High Concentrations Of Poverty Research Articles

Living in high-poverty areas is associated with reduced survival in patients with thoracoabdominal aortic aneurysms

ObjectivesStudies have demonstrated that socioeconomic status, insurance, race, and distance impact clinical outcomes in patients with abdominal aortic aneurysms. The purpose of this study was to assess if these factors also impact clinical outcomes in patients with thoracoabdominal aortic aneurysms (TAAAs). MethodsWe conducted a retrospective review of patients with TAAAs confirmed by computed tomography imaging between 2009 and 2019 at a single institution. Patients’ zip codes were mapped to American Community Survey Data to obtain geographic poverty rates. We used the standard U.S. Census definition of high-poverty concentration as >20% of the population living at 100% of the poverty rate. Our primary outcome was overall survival, stratified by whether the patient underwent repair. ResultsOf 578 patients, 575 had zip code data and were analyzed. In both the nonoperative (N = 268) and operative (N = 307) groups, there were no significant differences in age, race, comorbidities, clinical urgency, surgery utilization, or surgery modality between patients living in high-poverty areas (N = 95, 16.4%) vs not. In the nonoperative group, patients from high-poverty areas were more likely to have aneurysm due to dissection (37.5% vs 17.6%, P = .03). In multivariate analyses, patients from high-poverty zip codes had significantly worse nonoperative survival (hazard ratio [HR]: 1.9, 95% confidence interval [CI]: 1.1-3.3, P = .03). In the repair group, high poverty was also a significant predictor of reduced postoperative survival (HR: 1.65, 95% CI: 1-2.63, P = .04). Adding the Gagne Index, these differences persisted in both groups (nonoperative: HR: 1.93, 95% CI: 1.01-3.70, P = .05; operative: HR: 1.62, 95% CI: 1.03-2.56, P = .04). In Kaplan-Meier analysis, the difference in postoperative survival began approximately 1.5 years after repair. Private insurance was predictive of improved postoperative survival (HR: 0.42, 95% CI: 0.18-0.95, P = .04) but reduced nonoperative survival (HR: 2.05, 95% 1.01-4.14, P = .04). Data were insufficient to determine if race impacted survival discretely from poverty status. These results were found after adjusting for age, race, sex, maximum aortic diameter, coronary artery disease, distance from the hospital, insurance, and active smoking. Interestingly, in multivariate regression, traveling greater than 100 miles was correlated with increased surgery utilization (odds ratio: 1.58, 95% CI: 1.08-2.33, P = .02) and long-term survival (HR: 0.61, 95% CI: 0.41-0.92, P = .02). ConclusionsPatients with TAAAs living in high-poverty areas had significantly more dissections and suffered a nearly doubled risk of mortality compared with patients living outside such areas. These data suggest that these disparities are attributed to the overall impacts of poverty and highlight the pressing need for research into TAAA disparities.

How to recruit teachers for hard-to-staff schools: A systematic review of evidence from low- and middle-income countries

Education systems struggle to staff schools in rural areas or in areas with high concentrations of poverty. Potential policy solutions include financial incentives, mandatory rotations, and local recruitment drives, among others. First, this systematic review provides evidence on challenges with teacher staffing in certain types of schools. We observe lower teacher skill and higher teacher absence in rural areas in many countries. Second, the review synthesizes available experimental and quasi-experimental studies of government-implemented policies to increase the quantity or quality of teachers in hard-to-staff schools in low- or middle-income countries. Financial incentives—the most evaluated policies—are often effective at increasing the supply or reducing the turnover of teachers in hard-to-staff schools, and well-designed incentives can also increase the quality of teachers in these schools. Impacts on student outcomes are often positive. Although there are fewer evaluations, behavioral and informational interventions have been cost-effective in reducing vacancies in two countries.

