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In the 1930s, maps created by the federal Home Owners' Loan Corporation (HOLC) nationalized residential racial segregation via "redlining," whereby HOLC designated and colored in red areas they deemed to be unsuitable for mortgage lending on account of their Black, foreign-born, or low-income residents. We used the recently digitized HOLC redlining maps for 28 municipalities in Massachusetts to analyze Massachusetts Cancer Registry data for late stage at diagnosis for cervical, breast, lung, and colorectal cancer (2001–2015). Multivariable analyses indicated that, net of age, sex/gender, and race/ethnicity, residing in a previously HOLC-redlined area imposed an elevated risk for late stage at diagnosis, even for residents of census tracts with present-day economic and racial privilege, whereas the best historical HOLC grade was not protective for residents of census tracts without such current privilege. For example, a substantially elevated risk of late stage at diagnosis occurred among men with lung cancer residing in currently privileged areas that had been redlined (risk ratio = 1.17, 95% confidence interval: 1.06, 1.29), whereas such risk was attenuated among men residing in census tracts lacking such current privilege (risk ratio = 1.01, 95% confidence interval: 0.94, 1.08). Research on historical redlining as a structural driver of health inequities is warranted. [ABSTRACT FROM AUTHOR]

We assessed the ability of high-risk criteria developed by Boston Health Care for the Homeless Program to identify increased mortality during a 10-year cohort study (January 2000–December 2009) of 445 unsheltered adults. To qualify as high-risk for mortality, an individual slept unsheltered for six consecutive months or longer plus had one or more of the following characteristics: tri-morbidity, defined as co-occurring medical, psychiatric, and addiction diagnoses; one or more inpatient or respite admissions; three or more emergency department visits; 60 years old or older; HIV/AIDS; cirrhosis; renal failure; frostbite, hypothermia, or immersion foot. A total of 119 (26.7%) individuals met the high-risk criteria. The remaining 326 individuals in the cohort were considered lowerrisk. During the study, 134 deaths occurred; 52 (38.8%) were among high-risk individuals. Compared with sheltered individuals, the age-standardized mortality ratio for the high-risk group was 4.0 (95% confidence interval 3.0, 5.2) times higher and for the lower-risk group was 2.2 (1.8, 2.8) times higher. The hazard ratio, a measure of survival, for the high-risk group was 1.7 (1.2, 2.4) times that of the lower-risk group. High-risk criteria predicted an increased likelihood of mortality among unsheltered individuals. The lower-risk group also had high mortality rates compared with sheltered individuals. [ABSTRACT FROM AUTHOR]

Objectives. To address evidence gaps in COVID-19 mortality inequities resulting from inadequate race/ethnicity data and no socioeconomic data. Methods. We analyzed age-standardized death rates in Massachusetts by weekly time intervals, comparing rates for January 1 to May 19, 2020, with the corresponding historical average for 2015 to 2019 stratified by zip code social metrics. Results. At the surge peak (week 16, April 15–21), mortality rate ratios (comparing 2020 vs 2015–2019) were 2.2 (95% confidence interval [CI] = 1.4, 3.5) and 2.7 (95% CI = 1.4, 5.5) for the lowest and highest zip code tabulation area (ZCTA) poverty categories, respectively, with the 2020 peak mortality rate 1.1 (95% CI = 1.0, 1.3) times higher in the highest than the lowest poverty ZCTA. Similarly, rate ratios were significantly elevated for the highest versus lowest quintiles with respect to household crowding (1.7; 95% CI = 1.0, 2.9), racialized economic segregation (3.1; 95% CI = 1.8, 5.3), and percentage population of color (1.8; 95% CI = 1.6, 2.0). Conclusions. The COVID-19 mortality surge exhibited large inequities. Public Health Implications. Using zip code social metrics can guide equity-oriented COVID-19 prevention and mitigation efforts. [ABSTRACT FROM AUTHOR]

Objectives. To assess the use of local measures of segregation for monitoring health inequities by local health departments. Methods. We analyzed preterm birth and premature mortality (death before the age of 65 years) rates for Boston, Massachusetts, for 2010 to 2012, using the Index of Concentration at the Extremes (ICE) and the poverty rate at both the census tract and neighborhood level. Results. For premature mortality at the census tract level, the rate ratios comparing the worst-off and best-off terciles were 1.58 (95% confidence interval [CI] = 1.36, 1.83) for the ICE for income, 1.66 (95% CI = 1.43,1.93) for the ICE for race/ethnicity, and 1.63 (95% CI = 1.40,1.90) for the ICE combining income and race/ethnicity, as compared with 1.47 (95% CI = 1.27, 1.71) for the poverty measure. Results for the ICE and poverty measures were more similar for preterm births than for premature mortality. Conclusions. The ICE, a measure of social spatial polarization, may be useful for analyzing health inequities at the local level. Public Health Implications. Local health departments in US cities can meaningfully use the ICE to monitor health inequities associated with racialized economic segregation. [ABSTRACT FROM AUTHOR]

