Virginia W Chang
Virginia W Chang
Scroll
Associate Professor of Social and Behavioral Sciences
-
Professional overview
-
Virginia W. Chang, MD, PhD is Associate Professor of Social and Behavioral Sciences at NYU School of Global Public Health, Associate Professor of Population Health at NYU School of Medicine, and Affiliated Associate Professor in the Department of Sociology at NYU. Dr. Chang is a graduate of the Inteflex Program at the University of Michigan, where she received her BS and MD degrees. She then completed a residency in internal medicine, fellowship training with the Robert Wood Johnson Foundation Clinical Scholars Program, and a PhD in sociology, all at the University of Chicago. Prior to joining NYU, Dr. Chang was in the Division of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania and a staff physician at the Philadelphia Veterans Administration Medical Center.
As a physician and sociologist, Dr. Chang integrates perspectives from medicine, epidemiology, sociology, and demography in her research. Much of her work has focused on obesity and health disparities, engaging topics such as the influence of socially structured context (e.g., racial segregation, income inequality, neighborhood social/physical disorder) on obesity; the relationship of obesity to mortality and disability; the influence of weight status on the quality of medical care; socioeconomic disparities in health and mortality; and the inter-relationships between health, medical technologies, and stratification.
Her research program has been funded by the NICHD, NHLBI, and NIA of the National Institutes of Health, the Veterans Health Administration, the Robert Wood Johnson Foundation, the Measy Foundation, the American Diabetes Association, and the Russell Sage Foundation. She is the recipient of numerous awards, including the Society of General Internal Medicine Award for Outstanding Junior Investigator of the Year and the Marjorie A. Bowman Award from the University of Pennsylvania School of Medicine for achievement in the health evaluation sciences. Dr. Chang is also a Diplomate of the American Board of Internal Medicine.
Dr. Chang’s publications span a variety of disciplines, including journals such as JAMA, Annals of Internal Medicine, JAMA Internal Medicine, Health Affairs, American Journal of Public Health, American Journal of Epidemiology, Journal of Health & Social Behavior, Social Science & Medicine, Demography, and Social Forces. She was recently an Associate Editor of the Journal of Health & Social Behavior.
-
Education
-
BS, Biomedical Sciences and Philosophy, University of Michigan, Ann Arbor, MIMD, Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MIMA, Sociology, University of Chicago, Chicago, ILPhD, Sociology, University of Chicago, Chicago, IL-Fellow, Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, ILResident, Department of Medicine, University of Chicago, Chicago, ILIntern, Department of Medicine, University of Chicago, Chicago, IL-Diplomate, American Board of Internal MedicineLicensed Medical Physician, Commonwealth of Pennsylvania
-
Honors and awards
-
Majorie A. Bowman Research Award, University of Pennsylvania School of Medicine (2010)Outstanding Junior Investigator of the Year, Society of General Internal Medicine (2008)Robert Austrian Faculty Award for Health Evaluation Reserach, Department of Medicine, University of Pennsylvania School of Medicine (2008)Physician Faculty Scholars Award, Robert Wood Johnson Foundation (2007)Finalist, Hamolsky Junior Facutly Award, Society of General Internal Medicine (2004)Finalist, Richard Saller Prize for Best Dissertation in the Division of the Social Sciences, University of Chicago (2003)Graduate University Fellowship, University of Chicago (2001)Eli G. Rochelson Memorial Award for Excellence in Pulmonary and Critical Care Medicine, University of Michigan Medical School (1994)Biomedical Research Program Scholarship, University of Michigan Medical School (1991)James B. Angell Scholar, University of Michigan (1988)William J. Branstrom Freshman Prize, University of Michigan (1986)
-
Areas of research and study
-
Global HealthHealth DisparitiesInternal MedicineObesityPopulation HealthSocial Behaviors
-
Publications
Publications
24-Year trends in educational inequalities in adult smoking prevalence in the context of a national tobacco control program : The case of Brazil
AbstractBandi, P., Chang, V. W., Sherman, S. E., & Silver, D. R. (n.d.).Publication year
2020Journal title
Preventive MedicineVolume
