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This article utilizes the Panel Study of Income Dynamics to demonstrate how disadvantages in healthy life expectancies accumulated across generations create disparate kin structures among African American families in the United States. The analysis quantifies the overlap in parents' healthy years with their adult children's healthy life expectancies and examines how much the overlap coincides with the adult children's childrearing years. Non-Hispanic Black adults experienced parental illness and death sooner than non-Hispanic White adults, and their parents' poor health coincided longer with their own health declines. Non-Hispanic White adults, on the other hand, enjoyed more years in good health with two healthy parents. The intergenerational accumulation of unequal healthy life expectancies directly translated into unequal kin structures for the subsequent third generation. Race inequities in the intergenerational kin structure and health were greater among women than among men, and non-Hispanic Black women spent the most years raising children in poor health with unhealthy or deceased parents. Disparities in the intergenerational tempos of fertility, mortality, and morbidity are building profound structural racial inequities within a fundamental social institution—the family. [ABSTRACT FROM AUTHOR]

Using high‐frequency spending data, we show that household consumption displays excess sensitivity to salient macroeconomic news, even when the news is not real. When the announced local unemployment rate reaches a 12‐month maximum, local news coverage of unemployment increases and local consumers reduce their discretionary spending by 1.5% relative to consumers in areas with the same macroeconomic conditions. Low‐income households display greater excess sensitivity to salience. The decrease in spending is not later reversed. Households in treated areas act as if they are more financially constrained than those in untreated areas with the same fundamentals. [ABSTRACT FROM AUTHOR]

Background: Residing in a disadvantaged neighborhood has been linked to increased mortality. However, the impact of residential segregation and social vulnerability on cause-specific mortality is understudied. Additionally, the circulating metabolic correlates of neighborhood sociodemographic environment remain unexplored. Therefore, we examined multiple neighborhood sociodemographic metrics, i.e., neighborhood deprivation index (NDI), residential segregation index (RSI), and social vulnerability index (SVI), with all-cause and cardiovascular disease (CVD) and cancer-specific mortality and circulating metabolites in the Southern Community Cohort Study (SCCS). Methods: The SCCS is a prospective cohort of primarily low-income adults aged 40–79, enrolled from the southeastern United States during 2002–2009. This analysis included self-reported Black/African American or non-Hispanic White participants and excluded those who died or were lost to follow-up ≤ 1 year. Untargeted metabolite profiling was performed using baseline plasma samples in a subset of SCCS participants. Results: Among 79,631 participants, 23,356 deaths (7214 from CVD and 5394 from cancer) were documented over a median 15-year follow-up. Higher NDI, RSI, and SVI were associated with increased all-cause, CVD, and cancer mortality, independent of standard clinical and sociodemographic risk factors and consistent between racial groups (standardized HRs among all participants were 1.07 to 1.20 in age/sex/race-adjusted model and 1.04 to 1.08 after comprehensive adjustment; all P < 0.05/3 except for cancer mortality after comprehensive adjustment). The standard risk factors explained < 40% of the variations in NDI/RSI/SVI and mediated < 70% of their associations with mortality. Among 1110 circulating metabolites measured in 1688 participants, 134 and 27 metabolites were associated with NDI and RSI (all FDR < 0.05) and mediated 61.7% and 21.2% of the NDI/RSI-mortality association, respectively. Adding those metabolites to standard risk factors increased the mediation proportion from 38.4 to 87.9% and 25.8 to 42.6% for the NDI/RSI-mortality association, respectively. Conclusions: Among low-income Black/African American adults and non-Hispanic White adults living in the southeastern United States, a disadvantaged neighborhood sociodemographic environment was associated with increased all-cause and CVD and cancer-specific mortality beyond standard risk factors. Circulating metabolites may unveil biological pathways underlying the health effect of neighborhood sociodemographic environment. More public health efforts should be devoted to reducing neighborhood environment-related health disparities, especially for low-income individuals. [ABSTRACT FROM AUTHOR]

This article reviews four books that explore the history and experiences of Black, Latino, and Asian suburbanization in the United States. The books highlight the struggles and agency of these communities in gaining access to middle-class suburbia, as well as the challenges they face in maintaining stability and navigating the suburban ideal. The authors also discuss the complexities of suburban integration, emphasizing that it is not solely about Black-White integration but also involves integration within racial and ethnic groups. Overall, these books provide a nuanced understanding of suburban diversity and exclusionary suburbanization in the United States. [Extracted from the article]

The COVID‐19 pandemic and associated policies may have impacted body weight and related lifestyle behaviors. Using 2017–2020 Behavioral Risk Factor Surveillance System data, we estimate the effects of COVID‐19 lockdown on Body Mass Index (BMI) and the probability of obesity among adults in the United States. Our triple‐differences approach, using recent pre‐pandemic years as counterfactuals, identifies statistically significant lockdown‐induced increases in body weight. Event study results highlight a lagged effect of lockdown on body weight, with BMI increases manifesting 2 months post‐lockdown. These effects are particularly pronounced among non‐white adults, low‐income individuals, females, and metropolitan residents. The lockdown's impact on mental health, a potential mechanism driving BMI increases, is concentrated among non‐white, low‐income adults. We observe potential post‐lockdown changes in diet and sedentary behaviors, evidenced by increased Google searches for high‐calorie foods, food delivery apps, and video streaming. Google searches related to healthy habits, such as exercise, yield mixed results. [ABSTRACT FROM AUTHOR]

Background and Aims: Impoverished people who inject drugs (PWID) are at the epicenter of US drug‐related epidemics. Medicaid expansion is designed to reduce cost‐related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. Design: A two‐way fixed‐effects model was used to analyze serial cross‐sectional observational data. Setting: Seventeen metro areas in 13 US states took part in the study. Participants: Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64 years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. Measurements State‐level Medicaid expansion was measured using Kaiser Family Foundation data. Individual‐level self‐report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). Findings The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two‐thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage‐point increase in the probability of insurance coverage, and a 9.0 (95% CI = −15.0, −0.2) percentage‐point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). Conclusions: US Medicaid expansion may curb drug‐related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non‐financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer ranks as the 5th most prevalent cancer and the 4th leading cause of cancer-related deaths worldwide. Various treatment modalities, including surgical resection, chemotherapy, and radiotherapy, are available for gastric cancer patients. However, disparities related to age, sex, race, socioeconomic factors, insurance status, and demographic factors often lead to delayed time to treatment. Methods: In this retrospective study, conducted between 2004 and 2019, we utilized data from the National Cancer Database (NCDB) to investigate the factors contributing to disparities in the time to first treatment, surgery, chemotherapy, and radiotherapy among gastric cancer patients. Our analysis incorporated several variables, and statistical analysis was conducted to provide valuable insights into these disparities. Results: We observed notable disparities in the timing of treatment for various demographic groups, including age, sex, race, insurance status, geographic location, and facility type. These disparities include longer time to treatment in males (32.67 vs 30.75), Native Americans (35.10 vs 31.09 in Asians), low-income patients (32 vs 31.15), patients getting treatment in an academic setting (36.11 vs 29.61 in community setting), significantly longer time to chemotherapy in 70+ age group (51.13 vs 40.38 in <40 y age group), black race (55.81 vs 47.05 in whites), low income people (49.64 vs 46.74), significantly longer time to radiotherapy in females (101.61 vs 79.75), blacks and Asians (109.68 and 113.96 respectively vs 92.68 in Native Americans) etc. There are various other disparities in time to surgery, chemotherapy, and radiotherapy. Conclusions: Understanding these disparities is crucial in developing targeted strategies to improve timely access to appropriate treatments and enhance outcomes for gastric cancer patients. Future research with updated data and prospective study designs can provide a more comprehensive understanding of the factors influencing patient outcomes in gastric cancer. [ABSTRACT FROM AUTHOR]

