New York State Counties Research Articles

Key informant perspectives on overcoming HPV vaccination barriers in low-immunization NY counties

ABSTRACT Human papillomavirus (HPV) infection is an important public health concern, with nearly 2,900 cases of HPV-related cancers reported in New York State (NYS) each year. Despite concerted efforts to enhance vaccine uptake in NYS, HPV vaccination rates among 13–15-year-olds failed to meet the 2020 healthy People target, and continue to lag behind the 2030 goal, of 80%. In counties with low immunization levels, understanding factors influencing decision-making among unvaccinated adolescents is crucial. This study aimed to identify barriers, facilitators, and potential interventions to improve HPV vaccine uptake. Qualitative semi-structured interviews were conducted with key informants in 15 NYS counties within the lowest quartile of HPV vaccine coverage among 13-year-old adolescents. Public health representatives, including Immunization Quality Improvement for Providers (IQIP) consultants, vaccine coordinators, medical directors, and primary care providers, were identified through purposive and snowball sampling. Interviews explored vaccination coverage knowledge, barriers and facilitating factors, and recommended strategies for improvement. All conversations were audio-recorded, transcribed, and analyzed using ATLAS.ti. Forty-four interviews were conducted, revealing barriers to HPV vaccination such as limited vaccine knowledge, vaccine misinformation, and accessibility. Key informants asserted barriers could be primarily addressed through education efforts, such increased public awareness, improved parent–doctor conversations, additional provider education on vaccine benefits, and supplementary education in patient spaces. Targeted education efforts and improved provider communication strategies have the potential to bolster HPV vaccination rates in NYS. These findings offer valuable insights for guiding future initiatives in communities facing significant barriers to vaccination.

Long-term persistence of diverse clones shapes the transmission landscape of invasive Listeria monocytogenes

BackgroundThe foodborne bacterium Listeria monocytogenes (Lm) causes a range of diseases, from mild gastroenteritis to invasive infections that have high fatality rate in vulnerable individuals. Understanding the population genomic structure of invasive Lm is critical to informing public health interventions and infection control policies that will be most effective especially in local and regional communities.MethodsWe sequenced the whole draft genomes of 936 Lm isolates from human clinical samples obtained in a two-decade active surveillance program across 58 counties in New York State, USA. Samples came mostly from blood and cerebrospinal fluid. We characterized the phylogenetic relationships, population structure, antimicrobial resistance genes, virulence genes, and mobile genetic elements.ResultsThe population is genetically heterogenous, consisting of lineages I–IV, 89 clonal complexes, 200 sequence types, and six known serogroups. In addition to intrinsic antimicrobial resistance genes (fosX, lin, norB, and sul), other resistance genes tetM, tetS, ermG, msrD, and mefA were sparsely distributed in the population. Within each lineage, we identified clusters of isolates with ≤ 20 single nucleotide polymorphisms in the core genome alignment. These clusters may represent isolates that share a most recent common ancestor, e.g., they are derived from the same contamination source or demonstrate evidence of transmission or outbreak. We identified 38 epidemiologically linked clusters of isolates, confirming eight previously reported disease outbreaks and the discovery of cryptic outbreaks and undetected chains of transmission, even in the rarely reported Lm lineage III (ST3171). The presence of animal-associated lineages III and IV may suggest a possible spillover of animal-restricted strains to humans. Many transmissible clones persisted over several years and traversed distant sites across the state.ConclusionsOur findings revealed the bacterial determinants of invasive listeriosis, driven mainly by the diversity of locally circulating lineages, intrinsic and mobile antimicrobial resistance and virulence genes, and persistence across geographical and temporal scales. Our findings will inform public health efforts to reduce the burden of invasive listeriosis, including the design of food safety measures, source traceback, and outbreak detection.

Demographic and geographic distribution of diabetes and pre-diabetes risk in rural settings: results from a cross-sectional, countywide rural health survey in Sullivan County, New York

ObjectiveTo perform a detailed characterisation of diabetes burden and pre-diabetes risk in a rural county with previously documented poor health outcomes in order to understand the local within-county distribution of...

"I Finally Feel Like I Have Help. Before, I Was Completely Alone": A Grounded Theory of Community-Based Hospice Transitions.

