Large US Cities Research Articles

Persistent Pandemics

We ask whether mortality from historical pandemics has any predictive content for mortality in the Covid-19 pandemic. We find strong persistence in public health performance. Places that performed worse in terms of mortality in the 1918 influenza pandemic also have higher Covid-19 mortality today. This is true across countries as well as across a sample of large US cities. Experience with SARS in 2003 is associated with slightly lower mortality today. We discuss some socio-political factors that may account for persistence including distrust of expert advice, lack of cooperation, over-confidence, and health care supply shortages. Multi-generational effects of past pandemics may also matter.

Neighborhood-level Asian American Populations, Social Determinants of Health, and Health Outcomes in 500 US Cities.

The US Asian American (AA) population is projected to double by 2050, reaching ~43 million, and currently resides primarily in urban areas. Despite this, the geographic distribution of AA subgroup populations in US cities is not well-characterized, and social determinants of health (SDH) and health measures in places with significant AA/AA subgroup populations have not been described. Our research aimed to: 1) map the geographic distribution of AAs and AA subgroups at the city- and neighborhood- (census tract) level in 500 large US cities (population ≥66,000); 2) characterize SDH and health outcomes in places with significant AA or AA subgroup populations; and 3) compare SDH and health outcomes in places with significant AA or AA subgroup populations to SDH and health outcomes in places with significant non-Hispanic White (NHW) populations. Maps were generated using 2019 Census 5-year estimates. SDH and health outcome data were obtained from the City Health Dashboard, a free online data platform providing more than 35 measures of health and health drivers at the city and neighborhood level. T-tests compared SDH (unemployment, high-school completion, childhood poverty, income inequality, racial/ethnic segregation, racial/ethnic diversity, percent uninsured) and health outcomes (obesity, frequent mental distress, cardiovascular disease mortality, life expectancy) in cities/neighborhoods with significant AA/AA subgroup populations to SDH and health outcomes in cities/neighborhoods with significant NHW populations (significant was defined as top population proportion quintile). We analyzed AA subgroups including Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, and Other AA. The count and proportion of AA/AA subgroup populations varied substantially across and within cities. When comparing cities with significant AA/AA subgroup populations vs NHW populations, there were few meaningful differences in SDH and health outcomes. However, when comparing neighborhoods within cities, areas with significant AA/AA subgroup vs NHW populations had less favorable SDH and health outcomes. When comparing places with significant AA vs NHW populations, city-level data obscured substantial variation in neighborhood-level SDH and health outcome measures. Our findings emphasize the dual importance of granular spatial and AA subgroup data in assessing the influence of SDH in AA populations.

Feasibility and Acceptability of a Smoking Cessation Program for Individuals Released From an Urban, Pretrial Jail

Tobacco use prevalence among individuals involved in the criminal-legal system is 125% higher than that of the general population and leads to high levels of smoking-related morbidity and mortality. To examine the acceptability, feasibility, and preliminary clinical outcomes of a smoking cessation intervention for individuals who are incarcerated. This pilot randomized clinical trial was conducted from January 2019 to May 2020. Participants were recruited in a pretrial county jail in a large Midwestern US city and were followed up after release. Participants were incarcerated, smoked daily before incarceration, desired to stay quit or reduce cigarette smoking upon release, and expected to be released to the community within 90 days of enrollment. Data analysis was performed from June to October 2020. Participants randomized to the counseling plus nicotine replacement therapy (NRT) group received 1 hour of smoking cessation counseling in jail, a supply of nicotine lozenges upon release, and up to 4 telephone counseling sessions after release. Those randomized to brief health education (BHE) received 30 minutes of general health education in jail. The primary clinical outcome was biologically verified 7-day point prevalence abstinence (PPA) at 3 weeks after release. Secondary clinical outcomes included 7-day PPA at 12 weeks, changes in number of cigarettes per day, and time to smoking lapse and relapse. A total of 46 participants (42 men [91%]; mean [SD] age, 38.2 [9.1] years) were enrolled and remained eligible at release; 23 were randomized to the counseling plus NRT group and 23 were randomized to the BHE group. Recruitment, enrollment, and retention of participants was feasible and acceptable. There were no significant differences in smoking abstinence between groups as determined by 7-day PPA at 3 weeks (adjusted 7-day PPA, 11.9% for counseling plus NRT vs 10.6% for BHE; odds ratio, 1.13; 95% CI, 0.14-9.07) and at 12 weeks (adjusted 7-day PPA, 11.1% for counseling plus NRT vs 14.3% for BHE; odds ratio, 0.75; 95% CI, 0.09-6.11). Cigarettes per day for the counseling plus NRT group decreased more compared with the BHE group at both 3 weeks (difference [SE], -4.58 [1.58] cigarettes per day; 95% CI, -7.67 to -1.48 cigarettes per day; P = .007) and 12 weeks (difference [SE], -3.26 [1.58] cigarettes per day; 95% CI, -5.20 to -0.20 cigarettes per day; P = .04) after release. Initiation of counseling plus NRT during incarceration and continuing after release is feasible and acceptable to participants and may be associated with reduced cigarette use after release. However, additional supports are needed to increase engagement in telephone counseling after release. A larger clinical trial is warranted to determine the effectiveness of counseling plus NRT. ClinicalTrials.gov Identifier: NCT03799315.