Research on residential segregation and health, primarily conducted in the USA, has chiefly employed city or regional measures of racial segregation. To test our hypothesis that stronger associations would be observed using local measures, especially for racialized economic segregation, we analyzed risk of fatal and non-fatal assault in Massachusetts (1995-2010), since this outcome is strongly associated with residential segregation. The segregation metrics comprised the Index of Concentration at the Extremes (ICE), the Index of Dissimilarity, and poverty rate, with measures computed at both the census tract and city/town level. Key results were that larger associations between fatal and non-fatal assaults and residential segregation occurred for models using the census tract vs. city/town measures, with the greatest associations observed for racialized economic segregation. For fatal assaults, comparing the bottom vs. top quintiles, the incidence rate ratio (and 95% confidence interval (CI)) in models using the census tract measures equaled 3.96 (95% CI 3.10, 5.06) for the ICE for racialized economic segregation, 3.26 (95% CI 2.58, 4.14) for the ICE for income, 3.14 (95% CI 2.47, 3.99) for poverty, 2.90 (95% CI 2.21, 3.81) for the ICE for race/ethnicity, and only 0.93 (95% CI 0.79, 1.11) for the Index of Dissimilarity; in models that included both census tract and city/town ICE measures, this risk ratio for the ICE for racialized economic segregation was higher at the census tract (3.29; 95% CI 2.43, 4.46) vs. city/town level (1.61; 95% CI 1.12, 2.32). These results suggest that, at least in the case of fatal and non-fatal assaults, research on residential segregation should employ local measures, including of racialized economic segregation, to avoid underestimating the adverse impact of segregation on health. [ABSTRACT FROM AUTHOR]

Background Growing spatial social and economic polarisation may be an important societal determinant of health, but only a few studies have used the recently developed Index of Concentration at the Extremes (ICE) to analyse the impact of joint concentrations of privilege and privation on health outcomes. We explore use of the ICE to investigate risk of hypertension in an urban, multiracial/ethnic, and predominantly working-class study population of US adults. Methods We generated novel ICE measures at the census tract level that jointly assess extreme concentrations of both income and racial/ethnic composition. We then linked the ICE measures to data from two observational, cross-sectional studies conducted in the Boston metropolitan area (2003-2004; 2008-2010; N=2145). Results The ICE measure for extreme concentrations of white compared with black residents was independently associated with lower odds of hypertension (OR=0.76; 95% CI 0.62 to 0.93), controlling for race/ethnicity, age, gender, smoking, body mass index, household income, education and self-reported exposure to racial discrimination. Even stronger associations were observed for the ICE measures that compared concentrations of high-income white residents versus low-income residents of colour (OR=0.61; 95% CI 0.40 to 0.96) and high-income white versus low-income black residents (OR=0.48; 95% CI 0.29 to 0.81). Conclusions Results suggest public health studies should explore the joint impact of racial/ethnic and economic spatial polarisation on population health. [ABSTRACT FROM AUTHOR]

Objectives: To assess the validity of demographic data reported in news media-based data sets for persons killed by police in Massachusetts (2004-2016) and to evaluate misclassification of these deaths in vital statistics mortality data. Methods: We identified 84 deaths resulting from police intervention in 4 news media-based data sources (WGBH News, Fatal Encounters, The Guardian, and The Washington Post) and, via record linkage, conducted matched-pair analyses with the Massachusetts mortality data. Results: Compared with death certificates, there was near-perfect correlation for age in all sources (Pearson r > 0.99) and perfect concordance for gender. Agreement for race/ethnicity ranged from perfect (The Counted and The Washington Post) to high (Fatal Encounters Cohen's κ = 0.92). Among the 78 decedents for whom finalized International Classification of Diseases, 10th Revision (ICD-10), codes were available, 59 (75.6%) were properly classified as "deaths due to legal intervention". Conclusions: In Massachusetts, the 4 media-based sources on persons killed by police provide valid demographic data. Misclassification of deaths due to legal intervention in the mortality data does, however, remain a problem. Replication of the study in other states and nationally is warranted. [ABSTRACT FROM AUTHOR]

Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes-health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background-as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings. [ABSTRACT FROM AUTHOR]

Background Few studies have simultaneously included exposure information on occupational hazards, relationship hazards (eg, intimate partner violence) and social hazards (eg, poverty and racial discrimination), especially among low-income multiracial/ethnic populations. Methods A cross-sectional study (2003-2004) of 1202 workers employed at 14 worksites in the greater Boston area of Massachusetts investigated the independent and joint association of occupational, social and relationship hazards with psychological distress (K6 scale). Results Among this low-income cohort (45% were below the US poverty line), exposure to occupational, social and relationship hazards, per the 'inverse hazard law,' was high: 82% exposed to at least one occupational hazard, 79% to at least one social hazard, and 32% of men and 34% of women, respectively, stated they had been the perpetrator or target of intimate partner violence (IPV). Fully 15.4% had clinically significant psychological distress scores (K6 score ≥13). All three types of hazards, and also poverty, were independently associated with increased risk of psychological distress. In models including all three hazards, however, significant associations with psychological distress occurred among men and women for workplace abuse and high exposure to racial discrimination only; among men, for IPV; and among women, for high exposure to occupational hazards, poverty and smoking. Conclusions Reckoning with the joint and embodied reality of diverse types of hazards involving how people live and work is necessary for understanding determinants of health status. [ABSTRACT FROM AUTHOR]

We compared all-cause mortality rates stratified by individual-level education and by census tract area-based socioeconomic measures for Massachusetts (1999-2001). Among persons aged 25 and older, the age-adjusted relative index of inequality was slightly higher for the census tract than for the individual education measures (1.5 vs 1.2, respectively). Only the census tract socioeconomic measures could provide a relative index of inequality (2-3) for deaths before age 25 or detect expected socioeconomic disparities for deaths among persons 65 and older (relative index of inequality = approximately 1.2 vs 0.8 for census tract measures and individual education, respectively). [ABSTRACT FROM AUTHOR]

Objectives. We analyzed neighborhood heterogeneity in associations among mortality, race/ethnicity, and area poverty. Methods. We performed a multilevel statistical analysis of Massachusetts all-cause mortality data for the period 1989 through 1991 (n = 142836 deaths), modeled as 79813 cells (deaths and denominators cross-tabulated by age, gender, and race/ethnicity) at level 1 nested within 5532 block groups at level 2 within 1307 census tracts (CTs) at level 3. We also characterized CTs by percentage of the population living below poverty level. Results. Neighborhood variation in mortality across CTs and block groups was not accounted for by these areas' age, gender, and racial/ethnic composition. Neighborhood variation in mortality was much greater for the Black population than for the White population, largely because of CT-level variation in poverty rates. Conclusions. Neighborhood heterogeneity in the relationship between mortality and race/ethnicity in Massachusetts is statistically significant and is closely related to CT-level variation in poverty. (Am J Public Health. 2005;95:260-265.). [ABSTRACT FROM AUTHOR]

Study objective: To investigate of the extent to which violence over the life course accelerates the onset of perimenopause, as measured by menstrual changes. Design: Prospective cohort study. Setting: Boston, Massachusetts. Participants: 603 premenopausal women aged 36-45 years at baseline who completed a cross sectional survey on childhood and adult violence history. Main outcome measure: Time to perimenopause, defined as time in months from baseline interview to a woman's report of (1) an absolute change of at least seven days in menstrual cycle length from baseline or subjective report of menstrual irregularity; (2) a change in menstrual flow amount or duration; or (3) cessation of periods for at least three months, whichever came first. Main results: Experience of abuse was associated with delayed onset of menstrual changes indicative of onset of perimenopause. Women reporting childhood or adolescent abuse entered perimenopause about 35% slower than women who reported no abuse (IRRadj = 0.65, 95% CI 0.45 to 0.95) after adjusting for age, age at menarche, ever live birth, ability to maintain living standard, smoking, BMI, and depression. There was a similar association among women who reported first abuse during adulthood (IRRadj =0.72, 95% CI 0.28 to 1.80). These findings persisted when the cohort was restricted to non-depressed women (childhood/adolescent IRRadj =0.57, 95% Cl 0.36 to 0.90; adulthood IRRadj = 0.63, 95% Cl 0.23 to 1.77). Conclusions: This study is the first longitudinal analysis of the timing of perimenopause to show an association with a history of physical or sexual abuse. Further study of the relation between violence and reproductive aging is needed. [ABSTRACT FROM AUTHOR]

