Black Residents Research Articles

In Their Own Words: Black Farmers In Appalachian Kentucky In The 21st Century

Abstract: Studies of the southern United States have “the potential to renovate geographic knowledge by centering a Black sense of place in research examining race and region” (Bledsoe et. al 7). Appalachia, a region which both overlaps with portions of the South and maintains a separate regional identity, likewise holds this potential to renovate geographic knowledge. A Black sense of place can be centered through examining how narratives that connect food, land, and collective struggle (White xviii) help to “recover, tell, and honor” the stories of Black rural residents (3). In particular, oral history has the power to disrupt dominant narratives (see Johnson; see D. Scott), address regional knowledge gaps through collective memories (see Grim; Brown, Gone ), and seek to understand the lives and experiences of Black rural people and Black rural spaces (see Grim; see Johnson; see D. Scott). In this paper, the author examines twelve oral histories he conducted with Black farmers in central and eastern Kentucky and analyzes how these narratives fit within broader understandings and theorizations of community, identity, agriculture, race, and Appalachia.

"See Detroit Like We Do": White Savior Capitalism and the Myth of Black Obsolescence

Abstract: This essay investigates the phenomenon of wealthy white men who use financial means and power to "revive" Detroit after a perceived "death" through what we call white savior capitalism. This "death," popularized by media portrayals of decline, relies on projecting an image of Detroit, a Black-majority city on stolen Native land, as a vacant, postindustrial "frontier" despite the continued existence and resistance of Black and Indigenous residents. We trace the prehistory of white savior capitalism to the area's eighteenth-century conquest by French settlers, the exclusionary redevelopment policies of Mayor Coleman Young's administration (1974–94), and Detroit's use of federal antipoverty funds and eminent domain to establish a General Motors Plant in the Poletown neighborhood. Finally, we demonstrate how the recent and ongoing "rediscovery" of Detroit by businesspeople such as Dan Gilbert gave rise to white savior capitalism. Parallel to these developments, activist movements in the Black Left have presented alternative solutions and imagined futures that include Black and Native Detroit.

The Role of Neighborhood Air Pollution in Disparate Racial and Ethnic Asthma Acute Care Use.

Rationale: The share of Black or Latinx residents in a census tract remains associated with asthma-related emergency department (ED) visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to the within-city heterogeneity of long-term air pollution exposure remains unclear. Objectives: To investigate the role of intraurban spatial variability of air pollution in asthma acute care use disparity. Methods: An administrative database was used to define census tract population-based incidence rates of asthma-related ED visits. We estimate the associations between census tract incidence rates and 1) average fine and coarse particulate matter, nitrogen dioxide (NO2), and sulfur dioxide (SO2), and 2) racial and ethnic composition using generalized linear models controlling for socioeconomic and housing covariates. We also examine for the attenuation of incidence risk ratios (IRRs) associated with race/ethnicity when controlling for air pollution exposure. Measurements and Main Results: Fine and coarse particulate matter and SO2 are all associated with census tract-level incidence rates of asthma-related ED visits, and multipollutant models show evidence of independent risk associated with coarse particulate matter and SO2. The association between census tract incidence rate and Black resident share (IRR, 1.51 [credible interval (CI), 1.48-1.54]) is attenuated by 24% when accounting for air pollution (IRR, 1.39 [CI, 1.35-1.42]), and the association with Latinx resident share (IRR, 1.11 [CI, 1.09-1.13]) is attenuated by 32% (IRR, 1.08 [CI, 1.06-1.10]). Conclusions: Neighborhood-level rates of asthma acute care use are associated with local air pollution. Controlling for air pollution attenuates associations with census tract racial/ethnic composition, suggesting that intracity variability in air pollution could contribute to neighborhood-to-neighborhood asthma morbidity disparities.

Formaldehyde Exposure Racial Disparities in Southeast Texas.