131AbstractBrazil was a low and middle-income country (LMIC) in the late-1980s when it implemented a robust national tobacco-control program (NTCP) amidst rapid gains in national incomes and gender equality. We assessed changes in smoking prevalence between 1989 and 2013 by education level and related these changes to trends in educational inequalities in smoking. Data were from four nationally representative cross-sectional surveys (1989, n = 25,298; 2003 n = 3845; 2008 n = 28,938; 2013 n = 47,440, ages 25–69 years). We estimated absolute (slope index of inequality, SII) and relative (relative index of inequality, RII) educational inequalities in smoking prevalence, separately for males and females. Additional analyses stratified by birth-cohort to assess generational differences. Smoking declined significantly between 1989 and 2013 in all education groups but declines among females were steeper in higher-educated groups. Consequently, both absolute and relative educational inequalities in female smoking widened threefold between 1989 and 2013 (RII: 1.31 to 3.60, SII: 5.3 to 15.0), but absolute inequalities in female smoking widened mainly until 2003 (SII: 15.8). Conversely, among males, declines were steeper in higher-educated groups only in relative terms. Thus, relative educational inequalities in male smoking widened between 1989 and 2013 (RII: 1.58 to 3.19) but mainly until 2008 (3.22), whereas absolute equalities in male smoking were unchanged over the 24-year period (1989: 21.1 vs. 2013: 23.2). Younger-cohorts (born ≥1965) had wider relative inequalities in smoking vs. older-cohorts at comparable ages, particularly in the youngest female-cohorts (born 1979–1988). Our results suggest that younger lower-SES groups, especially females, may be particularly vulnerable to differentially higher smoking uptake in LMICs that implement population tobacco-control efforts amidst rapid societal gains.Affect and heart disease
AbstractChang, V. W. (n.d.).Publication year
2008Journal title
BMJVolume
337Issue
7660Page(s)
3-4Abstract~Anti-Vaccine Attitudes among Adults in the U.S. during the COVID-19 Pandemic after Vaccine Rollout
AbstractChang, V. W., Choi, J., Lieff, S., Meltzer, G., Grivel, M., Chang, V., Yang, L., & Desjarlais, D. (n.d.).Publication year
2022Journal title
VaccinesVolume
10Issue
6AbstractEven though vaccination is the most effective measure against COVID-19 infections, vaccine rollout efforts have been hampered by growing anti-vaccine attitudes. Based on current knowledge, we identified three domains (beliefs, discrimination, and news) as our correlates of primary interest to examine the association with anti-vaccine attitudes. This is one of the first studies to examine key correlates of anti-vaccine attitudes during the critical early stages of vaccine implementation in the United States. An online survey was administered in May 2021 to a non-representative, nationally based sample of adults (N = 789). Using multivariable logistic regression analysis, we found that individuals who expressed worry about COVID-19 (OR = 0.34, 95% CI 0.21, 0.55) and had greater knowledge of COVID-19 (OR = 0.50, 95% CI 0.25, 0.99) were less likely to hold antivaccine attitudes. Conversely, individuals who held stigmatizing views of COVID-19 (OR = 2.47, 95% CI 1.53, 3.99), had experienced racial discrimination (OR = 2.14, 95% CI 1.25, 3.67) and discrimination related to COVID-19 (OR = 2.84, 95% CI 1.54, 5.24), and who had been watching Fox News (OR = 3.95, 95% CI 2.61, 5.97) were more likely to hold anti-vaccine attitudes. These findings suggest COVID-19 beliefs, experiences of discrimination, and news sources should be considered when designing targeted approaches to address the anti-vaccine movement.Anti-vaccine attitudes and COVID-19 vaccine status at the end of the U.S. public health emergency
AbstractChoi, J., Feelemyer, J., Choe, K., Lynch, K., McKnight, C. A., Yang, L., Jarlais, D. D., & Chang, V. W. (n.d.).Publication year
2025Journal title
VaccineVolume
55AbstractIntroduction: Despite the end of the federal COVID-19 public health emergency in May 2023, COVID-19 prevention remains a priority. This study investigates how public vaccination attitudes and perceived COVID-19 risks relate to vaccination status, aiming to identify factors associated with COVID-19 vaccination post-emergency. Methods: An online survey was conducted from April to May 2023 among a non-representative, nationally-based sample of MTurk workers. The primary outcome was COVID-19 vaccination status. Variables examined included anti-vaccine attitudes, health status, COVID-19 experiences, and sociodemographic factors. We created a composite measure of anti-vaccine attitudes from 15 items with three levels. Bivariate tests of association and multivariable logistic regression were performed. Results: A final sample of 989 adults were included in this analysis. In our multivariable model, individuals with higher anti-vaccine attitudes were less likely to be vaccinated against COVID-19 compared to those with low anti-vaccine attitudes (OR = 0.10, 95 % CI 0.04, 0.25). Those who identified as LGBQ+ (OR = 2.55, 95 % CI 1.32, 4.94), had chronic conditions (OR = 2.94, 95 % CI 1.43, 6.01) and had felt stigmatized from COVID-19 infections (OR = 3.33, 95 % CI 1.47, 7.58) were more likely to be vaccinated, even after adjusting for anti-vaccine attitudes. News source, perceived risk of contagion by contact, and long COVID-related