Disparities In Coverage Research Articles

The Brazilian vaccine divide: How some municipalities were left behind in the Covid-19 vaccine coverage.

This study aims to assess the progress of geographic, socioeconomic, and demographic disparities in Covid-19 vaccination coverage in Brazil over the first two years of the vaccination campaign. Data from the National Immunization Program Information System were used to estimate covid-19 vaccine coverage. Brazilian municipalities were divided into two groups based on their vaccine coverage for the booster dose. The first group comprised 20% of municipalities with the lowest coverage, while the second group (80% of municipalities) had higher coverage. The analysis was conducted separately for four age groups: 5-11, 12-17, 18-59, and 60+. Explanatory variables included socioeconomic and health services indicators. Crude and adjusted logistic regression models were used to estimate the probability of a municipality being among those with the worst vaccination coverage according to the categories of exploratory variables. Between January/2021 and December/2022, Brazil administered 448.2 million doses of the covid-19 vaccine. The booster vaccination coverage varied from 24.8% among adolescents to 79.7% among the elderly. The difference between the group with the highest and lowest coverage increased during the national vaccination campaign. Municipalities with lower education levels, higher proportion of Black population, higher Gini index, and worse health service indicators had a greater likelihood of having lower vaccination coverage. High and increasing levels of inequality in Covid-19 vaccination were observed in Brazil across all age groups during the vaccination campaign in 2021-2022.

Racial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States: The contribution of vaccine-related attitudes

ObjectiveRacial and ethnic disparities in influenza vaccination coverage among pregnant women in the United States have been documented. This study assessed the contribution of vaccine-related attitudes to coverage disparities. MethodsSurveys were conducted following the 2019–2020 and 2020–2021 influenza seasons in a US research network. Using electronic health record data to identify pregnant women, random samples were selected for surveying; non-Hispanic Black women and influenza-unvaccinated women were oversampled. Regression-based decomposition analyses were used to assess the contribution of vaccine-related attitudes to racial and ethnic differences in influenza vaccination. Data were combined across survey years, and analyses were weighted and accounted for survey design. ResultsSurvey response rate was 41.2% (721 of 1748) for 2019–2020 and 39.3% (706 of 1798) for 2020–2021. Self-reported influenza vaccination was higher among non-Hispanic White respondents (79.4% coverage, 95% CI 73.1%–85.7%) than Hispanic (66.2% coverage, 95% CI 52.5%–79.9%) and non-Hispanic Black (55.8% coverage, 95% CI 50.2%–61.4%) respondents. For all racial and ethnic groups, a high proportion (generally >80%) reported being seen for care, recommended for influenza vaccination, and offered vaccination. In decomposition analyses, vaccine-related attitudes (e.g., worry about vaccination causing influenza; concern about vaccine safety and effectiveness) explained a statistically significant portion of the observed racial and ethnic disparities in vaccination. Maternal age, education, and health status were not significant contributors after controlling for vaccine-related attitudes. ConclusionsIn a setting with relatively high influenza vaccination coverage among pregnant women, racial and ethnic disparities in coverage were identified. Vaccine-related attitudes were associated with the disparities observed.

“We're potentially worsening health inequalities”: Evaluating how delivery of the 2022 London polio booster campaign was tailored to Orthodox Jewish families to reduce transmission vulnerability

