Census Tract Of Residence Research Articles

Geographic Density and Uptake of Pre-exposure Prophylaxis (PrEP) Among Young Gay, Bisexual and Other Sexual Minority Men: A Global Positioning System (GPS) Study

The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017–January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) individual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies.

Elevated COVID19 mortality risk in detroit area hospitals among patients from census tracts with extreme socioeconomic vulnerability.

Backgroundthe incidence of novel coronavirus disease (COVID19) is elevated in areas with heightened socioeconomic vulnerability. Early reports from US hospitals also implicated social disadvantage and chronic disease history as COVID19 mortality risk factors. However, the relationship between race and COVID19 mortality remains unclear.Methodswe examined in-hospital COVID19 mortality risk factors in a multi-hospital tertiary health care system that serves greater Detroit, Michigan, a predominantly African American city with high rates of poverty and chronic disease. Consecutive adult patients who presented to emergency departments and tested positive for COVID19 from 3/11/2020 through 4/18/2020 were included. Using log-binomial regression, we assessed the relationship between in-hospital mortality and residence in census tracts that were flagged for extreme socioeconomic vulnerability, patient-level demographics, and clinical comorbidities.Findingsa total of 1,015 adults tested positive for COVID19 during the study period; 80% identified as Black people, 52% were male and 53% were ≥ 65 years of age. The median body mass index was 30•4 and the median Charlson Comorbidity Index score was 4. Patients from census tracts that were flagged for vulnerability related to socioeconomic status had a higher mortality rate than their peers who resided in less vulnerable census tracts (β 0.26, standard error (SE) 0.11, degrees of freedom (df) 378, t-value (t) 2.27, exp(β) 1.29, p-value 0.02). Adjustment for age category, Black race, sex and/or the Charlson Comorbidity Index score category reduced the magnitude of association by less than 10% [exp(β) 1.29 vs. 1.21]. Black race [p = 0.38] and sex [p = 0.62] were not associated with mortality in this sample.Interpretationpeople who lived in areas flagged for extreme socioeconomic vulnerability had elevated mortality risk in our predominantly African-American cohort of COVID19 patients who were able to seek hospital care during the so-called ‘first wave’ of the pandemic. By contrast, Black race was not associated with mortality in our sample.

Timing of mortality in mothers with recurrent convictions for driving under the influence of alcohol and their children, from childbirth to child age 17

BackgroundWe tested variation in the timing of child and maternal mortality associated with severe maternal AUD, as represented by recurrent arrests for driving under the influence of alcohol (rDUI). MethodsrDUI mothers (N = 1614) and Controls with no alcohol-related driving offenses (N = 109,928) who gave birth in Missouri from 2000 to 2004 were identified using vital records. Propensity score matching adjusted for birth record measures including delayed prenatal care, smoking during pregnancy, relationship with reproductive partner [married/unmarried, paternity acknowledged/unacknowledged], partner DUI status from driving records, and for socioeconomic characteristics of maternal residential census tract at birth derived from census data. Survival analysis was used to test months from childbirth to child or maternal death as a function of lifetime rDUI status. ResultsMaternal rDUIs were associated with a consistently elevated probability of child mortality from birth through child age 17 after propensity score-adjustment (Hazard Ratio [HR] = 1.70, 95 % CI = 1.17–2.47). Maternal mortality was not elevated, relative to Controls, until child age 6−11 (HR = 1.58, 95 % CI = 1.05−2.35) and increased again from child age 12−17 (HR = 4.12, 95 % CI = 3.04−5.86). ConclusionsSevere maternal AUD, as characterized by rDUI, increases the risk for child mortality over that of Controls through age 17. Delays in rDUI maternal mortality until child age 6 may indicate a period when maternal referral for intervention to reduce harm to child and mother is likely to be especially effective.

Measuring Hazards of Undetectable Viral Load among Hepatitis C Antibody Positive Residents of a Large Southern California County.