Formaldehyde (HCHO) exposures during a full year were calculated for different race/ethnicity groups living in Southeast Texas using a chemical transport model tagged to track nine emission categories. Petroleum and industrial emissions were the largest anthropogenic sources of HCHO exposure in Southeast Texas, accounting for 44% of the total HCHO population exposure. Approximately 50% of the HCHO exposures associated with petroleum and industrial sources were directly emitted (primary), while the other 50% formed in the atmosphere (secondary) from precursor emissions of reactive compounds such as ethylene and propylene. Biogenic emissions also formed secondary HCHO that accounted for 11% of the total population-weighted exposure across the study domain. Off-road equipment contributed 3.7% to total population-weighted exposure in Houston, while natural gas combustion contributed 5% in Beaumont. Mobile sources accounted for 3.7% of the total HCHO population exposure, with less than 10% secondary contribution. Exposure disparity patterns changed with the location. Hispanic and Latino residents were exposed to HCHO concentrations +1.75% above average in Houston due to petroleum and industrial sources and natural gas sources. Black and African American residents in Beaumont were exposed to HCHO concentrations +7% above average due to petroleum and industrial sources, off-road equipment, and food cooking. Asian residents in Beaumont were exposed to HCHO concentrations that were +2.5% above average due to HCHO associated with petroleum and industrial sources, off-road vehicles, and food cooking. White residents were exposed to below average HCHO concentrations in all domains because their homes were located further from primary HCHO emission sources. Given the unique features of the exposure disparities in each region, tailored solutions should be developed by local stakeholders. Potential options to consider in the development of those solutions include modifying processes to reduce emissions, installing control equipment to capture emissions, or increasing the distance between industrial sources and residential neighborhoods.

Alabama Black Belt Politics: Promise and Peril, 1890-1935

This thesis examines African Americans in Alabama’s Black Belt—the majority constituent in the region—and their centrality in Republican and Communist Party voter campaigns. The Black Belt, originally named for the geological conditions of the soil, was home to a large enslaved population in the nineteenth century. As African Americans became the largest settled community across the belt’s counties, they were seen as useful constituents, first by Alabama politicians in the early twentieth century, and then, by the Communist Party in the 1930s. Both hoped to mobilize African American voters to bolster support for their own parties. These instances reflect a consistent trend of disregarding Black Belt residents as independent political actors. This thesis shows that despite earlier failures by the Republican Party to politically incorporate African Americans, the Communist Party would later create a mutually beneficial relationship. African Americans worked within the party to advocate for their own needs. This self-advocacy by African Americans is often overlooked in regional histories of the area. 

Belonging in Surgery: A Validated Instrument and Single Institutional Pilot.

The aim of this study was to develop and validate an instrument to measure Belonging in Surgery among surgical residents. Belonging is the essential human need to maintain meaningful relationships and connections to one's community. Increased belongingness is associated with better well-being, job performance, and motivation to learn. However, no tools exist to measure belonging among surgical trainees. A panel of experts adapted a belonging instrument for use among United States surgery residents. After administration of the 28-item instrument to residents at a single institution, a Cronbach alpha was calculated to measure internal consistency, and exploratory principal component analyses were performed. Multiple iterations of analyses with successively smaller item samples suggested the instrument could be shortened. The expert panel was reconvened to shorten the instrument. Descriptive statistics measured demographic factors associated with Belonging in Surgery. The overall response rate was 52% (114 responses). The Cronbach alpha among the 28 items was 0.94 (95% CI: 0.93-0.96). The exploratory principal component analyses and subsequent Promax rotation yielded 1 dominant component with an eigenvalue of 12.84 (70% of the variance). The expert panel narrowed the final instrument to 11 items with an overall Cronbach alpha of 0.90 (95% CI: 0.86, 0.92). Belonging in Surgery was significantly associated with race (Black and Asian residents scoring lower than White residents), graduating with one's original intern cohort (residents who graduated with their original class scoring higher than those that did not), and inversely correlated with resident stress level. An instrument to measure Belonging in Surgery was validated among surgical residents. With this instrument, Belonging in Surgery becomes a construct that may be used to investigate surgeon performance and well-being.

