Black Residents Research Articles

Black insurgent aesthetics and the public imaginary

ABSTRACT This article analyzes the spontaneous production of graffiti art and murals covering the entrances of businesses in the central business district of Oakland, CA, in the wake of the global protest movements, in 2020, against state violence and systemic racism. I argue that the art made legible what gets hidden through the violent processes of gentrification, neoliberal urbanism, and displacement/dispossession. The paper rethinks what borders, policing, and reclamation mean in a time of economic instability and a global health crisis, through the placement of these vernacular expressions in Downtown Oakland. What is revealed through the art is the convergence of two co-constitutive publics – a segregated, decaying city mostly inhabited by poor and working-class Black and Latinx residents and laborers, and a modern, prosperous, neoliberal city that caters to a privileged class of white residents and tourists – especially as the city grappled with the management and regulation of public space in the midst of a global pandemic. The article thus theorizes public space as layered and always contested, and not simply a space of conflict but also collective engagement.

Is spatial mismatch really spatial, and really a mismatch? Recent evidence on employment among Hispanic and Black people in the U.S.

ABSTRACT In 1968, John Kain hypothesized that Black residential suburbanization had not accompanied suburbanizing jobs, leading to poor employment outcomes for young Black men. This paper reinvestigates spatial mismatch in the 2000s and 2010s, focusing on differences between urban and suburban White, Black, and Hispanic residents of the U.S. We find some evidence for spatial mismatch when pooling data across all years, and stronger evidence for mismatch among Black people than among Hispanic people. First, both urban Black and Hispanic people earn lower wages than equivalent suburbanites, all else equal. Second, urban Black people have a higher probability of un- and under-employment relative to their suburban counterparts. Third, Black and Hispanic people have longer commutes than equivalent Whites do, but suburban residence mitigates this effect. Yet we also find evidence that in recent years, spatial mismatch may not be as serious a problem as many people believe. For example, the wage premium for suburban people—White, Black, and Hispanic—has fallen. Further, urban Hispanic people are not more likely to be unemployed than equivalent suburbanites. Finally, urban and suburban Black and Hispanic people do not work in different types of occupations, so location is not associated with suburbanites of color holding more or less “desirable” jobs.

Recasting the Global South

Recasting the Global South

A New Scale for Global History

A New Scale for Global History

AUTHOR REPLY

We thankDr. Schafer and Dr. Sundi for contributing to this timely discussion of the social and biological determinants of health disparities. As we hope to highlight, metastatic bladder cancer-specific survival has disparate outcomes between gender, race, and socioeconomic status. Given the high mortality and low overall survival of metastatic bladder cancer, this space has significant potential for improvement in care by targeting interventions for Black women and residents of high poverty areas.

Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States.

To estimate the number and geographic distribution of children and adolescents in the United States who reside in counties with neither child and adolescent psychiatrists nor sufficient Internet broadband to support telepsychiatry services. This analysis combined data from the Health Resources and Services Administration's Area Health Resource Files on child psychiatrist workforce with Federal Communications Commission information on broadband coverage to generate a composite of in-person and digital access to child psychiatric services throughout the United States. Using multivariable fixed-effects Poisson regression analysis, we estimated the number of children and adolescents (aged 5-19 years) without access to psychiatric services and examined disparities across counties in the United States. We estimate that 6,035,402 children and adolescents in the United States (approximately 10%) have inadequate in-person and digital availability of child psychiatric services within their counties. Although this was true for only 3% of children and adolescents in urban counties, this applied to more than half (51%) in rural counties (adjusted odds ratio [AOR]= 2.71; 95% CI= 1.94, 3.78; p< .001). Likewise, only 3% of children and adolescents in high-income counties had insufficient digital and physical access, compared to more than 4 in 10 children and adolescents (41%) in low-income counties (AOR= 0.43; 95% CI= 0.30-0.61; p< .001). Counties with a higher density of Black and Hispanic residents had greater likelihood of service availability (p< 0.001), potentially a function of living in metropolitan communities. Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.