Background Hepatitis C virus (HCV) infection is the most common bloodborne infection in the U.S. However, only a small proportion of persons are treated and cured. Previous research has not characterized sociodemographic characteristics of who receives treatment. We examined predictors of undetectable for HCV in Orange County, the sixth largest county in the United States, where HCV is the most commonly reported infection. Methods: From 2014 to 2020, we acquired public health surveillance data from 91,165 HCV antibody-positive care encounters from the California Reportable Disease Information Exchange (CalREDIE). We used a time-to-event proportional hazards framework to estimate individual and area-level correlates of time-to-HCV undetectable viral load among HCV + individuals. Results: Older adults (>65 years) showed an increased hazard of undetectable viral load relative to younger adults (HR = 2.00). In addition, residents of census tracts with greater enrollment in health insurance showed a greater likelihood of undetectable viral load (HR = 1.36). The moderating effect of higher tract median household income and higher tract levels of health insurance were more likely to have undetectable viral load and was statistically significant. Conclusion: In a large urban county, HCV antibody-positive older adults appear much more likely to show undetectable viral load compared to younger adults. Residents in areas with higher quartiles of health insurance enrollment have an increased likelihood of undetectable viral load. The extent to which constraints impede HCV care requires further investigation, including follow-up studies on health insurance type to test the relationship of health insurance type to undetectable viral load.

Geospatial Health in the Context of Privilege and Cost: Determining Characteristic Based on Travel to Leisure and Protest Locations during COVID-19 Mitigation

Objectives: Determine community characteristics, within the context of the COVID-19 pandemic, based on travel to the popular leisure destination, Lake of the Ozarks in Missouri, and racial-justice protest locations in St. Louis, Missouri during key dates in May 2020. Methods: Travel data was acquired from a U.S. marketing firm and consisted of anonymized and aggregated device GPS data. Sample inclusion was limited to residents of census-tracts within the City and County of St. Louis and St. Charles County, Missouri (n=384). Tract characteristics were obtained from the U.S. Census Bureau. Results: Tracts with higher proportion of residents traveling to protest locations were significantly more likely to have higher proportion of: non-white residents, residents with no health insurance, and residents working in healthcare support and food service. Conclusions: Based on characteristics, residents from tracts that had higher significant travel to protests are likely to be more adversely affected by the CoVID-19 pandemic. Further, significant differences in community characteristics highlight the racial inequities identified in CoVID-19 transmission. Policy Implications: Findings suggest it may be advantageous for local CoVID-19 mitigation efforts to adapt or collaborate with local racial-justice protesters.

Ethnic density, social support, and loneliness among Chinese immigrants in Philadelphia

Living in more ‘ethnically dense’ areas is thought to promote health, possibly by facilitating social support and a sense of belonging. Because of kin networks and cultural obligations, family relationships may be particularly important for Asian immigrants. Chinese-origin individuals are the largest group of Asian Americans and among the most highly segregated, but the psychosocial benefits of living in Chinese neighborhoods are not established. We examined whether Chinese immigrants in areas of higher ethnic density report more social support from family and friends, and less loneliness. For 606 participants recruited 1/2016-5/2019 throughout the Philadelphia region, residences were linked to American Community Survey 2013-2017 data. Ethnic density, operationalized as percent of Census tract residents who were Chinese, was categorized into quintiles. Family/friend support and loneliness were self-reported, then dichotomized to distinguish high levels of family support, friend support, and loneliness. In logistic regression adjusting for age, sex, and individual- and tract-level socioeconomic characteristics, ethnic density was associated with high family support (odds ratio (OR) 1.85, 95% confidence interval (CI) 1.09, 3.11) for highest vs. lowest ethnic density quintile)) and inversely associated with loneliness (OR 0.31, 95% CI 0.12, 0.79, highest vs. lowest quintile). Our findings support the hypothesis that residents of areas with higher ethnic density report more social support from family and less loneliness. Whether these benefits arise from characteristics of the community overall or from the aggregation of individual assets remains to be clarified but has implications for efforts to develop community resources that would benefit all their residents.