In recent years, faith communities across the United States have begun to create affordable housing on church property, inspired by sincerely held religious beliefs. Some are building microhomes behind their houses of worship. Others are converting residences once used by religious ministers--from rectories to abbeys to convents--into units for seniors and low-income families. Still others are repurposing their vacant schools, church parking lots, and undeveloped parcels of land for denser multifamily structures, from townhouses to apartment buildings. Within housing-advocacy circles and among faith communities, these continent-wide efforts to create affordable housing on church property have manifested an affirmative declaration: "Yes, In God's Backyard." Legal scholarship and popular media have extensively documented the affordable-housing crisis. In particular, scholars and commentators have underscored the pernicious role of exclusionary zoning in strangling housing production, ultimately sending regional housing prices skyward. When faith communities create affordable housing on church property, much of which is located in residentially zoned areas, they seek something other than fair market value. Some might call it "charity" (tzedakah) or "discipleship," a commitment to "welcome the stranger" or to "love your neighbor as yourself." Faith communities seek theologically and morally sound uses for their underutilized property, but often struggle to overcome the regulatory and financial hurdles of adaptive reuse. Local governments can incentivize redevelopment that benefits the wider community, growing their affordable housing supply. But their mutual benefit does not exempt faith communities from challenge when they choose to redevelop church property for affordable housing. Neighbors may seek to thwart faith communities from introducing denser, multifamily residential structures in their backyard, relying on land-use restrictions designed to prohibit less costly forms of housing. When they succeed, these challenges from NIMBY ("Not In My Backyard") neighbors can limit both housing supply and the free exercise of religion. This Feature thus proposes a novel response to exclusionary zoning: religious liberty. Where sincerely held religious beliefs inspire faith communities' efforts to create affordable housing, these communities can assert constitutional and statutory free exercise protections against land-use decisions that obstruct denser, less expensive, multifamily developments on church land. This Feature also explores municipal and state legislative reforms that lower the barrier where faith communities struggle to overcome the regulatory and financial hurdles of adaptive reuse and demonstrates the breadth of potential for affordable housing on church property, drawing on public sources and a novel data set to map parcels owned by Roman Catholic dioceses in Chicago, Illinois and Oakland, California across municipal zones. Regardless of how faith communities came to own property within their limits, or why faith communities seek to repurpose property within their limits, most local governments need property within their limits to create affordable housing. And faith communities are willing partners in their endeavor. [ABSTRACT FROM AUTHOR]

Puerto Rico is a lush archipelago located between the Caribbean Sea and the North Atlantic Ocean. More than three million U.S. citizens with diverse racial and ethnic histories and cultures live on the islands. But life for Puerto Ricans has been challenging with high rates of impoverishment, disability, unemployment, and devastating natural disasters. In addition to these challenges, Puerto Rico has a complicated relationship with the United States. Indeed, residents, 99 percent of whom identify as Hispanic, are treated "separately and unequally" in many aspects by the federal government compared to their state counterparts. One significant difference is the federal tax treatment of Puerto Rican residents. This article details the past and present federal taxation of Puerto Rico residents. The article also presents and exposes detailed economic data to demonstrate explicitly that Puerto Ricans are not reaping federal benefits (including tax benefits) as a "welfare island." In fact, Puerto Rico suffers federal fiscal shortfalls that have been justified by misguided and racist U.S. Supreme Court Insular Cases and their progeny. This analysis establishes that the failure to include most Puerto Rico residents in the federal income tax system has burdened rather than benefited them and their local economy. The benefit versus burden tax analysis is framed using the U.S. Supreme Court's and lower court's opinions in the matter of United States v. Mr. Jose Luis Vaello Madero. Mr. Vaello Madero is a disabled, elderly Puerto Rican, who is representative of many residents. In its 8-1 majority opinion, the U.S. Supreme Court reaffirms the disparate treatment of Puerto Rican residents by arguing, among other claims, that "not taxing" Puerto Ricans is a benefit. This article demonstrates that this argument is not only incorrect, but it whitewashes the racist history upon which it is justified. [ABSTRACT FROM AUTHOR]

Hispanics are disproportionately affected by low rates of physical activity and high rates of chronic diseases. Hispanics generally and Mexican Americans specifically are underrepresented in research on physical activity and its impact on mental well-being. Some community-based interventions have been effective in increasing physical activity among Hispanics. This study examined data from a sample of low-income Hispanic participants in free community exercise classes to characterize the association between self-reported frequency of exercise class attendance, intensity of physical activity, and participant well-being. As part of two cross-sectional samples recruited from a stratified random sample of community exercise classes, 302 participants completed a questionnaire consisting of a modified version of the Godin-Shephard Leisure-Time Exercise Questionnaire (LTEQ) and the Mental Health Continuum Short Form (MHC-SF). Adjusted logistic regression analyses indicated that those who achieve mild, moderate, and strenuous self-reported physical activity have 130% higher odds (p = 0.0422) of positive mental well-being after adjustment for age, frequency of attendance, and self-reported health. This study provides evidence that the intensity of physical activity is associated with flourishing mental well-being among Hispanic adults. The association between physical activity and mental well-being is more pronounced when considering participants engaged in mild levels of physical activity. The study further provides insight into the planning and development of community-based physical activity programming tailored to low-income populations. [ABSTRACT FROM AUTHOR]

To determine if vision impairment (VI) is associated with food insecurity among the United States (US) adults. This is a cross-sectional study of US adults ≥18 years below a threshold of 150% poverty from the National Health Interview Survey (NHIS), years 2011–2018. Outcome measures included food insecurity status, based on response to the NHIS adult (10-item) food insecurity tool, either as a binary (food secure or insecure) or ordinal (high, marginal, low, and very low) variable. VI was defined as self-reported trouble seeing, even when wearing glasses or contact lenses. Multivariable logistic regression analyses adjusted for potential confounders examined associations between VI and food insecurity. Participants (N = 62075) were majority female (57%), White (62%), and non-Hispanic (74%). Of them, 16% reported VI and 28% were food insecure. In fully adjusted logistic regression models, adults with VI had 216% higher odds (95% CI = 2.01–2.31) of being food insecure than adults without VI. Further, there was a dose–response relationship between VI and food insecurity noted in a multinomial model: VI predicted 159% higher risk of marginal food security (95% CI = 1.44–1.75), 197% higher risk of low food security (95% CI = 1.80–2.16), and 295% higher risk of very low food security (95% CI = 2.69–3.22), as compared to high food security. VI is associated with food insecurity, increasingly so among adults with highest levels of food insecurity in this national sample of low-income US adults. This data highlights the need for targeted interventions to address and reduce the burden of food insecurity among US adults with VI. [ABSTRACT FROM AUTHOR]