Reliability and Validity of the Cornell Scale for Depression in Dementia and Invariance Between Black Versus White Residents in Nursing Homes.

The purpose of this study was to expand on prior work testing invariance on several depression measures in community-based older adults and explore the psychometric properties and evidence of invariance between racial groups based on the Cornell Scale for Depression in Dementia. This was a descriptive measurement study. This was a secondary data analysis using baseline data from 2 studies: Testing the Implementation of the Evidence Integration Triangle for Behavioral and Psychological Symptoms Associated with Dementia and the study Testing the Impact of Function and Behavior Focused Care for Nursing Home Residents with Dementia. Combined, 67 nursing homes participated from 2 states and 889 residents were recruited. The mean age of the participants was 86.58 (SD 10.31) and most were women (72%) and White (70%). This was a descriptive study, and a Rasch analysis was done to establish reliability based on internal consistency and evidence of differential item functioning (DIF) across races. Validity was based on item fit and model testing with structural equation modeling to compare models between White and Black participants. There was evidence of internal consistency (alpha coefficient of 0.98) and no significant evidence of DIF. The item related to suicide had a high logit and did not significantly load onto the measurement model for Black individuals. There was not a good spread of the items across the concept of depression. The model had a better fit with the items when used with White versus Black participants. The findings indicate that it would be helpful to add some additional items that reflect depressive symptoms among this population. Further, the findings serve as a reminder that this measure may be biased toward identification of symptoms of depression among White versus Black residents.

The Cuban Revolution Comes to America

The Cuban Revolution Comes to America

Association of Residential Racial and Ethnic Segregation With Legal Intervention Injuries in California

The continued harm of Black individuals in the US by law enforcement officers calls for reform of both law enforcement officers and structural racism embedded in communities. To examine the association between county characteristics and racial and ethnic disparities in legal intervention injuries. This retrospective, cross-sectional study was conducted among 27 671 patients presenting to California hospitals from January 1, 2016, to December 31, 2019, with legal intervention injuries (defined as any injury sustained as a result of an encounter with any law enforcement officer) as identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Legal intervention injuries were classified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision external cause of injury code Y35. Expected injury counts were calculated for each county by multiplying statewide median rates of injury per capita for each age-racial and ethnic group, and then observed to expected injury ratios were measured. The association between county injury ratio, percentage of Black individuals, and residential segregation (measured using an index of dissimilarity) was modeled, stratifying by race and ethnicity. A total of 27 671 patients (24 159 male patients [87.3%]; 1734 Asian and Pacific Islander [6.3%], 5049 Black [18.2%], 11 250 Hispanic [40.7%], and 9638 White [34.8%]; mean [SD] age, 34.2 [12.5] years) presented with legal intervention injuries in California from 2016 to 2019. Observed to expected injury ratios ranged from 0 to 7 for Black residents and from 0 to 5 for White residents. High observed to expected injury ratios for Black residents (408 observed vs 60 expected; ratio = 7) were clustered around San Francisco Bay Area counties and corresponded with a higher proportion of Black residents. High observed to expected injury ratios for White residents (57 observed vs 11 expected; ratio = 5) clustered around rural northern California counties and corresponded with higher mean percentage of residents with income below the federal poverty level and fewer urban areas. This study suggests that residential segregation may be associated with increased legal intervention injury rates for Black residents of California counties with a large percentage of Black residents. Reform efforts to address racial and ethnic disparities in these injuries should carefully consider and address the legacy of discriminatory policies that has led to segregated communities in California and the United States.