Party affiliation and the legacy of HOLC redlining maps

The Home Owners' Loan Corporation (HOLC) redlining maps were formalized in the 1930s to assess lending risks in certain neighborhoods based on their racial or ethnic composition and systematically denied services such as mortgage loans and insurance. Despite the abolishment in the 1960s, many consequences of redlining persist in many American cities today. In this paper, we combine historical HOLC redlining maps and modern-day voter registration data to examine the relationships between redlining and party affiliation in Miami-Dade County, Florida. We use probit regressions to estimate the likelihood of residents’ affiliation with different parties in relation to redlining, controlling for resident characteristics and census block group factors. We find that, after accounting for socio-demographics, residents in historically redlined neighborhoods are more likely to be Democratic voters and less likely to be Republican voters. Additionally, we show that certain resident characteristics contribute to their party affiliation. Specifically, female residents are more likely to be Democratic voters but less likely to be Republican voters. There is also a clear pattern in racial disparities regarding party affiliation. Black residents are more likely to be Democratic voters but less likely to be Republican voters when compared to White residents. Our results highlight future urban planning efforts to prioritize the integration of redlined and non-redlined neighborhoods to avoid political polarization and isolation induced by historical urban policies such as redlining.

Mapping Buprenorphine Access at Philadelphia Pharmacies.

Buprenorphine is not reliably stocked in many pharmacies, and pharmacy-level barriers may deter patients from opioid use disorder care. We surveyed all outpatient pharmacies in Philadelphia to describe variation in buprenorphine access and developed a map application to aid in identifying pharmacies that stock the medication. Using a dataset from the Bureau of Professional and Occupational Affairs, we conducted a telephone survey of operating outpatient pharmacies (N = 422) about their buprenorphine stocking and dispensing practices. We used ArcGIS Pro 3.0.3 to join US Census Bureau ZIP code-level race and ethnicity data, conduct descriptive analyses, and create a map application. We collected data from 351 pharmacies (83% response rate). Two hundred thirty-eight pharmacies (68%) indicated that they regularly stock buprenorphine; 6 (2%) would order it when a prescription is sent. Ninety-one (26%) said that they do not stock or order buprenorphine, and 16 (5%) were unsure. We identified 137 "easier access" pharmacies (39%), meaning they regularly stock buprenorphine, dispense to new patients, and have no dosage maximums. Zip codes with predominantly White residents had a median (interquartile range) of 3 (2-4) "easier access" pharmacies, and those with predominantly Black residents a median (interquartile range) of 2 (1-4.5). Nine zip codes had no "easier access" pharmacies, and 3 had only one; these 3 zip codes are areas with predominantly Black residents. Buprenorphine access is not equitable across Philadelphia and a quarter of pharmacies choose not to carry the medication. Our map application may be used to identify pharmacies in Philadelphia that stock buprenorphine.

A Link Between the George Floyd Incident and De-Policing: Evidence From Police Arrests Across Three Racial and Ethnic Groups

The purpose of this study is to examine the George Floyd effect on depolicing. Police misdemeanor and felony arrests by the Houston Police Department (HPD), with these police actions serve as the primary measures of law enforcement behavior. Specifically, we break down police misdemeanor and felony arrests among Hispanic, Black, and White residents. An Interrupted Time Series Analysis model is used in the analysis. The primary findings suggest that there was an initial steep drop of police arrests immediately after the Floyd incident for both misdemeanor and felony arrests. The long-term effect, however, remains present in only misdemeanant arrests. Police felony arrests went back to pre-incident levels within a short period of time. In addition, it is noted that the pattern of arrests between Blacks and Hispanics is similar. Some policy implications and the limitations of the study are discussed in a concluding section.

Access to housing credit and marriage: evidence from redlining maps

AbstractThis study evaluates the impact of a policy popularly known as “redlining” on marriage. This policy led to the creation of a series of maps that guided banks in their lending, where some areas were favored and others were discriminated against. Given the quasi-randomness of mortgage discrimination, this policy allows us to make inferences regarding whether housing credit constraints affect marriage. Furthermore, it also provides insight into whether unequal access to housing credit played a role in the contemporary racial marriage gap. This policy allows us to make these inferences due to the fact that neighborhood blocks that were more heavily discriminated against had higher proportions of Black residents. The study uses a spatial differences in discontinuities design to show that the maps led to a reduction in marriage in discriminated areas. These effects are shown to not be due to sorting. They can also be ascribed to the housing credit mechanism per se, rather than competing second-order mechanisms that result from individuals being denied mortgages. These second-order effects can include, for instance, neighborhood decline effects found in other redlining work.

Association of Historical Housing Discrimination and Colon Cancer Treatment and Outcomes in the United States.