factors were not significantly associated with vaccination status in the multivariable model. Discussion: Our findings highlight the persistent relationship between anti-vaccine attitudes and vaccination status in the “post-pandemic” era. Beyond vaccine attitudes, sexual orientation, chronic conditions, and stigmatization experiences may influence perceived need for protection. Stigma can sometimes reinforce social norms driving vaccination, but this effect is nuanced, particularly with anti-vaccine attitudes. To promote vaccine uptake, interventions should prioritize community support, counter misinformation, and enhance vaccine literacy. Building trust among vulnerable populations is essential, rather than relying on public health messaging that may reinforce social stigma.Association between racial residential segregation and walkability in 745 U.S. cities
AbstractSpoer, B. R., Conderino, S. E., Lampe, T. M., Ofrane, R. H., De Leon, E., Thorpe, L. E., Chang, V. W., & Elbel, B. (n.d.).Publication year
2023Journal title
Health and PlaceVolume
84AbstractDespite higher chronic disease prevalence, minoritized populations live in highly walkable neighborhoods in US cities more frequently than non-minoritized populations. We investigated whether city-level racial residential segregation (RRS) was associated with city-level walkability, stratified by population density, possibly explaining this counterintuitive association. RRS for Black-White and Latino-White segregation in large US cities was calculated using the Index of Dissimilarity (ID), and walkability was measured using WalkScore. Median walkability increased across increasing quartiles of population density, as expected. Higher ID was associated with higher walkability; associations varied in strength across strata of population density. RRS undergirds the observed association between walkability and minoritized populations, especially in higher population density cities.Behavioral correlates of COVID-19 worry : Stigma, knowledge, and news source
AbstractMeltzer, G. Y., Chang, V. W., Lieff, S. A., Grivel, M. M., Yang, L. H., & Des Jarlais, D. C. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
21AbstractNon-adherence to COVID-19 guidelines may be attributable to low levels of worry. This study assessed whether endorsing COVID-19-stigmatizing restrictions, COVID-19 knowledge, and preferred news source were associated with being ‘very worried’ versus ‘not at all’ or ‘somewhat’ worried about contracting COVID-19. Survey data were collected in July–August 2020 from N = 547 New York State (NYS) and N = 504 national Amazon MTurk workers. Respondents who endorsed COVID-19 stigmatizing restrictions (NYS OR 1.96; 95% CI 1.31, 2.92; national OR 1.80; 95% CI 1.06, 3.08) and consumed commercial news (NYS OR 1.89; 95% CI 1.21, 2.96; national OR 1.93; 95% CI 1.24, 3.00) were more likely to be very worried. National respondents who consumed The New York Times (OR 1.52; 95% CI 1.00, 2.29) were more likely to be very worried, while those with little knowledge (OR 0.24; 95% CI 0.13, 0.43) were less likely to be very worried. NYS (OR 2.66; 95% CI 1.77, 4.00) and national (OR 3.17; 95% CI 1.95, 5.16) respondents with probable depression were also more likely to be very worried. These characteristics can help identify those requiring intervention to maximize perceived threat to COVID-19 and encourage uptake of protective behaviors while protecting psychological wellbeing.Being poor and coping with stress : Health behaviors and the risk of death
AbstractKrueger, P. M., & Chang, V. W. (n.d.).Publication year
2008Journal title
American journal of public healthVolume
98Issue
5Page(s)
889-896AbstractObjectives. Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Methods. Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n=40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. Results. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. Conclusions. The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.Birth weight, early life weight gain and age at menarche : a systematic review of longitudinal studies
AbstractJuul, F., Chang, V. W., Brar, P., & Parekh, N. (n.d.).Publication year
2017Journal title
Obesity ReviewsVolume
18Issue
11Page(s)
