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Transgender patients are at elevated risk of intimate partner violence (IPV), but national guidelines do not recommend routine screening for this population. This paper explores the feasibility and effectiveness of routine IPV screening of transgender patients in a primary care setting by describing an existing screening program and identifying factors associated with referral and engagement in IPV-related care for transgender patients. An IPV "referral cascade" was created for 1,947 transgender primary care patients at an urban community health center who were screened for IPV between January 1, 2014 to May 31, 2016: (a) Of those screening positive, how many were referred? (b) Of those referred, how many engaged in IPV-specific care within 3 months? Logistic regression identified demographic correlates of referral and engagement. Of the 1,947 transgender patients screened for IPV, 227 screened positive. 110/227 (48.5%) were referred to either internal or external IPV-related services. Of those referred to on-site services, 65/103 (63.1%) had an IPV-related appointment within 3 months of a positive screen. IPV referral was associated with being assigned male at birth (AMAB) versus assigned female at birth (AFAB) (AOR = 2.69, 95% CI 1.52, 4.75) and with nonbinary, rather than binary, gender identity (AOR = 2.07, 95%CI 1.09, 3.73). Engagement in IPV-related services was not associated with any measured demographic characteristics. Similar to published rates for cisgender women, half of transgender patients with positive IPV screens received referrals and two-thirds of those referred engaged in IPV-specific care. These findings support routine IPV screening and referral for transgender patients in primary care settings. Provider training should focus on how to ensure referrals are made for all transgender patients who screen positive for IPV, regardless of gender identity, to ensure the benefits of screening accrue equally for all patients. [ABSTRACT FROM AUTHOR]

In 2006, the Massachusetts legislature passed a landmark health care reform bill (the Reform) that has served as a model for the national health care reform. By aiming to provide 'access to affordable, quality, accountable health care,' the goals of this reform were to reduce the number of uninsured Massachusetts residents while containing the growth of health care costs and improving the quality of health care services. The current paper examines the impact of the Reform on the quality of care in addition to hospital costs simultaneously from a perspective of efficiency analysis. We develop an integer-valued non-radial Russell data envelopment analysis (DEA) model, which is unit variant and calculate the hospitals' efficiency directly. However, the proposed integer-valued model is non-linear. The current paper thus transforms this model into a parametric integer linear programming. We develop a method to derive its optimal solutions. We then use the new DEA model to calculate and compare the efficiency scores of hospitals in Massachusetts and Connecticut pre- and post-Reform. The analysis shows that the Reform has achieved its cost containment and quality improvement goals at the same time. These analyses provide potentially useful information to hospital regulators and government regulators, especially in light of the national interest on health care legislation. [ABSTRACT FROM AUTHOR]

Engagement in HIV care and a high level of antiretroviral therapy (ART) adherence for people living with HIV is crucial to treatment success and can minimize the population burden of the disease. Despite this, there is a critical gap in HIV prevention science around the development of interventions for serodiscordant male couples. This paper reports on the results of a randomized controlled trial to assess the efficacy of Stronger Together, a dyadic counseling intervention aimed at increasing engagement in and optimizing HIV care among serodiscordant male couples in Atlanta, GA, Boston, MA, and Chicago, IL. Between 2014 and 2017, 159 male serodiscordant couples (total N = 318) in Atlanta, GA, Boston, MA, and Chicago, IL were enrolled and equally randomized to either the Stronger Together intervention arm (a three-session dyadic intervention involving HIV testing and adherence counseling) or a standard of care (SOC) control arm. Couples completed individual study assessments via an audio computer assisted self-interviewing (ACASI) system at baseline, 6, 12 and 18 months. Primary outcomes included being prescribed and currently taking ART, and fewer missed doses of ART in the past 30 days; because the trial was not powered to examine viral suppression, we examined this as an exploratory outcome. Longitudinal data analysis was by an intention-to-treat approach. Participants ages ranged from 18 to 69 (mean = 35.9), and are predominantly white (77.5%), and college educated (68.4% earned a college degree or higher). Participants randomized to the Stronger Together arm had a significantly greater odds of being prescribed and currently taking ART over time than those in the SOC arm (at 12 months OR 2.75, 95%CI 1.35–4.67, p-value 0.020, and at 18 months OR 2.91, 95%CI 1.61–4.88, p-value 0.013). Similarly, those in the Stronger Together arm had a significantly lower odds of missing a dose of ART in the past 30 days over time compared to those in the SOC arm (at 12 months OR 0.28, 95%CI 0.09–0.81, p-value 0.019, and at 18 months OR 0.25, 95%CI 0.07–0.82, p-value 0.023). Among male couples in serodiscordant relationships, the Stronger Together intervention resulted in significantly improved HIV treatment outcomes at both 12 and 18 months of follow-up. This trial is the first to date to demonstrate evidence of efficacy for a dyadic counseling intervention and has the potential to fill a critical gap in secondary HIV prevention interventions for serodiscordant male couples. [ABSTRACT FROM AUTHOR]

Introduction Collabo RATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate Collabo RATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete Collabo RATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the Collabo RATE score. Results While Collabo RATE score increased only slightly with increasing patient age ( OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher Collabo RATE scores ( OR 1.224, 95% CI 1.073-1.397). Clinician also predicts Collabo RATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to Collabo RATE scores, with Site 3 scoring significantly higher than Site 1 ( OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that Collabo RATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. [ABSTRACT FROM AUTHOR]