A polio booster campaign targeting all children aged 1–9 was implemented across London between August–December 2022 as part of a national enhanced poliovirus incident response. Orthodox Jewish (OJ) children were particularly vulnerable to transmission due to disparities in childhood vaccination coverage and the transnational spread of poliovirus affecting linked populations in New York and Israel. This study aimed to evaluate how the polio booster campaign was tailored to increase uptake and enable access for OJ families in northeast and north central London boroughs, and the impact of the campaign on local-level vaccine inequities. Semi-structured in-depth interviews (n = 36) were conducted with participants involved in the implementation and delivery of the polio booster campaign, and OJ mothers. Site visits (n = 5) were conducted at vaccine clinics, and rapid interviews (n = 26) were held to explore parental perceptions of the poliovirus incident and childhood immunisations. Enablers to vaccination during the campaign included the production of targeted printed communications and offering flexible clinic times in primary care settings or complementary delivery pathways embedded in family-friendly spaces. Barriers included digital booking systems. Mothers reported being aware of the poliovirus incident, but the majority of those interviewed did not feel their children were at risk of contracting polio. Healthcare provider participants raised concerns that the vaccine response had limited impact on reducing disparities in vaccine uptake. While OJ families were recognised as a priority for public health engagement during the poliovirus incident response, this evaluation identified limitations in reducing transmission vulnerability during the booster campaign. Lessons for future campaign delivery include effectively conveying transmission risk and the urgency to vaccinate. Priorities for mitigating vaccine inequities include public engagement to develop messaging strategies and strengthening the capacity of primary care and complementary delivery pathways to serve families with higher-than-average numbers of children.

Evaluation of the Potential for Territorial Ecological Restoration: A Case Study of Zhaoping County, China

Territorial ecological restoration (TER) is a critical step for promoting the development of an ecological civilization, as well as a significant strategic task relating to national ecological security and the well-being of a population. However, calculating the ecological restoration potential (ERP) is a key challenge in TER. Using Zhaoping County as an example, this study calculated the ecological restoration natural potential (ERNP), including the vegetation coverage potential, water conservation potential, windbreak and sand fixation potential, and biodiversity potential, and proposed an ERP calculation method based on the correction of ERNP with an ecological security pattern (ESP) and social support (SS). The findings revealed several key points. First, using the similarity habitat method to calculate ERNP highlighted significant disparities in the vegetation coverage, water conservation, windbreak and sand fixation, and biodiversity across Zhaoping County. These variations were contrary to regional ecological service functions. Second, overall, the ESP levels in Zhaoping County were high, accounting for about 60.42% of its total area being classified as high or relatively high level, with the towns exhibiting strong SS abilities primarily located in the northern region. Third, the ERP results which are between 0 and 1 indicated that areas with higher potential were mainly found in the west and northeast of Zhaoping, while lower potential areas were concentrated in the northwest and south; of them, the ERP index value in most regions is between 0.2 and 0.3, accounting for about 43.97% of the area. Finally, suggestions for the TER project layout and measures to enhance the ERP were proposed based on these ERP calculations. This study offers new insights into ERP strategies while providing guidance for identifying critical areas requiring restoration.

Influenza vaccination coverage among persons ages six months and older in the Vaccine Safety Datalink in the 2017–18 through 2022–23 influenza seasons

BackgroundIn the United States, annual vaccination against seasonal influenza is recommended for all people ages ≥ 6 months. Vaccination coverage assessments can identify populations less protected from influenza morbidity and mortality and help to tailor vaccination efforts. Within the Vaccine Safety Datalink population ages ≥ 6 months, we report influenza vaccination coverage for the 2017–18 through 2022–23 seasons. MethodsAcross eight health systems, we identified influenza vaccines administered from August 1 through March 31 for each season using electronic health records linked to immunization registries. Crude vaccination coverage was described for each season, overall and by self-reported sex; age group; self-reported race and ethnicity; and number of separate categories of diagnoses associated with increased risk of severe illness and complications from influenza (hereafter referred to as high-risk conditions). High-risk conditions were assessed using ICD-10-CM diagnosis codes assigned in the year preceding each influenza season. ResultsAmong individual cohorts of more than 12 million individuals each season, overall influenza vaccination coverage increased from 41.9 % in the 2017–18 season to a peak of 46.2 % in 2019–20, prior to declaration of the COVID-19 pandemic. Coverage declined over the next three seasons, coincident with widespread SARS-CoV-2 circulation, to a low of 40.3 % in the 2022–23 season. In each of the six seasons, coverage was lowest among males, 18–49-year-olds, non-Hispanic Black people, and those with no high-risk conditions. While decreases in coverage were present in all age groups, the declines were most substantial among children: 2022–23 season coverage for children ages six months through 8 years and 9–17 years was 24.5 % and 22.4 % (14 and 10 absolute percentage points), respectively, less than peak coverage achieved in the 2019–20 season. ConclusionsCrude influenza vaccination coverage increased from 2017 to 18 through 2019–20, then decreased to the lowest level in the 2022–23 season. In this insured population, we identified persistent disparities in influenza vaccination coverage by sex, age, and race and ethnicity. The overall low coverage, disparities in coverage, and recent decreases in coverage are significant public health concerns.

