Objective: While prior studies showed lower socioeconomic status was associated with worse acute asthma exacerbations (AAE) and asthma-related emergency department/urgent care (ED/UC) visits, few have quantified contributions of risk factors. We aim to identify and quantify risk factors driving these disparities across levels of neighborhood deprivation. Methods: We conducted a cohort study of 79,562 adults with mild asthma in Kaiser Permanente Southern California, United States, during 2013-2018, with follow-up through 2019, comparing participants in Neighborhood Deprivation Index (NDI) quintiles five (Q5, most deprived) and one (Q1, least deprived). Outcomes included AAE and asthma-related ED/UC visits. We employed Oaxaca-Blinder decomposition to quantify contributions of 14 risk factors to these disparities. Results: Individuals in NDI Q5 had a 1.5% higher rate of AAE and a 3% higher rate of ED/UC visits than those in Q1. The 14 risk factors explained 61.2% of the AAE disparity and 52.3% of the ED/UC disparity. Race and ethnicity contributed most, 33.1% of the AAE disparity and 22.8% of the ED/UC disparity, followed by body mass index, prior asthma exacerbations, and exercise levels. Conclusions: These results underscore the need for targeted interventions addressing socioeconomic and behavioral factors to reduce asthma-related health disparities, particularly in disadvantaged populations.

Causal evidence regarding neighborhood effects on health remains tenuous. Given that children have little agency in deciding where they live and spend proportionally more of their lives in neighborhoods than adults, their exposure to neighborhood conditions could make their health particularly sensitive to neighborhood effects. In this paper, we examine the relationship between exposure to poor neighborhoods from birth to ages 4–10 and childhood asthma. We used data from the 2003–2007 California Maternal Infant and Health Assessment (MIHA) and the 2012–2013 Geographic Research on Wellbeing (GROW) survey ( N = 2619 mother/child dyads) to fit relative risks of asthma for children who experience different types of neighborhood poverty mobility using Poisson regression controlling for individual-level demographic and socioeconomic characteristics, and neighborhood satisfaction. Our results demonstrate that [1] living in a poor neighborhood at baseline and follow-up and [2] moving into a poor neighborhood were each associated with higher risk of asthma, compared with children not living in a poor neighborhood at either time. Exposure to impoverished neighborhoods and downward neighborhood poverty mobility matters for children’s health, particularly for asthma. Public health practitioners and policymakers need to address downward neighborhood economic mobility, in addition to downward family economic mobility, in order to improve children’s health.

Exposure to secondhand smoke is a significant health risk for multiple diseases. However, living with a smoker may also create a household culture of negative health behaviors linked to obesity, which carries additional health risks. While research has recognized that the same health behavior may spread through social contacts, the possibility of health behavior contagion across different domains is essentially unstudied. This study examined living with a smoker and obesity in middle-aged and older women, using limited access data from the Women’s Health Initiative Observational Study obtained from NHLBI (N = 85,809). Participants ranged from 50 to 79 years of age; 6,223 participants reported living with a smoker. Analyses were cross-sectional and used multiple linear and, for binary outcomes, logistic regression. Weight and BMI were objectively measured and all analyses controlled for age, education, income, ethnicity, and marital status. Living with a smoker was related to an increased weight of 5.29 pounds (p < .001). In addition, living with a smoker was associated with 37% increased odds of obesity (BMI ≥ 30, p < .001). Further, among obese participants, living with a smoker was associated with 35% increased odds of a higher level of obesity (BMI ≥ 35, p < .001). Understanding the link between living with a smoker and obesity may help broaden health promotion interventions among middle-aged and older women, a population at risk for passive smoking. This project was supported by the NIH/NCI (R03CA215947).

It has been argued that making contraception more convenient could increase use and continuation. Suggestions for making oral contraceptives (OCs) more convenient include (1) removing the prescription requirement and (2) providing users with more pill packs. We test the association of both of these measures with OC continuation in a setting where low-income women can obtain OCs without a prescription by crossing the border into Mexico.

