A Wilderness of Waves: Harry Dean, Rural Life, and 1920s Black Maritime Travel Writing

Temporal Trends in Rural vs Urban Sepsis-Related Mortality in the United States, 2010-2019

African Vernacular Symbols of Black Intersex Children in Sinethemba Ngubane's Installations (2007-2016)

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S. Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35-84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years. From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar. Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).

Over the course of the past half century, policing in the United States has gone from an institution in deep crisis and a flashpoint in the country’s culture wars to a widely admired example of innovative, bipartisan reform—and then back again. In the late 1960s and early 1970s, police forces were overwhelmingly white, male, and politically reactionary. Liberals saw the police as racist, violent, and ineffective and blamed them, with justification, for the hundreds of riots that convulsed American cities under Presidents Lyndon Johnson and Richard Nixon. At the same time, conservatives rallied around the police as symbols of “law and order”—the cause that, more than any other, won Nixon the White House in 1968.1 By the late 1990s, however, the police had become far more diverse and far less insular, and new approaches to law enforcement, especially “community policing” and “problem-oriented policing,” had won remarkably broad respect across lines of race, class, and ideology.2 Enthusiasts of “new governance” regularly pointed to police departments as models of the kind of pragmatic reform other public sectors could profitably emulate.3 The pitched battles over the police in the Johnson and Nixon years, the jeering of officers as “pigs,” and the strident calls to “support your local police” felt increasingly remote.Then all the progress seemed to disappear. President Donald Trump resurrected “law and order” as a partisan rallying cry, championed the most violent and aggressive forms of policing, and allied himself with officers more loudly and divisively than Nixon ever had. In the summer of 2020, when tens of millions of protesters marched across the United States and riots broke out in a series of cities, the motivating grievances were about the police, and especially about the large number of young Black men killed by law enforcement officers. For many on the left, reforming the police no longer seemed possible; they wanted to abolish the police or least to slash their budgets.4 Americans on the right, meanwhile, increasingly saw attacks on law enforcement as attacks on them and on their idea of what the country should be.5 The calls in 2020 to “defund the police” were blamed, in 2021, for rising homicide rates across the United States, for spates of robberies and car thefts in some cities, and—by moderate Democrats—for off-year electoral losses to Republicans.6 Law enforcement is again a political battleground, not just dividing Democrats from Republicans but pitting progressives against moderates, young against old, and marginalized community against marginalized community.7 Once again, the police are in crisis, and once again they seem part of the reason the country is in crisis. The recent history of policing is a tale of reversals and upended expectations.In other ways, as well, the enterprise of policing is marked by contradictions. This is especially true of the deep and complicated connections between policing and equality. Public law enforcement agencies are inherently redistributionist, socializing the use of force, but ever since the birth of modern policing in London in the late nineteenth century, officers have protected the privileged against the “dangerous classes,” and American policing in particular has long and continuing connections with racial subordination. People of color in the United States are more likely than whites to be victims of crime and more likely to be victims of police violence and abuse; they suffer from both police nonfeasance and police malfeasance. Inadequate protection against crime is among the most damaging forms of racial inequality in the United States, but so is the appallingly large number of young people of color, particularly African Americans, killed every year by the police.Charting a new course for public safety thus means confronting paradoxes and trade-offs. It requires accepting necessary compromises while rejecting those that have been tolerated for lack of imagination. It also means confronting two different social divides. The first is the ideological divide, the growing chasm between left and right that today, as half a century ago, has made policing a partisan flashpoint. The second divide is sociological: the gulf separating privileged Americans from the poor people and people of color who disproportionately bear the burdens of both crime and abusive forms of policing. Each of these two divides has implications for police reform. The ideological divide places a premium on proposals that can gain broad, cross-partisan support. The sociological divide provides reason to give special weight to the interests and views of poor people and people of color, especially African Americans.8Although police reform was never as successful as it was said to be in the 1980s and 1990s, neither was it a dead end. There are ways to make policing fairer, more effective, less abusive, and less lethal by building on successes of past reforms while addressing their very real shortcomings. Fortunately, moreover, the proposals most likely to work are supported by Americans on both sides of the ideological divide and by a majority of the groups most affected by crime and by abusive policing.How can American policing be transformed into a more effective and egalitarian system of public safety? We need to start with four key facts. First, crime has devastating, disproportionate impacts on poor people and people of color, especially Black Americans. Second, police violence and other forms of abusive law enforcement also take a tragic and outsize toll on poor people and people of color, and here, too, Black Americans are particularly likely to be victimized. Third, improved policing has helped make crime far less common today than thirty or forty years ago, but some of the