Post-epidemic health system recovery: A comparative case study analysis of routine immunization programs in the Republics of Haiti and Liberia.

Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively. First, we triangulated data between the peer-reviewed and grey literature; in-depth key informant interviews with subject matter experts; and quantitative metrics of population health and health system functioning. We used these data to construct thick descriptive narratives for each case. Finally, we performed a cross-case comparison by applying a thematic matrix based on the Essential Public Health Services framework to each case narrative. In Liberia, post-Ebola routine immunization coverage surpassed pre-epidemic levels, a feat attributable to investments in surveillance, comprehensive risk communication, robust political support for and leadership around immunization, and strong public-sector recovery planning. Recovery efforts in Haiti were fragmented across a broad range of non-governmental agencies. Limitations in funding, workforce development, and community engagement further impeded vaccine uptake. Consequently, Haiti reported significant disparities in subnational immunization coverage following the epidemic. This study suggests that embedding in-country expertise within outbreak response structures, respecting governmental autonomy, aligning post-epidemic recovery plans and policies, and integrating outbreak response assets into robust systems of primary care contribute to higher, more equitable levels of routine immunization coverage in resource-constrained settings recovering from epidemics.

Mpox Vaccination and the Role of Social Vulnerability in Durham County, North Carolina, USA.

Disparities in vaccine coverage among groups in the USA is common, possibly due to higher vaccine hesitancy in certain populations, difficulty accessing vaccines, and underlying social vulnerability. The aim of this study was to investigate the association between mpox vaccine administration, social determinants of health, and social vulnerability index (SVI) in Durham County, North Carolina, USA. Random forest regression (RFE) and min-max scaling preprocessing were used to predict mpox vaccinations in Durham County at the census tract level. The top eleven most influential features and their correlations with mpox vaccination were calculated. Non-Hispanic white individuals, males, and those between the ages of 20 and 40 years were overrepresented in mpox vaccine reception in Durham County. Surprisingly, lacking a high school diploma, lacking health insurance, lacking a household vehicle, and living below the poverty line were all positively associated with receiving the mpox vaccine. Being a Black or African American and Hispanic or Latino individual was also positively associated with receiving the mpox vaccine. Vaccine outreach efforts in Durham County, North Carolina, had success in reaching at-risk individuals, including socially vulnerable individuals. Future research should focus more specifically on how social vulnerability relates to vaccine reception for vaccine-preventable diseases.

Disparities in COVID-19 Vaccination Status Among Long-Term Care Facility Residents - United States, October 31, 2022-May 7, 2023.

Residents of long-term care (LTC) facilities constitute a population that is vulnerable to SARS-CoV-2 infection; COVID-19 vaccination effectively reduces severe COVID-19 in these settings. To examine demographic differences in primary and up-to-date vaccination status against COVID-19 among LTC facility residents, a descriptive analysis of COVID-19 vaccination data from the National Healthcare Safety Network (NHSN) COVID-19 vaccination data from October 31, 2022, to May 7, 2023, were analyzed. Being up to date was defined as having received a bivalent COVID-19 vaccine dose or having completed a primary vaccination series <2 months earlier. Geographic disparities in vaccination coverage were identified, with substantially lower prevalences of up-to-date status among LTC facility residents in the South (Region 6) (37.7%) and Southeast (Region 4) (36.5%) than among those in the Pacific Northwest (Region 10) (53.3%) and Mountain West (Region 8) (59.6%) U.S. Department of Health and Human Services regions. Up-to-date status was lowest among Black or African American (39.9%) and multiracial (42.2%) LTC facility residents. Strategies to increase up-to-date COVID-19 vaccination among LTC facility residents could include and address these geographic and racial differences.