Land conservation efforts throughout the United States sustain ecological benefits while generating wealth in the housing market through capitalization of amenities. This paper estimates the benefits of conservation that are capitalized into proximate home values and quantifies how those benefits are distributed across demographic groups. Using detailed property and household-level data from Massachusetts, we estimate that new land conservation led to $62 million in new housing wealth equity. However, houses owned by low-income or Black or Hispanic households are less likely to be located near protected areas, and hence, these populations are less likely to benefit financially. Direct study of the distribution of this new wealth from capitalized conservation is highly unequal, with the richest quartile of households receiving 43%, White households receiving 91%, and the richest White households receiving 40%, which is nearly 140% more than would be expected under equal distribution. We extend our analysis using census data for the entire United States and observe parallel patterns. We estimate that recent land conservation generated $9.8 billion in wealth through the housing market and that wealthier and White households benefited disproportionately. These findings suggest regressive and racially disparate incidence of the wealth benefits of land conservation policy. [ABSTRACT FROM AUTHOR]

Supply-side interventions such as prescription drug monitoring programs, "pill mill" laws, and dispensing limits have done little to quell the burgeoning opioid crisis. An increasingly popular demand-side alternative to these measures – now adopted by 38 jurisdictions in the USA and 7 provinces in Canada — is court-mandated involuntary commitment and treatment. In Massachusetts, for example, Part I, Chapter 123, Section 35 of the state's General Laws allows physicians, spouses, relatives, and police officers to petition a court to involuntarily commit and treat a person whose alcohol or drug abuse poses a likelihood of serious harm. This paper explores the ethical underpinnings of this law as a case study for others. First, we highlight the procedural and substantive standards of Section 35 and evaluate the application of the law in practice, including the frequency with which it has been invoked and outcomes. We then use this background to inform an ethical critique of the law. Specifically, we argue that the infringement of autonomy and privacy associated with involuntary intervention under Section 35 is not currently justified on the grounds of a lack of evidenced benefits and a risk of significant of harm. Further ethical concerns also arise from a lack of standard of care provided under the Section 35 pathway. Based on this analysis, we advance four recommendations for change to mitigate these ethical shortcomings. [ABSTRACT FROM AUTHOR]

Linguistic identity of migrant communities is highly related to cultural practices. Given that social and individual identity emerges through social interaction and discursive practices where the role of linguistic processes is fundamental, this paper analyses how Portuguese migrants and their descendants negotiate and contest their cultural and linguistic identity while struggling to maintain their language and traditions in Eastern Massachusetts. [ABSTRACT FROM AUTHOR]

The article examines the media's prejudicial effect on the Boston Marathon Bombing trial. It discusses ways in which Sixth Amendment to the U.S. Constitution secures to an accused the right to a trial in the state where the crime has been committed. It reports laws in the U.S. protect criminal defendants from the unfairness and hardship that arises from prosecution in a foreign venue.

Background: In the United States, worksite wellness programs are more often offered by larger employers. The Massachusetts Working on Wellness (WoW) program is an innovative, statewide capacity-building model designed to increase the number of smaller employers (200 or fewer workers) adopting health promotion initiatives. This article describes the WoW program design and approaches to recruitment, implementation, and evaluation.Methods/design: WoW provides employer training, technical assistance and seed funding, utilizing a Wellness Program Development framework based on recognized good practices. For-profit employers with 200 employees or fewer are eligible for and encouraged to apply for a Massachusetts Small Business Wellness Tax Credit. During the phase described in this paper, employer organizations applied to the program and committed to designating a champion responsible for program implementation. Interventions were to include policy and environmental supports, as well as those targeting individual behavior change through raising awareness and education. Supports provided to employers included seed grants for qualifying activities (up to $10,000 with matching required), community linkages, data collection and organization-specific feedback tools, an on-line curriculum supplemented with technical assistance, and an expert webinar series. Data collection at multiple time points, from the initial application through program completion, provides information for evaluation of recruitment, planned and completed activities.Discussion: This model is grounded in literature on good practices as well as in local knowledge about Massachusetts employers. It does not directly address the influence of working conditions, which can affect both worker participation and health behaviors. Implementation may be less successful with some organizations, such as those with many workers who are part-time or geographically distributed rather than in a centralized physical location. Program evaluation will assess the extent to which WoW achieves its goals. The data are expected to increase understanding of the needs of smaller employers and industries not traditionally implementing employee wellness programs. [ABSTRACT FROM AUTHOR]

This is a case study of Transition House in Cambridge, MA, a pioneering feminist agency founded in 1976. Transition House has survived and is, today, a thriving agency. Based on interviews with and papers collected from those involved in founding and running it, as well as a few guests/clients, I argue that Transition House's evolution was impelled by three major forces shared with other early domestic violence agencies: changes in the culture due in part to successes of the battered women's movement in the early years, changes in the larger political-economic context due to national policies and economic trends, which make getting out of poverty in 2017 more difficult than it was in the 1970s, and learning from survivors and from evolving research on domestic violence. In 1976, the immediate focus was on women "battered" by their partners, and the agency was strongly identified with the women's movement. In 2017, the focus is on women who are battered by economic and social conditions as much as by their partners, and the agency is seen as a partner with the city and with other nonprofit agencies. [ABSTRACT FROM AUTHOR]