Association of community types and features in a case–control analysis of new onset type 2 diabetes across a diverse geography in Pennsylvania

ObjectivesTo evaluate associations of community types and features with new onset type 2 diabetes in diverse communities. Understanding the location and scale of geographic disparities can lead to community-level interventions.DesignNested...

1425. Impact of Social Determinants on Racial Differences in Carbapenem-Resistant Enterobacteriaceae Incidence, Atlanta, 2012-2018

BackgroundPublic health prioritizes addressing social determinants of health to promote health equity. We hypothesized that social determinants of health, including poverty, are associated with racial disparity in the incidence of carbapenem-resistant Enterobacteriaceae (CRE).MethodsThe Georgia Emerging Infections Program conducted CDC-funded, active population-based CRE surveillance in metropolitan Atlanta (2017 population: 3.9 million) from 2012-2018. CRE cases were defined as Atlanta residents with a urine or normally sterile specimen growing E. coli, Klebsiella spp., or Enterobacter spp. resistant to ≥ 1 carbapenems (excluding ertapenem) and all third generation cephalosporins tested. Poverty, education and insurance levels by census tract of residence were obtained from the US Census Bureau’s 2017 American Community Survey. Race and end-stage renal disease (ESRD) were determined from chart review, and primary care provider (PCP) shortage area was obtained from the Health Resources and Services Administration. Age-adjusted incidence rate ratios were individually calculated using direct age standardization. Covariates were considered for inclusion in a multivariable Poisson regression model for the expected rate of CRE.ResultsAdjusting for age, CRE incidence was three times higher in blacks than whites. Higher CRE incidence was also observed among cases assigned > 40% below poverty level, > 15% below high school education, > 10% uninsured, and in a PCP shortage area (Table 1). CRE incidence was 58 times higher among ESRD cases than non-ESRD cases. In the multivariable model (Figure 1) addition of education, poverty or ESRD (p< 0.001), but not PCP access (p = 0.61) and insurance status (p=0.19), significantly reduced the racial difference in CRE incidence compared to race and age alone. Although controlling for age and either education, poverty level or ESRD reduced CRE among blacks, CRE incidence in blacks remained double that of whites.Figure 1. Comparison of race CRE incidence rate ratio adjusting for age alone (red line) to adjusting for age and individual social determinants (blue bars)” Table 1. Social Determinants Distribution and Age-Adjusted CRE Incidence Rate Ratio (N = 378) ConclusionPoverty level, ESRD and education only partially account for the racial differences seen in CRE incidence. While ESRD suggests a possible biologic component, persistent racial differences indicate the need for targeted public health interventions to address social determinants of health.Disclosures All Authors: No reported disclosures

Abstract PO-170: Associations of residential disadvantage and Hispanicity with important breast cancer risk factors among Hispanic women in Chicago