FRI520 Disparities In Available Surgeons And Specialty Physicians Providing Endocrine-related Health Care Coverage To Populations In South Texas And The Rio Grande Valley

Abstract Disclosure: V. Alia: None. E.W. Alvarado: None. E.M. Diaz: None. H. Reinhart: None. Introduction: The Rio Grande Valley and South Texas is home to some of the most medically underserved populations in the nation, with gaps in health care ranging from low rates of adequately insured individuals, to the amount of primary and specialty healthcare services available [1]. Populations living in these areas near the Texas-Mexico border have some of the highest incidence of metabolic and endocrine-related disease in the U.S., while paradoxically having a large deficit in endocrine-specialists available to meet the medical and surgical needs of the community [1,2,3]. Methodology: We analyzed data from the National Center for Health Workforce Analysis (NCHWA), as well as data from the Texas department of state health services (TDSHS) to determine current and projected endocrine-related healthcare coverage needs in South Texas and the Rio Grande Valley (RGV) between 2013 to 2025 and 2018 to 2032 respectively [2,3]. Results: Analysis of the data provided by the NCHWA revealed that by 2025 the southern region of the U.S. is projected to have the largest shortage of full-time equivalent (FTE) surgical specialty physicians in the entire country with a deficit of 10,210 [3]. ​Additionally, data displaying critical-shortages provided by the TDSHS stated that in 2018 the percent demand met (PDM) for FTE endocrinologists in South Texas was only 76.6% with a projected decline to 65.7% by 2032 [2]. Noteworthy data from the TDSHS also stated that in 2018 the RGV specifically had a significant deficit in endocrinologists with a PDM of only 53.6%, while simultaneously having a projected increase to 66.4% by 2032 [2]. The TDSHS classified specialties in South Texas to be critically short when they are projected to have a deficit of ≥100 FTEs and &amp;lt;80% of the physician demand being met [2]. Conclusion: The collection of data analyzed led us to effectively identify significant disparities in endocrine-related healthcare coverage in the South Texas region, specifically the RGV. Additionally, new multidisciplinary healthcare institutions built in the RGV are striving to improve patient access to primary and subspecialty care by recruiting and training physicians in the area, but further action is still needed to counteract the described critical-shortages in physicians responsible for the long-term management of endocrine-related diseases. Presentation: Friday, June 16, 2023

Flood Risk Mapping and the Distributional Impacts of Climate Information

This paper examines the provision of official flood risk information in the United States and its distributional impacts on residential flood insurance take-up. Assembling new data on all flood maps produced after Hurricane Katrina, I first document that updated maps decreased the number of properties zoned in high-risk floodplains and incorrectly omitted five million properties that should have been rezoned inside these areas. Removals and omissions disproportionately occurred in neighborhoods with more Black and Hispanic residents. Leveraging the staggered timing of map updates, I estimate they decreased flood insurance take-up and exacerbated racial disparities in insurance coverage. These effects are driven by beliefs about risks and regulatory constraints. Correcting flood maps could increase welfare by $20 billion annually, but past updates decreased welfare due to distorted risk and price signals.

Factors associated with vaccine coverage improvements in Senegal between 2005 and 2019: a quantitative retrospective analysis

ObjectiveSenegal has demonstrated catalytic improvements in national coverage rates for early childhood vaccination, despite lower development assistance for childhood vaccines in Senegal compared with other low-income and lower-middle income countries....

Medicaid Expansion Lowered Uninsurance Rates Among Nonelderly Adults In The Most Heavily Redlined Areas.