Chronic psychological stress may raise the risk of preterm delivery by raising levels of placental corticotropin-releasing hormone (CRH). Women who have been the targets of racism or personal violence may be at particularly high risk of preterm delivery. The aims of this study are to examine the extent to which: (1) maternal experiences of racism or violence in childhood, adulthood, or pregnancy are associated with the risk of preterm birth; (2) CRH levels are prospectively associated with risk of preterm birth; and (3) CRH levels are associated with past and current maternal experiences of racism or violence. We have begun to examine these questions among women enrolled in Project Viva, a Boston-based longitudinal study of 6000 pregnant women and their children. [ABSTRACT FROM AUTHOR]

Suggestions that more men than women are dying from COVID-19 have appeared in scientific journals[1] and newspapers.[[2]] To our knowledge, however, no comparisons have been made of relative or absolute mortality differences between women and men. Both matter: a small relative increase in rates applied to a high baseline rate can lead to the same excess counts of deaths as a large relative increase applied to a lower baseline rate. Notably, the sharp rise in excess mortality observed during the first 2 weeks of April, 2020, was similar for women and men (appendix), whereby the age-standardised rate ratio for 2020 versus 2015-19 equalled 1-48 (95% CI 1-13-1-94) for women and 1-55 (1-19-2-03) for men. [Extracted from the article]

Background: Scant research has analyzed contemporary US cancer incidence rates in relation to historical redlining (ie, 1930s US federally imposed residential segregation), implemented via the color-coded federal Home Owners' Loan Corporation (HOLC) maps., Methods: We analyzed Massachusetts Cancer Registry data for all patients with primary invasive breast cancer (BC) diagnosed in 2005-2015 among women in the 28 Massachusetts municipalities with digitized 1930s HOLC maps. Multilevel Poisson regression estimated BC incidence rate ratios (IRR), overall and by tumor estrogen receptor (ER-positive, ER-negative) and progesterone receptor (PR-positive, PR-negative) status, in relation to HOLC grade and contemporary census tract (CT) social characteristics., Results: Net of age and racialized group, the extremes of BC incidence were detected by combinations of HOLC grade and contemporary CT racialized economic segregation. Compared with CTs with the best HOLC grade (A + B) and most privileged contemporary characteristics (T1), for all, ER-positive and PR-positive BC, incidence was highest in T1 and mixed HOLC grade CTs (eg, IRRER+; Mixed-T1 = 1.10, 95% confidence interval [CI] = 1.01 to 1.21) and lowest in CTs with most concentrated racialized economic deprivation (T3) and no HOLC grade (eg, IRRER+; No Grade-T3 = 0.85, 95% CI = 0.75 to 0.95). For ER-negative and PR-negative BC, incidence was highest in CTs with the most contemporary deprivation, but the best HOLC grade (eg, IRRER-; A+B-T3 = 1.27, 95% CI = 0.93 to 1.75) and lowest in T1 and worst HOLC-graded CTs (eg, IRRER-; D-T1 = 0.84, 95% CI = 0.56 to 1.25)., Conclusion: Breast cancer risk may be shaped by combined histories of redlining and present-day CT characteristics., (© The Author(s) 2022. Published by Oxford University Press.)

Objectives. To investigate how census tract (CT) estimates of mortality rates and inequities are affected by (1) differential privacy (DP), whereby the public decennial census (DC) data are injected with statistical "noise" to protect individual privacy, and (2) uncertainty arising from the small number of different persons surveyed each year in a given CT for the American Community Survey (ACS). Methods. We compared estimates of the 2008-2012 average annual premature mortality rate (death before age 65 years) in Massachusetts using CT data from the 2010 DC, 2010 DC with DP, and 2008-2012 ACS 5-year estimate data. Results. For these 3 denominator sources, the age-standardized premature mortality rates (per 100 000) for the total population respectively equaled 166.4 (95% confidence interval [CI] = 162.2, 170.6), 166.4 (95% CI = 162.2, 170.6), and 166.3 (95% CI = 162.1, 170.5), and inequities in the range from best to worst quintile for CT racialized economic segregation were from 103.4 to 260.1, 102.9 to 258.7, and 102.8 to 262.4. Similarity of results across CT denominator sources held for analyses stratified by gender and race/ethnicity. Conclusions. Estimates of health inequities at the CT level may not be affected by use of 2020 DP data and uncertainty in the ACS data.

