Low-income Persons Research Articles

Reducing Digital Inequities: The Role of Helping Professionals in Designing Just and Inclusive Strategies

This policy brief calls on social workers and other helping professionals to participate in efforts to address broadband internet access inequities. We first highlight continuing access inequities and their consequences for low-income persons, as well as older persons, minority group members, those with disabilities, and those living in rural areas. We then describe new initiatives to improve broadband access and digital literacy through state and local programs funded by the 2021 $65 billion federal Infrastructure Investment and Jobs Act. Finally, strategies are discussed for social worker engagement in such work, which include policy advocacy, contributing to the implementation of emerging programs, and serving as information conveyors to their clients concerning digital access and literacy training opportunities.

State Social Expenditures and Preterm Birth and Low Birth Weight in the US

Adverse birth outcomes in the US, including preterm birth and low birth weight, are strongly tied to socioeconomic disadvantage and disproportionately impact infants of Black mothers. Increasing investments in social programs represents a potential policy approach to addressing disparities in birth outcomes. To examine state-level associations of government expenditures on social programs with rates of preterm birth and low birth weight both overall and by race. This cross-sectional, ecological study was conducted among liveborn infants in the 50 US states between January 1, 2011, and December 31, 2019. Data analysis was performed from May 2022 to May 2024. Yearly state and local government expenditures per low-income person on social programs in the following categories: state refundable Earned Income Tax Credit; cash assistance; childcare assistance; housing and community development; and public health. Yearly state-level rates of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g). From January 1, 2011, to December 31, 2019, there were 35.1 million live births in the US, of which 3.4 million (9.8%) were preterm and 2.8 million (8.1%) were low birth weight. Median (IQR) state social expenditures per low-income person were $1546 ($1074-$2323). Greater total state social expenditures were associated with lower overall rates of preterm birth (adjusted prevalence ratio [aPR] for every increase of $1000 per low-income person, 0.99; 95% CI, 0.97-0.999) but not with overall rates of low birth weight. In secondary analyses, greater state social expenditures were associated with lower preterm birth rates for infants of Black mothers (aPR, 0.96; 95% CI, 0.92-0.999). Greater state expenditures specifically on cash assistance (aPR, 0.64; 95% CI, 0.43-0.94) and housing and community development (aPR, 0.91; 95% CI, 0.84-0.98) were associated with lower preterm birth rates for infants of Black mothers. In this cross-sectional, ecological study, greater state-level expenditures on social programs were associated with reduced rates of preterm birth, particularly for infants of Black mothers. State and local governments may consider bolstering investments in cash assistance and housing and community development to address maternal and infant health disparities.

Equity issues associated with the widespread implementation of autonomous vehicles

Abstract Autonomous vehicles (AVs), either shared or privately owned, are predicted to become a common transport mode used by the general population in coming decades. Policies governing the use of AVs may increase or decrease social inequities. This review synthesizes existing literature and provides policy recommendations to enhance equity as the use of AVs becomes more widespread. We identified nine areas in which AVs could impact equity: (i) assessment of community mobility needs and priorities, (ii) education and outreach, (iii) disparities in infrastructure quality, (iv) equitable distribution of customer services, (v) access to AVs by persons with low incomes, (vi) shared infrastructure services, (vii) barriers to shared AV use, (viii) access to AVs by persons with disabilities and (ix) disruption of existing transportation jobs. Recommendations for promoting equitable use of AVs include (i) policies governing how jurisdictions oversee AV implementation and (ii) policies addressing how jurisdictions issue permits to AV service providers. Oversight policies include ensuring input from disadvantaged communities, providing subsidies for low-income users, establishing ride-sharing rules to protect vulnerable populations, reviewing the equity implications of proposed AV infrastructure improvements, providing retraining opportunities for those who may lose jobs due to AV implementation and monitoring the impact of AV policies implemented. Permitting processes include ensuring equitable access to AVs for low-income, minority, and older users and persons with disabilities, ensuring equitable distribution of AV service areas and verifying that data from all communities are incorporated into the artificial intelligence algorithms used to guide AVs.

Availability, price and affordability of insulin, delivery devices and self-monitoring blood glucose devices in Indonesia.

