Large African American Population Research Articles

“Stop the Steal”: Racial Resentment, Affective Partisanship, and Investigating the January 6th Insurrection

Our analysis of data from a nationally representative survey of adults shows that beliefs in whether the January 6th insurrection was justifiable and whether it required investigation through the creation of the U.S. House Select Committee are inexorably steeped in affective partisanship and racial resentment. It is easy to attribute the insurrection to partisan machinations, but evidence shows that racial resentment is the dominant explanation: this includes the fact that allegations of election fraud were centered on districts with large African American and Latino populations; that many of the insurrectionists were white nationalists, racists, and members of radical right-wing groups; and that a large proportion of the electorate had voted to retain a president who fueled whites’ sense of victimization by African Americans and other minorities. We argue that reactions to the legitimacy of the January 6th insurrection have become an example of how racial resentment fuels affective partisanship.

Identifying community-level disparities in access to driver education and training: Toward a definition of driver training deserts

Objective Obtaining a license may be challenging for teens due to access to driving instruction; in some states, behind-the-wheel (BTW) instruction is required to secure a license before age 18. We investigate spatial accessibility to BTW centers, and how this geographic distribution intersects with metrics of social disparity at the metropolitan level, toward identifying Driver Training Deserts (DTDs): geographic areas of disconnection to driver training. Methods For the Columbus OH region, we collect socioeconomic variables at the Census tract unit of analysis and geocoded locations of public and private BTW training centers and estimate travel time to the nearest BTW training center. We define travel time as either the mean or the maximum travel time to BTW centers across all 1 km × 1 km grid cells within a Census tract. We employ spatial statistical approaches, including homogeneous/inhomogeneous K functions, to determine whether BTW training centers are clustered. Next, we define DTDs as Census tracts with a poverty rate and travel time to BTW centers larger than the 75th percentile values across the region. Results BTW training centers are spatially clustered across the region; the magnitude of this clustering is so great that BTW centers exhibit statistically significant patterns of clustering, even when considering the underlying spatial distribution of socio-economic characteristics. We find that 11–27 Census tracts are identified as DTDs depending on the definition of travel time. DTDs contain a disproportionate percent of the high poverty population (8.7–23.5%) and, depending on the definition of travel time, a disproportionately large African American population. Conclusions Methodologically, defining DTDs necessitates a fine-grained spatial approach as suburban and rural Census tracts tend to be large and thus can be poorly represented by travel times averaged over the Census tract. Defining DTDs as a measure of individual-specific variables – income and impedance – allows DTDs to be addressed with policy interventions. The findings motivate future research correlating DTDs with licensure rates, enrollment in driver training, and safe driving outcomes to understand if DTDs can help explain health equity outcomes related to young driver safety.

Understanding public perspectives on fracking in the United States using social media big data

ABSTRACT People’s attitudes towards hydraulic fracturing (fracking) can be shaped by socio-demographics, economic development, social equity and politics, environmental impacts, and fracking-related information. Existing research typically conducts surveys and interviews to study public attitudes towards fracking among a small group of individuals in a specific geographic area, where limited samples may introduce bias. Here, we compiled geo-referenced social media big data from Twitter during 2018–2019 for the entire United States to present a more holistic picture of people’s attitudes towards fracking. We used a multiscale geographically weighted regression (MGWR) to investigate county-level relationships between the aforementioned factors and percentages of negative tweets concerning fracking. Results indicate spatial heterogeneity and varying scales of those associations. Counties with higher median household income, larger African American populations, and/or lower educational level are less likely to oppose fracking, and these associations show global stationarity in all contiguous US counties. Eastern and Central US counties with higher unemployment rates, counties east of the Great Plains with less fracking sites nearby, and Western and Gulf Coast region counties with higher health insurance enrolments are more likely to oppose fracking activities. These three variables show clear East-West geographical divides in influencing public perspective on fracking. In counties across the southern Great Plains, negative attitudes towards fracking are less often vocalized on Twitter as the share of Republican voters increases. These findings have implications for both predicting public perspectives and needed policy adjustments. The methodology can also be conveniently applied to investigate public perspectives on other controversial topics.

669 Evaluation and efficacy of skin of color dermatology education among underserved adolescents

Melanoma education among underserved adolescents is limited as per a review of current literature. This study focused on educating and promoting knowledge of melanoma pertaining to skin of color, in addition to common dermatological conditions with the target population of underserved high students in Detroit Michigan. Detroit Michigan was chosen because it has a large African American population. Students in underserved areas are at a greater disadvantage when it comes to exposure to dermatology and knowledge of dermatology-related conditions.