Living in High-Poverty Areas Significantly Reduces Survival in Patients With Thoracoabdominal Aortic Aneurysm

Studies have demonstrated that low socioeconomic status, insurance, and race impact clinical outcomes in patients with abdominal aortic aneurysms. The purpose of this study was to assess if living in high-poverty areas, insurance, and race impact clinical outcomes in patients diagnosed with thoracoabdominal aortic aneurysm (TAAA). We conducted a retrospective review of patients with TAAAs confirmed by computed tomography imaging between 2009 and 2019 at a single institution. Patients’ zip codes were mapped to American Community Survey Data to obtain geographic poverty rates. We used the standard US Census definition of high poverty concentration, as >20% of the population was living at 100% of the poverty rate. Our primary outcome was overall survival, stratified by whether or not the patient underwent repair. We also assessed if poverty concentration and distance influenced repair rates. Of 578 patients, 575 had zip code data and were analyzed. In both the nonoperative (N = 258) and repair (N = 311) groups, there were no significant differences in age, race, or comorbidities between patients living in high-poverty areas (N = 95, 16.4%) vs not. In the nonoperative group, patients from high-poverty areas were more likely to have aneurysm due to dissection (37.5 vs 17.6%, P = .03). In multivariate analyses, patients from high-poverty zip codes had significantly worse overall survival (hazard ratio [HR]: 1.9, 95% confidence interval: 1.1-3.3; P = .03). In the repair group, high poverty was also a significant predictor of reduced postoperative survival (HR: 1.65, 95% confidence interval: 1-2.63; P = .04) (Fig 1). Private insurance was predictive of improved postoperative survival (HR: 0.42, 95% confidence interval: 0.18-0.95; P = .04). These results were found after adjusting for age, race, sex, maximum aortic diameter, coronary artery disease, distance from the hospital, insurance status, and active smoking. There were insufficient data to determine if race impacted survival discretely from poverty status. Interestingly, traveling greater than 100 miles improved long-term survival (HR: 0.61, 95% confidence interval: 0.41-0.92, P = .02) (Table). In multivariate regression, patients living over 100 miles from the hospital were significantly more likely to undergo repair (odds ratio: 1.58, 95% confidence interval: 1.08-2.33; P = .02). There was no significant difference in surgery utilization based on poverty adjusting for the same factors. This study demonstrates socioeconomic disparities in TAAA survival. Patients with TAAA living in high-poverty areas had significantly more dissections and suffered a nearly doubled risk of mortality compared with patients living outside such areas. This study highlights the pressing need for further research into TAAA disparities.TableVariables predictive of survival for patients with TAAAHazard ratio95% confidence intervalP valueNonoperative group (overall survival) High poverty1.901.103.27.021 Distance to hospital over 100 miles0.560.370.83.004 InsuranceMedicareReferent11Medicaid1.290.562.97.54Private2.051.014.14.044Operative repair group (postoperative survival to 5 years) High poverty1.651.02.63.036 Distance to hospital over 100 miles0.610.410.92.017 InsuranceMedicareReferent11Medicaid0.740.321.68.47Private0.420.180.95.037TAAA, Thoracoabdominal aortic aneurysm.Elevated hazard ratio indicates increased risk of mortality. Open table in a new tab

SPATIAL ANALYSIS OF REGIONAL POVERTY IN CENTRAL JAVA INDONESIA

This study analyzes the effect of the spatial interaction of poverty in districts/cities in Central Java for three periods, 2010, 2015, and 2019. The method used in this research is a spatial analysis using Global Moran's I Statistics, Local Indicator of Spatial Association (LISA), and spatial regression with Spatial Autoregressive Model (SAR). Spatial distribution analysis concluded that the high concentration of poverty for three periods occurred in the southern part of Central Java, accompanied by a high concentration of unemployment and population. The results of non-spatial regression analysis concluded that there was a negative effect of economic growth on poverty, a positive influence of population on poverty in Central Java for the three study periods, and a negative effect of education on poverty only in 2019. The estimation model uses SAR as the best model chosen to explain poverty conditions in Central Java, and it shows that poverty in neighboring areas has a positive value, so it can be concluded that there is a spatial effect of poverty in Central Java. The spatial influence of poverty implies that the government carries out an integrated poverty alleviation program to produce policies that have local impacts in one area but must have a spatial impact, which means reducing poverty between regions.