Background: Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum. Methods: We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross‐sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months. Results: Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common. Conclusions: Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression. Key points: Human milk expression was common among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollees in the first year postpartum.The prevalence of milk expression decreased over the first year postpartum.Among those who fed human milk, 56.8% expressed milk in Month 1 and 13.9% expressed milk in Month 13.Reasons for expressing milk changed over time. [ABSTRACT FROM AUTHOR]

This study assessed the economic status of the country of origin of US doctoral graduates from the sub‐Saharan African region and their post‐graduation residency plans. The National Science Foundation's 2012–2017 Survey of Earned Doctorates provided data for the study. The data were analysed using descriptive statistics and contingency table analysis. The results revealed an association between the economic status of the country of origin and the post‐graduation residency plan. Sixty percent of students from the low‐income and lower‐middle‐income categories expressed an intention to stay in the United States after graduation. The study concluded that the economic status has a relationship with the decision of sub‐Saharan African doctoral students' residency plans. The recommendation is that sub‐Saharan African countries introduce and implement policies that incentivize high‐calibre personnel trained abroad to return to their home country. [ABSTRACT FROM AUTHOR]

Background: Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. Methods: Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks. Results: Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. Conclusion: Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities. [ABSTRACT FROM AUTHOR]

Background: Performing elective orthopaedic surgery on patients with high BMI, poorly controlled hyperglycemia, and who use tobacco can lead to serious complications. Some surgeons use cutoffs for BMI, hemoglobin A1c, and cigarette smoking to limit surgery to patients with lower risk profiles rather than engaging in shared decision-making with patients about those factors. Other studies have suggested this practice may discriminate against people of lower income levels and women. However, the extent to which this practice approach is used by orthopaedic surgeons at leading hospitals is unknown. Questions/purposes: (1) How often are preoperative cutoffs for hemoglobin A1c and BMI used at the top US orthopaedic institutions? (2) What services are available at the top orthopaedic institutions for weight loss, smoking cessation, and dental care? (3) What proportion of hospital-provided weight loss clinics, smoking cessation programs, and dental care clinics accept Medicaid insurance? Methods: To investigate preoperative cutoffs for hemoglobin A1c and BMI and patient access to nonorthopaedic specialists at the top orthopaedic hospitals in the United States, we collected data on the top 50 orthopaedic hospitals in the United States as ranked by the 2020 US News and World Report 's "Best Hospitals for Orthopedics" list. We used a surgeon-targeted email survey to ascertain information regarding the use of preoperative cutoffs for hemoglobin A1c and BMI and availability and insurance acceptance policies of weight loss and dental clinics. Surgeons were informed that the survey was designed to assess how their institution manages preoperative risk management. The survey was sent to one practicing arthroplasty surgeon, the chair of the arthroplasty service, or department chair, whenever possible, at the top 50 orthopaedic institutions. Reminder emails were sent periodically to encourage participation from nonresponding institutions. We received survey responses from 70% (35 of 50) of hospitals regarding the use of preoperative hemoglobin A1c and BMI cutoffs. There was no difference in the response rate based on hospital ranking or hospital region. Fewer responses were received regarding the availability and Medicaid acceptance of weight loss and dental clinics. We used a "secret shopper" methodology (defined as when a researcher calls a facility pretending to be a patient seeking care) to gather information from hospitals directly. The use of deception in this study was approved by our institution's institutional review board. We called the main telephone line at each institution and spoke with the telephone operator at each hospital asking standardized questions regarding the availability of medical or surgical weight loss clinics, smoking cessation programs, and dental clinics. When possible, researchers were referred directly to the relevant departments and asked phone receptionists if the clinic accepted Medicaid. We were able to contact every hospital using the main telephone number. Our first research question was answered using solely the surgeon survey responses. Our second and third research questions were addressed using a combination of the responses to the surgeon surveys and specific hospital telephone calls. Results: Preoperative hemoglobin A1c cutoffs were used at 77% (27 of 35) of responding institutions and preoperative BMI cutoffs were used at 54% (19 of 35) of responding institutions. In the secret shopper portion of our study, we found that almost all the institutions (98% [49 of 50]) had a medical weight loss clinic, surgical weight loss clinic, or combined program. Regarding smoking cessation, 52% (26 of 50) referred patients to a specific department in their institution and 18% (9 of 50) referred to a state-run smoking cessation hotline. Thirty percent (15 of 50) did not offer any internal resource or external referral for smoking cessation. Regarding dental care, 48% (24 of 50) of institutions had a dental clinic that performed presurgical check-ups and 46% (23 of 50) did not offer any internal resource or external referral for dental care. In the secret shopper portion of our study, for institutions that had internal resources, we found that 86% (42 of 49) of weight loss clinics, 88% (23 of 26) of smoking cessation programs, and 58% (14 of 24) of dental clinics accepted Medicaid insurance. Conclusion: Proceeding with TJA may not be the best option for all patients; however, surgeons and patients should come to this consensus together after a thoughtful discussion of the risks and benefits for that particular patient. Future research should focus on how shared decision-making may influence patient satisfaction and a patient's ability to meet preoperative goals related to weight loss, glycemic control, smoking cessation, and dental care. Decision analyses or time trade-off analyses could be implemented in these studies to assess patients' tolerance for risk. Clinical Relevance: Orthopaedic surgeons should engage in shared decision-making with patients to develop realistic goals for weight loss, glycemic control, smoking cessation, and dental care that consider patient access to these services as well as the difficulties patients experience in losing weight, controlling blood glucose, and stopping smoking. [ABSTRACT FROM AUTHOR]

The concept of privilege has received increased attention recently, particularly with regard to inequities in privilege in the United States costing Black Americans their lives at the hands of police officers. Despite a nearly two hundred year history, however, the concept of privilege has not been subjected to a behavioral analysis that focuses on the contextual conditions the inequities we call privilege involve. This paper is a first attempt at such a conceptual analysis, approaching privilege as a manipulable aspect of context, with inherent links to the behavioral repertoires of both privileged people and underprivileged people. Specifically, we propose that privilege involves a high proportion of appetitive to aversive stimulation in the learning environment, which subsequently impacts the relative sensitivity of the repertoire to appetitive and aversive learning opportunities. This approach is explicated, and further explored in terms of its implications, along with specific recommendations for extending the consideration of privilege beyond checking. [ABSTRACT FROM AUTHOR]