progress has been lost in recent years. Fourth, there have been successes over the past several decades in reforming police departments, but the victories have been partial and very often fleeting.Fear of crime is often whipped up for partisan purposes, but the damage that crime inflicts on victims, as well as on their families and communities, is real and massive. Criminal victimization is also regressive, falling most heavily on those who are already disadvantaged. All of this is particularly true of the most extreme forms of violence—homicide, aggravated assault, and rape—which can fairly be called epidemic in the United States and which victimize African Americans, along with their families and neighborhoods, at greatly elevated rates.There are between fifteen thousand and twenty thousand homicides annually in the United States—a rate of about five or six per one hundred thousand people in the country. Among Black Americans, though, the rate is much higher. African Americans die violently at seven times the rate of whites; for men the ratio is nine to one. Homicide is the third-leading cause of death among Americans aged fifteen to thirty-four; it is the leading cause of death among Black males under forty-five and the second-leading cause of death among Latino males under forty-five. Young Black men are fifteen times more likely than their white counterparts to be the victims of homicide. Violence is responsible for more lost years of Black male lives than cancer, stroke, and diabetes combined. Meanwhile more than a million Americans are hospitalized each year from attacks that do not turn out to be fatal, and African Americans are more likely than whites to be the victims of these attacks, too. Black people are also disproportionately represented among the several hundred thousand victims of rape each year in the United States.9The failure to protect African Americans and other marginalized populations from crime is among the starkest and most damaging forms of racial inequality in the United States. No other wealthy country tolerates such extreme racial disparities in the risks of violent victimization.10Moreover, beyond the lives that it cuts short, homicide and other forms of extreme violence can have tragic consequences for the families of victims and for the neighborhoods where it occurs. High rates of violence make fear a constant presence in people’s lives, affecting the material conditions of their daily existence in countless ways. It turns heat waves more deadly, for example, by making people afraid to leave their homes. Children living in neighborhoods with high rates of violence perform worse in school, reinforcing the cycle of disadvantage that keep families locked in intergenerational poverty. This is not just a matter of correlation: Black schoolchildren do dramatically worse on standardized tests in the days immediately after a local homicide than in the days just before. Exposure to lethal violence makes it hard for them to concentrate, and the effects appear to accumulate with each additional killing. Crime, especially homicide and other serious forms of violence, also depress property values, helping to maintain the gaping disparities between the household wealth of Americans of different races and robbing local governments of tax revenues, which in turn makes it harder for them to confront not only violence but virtually every other challenge they face. For communities as well as for individuals, exposure to criminal victimization, and in particular to homicide and serious assault, is a pillar of American inequality.11Much of the explanation for the racial disparities in rates of criminal victimization in the United States lies outside the criminal justice system: in the pervasive, interlocking disadvantages imposed on people of color, especially on African Americans. Discrimination perpetuates poverty, and poverty breeds crime, making potential offenders more desperate and potential victims more vulnerable.12 But part of the explanation is inadequate policing, and more precisely the long history of police departments protecting white, wealthy neighborhoods more than poor neighborhoods disproportionately populated by people of color.13If poor people and people of color in the United States have long suffered from inadequate protection against crime, they have also suffered from an excess of violence and abuse at the hands of the police. Police officers kill roughly a thousand Americans every year. Somewhere between half and eighty percent of the deaths, probably, are unjustified.14 And the victims of police killings are disproportionately people of color, with young Black people men especially at risk. Black Americans are fourteen percent of the population but more than a quarter of the people shot dead by the police.15 From 1980 through 2019, on an age-adjusted basis, Black people were more than three times as likely to be killed by the police as whites; Latinos were close to twice as likely.16 Between 2015 and 2019, an unarmed Black man was four times as likely to be fatally shot by the police as an unarmed white man.17 For Black and white males between the ages of twenty and twenty-four, the ratio was five to one.18Deaths at the hands of law enforcement officers are the most extreme way, but far from the only way, in which the burdens of policing fall disproportionately on African Americans and other people of color. People of color, especially young Black men, are more likely to be stopped by the police. When they are stopped, they are less likely to be treated with respect, more likely to grabbed or struck, more likely to be searched, and more likely to be arrested.19The harsh, often brutal treatment of African Americans and other people of color by police has ramifications far beyond the deaths, physical injuries, and indignities it inflicts. Stops and arrests are entry points into the carceral system. Excessively aggressive, discriminatory policing helps to sustain jail and prison populations that are bloated and racially lopsided. And the interactions that people have with the police reverberate through their communities, with lasting effects not just on attitudes toward law enforcement but on broader ideas about law, government, and society.20 Unsurprisingly, African Americans consistently report less confidence in the police than