Determinants of Antenatal Care Utilization Among Childbearing Women in Burkina Faso.

IntroductionAntenatal care (ANC) is one of the pillars of maternal and child health programs aimed at preventing and reducing maternal and child morbidity and mortality. This study aims to identify the factors associated with ANC use, considering both health care demand and supply factors in the single analysis.MethodsWe used data from the endline survey conducted to evaluate the impact of the performance-based financing (PBF) program in Burkina Faso in 2017. This study was a blocked-by-region cluster random trial using a pre–post comparison design. The sample was derived in a three-stage cluster sampling procedure. Data collection for the endline surveys included a household survey and a facility-based survey. Women of childbearing age who gave birth at least once in the past 2 years prior to this survey and residing in the study area for more than 6 months were included in this study. Multilevel statistical techniques were used to examine individual and contextual effects related to health care demand and supply simultaneously and thus measure the relative contribution of the different levels to explaining factors associated with ANC use.ResultsThe working women were five times [odd ratio (OR): 5.41, 95% confidence intervals (CI) 4.36–6.70] more likely to report using ANC services than the women who were not working (OR: 5.41, 95% CI 4.36–6.70). Women living in a community with high poverty concentration were 32.0% (OR: 0.68, 95% CI 0.50–0.91) less likely to use ANC services than those in a community with low poverty concentration. Women living in a community with a medium concentration of women's modern contraceptive use were almost two times (OR: 1.88, 95% CI 1.70–2.12) more likely to use ANC services than those living in a community with a low concentration of women's modern contraceptive use. Women living in the health area where the level of ANC quality was high were three times (OR: 2.96, 95% CI 1.46–6.12) more likely to use ANC services than those in the health area where the ANC quality was low.ConclusionPolicies that increase the opportunity for improving the average ANC quality at the health facility (HF), the level of women's modern contraceptive use and women employment would likely be effective in increasing the frequency of use of antenatal services.

Using Electronic Health Records to understand the population of local children captured in a large health system in Durham County, NC, USA, and implications for population health research

Although local policies aimed at reducing childhood health inequities can benefit from local data, sample size constraints in population representative health surveys often prevent rigorous evaluations of child health disparities and health care patterns at local levels. Electronic Health Records (EHRs) offer a possible solution as they contain large amounts of information on pediatric patients within a health system. In this paper, we consider the suitability of using EHRs from a large health system to study local children's health by evaluating the extent to which the EHRs capture the county's child population. First, we compare the demographic characteristics of Duke University Health System pediatric patients who live in Durham County, NC (USA) to the child population estimates in the 2015–2019 American Community Survey. We then examine geographic variation in census tract rates of children captured in the EHR data and estimate negative binomial models to assess how tract characteristics are associated with these rates. We also perform these analyses for the subset of pediatric patients who have a well-child encounter. We find that the demographic characteristics of pediatric patients captured by the EHRs are similar to those of the county's child population. Although the county rate of children captured in the EHRs is high, there is variation across census tracts. On average, census tracts with higher concentrations of non-Hispanic Black residents have lower capture rates and tracts with higher concentrations of poverty have higher capture rates, with the poorest tracts showing the largest racial gap in rates of children captured by EHRs. Our findings suggest that EHRs from a large health system can be used to assess children's population health, but that EHR-based evaluations of children's health disparities and health care patterns should account for differences in who is captured by the EHRs based on census tract characteristics.