Heirs Property, Critical Race Theory, and Reparations☆

AbstractWe use critical race theory (CRT) to examine the involuntary loss of land and homes among Black residents of the southeastern United States and in particular among the Gullah/Geechee. An Afro‐indigenous population, the Gullah/Geechee have deep roots in the federally designated Gullah/Geechee Cultural Heritage Corridor, an area of sea islands and coastal Lowcountry within 25 coastal counties in North and South Carolina, Georgia, and Florida. We identify legal vulnerabilities associated with heirs property, in particular tax sales and predatory partition actions, as mechanisms used within the legal system to dispossess owners of their land. Our use of CRT allows us to understand heirs property as a legacy of the Jim Crow era and to recognize material motivations behind continued racial discrimination that has led to involuntary land loss. CRT also leads us to consider the question of empowerment of the Gullah/Geechee population through a program of reparations for wrongful taking of land and homes since coastal development began roughly 70 years ago. One possible mechanism for reparations is to increase existing lodging taxes on coastal tourism along the Gullah/Geechee coast.

Understanding the Experiences of Black Women Medical Students and Residents: A Narrative Review.

BackgroundFew research studies examine medical students and residents with intersectional identities. In the emerging literature, data on Black women's experiences may be misrepresented and misinterpreted as studies aggregate data for women, students of color, and Black/African American men. As such, these studies do not account for the nuanced experiences of gendered racism that Black women students and residents may encounter during their medical education.MethodsUsing Crenshaw's intersectionality as an analytical tool, we conducted a narrative review to highlight how Black women medical students and residents are rendered invisible in the current literature on medical education.ResultsThe results generated 13 citations specifically discussing Black women medical students and residents, with only six studies being empirical research.ConclusionWe conclude that 13 articles is inadequate for understanding the experiences of these populations. Without centering Black women or using an intersectional lens, researchers could invalidate the lived experiences of this population and create barriers to the political resources Black women learners need to be successful. Moreover, the lack of intention behind addressing the needs of Black women can be viewed as complicity in the oppressive structures that serve to subjugate them.

Local Prohibitions on Marijuana: Factors Associated With Bans on Medical and Recreational Businesses

Marijuana legalization in U.S. states has introduced new regulatory processes, which allow for some degree of local authority. A common provision in state laws has provided a local option, which enables municipalities to prohibit commercial cannabis facilities within their borders. This paper examined potential determinants of prohibition decisions, with an emphasis on community and local government characteristics. Using a multivariate logistic regression model, determinants of local decisions to prohibit cannabis businesses in Michigan were analyzed. A unique feature of Michigan’s approach to legalization included separate local options to opt into medical marijuana and opt out of recreational marijuana. The results found that both community and local government characteristics explain variation in prohibitions on marijuana businesses. In general, local governments were more tolerant of marijuana businesses in areas with lower densities of senior citizens and higher densities of Black residents. However, the effects of some determinants varied based on whether the decision was to allow medical or recreational marijuana. Higher income areas were more likely to opt out of recreational marijuana, but they were no different from other areas on the likelihood of opting into medical marijuana. Prohibition decisions also were affected by local government characteristics, such as the number of members on city council, female representation, and having a council-manager form of government.

Client Racial Composition in First-Episode Psychosis Programs Compared With Compositions in Program Service Areas.

The authors examined the extent to which clients served by first-episode psychosis programs reflected the racial composition of the surrounding service area and, to the extent that they did not, explored possible explanatory factors. As part of a national study of coordinated specialty care (CSC) sites in the United States, 35 programs documented race for 772 clients. Programs identified a geographic service area for their clients. Using Census data, the authors identified the proportion of clients in this service area who were Black and then examined the extent of disproportionality, calculated as a risk ratio and as a relative difference in racial composition between CSC programs and their service areas. Overall, 71% of CSC programs had a disproportionately greater proportion of Black clients than Black residents within the service area. This disproportionality was still evident after conducting sensitivity analyses that included adjusting for sampling error in the service area population estimates; however, smaller study sites displayed greater fluctuations in disproportionality in the sensitivity analyses. Using data from diverse CSC programs, the authors illustrate that the odds of Blacks receiving services through a CSC program are much higher than would be expected on the basis of the population living in the area being served by the program. Multiple reasons may explain this finding, but in the absence of clear explanatory factors, this result may be ripe for discussion and further investigation.

A Spatiotemporal Analysis of the Association of California City and County Cannabis Policies with Cannabis Outlet Densities.