Abstract Background: Hispanics are the second largest and fastest growing ethnic minority population in the United States (US). Hispanic women experience worse breast cancer (BC) outcomes when compared to non-Hispanic Whites. In the United States, obesity and breast density are established risk factors for BC in general and for Hispanic women specifically. We sought to evaluate associations of residential disadvantage and Hispanicity with two established BC risk factors (obesity and breast density) among Hispanic women in Metro Chicago. Methods: We included 13,816 Hispanic women from the Metro Chicago Breast Cancer Registry. Obesity was defined as body mass index, categorized as: normal weight (18.5–24.9kg/m2), overweight (25–29.9 kg/m2), obese (&amp;gt;=30–24.9kg/m2), and morbidly obese (&amp;gt;= 35kg/m2). Breast density was reported by the interpreting radiologist at mammography using the BIRADS categories which were dichotomized for this analysis as dense (heterogeneously or extremely dense) vs. not dense (fatty or scattered fibroglandular). Characteristics of residential census tracts at diagnosis were obtained from the 2010 U.S. Census. Hispanicity was defined using: percent Hispanic, percent foreign-born and percent Hispanics that speak English not well and not at all. Each variable was standardized and summed to create a score (inter-item reliability=0.76), which was dichotomized at the median for some analyses. Two established tract level measures of neighborhood socioeconomic status were defined. Neighborhood disadvantage was an equally weighted sum of the proportions of families with incomes below the poverty line, families receiving public assistance, persons unemployed, and female-headed households with children. Neighborhood affluence was an equally weighted sum of the proportions of families with income of $75,000 or more, adults with college education or more, and civilian labor force employed in professional and managerial occupations score. Results: Overall, 36%, 26% and 18% of women were overweight, obese and morbidly obese, respectively, and roughly 50% had dense breasts. Women living in high hispanicity neighborhoods tended to live in more disadvantaged neighborhoods, to lack private health insurance, and to be obese (p&amp;gt; 0.0001 for all). Hispanicity was not associated with breast density. After adjusting by age, parity, age, health insurance, age at first birth, parity, menopause, age at menarche, we observed that greater hispanicity was associated with increased prevalence of overweight and obesity, but the association of Hispanicity with obesity was largely explained by the addition of tract disadvantage into the model. Conclusions: Our results are consistent with previous cross-sectional studies and further suggest that neighborhood disadvantage accounts for most of the association of hispanicity with being overweight. Future studies could link residential histories to evaluate the role of cumulative, longer-term residence in high Hispanicity areas on these risk factors. Citation Format: Carola T. Sanchez Diaz, Garth H. Rauscher. Associations of residential disadvantage and Hispanicity with important breast cancer risk factors among Hispanic women in Chicago [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-170.

Activity Locations, Residential Segregation, and the Significance of Residential Neighborhood Boundary Perceptions.

The inadequacies of residential census geography in capturing urban residents' routine exposures have motivated efforts to more directly measure residents' activity spaces. In turn, insights regarding urban activity patterns have been used to motivate alternative residential neighborhood measurement strategies incorporating dimensions of activity space in the form of egocentric neighborhoods-measurement approaches that place individuals at the center of their own residential neighborhood units. Unexamined, however, is the extent to which the boundaries of residents' own self-defined residential neighborhoods compare with census-based and egocentric neighborhood measurement approaches in aligning with residents' routine activity locations. We first assess this question, examining whether the boundaries of residents' self-defined residential neighborhoods are in closer proximity to the coordinates of a range of activity location types than are the boundaries of their census and egocentric residential neighborhood measurement approaches. We find little evidence that egocentric or, crucially, self-defined residential neighborhoods better align with activity locations, suggesting a division in residents' activity locations and conceptions of their residential neighborhoods. We then examine opposing hypotheses about how self-defined residential neighborhoods and census tracts compare in socioeconomic and racial composition. Overall, our findings suggest that residents bound less segregated neighborhoods than those produced by census geography, but self-defined residential neighborhoods still reflect a preference toward homophily when considering areas beyond the immediate environment of their residence. These findings underscore the significance of individuals' conceptions of residential neighborhoods to understanding and measuring urban social processes such as residential segregation and social disorganization.

Do fine particulate air pollution (PM2.5) exposure and its attributable premature mortality differ for immigrants compared to those born in the United States?