1272-1288AbstractBackground and objective: Adiposity in pre- and postnatal life may influence menarcheal age. Existing evidence is primarily cross-sectional, failing to address temporality, for which the role of adiposity in early life remains unclear. The current study sought to systematically review longitudinal studies evaluating the associations between birth weight and infant/childhood weight status/weight gain in relation to menarcheal age. Methods: PubMed, EMBASE, Web of Science, Global Health (Ovid) and CINAHL were systematically searched. Selected studies were limited to English-language articles presenting multi-variable analyses. Seventeen studies reporting risk estimates for birth weight (n = 3), infant/childhood weight gain/weight status (n = 4) or both (n = 10), in relation to menarcheal age were included. Results: Lower vs. higher birth weight was associated with earlier menarche in nine studies and later menarche in one study, while three studies reported a null association. Greater BMI or weight gain over time and greater childhood weight were significantly associated with earlier menarche in nine of nine and six of seven studies, respectively. Conclusions: Studies suggested that lower birth weight and higher body weight and weight gain in infancy and childhood may increase the risk of early menarche. The pre- and postnatal period may thus be an opportune time for weight control interventions to prevent early menarche, and its subsequent consequences.Book review: Conceiving Risk, Bearing Responsibility : Fetal Alcohol Syndrome & the Diagnosis of Moral Disorder by Elizabeth M. Armstrong
AbstractChang, V. W. (n.d.).Publication year
2005Journal title
American Journal of SociologyVolume
110Issue
5Page(s)
1513-1515Abstract~Book review: Obesity Among Poor Americans : Is Public Assistance the Problem? by Patrica K. Smith
AbstractChang, V. W. (n.d.).Publication year
2010Journal title
Contemporary SociologyVolume
39Issue
2Page(s)
204-205Abstract~COVID-19 stigmatization after the development of effective vaccines: Vaccination behavior, attitudes, and news sources
AbstractChang, V. W., Des Jarlais, D. C., Lieff, S., Grivel, M., Meltzer, G., Choi, J., Weng, C. A., Feelemyer, J. P., Chang, V. W., & Yang, L. (n.d.).Publication year
2023Journal title
PloS oneVolume
18Issue
4Page(s)
e0283467AbstractTo compare COVID-19 stigmatization at two pandemic time points (1) August 2020-during lockdowns and prior to vaccine rollout, and (2) May 2021-during vaccine rollout, when approximately half of U.S. adults were vaccinated.Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA
AbstractChoi, E. Y., Lee, H., & Chang, V. W. (n.d.).Publication year
2023Journal title
Journal of Epidemiology and Community HealthVolume
77Issue
11Page(s)
728-735AbstractBackground The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status. Methods Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older. Results We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods. Conclusion Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death
AbstractMyrskylä, M., Mehta, N. K., & Chang, V. W. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
7Page(s)
e83-e90AbstractObjectives. We sought to analyze how early exposure to the 1918 influenza pandemic is associated with old-age mortality by cause of death. Methods. We analyzed the National Health Interview Survey (n = 81 571; follow-up 1989-2006; 43 808 deaths) and used year and quarter of birth to assess timing of pandemic exposure. We used Cox proportional and Fine-Gray competing hazard models for all-cause and cause-specific mortality, respectively. Results. Cohorts born during pandemic peaks had excess all-cause mortality attributed to increased noncancer mortality. We found evidence for a trade-off between noncancer and cancer causes: cohorts with high noncancer mortality had low cancer mortality, and vice versa. Conclusions. Early disease exposure increases old-age mortality through noncancer causes, which include respiratory and cardiovascular diseases, and may trigger a trade-off in the risk of cancer and noncancer causes. Potential mechanisms include inflammation or apoptosis. The findings contribute to our understanding of the causes of death behind the early disease exposure-latermortality association. The cancer-noncancer trade-off is potentially important for understanding the mechanisms behind these associations.Ethnic Enclaves, Mental Health and Cardiometabolic Risk in Asian Americans
AbstractChoi, E. Y., & Chang, V. W. (n.d.).Publication year
2023Abstract~Extent and determinants of discrepancy between self-evaluations of weight status and clinical standards
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2001Journal title
Journal of general internal medicineVolume
16Issue
8Page(s)
538-543AbstractOBJECTIVES: To examine the extent and type of discordance between personal and medical classifications of weight status, and to examine the influence of sociodemographic factors on the misclassification of weight status. DESIGN/SETTING: The 1991 Health Promotion and Disease Prevention Supplement of the National Health Interview Survey, a nationally representative, cross-sectional survey of the U.S. population. PARTICIPANTS: Adults 18 years and older (N = 41,676). MEASUREMENTS AND MAIN RESULTS: Respondents' self-evaluations of weight status were compared to classification of their body mass index (BMI) by medical standards. Twenty-nine percent of respondents incorrectly classified their weight status relative to medical standards, and the nature of this error was variable. While 27.4% of overweight persons judged their weight to be "just about right," of those who did judge themselves to be overweight, 23.9% were