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the "war on drugs" in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that "drug war logic" has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts. A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment. The U.S. drug war's frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others. Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is a common disorder in pregnancy. Although sertraline is the most frequently prescribed antidepressant for pregnant people in the United States, limited information about its pharmacokinetics in pregnancy is available. Our objectives were to characterize plasma sertraline concentration to dose (C/D) ratios across pregnancy and postpartum and investigate the effect of pharmacogenetic variability on sertraline elimination. We performed a prospective observational cohort study in people with a singleton pregnancy ≤ 18 weeks gestation and a lifetime diagnosis of MDD at the 3 Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)‐funded Obstetrical‐Fetal Pharmacology Research Center sites. Subjects (N = 47) were receiving maintenance sertraline therapy and chose to continue it during pregnancy. Blood samples were obtained 24‐hours postdose every 4 weeks across pregnancy and twice postpartum for measurement of plasma concentrations of sertraline and desmethylsertraline. Overall mean sertraline C/D ratios were decreased at study onset and remained consistently low until after delivery. During the last 4 weeks of pregnancy the mean sertraline C/D ratio (95% confidence interval (CI)), 0.25 (95% CI, 0.19, 0.3) ng/mL/dose (mg/day), was smaller than the mean ratio at ≥ 8 weeks after delivery, 0.32 (95% CI, 0.27, 0.37) ng/mL/dose (mg/day), a 22% difference. Mean sertraline/desmethylsertraline ratios were highest after birth, which confirmed increased sertraline elimination during pregnancy. Sertraline C/D ratios in participants with functional CYP2C19 activity did not change significantly during pregnancy, whereas ratios in participants with poor or intermediate CYP2C19 activity decreased by 51%. Exploratory pharmacogenomic analysis indicated that pregnant people with poor or intermediate CYP2C19 activity are at risk for subtherapeutic sertraline concentrations during pregnancy. [ABSTRACT FROM AUTHOR]

This study examines the effectiveness of the Community Reinvestment Act (CRA) in facilitating small business lending to lower-income neighborhoods. Taking advantage of an exogenous policy shock that resulted in neighborhood-level changes in CRA eligibility, we identify changes in small business lending in tracts that became CRA eligible and CRA ineligible and compare these with control groups constructed in two ways. The results of our difference-in-differences analysis uniformly show increases in the number of loans associated with CRA eligibility, which is consistent with a view that the CRA promotes small business lending in lower-income neighborhoods. [ABSTRACT FROM AUTHOR]

The author offers observation on the importance for the U.S. to invest more in breastfeeding support ensuring that the needs and wants of people of color and other socio-economically disadvantaged groups are met. Topics discussed include breastfeeding inequities and importance, barriers for improving breastfeeding, and information on the Baby Friendly Hospital Initiative Ten Steps.

• Wildfire destruction was predicted by building type, tenure, and value. • Building value-destruction association was explained by density and proximity to roads. • Post-fire reconstruction was predicted by building type, tenure, and value. • Findings suggest housing stock filtering and cost-burden gentrification. As the number of highly destructive wildfires grows, it is increasingly important to understand the long-term changes that occur to fire-affected places. Integrating approaches from social and biophysical science, we document two forms of neighborhood change following the 2018 Camp Fire in the United States, examining the more than 17,000 residential structures within the burn footprint. We found that mobile or motor homes, lower-value residences, and absentee owner residences had a significantly higher probability of being destroyed, providing evidence that housing stock filtering facilitated socially stratified patterns of physical damage. While the relationship between building value and destruction probability could be explained by measures of building density and distance to nearby roads, building type remained an independent predictor of structure loss that we could not fully explain by adding environmental covariates to our models. Using a geospatial machine learning technique, we then identified buildings that had been reconstructed within the burn footprint 20 months after the fire. We found that reconstructed buildings were more likely to have been owner-occupied prior to the fire and had higher average pre-fire property value, suggesting an emerging pattern of cost-burden gentrification. Our findings illustrate the importance of examining the built environment as a driver of socially uneven disaster impacts. Wildfire mitigation strategies are needed for mobile and motor home residents, renters, low-income residents, and dense neighborhoods. [ABSTRACT FROM AUTHOR]

Background: Digoxin is indicated for the management of heart failure with reduced ejection fraction and atrial fibrillation. Despite stronger guideline recommendations for other pharmacologic and device therapies, digoxin retains a role in select patients unable to tolerate or refractory to standard therapies. Contemporary utilization of and costs related to digoxin in the United States of America (USA) remain uncharacterized. The objective of this study was to estimate trends in digoxin use and expenditures across the USA from 2010 to 2017. Methods: We utilized the Medical Expenditure Panel Survey to estimate trends in digoxin use and expenditures across the USA from 2010 to 2017. The Medical Expenditure Panel Survey is an overlapping panel survey that interviews households in the USA to ascertain their healthcare utilization and expenditures. Complex sampling procedures allow for nationally representative estimates of utilization and expenditures. We report the number of digoxin users and expenditures across key subgroups in 2-year increments from 2010 to 2017. Results: The number of digoxin users in the USA declined by 47% from 766 users per 100,000 adults in 2010–11 to 402 users per 100,000 adults in 2016–17. While digoxin use declined among women and self-identified White adults, adults living at or below the federal poverty level and those who self-identified as Asian or Hispanic represent an increasing proportion of overall digoxin users. While nationwide digoxin expenditures declined by 26% from 2010–11 to 2012–13, they peaked at $260.3 million in 2014–15 and remained elevated at $188.7 million in 2016–17. Conclusions: Despite a nationwide trend towards declining use, digoxin remains prevalent amongst people of Asian and Hispanic descent in the USA. After a spike in cost in 2013, digoxin prices have yet to return to pre-spike levels. The role of digoxin in contemporary heart failure and arrhythmia management will continue to evolve as additional randomized and observational analyses become available. [ABSTRACT FROM AUTHOR]