Little is known about community-based transitions to home hospice care. We used a Straussian grounded theory approach to understand the basic social process of care transitions that patients and their caregivers use when electing hospice care. Participants were recruited from hospice agencies serving 3 counties in New York State. Data were collected through 7 interviews of patients, patient-and-caregiver dyads, and a hospice nurse (n = 10). Data were analyzed using the constant comparative method. Our results generated an emerging grounded theory of the hospice care transition processes rooted in maintaining personhood and autonomy. There were 5 contemporaneous steps: (1) recognizing futility and pursuing comfort; (2) seeking help and input as health declines; (3) shopping for the right services, overcoming obstacles, and self-referring to hospice care; (4) attending to the business of dying while living; and (5) processing and expressing emotions. Although not central to the care transition process, an additional step was identified that occurred after the transition to hospice care: planning for an uncertain future. The hospice care transition process identified in the study reveals important mechanistic targets for the development of interventions that promote patient-centered hospice care transitions in the home setting.

Making Decisions About Calling 988 Versus 911: Understanding End-User Views Before the Launch of 988.

The 988 telephone number was implemented in July 2022 as an easily accessible way to reach the National Suicide Prevention Lifeline and has been envisioned as one step in building a more robust crisis care continuum in the United States. This study aimed to describe how various stakeholders anticipated using 988 compared with the most widely known crisis line: 911. Focus groups (N=15, with 76 total participants) were conducted in three counties in New York State between October and November 2021, before the launch of 988. Five stakeholder groups were included: mental health services consumers, family members of consumers, community members, mental health providers, and crisis call takers. Thematic analysis was used to code and analyze all focus group transcripts. Participants anticipated that key uses for 988 would be accessing support during a crisis, obtaining connections to local resources and services, and receiving alternatives to law enforcement response. However, participants continued to articulate uses for 911 during a mental health crisis, especially for situations involving "safety concerns." The broad expectations for 988 suggest that the line must be flexible and responsive to a range of needs and that communities should clearly define what is available through 988. More implementation research is needed to ensure a detailed understanding of those whom 988 is serving, how the line meets callers' needs, and the line's potential for connecting people to needed services.

School-based health centers as an approach to address health disparities among rural youth: A study protocol for a multilevel research framework.

School-Based Health Centers (SBHCs) are important healthcare providers for children in medically underserved communities. While most existing research on SBHCs has focused on urban environments, this study protocol proposes a mixed-methods, multi-level research framework to evaluate the role of SBHCs in addressing health disparities among underserved children and adolescents in rural communities. The study area includes four high-poverty rural counties in New York State served by Bassett Healthcare Network that permits a comparison of school districts with SBHCs to those without SBHCs, all served by providers within the Bassett Healthcare Network. We employ a human ecological framework that integrates the micro layer of individuals and families, the meso layer of school districts and community institutions, and the macro layer of local and state policies. Our research framework first identifies the socioecological health risk factors, and then proposes innovative strategies to investigate how SBHCs impact them. We propose evaluating the impact of SBHCs on the individual (micro) level of child healthcare utilization using patient records data. At the meso level, we propose to investigate how School-SBHCs partnership may facilitate greater cross-agency collaboration and broader structural and social determinist of health to address health disparities. At the macro level, we propose to assess the impact of SBHCs and cross-agency collaboration on outcomes associated with a culture of community health. This study protocol will enable researchers to assess how SBHCs reduce rural health disparities, and provide evidence for organizational and public policy change.

Food insecurity in high-risk rural communities before and during the COVID-19 pandemic

ObjectiveTo perform a geospatial analysis of food insecurity in a rural county known to have poor health outcomes and assess the effect of the COVID-19 pandemic. MethodsIn 2020, we mailed a comprehensive cross-sectional survey to all households in Sullivan County, a rural county with the second-worst health outcomes among all counties in New York State. Surveys of households included validated food insecurity screening questions. Questions were asked in reference to 2019, prior to the pandemic, and for 2020, in the first year of the pandemic. Respondents also responded to demographic questions. Raking adjustments were performed using age, sex, race/ethnicity, and health insurance strata to mitigate non-response bias. To identify significant hotspots of food insecurity within the county, we also performed geospatial analysis. FindingsFrom the 28,284 households surveyed, 20% of households responded. Of 4725 survey respondents, 26% of households reported experiencing food insecurity in 2019, and in 2020, this proportion increased to 35%. In 2020, 58% of Black and Hispanic households reported experiencing food insecurity. Food insecurity in 2020 was also present in 58% of unmarried households with children and in 64% of households insured by Medicaid. The geospatial analyses revealed that hotspots of food insecurity were primarily located in or near more urban areas of the rural county. ConclusionsOur countywide health survey in a high-risk rural county identified significant increases of food insecurity in the first year of the COVID-19 pandemic, despite national statistics reporting a stable rate. Responses to future crises should include targeted interventions to bolster food security among vulnerable rural populations.

