptoms.

Results of the study showed that men who experienced more racial discrimination were more likely to have exclusively Black sex partners. This could be a self-preservation mechanism, avoiding the daily discrimination that comes with navigating White social spaces.

Additionally (and perhaps intuitively), Black sexual exclusivity was associated with experiencing less sexual racial discrimination — perhaps by avoiding white sexual partners.

This work suggests that Black sexual exclusivity could help prevent depressive symptoms, by protecting Black SMM from sexual racial discrimination in addition to fostering love, closeness, and pleasure.

1Joseph Beam, “Caring for Each Other,” Black/Out, Summer 1986

Reference: English D, Hickson DA, Callander D, Goodman MS, Duncan DT. Racial Discrimination, Sexual Partner Race/Ethnicity, and Depressive Symptoms Among Black Sexual Minority Men. Arch Sex Behav. 2020 Mar 28. doi: 10.1007/s10508-020-01647-5.

Posted in Depression, Ethnicity, Health Disparities, Mental Health, Race, Racism, Social Networks | Leave a comment

@DearPandemic: a COVID-19-related scientific communication effort for the public

Epidemiologists and other scientists have become an important source of information for the public amid so much misinformation around COVID-19. “Dear Pandemic” is a public service effort by Dr. Sandra Albrecht, Assistant Professor of Epidemiology, in conjunction with an all-female team of 10 PhD-trained public health scientists/faculty from various institutions in the US and the UK, with expertise ranging across epidemiology, demography, nursing, health policy, and mental health clinical practice, among others. Together, they interpret the latest scientific findings, respond to queries from the public, and dispel myths around the virus via their “Dear Pandemic” social media profiles on Facebook, Instagram, and Twitter (@DearPandemic).  The team comes from different walks of life, so their collective networks exhibit broad geographic, political, cultural, and racial/ethnic diversity. Originally intended as a side project to deliver science-informed content to family, friends, and neighbors, this effort has grown into a large scientific communication effort with international reach that aims to educate and amplify facts and science for the public (see this JAMA Network article which calls for such efforts: https://jamanetwork.com/channels/health-forum/fullarticle/2764847).

Follow @DearPandemic and share with family and friends:

Facebook: https://www.facebook.com/dearpandemic/

Twitter: https://twitter.com/DearPandemic

Instagram: https://www.instagram.com/dear_pandemic/

Posted in COVID-19, Pandemic, Teaching Tools | Leave a comment

Severe COVID-19 Projections: Data Visualization Tool

An online data visualization tool has just been released that allows users to explore the COVID-19 projections being released weekly by Jeff Shaman’s lab at the Columbia University Mailman School of Public Health.  These data have been powering Columbia’s interactive online mapping tool that shows projected numbers for severe COVID-19 disease compared to the supply of available critical care beds under a variety of scenarios.  The new data visualization tool allows users to see daily projected estimates of new cases, newly infected individuals and available critical care beds under a variety of scenarios for states and counties in the U.S.  The methods used to make these estimates are described here.

Data visualization of daily COVID-19 cases and available hospital critical care beds.

This data visualization tool was created by Tonguc Yaman, a doctoral student in the Department of Epidemiology, using Shiny R Server.

 

 

Posted in COVID-19, Health Disparities, Neighborhood Environments | Leave a comment

Mapping Food Insecurity During the COVID-19 Pandemic

Prior to the COVID-19 pandemic, 11% of households and nearly 16% of families with children were food insecure. With schools closed and families out of work, food insecurity rates are expected to skyrocket in the coming months. During the crisis, food store shelves have frequently been empty due to bulk purchasing and an increase in at-home meal consumption. In an effort to ensure food is available for SNAP shoppers when they receive their monthly benefits, social media campaigns have encouraged non-SNAP shoppers to avoid food shopping during SNAP distribution dates. This is a particular concern in counties with large SNAP populations and in states with only a few SNAP distribution days per month (e.g., Nevada, Virginia, New Jersey). To inform these efforts, Dr. Eliza Kinsey, a post-doctoral researcher with the Social and Spatial Epi Unit, developed a web mapping tool of SNAP distribution schedules and participation rates by county. This tool is intended to be used, both by household food shoppers and by policy-makers in designing strategic efforts to combat the food insecurity and nutrition challenges brought on by the COVID-19 crisis.

The maps use current SNAP schedule distribution information and 2018 participation counts. Dr. Kinsey plans to update the mapping tool regularly with pertinent SNAP participation changes and unemployment data.

Food insecurity in America

Posted in Food Insecurity, Health Disparities, Info-Graphix, Mapping, Pandemic, Socioeconomic Status, Spatial Analysis | Leave a comment

Updated: County Level Estimates of Highly Stressed Health Care Systems

The Built Environmental and Health Research Group’s online mapping tool has been updated with new data showing counties that are at high risk of experiencing patient volumes that exceed their hospital capacity over the next 6 weeks.  The maps show at risk counties for three different levels of social distancing and two levels of intensity of surge responses by hospitals.  The estimates use Jeffrey Shaman and colleague’s models of disease spread and the estimates posted previously of how many critical care hospital beds can be made available under various assumptions of hospital responses to patient surges. A full description of the methods can be found |here|

As in prior posts, the mapping site is a work in progress and will be updated frequently.