Design of COVID-19 staged alert systems to ensure healthcare capacity with minimal closures

Community mitigation strategies to combat COVID-19, ranging from healthy hygiene to shelter-in-place orders, exact substantial socioeconomic costs. Judicious implementation and relaxation of restrictions amplify their public health benefits while reducing costs. We derive optimal strategies for toggling between mitigation stages using daily COVID-19 hospital admissions. With public compliance, the policy triggers ensure adequate intensive care unit capacity with high probability while minimizing the duration of strict mitigation measures. In comparison, we show that other sensible COVID-19 staging policies, including France’s ICU-based thresholds and a widely adopted indicator for reopening schools and businesses, require overly restrictive measures or trigger strict stages too late to avert catastrophic surges. As proof-of-concept, we describe the optimization and maintenance of the staged alert system that has guided COVID-19 policy in a large US city (Austin, Texas) since May 2020. As cities worldwide face future pandemic waves, our findings provide a robust strategy for tracking COVID-19 hospital admissions as an early indicator of hospital surges and enacting staged measures to ensure integrity of the health system, safety of the health workforce, and public confidence.

Discontented and Jack of all trades: Revisiting male survival sex workers through modern sex work lenses

Researchers have been moving toward understanding sex workers as agentic and career-based social actors for some time. However, while these modern sex work lenses are readily applied to a variety of high-end and emerging forms of sex work, the field has often been reluctant to frame impoverished and potentially exploitative sex work in the same manner. Here, I ask whether and how the frameworks of “agency” and “career” can be applied to a population of poor male-identified survival sex workers. I use data from an innovative mixed-methods community-based approach that yields a broad sample of majority African American male survival sex workers from a large US city. I argue that by privileging respondents’ own interpretation of their lives, it is possible to construct a nuanced understanding of sex work as a “career” and to conceive of their work as both a profession and a source of disadvantage. I conclude that we should continue to focus on the voices of sex workers themselves in defining what sex work means and how it affects their lives.

Adolescent Exposure To Deadly Gun Violence Within 500 Meters Of Home Or School: Ethnoracial And Income Disparities.

To identify the prevalence of and disparities in past-year exposure to deadly gun violence near adolescents' homes and schools, we linked national data on deadly gun violence incidents from the Gun Violence Archive to the age-fifteen wave of the Fragile Families and Child Wellbeing Study, a cohort of children born during 1998-2000 in large US cities. We found that 21percent of adolescents in this cohort resided or attended school within 500 meters of a prior-year deadly gun violence incident during 2014-17. Rates of exposure were higher for Black and Hispanic adolescents than for White adolescents and higher for poor and near-poor adolescents than middle-to-high-income adolescents. Middle-to-high-income Black and Hispanic adolescents were more likely to be exposed to violence near home or school than poorer White adolescents. Because exposure to violence is detrimental to health, policies that reduce gun violence could improve population health disparities.