The average effectiveness of local migration exchanges

AbstractWe develop a measure of the average effectiveness of migration exchanges with destinations, for local origins. We also decompose this new measure into components summarising the average effectiveness of a region's exchanges with places for which it has net out‐migration, and places for which it has net in‐migration. This makes it possible to define regions that are effective exchangers, balanced exchangers, effective gainers, or effective losers, with respect to their migration exchange patterns. This is discussed in the context of the measure's ability to add insights to migration theory. In addition, we provide an application of the approach to intercounty migration for counties in New York State.

Epidemiologic patterns of adolescent idiopathic scoliosis detection and treatment in new york state.

The purpose of this study is to examine the epidemiologic trends of adolescent idiopathic scoliosis (AIS) detection and treatment in New York State (NYS), including disparities in access. The New York Statewide Planning and Research Cooperative System database was reviewed to identify patients who underwent treatment for, or were diagnosed with, AIS from 2008 to 2016. Age determined adolescence; and the surgery date, 3-digit zip code, sex, race, insurance status, institution and surgeon license number were recorded to identify such trends. The geographical distribution was assembled from an NYS shapefile, obtained from the Topologically Integrated Geographic Encoding and Referencing database with analysis performed using tigris R. In total 54 002 patients with AIS, 3967 of whom were surgically treated, were identified for analysis. Diagnoses spiked in 2010. Females were diagnosed and underwent surgical treatment more frequently than males. AIS was diagnosed and treated in white patients more frequently than in black and Asian patients combined. From 2010 to 2013, the patients self-paying for surgical treatment decreased more than other payment modalities. Medium-volume surgeons continually increased the number of cases performed, whereas low-volume surgeons exhibited the opposite pattern. High-volume hospitals had a decrease in the number of cases from 2012 and were overtaken by medium-volume hospitals in 2015. Most procedures are performed within the New York City (NYC) area, though AIS was common in all NYS counties. AIS diagnoses increased after 2010, with fewer patients self-paying for surgery. White patients underwent more procedures than minority patients. Surgical cases were disproportionally performed in the NYC area compared to statewide.

Testing network autocorrelation without replicates.

In this paper, we propose a portmanteau test for whether a graph-structured network dataset without replicates exhibits autocorrelation across units connected by edges. Specifically, the well known Ljung-Box test for serial autocorrelation of time series data is generalized to the network setting using a specially derived central limit theorem for a weakly stationary random field. The asymptotic distribution of the test statistic under the null hypothesis of no autocorrelation is shown to be chi-squared, yielding a simple and easy-to-implement procedure for testing graph-structured autocorrelation, including spatial and spatial-temporal autocorrelation as special cases. Numerical simulations are carried out to demonstrate and confirm the derived asymptotic results. Convergence is found to occur quickly depending on the number of lags included in the test statistic, and a significant increase in statistical power is also observed relative to some recently proposed permutation tests. An example application is presented by fitting spatial autoregressive models to the distribution of COVID-19 cases across counties in New York state.

Medications Associated With Geriatric Syndromes (MAGS) and Hospitalization Risk in Home Health Care Patients.

Polypharmacy is common in home health care (HHC). This study examined the prevalence of medications associated with geriatric syndromes (MAGS), its predictors, and association with subsequent hospitalization in HHC. Analysis of HHC electronic medical records, the Outcome and Assessment Information Set (OASIS), and Medicare HHC claims. A total of 6882 adults ≥65years old receiving HHC in 2019 from a large, not-for-profit home health agency serving multiple counties in New York State. MAGS use was identified from active medications reconciled during HHC visits (HHC electronic medical records). MAGS use was operationalized as count and in quartiles. Hospitalization during the HHC episode was operationalized as a time-to-event variable (ie, number of days from HHC admission to hospitalization). We used regression analyses to identify predictors of MAGS use, and survival analyses to examine the association between MAGS and hospitalization. Nearly all (98%) of the HHC patients used at least 1 MAGS and 41% of all active medications used by the sample were MAGS. More MAGS use was found in HHC patients who were community-referred, taking more medications, and having more diagnoses, depressive symptoms, and functional limitations. Adjusted for covariates, higher MAGS quartiles were not independently associated with the risk of hospitalization, but higher MAGS quartiles combined with multimorbidity (ie, having ≥10 diagnoses) were associated with a 2.3-fold increase in hospitalization risk (hazard ratio 2.24; 95% confidence interval: 1.61-3.13; P < .001), relative to the lowest quartile of MAGS use and having <10 diagnoses. More than 40% of medications taken by HHC patients are MAGS. Multimorbidity and MAGS use collectively increased the risk of hospitalization by up to 2.3 times. HHC clinicians should carefully review patients' medications and use information about MAGS to facilitate discussion about deprescribing with patients and their prescribers.