Within the United States' National Inventory of Dams, 15,000 dams have been classified as having a high hazard potential, meaning failure or misoperation would lead to probable loss of human life. However, state dam officials evaluate dam hazard potential on a case-by-case basis, ultimately relying on human judgement. Such a process lacks objectivity and consistency across state boundaries and can be time-consuming. Here, the authors present a parameterized geospatial and machine learning dam hazard potential classification model to overcome these limitations. The parameters of this model can be tuned for optimal performance. However, for this classification problem, the regulatory and physical implications of the types of model misclassifications are best captured through multiple objectives. Therefore, this research additionally contributes a novel multiobjective approach to machine learning parameter tuning. This research demonstrates the utility of this approach for dams in Massachusetts, United States, using a multiobjective evolutionary algorithm to explore different model parameterizations and identify analyst-relevant tradeoffs among objectives describing model performance. Such an approach allows for greater justification of model parameters as well as greater insights into the complexities of the dam hazard potential classification problem. [ABSTRACT FROM AUTHOR]

This paper empirically analyses a Massachusetts law (Chapter 40B) allowing developers of income-restricted housing to appeal local land-use decisions to a state administrative body. Based on a unique dataset, we assess whether Chapter 40B was more likely to be used by developers in municipalities that place stronger restrictions on development. We find that the use of Chapter 40B to overcome regulatory barriers depends on the type of project. For rental development, developers were more likely to use the law in municipalities that were relatively accessible to jobs and that placed relatively stringent zoning restrictions on multifamily development. The use of Chapter 40B for condominium development was more likely in larger, less well-located municipalities with relatively stringent wetlands regulations. [ABSTRACT FROM PUBLISHER]

Critics of many popular urban school reforms in the United States allege that these reform efforts unfairly insert market forces into the public domain, resulting in widening inequalities. In this paper, I challenge the notion that market forces per se are responsible for the gentrification that school reform often facilitates. Drawing on in-depth interviews, government documents, and media accounts, I analyse one component of school reform in Boston, the overhaul of the city’s public school student assignment policy, which curtailed parental choice (and, therefore, market pressure) within the city’s school system, while still potentially perpetuating inequalities. I discuss the implications of these findings for urban social theory related to education reform. [ABSTRACT FROM PUBLISHER]

An introduction is presented in which the editor discusses various reports within the issue on topics including the Massachusetts Health Reform Survey, self-reported health measures in predicting individuals with high future health care needs, and the American Community Survey and the Survey of Income Program Participation.

Background: The coronavirus 2019 (COVID-19) pandemic fundamentally changed how populations interface with the healthcare system. Despite historical spikes in US mortality during the pandemic, emergency department (ED) visits were paradoxically low. This is a concerning phenomenon that raises a red flag regarding access to care, especially among vulnerable populations. In this study we sought to understand how ED utilization evolved during the COVID-19 pandemic among traditionally understudied, low-income, racially diverse US- and foreign-born mothers. Methods: This is a secondary analysis of a pre-existing dataset of 3,073 participants enrolled in the Boston Birth Cohort at birth and followed prospectively. We obtained ED visit diagnoses from 2019 and 2020 via electronic health records, categorized according to the International Classification of Diseases, 10th Revision, and compared them using graph plots, chi-square, and negative binomial regression. Results: The number of ED visits decreased by 29.1% (P < 0.001) from 2019 (1,376) to 2020 (976). However, visits for infectious and parasitic diseases, including COVID-19, increased by 90.6% (32:61) with COVID-19 accounting for 77%of those visits in 2020 (47/61).Mental health-related visits increased by 40.9% (44:62), with diagnoses of alcohol use disorder increasing by 183% (6:17). Regression analysis showed 50% less EDutilization among foreign- vsUS-born participants; however, the increase in infectious diseases visits was greater among foreign-born compared to US-born mothers (185% vs 26%, P = 0.01), while the increase in mental health diagnoses was greater among US-born mothers (69% vs -33%, P = 0.10). Conclusion: Despite a decrease in total ED visits during the pandemic, there was an increase in COVID-19- (immigrant > US born) and mental health- (US-born only) related visits. Our findings demonstrate that EDs remain a critical access point for care for minority populations and have implications for preparedness, resources, and services of EDs in urban settings to better address the needs of communities. However, alternative avenues for healthcare services for these populations, particularly during health crises, warrant further investigation. [ABSTRACT FROM AUTHOR]

The Massachusetts Affordable Housing Policy of 1969 (known as the ‘Anti-Snob Zoning Act’, or simply 40B), is one of the most admirable and controversial acts in the history of the state. It was intended to break through the exclusionary ‘snob’ zoning that was customary in United States suburbs at the time, and to open the suburbs to low- and moderate-income residents by encouraging the production of affordable housing statewide. The paper analyses 40B and the modifications it has undergone over the years in light of the relation between centralized state power and decentralized local government power with regard to planning. Understanding of the changes in local–state power relations can provide an explanation for the changes that have occurred over the years in implementing the law. The findings suggest that mutual learning, and understandings developed over the years among all involved, can provide the greatest benefit to low- and moderate-income residents. [ABSTRACT FROM PUBLISHER]

We study the role of access to health insurance coverage as a determinant of individuals' subjective well-being (SWB) by analyzing large-scale healthcare reforms in the United States. Using data from the Behavioral Risk Factor Surveillance System and Panel Study of Income Dynamics, we find that the 2006 Massachusetts reform and 2014 Affordable Care Act Medicaid expansion improved the overall life satisfaction of Massachusetts residents and low-income adults in Medicaid expansion states, respectively. The results are robust to various sensitivity and falsification tests. Our findings imply that access to health insurance plays an important role in improving SWB. Without considering psychological benefits, the actual benefits of health insurance may be underemphasized., (© 2021 John Wiley & Sons Ltd.)

