Percentage Of African-American Residents Research Articles

Gentrification and Air Quality in a Large Urban County in the United States

Introduction: Increases in industrialization and manufacturing have led to worsening pollution in some components of air quality. In addition, gentrification is occurring in large cities throughout the world. As these socioeconomic and demographic changes occur, there have been no studies examining the association of gentrification with air quality. To investigate this association, we studied the trends of gentrification, changes in racial distribution and changes in air quality in each zip code of a large urban county over a 40-year period. Methods: We conducted a retrospective longitudinal study over 40 years in Wayne County, Michigan using socioeconomic and demographic data from the National Historical Geographic Information System (NHGIS) and air quality data from the United States Environmental Protection Agency (EPA). To assess gentrification, longitudinal analyses were performed to examine median household income, percentage with a college education, median housing value, median gross rent and employment level. The racial distribution was evaluated in each zip code during the time period. Gentrification was studied in relation to air quality using nonparametric 2-sample Wilcon-Mann-Whitney tests and Binomial Generalized Linear Regression models. Results: Although air quality improved overall over the 40-year period, there was a lesser rate of improvement in gentrified areas. Furthermore, gentrification was strongly associated with racial distribution. The most substantial gentrification occurred from 2010 to 2020, in which a specific cluster of adjacent zip codes in downtown Detroit experienced intense gentrification and a drop in the percentage of African-American residents. Conclusions: Gentrified areas seem to have a less pronounced improvement in air quality over time. This reduction in air quality improvement is likely associated with demolitions and the construction of new buildings, such as sporting arenas and accompanying traffic density. Gentrification is also strongly associated with an increase in non-minority residents in an area. Although previous definitions of gentrification in the literature have not included racial distribution, we suggest that future definitions should include this metric given the strong association. Minority residents who are displaced as a result of gentrification do not experience the improvements in housing quality, accessibility to healthy foods and other associations of gentrification.

A Comparison of Applicant and Resident Physician Demographics Among Surgical Subspecialties From 2009 to 2019: Trends in Gender and Underrepresented Minorities in Medicine.

The purposes of this study were to compare applicant statistics to resident physician demographics among several surgical subspecialties (SSSs), to identify trends of gender and underrepresented minorities in medicine (UIM), and to evaluate current diversity among these specialties. Graduate medical education reports from 2009 to 2019 were queried to determine trends among programs. Further identification of gender and UIM statistics was obtained in 4 several SSSs: integrated plastic surgery, orthopedic surgery (OS), otolaryngology surgery (ENT), and neurosurgery (NS). These were compared with Association of American Medical Colleges data of residency applicants for the respective years. Significant differences were seen among gender and UIM(s) of the applicant pool when compared with resident data. All specialties had significantly fewer American Indian and African American residents compared with applicants. Significant differences between applicants and residents were also found among Hispanic, Native Hawaiian, and female demographics. All SSSs had a significant positive trend for the percentage of female residents. Significant differences between specialties were identified among African American, Hispanic, and female residents. Orthopedic surgery and NS had significantly higher percentage of African American residents compared with ENT and integrated plastic surgery. Neurosurgery had significantly higher percentage of Hispanic residents compared with OS and ENT. Integrated plastic surgery and ENT had significantly higher percentage of female residents compared with OS and NS. There has been significant increase in number of residency programs and resident positions since 2009. However, increase in female residents and UIM(s) among SSSs has not matched the pace of growth.

Do algorithms discriminate against African Americans in lending?

Vast evidence exists of discrimination in lending against African Americans. Does such widespread discrimination persist in peer-to-peer lending, in the absence of information about borrowers’ ethnicity? To investigate this question, we gather data from a large peer-to-peer lender that uses algorithms and no face-to-face interviews to determine loan approval and conditions. With data from 3.6 million loan applications and 817,000 granted loans during 2016 and 2017, we perform regressions of loan acceptance and loan conditions on the percentage of African American residents by 3-digit zip area. The evidence shows the persistence of discrimination in peer-to-peer lending against African American borrowers. In areas with higher proportions of African American residents, the results reveal higher loan rejection, higher loan spread, and shorter loan maturity. Discrimination in peer-to-peer lending also affects Native American and Asian borrowers. Thus, the expansion of peer-to-peer lending cannot end discrimination in lending.