Background:Cannabis outlets may affect health and health disparities. Local governments can regulate outlets, but little is known about the effectiveness of local policies in limiting outlet densities and discouraging disproportionate placement of outlets in vulnerable neighborhoods.Methods:For 241 localities in California, we measured seven policies pertaining to density or location of recreational cannabis outlets. We geocoded outlets using web-scraped data from the online finder Weedmaps between 2018 and 2020. We applied Bayesian spatiotemporal models to evaluate associations of local cannabis policies with Census block group-level outlet counts, accounting for confounders and spatial autocorrelation. We assessed whether associations differed by block group median income or racial–ethnic composition.Results:Seventy-six percent of localities banned recreational cannabis outlets. Bans were associated with fewer outlets, particularly in block groups with higher median income, fewer Hispanic residents, and more White and Asian residents. Outlets were disproportionately located in block groups with lower median income [posterior RR (95% credible interval): 0.76 (0.70, 0.82) per $10,000], more Hispanic residents [1.05 (1.02, 1.09) per 5%], and fewer Black residents [0.91 (0.83, 0.98) per 5%]. For the six policies in jurisdictions permitting outlets, two policies were associated with fewer outlets and two with more; two policy associations were uninformative. For these policies, we observed no consistent heterogeneity in associations by median income or racial–ethnic composition.Conclusions:Some local cannabis policies in California are associated with lower cannabis outlet densities, but are unlikely to deter disproportionate placement of outlets in racial–ethnic minority and low-income neighborhoods.

Differences in incident and recurrent myocardial infarction among White and Black individuals aged 35 to 84: Findings from the ARIC community surveillance study

No previous study has examined racial differences in recurrent acute myocardial infarction (AMI) in a community population. We aimed to examine racial differences in recurrent AMI risk, along with first AMI risk in a community population. The community surveillance of the Atherosclerosis Risk in Communities Study (2005-2014) included 470,000 people 35 to 84 years old in 4 U.S. communities. Hospitalizations for recurrent and first AMI were identified from ICD-9-CM discharge codes. Poisson regression models were used to compare recurrent and first AMI risk ratios between Black and White residents. Recurrent and first AMI risk per 1,000 persons were 8.8 (95% CI, 8.3-9.2) and 20.7 (95% CI, 20.0-21.4) in Black men, 6.8 (95% CI, 6.5-7.0) and 14.1 (95% CI, 13.8-14.5) in White men, 5.3 (95% CI, 5.0-5.7) and 16.2 (95% CI, 15.6-16.8) in Black women, and 3.1 (95% CI, 3.0-3.3) and 8.8 (95% CI, 8.6-9.0) in White women, respectively. The age-adjusted risk ratios (RR) of recurrent AMI were higher in Black men vs White men (RR, 1.58 95% CI, 1.30-1.92) and Black women vs White women (RR, 2.09 95% CI, 1.64-2.66). The corresponding RRs were slightly lower for first AMI: Black men vs White men, RR, 1.49 (95% CI, 1.30-1.71) and Black women vs White women, RR, 1.65 (95% CI, 1.42-1.92) CONCLUSIONS: Large disparities exist by race for recurrent AMI risk in the community. The magnitude of disparities is stronger for recurrent events than for first events, and particularly among women.

1197-P: The Demographic and Geographic Distribution of Diabetes and Prediabetes Risk in Rural Settings

