State-level Measures Research Articles

Gratitude, flourishing and prosocial behaviors following experimental sleep restriction and sleep extension

ABSTRACT People who are grateful, resilient and flourishing in life show better health, including better sleep. This correlational finding is typically attributed to personality factors or to positive outlooks causing better sleep. We investigated the reverse causal interpretation: do sleep losses and sleep gains experimentally affect feelings and expressions of gratitude, resilience and flourishing? Young adults (N = 90) were randomly assigned to sleep restriction, sleep extension or to sleep normally while wearing wristband actigraphy between Monday and Friday study sessions. State-level measures of flourishing, resilience and gratitude improved across the week with sleep extension and worsened with sleep restriction (ηp 2 = .13 to .17). Trait-level measures showed modest or no changes. Sleep-extended participants wrote twice as many details on their gratitude list as the other two conditions (ηp 2 = .11). Most effects persisted when accounting for mood. Therefore, subtle changes in nighttime sleep causally influence the components that underlie mental well-being.

Area deprivation index and social vulnerability index in Milwaukee County: Impact on hospital outcomes after traumatic injuries

BackgroundPredisposing factors for traumatic injuries are complex and variable. Neighborhood environments may influence injury mechanism or outcomes. The Social Vulnerability Index (SVI) identifies areas at risk for emergencies; Area Deprivation Index (ADI) measures socioeconomic disadvantage. The objective was to assess the impact of SVI or ADI on hospital length of stay (LOS) and mortality for injured patients to determine whether SVI or ADI indicated areas where injury prevention may be most impactful. MethodsAdult patients who resided in Milwaukee County and were treated for injuries from 2015 to 2022 at a level I trauma center were included. Patients’ addresses were geocoded and merged with 2020 state-level SVI and ADI measures. SVI ranks census tracts 0–100 from least to most vulnerable. ADI ranks census block groups 1–10 from least to most disadvantaged. ADI and SVI rankings were converted to deciles. Statistical analyses included descriptive statistics, chi-square tests, and regression models for LOS and in-hospital mortality, adjusted for either SVI or ADI within separate models, age, sex, race or ethnicity, mechanism of injury (MOI), injury severity score (ISS). Results14,542 patients were included; 63 % were male. Mean total hospital LOS was 6.4 ± 9.8 days, and in-hospital mortalities occurred in 5.2 % of patients. Based on SVI and ADI, 5,280 (36 %) patients resided in high vulnerability areas and 5,576 (39 %) lived in highly disadvantaged areas, respectively. After adjusting for patient factors, SVI deciles #6, 9, 10 were associated with increased hospital LOS, and SVI decile #5 was associated with in-hospital mortality (OR = 2.22, 95 %CI:1.06–4.63; p = 0.034). When adjusted for ADI, the 7th-10th deciles were associated with increased hospital LOS. Greater age and ISS were associated with increased hospital LOS and mortality when adjusted for SVI and ADI. ConclusionsSVI and ADI identified a similar proportion of patients in high vulnerability or disadvantaged areas. Higher SVI and ADI deciles were associated with longer hospital LOS, and only the 5th SVI decile was associated with in-hospital mortality. Highly disadvantaged or vulnerable areas may have a longer LOS, but SVI and ADI have limited influence on trauma mortality. Continued research on neighborhood and community factors and trauma outcomes is needed.

The space of permanent and state-level exceptional security measures: Formative years of Israel and Turkey

Studies examining the spatial patterns of exceptional security measures focus on constructed spaces or national territories exposed to international military intervention. Contemporary literature defines these spaces as zones of lawlessness where the exception prevails. By examining the security policies in the historical homelands of the Palestinians in Israel and the Kurds in Turkey, this article shows how exceptional security and the law co-constitute each other. Through a comparative historical analysis of the formative years of the Israeli and Turkish states, we argue that permanent exceptional security measures in territories inhabited by minority citizens are relevant to the political context in which the constituent power frames the political characteristics of the nation. In the process, exceptional security measures coexisting with the law become instrumental in maintaining and reproducing the distinction between the ‘legitimate members’ of the nation and the ‘enemies’ of the nation/state. The coexistence of exceptional security measures with the legal system challenges the conventional understanding of the exception and its dichotomous relationship with the norm, as outlined by Schmitt and Agamben. Instead, the conceptual framework of ‘legal violence,’ as articulated by Benjamin, offers a more comprehensive perspective for understanding the early years of the Israeli and Turkish states.