Insulin is essential for the survival of people with type 1 diabetes and for better management of people with type 2 diabetes. People with diabetes using insulin also require self-monitoring blood glucose (SMBG) devices (e.g., meters, strips, continuous monitoring systems) for day-to-day management. It is essential to ensure that insulin and these devices are available and affordable. This study aimed to evaluate the availability, price, and affordability of insulin and SMBG devices in Indonesia using an adaptation of the World Health Organization/Health Action International (WHO/HAI) price survey. A total of 34 public health facilities (hospitals, primary healthcare centres/Puskesmas) and 37 private pharmacies were sampled. Information from three major online marketplaces was also collected. Prices were expressed as median patient prices (US$). Affordability was defined as the number of days' wages needed by the lowest paid unskilled government worker (LPGW) to purchase 30 days' supply of insulin, delivery devices and SMBGs. Availability of analogue insulin was slightly higher in public facilities (63.6%) than in the private sector (43.2%), with no human insulin available in both sectors. Conversely, better availability was observed in private facilities for SMBG devices as public sector facilities did not supply devices for self-testing. Median prices for 1000IU analogues varied between the public sector (US$ 5.26) and the private sector (US$11.24). The highest median price of analogues was seen in online marketplaces (US$ 28.65). The least costly median price of SMBG devices were observed in online platforms (meter: US$ 18.37, test strip: US$ 0.27, lancet: US$ 0.02). A low-income person had to work 2-3 days to buy 1000IU of analogues. It required 5-7 days' and 4-5 day's wages to purchase a meter and a month's supply of test strips, respectively. The availability and affordability of insulin and SMBG devices remain important issues in Indonesia requiring holistic approaches for further improvement.

Dietary practice and nutritional status of low-income earners in a rural adult population in Delta State, Nigeria: a cross-sectional study.

due to the inability of low-income populations to access nutritious foods or basic education, these groups usually consume unhealthy diets, which frequently lead to nutrition issues like obesity, malnutrition, and other health morbidities. The purpose of the study was to evaluate the nutritional knowledge, dietary practices, nutritional status, and factors influencing the dietary habits of low-income persons living in a rural constituency in Southern Nigeria. a cross-sectional study was carried out on 419 consenting low-income adults (18 years and older) using a simple random technique, in order to collect data on their socio-demographic traits, nutritional knowledge, dietary practices, and nutritional status. Statistical Package for Social Sciences (SPSS) version 22.0 was used to analyze the data generated. the respondents´ the average age was 40.9 ± 15.68 years while 224 (53.5%) of those surveyed were females. The proportion of responders with a secondary education was highest 279 (66.6%). The most common occupation among respondents was farming 151 (36.1%) and petty trading 135 (32.2%). Overall, 314 (74.9%) of low-income adults had poor dietary habits, and 245 (60.6%) had poor nutrition knowledge. Occupation and gender were significantly associated with nutritional status P<0.05. The majority of respondents 56.2% (235) were overweight or obese, and multivariate logistic regression analysis shows that respondents with concern about gaining weight were more likely to be overweight or obese (OR=1.065, 95% CI=0.832-1.363). the findings from the study indicate that inadequate nutritional knowledge and poor dietary habits, reflected in respondents' body weight are likely to increase the risk of non-communicable diseases, necessitating the need for nutritional education among rural populations.

A PHOTOVOICE STUDY OF THE EXPERIENCES OF BIPOC OLDER ADULTS DURING THE COVID-19 PANDEMIC

Abstract The coronavirus disease 2019 (COVID-19) pandemic intensified the stressful and already difficult circumstances of communities of color. Yet, no current photovoice research has highlighted the lived experiences of low-income Black, Indigenous, and persons of color (BIPOC) older adults during the pandemic. This qualitative study used photovoice to visually portray the struggles of low-income BIPOC older adults and how they recovered from and adapted to the impact of the pandemic. The data analyzed were drawn from interviews, focus groups, photographs, and written stories exploring their experiences and how they found meaning. Results show that participants faced different challenges during the pandemic, such as the fear of COVID-19 exposure and death, struggles to adopt COVID-19 mitigation strategies, loneliness, and social isolation. Amid this crisis of suffering, isolation, and sadness, participants found meaning through a positive reappraisal of the negative situation and engaging in emotional, spiritual, social, and physical self-care practices. The findings have implications for clinical social workers, mental health counselors, faith communities, nurse managers and administrators, and policymakers.