Association of County-Level Poverty and Inequities With Firearm-Related Mortality in US Youth

Youth firearm-related deaths are a public health crisis in the US. The association between county-level poverty and the risk of firearm-related deaths among youth is unknown, however. To examine the association between county-level poverty concentration and firearm-related mortality rates in US youth. This cross-sectional study analyzed US firearm fatalities in children and young adults aged 5 to 24 years that occurred between January 1, 2007, and December 31, 2016. Data were obtained from the Centers for Disease Control and Prevention's Compressed Mortality File, and annual intercensal county population data were obtained from the US Census Bureau. Data analyses were conducted between November 1, 2019, and June 30, 2020. County-level poverty was categorized into 5 groups: 0% to 4.9%, 5% to 9.9%, 10% to 14.9%, 15% to 19.9%, and ≥20% of the population living below the federal poverty level. The main outcomes were firearm-related deaths in total and by specific intent (homicide, suicide, and unintentional) per 100 000 youths over the entire study period. Multivariable negative binomial regression models were used to analyze the association between firearm-related mortality rates and county poverty concentration, controlling for demographic variables, urbanicity, and statewide firearm prevalence. Adjusted incidence rate ratios (IRRs) were calculated, and statewide firearm prevalence was estimated. The population-attributable fraction (PAF) and years of potential life lost for each intent were calculated. A total of 67 905 firearm-related deaths among youth (predominantly composed of 60 164 male individuals [88.6%]) from 2007 to 2016 were analyzed. Of these deaths, 42 512 were homicides (62.6%), 23 034 were suicides (33.9%), and 1627 were unintentional (2.4%). Firearm-related mortality risk increased in a stepwise manner with increasing county poverty concentration. Compared with counties with the lowest poverty concentration, counties with the highest poverty concentration had an increased rate of total firearm-related deaths (adjusted IRR, 2.29; 95% CI, 1.96-2.67), homicides (adjusted IRR, 3.55; 95% CI, 2.80-4.51), suicides (adjusted IRR, 1.45; 95% CI, 1.20-1.75), and unintentional deaths (adjusted IRR, 9.32; 95% CI, 2.32-37.4). The PAF was 0.51 (95% CI, 0.43-0.57) for all firearm-related deaths, 0.66 (95% CI, 0.57-0.73) for homicides, 0.30 (95% CI, 0.17-0.42) for suicides, and 0.86 (95% CI, 0.46-0.97) for unintentional deaths. This calculation translated to 34 292 firearm-related deaths that would not have occurred if all counties had the same risk as counties with the lowest poverty concentration. A total of 3 833 105 years of potential life lost was observed. This study found an association between firearm-related mortality rates among youth and county-level poverty concentration. With more than half of firearm-related deaths and two-thirds of firearm-related homicides potentially associated with living in an area with a high concentration of poverty, a multidimensional strategy to reduce poverty and firearm-related deaths is urgently needed.

Symbolic domination in the neoliberal city: space, class, and residential stigma

ABSTRACT This study examines how perceptions of residential reputation and stigma vary according to differences in social class and spatial structures. The focus of our inquiry is the city of Santiago, Chile – a highly segregated city in Latin America. We suggest that residential stigma is the focus of a larger assemblage of material and non-material marginalization; it is a point of convergence of multiple forms of social stratification. We combine a representative survey of 600 residents with geo-referenced census data, building composite measures to represent concrete class and spatial structures using clustering techniques. Results reveal that living in more affluent segregated areas is associated with a better perceived residential reputation, whereas perceived residential stigma is greater in geographical areas with a high concentration of poverty, land devaluation, population density, and overcrowding, regardless of whether these areas present high levels of criminality. Interestingly, when we include social class along with the spatial structure, the former loses significance as a predictor of both perceived residential reputation and stigma. The spatial structure therefore goes some way toward mediating the relationship between class and perceived residential reputation. This suggests the need for public policies designed to reduce the current symbolic domination that exists in Santiago.