In the United States (US), immigrants constitute a considerable and growing proportion of the general population. Compared to the US-born, immigrants have differential health risks, and it is unclear if environmental exposures contribute. In this work, we estimated disparities between immigrants and the US-born in fine particulate matter (PM2.5) exposure and attributable premature mortality, including by region of origin and time since immigration. With PM2.5 estimates from a validated model at ~1 km2 spatial resolution and residential Census tract population data, we calculated the annual area-weighted average PM2.5 exposure for immigrants overall, the US-born, and immigrants separately by geographic region of origin and time since immigration. We then calculated the premature mortality attributed to PM2.5 for each population group, assessing disparities by immigrant status in PM2.5 exposure and attributable premature mortality in the US as a whole and in each US county to evevaluate spatial heterogeneity. Overall, immigrants were exposed to slightly higher PM2.5 (0.36 μg/m3, 3.8%) than the US-born. This exposure difference translates to 2.11 more premature deaths attributable to PM2.5 per 100,000 in population for immigrants compared to the US-born in 2010. Immigrant – US-born disparities in PM2.5 and attributable premature mortality were more severe among immigrants originating from Asia, Africa, and Latin America than those from Europe, Oceania, and North America. Disparities between immigrant groups by time since immigration were comparatively small. Sensitivity analyses using 2000 data and a non-linear set of PM2.5 attributable mortality coefficients identified similar patterns. Our findings suggest that environmental exposure disparities, such as in PM2.5, may contribute to immigrant health disparities in the US.

The Relationship between Ambient Temperature and Sickle Cell Disease-Related Hospital Admissions in South Carolina

BackgroundSickle cell disease (SCD) is the most common inherited blood disorder in the United States and impacts millions of people globally. Climate change may significantly impact the health of these individuals; however to date, very limited research has examined the relationship between weather and sickle cell disease hospitalizations.MethodsWe evaluated the association between temperature and SCD-related hospital admissions among residents of South Carolina (SC) between 2003 and 2006. Daily temperature data were obtained from the US National Climatic Data Center for the most proximal weather station to each patient's residential address at the time of hospital admission. We restricted to first hospitalization for each patient. We used a semi-symmetric bidirectional case-crossover design to examine the relationship between hospital admissions and temperatures (continuous, extreme high and low temperatures) for 0 to 7 days prior (for case period) and an equivalent 7 days during the same month. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsAmong 1,937 individuals with at least one SCD hospital admission, the mean age was 24 years, and the median annual household income in the census tract of residence was about $37,000. The OR between hospital admission and temperature on the day prior to hospital admission was 1.01 (95%CI: 0.99,1.03), the OR for temperatures above 80 degrees F on the day prior was OR: 1.38 (95%CI:0.95,2.01), and for temperatures below 32 degrees F on the day was OR was 1.00 (95%CI:0.66,1.50). The associations for all other time windows that we investigated were similar.ConclusionsIn this dataset of SCD-related hospital admissions, we observed no strong relationship between temperature and hospital admission, however a weak positive relationship was observed for temperatures below freezing on days immediately prior to the hospital admission. Further investigation is warranted.

Sickle Cell Disease-Related Hospital Admissions and Acute Particulate Matter 2.5 Exposures

BackgroundFew studies have examined the impact of ambient air pollution exposures on sickle cell disease (SCD)- related hospital admissions. The findings of these studies have suggested potential relationships between SCD-related hospital admissions with acute exposures to ozone and particulate matter but the findings have been inconsistent. MethodsWe evaluated the association between acute exposure to ambient particulate matter 2.5 (PM2.5) air pollution and SCD-related hospital admissions among residents of South Carolina (SC). We obtained data on the first incident hospital admission between 2003 and 2006. PM2.5 exposures were estimated at the residential zip code level using spatio temporal statistical modeling. We used a semi-symmetric bidirectional case-crossover design to examine the association between hospital admissions and PM2.5 exposures 0 to 7 days prior to hospital admission (for the case period) and an equivalent 0 to 7 day control period within the same month, same days of the week. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsAmong 1,937 individuals with at least one SCD hospital admission, the median age was 22 years, and the median percentage of persons living below poverty in the census tract of residence was about 16%. The average PM2.5 estimated exposure was about 10.1 ug/m3 on the day of hospital admission. The OR between admission and PM2.5 exposures on the day prior was 1.02 (95%CI: 1.00,1.03) while all other time windows examined hovered around 1.00 and were not statistically significant. ConclusionsWe observed some suggestion of increased risk for SCD-related hospital admission with an increase in PM2.5 exposures on the day prior to admission. However further investigation is needed to confirm these results.