The impact of obesity on triple negative breast cancer (TNBC) outcomes at a diverse academic cancer center.

e12529 Background: Multiple studies have linked obesity (BMI ≥30 kg/m2) to poor outcomes from triple negative breast cancer (TNBC). To further explore the association between obesity and TNBC, we conducted a retrospective chart review at our institution to examine the association of race and obesity with disease free survival (DFS) and pathologic complete response (pCR) rates. Our institution is a unique setting in which to study this because of its large African-American (AA) pt population relative to other academic medical centers in the United States. Methods: A chart review of 247 early-stage TNBC pts treated from 2004- 2017 was conducted. All cases were retrieved from pathology archival reports. Of these 247 pts, 116 were treated with adjuvant chemotherapy and 131 were treated with neoadjuvant chemotherapy (NAT). Pts were categorized as obese (BMI = / > 30) and non-obese (BMI < 30), AA [n = 151], Caucasian [n = 84], other [n = 11], and missing [n = 1]. The association of race and BMI with pCR following NAT (for the NAT group), and the association of race and BMI with DFS (for all pts) was evaluated. Results: 50.3% of AA pts and 32% of Caucasians were obese. 43% of obese pts had node-positive disease at diagnosis, compared with 31% of non-obese pts. Among the node-positive TNBC pts, non-obese pts had a trend towards a longer DFS than obese pts with a HR 0.80 (95% CI 0.37 – 1.71) and a non-statistically significant p-value of 0.562. We evaluated pCR rates based on race and BMI. Among AA pts, 56.9% did not achieve pCR after NAT, and of these pts 44.4% were obese; 43.1% achieved pCR and of these 58.8% were obese (p = 0.206). Among Caucasian pts, 65% did not achieve pCR, and of these 43.3% were obese; of the 35% of Caucasian pts who achieved pCR, 31.25% were obese (p = 0.424). Among pts who eventually developed distant metastases, there was a strong trend towards shorter DFS in the obese group, with a HR 1.92 (95% CI 0.94-3.95) and a non-statistically significant p-value of 0.075. Conclusions: In this sizable population of TNBC pts at a racially diverse academic medical center, obesity was associated with a higher incidence of nodal involvement at diagnosis, and shorter interval of time to development of distant metastatic disease. Race was not found to impact pCR or DFS in a statistically significant way. This could have been related to small sample size (particularly in the NAT group), or because some socioeconomic variables often tied to poor outcomes among minority pts may have been minimized in this study. The association of obesity with node positivity at diagnosis and with shorter interval times for development of metastases highlights the importance of adopting initiatives to minimize obesity in oncology practices and in the primary care setting. Improving access to healthy food and to safe spaces for exercise will help to prevent obesity, and thus may reduce the risk of developing TNBC and improve breast cancer outcomes among all pts, regardless of race.

Assessment of Structural Barriers and Racial Group Disparities of COVID-19 Mortality With Spatial Analysis