Effects of New Jersey's Abbott preschool program on children's achievement, grade retention, and special education through tenth grade

Relatively few studies provide rigorous estimates of the long-term effects of large-scale public preschool programs, and their findings vary greatly. This study investigates the effects in third through tenth grade of New Jersey's Abbott preschool program which has many of the features and contexts hypothesized to mitigate fadeout. The program was designed and implemented in the context of a Court mandated systemic reform of education and its funding from preschool through high school. We describe in detail the program's features including an extensive, multitiered continuous improvement system. Sample size for analyses ranged from 426 to 785 depending on the grade and assessment. Participants were primarily Black and Hispanic students living in 31 communities with high concentrations of poverty. Inverse weighting by propensity scores was employed with multiple imputation for missing data to estimate effects on achievement, grade retention, and special education. Substantial positive effects were found in language arts and literacy, mathematics, and science on statewide assessments. Effects did not fade after grade 3. Achievement effects appear to be larger for 2-year than 1-year of the preschool program. Grade retention was significantly lower through grade 10. Effects on special education placement were imprecisely estimated but consistent with other findings of reduced special education. Results were robust with respect to alternative methods to control for measured and unmeasured differences between preschool and comparison groups and for missing data. This study adds to the evidence on preschool program features and contexts associated with long-term effects.

Still the Linchpin: Segregation and Stratification in the USA

High levels of black residential segregation emerged over the course of the twentieth century as the black population urbanized. Segregation was achieved by means of different mechanisms at different times and places, beginning with targeted violence directed at African Americans followed later by discrimination in real estate and banking using devices such as deed restrictions, restrictive covenants, and racial redlining, practices that were institutionalized in federal policies during the New Deal. By 1977, however, discrimination had been outlawed in most US markets and average black segregation began to decline. The declines, however, were inversely proportional to the size of the black community. As Latinos grew in number after the 1970s, levels of racial isolation within Hispanic neighborhoods also rose. At the same time, class segregation increased, especially among families with children, and inequalities of wealth and income grew to create a polarized urban geography. High concentrations of affluence now prevail for affluent whites and Asians living in wealthy post-industrial coastal areas, with high concentrations of poverty prevailing for poor blacks and Hispanics in older, declining industrial areas in the Midwest and the South, which also contain pockets of white and Asian poverty. The new political geography of race and class effectively denies blacks and Hispanics their access to quality education and undermines their lifetime earning prospects to create self-perpetuating system of social and economic stratification.

La esencia del capital social en comunidades rurales de migrantes. Estudio de caso Tula, Tamaulipas, México

Este ensayo discute el tema de la confianza que incide en la formación del capital social y su rela-ción con el uso de las remesas de las comunidades de migrantes. El propósito de este trabajo es refle-xionar sobre las causas de porqué, existiendo un fuerte capital social en las asociaciones de migran-tes, esta confianza y cohesión de participación ciu-dadana para gestionar las remesas colectivas, no es permeada en las familias y comunidades de origen del migrante, principalmente en los municipios con alta concentración de pobreza y marginación, como es el caso del municipio de Tula, Tamaulipas. Al respecto, se tiene como supuesto que las asociacio-nes de migrantes organizados, están bien cohesio-nados y enfrentan las problemáticas económicas de sus lugares de origen, porque confían en las autori-dades y en los programas públicos, sin embargo, los miembros e integrantes de la sociedad de las familias de origen, por falta de capacitación y des-conocimiento de los programas públicos, no tienen la confianza en crear redes locales, ni el interés de participar en posible proyectos financiados con las remesas.

Assessment of teaching to predict gains in student achievement in urban schools.

We examined the degree to which assessment of teachers' instructional and behavior management practices, as measured by the Classroom Strategies Assessment System (CSAS; Reddy & Dudek, 2014), relates to gains in student achievement as measured by the Measures of Academic Progress (Northwest Evaluation Association [NWEA], 2011). Two-level hierarchical linear modeling was applied to achievement scores from 2,771 students in 130 kindergarten through 8th-grade classrooms in 13 urban schools serving students in communities with high concentrations of poverty. Results suggest that teachers' use of evidence-based instructional and behavior management strategies, as measured by the CSAS, were associated with reading and mathematics gains. In general, students in classrooms with higher quality use of evidence-based teaching strategies exhibited greater gains, whereas students in classrooms with lower quality use of effective strategies exhibited lesser gains. Implications of these findings for research and educational practice are presented. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Poverty, Neighbourhood Antisocial Behaviour, and Children's Mental Health Problems: Findings from the 2014 Ontario Child Health Study.