Poverty, Material Hardship, and Telomere Length Among Latina/o Children.

BackgroundDespite increased attention on the links between poverty and the health and wellbeing of youth, few have attempted to understand the physiological consequences associated with different forms of economic disadvantage among Latina/o children. The present study begins to address this gap by (1) examining whether different forms of economic disadvantage were related to telomere length for Latina/o children and (2) determining whether parents’ nativity shapes economic disadvantage-telomere length relationships.MethodsData were drawn from the Fragile Families and Child Wellbeing Study, a longitudinal, stratified multistage probability sample of couples and children in 20 large US cities. The sample consisted of 417 Latina/o children and their parents that were followed from birth to age 9. Ordinary least squares regressions were used to examine relationships between economic disadvantage and telomere length.ResultsFindings revealed that poverty status was not significantly related to telomere length, whereas some forms of material hardship were shown to play a role in the risk of premature cellular aging. More specifically, medical hardship and difficulty paying bills were associated with shorter telomere length at age 9. Results also provide minimal evidence economic disadvantage-telomere length patterns varied by parents’ nativity. Only medical hardship was related to shorter telomere length at age 9 for children with at least one foreign-born parent.ConclusionOverall, results indicate that the risk of premature cellular aging depends on the measure of economic disadvantage under investigation. Findings from this study can inform targeted strategies designed to reduce the deleterious consequences associated with economic deprivation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40615-021-01072-x.

Off-Cycle and Off Center: Election Timing and Representation in Municipal Government

Who governs America’s cities: organized interests or mass publics? Though recent scholarship finds that local governments enact policies that align with citizens’ preferences, others argue that it is organized interests, not mass publics that are influential. To reconcile these perspectives, we show that election timing can help shed light on when voters or groups will be pivotal in city politics. Examining 1,600 large US cities, we find that off-cycle elections affect city policy responsiveness asymmetrically, weakening responsiveness on those issues where there is an active and organized interest whose policy objectives deviate from the preferences of the median resident. Here, we focus on public employees’ interests and find that local governments that are elected off cycle spend more on city workers than would be preferred by citizens in more conservative cities. We conclude by discussing the implications of these findings for the study of interest groups and representation in local politics.

Clinical Trial of an AI-Augmented Intervention for HIV Prevention in Youth Experiencing Homelessness

Youth experiencing homelessness (YEH) are subject to substantially greater risk of HIV infection, compounded both by their lack of access to stable housing and the disproportionate representation of youth of marginalized racial, ethnic, and gender identity groups among YEH. A key goal for health equity is to improve adoption of protective behaviors in this population. One promising strategy for intervention is to recruit peer leaders from the population of YEH to promote behaviors such as condom usage and regular HIV testing to their social contacts. This raises a computational question: which youth should be selected as peer leaders to maximize the overall impact of the intervention? We developed an artificial intelligence system to optimize such social network interventions in a community health setting. We conducted a clinical trial enrolling 713 YEH at drop-in centers in a large US city. The clinical trial compared interventions planned with the algorithm to those where the highest-degree nodes in the youths' social network were recruited as peer leaders (the standard method in public health) and to an observation-only control group. Results from the clinical trial show that youth in the AI group experience statistically significant reductions in key risk behaviors for HIV transmission, while those in the other groups do not. This provides, to our knowledge, the first empirical validation of the usage of AI methods to optimize social network interventions for health. We conclude by discussing lessons learned over the course of the project which may inform future attempts to use AI in community-level interventions.