whites.21 But mistreatment by the police often leads, also, to an enervating sense of disempowerment—a sense of physical vulnerability, lack of belonging, and alienation—not just in the immediate victim of the mistreatment but in friends, family, and neighbors as well.22The damage that American policing does to people of color and their communities has received more attention over the past three decades for several reasons. Part of the explanation is changes in law enforcement: the expansion of police forces since the 1980s; more aggressive use of stop-and-frisk; crackdowns on low-level, quality-of-life offenses; and the spread of militarized equipment and tactics, including through the proliferation and increased use of SWAT teams.23 Increased public awareness of police violence has also played a role; the key contributors here have been the Black Lives Matter movement and the advent of smartphones and social media.24 But some part of the reason that police violence and its disproportionate use against people of color has loomed larger may also be a success to which law enforcement agencies themselves contributed: the dramatic, transformational decline of crime in the 1990s. As threats of private violence became less omnipresent in poor neighborhoods of color, threats of police violence—which had always been there, in the background—became more jarringly inexcusable.25As devastating a toll as crime now takes in the United States, it did far more damage thirty years ago. Between the early 1990s and the turn of the millennium, the national homicide rate dropped by roughly forty percent, and the decline was even larger in the neighborhoods and demographic groups hardest hit by crime. The rates of other crimes saw similar drops.26 The sociologist Patrick Sharkey notes that for Black men, the homicide drop was the largest public health achievement of the past several decades, shrinking the racial disparity in life expectancy and preserving roughly one thousand years of life for every one hundred thousand Black men. Sharkey has also documented the ways in which the decline of crime changed the fabric of life in poor neighborhoods, allowing public spaces to be reclaimed and alleviating the constant, debilitating fear of violent attack. Combined with changes in law enforcement, the crime decline of the 1990s altered the nature of the physical insecurity experienced in poor communities of color, particularly by young people, “from the threat of violent peers to the threat of abusive police.”27The plummeting crime rates of the 1990s were followed by more modest reductions in homicides and aggravated assaults in the early years of the twenty-first century. Homicide rates began to rise, though, around 2014, and then surged in cities across the country during the COVID-19 pandemic of 2020 and 2021.28 Some major American cities recorded more homicides in 2021 than in any prior year.29 And just as the crime decline in the 1990s was particularly pronounced in poor neighborhoods and predominantly Black neighborhoods, fatal shootings have risen most dramatically in recent years in those same neighborhoods.30 In Los Angeles, for example, Black Americans are nine percent of the population but constituted thirty-six percent of homicide victims in 2021; in New York City, the figures are twenty-four percent and sixty-five percent, respectively.31 Rates of other violent crimes do not appear to have risen as much as homicides, and the nationwide homicide rate in 2020 and 2021 remained well below its peak in the 1980s. Still, a significant amount of the progress made in reducing fatal attacks in the 1990s and early 2000s seems to have slipped away, at least temporarily and possibly for longer. Just as there was nothing unavoidable about the high crime rates of the 1980s, there is no guarantee those rates will not return.The causes of the crime drop in the 1990s are still debated, and so are the explanations for the rising homicide rates of the past several years. Some of the credit for the crime drop, though, almost certainly should go to improvements in policing: either to the expansion of police forces in the 1990s, or to changes in how the police operated, or most likely to both factors. The evidence is threefold. First, a growing body of research links increased police presence to decreases in crime, especially homicides. Some of this research examines the effects of changes in the size of local police forces; others look at the effects of temporary surges in police presence because of, for example, terrorist alerts.32 Second, the crime drop during the 1990s was roughly twice as large in New York City as elsewhere in the country, and the most plausible explanation for the difference is the especially large changes in the quantity of and quality of policing in New York City during that period.33 Third, there is strong evidence for the effectiveness of particular police strategies that became more widespread in the 1990s, especially tactics that focus on areas where a large number of crimes take place and other examples of “problem-oriented policing.”34American law enforcement didn’t just get better at controlling crime in the last decades of the twentieth century. It also improved in other ways, albeit unevenly, and too often transiently. At the beginning of the 1970s, for example, police departments in the United States were overwhelmingly white and overwhelmingly male. Many departments, particularly in big cities, grew more diverse in the 1980s and 1990s, often through hiring plans adopted in response to lawsuits. By the early 2000s, some large police forces were majority minority—this was true, for example, in Los Angeles, Detroit, and Washington, D.C.