The long-term financial stability of hospital systems represents a "grand challenge" in health care. New ownership forms, such as private equity (PE), promise to achieve better financial performance than nonprofit or for-profit systems. In this study, we compare two systems with many similarities, but radically different ownership structures, missions, governance, and merger and acquisition (M&A) strategies. Both were nonprofit, religious systems serving low-income communities - Montefiore Health System and Caritas Christi Health Care. Montefiore's M&A strategy was to invest in local hospitals and create an integrated regional system, increasing revenues by adding primary doctors and community hospitals as feeders into the system and achieving efficiencies through effective resource allocation across specialized units. Slow and steady timing of acquisitions allowed for organizational learning and balancing of debt and equity. By 2019, it owned 11 hospitals with 40,000 employees and had strong positive financials and low reliance on debt. By contrast, in 2010, PE firm Cerberus Capital bought out Caritas (renamed Steward Health Care System) and took control of the Board of Directors, who set the system's strategic direction. Cerberus used Steward as a platform for a massive debt-driven acquisition strategy. In 2016, it sold off most of its hospitals' property for $1.25 billion, leaving hospitals saddled with long-term inflated leases; paid itself almost $500 million in dividends; and used the rest for leveraged buyouts of 27 hospitals in 9 states in 3 years. The rapid, scattershot M&A strategy was designed to create a large corporation that could be sold off in five years for financial gain - not for health care integration. Its debt load exploded, and by 2019, its financials were deeply in the red. Its Massachusetts hospitals were the worst financial performers of any system in the state. Cerberus exited Steward in 2020 in a deal that left its physicians, the new owners, holding the debt., (Copyright © 2022 Jennifer L. Hefner and Ingrid M. Nembhard. Published under exclusive licence by Emerald Publishing Limited.)

In anticipation of extraterritorial application of antiabortion laws, many states have enacted laws that attempt to shield abortion providers, helpers, and patients from civil, professional, or criminal liability associated with legal abortion care. This essay analyzes and compares the statutory schemes of the seven early adopting shield states: California, Connecticut, Delaware, Illinois, Massachusetts, New Jersey, and New York. After describing what the laws do and how they operate, we offer reflections on coming disputes, areas of legal uncertainty, and ways to improve future shield laws. [ABSTRACT FROM AUTHOR]

Mounting evidence over the past several decades has demonstrated inequitable distribution of pollutants of ambient origin between sociodemographic groups in the United States. Most environmental inequality studies to date are cross-sectional and used proximity-based methods rather than modeled air pollution concentrations, limiting the ability to examine trends over time or the factors that drive exposure inequalities. In this paper, we use 1 km 2 modeled PM 2.5 and NO 2 concentrations in Massachusetts over an 8-year period and Census demographic data to quantify inequality between sociodemographic groups and to develop a more nuanced understanding of the drivers and trends in longitudinal air pollution inequality. Annual-average population-weighted PM 2.5 and NO 2 concentrations were highest for urban non-Hispanic black populations (11.8 µg/m 3 in 2003 and 8.4 µg/m 3 in 2010, vs. 11.3 µg/m 3 and 8.1 µg/m 3 for urban non-Hispanic whites) and urban Hispanic populations (15.9 ppb in 2005 and 13.0 ppb in 2010, vs. 13.0 ppb and 10.2 ppb for urban non-Hispanic whites), respectively. While population groups experienced similar absolute decreases in exposure over time, disparities in population-weighted concentrations increased over time when quantified by the Atkinson Index, a relative inequality measure. Exposure inequalities were approximately one order of magnitude greater for NO 2 compared to PM 2.5 , were more pronounced in urban compared to rural geographies, and between racial/ethnic groups compared to income and educational attainment groups. Our results also revealed similar longitudinal PM 2.5 and NO 2 inequality trends using Census 2000 and Census 2010 data, indicating that spatio-temporal shifts in air pollution may best explain observed trends in inequality. These findings enhance our understanding of factors that contribute to persistent inequalities and underscore the importance of targeted exposure reduction strategies aimed at vulnerable populations and neighborhoods. [ABSTRACT FROM AUTHOR]

Background: The US is experiencing an unprecedented opioid overdose epidemic fostered in recent years by regional contamination of the heroin supply with the fentanyl family of synthetic opioids. Since 2011 opioid-related overdose deaths in the East Coast state of Massachusetts have more than tripled, with 75% of the 1374 deaths with an available toxicology positive for fentanyl. Fentanyl is 30-50X more potent than heroin and its presence makes heroin use more unpredictable. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as 'heroin' and to observe the drugs and their use.Methods: A team of ethnographers conducted research in northeast Massachusetts and Nashua, New Hampshire in June 2016, performing (n=38) qualitative interviews with persons who use heroin.Results: (1) The composition and appearance of heroin changed in the last four years; (2) heroin is cheaper and more widely available than before; and (3) heroin 'types' have proliferated with several products being sold as 'heroin'. These consisted of two types of heroin (alone), fentanyl (alone), and heroin-fentanyl combinations. In the absence of available toxicological information on retail-level heroin, our research noted a hierarchy of fentanyl discernment methods, with embodied effects considered most reliable in determining fentanyl's presence, followed by taste, solution appearance and powder color. This paper presents a new 'heroin' typology based on users' reports.Conclusion: Massachusetts' heroin has new appearances and is widely adulterated by fentanyl. Persons who use heroin are trying to discern the substances sold as heroin and their preferences for each form vary. The heroin typology presented is inexact but can be validated by correlating users' discernment with drug toxicological testing. If validated, this typology would be a valuable harm reduction tool. Further research on adaptations to heroin adulteration could reduce risks of using heroin and synthetic opioid combinations. [ABSTRACT FROM AUTHOR]