1197-P: The Demographic and Geographic Distribution of Diabetes and Prediabetes Risk in Rural Settings

Introduction: Evaluating diabetes prevalence and prediabetes risk in rural settings can be difficult due to sparse population coverage and limited data. Objective: To evaluate diabetes burden and prediabetes risk in a rural county with documented poor health outcomes. Methods: In 2021, we mailed health surveys to all households in Sullivan County, a rural county with the second-worst health outcomes of all counties in New York State. We included questions on demographics, medical history, and the American Diabetes Association’s Prediabetes Risk Test in our survey. A score of 5 points or higher on this test is considered high risk for having prediabetes. To help mitigate non-response bias, statistical raking was performed using age, sex, race/ethnicity, and health insurance strata. We analyzed diabetes prevalence and prediabetes risk by demographic characteristics. We also used geospatial analysis within the county to assess for clustering of diagnosed diabetes cases and elevated prediabetes risk scores. Results: Of 4,725 survey responses analyzed, the adjusted diabetes prevalence in our sample was 14% compared to the 20BRFSS estimate of 8.6% for Sullivan County. In this rural area, diabetes prevalence was notably higher among non-Hispanic Black (23%) and Hispanic (16%) residents compared to non-Hispanic White (13%) residents. Prediabetes risk scores were elevated among 41% of respondents without a history of diabetes. Nearest neighbor analyses revealed that hotspots of diagnosed diabetes and high prediabetes risk scores were primarily located in more urban areas of this rural county. Conclusion: Our mailed health survey to all residents in Sullivan county demonstrated higher diabetes prevalence compared to modelled BRFSS estimates that are based on a small telephone sample. Our results suggest the need for better diabetes surveillance in rural communities, which may benefit from interventions specifically tailored for improving glycemic control among rural residents. Disclosure D.C.Lee: None. N.A.Mcgraw: None. L.Thorpe: None. C.Quintero arias: None. M.Rony: None. R.Patel: None. E.Jensen: None. R.Petcu: None. D.M.Imas: None. B.Elbel: None. R.Anthopolos: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)

1508-PUB: Food Insecurity in Rural Communities Before and During the COVID-Pandemic

Introduction: In times of economic crisis, there have been sharp increases in levels of food insecurity. During the COVID-pandemic, the USDA reported that food insecurity remained stable at 15% in America from 20to 2020. This national average may not reflect the heightened risk of rural areas and counties with known socioeconomic disadvantages. Objective: To evaluate food insecurity in a rural county with documented poor health outcomes and assess the impact of the COVID-pandemic. Methods: We performed a cross-sectional survey of all households in Sullivan County, a rural county that has the second-worst health outcomes among all counties in New York State. The survey included two screening questions that have been validated to identify households with food insecurity. The questions were asked in reference to 2019, before the pandemic, and for 2020, during the pandemic. Respondents were also asked to fill out household and demographic questions. To help mitigate non-response bias, statistical raking was performed using age, sex, race/ethnicity, and health insurance strata. We also performed geospatial analysis within the county to identify significant clusters of food insecurity. Results: Of 4,725 survey responses analyzed, 26% of households reported food insecurity in 2019, which increased to 35% in 2020. We identified high levels of food insecurity in 58% of Black households and 58% of Hispanic households in 2020. Food insecurity in 2020 was also present in 58% of unmarried households with children and in 64% of households insured by Medicaid. Nearest neighbor analyses revealed that hotspots of food insecurity were primarily located in or near urban clusters within this rural county. Conclusion: Our countywide health survey of a particularly at-risk rural county identified significant increases in food insecurity during the COVID-pandemic. Economic responses to future pandemics may need to focus on bolstering food security among single households with children and those insured by Medicaid. Disclosure C.Quintero arias: None. B.Elbel: None. N.A.Mcgraw: None. D.C.Lee: None. M.Rony: None. E.Jensen: None. R.Patel: None. S.O'callaghan: None. C.A.Koziatek: None. K.Doran: None. R.Anthopolos: None. L.Thorpe: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124400)

Relationship between COVID-19 cases and vaccination rates in New York State counties.