Although social determinants of health (SDOH) are important factors in health inequities, they have not been explicitly associated with COVID-19 mortality rates across racial and ethnic groups and rural, suburban, and urban contexts. To explore the spatial and racial disparities in county-level COVID-19 mortality rates during the first year of the pandemic. This cross-sectional study analyzed data for all US counties in 50 states and the District of Columbia for the first full year of the COVID-19 pandemic (January 22, 2020, to February 28, 2021). Counties with a high concentration of a single racial and ethnic population and a high level of COVID-19 mortality rate were identified as concentrated longitudinal-impact counties. The SDOH that may be associated with mortality rate across these counties and in urban, suburban, and rural contexts were examined. The 3 largest racial and ethnic groups in the US were selected: Black or African American, Hispanic or Latinx, and non-Hispanic White populations. County-level characteristics and community health factors (eg, income inequality, uninsured rate, primary care physicians, preventable hospital stays, severe housing problems rate, and access to broadband internet) associated with COVID-19 mortality. Data on county-level COVID-19 mortality rates (deaths per 100 000 population) reported by the US Centers for Disease Control and Prevention were analyzed. Four indexes were used to measure multiple dimensions of SDOH: socioeconomic advantage index, limited mobility index, urban core opportunity index, and mixed immigrant cohesion and accessibility index. Spatial regression models were used to examine the associations between SDOH and county-level COVID-19 mortality rate. Of the 3142 counties included in the study, 531 were identified as concentrated longitudinal-impact counties. Of these counties, 347 (11.0%) had a large Black or African American population compared with other counties, 198 (6.3%) had a large Hispanic or Latinx population compared with other counties, and 33 (1.1%) had a large non-Hispanic White population compared with other counties. A total of 489 254 COVID-19-related deaths were reported. Most concentrated longitudinal-impact counties with a large Black or African American population compared with other counties were spread across urban, suburban, and rural areas and experienced numerous disadvantages, including higher income inequality (297 of 347 [85.6%]) and more preventable hospital stays (281 of 347 [81.0%]). Most concentrated longitudinal-impact counties with a large Hispanic or Latinx population compared with other counties were located in urban areas (114 of 198 [57.6%]), and 130 (65.7%) of these counties had a high percentage of people who lacked health insurance. Most concentrated longitudinal-impact counties with a large non-Hispanic White population compared with other counties were in rural areas (23 of 33 [69.7%]), included a large group of older adults (26 of 33 [78.8%]), and had limited access to quality health care (24 of 33 [72.7%]). In urban areas, the mixed immigrant cohesion and accessibility index was inversely associated with COVID-19 mortality (coefficient [SE], -23.38 [6.06]; P < .001), indicating that mortality rates in urban areas were associated with immigrant communities with traditional family structures, multiple accessibility stressors, and housing overcrowding. Higher COVID-19 mortality rates were also associated with preventable hospital stays in rural areas (coefficient [SE], 0.008 [0.002]; P < .001) and higher socioeconomic status vulnerability in suburban areas (coefficient [SE], -21.60 [3.55]; P < .001). Across all community types, places with limited internet access had higher mortality rates, especially in urban areas (coefficient [SE], 5.83 [0.81]; P < .001). This cross-sectional study found an association between different SDOH measures and COVID-19 mortality that varied across racial and ethnic groups and community types. Future research is needed that explores the different dimensions and regional patterns of SDOH to address health inequity and guide policies and programs.

Design and Rationale for the Deep South Interactive Voice Response System-Supported Active Lifestyle Study: Protocol for a Randomized Controlled Trial.

BackgroundThe rates of physical inactivity and related cancer incidence and mortality are disproportionately high in the Deep South region in the United States, a rural, medically underserved region with a large African American population compared with the rest of the nation. Given this region’s lower rates of literacy and internet access, interactive voice response (IVR) system–automated telephone-based interventions have the potential to help overcome physical activity intervention barriers (literacy, internet access, costs, and transportation) but have yet to be extended to rural, underserved populations, such as in the Deep South. Thus, extensive formative research is being conducted to develop and beta test the Deep South IVR System–Supported Active Lifestyle intervention in preparation for dissemination in rural Alabama counties.ObjectiveThis paper aims to describe the design and rationale of an ongoing efficacy trial of the Deep South IVR System–Supported Active Lifestyle intervention.MethodsA two-arm randomized controlled trial will be conducted to compare a 12-month physical activity intervention versus a wait-list control condition in 240 underactive adults from 6 rural Alabama counties. The Deep South IVR System–Supported Active Lifestyle intervention is based on the Social Cognitive Theory and includes IVR-automated physical activity–related phone counseling (daily in months 0-3, twice weekly in months 4-6, and weekly in months 7-12) and support from local rural county coordinators with the University of Alabama O’Neal Comprehensive Cancer Center Community Outreach and Engagement Office. The primary outcome is weekly minutes of moderate- to vigorous-intensity physical activity (7-day physical activity recall; accelerometry) at baseline, 6 months, 12 months, and 18 months. Rural Active Living Assessments will be conducted in each rural county to assess walkability, assess recreational amenities, and inform future environment and policy efforts.ResultsThis study was funded in March 2019 and approved by the institutional review board of the University of Alabama at Birmingham in April 2019. As of February 2020, start-up activities (hiring and training staff and purchasing supplies) were completed. Study recruitment and assessments began in September 2020 and are ongoing. As of February 2021, a total of 43 participants have been enrolled in Dallas County, 42 in Sumter County, and 51 in Greene County.ConclusionsIVR-supported phone counseling has great potential for addressing physical activity barriers (eg, culture, literacy, cost, or transportation) and reducing related rural health disparities in this region.Trial RegistrationClinicalTrials.gov NCT03903874; https://clinicaltrials.gov/ct2/show/NCT03903874.International Registered Report Identifier (IRRID)DERR1-10.2196/29245

Abstract OT-21-01: Personalized breast cancer screening in a population-based study: Women informed to screen depending on measures of risk (WISDOM)