Introduction: Evaluating diabetes prevalence and prediabetes risk in rural settings can be difficult due to sparse population coverage and limited data. Objective: To evaluate diabetes burden and prediabetes risk in a rural county with documented poor health outcomes. Methods: In 2021, we mailed health surveys to all households in Sullivan County, a rural county with the second-worst health outcomes of all counties in New York State. We included questions on demographics, medical history, and the American Diabetes Association’s Prediabetes Risk Test in our survey. A score of 5 points or higher on this test is considered high risk for having prediabetes. To help mitigate non-response bias, statistical raking was performed using age, sex, race/ethnicity, and health insurance strata. We analyzed diabetes prevalence and prediabetes risk by demographic characteristics. We also used geospatial analysis within the county to assess for clustering of diagnosed diabetes cases and elevated prediabetes risk scores. Results: Of 4,725 survey responses analyzed, the adjusted diabetes prevalence in our sample was 14% compared to the 20BRFSS estimate of 8.6% for Sullivan County. In this rural area, diabetes prevalence was notably higher among non-Hispanic Black (23%) and Hispanic (16%) residents compared to non-Hispanic White (13%) residents. Prediabetes risk scores were elevated among 41% of respondents without a history of diabetes. Nearest neighbor analyses revealed that hotspots of diagnosed diabetes and high prediabetes risk scores were primarily located in more urban areas of this rural county. Conclusion: Our mailed health survey to all residents in Sullivan county demonstrated higher diabetes prevalence compared to modelled BRFSS estimates that are based on a small telephone sample. Our results suggest the need for better diabetes surveillance in rural communities, which may benefit from interventions specifically tailored for improving glycemic control among rural residents. Disclosure D.C.Lee: None. N.A.Mcgraw: None. L.Thorpe: None. C.Quintero arias: None. M.Rony: None. R.Patel: None. E.Jensen: None. R.Petcu: None. D.M.Imas: None. B.Elbel: None. R.Anthopolos: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)

Impact of the COVID-19 pandemic on cardiovascular disease mortality in a major metropolitan area

BackgroundThe mortality from COVID-19 alone cannot account for the impact of the pandemic. Cardiovascular disease (CVD) mortality has increased disproportionately in specific racial/ethnic populations. ObjectiveThis study aimed to characterize how the COVID-19 pandemic impacted the association between CVD mortality and social and demographic factors as characterized by the Social Vulnerability Index (SVI). MethodsMedical Examiner Case Archive of Cook County, Illinois was utilized to identify CVD deaths in 2019 (pre-pandemic) and 2020 (pandemic). Rate ratios (RRs) were used to compare age-adjusted mortality rates (AAMRs). Addresses of deaths were geocoded to Chicago Community Areas. The Spearman's rank correlation coefficient (ρ) test was used to identify the association between SVI and CVD mortality. ResultsAAMRs of CVD deaths significantly increased among non-Hispanic Black individuals (AAMRR, 1.1; 95 % CI, 1.1–1.2) and Hispanic individuals (AAMRR, 1.8; 95 % CI, 1.5–2.1) from 2019 to 2020. Among non-Hispanic White individuals, the AAMR did not significantly increase (AAMRR, 1.0; 95 % CI, 0.9–1.1). A significant positive association was observed between SVI and the percentage of non-Hispanic Black residents (ρ = 0.45; P < 0.05), while the inverse was observed with the percentage of non-Hispanic White residents (ρ = −0.77; P < 0.05). A significant positive association between SVI and CVD mortality rate increased (ρ = 0.24 and 0.28; P < 0.05). ConclusionsSignificant association between SVI and CVD mortality was strengthened from 2019 to 2020, and CVD mortality increased among non-Hispanic Black and Hispanic populations. These findings demonstrate that the COVID-19 pandemic has led to an exacerbation of health inequities among different racial/ethnic populations resulting in increased CVD mortality.

Emergency Medicine Residency Does Not Reduce a Racial Minority-Based Test Performance Gap

BackgroundHealth care inequity is corrected more readily when safe, high-quality care is provided by physicians who reflect the gender, race, and ethnicity of patient communities. It is important to train and evaluate racially diverse physicians involved in residency training. ObjectiveThis study sought to determine any test-taking differences for black Emergency Medicine (EM) residents and whether any such differences would narrow as residency progressed. MethodsThis was an observational, cross-sectional study that reviewed performance (scaled scores) on the American Board of Emergency Medicine (ABEM) In-Training Examination (ITE) for 2018, 2019, and 2020. The study included EM residents in 3-year programs who took the ITE. A linear regression model was used for the variables of race, which included black physicians and white physicians (reference group), and level of training (EM resident year 1 [EM1] as the reference group). ResultsThere were 9591 residents included; 539 were black and 9052 were white. Mean scaled scores were higher as a function of training level. Regression showed a scaled score intercept of 73.51. The ITE score increased for all groups as a function of training level (EM2 β = +5.45, p < 0.0001; EM3 β = +8.09, p < 0.0001). The regression coefficient for black residents was −5.87 (p < 0.0001). There was relative improvement by training level compared with improvement in the reference group, but this difference was not materially or statistically significant. ConclusionIn this study of the ABEM ITE, a test-taking performance gap identified early in residency for black physicians persisted into late residency.