In the 1930s, the federally sponsored Home Owners' Loan Corporation (HOLC) used racial composition in its assessment of areas worthy of receiving loans. Neighborhoods with large proportions of Black residents were mapped in red (ie, redlining) and flagged as hazardous for mortgage financing. Redlining created a platform for systemic disinvestment in these neighborhoods, leading to barriers in access to resources that persist today. We investigated the association between residing in areas with different HOLC ratings and receipt of quality cancer care and outcomes among individuals diagnosed with colon cancer-a leading cause of cancer deaths amenable to early detection and treatment. Individuals who resided in zip code tabulation areas in 196 cities with HOLC rating and were diagnosed with colon cancer from 2007 to 2017 were identified from the National Cancer Database and assigned a HOLC grade (A, best; B, still desirable; C, definitely declining; and D, hazardous and mapped in red). Multivariable logistic regression models investigated association of area-level HOLC grade and late stage at diagnosis and receipt of guideline-concordant care. The product-limit method evaluated differences in time to adjuvant chemotherapy. Multivariable Cox proportional hazard models investigated differences in overall survival (OS). There were 149,917 patients newly diagnosed with colon cancer with a median age of 68 years. Compared with people living in HOLC A areas, people living in HOLC D areas were more likely to be diagnosed with late-stage disease (adjusted odds ratio, 1.06 [95% CI, 1.00 to 1.12]). In addition, people living in HOLC B, C, and D areas had 8%, 16%, and 24% higher odds of not receiving guideline-concordant care, including lower receipt of surgery, evaluation of ≥12 lymph nodes, and chemotherapy. People residing in HOLC B, C, or D areas also experienced delays in initiation of adjuvant chemotherapy after surgery. People residing in HOLC C (adjusted hazard ratio [aHR], 1.09 [95% CI, 1.05 to 1.13]) and D (aHR, 1.13 [95% CI, 1.09 to 1.18]) areas had worse OS, including 13% and 20% excess risk of death for individuals diagnosed with early- and 6% and 8% for late-stage disease for HOLC C and D, respectively. Historical housing discrimination is associated with worse contemporary access to colon cancer care and outcomes.

Historical Violence and Public Attitudes towards Justice: Evidence from the United States

ABSTRACT This article brings transitional justice scholarship to bear on the case of racial violence in the United States. We investigate how knowledge of racial terror lynchings shapes Black Americans’ support for symbolic and material transitional justice measures. We administer a survey with an embedded experiment to Black residents in Maryland, a US transitional justice pioneer. We provide select respondents with information about historical lynching violence and find that they are more likely to support symbolic transitional justice (e.g., apologies and memorial markers) than individuals presented with information on contemporary police killings. Regarding material transitional justice (e.g., monetary reparations and community projects), we find no significant differences between groups. Linked fate excepted, we do not find that key aspects of Black identity and the Black American experience (i.e., historical knowledge, police contact, church involvement and Black nationalist beliefs) moderate transitional justice attitudes. Our work indicates the promise and limits of information campaigns to mobilize support for transitional justice.

Factors Influencing Customer Participation in a Program to Replace Lead Pipes for Drinking Water.

Many public water systems are struggling to locate and replace lead pipes that distribute drinking water across the United States. This study investigates factors associated with customer participation in a voluntary lead service line (LSL) inspection and replacement program. It also uses quasi-experimental and experimental methods to evaluate the causal impacts of two grant programs that subsidized homeowner replacement costs on LSL program participation. LSLs were more prevalent in areas with a higher concentration of older housing stock, Black and Hispanic residents, renters, and lower property values. Owner-occupied and higher valued properties were more likely to participate in the LSL program. Results from the two grant program evaluations suggest that subsidies for low-income homeowners to cover LSL replacement costs can significantly boost participation, but only when the programs are well publicized and easy to access. Even then, there was still significant non-participation among properties with confirmed LSLs.

Exploring Historical and Contemporary Academic Disparities: A Comparative Study of Black and Non-Black Nova Scotians

In Canada, concerns persist regarding the academic underperformance among historically marginalized racial and ethnic groups. Extensive research has been conducted on the academic achievements of Aboriginal communities, but there’s a noticeable lack of focus on longstanding Afro-descendant populations. Our study aims to address this gap by examining discrepancies in numeracy and overall academic performance, particularly between Black and non-Black residents of Nova Scotia. Utilizing historical census data, we identified a small-to-medium size numeracy gap between European and African Nova Scotians, measuring about one-third of a standard deviation, prevalent in the late 19th and early 20th centuries. Furthermore, contemporary data from the 21st century reveals a gap in academic and cognitive test scores between African and other Nova Scotians of approximately half a standard deviation. We analyze these findings in the context of existing research on racial and ethnic academic disparities in the Americas.