Medicaid expansion narrowed racial and ethnic disparities in health coverage, but few studies have explored differential impact by exposure to structural racism. We analyzed data on historical residential redlining in US metropolitan areas from the Mapping Inequality project, along with data on uninsurance from the American Community Survey, to test whether Medicaid expansion differentially reduced uninsurance rates among nonelderly adults exposed to historical redlining. Our difference-in-differences analysis compared uninsurance rates in Medicaid expansion and nonexpansion states both before (2009-13) and after (2015-19) the state option to expand Medicaid pursuant to the Affordable Care Act took effect in 2014. We found that Medicaid expansion had the greatest impact on lowering uninsurance rates in census tracts with the highest level of redlining. Within each redline category, there were no significant differences by race and ethnicity. Our results highlight the importance of considering contextual factors, such as structural racism, when evaluating health policies. States that opt not to expand Medicaid delay progress toward health equity in historically redlined communities.

Inequities in COVID-19 Vaccination Coverage Among Pregnant Persons, by Disaggregated Race and Ethnicity - Massachusetts, May 2021-October 2022.

National estimates suggest that COVID-19 vaccination coverage among pregnant persons is lower among those identifying as Hispanic or Latino (Hispanic) and non-Hispanic Black or African American. When examining COVID-19 vaccination coverage during pregnancy by race and ethnicity, however, data are typically limited to large, aggregate categories that might obscure within-group inequities. To address this, Massachusetts examined COVID-19 vaccination coverage among pregnant persons by combinations of 12 racial and 34 ethnic groupings. Among 102,275 persons with a live birth in Massachusetts during May 1, 2021-October 31, 2022, receipt of ≥1 dose of a COVID-19 vaccine before or during pregnancy was 41.6% overall and was highest among persons who identified as Asian (55.0%) and lowest among those who identified as Hispanic (26.7%). However, within all broad racial and ethnic groupings, disparities in COVID-19 vaccination coverage were identified when the data were disaggregated into more granular categories; for example, COVID-19 vaccination coverage ranged from 10.8%-61.1% among pregnant persons who identified as Hispanic. Disaggregated analyses reveal diverse experiences within broad racial and ethnic groupings. This information can be used to guide outreach to pregnant persons in communities with lower rates of COVID-19 vaccination coverage during pregnancy.

Coverage and predictors of influenza and pertussis vaccination during pregnancy: a whole of population-based study

BackgroundRespiratory infections including influenza and pertussis are associated with significant morbidity and mortality in mothers and newborns. Vaccination during pregnancy against influenza and pertussis is recommended for all women but data on uptake in Australia is limited. MethodsWe conducted a retrospective population-based cohort study in Australia’s largest state, New South Wales (NSW), using a Perinatal Data Collection (PDC). Data included demographic, pregnancy, and birth details including pertussis and influenza vaccination during pregnancy for all women giving birth between 01 January 2016 and 31 December 2020. We used descriptive statistics to assess uptake of influenza and pertussis vaccination during pregnancy and Poisson loglinear regression to estimate associations between maternal characteristics and vaccine receipt. ResultsDuring 2016–2020, there were 477,776 births (mean maternal age 32.25 years). In 176,255 (36.9%) births the mother received both vaccines; 202,922 (42.5%) influenza and 315,620 (66.1%) pertussis vaccine. From 2016 to 2020, reported coverage increased from 26.7% to 58.7% for influenza and 43.1% to 78.8% for pertussis, respectively. After adjustment, characteristics associated with lower likelihood of receiving influenza and pertussis vaccination included: younger age (<30 years), being born in Australia/New Zealand, from lower socio-economic strata, having previous pregnancies, being later to first antenatal care, utilising the public hospital care model, smoking, having chronic hypertension and BMI > 25 kg/m2. ConclusionsWhile reported coverage of both influenza and pertussis vaccine in birthing women in NSW has increased over time, disparities in coverage exist and they highlight areas where evidence-based interventions to improve maternal vaccination could be targeted.

Epidemiology of confirmed measles virus cases, surveillance, incidence, and associated factors in Eritrea: 18-year retrospective analysis.