in fact normal or underweight according to their BMI. Overall, 16.6% of persons underassessed their weight category, and 12.4% overassessed their weight category. Multivariate analysis revealed that sex, age, race, income, education, and occupation influenced the misclassification of weight status. CONCLUSIONS: A substantial proportion of Americans deviate from medical standards in their self-evaluations of weight appropriateness, and this lack of correspondence may reflect the normative judgments of various population subgroups. Clinical and public health programs that employ a uniform strategy or approach to the population may not be efficacious.Extreme Heat and Cognitive Decline among Older Adults: An Unequal Burden Across Groups and Communities
AbstractChoi, E. Y., Lee, H., & Chang, V. W. (n.d.).Publication year
2023Abstract~Fundamental cause theory, technological innovation, and health disparities : The case of cholesterol in the era of statins
AbstractChang, V. W., & Lauderdale, D. S. (n.d.).Publication year
2009Journal title
Journal of health and social behaviorVolume
50Issue
3Page(s)
245-260AbstractAlthough fundamental cause theory has been highly influential in shaping the research literature on health disparities, there have been few empirical demonstrations of the theory, particularly in dynamic perspective. In this study, we examine how income disparities in cholesterol levels have changed with the emergence of statins, an expensive and potent new drug technology. Using nationally representative data from 1976 to 2004, we find that income gradients for cholesterol were initially positive, but then reversed and became negative in the era of statin use. While the advantaged were previously more likely to have high levels of cholesterol, they are now less likely. We consider our case study against a broader theoretical framework outlining the relationship between technology innovation and health disparities. We find that the influence of technologies on socioeconomic disparities is subject to two important modifiers: (1) the nature of the technological change and (2) the extent of its diffusion and adoption.Gender equality, development, and cross-national sex gaps in life expectancy
AbstractMedalia, C., & Chang, V. W. (n.d.).Publication year
2011Journal title
International Journal of Comparative SociologyVolume
52Issue
5Page(s)
371-389AbstractFemale life expectancy exceeds male life expectancy in almost every country throughout the world. Nevertheless, cross-national variation in the sex gap suggests that social factors, such as gender equality, may directly affect or mediate an underlying biological component. In this article, we examine the association between gender equality and the sex gap in mortality. Previous research has not addressed this question from an international perspective with countries at different levels of development. We examine 131 countries using a broad measure of national gender equality that is applicable in both Less Developed Countries (LDCs) and Highly Developed Countries (HDCs). We find that the influence of gender equality is conditional on level of development. While gender equality is associated with divergence between female and male life expectancies in LDCs, it is associated with convergence in HDCs. The relationship between gender equality and the sex gap in mortality in HDCs strongly relates to, but is not explained by, sex differences in lung cancer mortality. Finally, we find that divergence in LDCs is primarily driven by a strong positive association between gender equality and female life expectancy. In HDCs, convergence is potentially related to a weak negative association between gender equality and female life expectancy, though findings are not statistically significant.Health Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion
AbstractHowell, B. A., Hawks, L. C., Balasuriya, L., Chang, V. W., Wang, E. A., & Winkelman, T. N. (n.d.).Publication year
2023Journal title
Hospital and Community PsychiatryVolume
74Issue
10Page(s)
1019-1026AbstractOBJECTIVE: Individuals with criminal legal involvement have high rates of substance use and other mental disorders. Before implementation of the Affordable Care Act's Medicaid expansion, they also had low health insurance coverage. The objective of this study was to assess the impact of Medicaid expansion on health insurance coverage and use of treatment for substance use or other mental disorders in this population. METHODS: The authors used restricted data (2010-2017) from the National Survey on Drug Use and Health (NSDUH). Using a difference-in-differences approach, the authors estimated the impact of Medicaid expansion on health insurance coverage and treatment for substance use or other mental disorders among individuals with recent criminal legal involvement. RESULTS: The sample consisted of 9,910 NSDUH respondents who were ages 18-64 years, had a household income ≤138% of the federal poverty level, and reported