This article examines key scenes and ideas portrayed in the filmSpotlightand discusses related landmark Supreme Court cases as a reaffirmation of the value of a professional, free press in a democratic society. Based on actual events, the movie adaptation follows journalists from theBoston Globe(within an investigate unit with the actual name “Spotlight”) as they reveal one of the biggest scandals of the twenty-first century, the cover up of systematic abuse of children by priests; and go up against one of the most powerful institutions in the world, the Catholic Church. By giving a voice and a platform for the victims, and by meticulously researching the story, the film provides a clear and strong argument for the continued court protection of one of the United States’ founding principles: freedom of the press. [ABSTRACT FROM PUBLISHER]

The present research examined the perspectives of both White and Black racial justice activists on the roles of White allies in the struggle for justice for Black people in the United States. Study 1 used Q methodology, a mixed‐methods approach, which identified four distinct perspectives about the role of White allies from a sample of activists (33 White and 22 Black Americans): (1) mobilize to support Black leadership, (2) interpersonal activism, (3) avoid dominating Black people's efforts, and (4) lifelong learning. In Study 2, we interviewed activists (22 White and 12 Black Americans) to understand their evaluation of, and preference for, each of perspective identified in Study 1. Thematic analyses showed that each perspective had its pros and cons regarding considerations of how to best use ingroup advantages without dominating the movement. Our findings contribute to our understanding of potential tensions in solidarity‐based social movements. [ABSTRACT FROM AUTHOR]

Sex trafficking is serious form of gender-based violence that results in profound adverse health outcomes, yet one that is poorly understood. New York City is a major hub for sex trafficking, with a significant but unquantified number of victims originating from East Asian countries and trafficked via illicit massage businesses. Peer-reviewed studies among Asian survivors of international criminal sex trafficking do not exist. The aim of this study is to qualitatively examine the factors at various levels of influence that impact the recovery and reintegration process of Asian criminal sex trafficking survivors in the United States from the perspective of survivors and front-line service providers. The study was guided by community-based participatory research and trauma-informed approaches, leveraging a collaboration with a well-established service provider organization. Ten in-depth interviews were conducted between 2018 and 2019 with three Korean survivors and seven key informants who were anti-trafficking service providers working with East Asian clients. Data were analyzed using a grounded theory approach. Survivors and service providers vocalized factors at multiple levels that either facilitate or impede recovery and well-being. Levels of influence included structural (e.g., poverty/debt bondage, immigration status, limited English proficiency), cultural (e.g., fatalism, collectivism), institutional (e.g., lack of culturally appropriate, trauma-informed care), interpersonal (e.g., exploitation, social support), and individual (e.g., resilience). Stigma was a crosscutting factor that spanned all levels of influence. This study highlights the voices of survivors and front-line service providers to understand the lives of an under-researched population of Asian sex trafficking survivors. Ultimately, the root, structural causes of survivor marginalization need to be addressed, which stem from the intersection of class-, gender-, and race-related inequities. While survivors continue to experience exploitation and marginalization post-trafficking, they also carry an enormous amount of resilience that must be leveraged in their path to recovery from trauma. [ABSTRACT FROM AUTHOR]

The specific aim was to characterize retail purchases of red and processed meat and other major protein-rich foods in the U.S. and by state. Supermarket scanner data from grocery stores, supermarkets, and big box stores collected from 2017-2019 (NielsenIQ, New York, NY) was used to characterize retail purchases of red meat, processed meat, and other protein-rich foods in thirty-one states representative of US retail food sales. Red meat, processed meat, poultry, seafood, eggs, other meats, and non-meat foods (beans, nuts, seeds, meat alternatives) by weight accounted for 25.9%, 20.4%, 25.8%, 5.9%, 12.6%, 1.3%, and 10.1%, respectively of total sales in 2017-2019. Mean per capita purchases of red meat by weight was 30.1 g/d, ranging from 45.4 g/d in Mississippi to 21.9 g/d in New York. Mean per capita purchases of processed meat by weight was 23.8 g/d, ranging from 36.6 g/d in Mississippi to 15.2 g/d in California. We observed statistically significant correlations between red and processed meat purchases with cardiovascular mortality and colorectal cancer by state. Per capita retail purchases of red and processed meat appear to reflect a dietary pattern that is not consistent with current national and international dietary recommendations. [ABSTRACT FROM AUTHOR]

This paper interrogates the case for improved and broadened public sustainability reporting by universities, and explores whether and how global performance measures capture the institutional attitudes and activities pertinent to universities' contributions to sustainability. The analysis explores all stand-alone, English language reports produced by universities world-wide since 2007. The analysis focuses primarily on the Global Reporting Initiative (GRI) index. The paper finds that those universities which have adopted the GRI share a distinct conceptualisation of their role in society. The GRI framework is helpful in capturing universities' environmental impacts and benefits, but is lacking in relation to universities' human rights and social concerns. The paper identifies value in universities adopting a globally accepted sustainability reporting framework and makes specific suggestions as to how the framework might be better adapted for universities.