Early-life economic conditions and old-age male mortality: evidence from historical county-level bank deposit data

This paper studies the long-run mortality effects of in utero and early-life economic conditions. We examine how local economic conditions experienced during the Great Depression, proxied by county-level banking deposits during in utero and first years of life, influences old-age longevity. We find that a one-standard-deviation rise in per capita bank deposits is associated with an approximately 1.7 month increase in males’ longevity at old age. Additional analyses comparing state-level versus county-level economic measures provide insight on the importance of controlling for local-level confounders and exploiting more granular measures when exploring the relationship between early-life conditions and later-life mortality.

Evaluation of state laws and regulations applicable to radon in US child care centers

In the US, radon is the second most significant contributor to lung cancer, following smoking. Despite this, there is a notable absence of state-level measures and guidelines aimed at managing and mitigating the risks associated with exposure to radon gas. The objective of this research was to investigate whether state-level laws regarding radon in child care centers have a correlation with the proportion of counties in a given state that fall under radon zone 1 (with levels exceeding 4 pCi/L).The research method was a secondary analysis. Data was gathered from multiple sources, including the EPA radon website, academic journals, official state government websites, and state laws and regulations. The evaluation of current radon legislation was based on the EPA radon zones. To analyze the data, an independent T-Test was conducted with a significance level of P<0.05. The results showed that 39 states in the US have at least one county falling under radon zone 1, while 11 states have no counties in this category. Among these, 11 states have enacted legislation pertaining to child care centers, whereas 39 states lack any such regulations. Out of the 39 states that have one or more counties falling under radon zone 1, 28% (n=39) have implemented radon regulations specific to child care facilities. The study findings indicate that states situated entirely or partially within EPA radon zone 1 were 88% more likely to lack regulations mandating radon testing in child care centers, as compared to states not falling within this zone. However, while there is a noticeable association between state radon legislation for child care centers and the percentage of counties in radon zone 1, it is not statistically significant (p-value = 0.12).

THE RELEVANCE OF SNAP PROGRAM ACCESSIBILITY FOR FOOD INSECURITY, FOCUSING ON ADULTS WITH DISABILITIES

Abstract Individuals with disabilities are not only more likely than their peers without disabilities to experience food insecurity, but also encounter disproportionate barriers to Supplemental Nutrition Assistance Program (SNAP) enrollment. This study examined associations between state-level measures of SNAP enrollment accessibility (flexibility, efficiency, and accessibility in the enrollment process; and the presence of either broad-based categorical eligibility or the Combined Application Project) with SNAP participation and food insecurity levels among low-income participants (income ≤185% of the poverty threshold) aged ≥15 years in the 2021 Current Population Survey, both overall (n=19,895) and among those with disabilities (n=3,484). In multi-level models adjusted for individual and state characteristics, living in a state with broad-based categorical eligibility was associated with higher rates of SNAP participation among all low-income individuals (b= 0.300, 95% CI: 0.096, 0.505). Among those with disabilities, having greater flexibility in SNAP enrollment (b= 0.141, 95% CI: 0.007, 0.276) and living in a state with the Combined Application Project (b= 0.271, 95% CI: 0.017, 0.525) were associated with a higher likelihood of SNAP participation. Living in a state with more efficient SNAP enrollment was associated with lower food insecurity levels (b= -0.073, 95% CI: -0.136, -0.010) among all low-income individuals and having broad-based categorical eligibility was associated with lower food insecurity levels (b= -0.237, 95% CI: -0.451, -0.022) among those with disabilities. These findings highlight the importance of SNAP program accessibility to address food insecurity among all low-income Americans and suggest that enrollment barriers may differ for people with and without disabilities.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

Statewide Burden and Trends of Acute Myeloid Leukemia Attributable to Smoking in the United States of America from 1990-2019: A Benchmarking and Comparative Analysis