Despite the outstanding measles vaccine coverage (MVC) in Eritrea, sporadic outbreaks are not uncommon. Therefore, understanding the incidence of laboratory-confirmed measles virus cases, related factors, and spatial inequalities in testing and surveillance remains crucial. In this analysis, we evaluated the incidence and spatiotemporal distribution of measles in Eritrea. An evaluation of the factors associated with measles vaccination and IgM positive (+) febrile rash was also undertaken. A retrospective (period: 2002-2020) study was carried out by abstracting data from the integrated disease surveillance and response database (IDSR). Data was analyzed using descriptive statistics and binary logistic regression. Spatial variability and distribution of confirmed cases was evaluated using ArcGIS Pro version 3.0.1. In total, 9,111 suspected cases, 2,767 [1,431 (51.7%) females] were serologically tested. The median (IQR) age, minimum-maximum age were 7 years (IQR: 4-14 years) and 1 month-97 years, respectively. Among the 608(21.9%) laboratory-confirmed cases, 534 (87.8%) were unvaccinated and 53 (9.92%) were < 1 year old. The crude incidence rate for MV was 14/100,000 persons. The age-specific positivity rate per 100,000 suspected cases tested was 21.5 with individuals >30 years presenting with the highest rates (69.9/100,000). Higher odds (OR) of MV test positivity was associated with age at onset - higher in the following age-bands [10-14 years: OR = 1.6 (95%CI, 1.1-2.2, value of p = 0.005); 15-29 years: OR = 7.0 (95%CI, 5.3-9.2, value of p = 0.005); and > =30 years: OR = 16.7 (95%CI, 11.7-24) p < 0.001]. Other associations included: Address - higher in Anseba (OR = 2.3, 95%CI: 1.7-3.1, value of p<0.001); Debub (OR = 2.7, 95%CI: 1.9-3.9, value of p < 0.001); Gash-Barka (OR = 15.4, 95%CI: 10.9-21.7, value of p < 0.001); Northern Red Sea (OR = 11.8, 95%CI: 8.5-16.2, value of p < 0.001); and Southern Red Sea (OR = 14.4, 95%CI: 8.2-25.2, value of p < 0.001). Further, test positivity was higher in health centers (OR = 2.5, 95%CI: 1.9-3.4, value of p < 0.001) and hospitals (OR = 6.8, 95%CI: 5.1-9.1, value of p < 0.001). Additional factors included vaccination status - higher in the unvaccinated (OR = 14.7, 95%CI: 11.4-19.1, value of p < 0.001); and year of onset of rash - (higher >2015: OR = 1.4, 95%CI: 1.1-1.7, value of p<0.001). Uptake of measles vaccine associated with a similar complement of factors. In large part, efforts to eliminate measles in Eritrea are hindered by disparities in vaccine coverage, under-surveillance, and low vaccination rates in neighboring countries. Enhanced surveillance and regional micro planning targeting hard-to-reach areas can be an effective strategy to improve measles elimination efforts in Eritrea.

Urban-rural disparities in immunization coverage among children aged 12–23 months in Ethiopia: multivariate decomposition analysis

BackgroundImmunization is one of the most cost-effective public health interventions for improving children’s health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia.MethodsWe analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.ResultsThe percentage of children aged 12–23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1–3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity.ConclusionsThere was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children’s immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.

Impacts of the Affordable Care Act Medicaid Expansion on Mental Health Treatment Among Low-income Adults Across Racial/Ethnic Subgroups, 2010-2017.

This study examines whether the Affordable Care Act (ACA) Medicaid expansion (ME) was associated with changes in racial/ethnic disparities in insurance coverage, utilization, and quality of mental health care among low-income adults with probable mental illness using the National Survey on Drug Use and Health with state identifiers. This study employed difference-in-difference models to compare ME states to non-expansion states before (2010-2013) and after (2014-2017) expansion and triple difference models to examine these changes across non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic/Latino racial/ethnic subgroups. Insurance coverage increased significantly for all racial/ethnic groups in expansion states relative to non-expansion states (DD: 9.69; 95% CI: 5.17, 14.21). The proportion low-income adults that received treatment but still had unmet need decreased (DD: -3.06; 95% CI: -5.92, -0.21) and the proportion with unmet need and no mental health treatment increased (DD: 2.38; 95% CI: 0.03, 4.73). ME was not associated with reduced disparities.