Bedtime Schedules and Sleep Regulation among Children of Incarcerated Parents

To investigate variation by parental incarceration history in the bedtime schedules set for elementary-age children and whether sleep was effectively regulated. We ran multivariate regression models estimating the relationship between parental incarceration and 6 measures of bedtime schedules and sleep regulation. Our sample included 9-year-olds in the Fragile Families and Child Wellbeing Study (n=3246), a survey of children born in large US cities between 1998 and 2000 that has an oversample of unmarried mothers. Children's bedtime schedules did not differ at a statistically significant level by parental incarceration history, but children of ever- vs never-incarcerated fathers had lower odds of consistently adhering to a set bedtime. Children of ever-incarcerated fathers also slept for less time on average than did children of never-incarcerated fathers, and they had lower odds of obtaining sufficient sleep. Bedtime consistency partly mediated the association between paternal incarceration and total sleep duration. Although caregivers set appropriate bedtime schedules for children of ever-incarcerated fathers, consistent adherence to those schedules may be particularly challenging given the structural hardships of paternal incarceration. Policymakers, researchers, and practitioners working to improve sleep among children of incarcerated fathers should focus on helping families to develop strategies for implementing bedtime schedules as consistently and effectively as possible.

A scalable empathic supervision intervention to mitigate recidivism from probation and parole

Incarceration is a pervasive issue in the United States that is enormously costly to families, communities, and society at large. The path from prison back to prison may depend on the relationship a person has with their probation or parole officer (PPO). If the relationship lacks appropriate care and trust, violations and recidivism (return to jail or prison) may be more likely to occur. Here, we test whether an "empathic supervision" intervention with PPOs-that aims to reduce collective blame against and promote empathy for the perspectives of adults on probation or parole (APPs)-can reduce rates of violations and recidivism. The intervention highlights the unreasonable expectation that all APPs will reoffend (collective blame) and the benefits of empathy-valuing APPs' perspectives. Using both within-subject (monthly official records for 10 mo) and between-subject (treatment versus control) comparisons in a longitudinal study with PPOs in a large US city (NPPOs = 216; NAPPs =∼20,478), we find that the empathic supervision intervention reduced collective blame against APPs 10 mo postintervention and reduced between-subject violations and recidivism, a 13% reduction that would translate to less taxpayer costs if scaled. Together, these findings illustrate that very low-cost psychological interventions that target empathy in relationships can be cost effective and combat important societal outcomes in a lasting manner.

Comment on “COVID‐19's Lockdown and Crime Victimization: The State of Emergency under the Abe Administration”

Shen et al. (2021) investigate the effect of COVID-19 on criminal behavior in Japan using a difference-in-differences approach. Their study covers a 3-year time period from 2018 to 2020, using a database of publicly available crime statistics (Hanzai Toukei) from all 47 prefectures. While there is a growing, global evidence base exploring how the COVID-19 pandemic has affected criminal behavior, Shen et al. is the first to investigate this important social issue in Japan to date. Their key contribution is the finding that Japan's voluntary lockdown in April and May 2020 reduced both violent and property crime victimization rates significantly. Additional findings show a significant decline in sexual assault victimization for those below the age of 30, and that the 30–59 age group saw the greatest fall in crime victimization due to the COVID-19 pandemic. In this context, I would like to offer some specific comments on Shen et al.'s approach to regional differences in the data, its conclusions on mental health, and, finally, its policy recommendations regarding COVID-19 resource allocation. First, it is not clear why Shen et al. did not consider the regional variations in the data. It is evident from the Hanzai Toukei figures that the decrease in the number of arrests for “property crime” varied by region between 2018 and 2020. Shen et al. closely follows Leslie and Wilson (2020), whose analysis of data on police calls for service from 14 large metropolitan US cities showed that COVID-19 increased domestic violence. Given that city characteristics are unlikely to vary, regional differences in the Japanese data are something that should be emphasized. It would therefore be helpful to explain and justify why these differences were not explored further. Second, I would like to comment on one of Shen et al.'s conclusions pertaining to mental health. Shen et al. state that, “Japan has shown that the lockdown had a positive effect on mental health when proxied by suicide rates.” The statistics do indeed show a decline in the number of suicides during the lockdown. However, the number started to increase after the lockdown. Shen et al. refer to Ueda et al. (2020), and Tanaka and Okamoto (2021). In fact, both papers conclude that the number of deaths by suicide declined during the initial phase of the pandemic (February to June 2020), but from July 2020 actually began to accelerate, exceeding suicide numbers in the previous year. The source of the increase was suicides among females, children, and adolescents. Furthermore, and somewhat disturbingly, the number of suicides recorded in October 2020 was higher than the total number of deaths due to COVID-19 from the entire months of February 2020 until October 2020. It would therefore be prudent to state the limitations of using suicide rates as a proxy for mental health. Although Shen et al. only analyzed data from January to May in 2020, they should be clear that, while their analysis suggests an initially positive effect on mental health during the lockdown (when proxied by suicide rates, which showed a significant fall during the voluntary lockdown period, primarily in suicides stemming from economic and living conditions), previous studies have shown that suicides increased in the period following the COVID-19 lockdown, and, thus, its medium-to-long-term effects on mental health present a much more complicated picture. Finally, I wish to address one of the policy implications that Shen et al. put forward in their discussion. Having found that the lockdown reduced both violent and property crime rates, Shen et al. suggest that limited public resources could be reallocated from some sectors – such as police and criminal justice – to health care, in order to alleviate the added stresses on the health sector during the pandemic. However, is it right to say that, overall, the Japanese health sector was under such levels of stress? Ii and Watanabe (2021) analyze the impact of the first, second, and third waves of the COVID-19 pandemic on the health care system in Japan, and find a drastic decline in outpatient visits and inpatient admissions. Only about 3% of the total general beds in Japan were used for COVID-19 patients. Those hospitals which accepted COVID-19 patients have been under additional stresses, but many other clinics and hospitals have, in fact, suffered from a loss in demand. While there may need to be resource reallocation within the health sector, a diversion of resources from other sectors may not be necessary.