Parents make choices about their children's education within a neoliberal, racist system. Measurable metrics are used to evaluate school quality within a competitive, market-based system, yet those indicators often do not align with parents' definitions of a good school, and they obscure the role of race. This paper examines how white, privileged parents understand school quality and justify their educational decisions, illuminating how white parents subtly reinforce racial and socio-economic hierarchies.

Context: The authors examined the association between state-level policy protections and selfrated health disparities between transgender and cisgender adults. Methods: They used data on transgender (n =4,982) and cisgender (n=1.168,859) adults from the 2014-2019 Behavioral Risk Factor Surveillance System. The authors estimated state-specific health disparities between transgender and cisgender adults, and they used multivariable logistic regression models to compare adjusted odds ratios between transgender and cisgender adults by state-level policy environments. Findings: Transgender adults were significantly more likely to report poor/fair health, frequent mental distress, and frequent poor physical health days compared to cisgender adults. Disparities between transgender and cisgender adults were found in states with strengthened protections and in states with limited protections. Compared to transgender adults in states with limited protections. transgender adults in states with strengthened protections were marginally less likely to report frequent mental distress. Conclusions: Transgender adults in most states reported worse self-rated health than their cisgender peers. Much more research and robust data collection on gender identity are needed to study the associations between state policies and transgender health and to identify best practices for achieving health equity for transgender Americans. [ABSTRACT FROM AUTHOR]

Introduction: Studies have shown mixed findings regarding the impact of immigration policy changes on immigrants' utilization of primary care. Methods: We used a difference-in-differences analysis to compare changes in missed primary care appointments over time across two groups: patients who received care in Spanish, Portuguese, or Haitian Creole, and non-Hispanic, white patients who received care in English. Results: After adjustment for age, sex, race, insurance, hospital system, and presence of chronic conditions, immigration policy changes were associated with an absolute increase in the missed appointment prevalence of 0.74 percentage points (95% confidence interval: 0.34, 1.15) among Spanish, Portuguese and Haitian-Creole speakers. We estimated that missed appointments due to immigration policy changes resulted in lost revenue of over $185,000. Conclusions: We conclude that immigration policy changes were associated with a significant increase in missed appointments among patients who receive medical care in languages other than English. [ABSTRACT FROM AUTHOR]

Objective: In response to elevated risk factors, an opioid hazard awareness training for the sand, stone, and gravel mining sector was developed and embedded in annual safety training., Methods: After positive results from a prior study among Massachusetts workers, a revised training was disseminated across the United States. Two hundred post-training surveys were obtained and compared with results from the Massachusetts cohort., Results: Participants' knowledge about opioid-based medications, confidence in talking to a doctor about opioids and/or to a coworker about their own use of opioids, and ability to refer struggling coworkers to resources improved. Massachusetts respondents had slightly more favorable responses. Both cohorts had strong positive views of the training., Conclusions: These results highlight the feasibility and effectiveness of opioid hazard prevention training for a high-risk worker population., Competing Interests: Conflict of interest: None declared., (Copyright © 2023 American College of Occupational and Environmental Medicine.)

This study investigates how extreme precipitation scales with dewpoint temperature across the northeastern United States, both in the observational record (1948–2020) and in a set of downscaled climate projections in the state of Massachusetts (2006–99). Spatiotemporal relationships between dewpoint temperature and extreme precipitation are assessed, and extreme precipitation–temperature scaling rates are evaluated on annual and seasonal scales using nonstationary extreme value analysis for annual maxima and partial duration series, respectively. A hierarchical Bayesian model is then developed to partially pool data across sites and estimate regional scaling rates, with uncertainty. Based on the observations, the estimated annual scaling rate is 5.5% °C−1, but this varies by season, with most nonzero scaling rates in summer and fall and the largest rates (∼7.3% °C−1) in the summer. Dewpoint temperatures and extreme precipitation also exhibit the most consistent regional relationships in the summer and fall. Downscaled climate projections exhibited different scaling rates compared to the observations, ranging between −2.5% and 6.2% °C−1 at an annual scale. These scaling rates are related to the consistency between trends in projected precipitation and dewpoint temperature over the twenty-first century. At the seasonal scale, climate models project larger scaling rates for the winter compared to the observations (1.6% °C−1). Overall, the observations suggest that extreme daily precipitation in the Northeast only thermodynamic scales with dewpoint temperature in the warm season, but climate projections indicate some degree of scaling is possible in the cold season under warming. Significance Statement: A warmer climate will likely result in the intensification of extreme precipitation, with the potential to enhance flood and stormwater risk. However, the relationship between extreme precipitation and temperature (i.e., the precipitation–temperature scaling rate) remains uncertain, particularly at regional scales, inhibiting societal adaptation to extreme events. Using observations and climate projections of daily precipitation and dewpoint temperature across the northeastern United States, we demonstrate that extreme daily precipitation does indeed scale with dewpoint temperature, but the rate of scaling varies by season, with the strongest relationship in the warm season. [ABSTRACT FROM AUTHOR]