past-year criminal legal involvement. Medicaid expansion was associated with an 18 percentage-point increase in insurance coverage but no change in receipt of substance use treatment among individuals with substance use disorder. Individuals with any other mental illness had a 16 percentage-point increase in insurance coverage but no change in receipt of mental health treatment. CONCLUSIONS: Despite a large increase in health insurance coverage among individuals with criminal legal involvement and substance use or other mental disorders, Medicaid expansion was not associated with a significant change in treatment use for these conditions. Insurance access alone appears to be insufficient to increase treatment for substance use or other mental disorders in this population.Health, Polysubstance Use, and Criminal Justice Involvement Among Adults With Varying Levels of Opioid Use
AbstractWinkelman, T. N., Chang, V. W., & Binswanger, I. A. (n.d.).Publication year
2018Journal title
JAMA network openVolume
1Issue
3Page(s)
e180558AbstractImportance: Health profiles and patterns of involvement in the criminal justice system among people with various levels of opioid use are poorly defined. Data are needed to inform a public health approach to the opioid epidemic. Objective: To examine the association between various levels of opioid use in the past year and physical and mental health, co-occurring substance use, and involvement in the criminal justice system. Design, Setting, and Participants: This retrospective, cross-sectional analysis used the 2015-2016 National Survey on Drug Use and Health to assess the independent association of intensity of opioid use with health, co-occurring substance use, and involvement in the criminal justice system among US adults aged 18 to 64 years using multivariable logistic regression. Exposures: No opioid use vs prescription opioid use, misuse, or use disorder or heroin use. Main Outcomes and Measures: Self-reported physical and mental health, disability, co-occurring substance use, and past year and lifetime involvement in the criminal justice system. Results: The sample consisted of 78 976 respondents (42 495 women and 36 481 men), representative of 196 280 447 US adults. In the weighted sample, 124 026 842 adults reported no opioid use in the past year (63.2%; 95% CI, 62.6%-63.7%), 61 462 897 reported prescription opioid use in the past year (31.3%; 95% CI, 30.8%-31.8%), 8 439 889 reported prescription opioid misuse in the past year (4.3%; 95% CI, 4.1%-4.5%), 1 475 433 reported prescription opioid use disorder in the past year (0.8%; 95% CI, 0.7%-0.8%), and 875 386 reported heroin use in the past year (0.4%; 95% CI, 0.4%-0.5%). Individuals who reported any level of opioid use were significantly more likely than individuals who reported no opioid use to be white, have a low income, and report a chronic condition, disability, severe mental illness, or co-occurring drug use. History of involvement in the criminal justice system increased as intensity of opioid use increased (no use, 15.9% [19 562 158 of 123 319 911]; 95% CI, 15.4%-16.4%; prescription opioid use, 22.4% [13 712 162 of 61 204 541]; 95% CI, 21.7%-23.1%; prescription opioid misuse, 33.2% [2 793 391 of 8 410 638]; 95% CI, 30.9%-35.6%; prescription opioid use disorder, 51.7% [762 189 of 1 473 552]; 95% CI, 45.4%-58.0%; and heroin use, 76.8% [668 453 of 870 250]; 95% CI, 70.6%-82.1%). In adjusted models, any level of opioid use was associated with involvement in the criminal justice system in the past year compared with no opioid use. Conclusions and Relevance: Individuals who use opioids have complicated health profiles and high levels of involvement in the criminal justice system. Combating the opioid epidemic will require public health interventions that involve criminal justice systems, as well as policies that reduce involvement in the criminal justice system among individuals with substance use disorders.Income disparities in body mass index and obesity in the United States, 1971-2002
AbstractChang, V. W., & Lauderdale, D. S. (n.d.).Publication year
2005Journal title
Archives of Internal MedicineVolume
165Issue
18Page(s)
2122-2128AbstractBackground: Although obesity is frequently associated with poverty, recent increases in obesity may not occur disproportionately among the poor. Furthermore, the relationship between income and weight status may be changing with time. Methods: We use nationally representative data from the National Health and Nutrition Examination Surveys (1971-2002) to examine (1) income differentials in body mass index (calculated as weight in kilograms divided by the square of height in meters) and (2) change over time in the prevalence of obesity (body mass index, ≥30) at different levels of income. Results: Over the course of 3 decades, obesity has increased at all levels of income. Moreover, it is typically not the poor who have experienced the largest gains. For example, among black women, the absolute