Association between ambient temperature and sex offense: A case-crossover study in seven large US cities, 2007–2017

There is an increasing interest in the link between ambient temperature and sexual crime in the context of climate change. However, existing studies are limited in evaluating the acute effect of temperature and rarely estimate the attributable burden. Here, we show that in seven large US cities, every 5 °C rise in daily mean temperature was associated with a 4.5 % [95 % confidence interval (CI): 2.8–6.3 %] increase in sex offenses in the following 0–8 days. The associations were stronger in hot and cold season compared to moderate season, and could be enhanced by higher relative humidity and precipitation. The associations were only significant for sodomy, fondling and rape, and for sex offenses happened in certain locations (open space, education, street but not residence). We estimated that 2.6 % (95 %CI: 1.7–3.6 %) sex offenses were attributable to temperatures above city-specific median temperatures, corresponding to a mean annual sex offense rate of 2.9/100,000 (95 %CI: 1.9–4.0/100,000). Our findings highlight the potential rising sexual crime along with climate change and provide useful information for targeted preventions.

So close yet so different: Neighborhood inequality and child maltreatment

BackgroundExtensive research has documented the importance of neighborhood contextual factors in shaping maltreatment risk. Evidence is limited about the role of economic inequality within neighborhoods, which has increased substantially in the US over the past decade. ObjectiveThis study examines the relationship between neighborhood-level inequality and child maltreatment risk, paying particular attention to the cross-level interactions between neighborhood inequality and family income. Participants and settingA population-based cohort of 4,898 children born in large US cities was sampled in 1998–2000 and followed up at ages 1, 3, 5, and 9. MethodA set of regression models was analyzed to estimate the associations of family income, neighborhood inequality (operationalized as terciles of the Gini coefficient), and the interaction of these with child maltreatment risk, operationalized as physical abuse, psychological abuse, neglect, CPS involvement, and spanking. ResultsLow-income was associated with higher risks of neglect and CPS involvement, but not physical abuse, psychological abuse, or spanking. Among low-income families, higher neighborhood inequality was associated with lower likelihood of spanking. Among higher-income families, higher neighborhood inequality levels were associated with higher risks of physical abuse, yet lower risks of psychological abuse. ConclusionOur findings align with previous studies showing mixed results on the relationship between neighborhood inequality and health outcomes. Those results may suggest that the effect of low-income itself is more important than the neighborhood context. Further research is needed to identify the determinants of inequality at the neighborhood level and the underlying mechanisms of its association with child maltreatment risks.