Data-Driven Placement of PM2.5 Air Quality Sensors in the United States: An Approach to Target Urban Environmental Injustice.

In the United States, citizens and policymakers heavily rely upon Environmental Protection Agency mandated regulatory networks to monitor air pollution; increasingly they also depend on low-cost sensor networks to supplement spatial gaps in regulatory monitor networks coverage. Although these regulatory and low-cost networks in tandem provide enhanced spatiotemporal coverage in urban areas, low-cost sensors are located often in higher income, predominantly White areas. Such disparity in coverage may exacerbate existing inequalities and impact the ability of different communities to respond to the threat of air pollution. Here we present a study using cost-constrained multiresolution dynamic mode decomposition (mrDMDcc) to identify the optimal and equitable placement of fine particulate matter (PM2.5) sensors in four U.S. cities with histories of racial or income segregation: St. Louis, Houston, Boston, and Buffalo. This novel approach incorporates the variation of PM2.5 on timescales ranging from 1day to over a decade to capture air pollution variability. We also introduce a cost function into the sensor placement optimization that represents the balance between our objectives of capturing PM2.5 extremes and increasing pollution monitoring in low-income and nonwhite areas. We find that the mrDMDcc algorithm places a greater number of sensors in historically low-income and nonwhite neighborhoods with known environmental pollution problems compared to networks using PM2.5 information alone. Our work provides a roadmap for the creation of equitable sensor networks in U.S. cities and offers a guide for democratizing air pollution data through increasing spatial coverage of low-cost sensors in less privileged communities.

Is All Publicity Good Publicity? A Sentiment Analysis of Media Regarding Concussions in the NFL and its Effects on Viewership

With the increase in the rate of concussions within the National Football League (NFL), as well as an increase in studies finding the long-term effects of these concussions, there has been growing interest garnered by the media on the NFL’s concussion protocol. Other studies would suggest that these portrayals by the media, if negative, would impact the league's viewership; however, with no research done on the topic, this claim was unsupported. To determine this relationship, this study conducts a sentiment analysis using MeaningCloud Software on statements made within the years 2017 through 2021 regarding NFL concussions/concussion protocol, which was then compared to the average viewership of its corresponding season. Throughout the entirety of the years analyzed, MeaningCloud analyzed that 49 of the 99 statements about NFL concussions/concussion protocol were deemed to have negative polarity (49.5%), while only 24 had positive polarity (24.24%), conveying a very large disparity in the media coverage. These results disagreed with the current ideals that negative portrayals can impact enjoyment (therefore viewership), and could speak to the strength of the NFL’s business model.

COVID-19 Vaccine Uptake Among Students in Public Institutions of Higher Education in Arkansas in 2021.

Disparities in COVID-19 vaccine coverage among college students are not well studied. We analyzed the extent of COVID-19 vaccination among all students at public institutions of higher education in Arkansas in spring and fall 2021 and examined factors associated with vaccination rates. We matched student enrollment data for the spring and fall 2021 semesters separately with immunization registry data to determine the COVID-19 vaccination status of students in each semester. We used multivariable logistic regression to determine variables associated with being fully vaccinated. Overall, by the end of the fall 2021 semester, 49.1% of students were fully vaccinated, compared with 52.3% of students at the end of the spring 2021 semester. However, we observed important differences between student groups. Students who were in rural areas (vs urban areas), freshman (vs all other class years), at a 2-year college (vs 4-year college), non-Hispanic Black (vs Hispanic or non-Hispanic White), or in a nonhealth major (vs health major) were less likely to be fully vaccinated. Given the disparities in COVID-19 vaccine coverage among college students, continued efforts are needed in this young, but important, population segment to address students' confidence in vaccines and to make vaccines more available and accessible on and near campuses. Novel approaches for tailored messaging and interventions to facilitate vaccine uptake may be needed for groups such as non-Hispanic Black students and students in rural areas who are less likely, compared with their counterparts, to accept COVID-19 vaccines.