The current study explored adolescents' perceptions of what contributes to their experiences of success in a rural Title I school through interpretative phenomenological analysis (IPA). Participants included adolescents who were enrolled at a rural Title I Middle/High School in the southern United States. The single campus school district serves approximately 185 students from Prekindergarten to grade 12. Approximately, 73% of the students are identified as At-Risk, 88% of the students are economically disadvantaged, and 100% of the students qualify for free or reduced lunch. Ten students from this school, with assent and parental consent, participated in the current study. Participants' ages ranged from 13 to 18, and the students represented different genders (seven males, three females) and various racial and ethnic backgrounds (three Black/African American, four Latinx, two White, and one Biracial). Results from the current study suggest low-income adolescents in a rural Title I school perceived (a) school size, (b) family support, and (c) their own internal drive to succeed as contributing to their success at school. These themes, their corresponding subthemes, and representative participant statements are included. Implications for school administrators, teachers, and counselors along with directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Warfarin and a skeletal muscle relaxant are co-treatments in nearly a quarter-million annual United States (US) office visits. Despite international calls to minimize patient harm arising from anticoagulant drug interactions, scant data exist on clinical outcomes in real-world populations. We examined effects of concomitant use of warfarin and individual muscle relaxants on rates of hospitalization for thromboembolism among economically disadvantaged persons. Materials and Methods: Using 1999–2012 administrative data of four US state Medicaid programs, we conducted 16 retrospective self-controlled case series studies: half included concomitant users of warfarin + one of eight muscle relaxants; half included concomitant users of an inhaled corticosteroid (ICS) + one of eight muscle relaxants. The ICS analyses served as negative control comparisons. In each study, we calculated incidence rate ratios (IRRs) comparing thromboembolism rates in the co-exposed versus warfarin/ICS-only exposed person-time, adjusting for time-varying confounders. Results: Among ~70 million persons, we identified 8693 warfarin-treated subjects who concomitantly used a muscle relaxant, were hospitalized for thromboembolism, and met all other inclusion criteria. Time-varying confounder-adjusted IRRs ranged from 0.31 (95% confidence interval: 0.13–0.77) for metaxalone to 3.44 (95% confidence interval: 1.53–7.78) for tizanidine. The tizanidine finding was robust after quantitatively adjusting for negative control ICS findings, and in numerous prespecified secondary analyses. Conclusions: We identified a potential >3-fold increase in the rate of hospitalized thromboembolism in concomitant users of warfarin + tizanidine vs. warfarin alone. Alternative explanations for this finding include confounding by indication, a native effect of tizanidine, or chance. [ABSTRACT FROM AUTHOR]

• Longitudinal data for self-regulation in dual-language learners from 4 sites were analyzed. • Participating children were predominantly from families of low income. • Three patterns of growth were observed: early, later, and intermediate. • Those in the latter group did not develop self-regulation until after school entry. • Boys and lower SES children were more likely to be in the later growth group. Despite strong evidence self-regulation skills are critical for school readiness, there remains a dearth of longitudinal studies that describe developmental trajectories of self-regulation, particularly among low-resource and underrepresented populations such as Spanish-English dual-language learners. The present study examined individual differences in trajectories of self-regulation among 459 Spanish-English dual-language learners who were Hispanic from 4 different samples and 3 geographic locations in the United States. Self-regulation was assessed in all samples using repeated administration of the Head-Toes-Knees-Shoulders (HTKS) task from early childhood through early elementary school. Results of latent growth curve analyses revealed that growth was best represented by quadratic trajectories. Latent class growth analyses captured significant individual differences in self-regulation trajectories. One group of children (41%) started with higher HTKS scores and displayed rapid early growth in performance. A similar percentage of children (41%) displayed intermediate growth in self-regulation, starting with lower HTKS scores but displaying rapid growth commencing arrange 4.5 years. Finally, about 18% of the sample did not display growth in HTKS performance until after entry to elementary school, around age 6 years. Girls were half as likely as boys to be in this later developing group. Likewise, children from families at the upper end of the socioeconomic distribution in this low-income sample were significantly less likely to be in the later developing group relative to children from families with lower SES. Study findings indicate the importance of monitoring growth rates in self-regulation as a means of identifying children at risk for entering school without the requisite self-regulation skills. [ABSTRACT FROM AUTHOR]

Self-pay patients are an understudied yet important and financially vulnerable population of emergency department (ED) users. As ED facility fees may be a key cost driver in patient ED bills, we leveraged newly available hospital pricing data to describe ED facility fees for self- pay patients (cash prices) and how they vary according to hospital and regional characteristics in a sample of 1,621 hospitals across the United States. The median cash price for ED facility fees ranged from $160.78 for a level 1 visit to $1,097.43 for a level 5 visit. Hospital for-profit status and a bed count of 251 or more beds were associated with higher cash prices for ED facility fees across all visit levels. Meanwhile, location in a county with a poverty rate of 16 percent or more was correlated with lower facility fee cash prices for ED visit levels 2 and up. We hope that these findings can inform targeted policy efforts to better ensure affordable ED care for vulnerable patients. [ABSTRACT FROM AUTHOR]

Recent experience demonstrates that substantial progress in reducing homelessness is possible if resources are directed towards evidence-based, housing-focused solutions. However, the homeless assistance systems in most countries are not adequately resourced to assist persons experiencing "crisis homelessness," who account for the majority of the homeless population. Thus, we present a policy proposal for leveraging an expansion of Critical Time Intervention (CTI), an evidence-based behavioral health intervention, as a scalable solution for crisis homelessness. We draw on the specific policy context of the United States in proposing the use of funds from Medicaid, the public health insurance program for low-income individuals, to finance such an expansion, but argue our broader policy proposal has salience internationally as well. In presenting our proposal, we discuss why it represents a sound and feasible policy idea, focusing on the alignment between CTI and a promising new programmatic approach known as rapid rehousing. We describe the potential benefits of enacting this proposal and conclude with discussing the United States-specific and more general challenges that would need to be addressed to implement it, including the need for additional resources to cover the costs of the temporary financial assistance component of rapid re-housing. [ABSTRACT FROM AUTHOR]

Background: Chagas disease is a potentially life-threatening neglected disease of poverty that is endemic in continental Latin America. Caused by Trypanosoma cruzi (T. cruzi), it is one of six parasitic diseases in the United States targeted by the Centers for Disease Control as a public health problem in need of action. An estimated 300,000 people are infected with T. cruzi in the United States (US). Although its morbidity, mortality and economic burden are high, awareness of Chagas disease is lacking among many healthcare providers in the US. The purpose of this analysis is to determine if the number of diagnostic tests performed at a community health center serving an at-risk population for Chagas disease increased after information sessions. A secondary aim was to determine if there was a difference by provider type, i.e., nurse practitioner vs. physician, or by specialty in the number of patients screened. Methodology/Principal findings: We conducted a retrospective data analysis of the number of Chagas serology tests performed at a community health center before and after information sessions for clinicians. A time series analysis was conducted focusing on the Adult and Family Medicine Departments at East Boston Neighborhood Health Center (EBNHC). Across all departments there were 1,957 T. cruzi tests performed before the sessions vs. 2,623 after the sessions. Interrupted time series analysis across departments indicated that testing volume was stable over time prior to the sessions (pre-period slope = +4.1 per month; p = 0.12), followed by an immediate shift after the session (+51.6; p = 0.03), while testing volume remained stable over time after the session (post-period slope = -6.0 per month; p = 0.11). Conclusion/Significance: In this study, Chagas testing increased after information sessions. Clinicians who began testing their patients for Chagas disease after learning of the importance of this intervention added an extra, potentially time-consuming task to their already busy workdays without external incentives or recognition. Author summary: Chagas disease is a potentially fatal neglected disease of poverty. It is endemic in continental Latin America with an estimated 300,000 cases in the United States, primarily among low-income people who have immigrated to the US from Latin America. Few Chagas screening programs have been established in the US. Existing recommendations for Chagas disease testing and treatment are rarely followed for many reasons including a paucity of knowledge among providers. We aimed to determine if the number of Chagas tests performed increased after information sessions at a community health center. A secondary aim was to determine if there was a difference in number of tests performed by provider type. We found that the number of T. cruzi serologies performed in the ten months after information sessions increased significantly over that in the ten preceding months. Chagas testing increased across departments, though Chagas diagnostics were an extra and unmitigated time burden on clinicians. Increasing provider knowledge is a major step to increase diagnosis and treatment of this neglected disease, when clinicians are motivated by their inherent prosocial preferences including altruism i.e., by the positive impact of their work on patients' lives. [ABSTRACT FROM AUTHOR]