Association of Firearm Access, Use, and Victimization During Adolescence With Firearm Perpetration During Adulthood in a 16-Year Longitudinal Study of Youth Involved in the Juvenile Justice System

Preventing firearm violence requires understanding its antecedents. Yet no comprehensive longitudinal study has examined how involvement with firearms during adolescence-use, access, and victimization (defined as threatened with a weapon or gunshot injury)-is associated with the perpetration of firearm violence in adulthood. To examine the association between firearm involvement during adolescence and subsequent firearm perpetration and ownership in adulthood among youth involved in the juvenile justice system. This cohort study analyzed interview responses of 1829 randomly selected participants as part of the Northwestern Juvenile Project, a longitudinal study of health needs and outcomes of youth sampled from a temporary juvenile detention center in a large US city. Youth aged 10 to 18 years were interviewed in detention from November 1995 through June 1998. Participants were reinterviewed up to 13 times over 16 years through February 2015, for a total of 17 776 interviews. The sample was stratified by sex, race/ethnicity, age, and legal status (juvenile or adult court). Data were analyzed from April 2017, when data preparation began, through November 2020. Firearm involvement during adolescence: use (ie, threaten, shoot), access (ownership, ease of access, firearm in household, membership in gang that carries firearms), and victimization (gunshot injury, threatened with a weapon). Firearm involvement during adulthood: perpetration of firearm violence (ie, threatening with or using a firearm) and firearm ownership. Among the 1829 participants, 1388 had a 16-year follow-up interview: 860 males, 528 females; 809 were African American, 203 were non-Hispanic White; 374 were Hispanic; and 2 were other race/ethnicity; median (interquartile range) age of 32 (30-32) years. Eighty-five percent of males and 63.2% of females were involved with firearms as adolescents. Compared with females, males had significantly higher odds of every type of involvement except having a firearm in the home. In adulthood, 41.3% of males and 10.5% of females perpetrated firearm violence. Adolescents who had been threatened with a weapon or injured by firearms had 3.1 (95% CI, 2.0-4.9) and 2.4 (95% CI, 1.2-4.9) times the odds of perpetrating violence during adulthood. Similar associations were found for firearm ownership. Involvement with firearms during adolescence-including victimization-is a significant risk factor for firearm perpetration and ownership during adulthood.

Health Selection Into Eviction: Adverse Birth Outcomes and Children's Risk of Eviction Through Age 5 Years.

Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. We tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years. We analyzed 5,655 observations contributed by 2,115 participants in the Fragile Families and Child Wellbeing Study-a national, randomly sampled cohort of infants born in large US cities between 1998 and 2000-living in rental housing at baseline. We fitted proportional hazards models using piecewise logistic regression, controlling for an array of confounders and applying inverse probability of selection weights. Having been born low birthweight or preterm was associated with a 1.74-fold increase in children's hazard of eviction (95% confidence interval: 1.02, 2.95), and lengthy neonatal hospital stays were independently associated with a relative hazard of 2.50 (95% confidence interval: 1.15, 5.44) compared with uncomplicated births. Given recent findings that unstable housing during pregnancy is associated with adverse birth outcomes, our results suggest eviction and health may be cyclical and co-constitutive. Children experiencing adverse birth outcomes are vulnerable to eviction and require additional supports.

The Donut Effect of COVID-19 on Cities

Using data from the US Postal Service and Zillow, we quantify the effect of Covid- 19 on migration patterns and real estate markets within and across US cities. We find two key results. First, within large US cities, households and businesses have moved from the dense central business districts (CBDs) towards lower density suburban zip-codes. We label this the “Donut Effect” reflecting the movement of activity out of city centers to the suburban ring. Second, while this observed reallocation occurs within cities, we do not see major reallocation across cities. That is, there is less evidence for large-scale movement of activity from large US cities to smaller regional cities or towns. We rationalize these findings by noting that working patterns post pandemic will be primarily hybrid, with workers commuting to their business premises typically 3 days per week. This level of commuting is less than pre-pandemic, making suburbs relatively more popular, but too frequent to allow employees to leave the cities containing their employer.