Background: Smoking has long been associated with an increased risk of various cancers, and it plays a significant role in deaths related to Acute Myeloid Leukemia (AML), accounting for 1.69% of all cancer-related deaths in the United States of America (USA). Additionally, among all other risk factors contributing to AML development, smoking is responsible for a staggering 77.2% of AML-related deaths. However, there is a large statewide variation within the USA concerning AML burden. Comparable and consistent state-level measures of total AML burden have not been produced previously. Method: Using the Global Burden of Disease methodology “AML attributable to smoking” mortality, and disability-adjusted life years (DALYs) were analyzed by age group, sex and year from 1990-2019 for all residents in the USA using standardized approaches for data processing and statistical modeling. Results were produced in total number and age-standardized rate. The findings were reported both in absolute numbers and age- standardized rates. Results: The total number of deaths attributed to AML due to smoking showed an increase from 2,230 (95% uncertainty interval (UI): 1,159-3,275) in 1990 to 3,918 (95% UI: 1,833- 6,003) in 2019. Similarly, the DALYs (Disability-Adjusted Life Years) associated with AML increased from 52,843 (95% UI: 30,918-75,041) in 1990 to 81,356 (95% UI: 43,328-121,964) in 2019. However, the age-standardized mortality rate (ASMR) remained relatively stable, with no major difference observed (0.7 deaths per 100,000 95% UI: 0.38-1.02) in 1990 compared to 0.7 (95% UI: 0.35-1.05) in 2019. In contrast the age-standardized DALYs rate (ASDALR) decreased from 17.51 to 15.3 per 100,000 from 1990 to 2019. Regarding the highest annual percentage of change (APC) in total number of deaths due to AML, Nevada observed the greatest increase at 275% followed by Alaska at 236% and Arizona at 179% from 1990 to 2019. In contrast, the District of Columbia was the only state that showed a decrease in APC for total deaths with a decline of 6%. Analyzing ASMR, Indiana, and West Virginia observed the highest APC at 28% each, followed by Kentucky at 23%. Conversely, California experienced the highest decrease in ASMR APC, showing a decline of 30% from 1990 to 2019. Regarding age groups, the 95+ age group observed the highest APC increase in ASMR and ASDALR at 363% and 356%, respectively, followed by the 90-94 age group, which had an ASMR APC increase of 307% and ASDALR APC increase of 305%. Moreover, males exhibited a higher APC increase in the total number of deaths compared to females, with percentages of 85% and 62%, respectively, from 1990 to 2019. Conclusion: Large disparities in the total burden of AML attributable to smoking persist between US states despite marked improvements in management. Our findings show that a substantial proportion of AML cases in the United States are attributed to smoking, making it a modifiable risk factor for this aggressive hematologic malignancy. Healthcare professionals and policymakers should utilize this evidence to reinforce anti-smoking initiatives and raise public awareness about the link between smoking and AML.

Pandemic and Older Adults' Social Structure of Shared Time.

Shared time with family and friends is crucial for older adults' health and well-being. This study examines how a public health crisis affects older adults' social connectedness through their shared time with known persons. The study used data from the 2019-2020 American Time Use Survey (N = 9,697) to assess older adults' (aged 50+) social structure of shared time before and during the coronavirus disease 2019 pandemic. Logistic regression and hurdle model with state-fixed effects were used to estimate the relationships between state-level pandemic severity and measures of older adults' shared time while controlling for sociodemographic characteristics. There were small, statistically significant effects of pandemic severity on older adults' shared time. State-level incidence rates and policy stringency indexes were correlated with a lower likelihood of, and a decline in, older adults' shared time in public places and interactions with individuals outside their immediate family. State policy stringency was associated with more shared time in immediate family interactions. Furthermore, pandemic severity was not associated with a decrease in likelihood and older adults' shared time with nonresident immediate family. Policy stringency was more consequential than the incidence rate for older adults' social structure of shared time during the pandemic. Results indicate a place-based and role-based restructuring of older adults' daily shared time during the pandemic. Despite small effect sizes, the substantial old age population implies significant changes in shared time and patterns of daily connection at the population level. Theoretical and policy implications of the findings are discussed.

Contextual Influences on Nonresponse to Health Survey Questions About Sexual Orientation and Gender Identity.