Disparities in access to COVID-19 testing in Los Angeles County

COVID-19 has disparately impacted low-income persons and racial and ethnic minorities–primarily Black and Hispanic populations. Our objective is to quantify disparities in access to COVID-19 testing and identify barriers to testing during the winter 2020–2021 surge in COVID-19 infections in Los Angeles County. An online survey was administered between December 2020 and January 2021 through which respondents were asked about their use of COVID testing and the barriers to testing they experienced. Our sample of 1,984 was reweighted to match the demographics of Los Angeles County. Despite similar testing rates to White residents, Hispanic residents were more likely to report testing positive. Persons with an annual income of $20,000 or less were less likely to receive a test than those with an income of $100,000 or more. Barriers to testing were more prevalent among racial/ethnic minorities and low-income persons. White respondents and high-income persons were more likely to report the ability to take time off work to await test results. Rates of testing were not commensurate with the rates of infection across racial/ethnic groups, which may be explained by higher rates of reported barriers to testing among Black and Hispanic residents. These findings may inform policies that address structural barriers to testing that disproportionately impact racial/ethnic minorities and low-income populations.

California’s cap-and-trade program: is it effective in advancing social, economic, and environmental equity?

PurposeCompanies affected by California’s cap-and-trade legislation are allotted certain credits for production that can be used or sold and can purchase additional credits from the state, which become a revenue source to be used for activities that reduce carbon emissions. The purpose of this paper is to investigate who ultimately pays for this program, its effectiveness in reducing carbon emissions in accordance with established goals, and the related effectiveness to advance social, economic, and environmental equity.Design/methodology/approachThe methodology used for this research is secondary data analysis, triangulating three sources: California’s Climate Change Investment Reports, 2019-2021; repositories maintained by the California High-Speed Rail Authority and the California Air Resources Board; and a review of the literature and websites from other professional sources which addressed, directly and indirectly, the topics and questions explored in the study.FindingsKey findings include evidence of enhancing social and environmental equity but ineffectiveness in reducing carbon emissions in accordance with state goals. Furthermore, the program displays evidence of economic inequity as it demonstrates characteristics of regressive taxation and an inability of low-income persons to acquire electric vehicles due to high costs.Originality/valueThe research effort is unique in that no other academic efforts were located which attempt to examine the cap-and-trade program’s effectiveness in attaining its goals.

저소득 장년층 1인 가구의 생활경험에 관한 사례연구

The purpose of this study is to understand the life experiences of low-income middle-aged single person households who are prone to the crisis of the welfare blind spot. In-depth interviews were conducted with 8 participants who had agreed to the research purpose and analyzed using a qualitative case study method. As a result of the analysis, the life experience of low-income middle-aged single person households has 4 categories such as ‘Not intending to live alone’ ,‘Difficulties as a single person households’, ‘Different daily life for each single households’, ‘Suggestions for the middle-aged single person households’ and 16 sub-categories. Based on these results, policy and practical suggestions were made to prevent social isolation and improve the quality of life of low-income middle-aged single person households, which are emerging as new social risks.

Modeling The Number Of Tuberculosis Cases In West Java Using The Negative Binomial Approach

Objective: This study aims to model the number of Tuberculosis cases in West Java Province in 2021 using the Negative Binomial Regression approach. Methods: This study used quantitative analysis uses secondary data from the Central Bureau of Statistics website and the Health Office of West Java Province. 27 West Java districts/cities were studied. The number of tuberculosis cases was assumed to be affected by population density, poverty, sanitation, and health complaints in the past month. Negative Binomial Regression was used to analyse data. Results: The results showed that Poisson Regression caused overdispersion, which was solved using the Negative Binomial Regression approach. The Negative Binomial Regression model passed a detailed test. The partial test showed that only the variable percentage of low-income persons and the variable percentage of people with health concerns significantly affected the model with regression coefficients of 0.8755 and 1.0318, respectively. The final Negative Binomial Regression model with the lowest Akaike Information Criterion value of 491.9 is best for this investigation. Conclusion: The most suitable model for modelling the number of Tuberculosis cases in West Java Province in 2021 is the Negative Binomial Regression model with independent variables that significantly influence the model, namely the percentage of poor people and the percentage of people who have had complaints recently.