Objectives:To determine if levels of neighbourhood poverty and neighbourhood antisocial behaviour modify associations between household poverty and child and youth mental health problems.Methods:Data come from the 2014 Ontario Child Health Study—a provincially representative survey of 6537 families with 10,802 four- to 17-year-olds. Multivariate multilevel modelling was used to test if neighbourhood poverty and antisocial behaviour interact with household poverty to modify associations with children’s externalizing and internalizing problems based on parent assessments of children (4- to 17-year-olds) and self-assessments of youth (12- to 17-year-olds).Results:Based on parent assessments, neighbourhood poverty, and antisocial behaviour modified associations between household poverty and children’s mental health problems. Among children living in households below the poverty line, levels of mental health problems were 1) lower when living in neighbourhoods with higher concentrations of poverty and 2) higher when living in neighbourhoods with more antisocial behaviour. These associations were stronger for externalizing versus internalizing problems when conditional on antisocial behaviour and generalized only to youth-assessed externalizing problems.Conclusion:The lower levels of externalizing problems reported among children living in poor households in low-income neighbourhoods identify potential challenges with integrating poorer households into more affluent neighbourhoods. More important, children living in poor households located in neighbourhoods exhibiting more antisocial behaviour are at dramatically higher risk for mental health problems. Reducing levels of neighbourhood antisocial behaviour could have large mental health benefits, particularly among poor children.

Measuring teacher practices and student academic engagement: A convergent validity study.

We examined the convergent validity of observer ratings of teachers' use of evidence-based instructional and behavior management practices using the Classroom Strategies Assessment System (CSAS; Reddy & Dudek, 2014) with student academic engagement as measured by the Cooperative Learning Observational Code for Kids (CLOCK; Volpe & DiPerna, 2010). This study was conducted with a sample of 107 teachers and 2,000 students in 11 urban elementary schools serving students in a community with high concentrations of poverty. Correlational and multiple linear regression analyses examined whether CSAS instructional and behavior management scores predicted classwide academic engagement. Results provide initial evidence of the relationship between observer ratings of teacher practices and student engagement. Specifically, CSAS scores indicating higher quality instruction and behavior management were associated with higher student engagement. Multiple linear regression revealed that instructional practice scores (as measured by the CSAS) uniquely predicted student academic engagement (i.e., attention and participation during instruction) while behavior management practice scores did not. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Is Mother’s Education or Household Poverty a Better Predictor for Girl’s School Dropout? Evidence from Aggregated Community Effects in Rural India

Neighbourhoods and families are key social institutions instilled with development of early life course of adolescents. Limited research in India has examined exposure to community along with socioeconomic conditions for school-dropouts of girls. Multidimensional benefits of female education are increasingly recognized in recent years; hence, it becomes imperative to study the community components of school discontinuation particularly in rural area. This study aims to analyse effect of mother’s education, community poverty, and gender equitable attitudes associated with a girl’s school dropout. This study uses baseline survey data from an intervention program from poor-performing districts of India. Collinearity among individual predictors validated by variance inflation factor proceeded step-wise binary-logistic regression. Result suggests that communities with high concentrations of poverty and mother illiteracy are disadvantages with low gender perception and high levels of dropouts. Result suggests that girls living in poor communities are three times more likely to dropout and 70% more if belonged to communities with lower mother literacy. Girls who scored low on Gender Equitable Scale had less probability to dropout. The study concludes that girls from poor communities with low levels of mother literacy and non-egalitarian gender attitudes are at higher risk of school dropout.

Affordable Housing and the Socioeconomic Integration of Elementary Schools

Children from poor families achieve more academically if they are enrolled in schools that are socioeconomically integrated, but low-income students are increasingly attending schools characterized by high concentrations of poverty. Providing more housing opportunities for low-income families within the attendance zones of middle- and high-income schools has the potential to reverse this trend, but the link between the housing stock and the socioeconomic segregation of public schools has not been addressed in the existing literature. Using a panel of elementary schools in Florida, we show that increasing the stock of rental and affordable housing units in middle- and high-income neighborhoods has an important effect on the number of poor children attending these schools. Our results also reveal the types of housing units that have the largest impacts on socioeconomic segregation.