Purpose: We examined the relationship between state context and survey nonresponse to sexual orientation (SO) and gender identity (GI) questions. Methods: We obtained data from the 2014-2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Item nonresponse was defined as selecting "don't know/not sure" or "refused" for each of two questions about SO and GI. Nonresponse patterns included responding to both SO and GI questions; responding only to the SO question (nonresponse to GI); responding only to the GI question (nonresponse to SO); and responding to neither question. State-level contextual measures included legal protections for lesbian, gay, bisexual, transgender, or other sexual or gender minority (LGBT+) people, LGBT+ social movement strength, and public opinion regarding LGBT+ issues. Results: The analysis included 1,459,525 respondents from 44 states (190 state-years). On weighted analysis, 96.5% of adults answered both SO/GI questions, 2.4% responded only to GI, 0.4% responded only to SO, and 0.7% responded to neither. The demographic profile of individuals with GI-only nonresponse differed markedly from the profile of adults with SO-only nonresponse. An increasingly favorable legal climate for LGBT+ people was associated with greater rates of response to SO and GI questions. However, a more LGBT+ friendly state climate measured by social movement strength or public opinion was not consistently associated with reduced SO and GI question nonresponse. Conclusion: Contextual factors have mixed association with nonresponse to SO and GI question on BRFSS surveys. Our results warrant continued development of health survey questionnaires to elicit accurate information on respondents' SO and GI.

Potential Benefits in Remapping the Special Flood Hazard Area: Evidence from the U.S. Housing Market

A typical U.S. homebuyer's understanding of whether a property faces flood risk is based on whether the property is located inside the National Flood Insurance Program's (NFIP) Special Flood Hazard Area (SFHA). The SFHA boundary, however, may bias homebuyers’ perceptions of flood risk relative to unobserved true risk because the SFHA is an incomplete, and sometimes inaccurate, representation of flood hazards. Using a national dataset of property transactions, flood hazard data from the First Street Foundation, state-level measures of flood disclosure laws, and a spatially restricted triple-difference design, we distinguish capitalization effects of policy-driven (SFHA) versus quasi-objective (First Street) indicators of flood hazard. We identify these effects by assessing thousands of local spatial interactions between property SFHA designations, measures of quasi-objective flood hazard, and being in a state that mandates flood history disclosures. Being inside the SFHA generates a risk discount, but the signal is muted relative to underlying hazard exposure. Further, the SFHA signal can result in inefficient discounts for properties erroneously mapped in the SFHA. Disclosure requirements about flood history accentuate price effects for hazardous properties and result in more adequate risk internalization. In the absence of disclosures, however, we find either no or a weak risk signal for houses outside the SFHA that face flood hazard. Our results highlight potential benefits of updating SFHA boundaries to include all houses that may experience flooding, and argue in favor of requiring flood-related disclosures from sellers to improve the market's ability to internalize flood risk.