Physical Punishment of Children in Urban African American Neighborhoods

Use and support of physical punishment are known to be elevated among individuals who are African American. Less is known about the association between a neighborhood’s racial composition and the frequency with which its children experience physical discipline. This study aims to (a) determine if children in mostly Black urban neighborhoods are subjected to spanking and other physical punishments more commonly than those living elsewhere and (b) assess the degree to which neighborhood characteristics (besides racial makeup) account for associations between neighborhood racial composition and physical punishment use therein. Ordinary least squares regression models are used to analyze data regarding 3-year-old children from the Fragile Families and Child Wellbeing Study, which is designed to be nationally representative of births in US cities with at least 200,000 residents. It is found that greater proportions of mothers in mostly Black neighborhoods than in other neighborhoods reported any past-year use of spanking, hitting with a hard object, and slapping, as well as more than 20 past-year occurrences of hitting with a hard object and slapping. Furthermore, a direct association is found between the percentage of African American residents in a neighborhood and an index of physical punishment usage, which is robust to controls for a variety of characteristics of the mother’s household and neighborhood. It is important to account for greater exposure to physical punishment as a factor that may disadvantage children growing up in mostly Black communities.

Characteristics of U.S. Nursing Homes with COVID‐19 Cases

BACKGROUND/OBJECTIVESThe 2019 coronavirus disease (COVID‐19) has been documented in a large share of nursing homes throughout the United States, leading to high rates of mortality for residents. To understand how to prevent and mitigate future outbreaks, it is imperative that we understand which nursing homes are more likely to experience COVID‐19 cases. Our aim was to examine the characteristics of nursing homes with documented COVID‐19 cases in the 30 states reporting the individual facilities affected.DESIGNWe constructed a database of nursing homes with verified COVID‐19 cases as of May 11, 2020, via correspondence with and publicly available reports from state departments of health. We linked this information to nursing home characteristics and used regression analysis to examine the association between these characteristics and the likelihood of having a documented COVID‐19 case.SETTINGAll nursing homes from 30 states that reported COVID‐19 cases at the facility‐level.PARTICIPANTSNursing home residents in states reporting data.MEASUREMENTSWhether a nursing home had a reported COVID‐19 case (yes/no), and conditional on having a case, the number of cases at a nursing home.RESULTSOf 9,395 nursing homes in our sample, 2,949 (31.4%) had a documented COVID‐19 case. Larger facility size, urban location, greater percentage of African American residents, non‐chain status, and state were significantly (P < .05) related to the increased probability of having a COVID‐19 case. Five‐star rating, prior infection violation, Medicaid dependency, and ownership were not significantly related.CONCLUSIONCOVID‐19 cases in nursing homes are related to facility location and size and not traditional quality metrics such as star rating and prior infection control citations. J Am Geriatr Soc 68:1653‐1656, 2020.

Death Qualification in Black and White: Racialized Decision Making and Death‐Qualified Juries

Death qualification has been shown to have a number of biasing effects that appear to undermine a capital defendant's Sixth Amendment right to a fair jury. Attitudes toward the death penalty have shifted modestly but consistently over the last several decades in ways that may have changed the overall impact of death qualification. Specifically, the very large gap between black and white Americans' current support for capital punishment raises the question of whether death qualification procedures disproportionately exclude African Americans from capital jury participation. In order to examine this possibility, we conducted two countywide death penalty attitude surveys in the California county that has the highest percentage of African American residents in the state. Results show that death qualification continues to have a number of serious biasing effects—including disproportionately excluding death penalty opponents—which result in the significant underrepresentation of African Americans. This creates a death‐qualified jury pool with the potential to be significantly more likely to ignore and even misuse mitigating factors and to rely more heavily on aggravating factors in their death penalty decision making. The implications of these findings for the fair administration of capital punishment are discussed.

Abstract C21: [Advocate Abstract:] Addressing Breast Cancer Disparities in North Central Alabama