—and the percentage of female officers had grown as well. Smaller departments made less progress, though. Moreover, as court-ordered hiring plans have expired over the past twenty years, diversification has stalled even in larger departments, and some past gains have been undone.35Diversifying law enforcement agencies is not a panacea—there are no panaceas in police reform—but accumulating research suggests that minority and female officers are less likely to use unjustified force, especially against people of color.36 White male officers partnered with minority or female officers also change their patterns of policing for the better. And diverse departments are less insular, more open to outside ideas, and better connected to the communities they serve, all of which makes them more likely to adopt other reforms.37One particular way in which police diversity has facilitated other reforms is by countering the strident hostility of police unions toward efforts to reduce police violence, increase police and racial in law Police unions are not always of but even today they do more to than to for making law enforcement fairer, more effective, and less reason for that is that the of police unions and than police officers of Black and Latino officers have often championed reforms by police and the presence of officers of color may in some have police unions to moderate their most of those reforms over the past half century have been community policing and policing, both of which spread widely in the 1980s and 1990s, as and just as every police in the country to “community policing,” in part because it became a for At its though, community policing was more than a It was a of law enforcement from a and toward a that on and with the public and with other policing had major some of which will be And because community policing was with of it was hard to It though, because it often greatly increased public with the police and made people fear of crime to real reductions in when people felt they out and and to become with more people most community policing also police departments, and it focus beyond crime allowing them to a of other by the communities they It well with policing, which called on officers to work and on an basis, with other agencies and the public to of particular local but not policing to responsible for a disproportionate amount of but not the were officers. community policing, the focus on to and a body of evidence these with significant crime there are that and other forms of policing have helped some cities the national and reduce homicides in community policing and policing also increased attention to low-level, of such as and the Part of the idea was that when these of were left neighborhoods toward people on the and rates of serious this was the of Police on quality-of-life could be too, and the that these were in effective at reducing serious crime, but not as dramatically as policing and only when the community and particular in particular crackdowns on quality-of-life as community policing and policing, did not reduce the other of the from quality-of-life policing, policing the of in which the police with community groups and other agencies to particular groups of people responsible for a disproportionate of a first and most of which was in the 1980s and called because their most was often threats of consequences at the and groups violence in a particular But the also of social to the same people, and more recent of this more than policing. is growing that these when right, their moreover, community policing and policing their in poor were and not just because they were of from of officers in neighborhoods hit hardest by crime. policing and policing police to adopt what the had called the of law kind of policing in to from the of law enforcement in had called the which and the which when community policing and policing were to against life they on the In community policing and policing officers to for neighborhoods to a of other than law enforcement: and so that they had not up to be social but it out they often were at other agencies to more attention to marginalized several different community policing and policing have lost much of their over the past two The terrorist attacks of to calls for more aggressive forms of law enforcement, and and local in the early 2000s many departments to community policing and policing as forms of these the crackdowns on and in New York City, helped to community against them in many against the of police And it became increasingly that, even at their community policing and policing had some was that these attention to police This was not in the of either of could have with the public and agencies outside law enforcement to reduce police But they Police the of police violence, especially police because they did not the of the This was because the victims were of marginalized groups and or because did not still does on police killings or other forms of police violence, and the advent of body and of these were to It those and the Black Lives Matter movement to give the of police killings the attention it had long lethal police violence against Black Americans and Latinos has over the past half century. for the of the victims, the of killed by a police in the United States during the 1980s, and the drop was particularly Black Americans and The decline in police killings over the course of that to have been to new the use of lethal against In the three decades, in the age-adjusted rate of police killings of Black Americans and Latinos remained roughly constant while the rate for white Americans as a the age-adjusted for Americans also In some though, rates to From through 2019, police killings in areas and but by thirty percent in the thirty largest American cities, because of new on use of violence in some cities has dropped especially In Los Angeles, for example, significant of by the police appear to have been in half between and 2019, and police shootings appear to have by forty by officers increased in 2021 but remained far than in past In on the other of by the police have dropped by percent over the past fifteen years, but the rate of police shootings has not a similar Police shootings in between and in and again in and and then dropped over the several years, by to roughly the Los and have been of efforts at police reform over the past two decades, so the of by police in these cities over the past are in some reductions in of in both cities and significant reductions in police shootings in Los but in others progress on police shootings in also the in patterns of police violence, as in crime across the United States. The Police by the and the number of of per thousand arrests for hundreds of American police departments from to the from fifteen to the United States as a had New York rate of police almost Americans have been killed by the police in had New York homicide people have violently that same Police can and have but the victories have been and often