MP54-05 GEOGRAPHIC VARIATION IN UTILIZATION OF DOUBLET THERAPY FOR METASTATIC PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-05 GEOGRAPHIC VARIATION IN UTILIZATION OF DOUBLET THERAPY FOR METASTATIC PROSTATE CANCER Samuel Washington, Janet Cowan, Shoujun Zhao, Jennifer Rider, Nicholas Taylor, Warren Whyte, Peter Carroll, and Matthew Cooperberg Samuel WashingtonSamuel Washington More articles by this author , Janet CowanJanet Cowan More articles by this author , Shoujun ZhaoShoujun Zhao More articles by this author , Jennifer RiderJennifer Rider More articles by this author , Nicholas TaylorNicholas Taylor More articles by this author , Warren WhyteWarren Whyte More articles by this author , Peter CarrollPeter Carroll More articles by this author , and Matthew CooperbergMatthew Cooperberg More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical trials for men with metastatic prostate cancer have supported the use of combination therapies. However, real-world utilization of doublet therapy (i.e. androgen deprivation therapy (ADT) plus a novel hormonal therapy) and geographic variation in use have not been evaluated in detail. With recent data supporting triplet regimens, we must understand what factors already impact doublet therapy utilization before further intensification. Using a national cohort of community and academic medical oncology practices, we characterized real-world utilization of doublet therapy and examined factors associated with its use, including geographic region. METHODS: Using ConcertAI RWD, clinical data of men with metastatic prostate cancer was linked with state-level measures of socioeconomic factors and healthcare resources from the Area Health Resources File. Logistic regression examined associations between clinical and community characteristics and receipt of doublet therapy (vs ADT alone) within 90 days of diagnosis; models were adjusted for clinical factors, state level factors (excluding hospital beds, poverty, and education due to collinearity), and geographic region. Odds ratios (ORs) with 95% confidence intervals were reported. RESULTS: A total of 1,763 men with M1 disease were eligible, with a mean age of 68.6 years at diagnosis. Nearly half (48%) lived in the Southern region, 9.3% in North East, 18.6% in West, and 23.7% in Midwest. Roughly 13.8% were Black, and 1.3% American Indian, and 1.1% Asian. One-third received ADT alone (37.8%). Regression analysis for ADT+NHT vs. ADT included 1,604 men, of which 84.6% received doublet therapy. Geographic region [vs Southern: Midwest, OR 0.6, 95% CI 0.4-0.9; Northeast, OR 0.4, 95% CI 0.2-0.7], larger state population [(log-transformed) OR 0.09, 95 % 0.02-0.3], prior surgery or radiation (vs none, OR 1.7, 95% CI 1.3-2.3), greater urologist density [(log-transformed), OR 0.1, 95% CI 0.02-0.8] and radiation oncologist density [(log-transformed), OR 12.9, 95% CI 2.8-60.2] were significantly associated with receipt of doublet therapy compared to ADT alone. CONCLUSIONS: Doublet therapy use was impacted by geographic region and regional specialty care (i.e. urologist and radiation oncologist density), emphasizing the relationship between regional medical expertise and care implementation. As the drive to improve care grows, our study highlights how treatment remains influenced by where you live and the need for identifying actionable targets for organizational change at the regional level. Source of Funding: ConcertAI ERACE Research Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e755 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Washington More articles by this author Janet Cowan More articles by this author Shoujun Zhao More articles by this author Jennifer Rider More articles by this author Nicholas Taylor More articles by this author Warren Whyte More articles by this author Peter Carroll More articles by this author Matthew Cooperberg More articles by this author Expand All Advertisement PDF downloadLoading ...

Effects of person-centred planning and practices on the health and well-being of adults with intellectual and developmental disabilities: a multilevel analysis of linked administrative and survey data.

A person-centred service planning and practice approach (PCP) is one that is driven by service users' individual preferences, needs and priorities. The approach has been identified as a best practice and is codified in US policies that encourage and, in some contexts, require state systems of home and community-based services to adopt and demonstrate person-centred practice. However, there is insufficient research on PCP's direct impact on outcomes for service users. This study aims to contribute to the evidence base in this area by investigating the association between service experiences and outcomes of adults with intellectual and developmental disabilities (IDD) receiving state-funded services. The data for the study come from the 2018-2019 National Core Indicators® In-Person Survey that links survey responses with administrative records for a sample of 22 000 adults with IDD receiving services from 37 state developmental disabilities (DD) systems. Associations among service experiences and outcomes of survey participants are examined through multilevel regression techniques that include participant-level responses and state-level measures of PCP. The state-level measures are constructed by combining administrative records describing participants' service plans with the priorities and goals they expressed in response to the survey. Case managers' (CM) accessibility and attentiveness to individual preferences, as reported by survey participants, are significantly associated with self-reported outcomes such as perceived control over life decisions and sense of health and well-being. Controlling for participants' experiences with their CMs, their reports of the person-centred content of their service plans have net positive associations with outcomes. After accounting for experiences with the service system as reported by participants, the state system's person-centred orientation, measured by the extent to which service plans across the state reflect participants' wishes for improving their social connections, remains a significant predictor of participants' sense of control over their daily lives. This study contributes to the evidence base supporting PCP as a service model by identifying pathways that link person-centred service planning and delivery and person-centred orientation of state systems to positive outcomes reported by adults with IDD and by demonstrating the value of linking survey and administrative data. The key implication of the findings for policy and practice is that an overall person-centred orientation of state DD systems as well as PCP training for people who support planning for and delivery of direct supports will substantially improve the lives of adults with IDD.