Air Pollution and Mortality at the Intersection of Race and Social Class

BackgroundBlack Americans are exposed to higher annual levels of air pollution containing fine particulate matter (particles with an aerodynamic diameter of ≤2.5 μm [PM2.5]) than White Americans and may be more susceptible to its health effects. Low-income Americans may also be more susceptible to PM2.5 pollution than high-income Americans. Because information is lacking on exposure–response curves for PM2.5 exposure and mortality among marginalized subpopulations categorized according to both race and socioeconomic position, the Environmental Protection Agency lacks important evidence to inform its regulatory rulemaking for PM2.5 standards.MethodsWe analyzed 623 million person-years of Medicare data from 73 million persons 65 years of age or older from 2000 through 2016 to estimate associations between annual PM2.5 exposure and mortality in subpopulations defined simultaneously by racial identity (Black vs. White) and income level (Medicaid eligible vs. ineligible).ResultsLower PM2.5 exposure was associated with lower mortality in the full population, but marginalized subpopulations appeared to benefit more as PM2.5 levels decreased. For example, the hazard ratio associated with decreasing PM2.5 from 12 μg per cubic meter to 8 μg per cubic meter for the White higher-income subpopulation was 0.963 (95% confidence interval [CI], 0.955 to 0.970), whereas equivalent hazard ratios for marginalized subpopulations were lower: 0.931 (95% CI, 0.909 to 0.953) for the Black higher-income subpopulation, 0.940 (95% CI, 0.931 to 0.948) for the White low-income subpopulation, and 0.939 (95% CI, 0.921 to 0.957) for the Black low-income subpopulation.ConclusionsHigher-income Black persons, low-income White persons, and low-income Black persons may benefit more from lower PM2.5 levels than higher-income White persons. These findings underscore the importance of considering racial identity and income together when assessing health inequities. (Funded by the National Institutes of Health and the Alfred P. Sloan Foundation.)

FOOD INSECURITY AMONG LOW-INCOME OLDER PERSONS IN HONG KONG: THE ROLE OF PUBLIC ASSISTANCE, SOCIAL SERVICES, AND SOCIAL CAPITAL

Food is one of the physiological needs that have an immediate impact on healthy aging. However, the persistent poverty problem in Hong Kong has increasingly made it difficult for low-income older persons to meet their basic needs. This paper examines to what extent poor older persons suffer from food insecurity and how their food insecurity is related to the different types of resources they have. Based on the data collected through a questionnaire survey and in-depth interviews, the study found that about 20% of low-income older persons experienced food insecurity, and male, older seniors, and those in a larger household with lower socio-economic status were particularly vulnerable. Among the resources that older people can utilize, public assistance and social services were found to be more conducive to food security than social capital. The implementation of a food voucher scheme and the facilitation of food distribution and social eating are suggested.

Abstract A053: Assessing the impact of the COVID-19 pandemic on a statewide breast and cervical cancer safety net screening and diagnostic program: Are there differences by rural – urban geography?

Abstract Background: COVID-19 disrupted the healthcare system and services across the cancer continuum. Early on, breast and cervical (B &amp; C) screenings were effectively halted, and many diagnostic and treatment procedures delayed. Emerging evidence suggests that uninsured populations and patients of color were disproportionately affected, but less is known about rural-urban differences. The Illinois Breast and Cervical Cancer Screening Program (IBCCP), administered by agencies across 102 counties, provides screening and diagnostic services for low-income, uninsured, and underinsured persons. This study assesses the impact of COVID-19 on agencies’ administrative functions and clients’ ability to receive services, and to examine rural-urban differences. Methods: IBCCP coordinators were invited to complete an online survey that asked about COVID-19’s effect on administrative functions and services at two different time periods, the height of the pandemic and in the past month (11/2021-12/2021). Chi-square and Fisher’s exact tests were used to examine differences between rural and urban agencies (classified by using the 2013 NCHS Urban-Rural Classification Scheme).Results: In total, 32 agencies (50% urban, 50% rural), responded. Concerning administrative functions, in the past month compared to at the height of the pandemic, fewer agencies overall reported that COVID-19 had a moderate to great impact (compared to occasional or no impact) on staffing (47% vs. 74%) and client enrollment (34% vs. 90%). Although not significant, more rural than urban agencies reported effects on staffing (56% vs. 38%) and enrollment (50% vs. 19%) in the past month. Concerning clients’ ability to receive services, in the past month compared to the height of the pandemic, fewer agencies overall reported COVID-19 effects on screening (31% vs. 75%), diagnostic (19% vs. 61%), and treatment (3% vs. 38%) services. Some rural-urban differences were noted; at the height of the pandemic, urban agencies were more likely to report effects on diagnostic (88% vs. 33%, p=.002) and treatment (56% vs. 19%, p=.028) services when compared to rural. Although not significant, in the past month, more urban (vs. rural) agencies reported COVID-19 related effects on screening (44% vs. 19%), diagnostic (31% vs. 6%), and treatment (7% vs. 0%) services. Conclusion: Overall, agencies implementing this safety net program are generally rebounding from the pandemic’s effect on administrative functions and clients’ ability to receive services. However, rural and urban agencies may be differentially affected by the pandemic. For example, in the past month, a greater proportion of rural agencies reported effects on administrative functions Interestingly, more urban agencies reported lingering effects on clients’ ability to receive screening and diagnostic services. These trends suggest that rural and urban agencies may be differentially affected by the pandemic and geographically tailored responses may best support recovery. Citation Format: Leslie R. Carnahan, Ananya Stoller, William Barshop, Genevieve Rizzo, Arden Handler. Assessing the impact of the COVID-19 pandemic on a statewide breast and cervical cancer safety net screening and diagnostic program: Are there differences by rural – urban geography? [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A053.