We investigate the association between nativity status (U.S.- vs foreignborn) and viral suppression among women of color (WOC) with HIV (HIV +) and whether this association was modified by education and housing. Methods: Data were from 549 HIV + WOC, who participated in the Health Resources and Services Administration-funded WOC Initiative 2009–2013. We used generalized estimating equation models to quantify the association between the respondents' nativity status and viral suppression. Results: After adjusting for covariates, foreign-born WOC were 2.2 times (95% confidence interval: 1.25, 3.85) more likely to achieve viral suppression than U.S.-born WOC. This association was not modified by education or housing status. Conclusions: Despite facing barriers to care, foreign-born WOC were more likely to achieve viral suppression than U.S.-born WOC. Programs aiming to end the HIV epidemic and reduce HIV disparities in the U.S. should consider these findings as they provide a more nuanced understanding of HIV + WOC. [ABSTRACT FROM AUTHOR]

There is increasing documentation that refugees face experiences of interpersonal or structural discrimination in health care and employment. This study examines how Somali refugees understand various forms of discrimination in employment and health care related to their health, utilization of, and engagement with the health care system in the United States. We draw on semistructured qualitative interviews (N = 35) with Somali young adults in three U.S. states—Minnesota, Massachusetts, and Maine. Using modified grounded theory analysis, we explore how experiences of discrimination in employment and health care settings impact health care access, utilization, and perceptions of health among Somali young adults. Discrimination was identified as a major barrier to using health services and securing employment with employer-sponsored insurance coverage. These findings highlight how interpersonal and structural discrimination in employment and health care are mutually reinforcing in their production of barriers to health care utilization among Somali refugees. [ABSTRACT FROM AUTHOR]

Background/Objectives: No data exist regarding the validity of International Classification of Disease (ICD)‐10 dementia diagnoses against a clinician‐adjudicated reference standard within Medicare claims data. We examined the accuracy of claims‐based diagnoses with respect to expert clinician adjudication using a novel database with individual‐level linkages between electronic health record (EHR) and claims. Design: In this retrospective observational study, two neurologists and two psychiatrists performed a standardized review of patients' medical records from January 2016 to December 2018 and adjudicated dementia status. We measured the accuracy of three claims‐based definitions of dementia against the reference standard. Setting: Mass‐General‐Brigham Healthcare (MGB), Massachusetts, USA. Participants: From an eligible population of 40,690 fee‐for‐service (FFS) Medicare beneficiaries, aged 65 years and older, within the MGB Accountable Care Organization (ACO), we generated a random sample of 1002 patients, stratified by the pretest likelihood of dementia using administrative surrogates. Intervention: None. Measurements: We evaluated the accuracy (area under receiver operating curve [AUROC]) and calibration (calibration‐in‐the‐large [CITL] and calibration slope) of three ICD‐10 claims‐based definitions of dementia against clinician‐adjudicated standards. We applied inverse probability weighting to reconstruct the eligible population and reported the mean and 95% confidence interval (95% CI) for all performance characteristics, using 10‐fold cross‐validation (CV). Results: Beneficiaries had an average age of 75.3 years and were predominately female (59%) and non‐Hispanic whites (93%). The adjudicated prevalence of dementia in the eligible population was 7%. The best‐performing definition demonstrated excellent accuracy (CV‐AUC 0.94; 95% CI 0.92–0.96) and was well‐calibrated to the reference standard of clinician‐adjudicated dementia (CV‐CITL <0.001, CV‐slope 0.97). Conclusion: This study is the first to validate ICD‐10 diagnostic codes against a robust and replicable approach to dementia ascertainment, using a real‐world clinical reference standard. The best performing definition includes diagnostic codes with strong face validity and outperforms an updated version of a previously validated ICD‐9 definition of dementia. [ABSTRACT FROM AUTHOR]

U.S. national and state population-based estimates of adults living with autism spectrum disorder (ASD) are nonexistent due to the lack of existing surveillance systems funded to address this need. Therefore, we estimated national and state prevalence of adults 18–84 years living with ASD using simulation in conjunction with Bayesian hierarchal models. In 2017, we estimated that approximately 2.21% (95% simulation interval (SI) 1.95%, 2.45%) or 5,437,988 U.S. adults aged 18 and older have ASD, with state prevalence ranging from 1.97% (95% SI 1.55%, 2.45%) in Louisiana to 2.42% (95% SI 1.93%, 2.99%) in Massachusetts. Prevalence and case estimates of adults living with ASD (diagnosed and undiagnosed) can help states estimate the need for diagnosing and providing services to those unidentified. [ABSTRACT FROM AUTHOR]

Peatlands provide a setting that is well suited for cranberry agriculture in the Northeastern United States. However, misconceptions exist about the amounts and forms of nitrogen (N) and phosphorus (P) export from cranberry farms. In this study, we report inorganic and organic forms of N and P export from five peatlands cultivated for cranberry production in southeastern, Massachusetts, United States. We then compare N loading rates among cranberry farms in southeastern Massachusetts, row crop farms in the Midwestern United States, and uncultivated peatlands in the United States and United Kingdom. Based on a fluvial mass balance analysis, we find that nonriparian cranberry farms export 2.56 kg of P ha−1 year−1of total P and 12.1 kg of N ha−1 year−1of total N. Total N export from riparian or "flow through" farms is two times higher than nonriparian farms due to less retention of N fertilizer in the vadose zone of riparian farms. Gross total N export from riparian and nonriparian cranberry farms consists of 35% particulate organic N, 26% dissolved organic N, 31% ammonium (NH4+), and 8% nitrate (NO3−). The low proportions of NO3− export (13% of total dissolved N [TDN]) for cranberry farms differ from NO3− export for row crop farms (75% of TDN; p <.001) but not for uncultivated peatlands (17% of TDN; p =.61). Despite being highly modified by fertilizers and artificial drainage, low NO3− export (2.2 kg of N ha−1 year−1) from cranberry farms is consistent with field measurements of rapid N turnover in uncultivated peatlands. This finding suggests that state‐funded wetland restoration efforts to restore denitrification in retired cranberry farms may be limited by NO3− rather than soil moisture or organic matter. [ABSTRACT FROM AUTHOR]