Rural-Urban Differences in Mortality From Ischemic Heart Disease, Heart Failure, and Stroke in the United States.

Purpose: The purpose of the study was to analyze the differences in colorectal cancer (CRC) incidence trends by gender, race and geographical location in Arkansas and to compare the trends with national data. Methods: We looked at 10 year data for colorectal cancer incidence and mortality between 1998-2002 and 2003-2007 (AR Cancer Registry from AR Department of Health) and also analyzed data from Surveillance Epidemiology and End Results (SEER) program of the National Cancer Institute. All figures are age-adjusted for 2000 U.S. Standard Million Population and reported as per 100,000 population. Results: There has been a decline in incidence of CRC for both U.S. and AR data between 1998-2002 and 2003-2007 for all races and for whites, though the incidence has increased for black males (BM) and black females (BF) in AR. Mortality has decreased for all gender and all race for both U.S. and AR. There has been a decrease for both incidence and mortality for the total population and for Whites in Arkansas. There has been a decrease in both incidence and mortality among white males and females in both rural and urban regions of the state. However, the incidence of both invasive and all CRC has increased for BM and BF (increase in rural and decrease in urban areas). The incidence of all CRC in blacks has increased from 59.6 to 62.5. For BM, the increase in incidence has been from 69.8 to 73.1 (decline in urban areas from 77.2 to 67.5 but an increase in rural areas from 62.4 to 79.1). For BF, the increase in incidence has been from 52.9 to 55.1 (again a decrease in urban areas from 61.6 to 54.7 and an increase in rural areas from 44.6 to 55.8). Mortality among blacks has decreased from 29.4 to 28.8, among BM from 35.6 to 34.9, and among BF 25.4 to 24.6. However, there has been a increase in mortality among BM in rural areas from 34.6 to 36.8, and among urban BF from 23.2 to 25.8. Conclusion: There is a disproportionately higher incidence and mortality among blacks compared with whites in both U.S. and AR. In AR, rural blacks have the highest incidence and mortality. Rural areas may have limited access to basic health care resources (less providers, greater poverty, poor literacy) and disease management is typically given priority over preventive health care. However, even in rural areas, there is a huge disparity in CRC incidence and mortality among whites and blacks. Cultural beliefs (where colonoscopy is often considered a violation of self), and personal beliefs that women are not affected may be stronger in rural blacks. Even among blacks, the disparities in rural and urban areas suggest that factors other than biology may be playing a greater role in colorectal cancer racial disparity.