Abstract Background: WISDOM is a 100,000 healthy women preference-tolerant, pragmatic study comparing traditional annual screening to personalized risk-based breast screening. The novelty of WISDOM personalized screening is the integration of previously validated genetic and clinical risk factors (age, family history, breast biopsy results, ethnicity, mammographic density) into a single risk assessment model that directs the starting age, timing, and frequency of screening. The goal of WISDOM is to determine if personalized screening, compared to annual screening, is as safe, less morbid, enables prevention, and is more accepted by women. The study is registered on ClinicalTrials.gov, NCT02620852. Methods: Women aged 40-74 years with no history of breast cancer, DCIS or previous double mastectomy can join the study online at wisdomstudy.org. Participants can either elect randomization or self-select a study arm. Then, they provide electronic consent and sign the Release for Medical Information via DocuSign. For all participants, 5-year risk of developing breast cancer is calculated according to the Breast Cancer Surveillance Consortium (BCSC) model. Participants in the personalized arm undergo panel-based mutation testing (BRCA1, BRCA2, TP53, PTEN, STK11, CDH1, ATM, PALB2, and CHEK2), and their 5-year risk is calculated using the BCSC score combined with a Polygenic Risk Score (BCSC-PRS) that includes 229 single nucleotide polymorphisms (SNPs) known to increase breast cancer risk. The SNPs and mutations are assessed by saliva-based testing through Color Genomics. Five-year risk level thresholds are used to stratify participants as low-, moderate- and high risk. Risk stratification determines age to start, stop, and frequency of screening in the personalized arm. Accrual: As of July 2020 the WISDOM Study is open to all eligible women in the United States. To date, 38,762 eligible women have registered, and 28,706 women have consented to participate in the trial. The median age is 56 years. Seventy-seven percent of participants are Caucasian, 2% African-American, 5% Asian, and 8% of self-reported Hispanic ethnicity. WISDOM is partnering with Blue Cross Blue Shield Association for regional plan opt-in coverage, self-insured companies (Salesforce, Genentech, Qualcomm, CalPERS) and Medi-Cal (Inland Empire Health Plan) using a coverage with evidence progression approach. Accrual expansion and diversity: To ensure that resulting data are meaningful and potentially practice-changing for all populations of women, the WISDOM Study is enhancing the diversity of our participant population by establishing WISDOM sites in diverse areas with large African-American (Alabama, Louisiana, Illinois) and Latina (Florida) populations. These new recruitment sites, intentionally selected for the diverse communities they serve, have established partnerships with community organizations and outreach navigators. Additionally, we have translated the WISDOM Study to Spanish to facilitate access by Latina communities. With the engagement of patient advocates and community partnerships, expanding diversity in the study population will strengthen our scientific knowledge of breast cancer risk and improve access to personalized breast cancer screening recommendations for all women. Enrollment will continue through 2022. Conclusions: Results of 5 years follow-up will enable us to demonstrate whether personalized screening improves outcomes for future patients and it improves healthcare value by reducing screen volumes and costs without jeopardizing outcomes. Citation Format: Irene Acerbi, Allison Stover Fiscalini, Mandy Che, Yiwey Shieh, Lisa Madlensky, Jeffrey Tice, Elad Ziv, Martin Eklund, Amie Blanco, Barry Tong, Deborah Goodman, Lamees Nassereddine, Nancy Anderson, Heather Harvey, Steele Fors, Hannah L Park, Antonia Petruse, Skye Stewart, Janet Wernisch, Larissa Risty, Ian Hurley, Barbara Koenig, Celia Kaplan, Robert Hiatt, Neil Wenger, Vivian Lee, Diane Heditsian, Susie Brain, Leah Sabacan, Tianyi Wang, Barbara A Parker, Alexander Borowsky, Hoda Anton-Culver, Arash Naeim, Andrea Kaster, Melinda Talley, Laura van 't Veer, Andrea Z LaCroix, Olufunmilayo I Olopade, Deepa Sheth, Augustin Garcia, Rachel Lancaster, Wisdom Study and Athena Breast Health Network Investigators and Advocate Partners, Laura Esserman. Personalized breast cancer screening in a population-based study: Women informed to screen depending on measures of risk (WISDOM) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-21-01.