Geographic variation in utilization of doublet therapy for metastatic prostate cancer.

41 Background: Clinical trials for men with metastatic prostate cancer have supported the use of combination therapies to improve survival outcomes, with recent work showing increased benefit of triplet regimens. However, real-world utilization of doublet therapy ( i.e., androgen deprivation therapy (ADT) plus a novel hormonal therapy (NHT)) and variation in use according to geographic region have not been evaluated in detail. With recent data supporting the use of triplet regimens we must understand what factors already impact doublet therapy utilization before we can intensify treatment further. Using data aggregated from a national cohort of community and academic medical oncology practices, we characterized real-world utilization of doublet therapy and examined factors associated with its use, including geographic region. Methods: Using ConcertAI RWD, clinical data of men with metastatic prostate cancer was linked with state-level measures of socioeconomic factors and healthcare resources from the Area Health Resources File. Logistic regression was used to evaluate associations between clinical and community characteristics and receipt of doublet therapy (vs ADT alone) within 90 days of diagnosis; models were adjusted for clinical factors, state level factors (excluding hospital beds, poverty, and education due to collinearity), and geographic region. Odds ratios (ORs) with 95% confidence intervals were reported. Results: A total of 1,763 men with M1 disease were eligible, with a mean age of 68.6 years at diagnosis. Nearly half (48%) lived in the Southern region, 9.3% in North East, 18.6% in West, and 23.7% in Midwest. Roughly 13.8% were Black, and 1.3% American Indian, and 1.1% Asian. One-third received ADT alone (37.8%). Regression analysis for ADT+NHT vs. ADT included 1,604 men, of which 84.6% received doublet therapy. Geographic region [vs Southern: Midwest, OR 0.6, 95% CI 0.4-0.9; Northeast, OR 0.4, 95% CI 0.2-0.7], larger state population [(log-transformed) OR 0.09, 95 % 0.02-0.3], prior surgery or radiation (vs none, OR 1.7, 95% CI 1.3-2.3), greater urologist density [(log-transformed), OR 0.1, 95% CI 0.02-0.8] and radiation oncologist density [(log-transformed), OR 12.9, 95% CI 2.8-60.2] were significantly associated with receipt of doublet therapy compared to ADT alone. Conclusions: Receipt of doublet therapy was impacted by geographic region and regional availability of specialty care (i.e. urologist and radiation oncologist density), emphasizing the relationship between regional medical expertise and care implementation. As the drive to improve care grows, our study highlights how treatment remains influenced by where you live and the need for identifying actionable targets for intervention and organizational change at the regional level.

Housing affordability and mental health in the United States: 2013–2020

This study examined the relationship between housing affordability and mental health of American homeowners and renters during 2013–2020, using fractions of people spending more than 30 percent of their income on housing at the state level as an indicator for housing affordability. State-level housing affordability measures were obtained from the American Community Survey and matched with individual-level data from the Behavioral Risk Factor Surveillance System Survey. By using linear regression models and exploiting variation in housing affordability at the state level for different income groups, this study found that unaffordable housing was associated with poor mental health among renters but not among homeowners. The findings suggest that housing affordability disproportionately affects the mental health of people who rely on renting for their housing needs.

State Differences in Tipping Attitudes and Behavior: Attributable to State Differences in Tipping Motivations?

Consumers around the world give away billions of dollars annually in the form of voluntary payments (aka, tips) to service workers who have served them. This widespread and important economic activity varies across geographic areas within nations, but that geographic variability has been under-studied. This paper seeks to answer the question: “Are state differences in tipping attitudes and behavior attributable to state differences in motivations for tipping?” To that end, new measures of average tipping attitudes and motives in each of the states of the United States are developed, and their relationships with state tipping behaviors, as well as other theoretically relevant state-level measures, are tested. Results suggest meaningful and reliable state differences in attitudes toward and motivations for tipping, and that the latter differences underlie some, but not all, state differences in tipping behavior.