Local mobility among pregnant women with and without asthma

Background/aim: Studies evaluating environmental effects on perinatal health often estimate exposures based on residential address assuming pregnant women are stationary. Pregnant women are frequently mobile but their mobility is understudied. We investigate local and residential mobility across pregnancy in a prospective cohort of pregnant women. Methods. B-WELL-Mom is a prospective cohort study of 418 pregnant women with and without asthma. This analysis includes 277 women who participated in the local mobility sub-study. Participants carried a GPS-activated device to assess locational changes (i.e., local mobility) throughout pregnancy. They also self-reported residential mobility (i.e., residential relocation) during each trimester and ~4 months post-partum. GPS locations and successive residential addresses throughout pregnancy were geocoded to determine local and residential mobility. Results. At enrollment, 69 women (24.9%) had no asthma, 98 (35.4%) had well-controlled asthma, and 110 (39.7%) had poorly-controlled asthma. The proportion of time women spent inside their residential census tract increased from 30.5% during the first trimester to 41.1% during the third trimester. Women without asthma spent less time in their census tract compared to women with asthma especially during later pregnancy (trimester 3: 32% vs. 43%). During postpartum, women without asthma spent 51.9% of their time inside their census tract, whereas women with well-controlled asthma and poorly controlled women spent 56.5% and 76.3% of the time within their census tract, respectively. Approximately 27% of women moved during pregnancy, with 68% of movers relocating to a different census tract. Conclusions. Pregnant women are mobile beyond their residential address and local area. Local mobility declined through pregnancy, and women with asthma had less local mobility than women without asthma. Residential relocation was common, and a significant proportion of movers relocate to a different area. Studies assessing environmental effects on perinatal health should pay attention to local and residential mobility to improve exposure assessment.

Influence of urban greenspace on the early-life gut microbiome

Background. Emerging evidence suggests that early life exposure to trees and other vegetation (i.e., ‘greenspace’) may prevent development of allergies. A proposed biologic mechanism posits that human contact with natural environments affects the diversity of human commensal microbiota, thus promoting development of immunity. We conducted a pilot study to test the relationship of greenspace exposure in early life with gut microbiome diversity.Methods. We linked neighborhood environmental and sociodemographic measures from Drexel’s Urban Health Collaborative repository with data from a longitudinal birth cohort of children assembled from Children’s Hospital of Philadelphia, by census tract of the child’s residence at birth. Our pilot study included microbiome profiling of stool samples from 71 infants (born 2016-2018), from birth through 1-year of age. Overall greenness was derived from satellite imagery as the median normalized difference vegetation index (NDVI) in the summer months of 2016. We also assessed coverage of the census tract area by tree canopy and by grasses/shrubs, derived from the National Land Cover Database (2011) for the entire study region and from high-resolution landcover data for the City of Philadelphia (2008).Results. Greenspace of residential census tracts was associated with the change in gut microbial composition from age 1-12 months. In addition, cross-sectional associations were seen at age 1-month in Philadelphia. There was no association of greenspace with beta diversity at other ages (3, 6, or 12 months), nor with alpha diversity measures (species richness). The association of greenspace variables with the change in microbial composition from 1-12 months could not be linked to shifts in any particular microbial taxa.Conclusions. Our results suggest an influence of urban greenspace on development of the gut microbiome in early life. Given the potential to modify vegetation around homes in ways that may benefit health, robust investigation is warranted.