Pathways to Justice: Expanding Access for Everyone

This paper aims to explore and analyse the pathways to justice with a focus on expanding access for everyone. Access to justice is a fundamental right that ensures equality, fairness, and the protection of individual and collective rights within a legal framework. However, many individuals and marginalized communities face significant barriers when attempting to navigate the justice system, leading to a lack of access and resulting in systemic inequalities. This paper examines the challenges faced by different groups, such as low-income individuals, minorities, and persons with disabilities, and explores strategies to expand access to justice and promote inclusivity within the legal system. It analyses various approaches, including legal aid programs, technology-enabled solutions, community-based initiatives, and policy reforms, that have the potential to bridge the justice gap and enhance access for all.

Ten Seconds to Implosion: The Magna Carta Lawful Rebellion

The Magna Carta Lawful Rebellion [MCLR] is an example of a “legal cult,” a social group organized around key guru leaders who obtain their elevated status and hold followers via alleged special knowledge of law. The MCLR’s two gurus, David Robinson and Jacquie Phoenix (legal name Jacqueline Robinson), claimed the true binding law for residents of the Commonwealth is a hidden secret law, called “pseudolaw.” Pseudolaw is a highly conserved set of false legal concepts nested in a conspiratorial narrative. Pseudolaw originated in the US, but post-2000 has spread world-wide. The MCLR pseudolaw variant is that the 1215 Magna Carta remains in effect and operates as a supraconstitutional authority. Robinson and Phoenix claim that individuals may defeat conventional legal and state authority by swearing an oath of allegiance to Lord Craigmyle of Invernesshire, a “New Rebel Baron.” Special paperwork then permits extraordinary authority, including the right to execute government authorities and other enemies. However, MCLR adherents instead employed these concepts in petty domestic circumstances, and without any success. The MCLR’s leadership and adherent population appear similar: low-income, uneducated, and marginal persons with conspiratorial anti-authority beliefs. This “cult of peers” largely operates online. The MCLR was a minor and comparatively unsuccessful branch of UK pseudolaw culture until 2019, when Phoenix attracted numerous followers, and led a “Redress” movement that promised defeat of New World Order oppressors via execution of “traitors and quislings.” The 2021 failure of the “Redress” effort now threatens Phoenix’s status, and the long-term viability of the MCLR and its concepts.