 

Posted in COVID-19, Health Care, Health Disparities, Mapping, Spatial Analysis | Leave a comment

COVID-19 and Food Insecurity

Mailman School researchers are calling attention to the way in which COVID-19 is magnifying food insecurity in the U.S. and the link between food insecurity and long term health effects among children. The rapid spread of COVID-19 throughout the United States has led to statewide stay-at-home orders and school closures for the vast majority of the country. The National School Lunch Program, School Breakfast Program and Child and Adult Care Food Program serve a combined 35 million children daily, providing vital nutrition and financial assistance to low-income families. For many children across the country, schools and childcare centers are an essential source of nutrition, providing as much as two thirds of a child’s daily food intake. Projections in Philadelphia by Dr. Eliza Kinsey, a postdoctoral researcher in the Epidemiology Department, demonstrate that even a 3-day school closure could result in more than 400,000 missed meals among school-aged children. Dr. Kinsey has been invited to participate in the CDC’s COVID-19 Food Insecurity Working Group to help create national estimates of missed meals among children resulting from COVID-19 related school closures.

Prior to the COVID-19 pandemic, nearly 16% of families with children were food insecure. With schools closed and families out of work, food insecurity rates are expected to skyrocket in the coming months. Even short term food insecurity can have significant impacts on children’s health, including poorer behavioral, emotional and nutritional outcomes. Among children, food insecurity has been linked to increased risk of weight gain and obesity, which can have long-term consequences for chronic disease morbidity.

Food Pantry Shelves

Not only will household food insecurity spike due to loss of employment and school closures, social distancing practices will make it harder for low-income families to use common food insecurity coping strategies, such as eating at soup kitchens and sharing food with friends and family. Furthermore, shielding behaviors often employed by parents to ensure their children eat even in times of uncertain food access could result in a domino effect of health and nutritional implications for families. Lastly, food hording, as has been widely documented across the country, leaves low-income families who cannot afford to buy in bulk quantities at an extreme disadvantage when they find empty shelves at grocery stores. For families who rely on SNAP and WIC, this is even more worrisome as their food shopping is already restricted to stores that accept the benefits and stock the approved food items. SNAP households typically run out of benefits before receiving their next disbursement, which constrains the timing of food shopping trips.

In response to the rapid uptick in food insecurity across the country, Congress’ $100 billion Families First Coronavirus Act relief measure made a number of provisions to expand federal nutrition assistance programs. One key provision enables states to issue meal-replacement benefits through the Supplemental Nutrition Assistance Program (SNAP) for households with children receiving free or reduced-price meals, which would amount to a SNAP dollar value of roughly $114 per child a month. Local educational authorities are also enabled to use feeding practices from the USDA’s summer meals programs to ensure children receive adequate nutrition during school closures. However, as Dunn et al. observed in their recent New England Journal of Medicine perspective, federal guidelines on how to execute feeding programs safely and effectively amidst the COVID-19 outbreak are lacking and many school districts do not have experience with the summer feeding programs.

Additionally, work requirements for SNAP have been waived and states are allowed to increase SNAP allotments up to the maximum benefit amount as an emergency measure. However, at this time, states are not allowed to increase SNAP benefits for families already receiving the maximum benefit, which includes 2.5 million households with children. Federal guidance to address the current food insecurity crisis is critical for ensuring adequate nutrition and long-term health outcomes for millions of low-income children.

As local authorities await federal guidelines, many have implemented creative strategies of their own. Some school districts have begun delivering meals to students via school busses driving along their regular routes. Other cities and states, including Philadelphia and South Carolina are implementing grab-and-go food pick-up sites where families can obtain 5 days of food at one time. In an attempt to provide a more centralized, efficient response to food insecurity, New York City has named a Food Czar to oversee all response efforts in the city during the COVID-19 crisis. Despite innovative strategies to alleviate the impact of this crisis on the food security of children and families, the COVID-19 pandemic will exacerbate health disparities and have profound effects on the food and financial security of many in this country for years to come.

Dr. Kinsey will be leading research efforts to understand, and plan for, the clinical and public health effects of increased childhood food insecurity that is resulting from the COVID-19 pandemic.  Dr. Kinsey was recently awarded a career development award by the Eunice Kennedy Shriver National Institute for Child Health and Human Development of the National Institutes of Health (K99HD101657) to study the impact of early life food insecurity exposure on child weight gain and cognitive development trajectories. She will lead analyses in the Columbia Children’s Center for Environmental Health birth cohorts to examine the effects of food insecurity over the life-course.

Posted in COVID-19, Food Insecurity, Pandemic | Leave a comment