Objective: To examine the association of maternal lifetime experiences of racial discrimination with infant sleep duration over the first 2 years of life., Design: Prebirth cohort study., Setting: Massachusetts, USA (baseline: 1999-2002)., Participants: 552 mother-infant dyads in Project Viva, for whom the mother self-identified as being a woman of color., Measurements: During pregnancy, mothers completed the Experiences of Discrimination survey that measured lifetime experiences of racial discrimination in eight domains. The main outcome was a weighted average of their infants' 24-hour sleep duration from 6 months to 2 years., Results: 30% reported 0 domains of racial discrimination, 35% 1-2 domains, and 34% ≥3 domains. Any racial discrimination (≥1 vs. 0 domains) was higher among black (80%) versus Hispanic (58%) or Asian (53%) mothers and the United States versus foreign-born mothers (79% vs. 58%) and was associated with higher mean prepregnancy BMI (26.8 vs. 24.5 kg/m 2 ). Children whose mothers reported ≥3 domains versus 0 domains had shorter sleep duration from 6 months to 2 years in unadjusted analysis (β -18.6 min/d; 95% CI -37.3, 0.0), which was attenuated after adjusting for maternal race/ethnicity and nativity (-13.6 min/d; -33.7, 6.5). We found stronger associations of racial discrimination with offspring sleep at 6 months (-49.3 min/d; -85.3, -13.2) than for sleep at 1 year (-13.5 min/d; -47.2, 20.3) or 2 years (4.2 min/d; -21.5, 29.9)., Conclusions: Maternal lifetime experiences of racial discrimination was associated with shorter offspring sleep duration at 6 months, but not with infant's sleep at 1 and 2 years of age., (Copyright © 2020 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the association between self-reported racial discrimination and prenatal depressive symptoms among black women., Methods: Our study population consisted of two cohorts of pregnant women: the Asthma Coalition on Community, Environment, and Social Stress project (ACCESS) and Project Viva. We measured self-reported racial discrimination among black women using a modified Experiences of Discrimination scale (score 0-8). We assessed elevated depressive symptoms (EDS) with the Edinburgh Postnatal Depression Scale (≥13 on a 0-30 scale)., Results: Fifty-four percent of ACCESS and 78% of Viva participants reported experiencing racial discrimination. After adjusting for age, marital status, income, education, and nativity, a 1-U increment in Experiences of Discrimination score was associated with 48% increased odds of EDS (odds ratio, 1.48; 95% confidence interval, 1.24-1.76) for ACCESS participants but was not significantly associated among Viva participants (odds ratio, 1.12; 95% confidence interval, 0.92-1.37). In both cohorts, responding to unfair treatment by talking to others was associated with the lowest odds of EDS., Conclusions: Our findings suggest that higher levels of perceived racial discrimination may increase depressive symptoms during pregnancy among U.S. black women. Interventions involving talking to others may aid in reducing the risk of depressive symptoms among black women experiencing higher levels of racial discrimination., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Most occupational studies evaluate a single exposure in relation to a particular disease. However, workers typically experience multiple exposures simultaneously. There is also increasing evidence of disparities in health by sociodemographic characteristics, mostly related to social position such as gender, race/ethnicity, immigration status, income, and education. Little information exists on the worker experience of multiple occupational exposures as they vary among social groups. The objectives of this article were to: assess the burden of exposures reported within 1 year by a socially diverse population working in a range of industries; and evaluate whether sociodemographic characteristics affected the patterns of these exposures., Methods: Study participants were from 14 unionized worksites in meat processing, electrical lighting manufacturing, retail grocery stores, and school bus driving. A cross-sectional study design used a self-administered, computer-assisted questionnaire (English and Spanish) to assess sociodemographic characteristics and nine workplace exposures, within the past year. An interviewer-administered job history also was collected., Results: Twelve hundred eighty-two workers (72%) completed the survey: 36% women, 23% Latino, 39% black, 24% white, and 48% born outside the US. The prevalence of high exposures ranged from 21% (chemicals) to 39% (neck strain). Forty-six percent reported three or more high exposures. Exposure reporting varied among sociodemographic groups. Some of the disparities were explained by the jobs held by different groups, but after statistically controlling for job, many disparities remained., Conclusions: Sociodemographic characteristics should be considered when conducting exposure assessments using questionnaires. More research is needed to understand how social characteristics may influence exposures.