A Method to Analyze Rideshare Data for the Surveillance of Novel Strains of SARS-CoV-2

Background: The emergence of novel, partially vaccine-resistant strains of SARS-CoV-2 poses a serious risk to public health. The interactions between passengers and drivers facilitated by rideshare platforms, such as Uber and Lyft, are essentially a series of partially standardized, pseudo-random experiments of SARS-CoV-2 transmission. Rideshare companies share data with government health agencies, but no statistical method is available to aggregate these data for the systematic study of the transmission dynamics of COVID-19.Methods: We develop a proof-of-concept method for the analysis of data from rideshare interactions merged with COVID-19 diagnosis records. Using simulated data with rideshare volumes, disease prevalence, and diagnosis rates based on a large US city, we test hypotheses about the emergence of viral strains and their transmission characteristics in the presence of non-pharmaceutical interventions and superspreaders.Findings: Data from ten simulated trials of SARS-CoV-2 propagation within the Los Angeles rideshare network resulted in an average of 190,387·1 potentially infectious rideshare interactions. Assuming access to data on 25% of the total estimated infections (Partial Reporting), these interactions resulted in an average of 409·0 diagnosed rideshare infections given our transmission model assumptions. For each of the ten simulated trials, analysis given Partial Reporting could consistently differentiate between a baseline strain and an emergent, more infectious viral strain, enabling hypothesis testing about transmission characteristics.Interpretation: Simulated evaluation of a novel statistical method suggests that rideshare data combined with COVID-19 diagnosis data have the potential to automate continued surveillance of emergent novel strains of SARS-CoV-2 and their transmission characteristics.Funding Information: Stanford University, Stanford.Declaration of Interests: The authors have no relationships or disclosures relevant to the contents of this paper. All authors have no conflicts of interest, financial or otherwise.

Maternal caregiver's typologies and internalized behaviors in African American adolescents living in urban public housing.

This study explores how variations in maternal caregiver types may be associated with adolescents' internalized behaviors (i.e., depressive symptoms) and resources (i.e., attitudes toward delinquent behaviors and efficacious beliefs). Using a sample of 375 African American youth from public housing in three large US cities, we used Latent Profile Analysis to identify various maternal caregiver classes. Multinomial logistic regression analyses were conducted to assess whether youth can be correctly classified into maternal caregiver classes based on their internalized behaviors. Three maternal caregiver classes were identified. Results suggest youth living with high encouragement and high (supervision) maternal caregivers were associated with more conventional attitudes, higher self-efficacy, and lower depressive symptoms. Findings highlight how maternal caregivers can influence the internalizing behaviors of African American youth in US public housing. Individual, community, and system-level interventions can be leveraged to support the impact of these maternal caregivers.

Youth academic achievement, social context, and body mass index.

This study assesses the relationship between academic achievement and body mass index for age (BMI) trajectories across childhood and adolescence, and investigates how this relationship is moderated by social context. Specifically, we test the hypothesis that academic achievement is not associated with improved BMI among youth from disadvantaged social contexts. We test for differences by race/ethnicity, and examine the role of county-level economic mobility in shaping these patterns. We use data from the longitudinal Fragile Families and Child Wellbeing Study (FFCWS), an ongoing birth cohort study representative of children born in large US cities in 2000, and measure BMI, academic achievement, and social context at Years 5, 9, and 15. Estimating multilevel random effects linear regression models of BMI from childhood to adolescence, we find that youth who were exposed to social advantage displayed a negative association between academic achievement and BMI. In contrast, youth exposed to social disadvantage displayed no association between academic achievement and BMI. This difference was observed regardless of race/ethnicity. County-level economic mobility modified the observed relationship, such that youth living in places with low levels of mobility displayed higher BMI associated with high academic performance. The results suggest that the health costs of academic achievement among disadvantaged youth are concentrated in areas with low institutional support for upward mobility. The findings demonstrate that the unequal benefits of educational attainment begin early in life, while living in places that promote upward mobility can help individuals realize the health benefits of their own educational attainment.