Abstract “The mission of Susan G. Komen is to save lives and end breast cancer forever by empowering people, ensuring quality of care for all and energizing science the find the cures. In keeping with the mission, the North Central Alabama Affiliate is committed to the underserved population in our service area. The Komen North Central Alabama service area includes thirty-eight of sixty-seven counties in Alabama, geographically comprising more than half of the state, with approximately 2/3 of the total population of Alabama. The Komen North Central Alabama community profile is an assessment of breast cancer needs in local communities. The community profile identifies populations most at risk for dying from breast cancer, identify the needs and gaps in health systems, identify community asses, and better understand what people know, think and do about breast cancer. The community profile is the foundation for strategic planning and informs priorities for mission and non-mission work. By focusing on these priorities, Komen North Central Alabama can ensure that resources and programs reach the individuals most impacted by breast cancer. The data from the community profile highlighted the disparities that exist within the service area, which includes the some of the most populated, highest income counties, as well as some of the least populated, lowest income counties, both rural and urban. Of particular note, are five counties of Alabama, which are part of a region known as the Black Belt. These counties have the highest percentage of families with income below the poverty level, the highest percentage of women age 40 and up who have not had a mammogram in the past twelve months and the highest percentage of late stage diagnosis (stages III and IV). Additionally, Greene County also has a mortality rate nearly twice as high as that of other counties in the area. These counties have the highest percentage of African American residents. These counties also have the lowest literacy rates in the area. Also of interest is that in Jefferson County, an urban area, 1/3 of women diagnosed with breast cancer will die of the disease. In order to better understand the disparities, a health systems analysis of the target communities was conducted. This included data and asset mapping of service providers and key organizations. Information regarding the number of women eligible for the Alabama Breast and Cervical Cancer Early Detection Program and then number of women accessing the program was assessed. Access to care, community assets and key informants findings were also included. A common thread across all areas of the analysis of the underserved is the lack of funding or finances for adequate breast services. To address the findings of the community profile, the following priorities have been identified. • Reduce the rates of breast cancer death and late-stage diagnosis of breast cancer by addressing transportation issues. • Reduce the rates of breast cancer death and late-stage diagnosis of breast cancer by addressing cultural barriers. • Reduce the rates of breast cancer death and late-stage diagnosis of breast cancer by building and strengthening partnerships. • Reduce the rates of breast cancer death and late-stage diagnosis of breast cancer by expanding education and awareness outreach. “ Citation Format: Thelma P. Brown. [Advocate Abstract:] Addressing Breast Cancer Disparities in North Central Alabama. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C21.

Availability of Farmers’ Markets and Supplemental Nutrition Assistance Program/Electronic Benefit Transfer Systems and Associations With Rurality, Poverty, Race/Ethnicity, and Obesity Among North Carolina Counties

Increasing the number of farmers’ markets and implementing Electronic Benefit Transfer (EBT) systems for the Supplemental Nutrition Assistance Program (SNAP) at more farmers’ markets have been suggested as strategies to overcome food access issues, but little is known about their availability in the rural South. This study examines differences in availability of farmers’ markets and SNAP/EBT at markets by county-level rural/urban classification, percentage poverty, percentage racial/ethnic minority, and percentage obese residents in North Carolina counties. Data were collected using a cross-sectional survey. Though results related to rurality and economic status are mixed, regression analyses indicate that the percentage of African American residents is inversely associated with the number of markets and number of markets that accept EBT. Results suggest that access to farmers’ markets varies in North Carolina, and additional research is needed to determine whether this impacts obesity.

Decomposing Racial Disparities in Obesity Prevalence: Variations in Retail Food Environment.

Racial disparities in obesity exist at the individual and community levels. Retail food environment has been hypothesized to be associated with racial disparities in obesity prevalence. This study aimed to quantify how much food environment measures explain racial disparities in obesity at the county level. Data from 2009 to 2010 on 3,135 U.S. counties were extracted from the U.S. Department of Agriculture Food Environment Atlas and the Behavioral Risk Factor Surveillance System and analyzed in 2013. Oaxaca-Blinder decomposition was used to quantify the portion of the gap in adult obesity prevalence observed between counties with a high and low proportion of African-American residents is explained by food environment measures (e.g., proximity to grocery stores, per capita fast-food restaurants). Counties were considered to have a high African-American population if the percentage of African-American residents was >13.1%, which represents the 2010 U.S. Census national estimate of percentage African-American citizens. There were 665 counties (21%) classified as a high African-American county. The total gap in mean adult obesity prevalence between high and low African-American counties was found to be 3.35 percentage points (32.98% vs 29.63%). Retail food environment measures explained 13.81% of the gap in mean age-adjusted adult obesity prevalence. Retail food environment explains a proportion of the gap in adult obesity prevalence observed between counties with a high proportion of African-American residents and counties with a low proportion of African-American residents.

Obesity and Social Inequality in America

In the United States food has become a weapon for social control. Hunger and conversely obesity have contributed to the subjugation of underserved populations and served to perpetuate social inequality. This research provides an analysis of the literature on factors that influence obesity rates, however the question of why these factors play a significant role probes deeper into the political and social structures that lend themselves to such inequities. Obesity rates have historically been higher in Southern states, leading to a consideration of historical food preparation and consumption practices and the intergenerational transmission of food culture. This study uses ordinary least squares regression and data from the Centers for Disease Control, and Prevention (CDC), the United State Department of Agriculture (USDA) and the U.S. Census to examine the factors that influence state level obesity rates. The results indicate a significant positive correlation between Supplemental Nutritional Assistance Program (SNAP) assistance and the obesity rate. Lack of physical activity and the percentage of African American residents are also significantly correlated with the level of obesity. In contrast healthy food outlets within a half-mile of the residence appear to be associated with lower levels of obesity.