While the scale and scope of the criminal legal system is often discussed with attention to racial disproportionalities, the fact that disabled people are overrepresented at all points in the system is less discussed by social workers. Disabled people come into contact with the criminal legal system as suspects, defendants, incarcerated persons, victims, and witnesses. Compared to people without disabilities, disabled people are more likely to experience victimization, be arrested, be charged with a crime, and serve longer prison sentences once convicted. These trends are even more profound for disabled people with intersecting marginalized identities, such as people of color, women, poor people, and those who identify as LGBTQ. This article provides an overview of the connections between disability, law enforcement, and practices of imprisonment in the United States. We provide a historical overview of the involvement of disabled people in the criminal legal system, review the prevalence of disability in the criminal legal system, and then discuss the unique ways in which disabled people are impacted by the criminal legal system. We conclude by providing recommendations for social work practice and advocacy based in disability justice. [ABSTRACT FROM AUTHOR]

Poor people proved especially vulnerable to economic disruption during the coronavirus disease (COVID-19) pandemic, which highlighted the importance of poverty reduction as a policy concern. In this article, we explore the politics of poverty reduction during the COVID-19 crisis in Canada and the United States, two liberal welfare-state regimes where poverty reduction is a key policy issue. We show that, since the beginning of the pandemic, policies likely to reduce poverty significantly have been adopted in both Canada and the United States. Yet, this poverty reduction logic has emerged in different ways in the two countries--with the United States embracing more significant departures from its policy status quo. This situation leads us to ask the following question: in each country, what are the political conditions under which public policies susceptible of reducing poverty are enacted? To answer this question, we study the politics of poverty reduction both before and during the pandemic, as we suggest that grasping the evolution of partisan and electoral patterns over time is necessary to explain what happened during the pandemic, whose impact is closely related to how it interacts with such patterns. Our analysis suggests the need to consider more carefully the impact of both crises and partisanship on social policy, including poverty reduction. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to evaluate the trends in the impact of Medicaid expansion on the use of selected recommended clinical preventive services and examine the differences in use by income level over time.Methods: The data were obtained from the 2011-2019 Behavioral Risk Factor Surveillance System and were analyzed in 2021. This study conducted a difference-in-differences analysis of the association between Medicaid expansion and the use of 5 clinical preventive services, including colon/breast/cervical cancer screenings, HIV testing, and influenza vaccination. Annual percentage change was applied to assess the trends in the impact of Medicaid expansion on the use of clinical preventive services.Results: The use of all the 5 clinical preventive services varied over time. In almost every year, the use of 4 clinical preventive services (all but HIV testing) among Medicaid expansion states was higher than that among the nonexpansion states. People with lower income used 4 clinical preventive services (all but HIV testing) less frequently than those with higher income, regardless of their residence in expansion or nonexpansion groups. Among the lower-income group, the use of 5 clinical preventive services increased after Medicaid expansion almost every year, with the use of colon cancer screening and HIV testing reaching statistical significance and the impact of Medicaid expansion in the use of each clinical preventive service kept stable from 2014 to 2019.Conclusions: These findings provide evidence that Medicaid expansion may be associated with sustainably increased use of the selected recommended clinical preventive services among the lower-income population and that Medicaid expansion to reduce financial barriers may be an effective strategy to improve population health. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic, the unemployment rate in the United States peaked at 14.8% in April 2020. We examined patterns in unemployment following this peak in counties with rapid increases in COVID-19 incidence. Method: We used CDC aggregate county data to identify counties with rapid increases in COVID-19 incidence (rapid riser counties) during July 1–October 31, 2020. We used a linear regression model with fixed effect to calculate the change of unemployment rate difference in these counties, stratified by the county's social vulnerability (an indicator compiled by CDC) in the two months before the rapid riser index month compared to the index month plus one month after the index month. Results: Among the 585 (19% of U.S. counties) rapid riser counties identified, the unemployment rate gap between the most and least socially vulnerable counties widened by 0.40 percentage point (p<0.01) after experiencing a rapid rise in COVID-19 incidence. Driving the gap were counties with lower socioeconomic status, with a higher percentage of people in racial and ethnic minority groups, and with limited English proficiency. Conclusion: The widened unemployment gap after COVID-19 incidence rapid rise between the most and least socially vulnerable counties suggests that it may take longer for socially and economically disadvantaged communities to recover. Loss of income and benefits due to unemployment could hinder behaviors that prevent spread of COVID-19 (e.g., seeking healthcare) and could impede response efforts including testing and vaccination. Addressing the social needs within these vulnerable communities could help support public health response measures. [ABSTRACT FROM AUTHOR]

Decades of research have documented elevated rates of psychopathology among individuals affected by poverty. However, many studies have relied on predominately White samples, and on brief symptom screening measures which may not fully capture the experiences of individuals of color (who are disproportionately affected by poverty in the United States.) The present study examines prevalence rates of probable major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder, substance use disorder, and alcohol use disorder in a predominately Black sample that grew up in urban poverty, utilizing structured neuropsychiatric interview methods. Data are drawn from a subsample of the Chicago Longitudinal Study (CLS), which has followed a large cohort for over four decades. Outcomes were assessed using the Mini International Neuropsychiatric Interview (M.I.N.I.) 7.0.2. Results indicate high probable rates of all measured outcomes, with notably high rates of substance use and alcohol use disorder compared to rates reported in previous national studies. Differences by sex and childhood neighborhood poverty, as well as significant comorbidity among psychiatric, substance and alcohol use disorders were also detected. Findings underscore an urgent need for community-based, culturally tailored prevention and intervention initiatives to support the mental health of individuals living in poverty. The high prevalence of psychiatric, substance and alcohol use disorders in this study likely reflect systematic inequities faced by low-income people of color in the United States. Future directions for research and practice are discussed. [ABSTRACT FROM AUTHOR]