Accessibility and Availability of Insulin

Introduction: One hundred years after its discovery, insulin is still inaccessible for many people living with diabetes. In the recent World Health Organization (WHO) 2021 report on Barriers to Insulin Availability, WHO highlights the alarming state of global access to insulin. According to International Diabetes Federation (IDF), as reported in IDF Atlas, 10th edition, 73 million adult people with diabetes (PWD) live in Middle East and North Africa (MENA) Region. Materials and Methods: A survey was conducted in the International Diabetes Federation (IDF) MENA Region through its Member Associations in 2021. Eighteen countries out of 21 participated. Questions were about insulin support, beneficiaries, local production, insurance coverage, average cost, minimum wage, and barriers to access. Results: Fifty percent of countries had full government support and 44% had partial. In 56 % of countries, support is limited to human insulin, and the majority is restricted to citizens. Some PWDs have difficulties accessing insulin: low-income persons, refugees, noncitizens, or living in remote areas. Approximately 61% of countries have national social security funds and 61% private insurance coverage for insulin. In five countries, there is a law prohibiting nongovernmental organizations to receive international donations of insulin. Local production exists in only five countries surveyed. There is a wide variation in the cost of insulin from $1.42 to 100 and in the minimum wage ($7–2667). Additional barriers to access were delivery, storage, cost, electricity, war conditions, displacements, and sanctions. Conclusion: Although government support is available in the majority of countries, it is still mainly through the provision of human insulin and restricted to citizens. Many barriers affect access to insulin and its costremains unaffordable. Disparities exist between countries within the same classification of income. Mapping the current situation will help to improve it and monitor change. This document can be informative for PWD living or visiting any of these countries and can help understand cross-border travel for medical treatment, and local and regional policies.

“Sometimes choices are not made, because we have ‘a’ choice, they’re made because they are ‘the’ choice”: Barriers to weight management for clients in rural general practice

BackgroundObesity is an international health issue which currently affects over 34% of New Zealand adults and leads to further physical and psychosocial health complications. People living in rural communities experience health inequities and have a high-risk of becoming obese. The aim of this study was to explore and identify barriers to effective weight management in rural Waikato general practice.MethodsUsing semi-structured interviews, 16 rural Waikato participants shared their experiences with barriers to weight management. Interviews were transcribed and analysed using thematic analysis.ResultsFour themes were identified: resource constraints, rural locality barriers, rural sociocultural norms barriers, and participants’ understanding the solutions needed to overcome their specific barriers to effective weight management. For these participants, finding a feasible weight management strategy was a challenging first step in their weight management journey. A programme that would ‘work’ meant one that was economically viable for low-income persons, accessible, even if living rurally with less resources, and did not cause harm or jeopardise their social connections within family or community.ConclusionOverall, participants noted a lack of weight management strategy ‘choice’ because of income, isolation or accessibility of their rural location and/or the sociocultural norms of the community they lived in restricted options available to them. Future weight management initiatives may be better devised from within communities themselves and will need to be cognisant of the barriers specific to rural communities. Rural perspectives have much to offer in any such reconsideration of weight management initiatives.

Investigation on urban greenspace in relation to sociodemographic factors and health inequity based on different greenspace metrics in 3 US urban communities

BackgroundStudy results are inconclusive regarding how access to greenspace differs by sociodemographic status potentially due to lack of consideration of varying dimensions of greenspace.ObjectiveWe investigated how provision of greenspace by sociodemographic status varies by greenspace metrics reflecting coverage and accessibility of greenspace.MethodsWe used vegetation levels measured by Enhanced Vegetation Index (EVI), percent of greenspace, percent tree cover, percent tree cover along walkable roads, and percent of people living ≤500 m of a park entrance (park accessibility). We considered data for 2008–2013 in Census block groups in 3 US regions: New Haven, Connecticut; Baltimore, Maryland; and Durham, North Carolina. We examined geographical distribution of greenspace metrics and their associations with indicators of income, education, linguistic isolation, race/ethnicity, and age. We used logistic regression to examine associations between these greenspace metrics and age-standardized mortality controlling for sociodemographic indicators.ResultsWhich region had the highest greenspace depended on the greenspace metric used. An interquartile range (33.6%) increase in low-income persons was associated with a 6.2% (95% CI: 3.1, 9.3) increase in park accessibility, whereas it was associated with 0.03 (95% CI: −0.035, −0.025) to 7.3% (95% CI: −8.7, −5.9) decreases in other greenspace metrics. A 15.5% increase in the lower-education population was associated with a 2.1% increase (95% CI: −0.3%, 4.6%) in park accessibility but decreases with other greenspace metrics (0.02 to 5.0%). These results were consistent across the 3 study areas. The odds of mortality rate more than the 75th percentile rate were inversely associated with all greenspace metrics except for annual average EVI (OR 1.27, 95% CI: 0.43, 3.79) and park accessibility (OR 1.40, 95% CI: 0.52, 3.75).SignificanceEnvironmental justice concerns regarding greenspace differ by the form of natural resources, and pathways of health benefits can differ by form of greenspace and socioeconomic status within communities.Impact statementComparisons of exposure to greenspace between different greenspace metrics should be incorporated in decision-making within local contexts.

