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Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals' personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

As they are a long-term policy instrument, the results of many child savings account (CSA) programs take decades to realize. Because of this, important questions regarding the long-term impacts of the programs, as well as participants' perceptions regarding the programs' long-term impacts, are unanswered. In this study, we present findings from a qualitatively driven complex mixed methods follow-up of the first large CSA demonstration project, the quasi-experimental Michigan Saving for Education, Entrepreneurship, and Downpayment (SEED) program. We asked SEED account-holding and non-account-holding families how they communicated about college, saving for college, and future educational attainment, nearly ten years after the CSA demonstration project ended. In a novel approach, we conducted separate semi-structured interviews with dyads of parents and children, combining that information with survey data and account balance monitoring data, ultimately gaining a multidimensional picture of how families with and without SEED accounts were approaching planning for post-secondary education right before the transition to adulthood. We found that: (1) the vast majority of account-holding families did not make withdrawals from their SEED accounts, (2) recent family communication about the SEED accounts was related to the specificity of a child's post-secondary plans, (3) there were tensions between college aspirations and the concrete steps needed to get there, and (4) families voiced concerns regarding the substantial barriers to post-secondary education. These findings point to both the promises and challenges of CSAs that newly developed programs might want to consider., Competing Interests: Declaration of Interests None.

Purpose: To examine whether perceived safety modified the effectiveness of the Walk Your Heart to Health (WYHH) intervention in promoting physical activity and reducing central adiposity in predominantly non-Latino black (henceforth black) and Latino communities., Design: Generalized estimation equations were used to assess modifying effects of perceived safety on the route and perceived neighborhood safety on (1) WYHH participation at 8 weeks and 32 weeks, (2) associations between participation and physical activity, and (3) associations between physical activity and central adiposity., Setting: Community-based and faith-based organizations in black and Latino communities., Participants: There were 603 adults, aged 18 years and older, who were predominantly black, Latino, and female., Measures: Participation and physical activity (piezoelectric pedometer) were measured at each walking session. Perceived safety on the route (questionnaire), perceived neighborhood safety (questionnaire), and waist circumference were measured at baseline, 8 weeks, and 32 weeks., Analysis: Secondary analysis of repeated measures using generalized estimation equations., Results: Retention was 90% at 8 weeks and 64% at 32 weeks. Perceived safety on the route, but not perceived neighborhood safety, dampened participation at 8 weeks but not 32 weeks. Consistent participation in the intervention increased physical activity and reduced central adiposity irrespective of perceived safety on the walking route or perceived neighborhood safety., Conclusion: Efforts to improve safety in conjunction with interventions focused on increasing physical activity can work toward improving physical activity for blacks and Latinos, leading to a myriad of improved health outcomes including reduced central adiposity.

This study examines the independent effects of neighbourhood context (i.e. neighbourhood poverty) and exposure to perceived discrimination in shaping risk of obesity over time. Weighted three-level hierarchical linear regression models for a continuous outcome were used to assess the independent effects of neighbourhood poverty and perceived discrimination on obesity over time in a sample of 157 non-Hispanic Black, non-Hispanic White and Hispanic adults in Detroit, USA, in 2002/2003 and 2007/2008. Independent associations were found between neighbourhood poverty and perceived discrimination with central adiposity over time. Residents of neighbourhoods with high concentrations of poverty were more likely to show increases in central adiposity compared with those in neighbourhoods with lower concentrations of poverty. In models adjusted for BMI, neighbourhood poverty at baseline was associated with a greater change in central adiposity among participants who lived in neighbourhoods in the second (B=3.79, p=0.025) and third (B=3.73, p=0.024) poverty quartiles, compared with those in the lowest poverty neighbourhoods. The results from models that included both neighbourhood poverty and perceived discrimination showed that both were associated with increased risk of increased central adiposity over time. Residents of neighbourhoods in the second (B=9.58, p<0.001), third (B=8.25, p=0.004) and fourth (B=7.66, p=0.030) quartiles of poverty were more likely to show greater increases in central adiposity over time, compared with those in the lowest poverty quartile, with mean discrimination at baseline independently and positively associated with increases in central adiposity over time (B=2.36, p=0.020). The results suggest that neighbourhood poverty and perceived discrimination are independently associated with a heightened risk of increase in central adiposity over time. Efforts to address persistent disparities in central adiposity in the USA should include strategies to reduce high concentrations of neighbourhood poverty as well as discrimination.