Many studies have reported significant empirical associations between family structure during childhood and children's outcomes later in life. It may be that living in a nonintact family has adverse consequences for children. On the other hand, it may be that some unobserved process jointly determines family structure and children's outcomes. How then should one interpret the empirical evidence on the relationship between family structure and children's outcomes? The answer depends on the question asked and on the prior information available to the researcher. We seek to interpret the association between family structure and high school graduation found among respondents in the National Longitudinal Survey of Youth. We seek to answer the traditional question of the literature on treatment effects: How would the probability of high school graduation vary with family structure if family structure were not selected by parents but were, instead, an exogenously assigned ntreatment,m as in a clinical trial or other controlled experiment? The inferential problem is that the data alone do not suffice to identify the treatment effect. Hence any attempt to estimate a treatment effect depends critically on the prior information available to the researcher. We develop alternative estimates of the effect of family structure on high school graduation, obtained under differing assumptions about the actual process generating family structure and high school outcomes. We first assume strong prior information and present estimates of a set of parametric latent-variable models explaining family structure and children1s outcomes. We then assume no prior information at all and report estimates of nonparametric bounds on the graduation probabilities. Finally, we give nonparametric estimates obtained under the assumption that family structure is exogenous with respect to high school graduation. Our empirical analysis strengthens the evidence that living in an intact family increases the probability that a child will graduate from high school. We also report that the probability of high school graduation increases markedly with both parents1 education, regardless of family structure. At the same time, we stress that no empirical analysis of the effect of family structure on children's outcomes can be conclusive. In the absence of prior information, one can only bound the family structure effect. Any attempt to determine the effect more tightly must bring to bear prior information about the process generating family structure and children's outcomes. As long as social scientists are heterogeneous in their beliefs about this process, their estimates of family-structure effects may vary. Many studies in recent years have reported significant empirical associations between family structure during childhood and children's outcomes later in life. Several analyses have shown that, conditional on parental income, education, and other observed family characteristics, persons who live in singleparent families at some time during their childhood are more likely to become single parents themselves (Hetherington, Cox, and Cox, 1978; Hogan and Kitagawa, 1985). Other studies have shown that adolescents who live in single-parent families, stepparentlparent families, or with neither parent at age 14 are less likely to graduate from high school than are those who live with both biological parents at age 14 (Krein and Beller, 1986; McLanahan and Bumpass, 1988). These findings have been replicated with several data sets and appear to be consistent across the major racial and ethnic groups in the United States (Sandefur, McLanahan, and Wojtkiewicz, 1989). The recent increase in the prevalence of marital disruption and single parenthood makes it increasingly important to understand the documented associations between family structure and children's outcomes. It may be that, as the empirical evidence suggests, living in a nonintact family has adverse consequences for children. On the other hand, it may be that some unobserved process jointly determines family structure and children's outcomes. 2 For example, parents who are less committed to their families may be more likely to divorce and may also provide less guidance and emotional support to their children. Behavioral and/or medical problems such as alcoholism, depression, drug addiction, anxiety, or low self-esteem may make a person more likely to divorce and less effective as a parent. Another possibility is that parents take the interests of their children into account in making decisions about divorce. In particular, parents may compare the likely impact on their children of maintaining a marriage characterized by constant fighting and hostility with the impact of raising the children in a single-parent household. How then should one interpret the empirical evidence on the relationship between family structure and children's outcomes? The answer depends on the question asked and on the prior information available to the researcher. In this paper, we seek to interpret the association between family structure and high school graduation found among respondents in the National Longitudinal Survey of Youth (NLSY); Section 2 describes the NLSY data. We seek to answer the following question: How would the probability of high school graduation vary with family structure if family structure were not selected by parents but were, instead, an exogenously assigned "treatment," as in a clinical trial or other controlled experiment? Section 3 formalizes this question in the manner of Rosenbaum and Rubin (1983), Heckman and Robb (1985), and Manski (1990a) and discusses its relevance. This done, we explain the

Many studies have reported significant empirical associations between family structure during childhood and children's outcomes later in life. It may be that living in a nonintact family has adverse consequences for children. On the other hand, it may be that some unobserved process jointly determines family structure and children's outcomes. How then should one interpret the empirical evidence on the relationship between family structure and children's outcomes? The answer depends on the question asked and on the prior information available to the researcher. We seek to interpret the association between family structure and high school graduation found among respondents in the National Longitudinal Study of Youth. We seek to answer the traditional question of the literature on treatment effects: How would the probability of high school graduation vary with family structure if family structure were not selected by parents but were, instead, an exogenously assigned “treatment,” as in a clinical trial or other controlled experiment? The inferential problem is that the data alone do not suffice to identify the treatment effect. Hence any attempt to estimate a treatment effect depends critically on the prior information available to the researcher. We develop alternative estimates of the effect of family structure on high school graduation, obtained under differing assumptions about the actual process generating family structure and high school outcomes. We first assume strong prior information and present estimates of a set of parametric latent-variable models explaining family structure and children's outcomes. We then assume no prior information at all and report estimates of nonparametric bounds on the graduation probabilities. Finally, we give non-parametric estimates obtained under the assumption that family structure is exogenous with respect to high school graduation. Our empirical analysis strengthens the evidence that living in an intact family increases the probability that a child will graduate from high school. We also report that the probability of high school graduation increases markedly with both parents’ education, regardless of family structure. At the same time, we stress that prior information is necessary if one is to do more than bound the effect of family structure on children's outcomes. Any point estimate embodies prior information about the process generating family structure and children's outcomes. As long as social scientists are heterogenous in their beliefs about this process, their estimates of family-structure effects may vary.