COVID-19-Associated Coagulopathy: Safety and Efficacy of Prophylactic Anticoagulation Therapy in Hospitalized Adults with COVID-19

Background:COVID-19-associated coagulopathy increases mortality in patients with COVID-19 infection. The International Society of Thrombosis and Hemostasis (ISTH) has published a guidance document recommending thromboprophylaxis with low-molecular weight heparin (LMWH) for all hospitalized patients with COVID-19. Despite standard dose LMWH thromboprophylaxis, arterial and venous thrombotic events occur in up to 30-40% of COVID-19 patients admitted to the intensive care unit (ICU). It is not known if patients with coagulopathy from COVID-19 benefit from higher levels of prophylactic anticoagulation therapy. No data exist regarding the comparative safety or efficacy of intermediate dose versus standard prophylactic dose LMWH.Study Design and Methods:This is a multi-center, randomized, open-label study (NCT04360824) comparing standard prophylactic dose enoxaparin (40 mg SC daily if BMI < 30 kg/m2; 30 mg SC twice daily or 40 mg SC twice daily if BMI ≥ 30 kg/m2) versus intermediate-weight adjusted dose enoxaparin (1 mg/kg SC daily if BMI < 30 kg/m2 or 0.5 mg/kg SC twice daily if BMI ≥ 30 kg/m2) in hospitalized patients with laboratory-confirmed SARS-CoV-2 infection who are either admitted to an intensive care unit or have a modified ISTH Overt DIC score ≥ 3.Objectives:The primary endpoint is to compare all-cause 30-day mortality of patients treated with standard prophylactic dose versus intermediate-dose enoxaparin. The secondary endpoints are to determine whether the use of standard prophylactic dose versus intermediate dose enoxaparin impacts major bleeding, arterial thrombosis, venous thrombosis, time to intubation or transfusion of blood products. The exploratory endpoints are to determine the effects of SARS-CoV-2 infection on laboratory coagulation parameters to better understand the mechanism of COVID-19 coagulopathy compared to healthy control subjects; parameters include citrullinated histone H3 (H3Cit), a component of neutrophil extracellular traps. The null hypothesis is that intermediate dose enoxaparin (intervention arm) will have a mortality rate that is not less than standard prophylactic dose enoxaparin (standard of care arm). Assuming a true margin of 20%, a sample size of 82 patients in each arm of the study is required to have 80% power when testing for a difference.Baseline Data:Three centers are currently enrolling patients. As of August 1, 2020, we have enrolled 52 patients (28 males and 24 females) with a median age of 61 years (range 24-80). 51% were Caucasian, 36% Hispanic, and 16% other ethnicities. Median BMI was 31 kg/m2 (range 20-52). Baseline D-Dimer was elevated in 95% of participants with a median of 2.23 mg/mL (range 0.39-40.32). The majority of participants had normal baseline PT, PTT, and platelet levels. All patients had fibrinogen levels over 100 mg/dL with a median of 607 mg/dL. Plasma H3Cit was elevated significantly in patients with COVID-19 (n = 21) vs healthy control subjects (n = 10) (6.48 vs 1.09 ng/mL, P = 0.001).Conclusion:Baseline data for the first 52 patients enrolled confirm the presence of multiple risk factors for thrombosis such as elevated BMI, D dimer, and plasma markers of neutrophil extracellular traps. In contrast to initial reports from China, the prevalence of thrombocytopenia and hypofibrinogenemia was very low in our cohort. Hispanics represented 36% of our study population, compared with 19% of overall COVID-19 infections in the region, suggesting a higher severity of illness in this subpopulation. The enrollment of this trial is ongoing with the addition of sites that have larger African American populations. As safety and efficacy data mature, this study will help clarify the optimum dose of prophylactic enoxaparin to prevent COVID-19 associated coagulopathy.DisclosuresNo relevant conflicts of interest to declare.

Some Factors in State TANF Participation by Immigrants: An Examination Using the Group Threat Hypothesis

ABSTRACT This study asked what happens as the proportion of immigrants on states’ Temporary Assistance for Needy Families (TANF) rolls changes, employing the group threat hypothesis to analyze data dating 2000–2017. The data examined were extracted from compilations of information by federal agencies indicating states’ population by race/ethnicity, poverty and unemployment rates, and TANF participation by immigrants (as a percentage of total participation). Results showed states with relatively larger African American populations often had a lower percentage of immigrants enrolled in their TANF programs. Results also showed a negative association between percentage of TANF participation by immigrants and state unemployment rate. Policy implications are discussed.

How structural racism can kill cancer patients: Black patients with breast cancer and other malignancies face historical inequities that are ingrained but not inevitable. In this article, the second of a 2-part series, we explore the consequences of and potential solutions to racism and inequality in cancer care.

How structural racism can kill cancer patients: Black patients with breast cancer and other malignancies face historical inequities that are ingrained but not inevitable. In this article, the second of a 2-part series, we explore the consequences of and potential solutions to racism and inequality in cancer care.