ANALYSIS OF THE DISTRIBUTION AND FORMATION OF DESERTIFICATION PROCESSES IN KAZAKHSTAN AND MEASURES FOR PREVENTION

Desertification is a slow and imperceptible crisis. In turn, it undermines the sustainability of the global community. The process of desertification occurs under the influence of various factors in nature. Desertification is a consequence of a number of important processes occurring in arid and semi-arid conditions. Usually, the process of desertification of the territory of Kazakhstan and Central Asia is considered due to the changes in its geological periods.The paper examines the problems of desertification in Kazakhstan and measures to prevent it, because the desert area occupies most of its territory and it is one of the regions prone to desertification in the world. In this research work, we analyzed the main features of Kazakhstan's arid and semi-arid zones, the spatial distribution of Kazakhstan's desertification susceptibility, the processes of its formation history, the adverse effects of desertification, and measures to prevent desertification processes in Kazakhstan. The results of the analysis of the above-mentioned contents show that the majority of the territory of Kazakhstan, especially in the southern and western regions with a dense population, has a lot of arid and semi-arid lands, and at the same time, these regions are prone to desertification. As we have seen from the discussion of the negative effects of desertification, desertification and drought in Kazakhstan cause not only environmental, but also economic and social problems. Another thing we noticed is that although measures to prevent desertification in Kazakhstan were well taken during the Soviet Union, since the years of independence, it has not been considered as an important issue. However, the results of the analysis of the materials also show that in the last ten years, a number of international and state-level measures to deal with desertification have been initiated in Kazakhstan. At the same time, one of the actual problems identified in the article is the incomplete implementation of some projects to prevent desertification in Kazakhstan or their stagnation, this phenomenon requires further in-depth research.

Forecasting the realized variance of oil-price returns using machine learning: Is there a role for U.S. state-level uncertainty?

Predicting the variance of oil-price returns is of paramount importance for policymakers and investors. Recent research has focused on whether disaggregate measures of economic-policy uncertainty provide better forecasts. Given that the United States (U.S.) is a major player in the international oil market, we extend this line of research by exploring by means of machine-learning techniques whether accounting for U.S. state-level measures of economic-policy uncertainty results in more accurate forecasts. We find improvements in forecast accuracy, especially when we study intermediate and long forecast horizons. This finding is robust to various changes in the model configuration (realized variance vs. realized volatility, sample period, recursive vs. rolling-estimation window, loss function of forecast consumers). Understandably, our findings have important implications for oil traders and policy authorities.

State-level performance measures and database development for inland waterway freight transportation: A US context and a case study

Inland waterway (IW) navigation serves as a cost- and energy-effective means for goods movement. Despite the cost and energy advantages and the large volume of goods carried, performance measurement of IW freight transportation has not been paid much attention to in the US. In this paper, we propose a methodology to develop state-level performance measures (PMs) and the associated database for IW freight transportation with an application to the state of Illinois. The methodology consists of four steps: 1) constructing an initial pool of PMs; 2) identifying available data elements; 3) refining PMs by federal, state, and additional stakeholder relevance; and 4) further refining PMs based on data processing feasibility. Applying the methodology to the Illinois IW freight transportation system demonstrates its practicality for PM and associated database development. At the same time, we also identify several data issues as well as political and institutional challenges. Given the generality of the methodology and the application demonstration, the methodology can not only direct the PM development for Illinois but lend useful insights into similar PM development for other states in the US as well as other regions in the rest of the world for better IW freight transportation.

Development and Validation of the State Moral Elevation Scale: Assessing State-Level Elevation Across Nonclinical and Clinical Samples.

Research on moral elevation has steadily increased and identified several psychosocial benefits that bear relevance to both the general population and people with psychological distress. However, elevation measurement is inconsistent, and few state-level measures have been created and critically evaluated to date. To address this gap, the State Moral Elevation Scale (SMES) was developed and tested using an online sample (N = 930) including subsamples of general participants (nonclinical) and those who screened positive for mental health symptoms (clinical). Factor analysis indicated a single factor structure with nine items that demonstrated excellent reliability. Multigroup confirmatory factor analysis indicated good fit statistics and strict measurement invariance across clinical and nonclinical subsamples. Lastly, correlational analyses with related constructs provided evidence of construct validity for both subsamples. Thus, the SMES is a psychometrically valid and reliable assessment tool for state-level elevation which can be used in both general and clinical populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10902-022-00533-2.