Identifying regional poverty types in Slovakia

Even today the poverty is an important negative social phenomenon with evident spatial dimension. Areas with high poverty concentration constitute poverty regions with plenty of common but also different or specific characteristics. Research into the specific poverty features in regions lags behind that of the common characteristics and character of poverty. The aim is to show one of ways to carry out typification of poverty regions (on example of Slovakia). A universal conceptual and methodological frame applicable to any country is presented. Regional poverty types were sorted out by application of the hierarchical agglomerative methods of cluster analysis (Ward’s method) with nine indicators capturing the generally applicable dimensions, which determine poverty and profile of poverty regions. Results confirmed the presumption that the different economic, social, demographic, cultural and other different conditions and population structure in regions may determine the character of poverty. Obtained knowledge points not only to the particular population groups, which require attention but also to the regional poverty types that should be identified for the efficient fight against poverty in these regions.

Scott W.AllardPlaces in Need: The Changing Geography of PovertyNew York: Russell Sage Foundation, 2017. 288 p. $32.50 (pbk.).

Scott W.AllardPlaces in Need: The Changing Geography of PovertyNew York: Russell Sage Foundation, 2017. 288 p. $32.50 (pbk.).

Independent Effects of Neighborhood Poverty and Psychosocial Stress on Obesity Over Time.

The objective of the study was to examine the independent effects of neighborhood poverty and psychosocial stress on increases in central adiposity over time. Data are from a community sample of 157 Non-Hispanic Black, Non-Hispanic White, and Hispanic adults collected in 2002-2003 and 2007-2008, and from the 2000 Decennial Census. The dependent variable was waist circumference. Independent variables included neighborhood poverty, perceived neighborhood physical environment, family stress, safety stress, everyday unfair treatment, and a cumulative stress index. Weighted 3-level hierarchical linear regression models for a continuous outcome were used to assess the effects of neighborhood poverty and psychosocial stress on central adiposity over time. We also assessed whether psychosocial stress mediated the association between neighborhood poverty and central adiposity. Neighborhood poverty and everyday unfair treatment at baseline were independently associated with increases in central adiposity over time, accounting for the other indicators of stress. Perceptions of the neighborhood physical environment and cumulative stress mediated associations between neighborhood poverty and central adiposity. Results suggest that residing in neighborhoods with higher concentrations of poverty and exposure to everyday unfair treatment independently heighten risk of increased central adiposity over time. Associations between neighborhood poverty and central adiposity were mediated by perceptions of the neighborhood physical environment and by the cumulative stress index. Public health strategies to reduce obesity should consider neighborhood poverty and exposure to multiple sources of psychosocial stress, including everyday unfair treatment.

Did Health Care Reform Help Kentucky Address Disparities in Coverage and Access to Care among the Poor?

To evaluate the impact of Kentucky's full rollout of the Affordable Care Act on disparities in access to care due to poverty. Restricted version of the Behavioral Risk Factor Surveillance System (BRFSS) for Kentucky and years 2011-2015. We use a difference-in-differences framework to compare trends before and after implementation of the Affordable Care Act (ACA) in health insurance coverage, several access measures, and health care utilization for residents in higher versus lower poverty ZIP codes. Much of the reduction in Kentucky's uninsured rate appears driven by large uptakes in coverage from areas with higher concentrations of poverty. Residents in high-poverty communities experienced larger reductions, 8 percentage points (pp) in uninsured status and 7.5pp in reporting unmet needs due to costs, than residents of lower poverty areas. These effects helped remove pre-ACA disparities in uninsured rates across these areas. Because we observe positive effects on coverage and reductions in financial barriers to care among those from poorer communities, our findings suggest that expanding Medicaid helps address the health care needs of the impoverished.