A Neighborhood-Level Analysis of Low-Income Housing Tax Credit Developments in the State of California and Los Angeles County

Some housing researchers have criticized the United States housing subsidy scheme referred to as the Low-Income Housing Tax Credit (LIHTC) program for failing to promote better opportunities for low-income persons. In this study, therefore, we examine the socio-economic and built-environment characteristics of LIHTC developments at the neighborhood level. Specifically, we aim to investigate the characteristics associated with LIHTC developments compared to neighborhoods without this kind of development. We focus on California statewide initially and then narrow our focus to examine LIHTC developments in Los Angeles County (LAC). We then compare the results from the two levels of government. We compiled data from several sources including the U.S. Census Bureau, the State of California, the Southern California Association of Governments, and other secondary sources; used Geographic Information Systems (GIS) to aid in creating several location-based indicators; and employed logistic regression for analyses. Our results show that LIHTC developments at the statewide and county levels tend to be in racially/ethnically diverse neighborhoods with higher levels of economic hardship, lower rents, a higher percentage of renters, and spatial clustering of LIHTC developments. With LAC removed from the state-level analysis, economic hardship is not more likely to occur in LIHTC neighborhoods. This finding suggests, except for in LAC, state policies may be having some level of success in locating LIHTC housing outside of hardship areas. Finally, in examining additional built-environment variables in LAC, we find LIHTC developments were more likely to be in a neighborhood with a park than other neighborhoods in the county. We discuss these results further and conclude with a brief recap of results, policy recommendations, and suggestions for future research.

Integrating Rapid Diabetes Screening Into a Latinx Focused Community-Based Low-Barrier COVID-19 Testing Program

Community-based COVID-19 testing and vaccination programs play a crucial role in mitigating racial and ethnic disparities in COVID-19 service delivery. They also represent a platform that can be leveraged to expand access to testing for chronic diseases, including diabetes, that disproportionately affect the Latinx community and other marginalized communities. To evaluate outcomes associated with a diabetes testing strategy designed to reach low-income Latinx persons by leveraging COVID-19 testing infrastructure and community trust developed during the COVID-19 pandemic. This health care improvement study was conducted from August 1 to October 5, 2021, at an outdoor, community-based COVID-19 testing site at a transport hub in the Mission Neighborhood in San Francisco, California. Because the program was designed to expand access to diabetes screening to the local community, all individuals presenting for on-site testing were eligible. Data were analyzed in November 2021. Integration of rapid, point-of-care hemoglobin A1c screening as a testing option in an existing low-barrier COVID-19 testing program. Evaluation was guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and utilized programmatic data and structured surveys among clients and staff. Of 6631 individuals tested (median [IQR] age 39.3 [29.7-51.3] years; 3417 [52.3%] female, 4348 [65.6%] Latinx), 923 (13.9%) underwent hemoglobin A1c testing with or without COVID-19 testing and 5708 (86.1%) underwent COVID-19 testing only. Individuals tested for diabetes were more likely to be Latinx (763 of 923 individuals [82.7%] who underwent testing were Latinx vs 3585 of 5708 [62.8%] not undergoing testing), have an annual household income of less than $50 000 (450 individuals [81.2%] vs 2409 individuals [66.0%]), and not have health insurance (381 individuals [47.2%] vs 1858 individuals [39.9%]), and 206 (48.0%) had never tested for diabetes before. Overall, 313 (33.9%) and 113 (12.2%) individuals had prediabetes and diabetes, respectively; only 141 of 354 of these individuals (39.8%) had a primary care clinician whom they had seen in the prior 12 months, which was lower among Latinx individuals (113 of 307 individuals [36.8%] vs 28 of 47 [59.6%]). Acceptability of the rapid testing program was high-98% were satisfied with their visit and 96% said they would return for future services; key factors underpinning acceptability included friendly staff, efficiency, and a convenient location. In this health care improvement study conducted within an existing community-based COVID-19 testing program, integrating rapid testing for diabetes was feasible, reached low-income Latinx individuals, and identified many persons with prediabetes and diabetes, most of whom lacked access to services in formal health care settings. Leveraging pandemic-related public health responses represents an important opportunity for engaging socioeconomically disadvantaged populations into care for diabetes.