Unusually large outbreaks of mumps across the United States in 2016 and 2017 raised questions about the extent of mumps circulation and the relationship between these and prior outbreaks. We paired epidemiological data from public health investigations with analysis of mumps virus whole genome sequences from 201 infected individuals, focusing on Massachusetts university communities. Our analysis suggests continuous, undetected circulation of mumps locally and nationally, including multiple independent introductions into Massachusetts and into individual communities. Despite the presence of these multiple mumps virus lineages, the genomic data show that one lineage has dominated in the US since at least 2006. Widespread transmission was surprising given high vaccination rates, but we found no genetic evidence that variants arising during this outbreak contributed to vaccine escape. Viral genomic data allowed us to reconstruct mumps transmission links not evident from epidemiological data or standard single-gene surveillance efforts and also revealed connections between apparently unrelated mumps outbreaks. A study of recent mumps outbreaks in the United States reveals transmission patterns within and between Massachusetts communities and highlights the importance of combining detailed genomic and epidemiological data, both locally and nationwide. [ABSTRACT FROM AUTHOR]

Background: Cancer rehabilitation is an integral part of the continuum of care for survivors. Due to the increasing number of survivors, physiatrists commonly see cancer patients in their general practices. Essential to guiding the field is to understand the current training and practice patterns of cancer rehabilitation physicians.Objectives: To assess current trends in training and practice for cancer rehabilitation physicians, including the level of burnout among providers in this field.Design: Cross-sectional descriptive survey study.Setting: Online survey.Participants: American physicians who are affiliated with the Cancer Rehabilitation Physician Consortium (CRPC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The CRPC is a group of cancer rehabilitation providers (both fellowship-trained and not fellowship-trained) with the mission of furthering cancer rehabilitation medicine through education, research, and networking.Methods: All CRPC physicians were invited to complete a voluntary and anonymous 43-question online survey. The survey was conceived by a group of eight experts interested in providing additional information to the current literature regarding the training and practice in the cancer rehabilitation field.Main Outcome Measurements: Training, practice, opioid prescribing, and professional support.Results: Thirty-seven of 50 physicians participated (response rate = 74%). Respondents were from various states, the three most common being New York (16%, n = 6), Texas (16%, n = 6), and Massachusetts (11%, n = 4). About 57% (n = 21) of the respondents were employed in an academic medical center and 73% (n = 27) reported their primary departmental affiliation was Physical Medicine and Rehabilitation (PM&R). Approximately 78% (n = 29) credited mentorship early in training for their interest in the field. More than half (54%, n = 20) either strongly agreed or agreed that cancer rehabilitation fellowship training is necessary for graduating physiatrists who plan to treat oncology patients/survivors. National PM&R meetings were the primary source of continuing education for 86% (n = 31). Sixty-five percent (n = 24), strongly agreed or agreed that cancer rehabilitation physiatrists should know how to prescribe opioids, and 35% (n = 13) reported prescribing them when appropriate. About 54% (n = 20) rated their level of burnout as low or very low, and more than half (51%, n = 19) believed their burnout level was lower than physiatrists treating other rehabilitation populations.Conclusions: Cancer rehabilitation is a growing subspecialty in PM&R, and most physiatrists in general practice will treat many survivors-often for neurologic or musculoskeletal impairments related to cancer or its treatment. Cancer rehabilitation physicians perceive that they have relatively low levels of burnout, and early mentorship and fellowship training is beneficial. Professional conferences and mentorship are a primary source for continuing education.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Manganese pollution to plants, soils, and streams from Mn-rich mine spoils is a global and persistent issue. Some former mining sites can be revegetated readily while others struggle to support plants. We explored Mn in plants and soils following 75 years of soil development and reforestation of a pine-northern hardwood forest at the former Betts Mine in western Massachusetts, USA. We studied soils on four Mn-rich mine spoils and at two control sites: an undisturbed location adjacent to the mine and on a non-Mn mineral bearing rock formation to determine if soil conditions have influenced the uptake of Mn and Ca by vegetation. We collected mid-season foliage from five dominant canopy trees and four common understory plants and excavated three soil pits at each site during July 2018. We found that control sites had lower total Mn (980 ± 140 µg g−1) in their soils than on the mine spoil sites (5580 ± 2050 µg g−1). Our soil data indicated that < 1% of total Mn was strong acid extractable at mine spoil soils and control sites. Surprisingly, the canopy trees established on mine spoils at the Betts Mine had equal to or lower foliar Mn concentrations (840 ± 149 µg g−1) and lower Mn/Ca ratios (0.3 ± 0.1 mol mol−1) than at control sites (1667 ± 270 µg g−1; 1.1 ± 0.2 mol mol−1), refuting our hypothesis of mine spoils driving highest Mn uptake. Soil pH and physicochemical properties suggest Mn primarily exists within primary minerals or form insoluble oxides at the mine spoil sites. Our results suggest higher Ca availability and pH in soils likely reduced Mn uptake and promoted reforestation of the mine spoils. [ABSTRACT FROM AUTHOR]