Race and Education in New Orleans: Creating the Segregated City, 1764–1960 by Walter C. Stern

Reviewed by: Race and Education in New Orleans: Creating the Segregated City, 1764–1960 by Walter C. Stern Andrew Busch Race and Education in New Orleans: Creating the Segregated City, 1764–1960. By Walter C. Stern. Making the Modern South. (Baton Rouge: Louisiana State University Press, 2018. Pp. xx, 354. $49.95, ISBN 978-0-8071-6918-6.) The role of public schools as agents of urban segregation, rather than as sites where battles over segregation unfolded, is an understudied topic in southern scholarship and in national discourse. In Race and Education in New Orleans: Creating the Segregated City, 1764–1960, Walter C. Stern argues that to fully understand the hypersegregation of post–World War II American cities, we must also understand the role that public schools played in urban planning, in residents' perceptions of the city, and most important, in how urban land was valued. Ultimately, Stern argues, public school placement in the early twentieth century created, rather than simply reflected, racial geography in New Orleans. As the era of desegregation approached, both black and white New Orleans residents were already well versed in the role of schools in the city's racial geography. The predictable and sad outcome was a school system and a city that [End Page 467] consistently and overwhelmingly reflected "the construction and institutionalization of white supremacy" (p. 7). While the title suggests a narrative that spans two centuries, most of the book focuses on the late nineteenth and early twentieth centuries. Stern uses a wide and impressive variety of primary sources to support his argument that this period is crucial to understanding segregation in postwar cities. He employs newspaper articles, school board minutes, correspondence, and Sanborn insurance maps, among other documents. After chapter 1 discusses African American agency in the public school system through Reconstruction, chapters 2 through 5 analyze the relationship among race, schools, and urban planning in the first three decades of the twentieth century. In many southern cities, segregation took on a much stronger geographical component during these years; this pattern was particularly true in New Orleans, where environmental hazards limited the amount of land that could be developed as the city grew. Chapter 3 investigates the transformation of the Third Ward from an economically and racially mixed neighborhood into one that was predominantly African American. Here, racial mixing allowed officials to designate the neighborhood as black and then build a black school; white families soon fled the area. This outcome is an interesting and powerful example of how the placement of a black school destabilized a neighborhood, even as it increased educational opportunities for black children. Chapter 4 is a focused case study of the Bayou Road School, a black school that became the site of significant white protests after funding was cut across the district. Chapter 5 looks at how new water technology, racially restrictive covenants, and zoning laws all supported new white areas on the city's periphery and, consequently, promoted stricter segregation and isolation for black residents in the central city. By World War II, the pattern of segregation, now supported by the federal government as well as municipal authorities, was fully established. The 35,000 black people who migrated to New Orleans in the 1940s found severe residential segregation, overcrowded schools, and little opportunity. Race and Education in New Orleans is a notable contribution to the history of urban development and racial geography in the South. It makes two strong claims that should be interesting for scholars of urban history and geography, race relations, and education. First, Stern encourages scholars to look to the World War I era, rather than the post-World War II era, to find the roots of urban segregation and discrimination. In my opinion, this development is especially true of southern cities, which often had both larger African American populations and Jim Crow laws; residents and lawmakers in the South fought their battles much earlier than those in the better-studied cities of the Northeast and Midwest. Second, by claiming that battles over schools led to urban transformation, Stern opens up fresh debate about the very complex nature of racial discrimination in urban America. Certainly, housing policies, market mechanisms, and federal intervention...

Illegal Self-Emancipation in the Urban Upper South, 1800-1860

Contrary to common assumptions that self-emancipation by flight was only possible to regions outside the southern states, this article argues that many slaves actively took and preserved their freedom by hiding amongst free African American populations in urban areas. In the late eighteenth and early nineteenth centuries, free black communities within the slaveholding southern states emerged or were bolstered as a result of an increase in manumissions. For many African-American slaves, it was an age of emancipation. Yet for most enslaved people living in the US South it was a period of intensification and expansion of human bondage. The developments of the time provided more slaves with new opportunities to escape slavery by fleeing to free black communities. The concept of illegal freedom will be applied, which stands in contrast to the legal freedom that could be obtained on free soil. Few scholars have examined the various strategies employed by self-emancipators to remain concealed from the authorities. This article concentrates on runaway slaves in Baltimore and Richmond, two cities which had large African-American populations. The case will be made that enslaved African Americans carved new spaces of freedom within southern cities, with the assistance of free black communities. It will demonstrate that urban centers within the Upper South were important spaces of illegal freedom for slave refugees, largely because of their numerous free black populations, and that the two group’s experiences were deeply interwoven.