Context: The presence of new viral variants, in combination with the relaxation of social distancing and other preventative measures, has led to a spike in COVID-19 cases in the United States. The development of COVID-19 vaccinations may reduce the impact of these viral variants on case rates in the population. Objective: To determine the impact of COVID-19 vaccination rates on cases/100k population in each New York State (NYS) county. Study Design: Cross-sectional analysis of COVID-19 cases/100k population per NYS county, frozen at a single snapshot in time. Descriptive statistics and bivariate correlations were conducted to determine vaccination rates across 62 NYS counties, and linear regression was used to examine the effect of vaccination rates on cases/100k, controlling for size of county population. Dataset & Setting: Vaccination rates per county shared by the NYS Department of Health using data reported to the NYS Immunization Information System and the New York City Citywide Immunization Registry. COVID-19 case rates per county available through the John Hopkins University website. Population: NYS residents across 62 counties on March 31st, 2021. Outcome Measures: COVID-19 vaccination rates across counties at a single point in time were compared with cases/100k population. Results: Percentages with 1 dose and with 2 doses are highly correlated (r=.935, p<.001) with one another, and county population size was strongly correlated with cases per 100k (r=.715, p<.001). Both the 1 dose and 2 dose rates were negatively correlated with cases per 100k population, although not significantly. However, the two-dose vaccination rate was a significant negative predictor of cases per 100k population in NYS Counties (β= -.866, p=.031), with each percentage point of completed vaccination nearly equating to one case less in the daily count, when controlling for county population size (β =2.732, p<.001). Conclusion: While COVID-19 variants may impact vaccine effectiveness, current vaccination efforts are helping forestall some cases in NYS. Widespread vaccination is still an important goal. Primary care providers, public officials, and public health scientists should continue to urgently promote and support vaccination efforts.

Demographic and socioeconomic correlates of suicide deaths and nonfatal self-injury related hospital visits: An analysis of counties in New York State

For many years, suicide rates in U.S. general and veteran populations have steadily increased, stimulating research into suicide and nonfatal self-injury (NFSI). However, little research has examined community correlates of suicide and NFSI. This study used county data from New York State to identify community correlates of veteran and general population suicide deaths and general population NFSI-related hospitalization. In bivariate analyses, both suicide and NFSI-related hospitalization were associated with measures of social disintegration (i.e., smaller population size, larger male and/or White population) and socioeconomic disadvantage (i.e., higher disability rates disability, lower household incomes, more limited-English speaking households). In regression analyses, general-population suicide was independently associated with higher disability and veteran-suicide rates, whereas NFSI-related hospitalization was independently associated with lower household income. Findings attest the importance of low-cost, accessible, outpatient services and highlight social disintegration and socioeconomic disadvantage as salient, community risk factors for suicide and NFSI.

A Comparison Between Rural and Urban Jail Proximities to Inpatient Mental Health Care in New York State.

The authors created a model to examine the distance between jails and inpatient mental health care facilities in rural counties versus urban counties in New York State. Using U.S. census data, the top seven most rural counties and top seven most urban counties were selected for analysis. Results indicate that, overall, urban jails have closer access than rural jails to inpatient mental health care, with the furthest facilities for urban jails being 15.1 kilometers and the furthest for rural jails being 43.6 kilometers. The closest inpatient mental health care facility for urban jails was 174 meters, whereas the closest mental health care facility for rural jails was 0.02 kilometers. Average distance from inpatient mental health care was 4.3 kilometers for urban jails and 26 kilometers for rural jails. Policy implications are discussed.

Barriers to Meeting Community Needs in New York State during COVID-19: Results From a Pilot Survey of Nongovernmental Population and Community Health Professionals.

Capacity building and training help empower the community and population health organizations to partner with local health departments and collaboratively design multisectoral interventions that account for the complexity of public health and health promotion challenges in the era of COVID-19 and beyond. Ideally, training programs should be informed by an understanding of the needs and priorities of the professionals for whom they are intended. This brief report focuses on the results of a pilot online survey conducted as part of a larger pilot study by the New York State Association of County Health Officials and the Region 2 Public Health Training Center among population and community health professionals (n = 27) from four counties in New York State during the COVID-19 pandemic. Survey participants included a diverse group of staff members from various large and small nonprofit organizations, federally qualified health centers, academic institutions, hospitals, and insurers. Survey findings provide preliminary insights into the extent to which these organizations have been involved in the COVID-19 response in partnership with LHDs, barriers they faced in responding to the needs of the populations they serve and adjusting their work routines/operations to COVID-19 guidelines, and their top emerging organizational and training needs. Lessons learned from conducting an online survey during a public health emergency and implications for future training interventions for population and community health professionals are also discussed within the context of promoting multisectoral collaboration with local health departments, solving complex public health problems, and advancing health equity.