Objective: To describe prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birth parents (delivering people).Methods: We conducted a retrospective, cross-sectional study of the Medical Expenditure Panel Survey from 2008-2016. We identified newborn birth parents and a 2:1 nearest-neighbor propensity-matched control cohort of nonpregnant reproductive-aged individuals, then assessed for catastrophic health expenditures (spending greater than 10% of family income) in the delivery year. We applied survey weights to extrapolate to the noninstitutionalized U.S. population and used the adjusted Wald test for significance testing. We compared risk of catastrophic health expenditures between birth parents and the control cohort and described time trends and risk factors for catastrophic spending with subgroup comparisons.Results: We analyzed 4,056 birth parents and 7,996 reproductive-aged females without pregnancy in a given year. Birth parents reported higher rates of unemployment (52.6% vs 46.6%, P<.001), and high rates of gaining (22.4%) and losing (25.6%) Medicaid in the delivery year. Birth parents were at higher risk of catastrophic health expenditures (excluding premiums: 9.2% vs 6.8%, odds ratio [OR] 1.95, 95% CI 1.61-2.34; including premiums: 21.3% vs 18.4%, OR 1.53, 95% CI 1.32-1.82). Birth parents living on low incomes had the highest risk of catastrophic health expenditures (18.8% vs 0.7% excluding premiums for 138% or less vs greater than 400% of the federal poverty level, relative risk [RR] 26.9; 29.8% vs 5.9% including premiums, RR 5.1). For birth parents living at low incomes, public insurance was associated with lower risks of catastrophic health expenditures than private insurance, particularly when including premium spending (incomes 138% of the federal poverty level or lower: 18.8% public vs 67.9% private, RR 0.28; incomes 139-250% of the federal poverty level: 6.5% public vs 41.1% private, RR 0.16). The risk of catastrophic spending for birth parents did not change significantly over time from before to after Affordable Care Act implementation.Conclusion: Pregnancy and delivery are associated with increased risk of catastrophic health expenditures in the delivery year. Medicaid and public coverage were more protective from high out-of-pocket costs than private insurance, particularly among low-income families. [ABSTRACT FROM AUTHOR]

Objective: Ethnic/racial minority children in the United States are more likely to experience father loss to incarceration than White children, and limited research has examined the health implications of these ethnic/racial disparities. Telomere length is a biomarker of chronic stress that is predictive of adverse health outcomes. This study examined whether paternal incarceration predicted telomere length shortening among offspring from childhood to adolescence, whether maternal depression mediated the link, and whether ethnicity/race moderated results.Method: Research participants included 2,395 families in the Fragile Families and Child Wellbeing study, a national and longitudinal cohort study of primarily low-income families from 20 large cities in the United States. Key constructs were measured when children were on average ages 9 (2007-2010) and 15 (2014-2017).Results: Children who experienced paternal incarceration exhibited shorter telomere lengths between ages 9 and 15, and changes in maternal depression mediated this finding. Specifically, mothers who experienced a partner's incarceration were more likely to have depression between children's ages 9 and 15. In turn, increases in maternal depression between children's ages 9 and 15 predicted more accelerated telomere length shortening among children during this period. Paternal incarceration was more prevalent and frequent for ethnic/racial minority youth than for White youth.Conclusion: Paternal incarceration is associated with a biomarker of chronic stress among children in low-income families. Rates of paternal incarceration were more prevalent and frequent among Black American and multiethnic/multiracial families than among White Americans. As a result, the mass incarceration crisis of the criminal justice system is likely shaping intergenerational ethnic/racial health disparities. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine modifiable mediators for socioeconomic disparities in childhood obesity in the United States.Methods: This study used the data of 1,211 mother-child dyads from a US national birth cohort from pregnancy to 6 years post partum. Socioeconomic status was indicated by maternal education (college graduate vs. less) and family income (>185% vs. ≤185% of the poverty line). Single- and multiple-factor mediation analyses were conducted for socioeconomic disparities in childhood obesity at 6 years, adjusting for demographics.Results: The confounder-adjusted relative risk of childhood obesity was 1.79 for low maternal education and 1.42 for low family income. Low-maternal-education-related obesity was individually mediated by maternal preconception BMI (percentage of indirect effect, 8.8%), smoking during pregnancy (7.0%), infant weight gain (14.4%), child sleep duration (11.4%), and TV viewing during weekdays at 6 years (4.9%). Low-family-income-related obesity was mediated by maternal preconception BMI (18.5%), smoking during pregnancy (6.3%), child sleep duration (12.8%), and the home learning environment at 6 years (26.2%). In multiple-mediator analysis, significant mediators together mediated 54.0% of maternal-education-related or 39.4% of family-income-related disparities.Conclusions: Maternal preconception BMI, smoking during pregnancy, infant weight gain, child sleep, TV viewing, and the home learning environment substantially mediated socioeconomic disparities in childhood obesity in the United States. [ABSTRACT FROM AUTHOR]

Aim/Purpose Latina doctoral students' educational experiences are often mediated by their social class status, race, and gender. Latinas have sustained an increasing presence in doctoral programs at various colleges and universities across the United States; yet, they are continually underrepresented in doctoral programs at predominantly White institutions. The author identifies evidence-supported, personal and institutional factors that may contribute to working-class Latina doctoral students' successful persistence at predominantly White institutions. Background The tension between personal identities versus academic capability can make the doctoral education experience academically, socially, emotionally, and financially challenging for Latinas from low-income backgrounds. Latina/Latino Critical Race Theory and Multiracial Feminist Theory are introduced as lenses to examine aspects of the doctoral education experience that may impede or support Latina students' retention. Methodology As a conceptual article, this paper is an examination of research regarding the experiences of doctoral students of color at predominantly White institutions in the United States and summarizes how Latina doctoral students from economically disadvantaged backgrounds can succeed in these environments. Contribution This article outlines evidence-supported strategies that may influence workingclass Latina doctoral students' successful persistence at predominantly White institutions. Findings The research highlighted in this article emphasizes how factors such as embracing familismo, increasing faculty diversity, establishing peer networks, and creating inclusive class-conscious academic programs and new student orientations, may contribute to the doctoral persistence of Latinas from economically disadvantaged backgrounds attending predominantly White institutions. Recommendations for Practitioners Personal and institutional factors are recommended for faculty and student affairs professionals to support the doctoral persistence of Latina students such as embracing personal agency and academic efficacy, embracing familismo, recognizing the myth of meritocracy, establishing peer support networks, creating inclusive academic environments, establishing formal faculty mentorships, and fostering class conscious faculty. Recommendations for Researchers The literature presented in this paper provides ideas for future research opportunities that could further examine how supportive relationships and inclusiveness promote Latina doctoral students' educational success. Impact on Society Latinas experience overlapping forms of privilege and subordination depending on their race, social class, gender, sexual orientation, and academic setting. Future Research Further development of transformative research on this topic may improve inclusive educational practices and potentially increase access to doctoral-level education for Latinas and other economically disadvantaged students of color. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) has exposed and, to some degree, exacerbated social inequity in the United States. This study reveals the correlation between demographic and socioeconomic variables and home-dwelling time records derived from large-scale mobile phone location tracking data at the U.S. census block group (CBG) level in the twelve most populated Metropolitan Statistical Areas (MSAs) and further investigates the contribution of these variables to the disparity in home-dwelling time that reflects the compliance with stay-at-home orders via machine learning approaches. We find statistically significant correlations between the increase in home-dwelling time ( ∇ HDT ) and variables that describe economic status in all MSAs, which is further confirmed by the optimized random forest models, because median household income and percentage of high income are the two most important variables in predicting ∇ HDT. The partial dependence between median household income and ∇ HDT reveals that the contribution of income to ∇ HDT is place dependent, nonlinear, and different given varying income intervals. Our study reveals the luxury nature of stay-at-home orders with which lower income groups cannot afford to comply. Such disparity in responses under stay-at-home orders reflects the long-standing social inequity issues in the United States, potentially causing unequal exposure to COVID-19 that disproportionately affects vulnerable populations. We must confront systemic social inequity issues and call for a high-priority assessment of the long-term impact of COVID-19 on geographically and socially disadvantaged groups. [ABSTRACT FROM AUTHOR]