increase in obesity is 27.0% (1.05% per year) for those at middle incomes, but only 14.5% (0.54% per year) for the poor. Among black men, the increase in obesity is 21.1% (0.77% per year) for those at the highest level of income, but only 4.5% (0.06% per year) for the near poor and 5.4% (0.50% per year) for the poor. Furthermore, all race-sex groups show income differentials on body mass index, but patterns show substantial variation between groups and consistency and change within groups over time. For example, white women consistently show a strong inverse gradient, while a positive gradient emerges in later waves for black and Mexican American men. Conclusion: The persistence and emergence of income gradients suggests that disparities in weight status are only partially attributable to poverty and that efforts aimed at reducing disparities need to consider a much broader array of contributing factors.Income inequality and weight status in US metropolitan areas
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2005Journal title
Social Science and MedicineVolume
61Issue
1Page(s)
83-96AbstractPrior empirical studies have demonstrated an association between income inequality and general health endpoints such as mortality and self-rated health, and findings have been taken as support for the hypothesis that inequality is detrimental to individual health. Unhealthy weight statuses may function as an intermediary link between inequality and more general heath endpoints. Using individual-level data from the 1996-98 Behavioral Risk Factor Surveillance System, we examine the relationship between individual weight status and income inequality in US metropolitan areas. Income inequality is calculated with data from the 1990 US Census 5% Public Use Microsample. In analyses stratified by race-sex groups, we do not find a positive association between income inequality and weight outcomes such as body mass index, the odds of being overweight, and the odds of being obese. Among white women, however, we do find a statistically significant inverse association between inequality and each of these weight outcomes, despite adjustments for individual-level covariates, metropolitan-level covariates, and census region. We also find that greater inequality is associated with higher odds for trying to lose weight among white women, even adjusting for current weight status. Although our findings are suggestive of a contextual effect of metropolitan area income inequality, we do not find an increased risk for unhealthy weight outcomes, adding to recent debates surrounding this topic.Internet usage and the prospective risk of dementia : A population-based cohort study
AbstractCho, G., Betensky, R. A., & Chang, V. W. (n.d.).Publication year
2023Journal title
Journal of the American Geriatrics SocietyVolume
71Issue
8Page(s)
2419-2429AbstractBackground: Little is known about the long-term cognitive impact of internet usage among older adults. This research characterized the association between various measures of internet usage and dementia. Methods: We followed dementia-free adults aged 50–64.9 for a maximum of 17.1 (median = 7.9) years using the Health and Retirement Study. The association between time-to-dementia and baseline internet usage was examined using cause-specific Cox models, adjusting for delayed entry and covariates. We also examined the interaction between internet usage and education, race-ethnicity, sex, and generation. Furthermore, we examined whether the risk of dementia varies by the cumulative period of regular internet usage to see if starting or continuing usage in old age modulates subsequent risk. Finally, we examined the association between the risk of dementia and daily hours of usage. Analyses were conducted from September 2021 to November 2022. Results: In 18,154 adults, regular internet usage was associated with approximately half the risk of dementia compared to non-regular usage, CHR (cause-specific hazard ratio) = 0.57, 95% CI = 0.46–0.71. The association was maintained after adjustments for self-selection into baseline usage (CHR = 0.54, 95% CI = 0.41–0.72) and signs of cognitive decline at the baseline (CHR = 0.62, 95% CI = 0.46–0.85). The difference in risk between regular and non-regular users did not vary by educational attainment, race-ethnicity, sex, and generation. In addition, additional periods of regular usage were associated with significantly reduced dementia risk, CHR = 0.80, 95% CI = 0.68–0.95. However, estimates for daily hours of usage suggested a U-shaped relationship with dementia incidence. The lowest risk was observed among adults with 0.1–2 h of usage, though estimates were non-significant due to small sample sizes. Conclusions: Regular internet users experienced approximately half the risk of dementia than non-regular users. Being a regular internet user for longer periods in late adulthood was associated with delayed cognitive impairment, although further evidence is needed on potential adverse effects of excessive usage.Medicaid Expansion, Mental Health, and Access to Care among Childless Adults with and without Chronic Conditions