Individual and geographic variation in Driver's license suspensions: Evidence of disparities by race, ethnicity and income

IntroductionAlthough access to a motor vehicle is essential for pursuing social and economic opportunity and ensuring health and well-being, states have increasingly used driver's license suspensions as a means of compelling compliance with a variety of laws and regulations unrelated to driving, including failure to pay a fine or appear in court. Little known about the population of suspended drivers and what geographic resources may be available to them to help mitigate the impact of a suspension. MethodsUsing data from the New Jersey Safety Health Outcomes (NJ-SHO) data warehouse 2004–2018, we compared characteristics of suspended drivers, their residential census tract, as well as access to public transportation and jobs, by reason for the suspension (driving or non-driving related). In addition, we examined trends in the incidence and prevalence of driving- and non-driving-related suspensions by sub-type over time. ResultsWe found that the vast majority (91%) of license suspensions were for non-driving-related events, with the most common reason for a suspension being failure to pay a fine. Compared to drivers with a driving-related suspension or no suspension, non-driving-related suspended drivers lived in census tracts with a lower household median income, higher proportion of black and Hispanic residents and higher unemployment rates, but also better walkability scores and better access to public transportation and jobs. ConclusionsOur study contributes to a growing literature that shows, despite public perception that they are meant to address traffic safety, the majority of suspensions are for non-driving-related events. Further, these non-driving-related suspensions are most common in low-income communities and communities with a high-proportion of black and Hispanic residents. Although non-driving-related suspensions are also concentrated in communities with better access to public transportation and nearby jobs, additional work is needed to determine what effect this has for the social and economic well-being of suspended drivers.

Marital status, partner acknowledgment of paternity, and neighborhood influences on smoking during first pregnancy: findings across race/ethnicity in linked administrative and census data

BackgroundImproving prediction of cigarette smoking during pregnancy (SDP), including differences by race/ethnicity and geography, is necessary for interventions to achieve greater and more equitable SDP reductions. MethodsUsing individual-level data on singleton first births, 2010-2017 (N = 182,894), in a US state with high SDP rates, we predicted SDP risk as a function of reproductive partner relationship (marital status, paternity acknowledgement), maternal and residential census tract sociodemographics, and census tract five-year SDP rate. ResultsSDP prevalence was 12.7% (white non-Hispanics, WNH), 6.8% (Black/African Americans, AA), 19.5% (Native American, NA), 4.7% (Hispanic, H), and 2.8% (Asian, AS). In WNH and AA, with similar trends in other groups, after adjustment for non-linear effects of maternal age and education and for census tract risk-factors, there was a consistent risk-ordering of SDP rates by reproductive partner relationship: married/with paternity acknowledged < unmarried/acknowledged < unmarried/unacknowledged < married/unacknowledged. Associations with census tract SDP rate, adjusted for maternal and census tract sociodemographics, were stronger for AA and H (OR 2.65-2.67) than for NA (OR = 1.91), WNH (OR = 1.75), or AS (NS). AA SDP was increased in tracts having a higher proportion of WNH residents and was reduced in comparison with WNH at every combination of age, education and partner relationship. ConclusionsInattention to differences by race/ethnicity may obscure SDP risk factors. Despite marked race/ethnic differences in unmarried-partner cohabitation rates, failure to acknowledge paternity emerged as an important and consistent risk-predictor. Census-tract five-year SDP rates have heterogeneous origins, but the association of AA SDP risk with increased racial heterogeneity suggests an important influence of neighbor risk behaviors.

Association of household food insecurity and childhood weight status in a low-income population.

One in seven US households with children are food insecure. The health effects of household food insecurity (HFI) are well documented, but its association with childhood weight status remains unclear. We aimed to assess this association and to describe correlates of HFI in children. We conducted a cross-sectional study of 3019 low-income children aged 2 to 17 years. Data were extracted via chart review. HFI was assessed using the hunger vital sign screener. Body mass index (BMI) was calculated from documented clinical measurements. We used adjusted linear and logistic regression to assess the association of HFI with BMI z-score (BMIz) and weight status. We used logistic regression to examine correlates of HFI including age, race/ethnicity, tobacco exposure, number of parents and siblings living at home, weight status, and census-tract poverty rate and food access. Of participants whose HFI status was documented, 91% were food secure and 9% were food insecure. The mean (SD) BMIz was 0.81 (1.11). Fifty five percentage of children were healthy weight, 18% overweight, and 26% obese. In adjusted analyses, HFI was not associated with BMIz but was associated with decreased odds of obesity (OR 0.56; 95% CI 0.36-0.87). Tobacco exposure (1.63; 1.10-2.44), additional siblings (1.16; 1.04-1.30), and residence census tract with high poverty rate (1.02; 1.01-1.03) were all associated with HFI. We concluded that food-insecure children were less likely to have obesity and had differences in household makeup, exposures, and residential location compared to food-secure children. Clinicians should understand these relationships when counselling families about weight status and food insecurity.