Gender-Based Differences in the Epidemiology of Inflammatory Bowel Disease in a Predominantly African American Population

Introduction: Although Inflammatory Bowel Disease (IBD) is increasing in African American (AA) population, there is a sparsity of information on the epidemiological features of IBD in AA. Since there is a large AA population in our inner-city clinic, we did a study to compare our AA IBD patients to Non-AA patients. Methods: In order to establish a database of IBD patients seen in the GI clinic of a urban medical center, we used ICD-9 codes to identify all patients with a visit between 2011 and 2014 (n= 409). We identified three categories of patients (definitely not IBD (n=233), possibly IBD (n=68) and endoscopically positive IBD (n=109). We required that patients have two visits, one prior to 2015 and one on or after 2015 (n= 97). Data included demographics, endoscopic/histologic findings, details of treatment, and possible measurements to assess disease control. Data was analyzed using JMP 13 software. Results: Of the total 97 patients, 60 had Crohn's disease (CD); 37 had Ulcerative Colitis (UC), most of the patients were AA (75.5 %). There were more females than males for both CD (62 %) and UC(70%). When assessed based on race and disease AA Females were more likely than Non-AA to be represented in the disease class (UC (AAF= 67% vs Non-AAF =42% p=0.008) and CD (AAF=84% vs Non-AAF= 42% p=0.11). Overall, females were diagnosed later than males (mean age - 32.25 vs. 29.97) but it was not statistically significant. CD were more likely to have severe disease at first visit, defined by elevated C-reactive Protein (CRP) than UC (19 vs 6 mg per liter). AA had more active disease at first visit as defined by higher CRP in both CD and UC (CD AA=20 vs Non-AA=11; UC AA= 6.7 vs Non-AA =3.6). Patients with CD were more likely to be on a biologic (42% vs 16% p=0.009) and on combination therapy (63% vs 27% p=0.005). There were no significant differences between either race or gender with respect to treatment. Conclusion: Most patients in this general GI clinic IBD database were AA (76%) and for both CD and UC, there was a higher percentage of AA females with IBD as compared to Non-AA patients. CD patients were more likely to have severe disease as defined by CRP and AA had higher values than Non-AA. CD patients were more likely to be on biologics and combination therapy. While AA were more likely to have elevated CRP at first visit, there were no racial or gender differences in the use of biologics or combination therapy which were both more frequent in CD than UC.

Disparity in breast cancer mortality by age and geography in 10 racially diverse US cities

ObjectivesAssess geographic variation in breast cancer racial mortality disparity by age cohorts in US and ten cities with large African American populations. MethodsNon-Hispanic Black (NHB) and Non-Hispanic White (NHW) female breast cancer mortality rates and NHB:NHW rate ratio (RR) (disparity) were calculated by four age group categories: <40, 40–49, 50–64 and 65+ with time period 1999–2013. ResultsIn all 10 cities and the US, the most pronounced breast cancer disparities, measured by RR, were seen among younger women. In age group <40, the RR ranges from 1.71 in Houston to 5.37 in Washington, DC. For age group 50–64, the disparity was less pronounced, ranging from 1.24 in New York to 1.72 in Chicago. For 65+ age group, there was wide city to city variation in breast cancer mortality disparity. Three cities had higher mortality for NHW compared to NHB; Baltimore 0.78, Washington DC 0.94 and New York 0.98. One city had no statistically significant racial variation in breast cancer mortality in this age group and six cities had increased NHB: NHW mortality disparities. ConclusionsWhile the mortality rate for breast cancer is lower among younger women, the NHB:NHW disparities, as measured by rate ratios, are most pronounced in these age groups. Given the absence of available data regarding incidence, stage and subtypes, further research is necessary and such research is important, given the possible policy implications of these results with respect to screening guidelines and coverage for mammography and breast cancer treatment in particular for younger NHB women.

Contextual Predictors of Protest Behavior on Social Media: A #Ferguson Case Study

ABSTRACTUsing an original Python program, we extracted data from the 2014 #Ferguson Twitterstorm to explore contextual predictors of digital activism. Through content analysis we identify whether tweets related to police conduct, race relations, and perceptions of justice were influenced by local arrest rates and economic inequality. Instead, results suggest that race and partisanship drove much of the digital protest behavior. Negative perceptions of justice and police conduct largely originated from within Democratic-leaning communities and areas with larger African American populations. We speculate that deeper social grievances surfaced in the Ferguson case, causing the digital conversation to become both racialized and politicized.