Childless Elders in Assisted Living: Findings from the Maryland Assisted Living Study

We compared data drawn from a random sample of 399 current assisted living residents and a subsample of 222 newly admitted residents for two groups: childless residents and residents with children. The percentage of childless residents (26%) in our study was slightly higher than U.S. population estimates of childless individuals aged 65 years and older (20%). In the overall sample, the two groups differed significantly by age, race, and women's years of education. The childless group was slightly younger, had a higher percentage of African American residents, and had more years of education than the group with children. In the subsample, we looked at demographic, functional, financial, and social characteristics and found that childless residents reported fewer diagnoses of dementia and fewer visits from a relative but more reported paying less money per month for assisted living and having private insurance than residents with children. As childlessness among older adults continues to increase, it will become increasingly important to understand how child status affects the need for and experience of long-term care.

Abstract B94: A10-year retrospective analysis of African American and white patients with diffuse large B cell lymphoma treated at the University of Alabama at Birmingham

Abstract Introduction: Diffuse large B cell lymphoma (DLBCL) is the commonest type of NHL and has variable clinical behavior because of distinct molecular signatures that have recently been identified. The treatment of this lymphoma has improved dramatically after the addition of rituximab to the commonly used first line chemotherapy CHOP but there is still a wide variation in response to treatment. Our study aim was to see if race as well as socioeconomic status played a role in diagnosis as well as treatment of this disease. Methods: We performed a retrospective analysis of all patients from 1997-2007 with a biopsy confirmed diagnosis of DLBCL that were treated at the University of Alabama at Birmingham (UAB) and analyzed various factors like age, sex, marital status, insurance status, Stage, B symptoms, extranodal sites, ECOG performance status (PS), type of treatment and survival after stratifying them by reported race as either white or African American(AA). We excluded patients that had evidence of transformation or mixed histology or incomplete information about demographics or treatment. Results: A total of 292 patients met the inclusion criteria.10 patients with race reported as ‘Other’ were further excluded. A total of 282 patients were analyzed out of which 240(85%) of patients were white and 15% of patients were AA. Of note, Jefferson County where UAB is located has an approximately 33% of AA residents. The mean age of diagnosis for AA patients was lower at 48 yrs as compared to 52 yrs for white patients (p=0.01). AA patients were more likely to be uninsured (5%) as opposed to white patients (3%)(p=0.02). AA patients seemed to have an inferior performance status (PS) at presentation with only 57% presenting at with an ECOG PS of 0-1 as compared to 73% of white patients.(p&amp;lt;0.001). They also seemed presented at a later stage of the disease.31% presented at Stage I/II vs 34% of white patients (p&amp;lt;0.012) with correspondingly higher LDH values (50% with values greater than upper limit of normal compared to 37% of White patients, p=0.024). There was no significant difference in the type of first chemotherapy regimen that both groups received with approximately similar proportions receiving CHOP (42% of white patients vs 35% of AA patients) or R-CHOP(35% of white patients vs 44% of AA patients). The median survival for AA patients was 2 years as compared to 3 years in the white patients but this was not statistically significant (p=0.2). In conclusion, DLBCL is a heterogeneous disease with distinct molecular subtypes that have been recently identified. Our single institution 10-year analysis shows that a significantly greater proportion of AA patients appear to present at a younger age, with more advanced disease but do not seem to have a significant difference in overall survival. We hypothesize that these findings may be due to socioeconomic status as well as inherent differences in the biology of the tumor. There is a well documented decreased incidence of various B cell NHL in the African American population and this is confirmed in our analysis with only a 15% incidence of DLBCL even in a county with a higher percentage of AA residents. These observations can help guide further research into identifying the different molecular subtypes of DLBCL in various ethnic populations and help us develop more targeted therapy for this disease. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B94.

An Investigation of the Socio-Economic Aspects of Open Space and Agricultural Land Preservation

ABSTRACT In some regions of the United States, there is a growing concern with the development of farmlands for residential and commercial purposes. Where land becomes a precious commodity, many decisions about whether to preserve or sell are being made. This study investigates whether the decision to preserve is being made using insufficient criteria, in particular with the omission of socio-economic aspects. Using county-level data, regression analysis is used to determine whether significant relationships may exist between the amount of land preserved and socio-economic indicators. The results indicate that the amount of land preserved as a percentage of total county acreage is positively related to high incomes, high housing values, population growth, farmland prices, and the number of farms. In addition, the amount of land preserved as a percentage of total county acreage is negatively related to the county unemployment rate, the age of residents, and the percentage of African American residents. These results suggest that the socio-economic impacts associated with land preservation programs should be further investigated in net preservation benefits calculations. In particular, whether open space and farmland preservation programs should consider if they pose potential adverse impacts on minority and low-income residents.