Neighborhood Socioeconomic Deprivation Associated with Fat Mass and Weight Status in Youth.

(1) Background: Few studies have examined the relationship between neighborhood socioeconomic deprivation (SED) and weight-related outcomes in youth, controlling for weight-related behaviors. Hence, the purpose of this study was to examine the association between neighborhood SED, weight status, and fat mass in a diverse sample of youth, before and after controlling for physical activity and diet. (2) Methods: The sample included 828 youth from the Transitions and Activity Changes in Kids study. Neighborhood SED was expressed as an index score at the census tract of residence. Height, weight, and body composition were measured and used to calculate fat mass index (FMI) and weight status. Moderate-to-vigorous physical activity (MVPA) and sedentary behavior (min/h) were measured via accelerometry. Diet quality was assessed via the Block Food Screener for Kids. Multilevel regression models were employed to examine these relationships. (3) Results: Neighborhood SED was significantly associated with FMI and weight status before and after controlling for MVPA, sedentary behavior, and diet. Notably, youth residing in the most deprived neighborhoods had significantly higher FMI and were 30% more likely to be overweight/obese (OR = 1.30; 95% CI = 1.03–1.65). (4) Conclusions: Greater neighborhood SED was consistently and significantly associated with higher fat mass index and increased likelihood of overweight/obesity among youth.

Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Disproportionately Affects the Latinx Population During Shelter-in-Place in San Francisco.

BackgroundThere is urgent need to understand the dynamics and risk factors driving ongoing SARS-CoV-2 transmission during shelter-in-place mandates.MethodsWe offered SARS-CoV-2 reverse transcription-PCR and antibody (Abbott ARCHITECT IgG) testing, regardless of symptoms, to all residents (≥4 years) and workers in a San Francisco census tract (population: 5,174) at outdoor, community-mobilized events over four days. We estimated SARS-CoV-2 point prevalence (PCR-positive) and cumulative incidence (antibody or PCR-positive) in the census tract and evaluated risk factors for recent (PCR-positive/antibody-negative) versus prior infection (antibody-positive/PCR-negative). SARS-CoV-2 genome recovery and phylogenetics were used to measure viral strain diversity, establish viral lineages present, and estimate number of introductions.ResultsWe tested 3,953 persons: 40% Latinx; 41% White; 9% Asian/Pacific Islander; and 2% Black. Overall, 2.1% (83/3,871) tested PCR-positive: 95% were Latinx and 52% asymptomatic when tested. 1.7% of census tract residents and 6.0% of workers (non-census tract residents) were PCR-positive. Among 2,598 tract residents, estimated point prevalence of PCR-positives was 2.3% (95%CI: 1.2-3.8%): 3.9% (95%CI: 2.0-6.4%) among Latinx vs. 0.2% (95%CI: 0.0-0.4%) among non-Latinx persons. Estimated cumulative incidence among residents was 6.1% (95%CI: 4.0-8.6%). Prior infections were 67% Latinx, 16% White, and 17% other ethnicities. Among recent infections, 96% were Latinx. Risk factors for recent infection were Latinx ethnicity, inability to shelter-in-place and maintain income, frontline service work, unemployment, and household income &$50,000/year. Five SARS-CoV-2 phylogenetic lineages were detected.ConclusionSARS-CoV-2 infections from diverse lineages continued circulating among low-income, Latinx persons unable to work from home and maintain income during San Francisco’s shelter-in-place ordinance.