Mapping Cumulative Risk in Delaware: Approach and Implications for Health Equity.

Addressing health equity requires attention to upstream determinants of health, including environmental and social factors that act in tandem to increase communities' exposure to and vulnerability to toxicants. Cumulative risk assessment, which evaluates combined risks from environmental and social factors, is a useful approach for estimating potential drivers of health disparities. We developed a cumulative risk score of multiple indices of environmental and social conditions and assessed block group-level differences in New Castle County, Delaware. This cross-sectional study used choropleth maps to visualize the distribution of environmental, social, and cumulative risks and Moran's I statistics to assess spatial clustering of cumulative risk across the county and among individual block groups. Findings indicate that environmental risk rarely occurs without social risk and that environmental and social risks co-occur in distinct areas, resulting in large-scale clustering of cumulative risk. Areas of higher cumulative risk had more Black residents and people of lower socioeconomic status. Replicable measures of cumulative risk can show how environmental and social risks are inequitably distributed by race and socioeconomic status, as seen here in New Castle County. Such measures can support upstream approaches to reduce health disparities resulting from histories of environmental racism.

Disproportionate Rates of COVID-19 Among Black Canadian Communities: Lessons from a Cross-Sectional Study in the First Year of the Pandemic.

Racialized communities, including Black Canadians, have disproportionately higher COVID-19 cases. We examined the extent to which SARS-CoV-2 infection has affected the Black Canadian community and the factors associated with the infection. We conducted a cross-sectional survey in an area of Ontario (northwest Toronto/Peel Region) with a high proportion of Black residents along with 2 areas that have lower proportions of Black residents (Oakville and London, Ontario). SARS-CoV-2 IgG antibodies were determined using the EUROIMMUN assay. The study was conducted between August 15, 2020, and December 15, 2020. Among 387 evaluable subjects, the majority, 273 (70.5%), were enrolled from northwest Toronto and adjoining suburban areas of Peel, Ontario. The seropositivity values for Oakville and London were comparable (3.3% (2/60; 95% CI 0.4-11.5) and 3.9% (2/51; 95% CI 0.5-13.5), respectively). Relative to these areas, the seropositivity was higher for the northwest Toronto/Peel area at 12.1% (33/273), relative risk (RR) 3.35 (1.22-9.25). Persons 19 years of age or less had the highest seropositivity (10/50; 20.0%, 95% CI 10.3-33.7%), RR 2.27 (1.23-3.59). There was a trend for an interaction effect between race and location of residence as this relates to the relative risk of seropositivity. During the early phases of the pandemic, the seropositivity within a COVID-19 high-prevalence zone was threefold greater than lower prevalence areas of Ontario. Black individuals were among those with the highest seroprevalence of SARS-CoV-2.

Go-Go Music and Racial Justice in Washington, DC

In 2019, a noise complaint from a new, white resident of Shaw, a historically Black neighborhood of Washington, DC, led a local MetroPCS store to mute the go-go music that the storefront had played on its outdoor speakers for decades. The cultural and social implications of muting go-go music, a DC-originated genre of music that has played a central role in DC Black culture, inspired a viral hashtag, #dontmutedc, on social media, as well as a series of high-profile public protests against the muting. The #dontmutedc protests highlighted the increasing impact of gentrification on DC’s Black communities, and connected gentrification to several other important social issues affecting Black DC residents. In the wake of the #dontmutedc incident, several DC-area activist organizations have integrated go-go music into major, public-facing racial justice projects. The first part of this article presents a brief history of go-go music and race in DC community life, mainstream media, and law enforcement in order to contextualize the work of go-go-centered activist work in the aftermath of the #dontmutedc protests. The second part of this article highlights the go-go-centered activist work of three organizations: the Don’t Mute DC movement, Long Live Go-Go, and the Go-Go Museum and Café. These movements’ projects will be used to categorize three distinct approaches to go-go-centered racial justice activism in the Washington, DC, area.