A massive civil “justice gap” plagues the United States. Every day, low-income Americans—and disproportionately people of color—go without the legal information and representation they need to enforce their rights. This can cost them their homes, jobs, food security, or children. But unmet civil legal needs in housing, employment, and public benefits, for example, are not simply injustices—they are well-documented drivers of poor health, or social determinants of health. Those marginalized by virtue of both race and socioeconomic status are particularly harmed by inaccessibility to justice and also by chronic health conditions and lower life expectancy. When a tenant walks into court alone for an eviction hearing and faces an experienced landlord’s attorney, the tenant is unlikely to prevail, and her eviction can lead to myriad poor health outcomes. The health justice movement leverages law and policy to advance health equity. In recent years, it has gained tremendous traction, especially due to the COVID-19 pandemic’s spotlight on health disparities. In tandem, the access to justice movement is progressing with the advancement of major federal, state, and local legislation and initiatives. However, the movements have been running on parallel tracks, and their connections have been under-examined. This Article puts the two movements and bodies of scholarship squarely in dialogue with one another. True access to justice cannot be attained without leveraging law and policy in pursuit of health equity. There can be no justice for those who lack an equal opportunity to achieve health and well-being. This Article offers a new model for access to justice interventions defined by adherence to three core principles of health justice. To further health equity, access to justice strategies must (1) facilitate enforcement of extant laws; (2) elevate the power of affected individuals and communities; and (3) advance structural law and policy reform. Informed by the health justice framework, this model will allow the access to justice movement to realize its ultimate aspiration of social equality and provide for a healthier nation. [ABSTRACT FROM AUTHOR]

This paper describes the Smart Beginnings Integrated Model, an innovative, tiered approach for addressing school readiness disparities in low-income children from birth to age 3 in the United States through universal engagement of low-income families and primary prevention in pediatric primary care integrated with secondary/tertiary prevention in the home. We build on both public health considerations, in which engagement, cost and scalability are paramount, and a developmental psychopathology framework (Cicchetti & Toth, Journal of Child Psychology and Psychiatry, and Allied Disciplines 50:16–25, 2009), in which the child is considered within the context of the proximal caregiving environment. Whereas existing early preventive models have shown promise in promoting children's school readiness, the Smart Beginnings model addresses three important barriers that have limited impacts at the individual and/or population level: (1) identification and engagement of vulnerable families; (2) the challenges of scalability at low cost within existing service systems; and (3) tailoring interventions to address the heterogeneity of risk among low-income families. Smart Beginnings takes advantage of the existing platform of pediatric primary care to provide a universal primary prevention strategy for all families (Video Interaction Project) and a targeted secondary/tertiary prevention strategy (Family Check-Up) for families with additional contextual factors. We describe the theory underlying the Smart Beginnings model, some initial findings from its recent application in two cities, and implications for changing social policy to promote school readiness beginning during very early childhood. [ABSTRACT FROM AUTHOR]

In 1931, Edgar Sydenstricker, the former statistician of the US Public Health Service, challenged the common belief that the 1918 influenza outbreak had affected "the rich and the poor alike." Using data from 112,317 participants in a 1918 US national survey, he observed that, on the contrary, both morbidity and mortality from the flu had been higher among the poor than among the rich. To explain these differences, Sydenstricker stratified the analyses by 2 measures of affluence collected in the survey: "economic status" (from "very poor" to "well-to-do") and household crowding (i.e. number of people per household room). Economic status was associated with influenza attack rates within categories of crowding, but not the opposite, suggesting that characteristics of poverty other than "household congestion" were the culprit of the poor's higher influenza burden. Attack rate ratios for influenza in infants and older adults were greater for the poor or very poor. Sydenstricker reanalyzed an already 12-year-old data set in the context of the Great Depression to build the evidence base relating poverty to ill health. For this purpose he used a stratification approach to assess confounding, mediation, and interaction before the concepts were formally named. [ABSTRACT FROM AUTHOR]

Accessory dwelling units (ADUs) have been championed as a low-cost solution—both monetarily and politically—for America's housing affordability crisis. However, do these micro-units provide a city's lower-income community members with much needed affordable housing? And which income groups benefit from the theoretical supplemental income created by ADUs? Using socioeconomic data, building permit information, and geospatial analysis, this paper explores these questions by conducting a case study of the archetype of America's housing affordability crisis: San Francisco, California. Finding that, within the city and sample frame, few ADU permits have been filed in the most price-vulnerable communities, this paper challenges the theoretical benefits of ADUs espoused by politicians and academics. If the city continues to lean on ADU legislation, local legislators must strengthen current enforcement mechanisms and more narrowly tailor ADU-related rental restrictions. By offering model legislation and code language, this paper illustrates how San Francisco and other communities across the country can better ensure ADUs live up to their promise of affordability and access. [ABSTRACT FROM AUTHOR]

The article examines the impact of housing policies and housing rights of tenants and security of tenure during the COVID-19 pandemic in light of evictions filed in New Orleans, Louisiana from March to December 2020. Topics discussed include the impact of the pandemic on the social and economic vulnerability of low-income people and communities of color, role of the race-property relationship in the eviction crisis, and effect of failure of tenants to access legal representation on evictions.

The article discusses the issues on the imposition of special assessment fees on indigent criminal defendants in the U.S. and how it may violate the Eighth Amendment of the constitution. Other topics include the Supreme Court's acknowledgement of the relevance of the ability to pay in the 2019 case Timbs v. Indiana, and how the legal financial obligations (LFO) can adversely affect the families and communities of the defendants.

Benefit-cost analyses of regulations address Kaldor-Hicks efficiency but rarely investigate the distribution of benefits and costs as experienced by low-income households. In order to fill this gap, this article assembles the available evidence to determine how regulations of the automobile industry may impact the well-being of low-income Americans. The scope of the investigation includes air pollution, safety and fuel-economy regulations. We find that performing benefit-cost analyses for low-income households is more challenging than commonly understood. Given the difficulties in completing distributional analysis with available information, the authors offer practical suggestions on how to change the federal data systems and the rulemaking process to ensure that information is collected about how future automobile regulations impact the well-being of the poor. [ABSTRACT FROM AUTHOR]