Trouble Every Day

In November and December 1966, the young, predominantly white rock audience on the Sunset Strip in Los Angeles battled police over curfew and loitering laws. Both the Strip’s protesters and their critics associated these “Sunset Strip riots” with the Watts uprising of 1965, when Black residents of South Los Angeles resisted police brutality and economic exploitation. White bohemians claimed solidarity with, or perhaps merely appropriated, the moral imperatives of Black protest, while Black critics argued that the mild oppression faced by white teenagers on the Strip was irrelevant to the serious, systemic abuses inflicted on Black communities such as Watts. Yet the Sunset Strip protests also led white activists to consider questions of privilege and authenticity and to make sincere attempts to support Black movements. Frank Zappa and the Mothers of Invention’s “Trouble Every Day” and “Plastic People,” songs that critically address Watts and the Sunset Strip, respectively, exemplify the complex interplay among political radicalism, racial identity, and musical creativity in the growing counterculture surrounding rock. In the Black Lives Matter era, when many white musicians and their audiences seek to be effective allies in Black struggles, the “Sunset Strip riots” can serve as both inspiration and cautionary tale.

Oral Cholecalciferol Supplementation in Sahara Black People with Chronic Kidney Disease Modulates Cytokine Storm, Oxidative Stress Damage and Athero-Thromboembolic Risk.

The 25-hydroxyvitamin D3 (25OHD3) deficiency in chronic kidney disease (CKD) is associated with immune system dysfunction (pro-inflammatory cytokines storm) through macrophages renal infiltration, oxidative stress (OxS) damage and athero-thromboembolic risk. Conversely, cholecalciferol supplementation (25OHD-S) prevents kidney fibrosis by inhibition of vascular calcification and nephrotic apoptosis (nephrons reduction). The objective of this study was to investigate the pleiotropic effects of 25OHD-S on immunomodulation, antioxidant status and in protecting against thromboembolic events in deficiency CKD Black and White individuals living in the Southern Sahara (SS). The oral 25OHD-S was evaluated in 60,000 IU/month/36 weeks versus in 2000 IU/day/24 weeks in Black (n = 156) and White (n = 150). Total serum vitamin D was determined by liquid chromatography-tandem mass spectrometry. All biomarkers of pro-inflammatory cytokines (PIC) were assessed by ELISA tests. OxS markers were assessed by Randox kits. Homocysteine and lipoproteine (a) were evaluated by biochemical methods as biomarkers of atherothromboembolic risk. All statistical analyses were performed with Student’s t-test and one-way ANOVA. The Pearson test was used to calculate the correlation coefficient. The means will be significantly different at a level of p value < 0.05. Multiple logistic regressions were performed using Epi-info and Statview software. Vitamin D deficiency alters the PIC profile, OxS damage and atherothrombogenic biomarkers in both SS groups in the same manner; however, these disorders are more acute in Black compared to White SS individuals. The results showed that the serum 25OHD3 concentrations became normal (>75 nmol/L or >30 ng/mL) in the two groups. We have shown that the dose and duration of 25OHD-S treatment are not similar in Black SS residents compared to White SS subjects, whilst the same inhabit the south Sahara environment. It appears that a high dose intermittent over a long period (D60: 36 weeks) was more efficient in Black people; while a lower dose for a short time is sufficient (D2: 24 weeks) in their White counterparts. The oral 25OHD-S attenuates PIC overproduction and OxS damage, but does not reduce athero-thromboembolic risk, particularly in Black SS residents.