Breast Cancer Disparities Among Women in Underserved Communities in Northwest Indiana

Background: Breast cancer is the second most common cancer found in women, after skin cancers. Research has discovered that factors such as race, socioeconomic status, and education affect both screening levels and cancer staging at diagnosis. Black women as well as lower-income individuals usually have higher grade staging as well as higher mortality. Since Lake County medical systems serve both high and low-income communities we wanted to analyze breast cancer staging in Lake County to see how it compares to national trends.
 Methods: “Hospital A” provided data from 393 positive breast cancer diagnoses along with the clinical staging at diagnosis from January 2019 to December 2022 for both high and low-income neighborhoods. Using a Mantel-Haenszel chi-square test we compared staging levels among the different income neighborhoods as well as among different races.
 Results: When looking at total staging data from 2019-2022, there was a significant difference between the race category of "Black or African American" and "White" population staging data. White patients tend to have lower stages, during initial clinical diagnosis, compared to Black patients. The "Other" category, which included all other races that did not fit into the "Black or African American" or "White Category" such as Asians, also had lower staging upon diagnosis when compared to the “Black or African American” group but no statistically significant difference with the “White” population.
 Conclusion: Our data showed that in Lake County, Indiana there are disparities in cancer staging among both income levels as well as race. The lower-income areas in our study were correlated with a greater proportion of Black residents as compared to the higher income areas. This data shows that Lake County needs to be more proactive in screening its minority communities.

A sandwich effect: Gentrification and Black residential displacement in the university-adjacent West Philadelphia Promise Zone

ABSTRACT This study examines the landscape of gentrification and Black residential displacement within the West Philadelphia Promise Zone (WPPZ). Our intergenerational community-driven participatory action research team conducted a comparative longitudinal spatial analysis between Census data from 2008 to 2012 and 2013 to 2017 investigating variables of both gentrification and displacement including changes in population, racial demographics, per capita income, and housing costs and value. Our findings demonstrate that targeted block groups within the WPPZ are exhibiting indicators of displacement; however, they are not progressing at the same rate. We found that Black residents are impacted by the neighborhood changes at the highest rates and are being displaced from the north and the south, being squeezed to the middle resulting in a racialized pattern of gentrification that we deem a sandwich effect. Recommendations to respond to the displacement of Black residents in the WPPZ and other university-adjacent urban communities are presented.

Determinants of disparities of diabetes-related hospitalization rates in Florida: a retrospective ecological study using a multiscale geographically weighted regression approach

BackgroundEarly diagnosis, control of blood glucose levels and cardiovascular risk factors, and regular screening are essential to prevent or delay complications of diabetes. However, most adults with diabetes do not meet recommended targets, and some populations have disproportionately high rates of potentially preventable diabetes-related hospitalizations. Understanding the factors that contribute to geographic disparities can guide resource allocation and help ensure that future interventions are designed to meet the specific needs of these communities. Therefore, the objectives of this study were (1) to identify determinants of diabetes-related hospitalization rates at the ZIP code tabulation area (ZCTA) level in Florida, and (2) assess if the strengths of these relationships vary by geographic location and at different spatial scales.MethodsDiabetes-related hospitalization (DRH) rates were computed at the ZCTA level using data from 2016 to 2019. A global ordinary least squares regression model was fit to identify socioeconomic, demographic, healthcare-related, and built environment characteristics associated with log-transformed DRH rates. A multiscale geographically weighted regression (MGWR) model was then fit to investigate and describe spatial heterogeneity of regression coefficients.ResultsPopulations of ZCTAs with high rates of diabetes-related hospitalizations tended to have higher proportions of older adults (p < 0.0001) and non-Hispanic Black residents (p = 0.003). In addition, DRH rates were associated with higher levels of unemployment (p = 0.001), uninsurance (p < 0.0001), and lack of access to a vehicle (p = 0.002). Population density and median household income had significant (p < 0.0001) negative associations with DRH rates. Non-stationary variables exhibited spatial heterogeneity at local (percent non-Hispanic Black, educational attainment), regional (age composition, unemployment, health insurance coverage), and statewide scales (population density, income, vehicle access).ConclusionsThe findings of this study underscore the importance of socioeconomic resources and rurality in shaping population health. Understanding the spatial context of the observed relationships provides valuable insights to guide needs-based, locally-focused health planning to reduce disparities in the burden of potentially avoidable hospitalizations.