Objective: We tested the hypothesis that the US socioeconomic gradient in breast cancer incidence is declining, with the decline most pronounced among racial/ethnic groups with the highest incidence rates., Methods: We geocoded the invasive incident breast cancer cases for three US population-based cancer registries covering: Los Angeles County, CA (1978-1982, 1988-1992, 1998-2002; n = 68,762 cases), the San Francisco Bay Area, CA (1978-1982, 1988-1992, 1998-2002; n = 37,210 cases) and Massachusetts (1988-1992, 1998-2002; n = 48,111 cases), linked the records to census tract area-based socioeconomic measures, and, for each socioeconomic stratum, computed average annual breast cancer incidence rates for the 5-year period straddling the 1980, 1990, and 2000 census, overall and by race/ethnicity and gender., Results: Our findings indicate that the socioeconomic gradient in breast cancer incidence is: (a) relatively small (at most 1.2) and stable among US white non-Hispanic and black women; (b) sharper and generally increasing among Hispanic and Asian and Pacific Islander American women; and (c) cannot be meaningfully analyzed without considering effect modification by race/ethnicity and immigration., Conclusion: Our results indicate that secular changes in US socioeconomic gradients in breast cancer incidence exist and vary by race/ethnicity.

Introduction: Few papers address the methodological challenges in recruiting participants for studies of cancer prevention interventions designed for multiracial and multiethnic working-class populations. This paper reports the results of the sample selection and survey methods for two group-randomized intervention studies., Methods: The two group-randomized intervention studies, Healthy Directions-Small Business (HD-SB) and Healthy Directions-Health Centers (HD-HC), included a worksite-based study in 26 small manufacturing businesses and a study in 10 outpatient health centers. We used selection and recruitment methods to obtain a multiracial and multiethnic working-class study sample. In 2000 and 2001, we assessed baseline measures of sociodemographic characteristics and behavioral outcomes by self-report. We then computed intraclass correlation coefficients (ICCs)., Results: Of the 1740 participants in the HD-SB study, 68% were non-Hispanic whites, and 76% had working-class occupations. In the HD-HC study, 59% of 2219 participants were non-Hispanic whites. Among those who worked, 51% had working-class occupations. Large percentages of both samples reported not meeting recommended guidelines for the target behaviors. For example, 86% of members of both samples consumed fewer than the recommended five servings of fruits and vegetables per day. The ICCs for the four target behaviors in HD-SB were between 0.006 and 0.02. In the HD-HC study, the ICCs ranged from 0.0004 to 0.003., Conclusion: The two studies were successful in recruiting multiracial and multiethnic working-class participants. Researchers will find the estimates of the primary outcomes and their ICCs useful for planning future studies.

Objectives: We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States., Methods: We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island., Results: For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead., Conclusions: Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.

Use of multilevel frameworks and area-based socioeconomic measures (ABSMs) for public health monitoring can potentially overcome the absence of socioeconomic data in most US public health surveillance systems. To assess whether ABSMs can meaningfully be used for diverse race/ethnicity-gender groups, we geocoded and linked public health surveillance data from Massachusetts and Rhode Island to 1990 block group, tract, and zip code ABSMs. Outcomes comprised death, birth, cancer incidence, tuberculosis, sexually transmitted infections, childhood lead poisoning, and nonfatal weapons-related injuries. Among White, Black, and Hispanic women and men, measures of economic deprivation (e.g., percentage below poverty) were most sensitive to expected socioeconomic gradients in health, with the most consistent results and maximal geocoding linkage evident for tract-level analyses.

Objectives: To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States., Methods: Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6016425) or Rhode Island (RI; 1990 population = 1003464) for: STIs (MA: 1994-1998, n = 26535 chlamydia, 7464 gonorrhea, 2619 syphilis; RI: 1994-1996, n = 4473 chlamydia, 1256 gonorrhea, 305 syphilis); TB (MA: 1993-1998, n = 1793; RI: 1985-1994, n = 576), and non-fatal weapons related injuries (MA: 1995-1997, n = 6628)., Results: Analyses indicated that: (a). block group and tract socioeconomic measures performed similarly within and across both states, with results more variable for the ZIP Code level measures; (b). measures of economic deprivation consistently detected the steepest socioeconomic gradients, considered across all outcomes (incidence rate ratios on the order of 10 or higher for syphilis, gonorrhea, and non-fatal intentional weapons-related injuries, and 7 or higher for chlamydia and TB); and (c). results were similar for categories generated by quintiles and by a priori categorical cut-points., Conclusions: Supplementing U.S. public health surveillance systems with census tract or block group area-based socioeconomic measures of economic deprivation could greatly enhance monitoring and analysis of social inequalities in health in the United States.