Relationship Between COVID-19 Cases and Vaccination Rates in New York State Counties.

Vaccines against SARS-CoV-2 have been developed with unprecedented speed. The phased introduction of vaccines may be serving to offset the impact of new viral variants and policy relaxation. In order to assess the impact of vaccination, we examined a snapshot of vaccination rates across counties in a single state, at a single time point, comparing them with population-adjusted case counts. We calculated descriptive statistics and bivariate correlations for vaccination rates and cases across counties in New York State (NYS). We conducted a linear regression using cases/100K population per NYS county, frozen at a single snapshot in time, as the outcome variable, predicted by percentage of each county's population (completed series/two doses), controlling for county population. Percentages with one dose and with two doses were highly correlated (r=.935, P<.001) with one another. Both the one dose and two dose z rates were negatively correlated with cases per 100K population (not significant). Population size was strongly correlated with cases per 100K (r=.715, P<.001). The two-dose vaccination rate was a significant negative predictor of cases per 100K population in NYS counties (β= -.866, P=.031), with each percentage point of completed vaccination nearly equating to one case less in the daily count when controlling for county population size (β =2.732, P<.001). While variants may impact vaccine effectiveness, current vaccination efforts are helping forestall some cases in NYS. Widespread vaccination is still an important goal. Primary care providers, public officials, and public health scientists should continue to urgently promote and support vaccination efforts.

Site Location Optimization Based on Genetic Algorithm

With the goal of providing food to people in need, the FBST serves nearly 4,000 square miles in six counties in New York State. The MFP program is among the main activities of FBST, using an MFP truck loaded with food to serve 70 sites in New York State. An effective and fair schedule for visiting all 70 sites is necessary to optimize the MFP plan. In order to describe the problem, a triad {G, R, C} of goal, resource and constraint is established according to the decision theory. Based on the established triad, this paper establishes a multi-objective optimization model with the goal of improving validity and fairness, a genetic algorithm has been adopted to solve the problem. The time schedule for visiting sites is finally obtained after the iteration of 2000 times, which took 156.40 seconds. Considering that customers can go to further sites, the number of service sites and the location of sites can be optimized. The K-means clustering algorithm based on the improved demand centroid solution method is used to solve the site location selection. After optimizing the location of the site, the performance of seniorsite and regular-site systems is improved by 30.755% and 36.413% respectively.

Exceptional upward mobility sin papeles: the case of Familia Arias and their fútbol team in New York City

In this paper I analyze cases of Mexican families in New York, which have experienced exceptional upward mobility while being headed by long-term undocumented immigrants. The focus is on Familia Arias, from Tlaxcala. They are part of a larger group of families who I identified in an amateur football team based in New York. I explain that some of these families are exceptional because out of 53 family-households headed by undocumented or DACA immigrants from Mexico in New York City and Long Island, only half a dozen reported an annual family income above $70,000 USD. Along the paper I explain how individual and group factors in each case combine to promote this upward socio-economic mobility. These mechanisms or processes that promote mobility for long term unauthorized immigrants, strongly interacting around amateur football teams, include (i) transferring binational labour skills, (ii) long-time tenure in jobs or prosperous self-employment, and (iii) positive intra-family dynamics. Stories such as the ones of Marcela and Claudio Arias are part of 92 individual ethnographic cases I developed and collected between the fall of 2014 and the summer of 2017 in two urban counties – the Bronx and Queens – and suburban towns in Suffolk County, Long Island. Almost all of these cases were incorporated into the Mexican Initiative for Deferred Action project, initiated in the summer of 2015, which includes other areas, regions, and counties in New York State and the metro area (screening over 1,700 individuals). The 92 cases studied and developed are mainly short biographies, labour and migratory trajectories of foreign-born Mexicans, most of them unauthorized immigrants, who have been living in New York for an average of 17 years with an estimated median family-household income of $43,000 USD annually. Fútbol, for participants in Queen, in New York City, was a key activity to develop strong local networks in the city.