AbstractWinkelman, T. N., & Chang, V. W. (n.d.).Publication year
2018Journal title
Journal of general internal medicineVolume
33Issue
3Page(s)
376-383AbstractBackground: While the Affordable Care Act’s (ACA) Medicaid expansion has increased insurance coverage, its effects on health outcomes have been mixed. This may be because previous research did not disaggregate mental and physical health or target populations most likely to benefit. Objective: To examine the association between Medicaid expansion and changes in mental health, physical health, and access to care among low-income childless adults with and without chronic conditions. Design: We used a difference-in-differences analytical framework to assess differential changes in self-reported health outcomes and access to care. We stratified our analyses by chronic condition status. Participants: Childless adults, aged 18–64, with incomes below 138% of the federal poverty level in expansion (n = 69,620) and non-expansion states (n = 57,628). Intervention: Active Medicaid expansion in state of residence. Main Measures: Self-reported general health; total days in past month with poor health, poor mental health, poor physical health, or health-related activity restrictions; disability; depression; insurance coverage; cost-related barriers; annual check-up; and personal doctor. Key Results: Medicaid expansion was associated with reductions in poor health days (−1.2 days [95% CI, −1.6,-0.7]) and days limited by poor health (−0.94 days [95% CI, −1.4,-0.43]), but only among adults with chronic conditions. Trends in general health measures appear to be driven by fewer poor mental health days (−1.1 days [95% CI, −1.6,-0.6]). Expansion was also associated with a reduction in depression diagnoses (−3.4 percentage points [95% CI, −6.1,-0.01]) among adults with chronic conditions. Expansion was associated with improvements in access to care for all adults. Conclusions: Medicaid expansion was associated with substantial improvements in mental health and access to care among low-income adults with chronic conditions. These positive trends are likely to be reversed if Medicaid expansion is repealed.Medical modelling of obesity : A transition from action to experience in a 20 th century American medical textbook
AbstractChang, V. W., & Christakis, N. A. (n.d.).Publication year
2002Journal title
Sociology of Health and IllnessVolume
24Issue
2Page(s)
151-177AbstractObesity is now the focus of considerable attention in the medical profession, and many have noted that obesity has been progressively medicalised. The subjection of phenomena to medical explanation, however, has been associated with both the potential to relieve and also to exacerbate the attribution of individual responsibility. In order to understand the ways in which a particular phenomenon, obesity, can be variously conceptualised at different time-points within a medical framework, we conducted a content analysis of a series of medical textbook entries. Using the widely-consulted Cecil Textbook of Medicine, we reviewed entries on obesity from 1927 to 2000 and found that throughout this period the text consistently maintains that obesity results from a simple excess of caloric intake over expenditure. Despite the unwavering nature of this basic model, an evolving set of causal factors is superimposed. Early models invoke aberrant individual activities, such as habitual overeating, while later editions drop these factors in favour of genetic and, paradoxically, environmental effects. Obesity shifts in ontological status, as it is transformed from being the product of something that individuals do to something that they experience. Concurrent with these changes, we find a change in the social appraisal of obesity. In each edition there is a narrative regarding the cost/benefit relationship between obese persons and society, as well as a construction of accountability for obesity as an outcome. Obese individuals are progressively held less responsible for their condition in successive editions of the text. Initially cast as societal parasites, they are later transformed into societal victims. Using these texts and obesity as a case-example, we demonstrate that medical conceptualisation of a presumably cohesive object of knowledge can undergo transformation quite independently of definitive experimental evidence, with a persistent dialectic between etiological configuration and formulations of social culpability and remediation. We situate our findings with respect to ongoing debates concerning the nature and implications of medicalisation. This case effectively highlights a more general epidemiological tension between an individual level of focus on risk behaviours and a population level of focus that contexualises behaviours within a social and material framework.