Historically, patients on extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome have received ventilatory "lung rest" with conventional or high-frequency oscillating ventilators. We present a series of adults treated with high-frequency percussive ventilation (HFPV) to enhance recovery and recruitment during ECMO. Adult respiratory patients, treated between January 2009 and December 2012 were cared for with a combination of standard ECMO practices and a protocol of recruitment strategies, including HFPV. Data are reported as mean ± standard error of the mean, percentage, or median. Comparisons are made by χ for categorical variables and by t-test and Mann-Whitney test for continuous variables. Significance is noted at the 95% confidence level (p < 0.05). There were 39 HFPV patients. They were 39.9 ± 2.2 years of age and had 3.0 ± 0.37 days of mechanical ventilation before the initiation of ECMO. Their pre-ECMO PaO2 to FiO2 ratio (PF ratio) was 52.3 ± 3.0 and their pCO2 was 50.22 ± 2.4. HFPV patients required a mean of 143.1 ± 17.6 hours and a median of 106 hours (range 45.75-350.25) of ECMO support and had a 62% survival to discharge. The post-ECMO PF ratio in the HFPV cohort was 301.8 ± 16.7. A protocolized practice of active recruitment that includes HFPV is associated with reduced duration of ECMO support in adults with respiratory failure.

For poor families, the possession of assets--savings accounts, homes, and the like--has the potential not only to relieve some of the stress of living in poverty but also to make a better future seem like a real possibility. If children in families that own certain assets fare better than children in families without them, then helping poor families build those assets would be an effective strategy for two-generation programs. Indeed, write Michal Grinstein-Weiss, Trina Williams Shanks, and Sondra Beverly, plenty of evidence shows that assets are connected to positive outcomes for poor children. For example, young people who have any college savings at all, even a very small amount, are more likely to go to college; children in households with assets score higher on standardized achievement tests; and children of homeowners experience fewer behavioral problems. But this evidence comes from longitudinal data sets and is therefore correlational. Looking for causal relationships, the authors examine the results of experimental programs that opened various types of savings accounts for poor people and matched their contributions. Several of these trials included a control group that did not receive a savings account, making it possible to attribute any positive outcomes directly to the savings accounts rather than to their owners' personal characteristics. These programs dispelled the myth that poor people can't save; participants were generally able to accumulate savings. It's too early to tell, however, whether assets and asset-building programs have long-term effects on children's wellbeing, though one experiment found positive impacts on disadvantaged children's social-emotional development at age four. The most promising programs share several features: they are opened early in life; they are opened automatically, with no action required from the recipients; and they come with an initial deposit.

Background: Patients with severe H1N1 pneumonia created a sudden demand for extracorporeal membrane oxygenation (ECMO) capacity. In a single referral center, the established procedures, protocols, and staff of the Level I trauma service were adapted to help manage this nontrauma critical care crisis., Methods: When airway pressure release ventilation and high-frequency oscillator ventilation failed, we used standard ECMO circuits and the VDR-4 critical care ventilator. We cannulated patients percutaneously in the intensive care unit and transported them on ECMO. Trauma service resources included a mobile surgical transport team, direct to OR resuscitations, massive transfusion protocols, trauma performance improvement processes, trauma resuscitation nurses, in-house attending doctors, and experienced staff familiar with protocol-driven care., Results: During an 84-day period, 15 patients with severe H1N1 pneumonia were treated with ECMO. All patients were referred; 10 were transported on ECMO. Patients were aged 34.4 ± 4.1 years (6-58 years); 47% were male, and they had been ventilated 3.5 ± 0.8 days. Pre-ECMO PaO2/FIO2 ratios were 62.3 ± 6.1; ECMO duration was 9.4 ± 1.3 days for survivors; and post-ECMO PaO2/FIO2 ratio was 295.0 ± 35.1. Recovery occurred in 67% and 60% survived to discharge. No patient died of lung failure. Surviving patients were discharged at their neurologic baseline., Conclusion: H1N1 created a severe public health challenge for referral centers with ECMO capability. The resources of our trauma service were adapted to this nontrauma critical care crisis without disruption of other hospital services. These H1N1 patients treated with ECMO had a 67% recovery rate and a 60% survival rate. All survivors were discharged to home., Level of Evidence: Therapeutic/epidemiologic study, level V.

Background: The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center., Methods: Patients with refractory hypoxic ARDS received ECMO until they recovered lung function or demonstrated futility. ECMO was initiated at the referring facility if necessary, and aggressive critical care was maintained throughout., Results: ARDS due to multiple etiologies was managed with ECMO in 36 adults. The pre-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 48.3 ± 2.2. Regional facilities referred 89% of these patients, and 69% required ECMO for transport. The mean duration of ECMO was 7.1 ± .9 days for survivors, and the mean post-ECMO ratio of partial pressure of oxygen to fraction of inspired oxygen was 281.2 ± 11. ECMO was successfully weaned in 67% of patients, and 60% survived to discharge., Conclusions: ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate., (Copyright © 2013 Elsevier Inc. All rights reserved.)

This study examines whether there is a significant relationship between homeownership and engaged parenting practices among low- and moderate-income households. Using analytic methods which account for selection effects and clustering, we test whether homeownership can act as a protective factor against parental disengagement from children. Controlling for individual characteristics, analyses demonstrate that homeowners are more likely than renters to demonstrate engaged parenting behaviors such as organizing structured activities for their children. While renters are more likely to read to their children, the children of homeowners spend less time watching television and playing video games. Implications for low-income housing policy are discussed in light of these findings.