Environmental Benefit-Cost Analysis and the National Accounts

This paper demonstrates a new connection between benefit-cost analysis (BCA) and the national income and product accounts. The article computes an augmented measure of output, which is defined as gross domestic product (GDP) less environmental pollution damage. Environmental policy BCA is incorporated directly into the adjusted measure of output in two ways. In a particular time period, damages from pollution emissions are deducted from market GDP in a standard with-and-without policy comparison. Second, secular changes in damages, output (GDP), and correspondingly, in the adjusted measure of output are employed to estimate augmented rates of growth. Comparison to a no-policy counterfactual then yields the effect of the policy on the augmented measure of environmentally adjusted value added (EVA) growth. The empirical results suggest that, in the 30 states that adopted flue-gas desulfurization (FGD) technology between 2005 and 2011, augmented output grew 0.12% more quickly than in a no-scrub counterfactual. Augmented output growth in four states was at least 0.20% more rapid because of the installation of scrubbers. The paper reports that benefits-per-capita from FGD were mildly progressive and that counties with relatively large African American populations incur large benefits from FGD installation.

Comparing spatial distributions of infant mortality over time: Investigating the urban environment of Baltimore, Maryland in 1880 and 1920

Infant mortality is a sensitive indicator of urban environmental conditions, and investigating the geography of such an indicator provides insight into variables affecting public health in urban North America in 1880 and 1920. Geographic information systems (GIS) and spatial analysis now provide a means by which to view past infant mortality distributions from a new perspective, one not available at the time. This study makes use of data collected from the 1880 and 1920 Vital Statistics Death Records for Baltimore, Maryland - mapping each infant death to his or her place of residence. Previous work with the 1880 data indicates an uneven distribution of infant deaths with some degree of spatial clustering. The current study takes these findings a step further through the use of the local spatial autocorrelation statistic, Gi*, to identify the locations of clusters in one or both years. The aim of the comparison is to determine whether the location of infant mortality clusters remained the same over time indicating persistent environmental, and possibly demographic, challenges in certain neighborhoods. The data indicated hotspots of infant mortality in both years with persistence in the Fells Point area of Baltimore. The significant clusters appeared in neighborhoods with large African American and/or immigrant populations in both years. The hotspots in the primarily African American neighborhood were only significant in 1880 despite presenting some intriguing questions about what caused such a change, particular when the population in that part of the city did not change. This work offers insights into the spatial distribution of infant mortality in the past and clues regarding which parts of the city need additional investigation to better understand their social and environmental characteristics.

Socioeconomic disparities and comorbidities, not race, affect salivary gland malignancy survival outcomes.

This study sought to determine whether comorbidities, race, and socioeconomic factors affect 5- and 10-year survival outcomes for patients with salivary gland malignancies treated at a single large academic institution with a large African American population. A retrospective cohort study was performed of all patients with salivary gland malignancies, from 1990 to 2015, at a large academic medical center. Standard statistical analysis was performed using Kaplan-Meier survival curve analysis and Cox proportional hazard models. The overall 5- and 10-year survival rates decreased with age ≥ 60 years (P < .001), stage 3 or 4 (P < .001), clinical T stage 3 or 4 (P < .001), and clinical N stage 1, 2, or 3 (P < .001). Living in a ZIP code with an increasing proportion of residents with a high school degree or less (P < .05), being male (P < .05), increasing age at the time of diagnosis (P < .001), and increasing Charlson comorbidity index (P < .05) detrimentally impacted survival at 5 and 10 years. Race was associated with socioeconomic variables, but race was not a prognostic indicator of survival. Socioeconomic factors and comorbidities, not race, were negative prognostic indicators of survival of patients with salivary gland malignancies. Using race as a marker for socioeconomic status should be used with caution. 4. Laryngoscope, 127:2545-2550, 2017.

The determinants of success in local earmarking: The case of new york city council discretionary expense grants

This paper examines the determinants of success in seeking local government earmarked funding. We compile data of the aggregate amounts of the New York City Council discretionary expense grants received or requested by each council district every year during 2011-2013. The statistical results show that the allocation of the expense grants are politically motivated with more earmark funds flowing to the districts council leaders and key committee chairpersons represent. Furthermore, constituents of key committee chairpersons are more successful in the earmarking process. Districts with larger African American population have lower success ratios possibly because they request significantly more earmarks. These empirical findings are consistent with anecdotal perceptions that earmarking is not substantially effective in meeting community need.