Race, socioeconomic status associated with lower SGLT2 inhibitor use

Excerpt of the content: Jewish activist communities have historically been allies to communities of color in the fight for racial justice and equality in our country. Jews were among those who worked to establish the NAACP in 1909. In the early 1900s, Jewish newspapers drew parallels between the Black movement out of the South and the Jews' escape from Egypt, pointing out that both Blacks and Jews lived in ghettos, and calling anti-Black riots in the South "pogroms." Historically, Jewish leaders stressed the similarities rather than the differences between the Jewish and Black experience in America, and emphasized the idea that both groups would benefit the more America moved toward a society of merit, free of religious, ethnic, and racial restrictions. In more recent history, Blacks and Jews fought side by side in the Civil Rights Movement. The kinship and relationship between the Reverend Dr. Martin Luther King and Rabbi Abraham Joshua Heschel has been regularly and continually celebrated. What has been less often discussed is the relevance of the social circumstances that created and, in some cases, still sustains a rift between Black activists and white Jewish anti-racism activists. In the late 1960s, the birth of the Black Power movement shifted the emphasis in Black activist communities toward self-determination, self-defense tactics, and racial pride. While this shift was crucial to the evolution of Black consciousness and identity in America, the expansion from the singular nonviolence and racial integration approach espoused by King left many white Jewish activists with little input in the Black community and an anti-racism movement that seemed to be moving on without them. Click for larger view "Blacks and Jews fought side by side in the Civil Rights Movement," the author writes. Here, Dr. Martin Luther King Jr. and Rev. Fred Shuttlesworth march alongside Rabbi Abraham Joshua Heschel from Selma to Montgomery, Alabama, in March 1965. Since the 1960s, efforts at coalition building and solidarity work for justice between white Jewish and Black communities have suffered and never reached the pinnacle that was reached during the early days of the Civil Rights Movement. The rapid decline of American anti-Semitism since 1945 (alongside the nation's continuing and pervasive anti-Black racism) and the increasing gap in accumulated wealth and education between Black and Jewish communities have widened the rift of perceived shared interests between Black and Jewish activists. Many of the civil rights struggles that joined Blacks and Jews in the middle of the last century--i.e., anti-lynching, desegregation, voter registration, etc.--were typically organized around divisions in society that easily identified injustices between persecutors and their victims (a division in which Jews could also identify as victims). Between the late 1960s and the present, much of the anti-racism work that has galvanized Black activists has shifted and come to be concerned more specifically with disparities in access, privilege, and power between those with and without white skin privilege in our country. Click for larger view Members of Beyt Tikkun Synagogue pray alongside Rev. Dr. J. Alfred Smith Jr. of Allen Temple Baptist Church in Oakland, California, after the acquittal of Trayvon Martin's killer. Disappointingly few synagogues nationwide engaged in similar expressions of Jewish-Black solidarity. A Weakened Coalition In 2013, the lack of deep and abiding connections between Black and Jewish communities of activists became apparent to me in the disparate responses I encountered to the events surrounding the killing of Trayvon Martin and the subsequent acquittal of George Zimmerman. Here's a quick summary for any readers who need a reminder of what happened: in July 2013, after more than sixteen hours of deliberation, a jury of five white women and one Latina woman found George Zimmerman not guilty of second-degree murder and manslaughter. Previously, on a drizzly February night, Zimmerman had shot Martin, an unarmed seventeen-year-old, in a gated community in Sanford, near Orlando. Citing Florida's stand-your-ground law, Sanford police originally did not charge Zimmerman or take him into custody. Only after social media outrage and civil rights protests alleged racial profiling and discrimination did Governor Rick Scott appoint a special prosecutor, who brought the charges against Zimmerman six weeks after... Language: en

BackgroundTaiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan.MethodsBased on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women.ResultsAfter NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas.ConclusionWe concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities.

During 2018, Black or African American (Black) persons accounted for 43% of all diagnoses of human immunodeficiency virus (HIV) infection in the United States (1). Among Black persons with diagnosed HIV infection in 41 states and the District of Columbia for whom complete laboratory reporting* was available, the percentages of Black persons linked to care within 1 month of diagnosis (77.1%) and with viral suppression within 6 months of diagnosis (62.9%) during 2018 were lower than the Ending the HIV Epidemic initiative objectives of 95% for linkage to care and viral suppression goals (2). Access to HIV-related care and treatment services varies by residence area (3-5). Identifying urban-rural differences in HIV care outcomes is crucial for addressing HIV-related disparities among Black persons with HIV infection. CDC used National HIV Surveillance System† (NHSS) data to describe HIV care outcomes among Black persons with diagnosed HIV infection during 2018 by population area of residence§ (area). During 2018, Black persons in rural areas received a higher percentage of late-stage diagnoses (25.2%) than did those in urban (21.9%) and metropolitan (19.0%) areas. Linkage to care within 1 month of diagnosis was similar across all areas, whereas viral suppression within 6 months of diagnosis was highest in metropolitan areas (63.8%). The Ending the HIV Epidemic initiative supports scalable, coordinated, and innovative efforts to increase HIV diagnosis, treatment, and prevention among populations disproportionately affected by or who are at higher risk for HIV infection (6), especially during syndemics (e.g. with coronavirus disease 2019).

Traffic accidents scar Latin America's roads

2020 Rise to the challenge

Guest Editors’ Introduction: Opening Conversations that Matter in Public Music Studies

Malignant transformation of the prostate and progression of carcinoma appear to be the consequence of a complex series of initiation and promotional events under genetic and environmental influences. Increased incidence of the condition may be the result of improved detection, greater awareness of the condition, and possibly an increased life expectancy accompanied by a decrease in competing causes of death rather than a true increase in the prevalence of the disease. The marked racial and geographic differences are probably multifactorial, with genetic, environmental, and possibly social influences affecting progression of the disease. Among several risk factors, evidence for the familial inheritance of some prostate cancers is compelling. Dietary influences, hormonal milieu, and the role of environmental carcinogens are currently under intense investigation. As further risk factors are identified, it will become increasingly important to identify individuals at increased risk for the disease. These men should undergo regular evaluation with state-of-the-art methods.